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Working with MSF in South Sudan

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MAKING A DIFFERENCE John Mahady is pictured working on the Doctors Without Borders project in South Sudan.

Mayo man John Mahady is a logistical manager with international medical organisation MSF in South Sudan

I work in Médecins Sans Frontières’s Bentiu Town Project, in the Republic of South Sudan, a country that has been beset by a conflict which has at times been brutal, with civilians on occasion being subject to appalling levels of violence from all sides. My international and South Sudanese colleagues in this project are part of the wider Médecins Sans Frontières / Doctors Without Border (MSF) response in Leer and Mayendit counties, which are home to between 750,000 and 1,000,000 people.
Health care is minimal or nonexistent in most of South Sudan, leaving people unable to meet their basic needs. Last year MSF performed over 1.1 million outpatient consultations in the country.
From our base in Bentiu Town MSF provides health care to areas located in Leer and Mayendit counties. This work has sometimes led to security risks, as it had involved entering areas affected by conflict. Despite the risks, we are able to provide treatment for the main morbidities affecting the rural population, such as malaria, pneumonia and diarrheal diseases. We also provide basic reproductive health and treatment for survivors of sexual violence, including health promotion activities.
In Bentiu, my role as logistics manager means I’m responsible for ensuring that all utilities are operational and the compound’s transport and security are functioning. It is a seemingly endless task and no day is the same.
Within days of arriving, my first challenge was to repair a surface-water discharge system. Surface water in South Sudan is a problem due to the soil type, the lack of drainage and the torrential rainfalls during the rainy season, which all combine to cause a particularly high-water table, turning much of the area into a swamp. Without a proper functioning discharge system,  surface water can flood the compound in a matter of minutes.
I found that the surface water discharge pipe had collapsed at the location where it crosses the main road, likely due to the heavy water tankers and other traffic that crosses the road each day. After analysing what was needed and supervising the repairs, I was glad to see the system back up and running.   

Treacherous journeys
In times of conflict, MSF has been able to operate through constant dialogue with local communities and all armed actors. We explain that we do not involve ourselves in politics and simply seek to provide health care to people whoever, and wherever, they are.
In the area that I work, MSF provides daily clinics and outreach services. This can involve MSF staff flying to remote areas and then hiking through swamps or even canoeing to islands, doing whatever we can to deliver health care to remote populations who may otherwise have none.
I myself was part of a two-person trip to some outreach clinics. We flew to a basic airstrip to deliver medicines, provide medical advice and review the facilities. We also delivered medicines for two other clinics. I can still see my colleagues carrying boxes on their heads as they headed into the bush towards their destination 20km away.
The clinic I reviewed was close to the airstrip and was very basic. There was evidence that a more substantial structure had been there before, but it had been destroyed during disturbances earlier this year. Now, there was only an open-air clinic, where about 50 people, including men, women, children and babies, had gathered. I assessed what kinds of materials would be required to replace the structure to help inform the decision about whether to rebuild the more substantial clinic.
Whilst that was a good experience, many others are heartbreaking.
One evening I was contacted by one of the compound guards who asked if he could borrow some pick axes and shovels. I called the guard station, wondering what this request was about. I discovered that the request had come from a guard who was off duty at the time. It emerged that earlier that day an eight-month-old child had been taken to the Ministry of Health hospital, suffering from malaria. The child’s condition deteriorated and it was decided to transfer them to the MSF Hospital, some 10km away. Tragically, the child died on the journey. The guard was the child’s father and he needed the equipment to dig their grave.  
After lending him the equipment I felt a little helpless because I could do so little to improve the situation. I also felt a tinge of loneliness when I thought of my own family and of being so far away from them.

Looking to the future
Despite the difficult moments, it is comforting to think that I am contributing to MSF’s work providing much needed health care to so many people. I am determined to leave the project in better condition than when I arrived. There are plans to build more accommodation, and it will be important that the utilities can support the increase in people. We hope to increase our presence so that we can expand the clinic’s services and deliver health care to more of the population.
I have offered my South Sudanese colleagues the opportunity to attend some basic engineering training. I envisage that this initiative will help build my relationship with the South Sudanese staff and reinforce their skills. At a minimum, it will be of use as the country regains its normal activities, both by way of industrial output and public services.  
During my stay in South Sudan, I can say that from first-hand experience the presence of MSF in the region is providing health care that otherwise would not exist … were MSF not present in the area, many more people would have succumbed to curable diseases such as malaria. 
I am happy that I have taken this time out to work with MSF, as I have already seen patients who would not be alive today were it not for our presence. One of the saddest parts of this experience is witnessing that those most affected by the lack of health care are babies, young children and young adults.
MSF delivers services to all presenting patients, regardless of political or religious affiliations. Consequently it saves lives. MSF not only provides an important medical service, it also offers some hope to ordinary people in a very difficult situation.        

John Mahady is from the parish of Lacken. He worked in farming, fishing and in Asahi, before he moved to Dublin. where he worked in the Federated Dublin Voluntary Hospitals, St James’s Hospital and Tallaght Hospital for 35 years. He is a Chartered Engineer of Engineers Ireland, and he currently works with MSF.