A woman from Lurcuk Payam receives a tetanus vaccination, March 20, 2009. (by David Widgington)

[Montréal, Québec, Canada -1°C] I visited Southern Sudan March/April 2009. It seems like such a long time ago. Reviewing the video footage and photographs I took during my visit, brings me back. Below is my latest video montage of a particular day: March 20, 2009.

This is the day I joined a team of World Vision staff on one of their vaccination programs. We went to Lurcuk Payam in Tonj North County, Warrap State. The one-and-a-half-hour drive along bumpy roads that are inaccessible during the rainy season, took us past clusters of traditional tukul homes and herds of strolling big-horned cows.

We arrived at 11h00 under the shade of the biggest tree that stood outside of the local clinic and borehole well where women come to fetch water. Two vaccinators spent five hours giving innoculations for measles, tuberculosis, polio, diphtheria and tetanus. In all, 276 Lurcuk children are vaccinated and 167 women of childbearing years receive a tetanus vaccine.

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We left Sudan because of war and now we are going back for the first time in twenty years.

(source: Map No. 3707 Rev. 10, UNITED NATIONS, Department of Peacekeeping Operations Cartographic Section, April 2007; demarcation line source is US Department of State)

The Sudan has been at war with itself in two successive civil wars since its independence in 1956 from British rule in the southern region and British-administered Egyptian rule in the rest (Anyanya 1: 1956-1972 & Anyanya 2: 1983-2005). Colonial powers may have decided to create Africa’s largest country by maintaining the two administrative regions together but they may just as easily have divided the country along the Jan 1, 1956 Line of Demarcation. Power in a post-colonial Sudan was handed over to the political elite in Khartoum to the detriment of Southern Sudan, Darfur, and other peripheral regions far from the capital. Power, wealth, resources and development have always been tightly controlled by a small click of autocrats based at the confluence of the White Nile and the Blue Nile rivers. This Line of Demarcation is the divide that is now a defining line needing negotiations should Southerners vote for independence in a 2011 self-determination referendum, scheduled in the Comprehensive Peace Agreement that ended the second civil war in January 2005.

In the late 1980s, the war’s front line moved agressively through the border areas now dividing Southern Sudan from the rest of the country. When the war reached Koor’s, Gabriel Bol’s and Garang’s villages near Akon—where Northern Bahr el Ghazal meets Warrap state—everyone ran for survival. Those not fast enough were killed. Some managed to hide. Others, mostly children, were taken by northern government-backed militia and enslaved, like Koor’s younger brother Chol who we meet in the film after he is released from bondage and brought to Nairobi begin school.

Families were scattered as militia burned villages, killed their inhabitants and stole cattle. They ran in all directions to escape. Boys, often quick and nimble, ran the fastest and furthest away from the killing. As the youth continued to evade the war, they found themselves merging into growing bands of lost youth heading east toward safety. More than fifty thousand Sudanese eventually settled into one of five refugee camps in Ethiopia. In 1991, Ethiopia’s Mengistu government, allies to the Sudan People’s Liberation Movement/Army (SPLM/A), fell. The new government chased the refugees out of Ethiopia, leaving the film’s three protagonists to roam for another year toward Kakuma II Refugee Camp in northern Kenya where they met.

Chris Koor Garang enrolls his younger brother, Chol, into a boarding school in Nairobi, Kenya. (courtesy Rebuilding Hope)

In 2001, the United States established the Refugee Resettlement Program for 4000 southern Sudanese refugees from Kakuma. Koor Garang was resettled in Tuscon, Arizona. Garang Mayuol went to Chicago, Illinois. Gabriel Bol Deng went to Syracuse, New York. A great book that should be read before viewing the film is David Eggers (2006) What is the What: the autobiography of Valentino Achak Deng. It provides the Lost Boys context in more detail than the film, which will help the viewer better understand where Koor, Garang and Gabriel are coming from.

