Sometimes people ask, “Why does APHL do global health work?” Granted I hear this less often than I did five or ten years ago – public health emergencies in the context of globalization have answered this question time and time again – but I do still hear it. When I get this question now, I immediately think of South Sudan.
Global Health Program staff member, Sherrie Staley, and I got off the plane in Juba, South Sudan with trepidation this past September expecting to spend an hour or more being grilled by the known-to-be-difficult immigration officers. We gingerly maneuvered through the one-room immigration, customs and control check points, and explained as best we could why we had dozens of digital thermometers in our suitcases. The term “public health laboratory” was completely foreign to the officers, but upon hearing the words “CDC project” and “HIV laboratory testing” we were whisked through.
Eager to learn more about this new country, we quickly ventured out to the hospitals to visit their laboratories. In most developing countries the clinical system has to take on public health functions as there is no clear distinction of roles between these two. Sherrie and I consider ourselves well-travelled having been to many of the 22 countries the Global Health Program supports. We have seen poverty, we have seen infrastructure failure, and we have witnessed various disease outbreaks firsthand. Yet neither of us were prepared for Al-Sabah Children’s Hospital.
Al-Sabah Children’s Hospital is the only children’s hospital in South Sudan. Walking through the hospital we saw women sitting along the corridor walls, waiting for care and treatment for their sick children. We met with the hospital director, a frail elderly woman, in her unlit office. I remember noticing her sad, tired eyes. She shared her heavy burdens. “One of our biggest challenges is we can’t run a blood blank at this hospital,” she explained. “Culturally we struggle with the notion of donating blood; patients have to come in with a relative who will donate blood to them.” How do we overcome this cultural barrier to ensure a sustainable blood supply for these babies, I wondered? She went on, “Even if we could get donations, we couldn’t store the blood because we only have electricity for two hours a day.” My mind started racing – solar powered refrigerators. “And even if we could get power,” she continued, “we have no cross matching capabilities. We do one HIV rapid test on the blood, and if it is negative we transfuse the blood.” In this setting, rapid test kits are not always rigorously reviewed to take into account their performance in the field. As such, the patient does not benefit from scientific rigor and the delivery of a quality test result may be compromised. The transfusion patient – in this case a child – is potentially being exposed to infected blood. The transfusion of incompatible blood may make the transfusion useless, and quite likely activates an immune and clotting system response that could result in death.
It took a second for me to digest the information, and I looked outside as I collected my thoughts. Babies and toddlers were laying under the tree keeping cool in the shade, oblivious to the public health challenges facing the hospital staff inside. How could we help? I considered the procurement of solar panels or generators; the facilitation of laboratory testing training specifically for HIV and cross matching; the provision of technical assistance around quality systems – the list of possibilities for helping this facility are endless. So little could go so far here in saving the lives of these infants. APHL belongs here, I thought. International public health is not about recognition, and glamour – it is difficult and messy and complicated. It is about saving lives.
The South Sudanese are a proud people. You can tell by their elegant gait, by their handshake, and by their story. But the South Sudanese people have suffered unspeakable pain. Sherrie and I were commenting to each other that this was the only country we had visited where we could not get the children to smile back at us or engage in playful banter. These truly were the “lost boys of Sudan.” Despite their stories, the South Sudanese people remain positive and eager to work hard to improve the quality of life in their nascent nation.
The laboratory staff we support soak in all they can from APHL trainings and, amidst the struggles of their tough lives, they look to APHL as a beacon of hope.
On this World AIDS Day, we celebrate all that has been achieved under the President’s Emergency Plan for AIDS Relief (PEPFAR) and we look to the future for all the good that still can be done. On this World AIDS Day we think of South Sudan and we are reminded why we do global public health work.