People will acknowledge independence only if we provide services

Q. You have gone into a frenzy trying to keep Juba clean; why has it taken long to do this?
Everything was a priority. In health they say, when several patients come, you give priority to the person whom, if you don’t serve quickly, will die. Others can stay for two, three, four weeks before they die. That’s why southern Sudan didn’t get the priority needed to ensure that it was clean. Time has come to keep Juba clean. We have taken this time, the preparation for independence, as an opportunity to support the system, to support the city council of Juba. They have been struggling. But now we are working as a team, with a committee led by the minister of Health. We also work closely with the ministry of Environment, and all agencies responsible. We are setting up a system. When we retrieve from the committee there will be already a system. The challenge is what next after independence. Everybody is wondering, where will money be secured? I think that will be found.

Q. Does this extend to areas outside Juba?
At the moment it’s limited to Juba town as we say it’s only for preparation of independence. The mother celebration will be in Juba. There’s a committee set for this mother celebration. That’s why we are cleaning juba town, but also setting up a system and we hope other states will learn from this. Some states are already clean — like Jonglei. They started the initiative back. Aweil has started. We are not sure how they are progressing. But really our concern is to see to it that all of southern Sudan is clean. When it comes to garbage collection, technical know-how on dumping it’s the ministry of Environment and I think they have plans. They have been crying about funding issues. I hope they will be addressed after independence.

Q. Do you think a cleaning culture will develop?

It needs a push. You clean today bottles are flying from vehicles. People are dumping. It’s a struggle. We need education, and with law enforcement, bit by bit people are responding. But it will take a while before we become like other countries that have really systems in place. Even the cleaners, in the first days you would bring them water. They would drink and dump the bottle there. And you are, like, eh, but you spent the whole morning cleaning! The mentality has to change. That takes time. It’s difficult, especially changing behavior of grown ups. We should use school children. We are moving from school to school. Even teachers, they don’t enforce the school children to clean. We went to several schools and said, we thought cleanliness starts at school. And it’s always easy to change the behavior of the young ones if they know that they come every morning and they have to clean. When they go home, they will even correct their parents. We have to find strategies of how to impart this cleaning ideology. The other challenge is the garbage collection. The kind of garbage generated in Juba is just overwhelming. We are trying our best but sometimes you see even some of the yellow bins that we have distributed still overflowing. Today you empty; in the afternoon it’s full to the beam, and you wonder. Are houses generating all this amount of garbage? Are these garbage been hidden somewhere? What is happening? What I know is that there are several hotels around and most of this garbage is generated by hotels. Hotels are supposed to recruit garbage collection firms. They don’t want to spend. You get heaps of garbage, get a loader and you clean it, the next day it’s as if you’ve done nothing. You know what time they dump? At night. So we are actually trying to get police to monitor some of the sites that are a headache to us. We have identified about 30 sites to monitor. If we get someone dumping, we are going to give him a hard time. We believe it’s mostly the hotels although we don’t rule out households, we also know households can’t generate too much garbage in a day. Some companies are not doing well, but since they are generating money it’s their role to ensure they collect their garbage, not the government. We have also planted flowers and trees. But you plant today tomorrow it’s stolen. The vehicle runs over it. And you wonder before you planted there was a hole and vehicles were not climbing over the pavement. It’s frustrating, but when you think of the independence excitement, we say, let’s continue.

Q. What’s the general state of health?
It’s more of education, awareness, sensitization. In all counties were prevalence has been high, if you ask what have you used to reduce rates, it’s awareness. We feel we are not doing enough of awareness. If people are not aware they will not go for treatment. If they are stigmatized they will not go for a test. If they know earlier of their status they are saving their lives and those of their beloved ones. We need to use a lot of health education methods – the posters, church, mosque, media. Funding has been an issue, but we hope that with independence, most of those beautiful plans that have been set, it’s high time to talk of implementation. The public will be frustrated if after independence we still talk of plan, plans, plans; because we have been planning for the last six years.

Q. Someone said last week that some communities believe condoms have the virus that causes HIV? Have you come across such?
When I was young, if one had HIV/Aids people would say, oh, sarwo. They think he has been bewitched. But you would see clear symptoms of some of our relatives who died. When you think about it today, it was just HIV/Aids. In the villages some still believe that some one has been attacked by the spirits of their fathers. As the minister said, health education is a priority. Now we need to enhance that department; we need to look for funds so that we can work in collaboration with the South Sudan Aids Commission.

Q. What are the challenges with manpower?
That one we even don’t talk of the ratio. Even the nurses. Abroad you would say a nurse to four patients. This one does not work here. Human resources are a challenge. If you go down to state hospitals, county hospitals, it’s a nightmare. And most doctors don’t want to go up country. One of the reasons is infrastructure – accommodation, basic tools that people need to do their work. It’s like sending a farmer to a farm without a hoe. We have been crying for money. Medical equipment is expensive. You can get one equipment at three million US Dollars. To equip all the hospitals with the resources we have, is not working. We need money set aside for only the basic medical equipment that a hospital should have. We are not talking about the sophisticated machines, even if we should now deserve that. How many people have been referred outside the country for treatment that our doctors can do inside the country, if it were not for lack of equipment and infrastructure. Security has been a priority, but we hope now things will change. That’s how people will acknowledge independence when social services have come.

Q. so you can’t for now cover the demand for medical facilities?
No. And all this time the health budget is just on paper.

Q. it doesn’t come in full?
The liquidity – you only see one third of it. And it’s like fire-fighting with the centralized system where each request goes to the ministry of Finance. It has been a nightmare.

Q. What has been the general improvement in health post-CPA and how do you foresee the future?
In 2005, 2006, we were sharing one prefab, with twenty of us packed in there – the undersecretary, Director-Generals – you didn’t know who was who. We had one computer. When one gets up you share that computer. You’d go to the health facilities you would cry. All the mattresses were rotten. Beds were falling apart. The whole of Juba Teaching Hospital had two or three doctors who had never received further training since, ten years or so. The health centers were terrible. Only the NGOs were struggling to run some of the centers. In Juba Teaching Hospital now we have consultants in hospitals, doctors who have come back. It’s no longer certificate nurses. The hospital used to be run by Traditional Birth Attendants. Today we have midwives and they have some of the basics. A lot has been done. It’s a drop in the ocean. We are coming from the hole that was deep, and was growing deeper. We struggled to cover it up to the surface. We are now at the surface

Q. Any special message as we head to Independence?
I know they have waited too long. We are trying our best. There are reasons why things have not improved to our expectations. With the independence, things will be different. We’ll be in control of our resources. And we know our priorities. It may take time. It needs patience.