Canamancan Travel Blog Entry No. 6

This Blog Entry covers our remaining time in Juba through to the trip back to Canada.

I left Simon and Kevin to get settled in their room and Gido drove me to the Ministry. Ms. Judy Gitu, Dr. Baba’s executive assistant and guardian to his office entrance, greeted me. This was my third visit to the office. There are three chairs in this outer room usually all occupied by people waiting for an audience. Folks are always coming and going and the most common words spoken are, “Is he in?” and “Dr. Baba is in a meeting.” To his credit, the doctor packs a lot into his day, helping those that he can and addressing most issues quickly. I was pleased to see him on what may have been short notice.

Dr. Samson Baba, Director, Ministry of Health,
GOSS (Nov., 2010)

During my last visit in 2010, Dr. Baba and I discussed the possibility of malaria vector control, specifically mosquito larviciding, as an added component to the current programs to reduce the incidence of malaria. At the time, he was very receptive, stating that the GOSS Health Council recently questioned why vector control was not being done. We discussed registering Pestalto, locations where we could initiate a program and funding sources. The meeting finished with my agreement to provide a letter of intent which would be discussed with his colleagues. However, nothing happened after that - out of sight, out of mind.

My talk on this occasion with the Director was short. I briefly reviewed our last one-on- one discussion and indicated that my current objectives were the registration of the company and a ground review of the community where a vector control program could be conducted. Dr. Baba stated that he would contact a lawyer for advice on how to register the company. He also suggested that Juba would be the best location to do a program. This was contrary to our first agreement. I had indicated that Juba was too large and complex to validate the vector control approach. We had decided upon two villages to the north of Juba, where for comparative purposes vector control would be applied to one and not the other. We touched on financing which also revealed a change in stance from our last meeting. At that time Dr. Baba acknowledged that Pestalto was a “for profit” service provider and he suggested that the Global Fund could be a source of funding for a vector control operation. I was now under the impression that he was steering towards a free demonstration. I reminded him that I was a “compassionate capitalist.”

The occasional knock on the door while we talked was indicative of the growing demand for his attention. My time was up. We would continue the discussion in two days. He was off to Kenya. Kevin, Simon and I would keep ourselves busy familiarizing ourselves with Juba and doing larval sampling.

Gido and I returned to the hotel, I paid him and arranged to meet him the next morning for the tour of Juba. Then I joined Simon and Kevin for Chinese cuisine in the compound across the road.

Over the meal and Tusker beer we discussed the day’s activities. I learned that Kevin had also paid Gido for the ride from the airport to the hotel, 140 Sudanese pounds. So Gido was paid twice, an exorbitant amount by Kevin. Gido did not mention it; I did say he was entrepreneurial. Powers of observation and communication amongst our team were apparently hindered by the issues earlier in the day and I suspected that we were looking like easy marks to Gido.

Our objectives the following day included obtaining a local simm card and minutes so that we could use our cell phone, acquired in Addis, for calls in Juba; exchanging our U.S. dollars for Sudanese pounds; exchanging the U.S. American Express Traveller’s cheques for cash; looking for mosquito larvae and getting GPS coordinates of mosquito larval habitats within Juba.

The first task was easy enough. There are a multitude of vendors walking through the traffic and in stalls along the roads offering cell phone simm cards and time cards at a reasonable price.

The next challenge, exchanging some U.S. cash with money exchangers at their booths along the road. There we learned a rather important lesson. U.S. currency with series numbers older than 2006 were not acceptable and could not be exchanged - roughly a third of our U.S. cash was unusable.

This was followed by a failed attempt to cash the Traveller’s cheques. No bank would take them; believe me we tried. I specifically asked Maggie at BMO when I purchased the cheques if they were accepted tender in Africa. “Why not? The only place you can’t use them is Cuba!” Hmmmm – I would have to enlighten Maggie. I knew from experience that credit cards were useless. I had the option of wiring U.S. funds from Canada using Western Union but that was a hassle. Western Unions are always crowded with long line ups of people dependent on receiving money from friends and relatives abroad. Money was going to be tight but I decided to “sweat it out” over the next few days.

Gido took us to a few wetland areas within the city and indeed we did find some mosquito larvae. A few were Anopheles, the vector for malaria. It was too early to get significant numbers; the rainy season had not started. However, Simon got some good footage of us sampling.

