Criminally Stupid, Morally Corrupt

There are some obstacles you expect to run into when attempting any type of project, particularly when it is political in any way. There is the typical bureaucracy, the endless paperwork, the stonewalling from various officials, the game of hot-potato that occurs whenever you walk into someone’s office and ask for something, only to get foisted off on someone else. There are uncooperative secretaries, and people you can never get on the phone, and conflicting information from various reliable sources and the flurry of meetings and emails that always leave you with more problems than what you started with. And there are some holes in the system that you can’t patch, some breaches in the normal routine that are the result of the years of conflict and chaos, which have become common, part of the structure of things.
But there are some types of obstacles you just don’t expect. Some kinds of negligence you don’t ever think you will run into because the implications are too disturbing to comprehend. And yesterday we ran into one of those.

During the Disease Control Priorities Conference, one of the main concerns people had involved drunkenness in the workplace. To me, it was like a dull buzz sounding in the back of pertinent facts and new information, so I didn't really consider it. I was too wrapped up in other things. But yesterday we came face to face with it, on a scale I wasn't expecting.
Alcohol, at a basic level, is huge here. Beer is readily available in all the villages; even the most remote outposts and villages can offer you a cold Pilsner or Tuskar beer at any moment. Sorghum, the staple grain and largest source of food and nourishment, is more often distilled into liquor or brewed into vats of beer, tubs of which are stored in tukuls to be served to guests or consumed during the heat of the day. Liquid lunches are fairly common. This isn’t much of a problem, as I think it takes a fair amount of beers to get drunk (and the alcohol content of sorghum beer is relatively low).
However, alcoholism is rampant. Part of this stems from the civil war. Sudan is home to some of the most courageous people in the world, but that bravery comes at a price. People living in times of conflict and war often have to become brave to survive. The act of cowardice is detrimental to existence, because sometimes, one must meet force with a force of their own-either violent force, or force of character. Rather than allow yourself to become accustomed to brutality day after day, and allow the violence being visited upon your friends and relatives become part of the norm, you have to react against it, and reacting against violence in any form is dangerous. In addition, merely living through times of chaos requires strength, and the ability to adapt and change and fight. Without any kind of order, with community falling apart and brutality and militarism becoming its substitute, one is forced to create order for themselves, and for many Sudanese, it seems that this order stemmed from upholding, even in the most limited sense, the idea of decency and community so endemic to Sudan.
But that doesn’t change the tragedies people lived through. The war brought devastation and destruction and death, and ordinary people trying to go about their ordinary lives were sucked into it, absorbed into it, and made witness to it. The things men and women lived through are often terrible to remember, and whereas bravery in times of chaos may be possible, it is harder to maintain in times of peace. Men who once fought brutally to maintain the life of Southern Sudan are now drowning themselves in alcohol. Mental health is one of the least addressed health issues in the entire developing world, and counseling, therapy, addiction programs and medication are all scarce, if unheard of.

Perhaps this is giving too much credit to the men and women who are now alcoholics. Certainly, some of them were weak of character then, and are weak of character now. Everyone has a brutal past, but not everyone is a drunk. I am merely trying to explain, more to myself than anyone else, why such a problem is so rampant, and so tolerated. No one wants to probe into issues like this. It is like stepping on a landmine.

