There are any number of elements that spark a new community to form, or an older one to be revitalized. In Paguir, South Sudan, a community grew from two simple things: clean water and health care.
Not so long ago, Paguir seemed deserted. Little evidence suggested so many people lived and suffered in the northernmost region of Jonglei State, near the border with Sudan. Homes and other structures were few and far between. Still, a scattered but sizeable population – by some estimates the area is home to about 35,000 people - resides in this isolated and hard-to-reach region.
A few years ago, Action Against Hunger deployed our emergency team to Paguir to respond to alarmingly high malnutrition rates. The team delivered urgent medical treatment and installed the community’s first borehole.
Our emergency assistance was never meant to be long-term, but we quickly recognized the high levels of need in the area and came up with a plan to establish a permanent program in the community.
Now, mothers and children come from far and wide to receive lifesaving care at our Stabilization Center. Severely malnourished children with medical complications are treated by Dr. Paulino, rather than being referred to a faraway medical center. A small outpatient service also treats adults with medical needs.
"Ever since I came here, I observed that these people were really suffering. Whenever they came with children to the Stabilization Center, you could see malnutrition from their appearance. You could see it even in adults, that they were malnourished," says Dr. Paulino, who arrived in Paguir a year ago to serve as the first ever doctor in the area.
In Paguir, access to markets is limited and as a result, many people do not have a healthy, nutritious diet. "You need a balanced diet that includes greens, cereals, and fruit. But if you come to this area, people don't eat greens,” says Dr. Paulino. "They really live a simple life and eat whatever is available. This place is not like a town where you can have options for food. This is a poor village.”
Across South Sudan, people have fled conflict for safer, more remote regions. They move farther away from the violence – but also farther away from health services.
"This is my first time working in such a remote place. There is no transport, you can move only by walking, even if there is an emergency. But when I arrived, I could see some similarities to my home village, because my village was also very far from Juba."
Growing up under his uncle's care, Dr. Paulino discovered an interest in school and found that he was a talented student. Now, as a doctor, the first of his family, he helps the most vulnerable children in Paguir to recover from malnutrition.
"I remember once there was a child with severe malaria who was brought in unconscious, convulsing. In the middle of the night, I woke up and ran to the center and stabilized the patient. When people started to realize that there was a real doctor in the area, it encouraged them to come. Those first months, more and more people came to the Stabilization Center," recalls Dr. Paulino.
When Action Against Hunger’s emergency team first arrived in Paguir in 2017, there were just a couple huts where people lived. The rest of the population was scattered in the bush.
Two years later, our outpatient treatment center, which can treat simple cases of malnutrition, was operating at the top of its capacity, serving the increasing number of people coming from farther and farther away. In December 2019, the Stabilization Center opened its doors and, slowly but surely, the surrounding area has grown into a bustling community.
"What is now the market used to have only a few tukuls [huts] and there was no food sold, only tea. Now there is food, people are setting up more shops, and I even see an increase in the population living around the Stabilization Center. Some of them have even become my friends," says Dr. Paulino. He started attending to patients while the new Stabilization Center was being built – with help from the community, using locally sourced materials – and he was there for the inauguration of the building.
"When we finally opened the center, it was the biggest happiness that I have ever seen in the faces of people. And all of them emphasized that we should continue doing our work. To me, this is a clear indication that Action Against Hunger is really doing a good job here."
More tukuls and shops are under construction. On the main path of the growing market, people say that living next to the health center gives them a sense of security.
“I moved here because I feel safe living next to the Stabilization Center,” says Nyamale Mawich, a new resident in the village. “There is also a market nearby. All this makes me want to be part of this community.”
When the people of Paguir first saw the medicines prescribed by Dr. Paulino, they were hesitant.
"We first talked to people, explaining what the medicine was and how to take the drugs. After this, more patients started coming,” he recalls. “When I asked where they were coming from they said from places two hours away, six hours away. I remember someone even came on foot from eight hours away. I realized then that these people were really suffering. They were walking for so long when there were no floods, imagine now with these floods.”
Devastating floods in the last year have driven mothers to carry their babies on basins on top of their heads just to get them to the Stabilization Center. To assist people in accessing care, we created an outreach team. They move in canoes to communities cut off by flooding to find mothers and malnourished children and bring them back to the Stabilization Center. No child is left behind.
"I wish I had a camera to take big pictures of the children that I rescued and how they look now, so I could hang them on the wall. A real transformation, they became healthy children. Some people say, 'Is that the child that was admitted? Wow,' they say, 'that is real change,'" recalls Dr. Paulino.
For all of his successful cases, Dr. Paulino’s work is never done: "I feel I could do so much more," he says. "Right now we're limited because of the resources we have, and sometimes that makes me sad because there are some cases I could manage."
"I'm sure in the coming years, things are going to get even better, more wards, a bigger pharmacy, a separate outpatient department, and even more staff so that we can do even more than what we're doing now." But for now, says Dr. Paulino: "I'm happy to be a pioneer, the very first person who started to work as a doctor in this area. I'm proud about that."