Each of the three boys’ (now men’s) stories are similar. They are representative of many “lost boys” who immigrated from refugee camps for distant countries, recieved an education and are beginning to return to Southern Sudan. Some are returning permanently to work in the government, to teach, to start businesses, etc. Others are going back as philanthropic visitors to build schools, supply clinics, etc.

The three grown men share the common goal of locating their families that they haven’t seen since the war sent them fleeing their respective village so long ago. Some members of their families now live in the same villages from which they ran. Others now live in larger state capitals. Some have fallen victim to the war and were killed like two million other Sudanese.

Gabriel Bol Deng in home village (courtesy: Rebuilding Hope)

Chris Koor Garang is studying to become a registered nurse and works as a Licensed Practical Nurse. He has set up a Non-governmental Organization (NGO) (The Ubuntu) to provide medical supplies to the modest Brown Back Medical Centre in Akon, to distribute mosquito nets to local people and share his skills with care givers there.

Gabriel Bol Deng finished his undergraduate degree in mathematics education and is a strong believer that education is the answer to relieve poverty for his people. He started his own NGO (Hope For Ariang) to build a school in his home town of Ariang. When he arrives in Akon, Gabriel Bol meets an uncle at the market and asks the whereabouts of his parents. He is told to go to his home village to find out because he is not the one to say. Upon arrival in the village, an aunt walks up to him, revealing that his mother lives on in Gabriel’s eyes that resembled hers. He later shares an intimate moment under a large and healthy tree and tells us:

Our ancestors, when they die, they know what those people who are alive are doing. And I believe my mom really, and my dad… they know what I’m doing. The tree grew out of where my placenta was buried and it’s where my mom was buried… My mom is giving something back in the form of a tree. This tree is the greatest blessing ever and the greatest connection between me and my mom… There is no better way to honor them than really, to help people and contributing to making life better in Ariang village.

Garang Mayuol's homecoming (coutesy: Rebuilding Hope)

Garang Mayuol’s main goal during his first visit home is to seek out and locate his mother who he hasn’t seen in twenty years. He would also help his two friends with their NGOs. All three of them realized, as they distribute mosquito nets and sewing kits to villagers, that the need quickly surpassed their supplies. The anguish from not being able to provide for everyone is self-evident on each of their faces, particularly when one man repeats to Koor over and over after being told that there are no mosquito nets, “Just one will be enough for me and my kids.” While buyig supplies in Kenya, they decided to purchase less mosquito nets than expected due to weight restrictions on the charter flight to South Sudan. A decision that weighed heavy on their shoulders.

The historical background provided in the film is minimal but it still provides context to the war that displaced four million people, sent one million into refugee camps outside of the country and killed two million. Post-colonial power, typical for the British in retreat, was distributed to a select few to British best interest rather than the best interests of the population as a whole.

Gabriel Bol describes the source of conflict in Sudan when he states that the main source of the problem lies in the hunger for leadership. He says that clicks and specific groups are dominating politics and using religion to divide the people of Sudan.

The film portrays divisions between Arabs and non-Arabs in Sudan within its historical narrative. When referring to the divide-and-conquer strategies of Sudan’s central government in the civil war (Muslim north vs Christian South) and in Darfur (Arab vs black non-Arabs), Marlowe suggests that non-Arab black Darfuris are natural allies of Southerners. The divisions exploited by the Khartoum government are much more complexe and are not necessarily divided along religious, linguistic or ethnic lines. They were exploited along political lines to control power and share wealth to suit their political ends. It is dangerous to hint about such cultural/ethnic divisions prior to a self-determination referendum, because the minorities on both sides of the North/South border will suffer if political powers continue to exploit these divisions to prevent or promote separation of the Sudan.

Despite this, Rebuilding Hope gave me a glimpse at something new in Southern Sudan. The diaspora who left their homeland because of war are returning with hope for the future and a with strong connection to the land and its people they were froced abandoned so long ago.

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Jen Marlowe recently wrote an update about South Sudan and updates us in her article: S. Sudan makes some progress amid possibility of war.

