|
Sudan
HEALTH
The high incidence of debilitating and sometimes fatal diseases
that persisted in the 1980s and had increased dramatically by
1991 reflected difficult ecological conditions and inadequate
diets. The diseases resulting from these conditions were hard
to control without substantial capital inputs, a much more adequate
health care system, and the education of the population in preventive
medicine.
By 1991 health care in Sudan had all but disintegrated. The civil
war in southern Sudan destroyed virtually all southern medical
facilities except those that the SPLA had rebuilt to treat their
own wounded and the hospitals in the three major towns controlled
by government forces--Malakal, Waw, and Juba. These facilities
were virtually inoperable because of the dearth of the most basic
medical supplies. A similar situation existed in northern Sudan,
where health care facilities, although not destroyed by war, had
been rendered almost impotent by the economic situation. Sudan
lacked the hard currency to buy the most elementary drugs, such
as antimalarials and antibiotics, and the most basic equipment,
such as syringes. Private medical care in the principal towns
continued to function but was also hampered by the dearth of pharmaceuticals.
In addition, harassed the Bashir government, the private sector
particularly the Sudan Medical Association, which was dissolved
and many of its members were jailed. Compounding the rapid decline
in health care have been the years of famine during most of the
1980s, culminating in the great famine of 1991, which was caused
by drought and widespread crop failures in Bahr al Ghazal State
and in Darfur and Kurdufan. The famine was so widespread that,
according to various estimates, 1.5 million to 7 million Sudanese
would perish.
Widespread malnutrition also made the people more vulnerable
to the many debilitating and fatal diseases present in Sudan.
The most common illnesses were malaria, prevalent throughout the
country; various forms of dysentery or other intestinal diseases,
also widely prevalent; and tuberculosis, more common in the north
but also found in the south. More restricted geographically but
affecting substantial portions of the population in the areas
of occurrence were schistosomiasis (snail fever), found in the
White Nile and Blue Nile areas and in irrigated zones between
the two Niles, and trypanosomiasis (sleeping sickness), originally
limited to the southern borderlands but spreading rapidly in the
1980s in the forested regions of southern Sudan. It was estimated
that by 1991 nearly 250,000 persons had been affected by sleeping
sickness. Not uncommon were such diseases as cerebrospinal meningitis,
measles, whooping cough, infectious hepatitis, syphilis, and gonorrhea.
Even in years of normal rainfall, many Sudanese in the rural
areas suffered from temporary undernourishment on a seasonal basis,
a situation that worsened when drought, locusts, or other disasters
struck crops or animals. More dangerous was malnutrition among
children, defined as present when a child's body weight was less
than 80 percent of the expected body weight for the age. The weight
criterion in effect stood for a complex of nutritional deficiencies
that might lead directly to death or make the child susceptible
to diseases from which he or she could not recover. A Sudanese
government agency estimated that half the population under fifteen--roughly
one-fourth of the total population--suffered from malnutrition
in the early 1980s. This figure increased substantially during
the famine of 1991.
Acquired immune deficiency syndrome (AIDS) was present in Sudan,
primarily in the southern states bordering Uganda and Zaire, where
the disease had reached epidemic proportions. There had been a
steady increase in AIDS in Khartoum, because of the hundreds of
thousands of people emigrating to the capital to escape the civil
war and famine. The use of unsterile syringes and untested blood
by health care providers clearly contributed to its spread. In
spite of the increase in the spread of AIDS, the Sudanese government
in 1991 lacked a coherent national AIDS control policy.
In the late 1970s and early 1980s, the government undertook programs
to deal with specific diseases in limited areas, with help from
the World Health Organization and other sources. It also initiated
more general approaches to the problems of health maintenance
in rural areas, particularly in the south. These efforts began
against a background of inadequate and unequal distribution of
medical personnel and facilities, and events of the late 1980s
and early 1990s caused an almost complete breakdown in health
care. In 1982 there were nearly 2,200 physicians in Sudan, or
roughly one for each 8,870 persons. Most physicians were concentrated
in urban areas in the north, as were the major hospitals, including
those specializing in the treatment of tuberculosis, eye disorders,
and mental illness. In 1981 there were 60 physicians in the south
for a population of roughly 5 million or 1 for approximately 83,000
persons. In 1976 there were 2,500 medical assistants, the crucial
participants in a system that could not assume the availability
of an adequate number of physicians in the foreseeable future.
After three years of training and three to four years of supervised
hospital experience, medical assistants were expected to be able
to diagnose common endemic diseases and to provide simple treatments
and vaccinations. There were roughly 12,800 nurses in 1982 and
about 7,000 midwives, trained and working chiefly in the north.
In principle, medical consultation and therapeutic drugs were
free. There were, however, private clinics and pharmacies, and
they were said to be growing in number in the capital area in
the late 1970s and early 1980s. The ever worsening shortage of
medical personnel and of pharmacenticals had, however, limited
the effectiveness of free treatment. In urban areas, physicians
and medical assistants could be seen only after a long wait at
the hospitals or clinics at which they served. In rural areas,
extended travel as well as long waits were common. In urban and
rural areas, the drugs prescribed were often not obtainable from
hospital pharmacies. In the Khartoum area, they could be obtained
at considerable cost from private pharmacies. In addition to the
problems of cost, however, were those posed by difficulties of
transportation and inadequate storage facilities. In the south,
especially during the rainy season, the roads were often impassable.