Regardless, what we saw yesterday was, for all intents and purposes, inexcusable. While at the Ministry of Health, we ran into two different directors involved with health care, with drug distribution, with administering health facilities and ensuring quality of care, who were so drunk as to be incoherent. It was 10 in the morning. One was rambling and shaking hands and slurring his words, toddling around, stumbling, in the middle of the courtyard where patients coming to the hospital (which is part of the MOH compound) were assembled to receive care. Incidentally, he was walking right past the minister’s office. But he had no shame.
The other I didn’t witness. Ed and Emmanual went to have a meeting with him and when they arrived after lunch, he was too drunk to recognize them. He pulled out our business cards and began going through them one by one, starting with the name Neesha, and ascribing it to Ed. He took them in circles, repeating himself, gazing off into space, and ultimately admitting that drugs, including anti-malarial’s, which were suppose to be distributed long before the rainy season came, had been sitting around the office since March, signed for, but not sent out. Sitting, in boxes, on the floor, while hundreds of people died.
The baby that George and I saw in Lafon who was sick with malaria could have used those drugs. So could the people in Keyala, the people’s whose houses had been burned down and who were living under a tree, out in the elements, bait for the anopheles. This particular shipment was bound for a hospital, but the hospital hadn’t received them (we know, because the sister who runs it was with us at the Ministry) All it takes to distribute medicines, to administer health facilities, to improve quality of care, is organization and computer literacy, and dedication. Secretaries could do a better job than these men. In the United States, this would be deemed criminal negligence. Nurses and doctors showing up to work drunk. It happens all over the state, in every hospital or center or unit. Men and women who hold people’s lives in their hands, who are some of the few in the position to actually make a difference and affect change and save lives, are throwing it away, and creating more pain and suffering for the people they are suppose to help. This undermines the entire system, the reputation of the health facilities, and the trust of the people. Who would bother to walk 10km with a child or a sick family member in their arms, if once at the facility, they were seen by a drunken doctor who does more harm than good? How can you expect people to begin to trust the medical profession (particularly at the expense of witchdoctors and traditional medicine) if health professionals at the centers don’t give you personal care, and your healer does?
Yet these men can’t be fired. It is risky business firing people in Sudan. Times are unsteady as it is, people have insiders to back up their appointments and keep them secure in their jobs. Unlike in the United States, where we claim to have a problem with alcoholics because they cant get jobs, here, you have alcoholics and you cant get them out of jobs. What kind of system is that? There are policies written to deal with this type of situation, but no one enforces them. So it continues, and medicines get held up and centers close and people die and learn not to expect anything better.

But perhaps just as appallingly, some negligence results, not from an addition, which one could argue you, have little control over, but from knowing and deliberate stupidity. Some men who show up to work sober cause more harm than their colleagues who show up drunk. We met with one man who was in charge of vaccinations and distribution. We were hoping to get the vaccination sites from him, to help in our distribution. Vaccinations are supposed to be given out at the payam or boma level, and to give you an idea, there are about 260 bomas. This man had 118 vaccination spots, for the entire state. 118 places to distribute vaccines in a state that is 80,000sqkms, or roughly the size of Maine. An area the size of Maine, with no roads, no highways, no infrastructure, one bank, and only 118 places to vaccinate someone.
Additionally, the vaccines were being stored at the incorrect location; the vaccinators were distributed not only incorrectly but illogically (the same amount given to Budi county, one of the smallest sections, to Kapoeta East, which covers from the boarder with Ethiopia all the way down to the boarder with Kenya, and stretches all the way to Torit.)
When were in Keyala, we saw a small child with a skin disease. We originally thought measles but we found out the child had been vaccinated the month before. But if the vaccination was expired, there is no telling what he had. How can you expect people to walk miles and miles and miles with a young child with them, to get the child jabbed in the arm, and given a fever deliberately, and walk all the way back, if the vaccine then doesn’t work. No one will come. This isn’t just harmful in the here and now, its harmful for the future. It’s taking steps backwards where there should be steps forward.

I am so frustrated at this. There is so much death and disease here, so much poverty, so much struggle every day to just do basic tasks. People spend a whole day cooking, and then on top of that have to find time to clean and fetch water and firewood, and send their children off to school and do all the other chores that prepare them for the next day. There are so many people already working so hard, and trying to improve, that to allow people who are either incompetent or addicted into the top jobs, the jobs that actually affect change, is morally irresponsible and completely against any type of long-term ideals for health. It creates distrust. Why will donors give money and medicine if the resources are misused? I don’t want this to be accepted as “how things are”. I don’t want people to expect this. Death wasn’t acceptable during the civil war. It sure as hell shouldn’t be acceptable now.