More from Jen Marlowe on Untold Stories: Pulitzer Centre on Crisis Reporting, including a video about education and health care in South Sudan.

Have you seen another film about South Sudan, Lost Boys or about changes taking place in Sudan that we should now about? If you are South Sudanese and have regturned to your homeland to rebuild after being in exile, what is your experience? Please share in the comments below.

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movie trailer:

We drive for one and a half hours, averaging 25 km/hour, along dirt roads that will become impassable during the rainy season, which is expected to begin toward the end of April and last until October. As we approach the village of Lurcuk, Community Health Workers place the megaphone speaker onto the roof of the vehicle and announce their arrival. We continue toward the big tree by the local clinic and its borehole to set up registration and immunization tables.

Registration starts immediately after a public education information session about immunization. Mothers and their children continue to arrive. The two Community Health Workers who give the needles into the arms and legs of the villagers, and dispense the polio drops into the mouths of children work at a frantic pace for four hours non-stop. I am amazed at their patience in dealing with screaming and crying children who resist their efforts.

In total, 276 children were immunized for various childhood diseases like measles, tuberculosis, polio, diphtheria, tetanus and 167 women of childbearing years received tetanus vaccines.

Below is a portrait gallery of villagers from Lurcuk, North Tonj County, Warrap State, Southern Sudan, who just received vaccinations under the big tree by the local clinic. They are each holding a piece of paper, on which is written their name, the vaccines they received and the date. All the photos were taken on Friday, March 21, 2009.

I’ve been hesitant to take mefloquine from the beginning because of the potential side effects (see previous post), which—according to the prescription—include but are not limited to “a sudden onset of unexplained anxiety, depression, restlessness or irritability, or confusion (probably signs of more serious mental problems).” Like most people, I’ve never been treated for depression, but I have felt ‘depressed’ before, lacking in confidence and motivation. A concern of mine is, would a drug like Larium (the brand name for m) instigate the “more serious mental problems” that the manufacturer delegates as the responsibility of the consumer? Besides, I don’t want to feel more anxious or depressed than what naturally occurs during episodes of cultural shock and adaptation, particularly not in situations that may already have their own normal levels of stress and misunderstanding that comes when being in unfamiliar cultural surroundings.

The warnings continue on the box with, “you may develop other serious side effects, including persistently abnormal heartbeat or palpitations,” but this time without the disclaimer blaming the person taking the medication. I’m not sure if I’ve had palpitations before but I may have. Are they warning that a heart attack may follow while taking these pills? Not something I want to contemplate from Southern Sudan or anywhere else for that matter!

Last night while chatting with Carla (the guesthouse owner) and another guest at Miti Mingi , we decided to make some tea. The only choice in the house was a herbal tea made of crushed leaves from the neem tree (Azadirachta indica). On the back of the box is written, “… Neem has remarkable healing properties…” Then it continues by listing them: boosts body’s immune system, stimulates the production of T-cells, purifies the blood, and prevents or cures during treatment of sore throats, colds, fevers, food poisoning, lowering blood pressure and cholesterol, irregular heartbeat… and the list finally mentioned malaria. Finally, an alternative and natural treatment against malaria. This tea was produced from trees in Kenya, and in the Kaswahili language the tree is called Muarubaini, which can be translated as the tree with forty cures.

According to Vandana Shiva, physicist, environmental activist, intellectual, author and future Nobel Prize winner(!?), the medicinal and chemical uses of the neem tree’s bark, leaves fruit and seed oil have been known and used in India for more than 4000 years.

I noticed the mention of neem on a back page of a pamphlet given to me at the Santé Voyage clinic where I received my vaccinations and consulted about malaria prevention. None of the medical staff mentioned any natural products as a possible alternative for the common prophylactics like mefloquine, aralen, chloroquine, etc.

