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I’m tired. And angry. I just held my cellphone light for one of our clinical officers while he tried to find a vein in a 6 month old baby’s arm. We have light in the clinic, but the baby was so dehydrated that the veins were almost impossible to see. They had collapsed because he had diarrhea, and although his mother had taken him to a local clinic about 30 minute drive from where we are, the clinic had no cannulas and could therefore not put a line in the baby’s arm. The clinical officer showed up at our clinic with alcohol on his breath and two babies in his vehicle. He asked us for cannulas. When my pharmacist and I inquired as to where the other drugs and supplies from the county were, we were told many had been taken and sold, or they were in Bor, or this person had no idea where they were.

As this baby thrashed around in his mother’s arms our clinical officer continued to prick him, trying his best to guess where the vein must be. The child had screamed himself hoarse yet, while he wailed, his face was dry. His dehydration meant his body could not even spare fluid for tears. He frantically gulped down water that his father had put in a small cup for him to drink. My clinical officer looked at me and told me he was tired. He had worked from 8 this morning. It’s 9 pm and was 37 °C today. He is fed up too. He said to me, “imagine how this baby would have been had he received fluids when he was supposed to. “ After we stood for another 20 minutes as I tried desperately to put my light as close as possible to find that elusive vein, it was decided the baby would be admitted and given oral rehydration salts until the morning. My clinical officer told me it was the first time he had not been able to get a line in someone, his reasoning, “maybe because I’m tired.”

When I stand back and look at this situation, my brain tries to work out why. Locally, it is because there are no cannulas at this clinic 15km away. This is because medicines are being mismanaged and there are not enough of them. This is due to corruption, people trying to sell medicine to benefit themselves, and the government not having enough money to buy appropriate numbers of drugs. The government doesn’t have enough money because they shut off their oil exports to Sudan because of a disagreement over transfer fees. The north says the oil will not be turned back on until the border dispute is figured out between the two countries. They also add that the border will not be finalized until they determine to which country the small oil rich area of Abyei belongs. This will not be decided until the two countries can agree if pastoralists that come to the area for half the year should be able to vote in a referendum. The South says no, the North says yes. A solution to this stalemate will certainly not be simple.

In the meantime, the government is trying. Everyone says the right things about corruption and the NGO’s try to fill in the enormous gaps left in the health, education, policing, financial, sanitation, and transportation sectors. The NGO’s try to work in a culturally sensitive manner, while working with local actors, and try not to ostracize themselves by questioning too much a lack of capabilities or transparency. Or worse they work around local groups and institutions, so that the solutions being implemented are only going to work as long as external funding continues. The corruption is something that is much more complicated and not something I am going to deal with here. The people that commit it are simply selfish, and I am sure they have many creative ways justify their actions to themselves. However, if the people who believe in a strong and independent South Sudan are not careful, it will eat this country from the inside out.

While people in government and other serving institutions figure out how to be honest, and NGO’s figure out how to innovative and speak out against injustice, and committed South Sudanese find a way to make their voices heard, the parents in our observation room wait while their baby sheds no tears. I am usually respectful and understanding of doing things in a way that is sensitive to local attitudes, which sometimes includes being quiet about certain irregularities, but I think it is time to make some noise. While this baby may no longer have a voice, I still do, and I’m going to use it.


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