A Mother's Burden

Preventing Malaria in South Sudan

By Ashley McLaughlin 
Photos by Stefanie Glinski, Ashley McLaughlin and Amanda Nero

Preventable diseases like malaria quickly become a deadly threat in South Sudan, a country affected by over four years of post-independence civil war, lack of basic services and rising humanitarian needs. As in much of East Africa, malaria is a leading cause of illness and death in South Sudan, where access to health care is extremely limited.

In 2017, the disease accounted for 61 per cent of all illnesses reported in health facilities, with over 1,000 deaths reported, according to the World Health Organization (WHO).

IOM midwife Annet provides preventive care to women at the Malakal protections of civilians site. Photo: Stefanie Glinski

Men wait at the Malakal Teaching Hospital in town, where an IOM mobile team is providing primary health care services. Photo: Stefanie Glinski.

An IOM mobile team provides primary health care services at the Malakal Teaching Hospital in Malakal town. Photo: Stefanie Glinski.

An IOM clinician examines a child at the Malakal Teaching Hospital. Photo: Stefanie Glinski.

25-year old Achuol, a pregnant mother with two children, lives in Malakal town, in South Sudan’s Upper Nile region, near the border with Sudan. Much of Malakal has been destroyed by the war, as the town and its residents experienced some of the most brutal fighting during the outbreak of the conflict in 2013 and 2014. Today, over 24,000 civilians, from Malakal and surrounding areas, are sheltering in a nearby displacement site protected by UN peacekeepers.

Achuol has recently returned to Malakal after fleeing to Uganda and Kenya following the outbreak of the war. “I want to be home, with my people,” she says. “Security is okay now and I have a house with iron sheeting and mud.”

Most health facilities in Malakal are damaged or non-operational, except for those run with support from aid organizations.

Damaged building at the Malakal Teaching Hospital. Photo: Stefanie Glinski.

A mother brings her son to the Assosa clinic in Malakal town. Photo: Ashley McLaughlin.

Aware of the importance of prenatal care, Achuol used to walk at least one hour each way to reach the closest clinics in Malakal.

In February 2018, the International Organization for Migration (IOM) began operating the small Assosa primary healthcare clinic in Malakal town. The clinic operates out of a sparse building, where clinicians see over 240 patients a week, most suffering from respiratory infections, malaria and acute watery diarrhea. The clinic is closer to Achuol’s home, easing her access to the necessary care. 

IOM midwife Caroline provides prenatal care to Achuol at the Assosa clinic. Photo: Ashley McLaughlin.

For pregnant women, malaria infection can lead to higher risks of both maternal and perinatal sickness or even death. Pregnant women have a reduced immune response, meaning that their immune system is less effective at fighting a malaria infection. Pregnant women are three times more likely to develop severe malaria than non-pregnant women acquiring infections from the same area. Malaria infection during pregnancy can lead to miscarriage, premature delivery, low birth weight, congenital infection, and/or perinatal death.

During Achuol’s first visit to the clinic, IOM midwife Caroline provided Achuol routine antenatal care, which included medicine to prevent malaria, crucial for Achuol who will be pregnant into the rainy season. Caroline also gave Achuol a mosquito net and advised her to sleep under a net every night (together with any of her children under five years), clear bushes and stagnant water close to her house and take the malaria prophylaxis medicine on a monthly basis.

Nour’s family fled Iraq in 1994 thinking they were leaving their home country for good. Nour did not know what country she would call their new home, nor could she predict the impact she would have on the lives of other women some 23 years later, back in Iraq.

The family spent seven years in Turkey waiting for their refugee application to be processed. During this time, Nour’s mother Insaf supported the family by sewing and selling passport bags, bible covers and handbags at local bazars and churches in Istanbul. They were eventually resettled in Canada in 2001. IOM did the travel arrangements in cooperation with the Government of Canada.

A women fetches water early in the morning at the Malakal PoC site. Photo: Ashley McLaughlin.