In Senegal, there is a movement to bring neem to the masses to decrease the numbers of unnecessary deaths from malaria. Below is a video from the Al Jazeera show ‘People & Power’, dating from December 8, 2008:

The Forestry Department at the Food and Agricultural Organization (FAO) of the United Nations have coordinated since 1994 the International Neem Network whose activities are documented in their recent, The Activities of the International Neem Network. Other online documentation can be read from the website.

So, I’ve decided to forgo the mefloquine prescription by leaving it in my bag. I will now drink neem herbal tea and will look for neem soap to wash with as an added repellent. Or course this will be done in tandem with my other preventative measures, like sleeping under a Permethrin-impregnated mosquito net, and using mosquito repellent on uncovered skin areas between dusk and dawn when mosquitoes are most active.

Santé Voyage Clinic

She was very helpful, detailing the various illnesses prevalent in Sudan and East Africa that I already listed in a previous post. Now I have a vaccination schedule that started during my visit, which started with five needles and a set of pills. It started with a 0.5mL vaccination of Hepatitis A ($58 each injection) in my left arm. My second and last shot is next week. 1mL of the Hepatitis B vaccination ($34 each injection) was injected into the upper part of my right arm. I need to get a second dose in one month right before I leave and a third a few months after my return; or if I leave earlier than one month from now, I need to get a three doses before I leave every week.

I was then given a Tuberculin Skin Test ($5 each time) that consists of having a 0.1mL injection just under the skin of my left forearm, creating a small bump (see photo of red spot circled in ink. The bump injection had been absorbed). Next week, I get a second shot. this is to provide a sample of the level of TB in my system before I leave. Three months after returning to Montréal, I need to do it again to see if I was exposed to TB while in Sudan.

That was it for my arms. the nurse then asked me to pull down my pants (which I obliged) to give me my last two shots: a Polio vaccine (free) in my left thigh that offers protection for life, followed by the Tetanus/Diptheria (free) combined vaccinatio in my right thigh, which is covers me for 10 years.

I came home with a packet of 4 pills as a oral vaccination against Typhoid Fever ($46). These I need to take in the morning one hour before eating, with water, every second day. I will be good for 7 years.

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The nurse offered my a vaccination against Rabies. It was very expensive ($350) and due to my impending departure date, I was not able to take it in time, stictly due to the rabies vaccine shortage. Because of the shortage, vaccination methods have changed. Rather than get a vaccination of 1mL, the clinic offered three small doses of 0.1mL, I think once a week, followed by a blood test two weeks after the third injection to verify if the vaccination worked. The blood test results, I was told, would take two months to be sent to me, so even if I was bitten by a rabid animal, I would still have to be treated as if I hadn’t received any vaccination therapy. Decidedly, I said no to the expensive vaccine. I’ll avoid the petting zoo.

I then had a short visit with a doctor who told me about the malaria options. He seemd very confidant about prescribing me whichever Malaria pills I chose, based on the options for Sudan. He recommended Mefloquine (($20/month) to be taken once a week, Doxycycline, (once a day – $30/month), or or Primaquine (also once a day – $35/month). There was another option for Atovaquone/Proguanil, but it is very expensive ($160/month). I decided to wait and do more research before deciding, IF I want to take malaria pills and if so, which ones.

Next week, I have my second of three appointments to get my Yellow Fever and Meningitis Vaccinations and continue with above.

I’ve always been reluctent to take Malaria pills for periods longer than a 4-6 weeks. According to the Center for Disease Control and Prevention (CDC), the following are the anti-malarial pill options: atovaquone/proguanil, chloroquine, doxycycline, mefloquine or primaquine. Some of the prescriptions require to take a pill once a day during travel in areas where malaria is prevalent, and up to one week before and after being in the area. For me that would mean taking anti-malarial medication for more than three months! Side effects vary depending on which of the pill options are prescribed but common ones include: stomach pain, nausea, vomiting, headache, dizziness, blurred vision, and itching.