At the end of the day, Gido expected $120 U.S. for his services and indeed this was the going rate. However, we negotiated successfully for a much lower price because of the overpayment the day before.

An early supper consisted of, you guessed, Chinese food and Tusker beer. The serving staff was Sudanese; the management and the cooking staff were Chinese. Mr. Kuber had informed that Chinese accounted for the largest component of foreigners in Southern Sudan. However, the only Chinese that I saw were either working in the restaurant or were customers who we met at the communal breakfast table.

We retired to our rooms and I for one, hit the shower. My bathroom had an open shower (no shower curtain and no pressure but the water was hot), a sink and a toilet sans seat. It was clean and not too much the worse for wear. My quarters were bug free with the exception of a few vampire bugs (mosquitoes) one of which managed to nail me that night while I slept. She probably got in through the opening that I fashioned between the mattress and the bed net for the hose of the CPAP machine. No worries, I was taking my daily dose of Malarone.

After checking e-mails on the internet and working on a blog, I headed out of the compound onto the laneway to make my daily call on the sat phone to my wife. I walked about 50 metres from the hotel to an intersection for a decent signal and to get away from the noise of the generators and the restaurant which became a rowdy bar when the sun went down. The night was dark and that intersection was not the best place to be. Traffic was scarce but vehicles came up fast, stirring up the dust from the dirt road and making visibility poor.

My head cold returned that day with a vengeance and I spent the night hacking. If I could hear the people in the adjacent rooms through the sheet metal walls, no doubt I interfered with their sleep. Sorry!

The next morning Mr. Kuber offered his driver and vehicle to take Kevin and I to meet with the Dr. Baba. We arrived at his office around 9:00 a.m. and the people in the reception room were overflowing into the hallway. Kevin and I found a couple of chairs at the end of the hall and kept our eyes peeled on his door. Within half an hour Dr. Baba emerged and signalled to us to give him a couple of minutes.

The Director had concluded that the most convenient place to run a trial vector control program would be the Kator payam, a municipality within Juba. He would provide us with a driver, a security person and contacts with whom we could discuss the incidence of malaria in Juba and another who would define the boundaries of the payam. Regarding the company registration to conduct business in Southern Sudan, the good doctor had not had time to see a lawyer – understandable; he would call me (the universal put-off?). I left him with the task of following up with the lawyer and he left me with the task of formulating a vector management proposal for Kator payam.

First we were taken to see Dr. Robert Azairwe, Senior Technical Advisor with MSH (Management Sciences for Health) whose address is Arlington, Virginia and Ms. Margaret Lejukole, the Monitoring and Evaluation Officer for the National Malaria Control Program, also with MSH. MSH is significant player as a non-profit health organization. These people were not GOSS employees and we were greeted with suspicion. I explained that we were proponents for vector management as an additional tool for malaria control. It was made clear that we would not receive any information without a formal request. That written request would probably be closely scrutinized and discussed by higher authorities within their organization and probably denied. MSH, like WHO, has not acknowledged that the battle to significantly reduce the impact of malaria must involve the implementation of proven modern vector control techniques. That will happen … with time.

Next we met with Joseph Abeya, a GIS specialist with the United Nations, again not with GOSS. He did provide maps of the City of Juba; however, his office did not know the boundaries of Kator payam. He would be most appreciative if we could supply him with that information. We would do our best.

Off we went; our driver - Jero, our security guard and facilitator – Michael, Kevin with the GPS camera, Simon with camera in hand and me. The first task was to find an authority on the boundaries and then … to define some larval habitats, to see if we could find some Anopheles larvae and to talk with some of the locals. Jero and Michael worked well together and tracked down the head administrator of the payam. That gentlemen was kind enough to interrupt his work (people were lined up in his office also) and outlined the boundary roads on our map.

It took Kevin about two hours to plot the boundary with the GPS camera. These periphery roads are mostly hard top congested with vehicles of every kind, people and livestock and lined with makeshift and permanent stalls and drainage ditches.

