Fidelity Measured in Violence

They cannot remember their ages or how long they have been married. They say this does not matter to most people in the Blue Nile anyway. What counts are their five children and being able to stay together through the constant fleeing and oppression from war – fidelity in marriage, it appears, is in part measured by violence.

They fled the war-torn state of Blue Nile State in Sudan eight months ago after the bombings over-ran their village. Without water or food, their family hid from the bombardments for three days, followed by a quick dash towards the border. The journey was difficult and his father and step-mother died along the way. Things became much quieter once they crossed the border into South Sudan and were soon settled in the border refugee camps—first in Jamam and later in Gendrassa refugee camp.

Today they face yet another battle. She is six months pregnant and fighting to stay alive infected by the Hepatitis E virus. The disease is a result of poor sanitation – eating food and drinking water contaminated with feces carrying the virus. She fell ill six days ago and rested in her tent while her four-day dose of traditional herbs ran its course. She could not eat or stand and just lay there slowly sipping the tonic made from the crushed bark of a local tree.

International Medical Corps has been pushing active case finding and referrals for those with acute jaundice syndrome for the past two weeks since a rapid increase in Hepatitis E cases and deaths were noted three weeks ago.

A recently trained International Medical Corps community promoter found her in her dark tent and immediately notified the International Medical Corps’ doctor to dispatch the ambulance. In a camp of nearly 10,000 refugees, any sense of urgency drowns in an ocean of tents, stopping at one white tent to find directions to yet another white tent. To make matters worse, it is the rainy season and the layers of mud caused the white Toyota Land Cruiser ambulance to slip and spin as it tediously rushed to her aid. The trail brought the ambulance within 150 meters from her tent and a 100-meter wide collection of standing water from the morning rains. The International Medical Corps physician and driver carried the stretcher on their shoulders and waded across the shin-deep waters. The tent was dark and stuffy with a handful of family members crowded around a sullen figure slumped over a bed. “Sabahl-al-kheir” (good morning) the doctor said and she looked up at him – she was still alive.

The trip back to the International Medical Corps clinic was much quicker. She was immediately admitted to the observation/ resuscitation center where a rapid assessment revealed a critically low blood glucose level signifying early liver failure. After receiving her first bolus of high concentration dextrose, she was converted to a steady infusion of dextrose to maintain her blood sugar. She and her baby were saved. Just 10 days prior a woman and her fetus died from the Hepatitis E virus after waiting the night before she was brought into the clinic on a donkey ambulance already in a comatose state. Between a memory of sadness and an extra sense of diligence, today the International Medical Corps physician found a small sense of redemption.

There are a host of social, cultural and environmental reasons why the sick do not access health services in a refugee camp. It is especially important to breakdown these barriers whether an infectious disease runs rampant throughout the camp or during times of stability. The young International Medical Corps community outreach program has one victory to be proud of.

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