Dr. James Wal (who almost died from childhood kala azar) helps supervise care of 1000 outpatient visits monthly.

56% female (We see more female paJents in all age groups.)
13% under 5 years
32% 5-15 years
55% adults

This age distribution includes complex patients, those with unexplained prolonged fevers, and those with non-communicable diseases more common in older people. Many complex diseases are rather inexpensive to treat once you reach a proper diagnosis, but most are not seen by MSF’s outpatient clinic. It’s good to treat adults, and healthy parents provide that unconditional love and mentorship so kids can grow up well.

And this year saw a resurgence of malaria. We test anyone with a fever for malaria. Many days, we diagnose 50 new cases–about 1200 per month!

Diagnosis of malaria is easy, treatment even easier. A finger poke, a drop of blood on a test strip, the result within minutes. If positive, the malaria can be treated with a tidy three-day treatment package. But malaria can get complicated. We hope patients present early, to prevent advanced cases which may infect the brain. But even garden- variety malaria can have dire consequences.

This little one had been treated for malaria, but still looked punk. Malaria had driven his hemoglobin down to 3 – about a quarter of the blood he should have. With a transfusion, he looked and breathed better in minutes. Mom supplemented his treatment with tamarind fruit. The Nuer believe it to be an antimalarial agent.

Outpatient problems have changed since the flooding. Parents no longer present with kala azar. We think that sand flies, which spread kala azar, may not have survived the flooding. Brucellosis, which causes fever and joint inflammaJon, has decreased. It’s spread by unpasteurized milk. No cows and no milk means hunger – but less brucellosis.

Non-communicable diseases remain a big issue. Our non-communicable diseases include ascites, often from congenital hepatitis B or hepatitis C; chronic lung disease, mostly from environmental factors or scarring from TB; diabetes, which can be caused by starvation; congestive heart failure, often after a streptococcal disease resulted in rheumatic fever. These illnesses will continue to plague our area, though the etiology may change.

The World Health Organization lists non-communicable diseases as the greatest cause of premature death (defined as death before age the age of 71) in the world. Average life expectancy for South Sudanese is now up to 55! If we can establish a firmer foundation of health care now, we hope that our patients will be less likely to mimic high income peoples plagued by diet-induced diabetes, heart disease, or even cancer.