Well, the first week the thermometer hit 110 degrees, the government decided to close schools to protect the kids. They sent a memo advising people to drink lots, submerge in water, and get shade. When the high temperatures persisted after a week, the kids got to return to school. Schools are required to have water – GOOD. They have shade – GOOD.
We at the clinic felt our brains melting. “I can’t think” was a common refrain. We too had water and shade – but it was 110 in the shade! Record high temperatures, and our persistently flooded area, make that hot air humid. Quite a combination! Our clinic, hospital, homes and the whole town lie lower than the river and swamps. We are protected only by mud dikes. The government was so worried that the dikes might collapse that they ordered everyone to stay off them. This was a problem for the kids. How could they jump in the water to cool off – and get clean – over the mud dikes that are guarded by police? The kids were miserable, and everyone got scabies.
Our scabies outbreak was quite a surprise. We basically stopped having to treat scabies when we moved to Old Fangak from the village of Keew – where women walked 40 min one way to scoop water out of a hole in the ground and carry it back on their heads. Once the fighting calmed down and we could move to Old Fangak, right on the river, the scabies disappeared. And how do floods affect other diseases? Surprisingly, the floods may have affected kala azar, spinal TB, and malaria.
The increase in swamp land caused the loss of our lovely acacia forests. Acacia trees are the habitat for the sand fly vector of kala azar. The number of cases has plummeted. Kala azar was the epidemic disease that Sjoukje and Jill treated for years: a fatal parasitic disease that killed in weeks to months, unless you got a month of daily injections. That epidemic killed 50% of the population of the region that they used to call Western Upper Nile (also called Bentiu). Now it seems that the sandfly vectors must have drowned.
Other good news is the decrease in spinal TB. It is too early to know if this is a true trend. It would be awesome if the disease is vanishing. If the incidence of spinal TB has decreased, is it because there are no cows left to spread mycoplasma bovum. Is m. bovum even the cause of spinal TB? Losing cows is certainly not good news to the Nuer. Nuer lives are embedded in cow culture. Cows are part of the blood line of the Nuer. Cows provide the milk that sustains people, cement a marriage union, and are the “savings account” for when times get rough. It’s hard to imagine what this tragedy means to the Nuer, the tragedy of losing cows. Perhaps the silver lining is that this loss may be reducing the “broken backs” of spinal TB.
Malaria cases seems to be higher than ever now. It is completely unclear what aspect of flooding – increased swamp land? – caused the shifting epidemiology of our malaria outbreaks. But the incidence of malaria in our clinic is staggering. Who knows if this is because of climate change and flooding, or the fact that MSF has stopped their Saturday outpatient clinics and thus the people all come to our clinic.