Medicine among Nilotics in the Sud.

Abstract

So you are going to Ler. Well, I wish you luck. I don't know how the doctor stands it out there. It's the fly capital of the world, the pilot remarked cheerfully to me as we took off in a small single-engine plane. He was taking me, together with the fortnightly supply of food, drugs, and mail, to the American couple living there. Ler was the last stop on a long journey over _ miles of crocodile L-t,-^ AroST?8^^5^ i infested swampland in I HT m*0,Wrm' o?? tne southern Sudan: an edira?^uy *? area known as the Sud ( yV:?(fig !)? I* is extremely EGYPT ^?, SAUW flat inhospitable country, /? j ^S A**fflA ?4 totally cut off by floods *rL?miUM ?'?*? f during tbe rains, while ? _ .^g'^^y-i^^^^L^^. A during the dry season y-'-V^?%:':'v^g^ the receding swamps I ?Jfc : : ? m'W:-:'-'^?\Wtt A become a semidesert. I '*>?:?: :^!v??^^:;::^#? *^^a I Ap911 ^rom tne ^ort \'.-V%V.1?-;???^?iJ^F.->' ? Sfe I ^ghtly Pi3116 service the I ?:???!'? ? ?-' #T V C*^ I on^y otner regular means L^^r^^ of communication with T ^^/;:^ [ the outside world was r1 v;r _ ^fcfe^-^'y-^k' ?'? '?' v*.1 ^y private radio. p*-* '^^^?fc??lS^ The southern Sudan T ?-* K^ > I suffered some 17 years : A ^y K^*-J ?:i?l ?f dvil war during the Zaire , Py^N? -?apsEl I 1960s ^d '70sThis 1 i--? IvSsT'^^^Pl: resulted in all external Y%*N?^ ^ be?lg dliven OUt L ' V * Cq^yl [ and schools and hospi |_^ /^S^ V cl?!P^ ta^s Deing destroyed, so ^ '-^^?* the people lived without medical services for years. I chose this area for my elective because the people of the Upper Nile, the Dinka and Nuer tribes, are extremely isolated and have preserved their culture intact. I also expected to find some very primitive and basic medicine; the reality proved to be more than I imagined. There was no running water or electricity in either the house or the hospital, and everywhere there were broken windows and handleless doors. Two wells served the whole area and frequently ran dry. Paradoxically in the middle of a swamp the greatest problem was water. On arrival I was carefully warned that my room was known as the scorpion room, but I was told not to worry since there were far worse things than a few scorpions in the southern Sudan. I shall never forget my first visit to the hospital. I expected dirt but was not prepared for what I saw. Through lack of water everything was filthy: the walls, the patients, the beds, and the mattresses were all covered with a multitude of flies. Ler is a government hospital, but the doctor working there is employed by a missionary organisation and thus does not have the control or support necessary to maintain the standards that she would wish. Of 20 nurses on the payroll, only two were working. As a result I did nursing and laboratory duties as well as those of a doctor. In addition to becoming adept at the ancient art of drawing water from the well and kindling charcoal fires, I also learned how to do a third-world cross-match for transfusions and to recognise parasites such as amoeba, strongyloides, and schistosomes in stools and malarial parasites in blood films.