A nurse vaccinates Nyakot Jok’s baby at an IMA World Health operated clinic in Minkaman, South Sudan. (Matt Hackworth/IMA World Health)

By Matt Hackworth/IMA World Health

MINGKAMAN, South Sudan—Intense fighting in a civil war forced Adout Malual to flee her home in 2014. Yet having a baby is perhaps what came closest to killing her.

“If this clinic wasn’t here, I would have died,” Malual says, her newborn restless and crying in her arms. “The bleeding was so bad I don’t know what I would have done at home.”

Malual has three children. She was prepared to give birth to her fourth at her temporary home in Mingkaman, a small town along the White Nile River well north of Juba, South Sudan’s capital. Pain and intense bleeding prompted her family to seek help from the Mingkaman Clinic.

“We were able to get her here just in time,” clinic manager and chief midwife Tereza Acheui says.

Many other mothers here are not so fortunate. Mothers die in childbirth more frequently in South Sudan than in almost any other place on Earth. And yet this clinic, set up under tents as a temporary means to serve people displaced by fighting in the country’s civil war, has not had a mother die in labor in more than three years.

Temporary structure, high quality care

When fighting broke out between rival political factions in 2013, legions of families were forced to flee in the face of armed conflict and brutal violence. The United Nations Family Planning Agency started the clinic in 2014 to serve Mingkaman’s sizable population of displaced people.

The UN asked IMA World Health to operate the clinic six months after it began. The unstable environment prompted other agencies to cease operations in the region. IMA stayed. The approach has been to support the government health systems in Lakes and Upper Nile States in operating the clinic, providing management and oversight. Local health workers provide day-to-day sexual and reproductive health services for women and children in a community where an estimated 40% of the population lives in temporary shelters.

Six years into their flight, families still live in makeshift accommodations. Improvised structures are everywhere around Mingkaman, plastic tarps withering under the hot equatorial sun. UN logos are fading from the weathered tarps families stretch across frames of scavenged wood.

The clinic has a similar temporary feel. The tents where patients are treated and medicines are dispensed are showing signs of wear. Designed for only one year of use, now at year six nurses can point with accuracy where leaks have developed.

While plans are underway to construct a more durable facility, patients are discharged mid-day from the primary treatment tent because the heat is too intense to bear. On a recent Wednesday, the tent’s temperature was well above 100 degrees Fahrenheit at noon.

Relief from the heat comes from two Acacia trees in the clinic’s courtyard. They provide shade while women wait in line for prenatal medicines or vaccines for their babies. IV fluid bags are tied to tree branches, providing life-saving medicine to a half-dozen women in recline, suffering the effects of malaria.

“This is our family.”

An experienced midwife, Acheui attributes South Sudan’s lack of medical facilities as a key contributing factor in its prevalent maternal mortality problem.

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South Sudan’s shortage of skilled medical staff is also part of the problem. Acheui is quick to credit her staff’s commitment in marking the achievement of a third year without a maternal death.

“They know what to do in an emergency. They know how to refer people for help when it is needed,” she says. “We don’t play with a person’s life.”

The clinic’s staff officially work for the local health system, at the state hospital in Bor. They receive an incentive to work here instead of the hospital, a two-hour boat ride away.

“They choose to work here because they say, ‘this is our family,'” says IMA’s Nancy McGaughey, a nurse who helped to start the program in 2014 and is still involved in its operation. “They do not discriminate between host and displaced people. They serve them all.”

The clinic’s staff have tents where they rest. A crew remains on call 24 hours a day to respond to emergencies. In six years of service to a community that is still considered transient, their reputation for saving lives has taken root.

Women who have traditionally had babies in home settings are now coming to this clinic.

“I had my other three children at home, but I think it is better to have them here,” Agok Dhor says. “If anything happens, they are prepared to handle it.”

Midwife Poni Angelou provides pre-natal medication to Anyet Ayour. With support from the UN Family Planning Agency and South Sudan's Ministry of Health, IMA World Health has operated this clinic since 2014. It focuses on supporting internally displaced persons. At least 24,000 people remain in Mingkaman, displaced by violence from South Sudan's civil war. The country's maternal mortality rate is among the world's worst. Yet, not a single mother has died in childbirth at this facility in more than three years.
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