The two Sudanese women thought they had malaria and were taking their medication, but things took a dire turn. Both complained of a splitting headache and fever that didn’t respond to the anti-malaria treatment.
By the time she was diagnosed with dengue fever, Raqiya
Abdsalam was unconscious.
“Soon after they examined me, I fell into a coma,” she said,
recounting her ordeal some three months ago. Both women have since recovered
and are at home in the city of El Obeid in the central province of North
Kordofan.
For decades, Sudan’s underfunded public health sector has
struggled to effectively diagnose or treat patients as significant government
spending went to its vast security services. A recent spike in mosquito-borne
diseases — such as dengue fever and malaria — has underscored the fragility of
the African country’s health system, boding ill for future challenges driven by
climate change.
Sudan’s best-equipped hospitals are concentrated in the
capital, Khartoum, leaving those from far-flung provinces reliant on aid
projects. But many of those have disappeared.
In October 2021, Sudan’s leading military figure, Gen.
Abdel-Fattah Burhan, led a coup that derailed the country’s short-lived
democratic transition. The move spurred a sharp reduction in aid, with the U.N
Office for the Coordination of Humanitarian Affairs reporting that funding
levels fell to less than 50% of required needs for both 2021 and 2022.
Burhan with his ruling generals and several other political forces
pledged in December to install a new civilian government. But political
wrangling is impeding a final deal, and it remains unclear when — and if —
donor funding will return to previous levels.
In late fall, a young doctor at a North Kordofan hospital
thought that what she was seeing was a new malaria outbreak. Patients arriving
at her hospital had malaria-like symptoms — high fever, body fatigue and a
migraine-like headache.
But after blood samples were sent to a laboratory in
Khartoum for testing, a worrisome picture emerged. Some of the patients did
have malaria, which is caused by a parasite, but others had dengue fever —
similar in symptoms but caused by a virus. If severe and untreated, dengue
fever can lead to organ failure and death.
The young physician said the hospital lacked the facilities
to deal with the outbreak. “Patients had to either lie on the floor or bring
their own beds to the hospital,” she said.
While malaria is common across central and southern Sudan,
large dengue outbreaks are rare. But, since last fall, dengue fever spread to
12 of the country’s 18 provinces, killing at least 36 people and infecting more
than 5,200, according to Sudan’s Ministry of Health. However, the actual
numbers are likely higher, given the limitations on testing.
“Most hospitals outside of Khartoum are not connected to the
Ministry of Health database,” said Alaaeldin Awad Mohamed Nogoud, a liver and
transplant surgeon who is also a prominent pro-democracy activist.
The World Health Organization says several factors enabled
the dengue outbreak, including the absence of disease surveillance
infrastructure and heavy flooding in autumn. The stagnant water allowed
mosquitoes to breed and fueled the spread of the disease.
Health experts also fear that growing mosquito migration,
induced by climate change, could spur new surges in dengue fever, among other
tropical diseases typically found beyond Sudan’s southern borders. The Aedes
aegypti, a long-legged mosquito growing in number across Sudan that can carry the
dengue virus, is causing particular concern.
According to Anne Wilson, an epidemiologist at the Liverpool
School of Tropical Medicine, containing illnesses spread by the Aedes aegypti
is difficult because it mostly bites during the day, rendering insecticide-treated
nets, similar to mosquito nets for beds, less effective.
Sudan’s public hospitals are state-run, but patients often
still pay for drugs and tests. Hospitals in rural areas are the most depleted,
stocked with little more than metal-frame beds and doctors.
In North Kordofan — the site of the recent dengue outbreak —
some believe the virus went unchecked for months due to a widespread lack of
blood testing equipment. Abdsalam and Amany Adris, the two women from El Obeid,
said several doctors had told them they had malaria before they were correctly
diagnosed.
After the Ministry of Health officially recognized the
outbreak in November, officials say free testing and treatment were made
available to dengue fever patients. And by January, North Kordofan was declared
free of dengue fever.
But even after that announcement, the young doctor from the
province said she was treating suspected cases. Few patients can afford to pay
for the blood tests themselves, however, she added, speaking on condition of anonymity
for fear of reprisal.
Both Nogoud and the young physician said widespread
shortages are forcing physicians to go to black market for basic medicines,
such as paracetamol IV drips to treat fever.
For years, Sudan has been in an economic crisis with annual
inflation topping 100% on most months. Since 2018, the Sudanese pound has lost
over 95% of its value against the dollar, making it difficult to buy
pharmaceuticals or medical equipment from abroad.
By the end of last year, Sudan’s National Medical Supplies
Fund — the body tasked with procuring pharmaceuticals — said the availability
of cancer drugs stood at 48% of needed levels, and other emergency medication
was at 68%. Doctors, working with little pay and in difficult conditions, have
regularly gone on strike.
Critics accuse the country’s leaders of not putting more
funds towards the health sector. The federal budget for 2021, listed on the
government’s website, said the country’s health ministry would receive less
than half of what would be allocated to the Sudanese Armed Forces and the Rapid
Support Forces, the country’s largest paramilitary group. The military
spokesperson did not respond to AP’s request for comment.
With few resources, the Health Ministry has turned to short
videos on social media, encouraging people in a catchy song to cover standing
water sources and install netting on windows.
Few see this as a long-term solution.
’’The whole country is in a state of chaos″, said Nada Fadul,
an infectious diseases physician and associate of the Sudanese non-governmental
organization NexGen.
″Health care might not become the priority for survival,”
Fadul added. -AP
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