These general side effects are listed in various combinations for most of the prescriptions listed above. Some have specific side effects. Doxycycline increases sun sensitivity (sunburning faster than normal) and women may develop a vaginal yeast infection. More disturbing are the side effects associated with mefloquine. After reading through the CDC’s side effects and warnings for mefloquine (which is more elaborate than the others) I remembered a friend of mine who travelled extensively through eastern Asia for longer than six months, taking anti-malarial pills the entire time. When he returned to Canada he was not well at all. He has symptoms of psychosis, schizophrenia that lasted weeks if not months! He was probably taking mefloquine based on the CDC’s list of side-effects and warnings:

The most common side effects reported by travelers taking mefloquine include headache, nausea, dizziness, difficulty sleeping, anxiety, vivid dreams, and visual disturbances. Mefloquine has rarely been reported to cause serious side effects, such as seizures, depression, and psychosis. These serious side effects are more frequent with the higher doses used to treat malaria; fewer occurred at the weekly doses used to prevent malaria.

Mefloquine is eliminated slowly by the body and thus may stay in the body for a while even after the drug is discontinued. Therefore, side effects caused by mefloquine may persist weeks to months after the drug has been stopped.

Most travelers taking mefloquine do not have side effects serious enough to stop taking the drug. (Other antimalarial drugs are available if you cannot tolerate mefloquine; see your health care provider.)

Travelers Who Should Not Take Mefloquine

The following travelers should not take mefloquine and should ask their health care provider for a different antimalarial drug:

• persons with active depression or a recent history of depression
• persons with a history of psychosis, generalized anxiety disorder, schizophrenia, or other major psychiatric disorder
• persons with a history of seizures (does not include the type of seizure caused by high fever in childhood)
• persons allergic to mefloquine
• Mefloquine is not recommended for persons with cardiac conduction abnormalities (for example, an irregular heartbeat).
• persons traveling to areas where mefloquine-resistant malaria exists

(source: Centers for Disease Control and Prevention, US Department of Health and Human Services)

During an extensive cycling trip to eastern Asia in the 1990s, I took chloroquine as my anti-malarial preventative treatment. Once I ran out after three months, I decided not to renew my supply after hearing of side-effect stories. I spoke to a doctor in Hong Kong who suggested I carry mefloquine with me in a two-pill doze as a self-treatment. He suggested that if I get the symptoms: extreme flu-like sypmtoms that may include fever, shaking chills, headache, muscle aches, tiredness, nausea, vomiting, and diarrhea. He suggested that if I got anyof these symptoms and did not have access to a doctor, to take the two pills to stop the disease from progressing while I sought a doctor to diagnose and treat my symptoms. The doctor told me that mefloquine was very strong, and after reading the above warnings, it seems as though it is.

After visiting the Medecins sans frontières/Doctors Without Borders (MSF) website, I came across their Malaria Overview page, that begins with, “Every year, nearly 2 millions people die of malaria.” MSF discusses diagnosis, treatment and prevention. They have been treating patients with malaria in Africa, Asia, and Latin America since 1985 and have conducted many drug resistance studies in collaboration with national health ministries and Epicentre, MSF’s epidemiological research institute.

Another organiztion, The Global Fund is also mandated to support large-scale international prevention, treatment and care programs to to Fight AIDS, Tuberculosis and Malaria. To date, it has inveted 149$ billion in 140 countries in their program.

The organization Roll Back Malaria Partnership, whose self-proclaimed vision is “by 2015 [...] malaria is no longer a major cause of mortality and no longer a barrier to social and economic development and growth anywhere in the world.” They discuss their goals of their Global Malaria Action Plan for a malaria-free world. Their website has a great segment of frequently asked questions commonly asked about the disease that are reviewed and answered by Aafje Rietveld from the World Health Organization, that has published the International Travel and Health guide to get “informed about the potential hazards of the countries they are travelling to and learn how to minimize any risk to their health.” Individual chapters of the guide can be downloaded directly from the site.

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Other than the predeparture vaccinations, I will look into some naturopathic approaches to boosting my immune system prior to leaving as well as some alternative options to vaccinations.