The internal roads are dirt laneways with family compounds containing one or more homes. The homes range from “high end” stuccoed cement block with clay roofing tiles to mud huts with thatched roofs. The compound walls are made from concrete block for those that are financially well off and from bamboo or sticks woven together for those who are not. Any garbage in the compounds such as plastic bottles is swept into the laneways to be crushed by passing vehicles and in the rainy season swept down to the creeks and eventually washed into the Bahr El Jebel River. The plastic pollution is mind boggling. Apparently some of this garbage is burned as evidenced by a pervasive acrid odour of burned plastic in the air. The undamaged plastic containers along with abandoned rusting vehicles and tires were suitable artificial habitats for mosquito larvae during the rainy season. A major component of a vector control program would have to be waste management.

The terrain within the payam slopes towards the river and intermittent tributaries. The severe soil erosion due to the high volume of rain in the rainy season is evident from the deep gullies cut into the allies running south and east. Some of these are impassable by car even in the dry season unless you have a high clearance 4-wheel drive vehicle, which we did. Another component of a vector control strategy would have to be flood and drainage management.

We came across an assistant to the chief of a “village” within the payam who was curious about our presence. He described the death from malaria of a pregnant woman who lived adjacent to the flood plain along the creek below. Apparently, prophylactic medical measures are not available to all who need them.


Later we came across a group of mud huts with people outside. We introduced ourselves to Moses who appeared to be the head of the family. We asked him if bed nets were used to prevent malaria. The response was yes on cool nights. So I wasn’t the only one who found it hard to sleep under a bed net when it’s hot and the mosquitoes are active.

Moses' family homes in Kator payam
(Juba, Southern Sudan; March 2011)

Moses (Kator payam, Juba, South Sudan; March, 2011)

Moses showing us his bed net that he doesn't use on
 hot nights (Kator payam, Juba, Southern Sudan; March 2011)

Towards the end of the tour we went down to the Bahr El Jebel River (also known as the Bahr al Jabal – River of the Mountain). This river becomes the White Nile that joins at Khartoum with Blue Nile out of Ethiopia. In Juba the river has significant size even in the dry season. We were told that come the rainy season it rises 20 feet, flooding the surrounding land and creating a substantial acreage of mosquito larval habitat.

A steady flow of water trucks moved to and from its shore. The drone of the gasoline pumps was loud and continuous. The trucks deliver the water to compounds with cisterns for household use with the probable exception of drinking. We observed dug wells with hand pumps when we were inside the payam and these are likely used to obtain drinking water. Cholera is a major killer in Juba and is contracted through contaminated water. There is a connection there somewhere.

Fishermen were relaxing close by mending their nets and on the far side crocodiles were preoccupied with mating and egg laying. Apparently they are a little testy at this time of year. Fishing in dugouts is not for the faint of heart.

We made our way back to the hotel and shared a meal with our new friends who agreed to take us to the airport the next day.

I had not received a call from Dr. Baba so I phoned Judy to see if there was any word –negatory. Before hanging up I made sure that she had the correct cell phone number.

We spent the evening packing which was a slow process for me because of poor sleep. I checked with Kevin regarding his available cash and tallied it with mine. By my calculations if the older U.S. bills were acceptable to Mr. Kuber, we had enough to pay for the food and accommodation.

Mr. Kuber accepted the older U.S. currency. In terms of usable funds, we were left with a few Sudanese pounds and a few large U.S. bills ( a mixture of old and new) which would pay the departure tax and the other compulsory expenses, some Euro’s to pay for breakfast in Frankfurt and the wad of Ethiopian Birr that would come in handy on our layover in Addis.

We had eaten breakfast, packed and were ready to go when Jero and Michael arrived mid-morning.

We provided a few parting gifts to Michael and Jero and bid our farewells in the airport parking lot and headed into the congestion and security hassles that we had grown to expect. Simon was heading to South Africa for a wedding by way of Nairobi and checked through first. Kevin and I followed for our flight to Addis.

By the time Kevin and I got through security and on the plane two hours later I was exhausted. In 36 hours - I would hold my wife in my arms and enjoy the comforts of my home and community.

EPILOGUE

Travel home went smoothly enough although Simon's flight from South Africa was delayed by a day.


I saw my family doctor and took care of that head cold.

Both Kevin and I rejoined the Pestalto "home team" to work on the company's snow melt mosquito management contracts in Ontario for the following weeks. I also prepared for a trip to Nigeria. There was a fellow there I needed to meet.