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The clinic, designed to serve the citizens in a southernmost corner of South Sudan, had been Joseph Dumba’s pride and joy.
When Dr. Dumba, originally a Sudanese refugee who’d put himself through medical school in the United States, went back to treat the people of his native county, Kajo Keji, medical services were largely unavailable.
“The county hospital was built in the 1930s, and it was run down, with no doctors, no nurses, no medicine,” Dr. Dumba recalled. “It’s a place, basically, to go and die.”
Starting in 2007, he and a few volunteers traveled regularly to Kajo Keji to provide basic medical care to the population — primarily subsistence farmers.
But Dr. Dumba couldn’t be there all the time, which meant he couldn’t provide the continuum of care that many of his patients needed. So he came up with the idea of opening a clinic, funded and supplied by his foundation, Healing Kadi, and hiring local doctors and nurses who could care for patients on a daily basis.
“The children were growing.”
Healing Kadi’s Marilyn Miller Memorial Clinic launched in 2013 with 3 doctors and 22 support staff. With those 25 employees, Dr. Dumba said the clinic was the largest employer in the county. It ran on a combination of solar power and a generator, and had a working laboratory along with an x-ray and ultrasound machine. Some patients traveled over 100 miles – often on foot – to receive healthcare at the clinic.
Dr. Dumba and his fellow Healing Kadi volunteers made regular trips to relieve doctors and refill supplies of medicine.
“The whole region around our clinic looked healthier,” recalls Jim Steier, a fellow doctor and Healing Kadi volunteer. “The children were growing, their bodies weren’t full of worms. It was remarkable.”
“Everyone else had left.”
But then, South Sudan’s civil war, which had been ongoing for several years, spread to Kajo Keji.
South Sudan became the world’s newest country in 2011, when an overwhelming majority of its citizens voted for independence from Sudan. It was hoped that region’s independence would put an end to violence and instability that had plagued Sudan since the 1950s.
But in 2013, fighting broke out between the government’s forces and an opposing group, leading to atrocities, famine, and severe economic decline.
The people whom Dr. Dumba’s clinic had served were forced to flee across South Sudan’s southern border to Uganda. “People were being killed,” he recalled. “When we closed the clinic [in 2017], we were the last ones to come out of the county. Everybody else had left.”
But many of the residents of Kajo Keji stuck together, crossing the border at around the same time. When they arrived at the refugee settlement in Uganda, they were primarily assigned to spots within 100 miles of one another.
Dr. Dumba, his fellow volunteers, and two of the original clinic doctors decided to follow them. “We asked the government of Uganda [if we could] continue to treat the patients we’d already treated for many years,” he said.
This map shows the route from Kajo Keji, where Dr. Dumba’s patients lived, to the Belameling refugee camp, a walking distance of about 36 miles. (Map by Direct Relief)
“I don’t know, because I wasn’t there.”
Civil war isn’t new to the region – or to Dr. Dumba, who was a young man about to attend university when conflict between the Sudanese government and rebel forces broke out.
Originally, he decided to join the rebels, but quickly tired of the bloodshed. “I wanted to do something better for our people in the future,” he said.
After staying in a refugee camp in Kenya, Dr. Dumba traveled to Tacoma, Washington, and went first to college – working nights as a janitor to pay his way through – then to medical school. Dr. Steier recruited him to join a practice in Omaha.
In 2003, Dr. Dumba’s mother – who had also fled the war and was living in Uganda, collapsed while walking and died. “I was about to do something for [my family] because they had really struggled,” he said. “My mom died of a condition and nobody knows what it is…I don’t know, because I wasn’t there.”
But the experience inspired him to bring healthcare to the place where he grew up, and he soon recruited Dr. Steier to join him.
“Little did I know what I was getting myself in for,” Dr. Steier said wryly.
“It’s like practicing 200 years ago.”
For the South Sudanese refugees living in the sprawling Belameling camp in Uganda’s Moyo District, Dr. Steier said, the clinic is the only option for receiving real antibiotics and reliable medicine.
But it’s not like the clinic they left behind. Currently, doctors operate out of one building with a metal roof and several adjoining tents.
“Mostly a doctor has a stethoscope and his hands and his eyes and his ears. It’s like practicing 200 years ago,” Dr. Steier said.
And the patients are sicker. Previously, in South Sudan, Kajo Keji’s farmers raised meat animals and cultivated rice, cassava, corn, and tomatoes. Pineapples, bananas, and mangoes grew wild. But in the camp, there’s no space for crops (although Dr. Dumba said his patients are eager to grow them) and a limited diet is leading to poor health and malnutrition.
The refugee camp, located along the Nile, draws mosquitoes, and malaria is rife. Children frequently need treatment for parasites.
“Every child we see has a belly full of parasites,” said Dr. Steier. Once the children are treated, “they have a growth spurt like you wouldn’t believe.”
But the demand for care is so high that the clinic has always struggled to keep medicine in stock. Supplies were once so depleted that the doctors thought they’d have to close the clinic.
“Once you’ve gone, you’re hooked.”
Last year alone, 45,000 patients sought treatment at the clinic. Few if any could pay. As a result, the doctors rely on support from outside sources. That’s where Direct Relief comes in.
Since 2009, Direct Relief has supported the Healing Kadi Foundation with a variety of medical resources – everything from prenatal vitamins to blood pressure medication.
“We couldn’t have operated, even in South Sudan, without the help of Direct Relief.” Dr. Dumba said. “The last shipment…came at the point when we really did not know what to do.”
Dr. Dumba took a fresh supply of Direct Relief medicines with him when he departed on a mission to Uganda this month.
While Uganda is where he’s most needed now, Dr. Dumba has dreams of returning to his clinic after the conflict dies down. He’s hoping it will soon be safer, so that staff can go back and prepare the clinic for patients.
But he doesn’t want to stop with one facility. “My plan is actually to duplicate [the clinic] all over the country so that people can become self-reliant,” he said. “Either I’m imagining or I’m dreaming. I’m not sure.”
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