Below, I’ll continually add maps I find that will give me that I-know-this-place feeling once I get myself to Sudan and help me better understand the situation there: its history, the migration of refugees & internally displaced persons (IDPs), its physical landscape and topography, its transport network, its development strategies, etc.

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MAP RESOURCES

Map Catalogue of the UNITED NATIONS SUDAN INFORMATION GATEWAY.

City Maps from the Ministry of Land, Housing and Public Utilities, Government of Southern Sudan

International Travel and Health maps from the World Health Organization

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SELECTED MAPS (Place mouse over maps to get their titles. click to download or view better quality image.)

GENERAL:

(source: Map No. 3707 Rev. 10, UNITED NATIONS, Department of Peacekeeping Operations Cartographic Section, April 2007)

January 1, 1956 Line of Demarcation Map

(source: Map No. 3707 Rev. 10, UNITED NATIONS, Department of Peacekeeping Operations Cartographic Section, April 2007; demarcation line source is US Department of State)

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DARFUR MAPS:

Darfur Confirmed Damaged and Destroyed Villages, Feb 2003 – December 2009

(Source: US Department of State, Humanitarian Information Unit, April 5, 2010)

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INTERNATIONAL AID MAPS:

Draft Map: UN Agency Presence in Sudan

(source: United Nations Office for the Coordination of Humanitarian Affairs (UCHA) November 3, 2008)

Sudan Humanitarian Planning Map

(source: NASA MODIS mosaic, UN Cartographic Section; UN OCHA; UNHCR; DCW OLS; UNDP GRID and Climate Research Unit of the University of East Anglia; 11 February 2004)

Southern Sudan Road Progress – October 2008

(source: UN Joint Logistics Centre, Sudan; Map #: UNJLC_SDN_704_A3; October 20, 2008)

Non-Food Items Sector Partners and Common Pipleline Pilot Project, South Sudan

(source: UN Joint Logistics Centre, Juba; Map number: unjlc_sdn_711_A3_07112; 24 November 2008)

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MIGRATION MAPS:

Spontaneous Returns from Place of Displacement and Final Destination of Returnees (tracked on-route)

(source: International Organization for Migration IOM, 2008)

IOM Internally Displaced Persons Return Routes – by road, river and air 2007-2008

(source: International Organization for Migration, 28 January 2008)

IDP Registration, Returns and Refugee Repatriation supported by IOMIDP Registration, Returns and Refugee Repatriation supported by IOM

(source: IOM GIS Unit, Data Source: IOM IDP Registration Databases, Movement statistics & IOM supported repatriation statistics; 18/09/2007)

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(source: European Coalition on Oil in Sudan, 2007)

OIL WELLS IN RELATION TO THE BOUNDARIES OF ABYEI ACCORDING TO THE ABYEI ROADMAP

(courtesy Global Witness 2009)

OIL WELLS IN RELATION TO THE BOUNDARIES OF ABYEI ACCORDING TO THE ABYEI BOUNDARIES COMMISSION

(courtesy Global Witness 2009)

OIL WELLS IN RELATION TO THE TRIBUNAL OF THE PERMANENT COURT OF ARBITRATION

(courtesy Global Witness 2009)

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Vegetation Cover in Sudan

(courtesy Food and Agriculture Organization FAO)

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WILDLIFE MAPS:

(courtesy: Wildlife Conservation Society)

European Coalition on Oil in Sudan & National Parks / Refuge Overlay

Sudan Oil & Wildlife Overlay (source: Wildlife Conservation Society and European Coalition on Oil in Sudan, 2007)

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POLITICAL BOUNDARY MAPS:

Comparative Map of the Abyei Area

Arbitration Award Map (source: Permanent Court of Arbitration, July 22, 2009)

Jonglei Tribal Groups

Southern Sudan State boundary Map

(prepared by: Information Management Department, UNMAO)

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INTERNATIONAL TRAVEL AND HEALTH MAPS:

Malaria 2007

(source: World Health Organization, 2008)

Yellow Fever 2007

(source: World Health Organization, 2008)