There and elsewhere, the refrigeration necessary for many pharmaceuticals
was not available. All of these difficulties were compounded by
inadequacies of stock rotation and inspection. Members of the
country's elite overcame these problems by taking advantage of
medical treatment abroad.
In the mid-1970s, the Ministry of Health began a national program
to provide primary health care with emphasis on preventive medicine.
The south was expected to be the initial beneficiary of the program,
given the dearth of health personnel and facilities there, but
other areas were not to be ignored. The basic component in the
system was the primary health care center staffed by community
health workers and expected to serve about 4,000 persons. Community
health care workers received six months of formal training followed
by three months of practical work at an existing center, after
which they were assigned to a new center. Refresher courses were
also planned. The workers were to provide health care information
and certain medicines and would refer cases they could not deal
with to dispensaries and hospitals. In principle, there would
be one dispensary for every 24,000 persons. Of the forty primary
health care centers and dispensaries to be completed by 1984,
about half were in place by 1981. In addition, local (district)
hospitals were to be improved. The program in the south was supported
by the Federal Republic of Germany (West Germany), which also
provided medical advisers. In 1981 the program was most advanced
in eastern Al Istiwai Province, but it was too early to assess
the effects on the health of the people, and the program had virtually
disappeared by 1991.
Two local programs for the control of endemic disease were also
undertaken in the late 1970s and early 1980s. One was in the area
of the Gezira Scheme, where it was estimated that 50 to 70 percent
of the people suffered from schistosomiasis, a health problem
aggravated by the presence of malaria and dysentery. The Blue
Nile Health Care Project, a ten-year program inaugurated in early
1980, was intended to deal with all of these waterborne diseases
simultaneously. Because people bathed in and drank the water in
the irrigation canals, which were contaminated by human waste,
a major change in their habits was required, as well as the provision
of healthful drinking water and sanitary facilities that did not
drain into the canals. Diarrheal diseases were to be treated with
rehydration salts that should diminish considerably the very high
rate of infant deaths. As of the 1991, the persistent civil war
and the collapse of the Sudanese economy made the inauguration
of these projects doubtful. Other programs to provide relief to
disease and famine victims in Sudan were organized by foreign
aid agencies' such as the World Food Program, the Save the Children
Fund, Oxford Committee for Famine Relief, and the French medical
group, Médecins sans Frontières (Doctors Without Borders).
* * *
Extensively detailed and systematic analyses of contemporary
Sudanese society or any large segment of it were not available
as of 1991. Nevertheless, many monographs have been written on
specific Sudanese subjects ranging from anthropology to zoology.
The Bashir government's systematic purge of the civil service,
the professional associations, the academic community, and the
trade unions disrupted and curtailed the flow of statistics and
information from ministries and other government and nongovernmental
organizations. Such research material has also been impeded by
the civil war in southern Sudan and the recurring famines.
To understand the physical and geographical nature of Sudan,
K.M. Barbour's The Republic of the Sudan: A Regional Geography
remains the standard work, supplemented by J.M.G. Lebon's Land
Use in the Sudan. Because the Nile flows are crucial to Sudan,
they have been extensively studied, producing a voluminous literature.
Information on this subject is synthesized in two works: John
Waterbury, Hydropolitics and the Nile Valley and Robert
O. Collins, The Waters of the Nile: Hydropolitics and the
Jonglei Canal, 1900-1988.
Interpretations of the population situation by several authors
are found in Population of the Sudan: A Joint Project on Mapping
and Analyzing the 1983 Census Data and in articles in the
Sudan Journal of Population Studies.
Most ethnic studies are monographs that describe a particular
ethnic group. Those include Edward E. Evans-Pritchard's The
Nuer and Francis Mading Deng's The Dinka of the Sudan.
For a more recent and sensitive treatment of ethnicity in Sudan,
see articles in The Middle East Journal, autumn 1990;
the perceptive novel by Francis Mading Deng, Cry of the Owl;
or Abel Alier's Southern Sudan: Too Many Agreements Dishonoured.
Anne Cloudsley's Women of Omdurman: Life, Love, and the Cult
of Virginity, Asma El Dareer's Woman, Why Do You Weep?
Circumcision and Its Consequences, and Hanny Lightfoot Klein's
Prisoners of Ritual: An Odyssey into Female Genital Circumcision
in Africa, are perhaps the three most informative studies
of women's role in Sudan.
Although it is somewhat outdated (he does not discuss the Muslim
Brotherhood, which only appeared in Sudan in the 1950s), J. Spencer
Trimingham's Islam in the Sudan remains the best reference
on orthodox Islam and the Sufi brotherhoods. Anthropologist Godfrey
Lienhardt's Divinity and Experience: The Religion of the Dinka
explores the importance of religion among the largest ethnic group
in Sudan.
The history of education in southern Sudan is covered in Lilian
Passmore Sanderson and Neville Sanderson's Education, Religion,
and Politics in Southern Sudan, 1899-1964. To assess the
contemporary reordering of the education system, one should examine
M. Abdalghaffar Othman's Current Philosophies, Patterns, and
Issues in Higher Education.
The two standard historical studies of the Sudan Medical Service
are Ahmed Bayoumi's The History of Sudan Health Services
and Herbert Chavasse Squire's The Sudan Medical Service.
(For further information and complete citations, see Bibliography.)
Data as of June 1991
|
