In this way Africa goes back

“Africa is going backwards. It is not that it is standing still; it is actually going backwards. It is the fault of wars that take resources away from the most fragile countries. In addition, in these most fragile countries, women and children are at the greatest risk. Women’s health is increasingly at risk”.

So says Chiara Maretti, 48, from Varese, a midwife, who has been in South Sudan for three years working with CUAMM, Doctors with Africa, an Italian NGO that deals with health in sub-Saharan African countries.

Don Dante Carraro, the director and soul of CUAMM, often recounts that since the wars broke out in Ukraine and between Israel and Gaza in a country like Sierra Leone, diesel fuel has shot up from 8,000 to 22,000 Leone a litre. The result is that ambulances are running sporadically, they then break down, and dozens and dozens of mothers needing emergency caesarean sections die as a consequence. He recounts that too many children in Karamoja, a region of Uganda, die of malnutrition. In addition, in Tanzania, another country where CUAMM is active, the price of drugs for diabetes is three times higher than it was a year ago. In the hospital in Wolisso, Ethiopia, the cost of a pair of sterile gloves is today one euro, and on any given day, hundreds and hundreds of pairs are used. As Chiara Maretti points out, these are “Unsustainable costs for such poor Countries. Here, in South Sudan, the government can no longer pay salaries because international donor funding has gone elsewhere”.

The stories of those who work with CUAMM are always extraordinary and Chiara’s is no exception.

“In Italy, I was a midwife in Como and Monza, but during my training I went to work in a very small dispensary, and in the middle of nowhere, in Kenya. That was my first time in Africa. Then, in 2014, I left with CUAMM for Sierra Leone. This was when the first Ebola epidemic broke out and we stayed there”.

What do you remember about Ebola?

The absolute isolation. In Africa, human contact is everything. Here greetings last a quarter of an hour, we shake hands, and hug then shake hands again, which are all very important rituals. With Ebola everything stopped. Markets and schools closed. I used to go to the hospital and I couldn’t even hold babies. This caused me huge suffering for as soon as I go into pediatrics I want to hold each and everyone one.

When did you arrive in South Sudan?

I first came in 2015 to teach at the midwives’ school that had been opened by CUAMM. Then I had to return to Italy and went to work in a private clinic in Switzerland but I did not last long there. I flew to Kurdistan where, for two years, I worked in reproductive health in refugee camps. While I was there, Don Dante Carraro called me to ask me to return to South Sudan and for three years, I have been the Country manager.

What are the biggest difficulties in South Sudan?

The political instability that is reflected in everything else. It is this that generates extreme, absolute poverty, which is not talked about any more. We barely talk about Sudan, where there is war, and almost everyone confuses the two states. It is estimated that over 700,000 refugees have arrived from Sudan, ironically fleeing to this place that - according to the latest data - is the poorest country in the world and ranks first in maternal and infant mortality. We felt it was an important milestone to be able to celebrate six months without maternal mortality in the three hospitals where CUAMM is stationed. In any other Country, you would not even talk about it; while here it is a huge success. In Italy, I have colleagues who retire after 40 years without ever having seen a woman die in childbirth. Lucky them. That is it; the difficulty is not to let it get you down, because it feels like starting over every time. We have to look at the long-term results.

What is your personal recipe for not being overwhelmed by the tragedies you see around you?

It is like emptying the sea with a teaspoon. However, every teaspoon has a name and a surname; it is a life. If in the three years I have been in South Sudan I had managed to save just one mother, then it has been worth it. We must never lose sight of why we are here. Then there is my slightly crazy and very personal way of doing things, which is to go to the hospital, to serve, even on Saturdays and Sundays when I should not be working. I need to see patients; I need to keep my feet on the ground and see, and feel, why I am here.

War takes resources away from women’s health. Ukraine, Israel and Gaza. Which of these two conflicts has had the greatest impact on the situation of women in Africa?

I cannot say which one is worse because the most obvious reflection we have had here is that most international funds have been diverted. Those wars are perceived as emergencies while our situations are defined as chronic and, therefore, since the beginning of the war in Ukraine there has been a major slowdown in the arrival of funds. The coup de grace for us has been Gaza. Since the war broke out, money has trickled to us. It is called donor’s fatigue, which sees Africa as a lost cause.

What is the situation in South Sudan?

Dramatic. For the ten years to 2023, we received funds from a pool headed by the British and Canadian governments. Today, this Country, which has no resources of its own, receives funds from a World Bank project, through UNICEF, but the budget allocated to NGOs is less than half of what we had until last year. Therefore, the organisations have no choice but to cut the number of staff, the doctors, the midwives, and the expats.

How does this impact the life of “your” hospitals?

Fortunately, the CUAMM system is holding up, thanks to a number of donors, including private ones, who make a difference. Then this NGO has always invested heavily in human resources, people who do not come to work in place of Africans in the hospitals but work with local colleagues. It is all about training, which is a splendid, yet complicated recipe. We support two midwifery schools because they are the lifeblood of the system.

It is much easier, in fact, to come here and build a hospital from scratch with expatriates who make the mechanism run like clockwork, but this model does not facilitate Africa, or the local health system, to grow. We, who are active in the government hospitals, have to respect, every day, a complicated set of dynamics. Then, there is the new shortage of medicines, of which we receive less and less. Every month, CUAMM has to intervene with its own funds to have sufficient amounts. In other hospitals, women who have to have a caesarean have to buy their own gauze and sutures.

What can be done?

Continue to believe in this magnificent continent. I see newly graduated midwives working in hospitals; or in health centers lost in the wilderness I meet a former student who may be living in a mud hut, but who is at work with a smile. I have very good African colleagues, who are surgeons and midwives of the highest caliber. The extraordinary thing is that they trained in their own countries like Uganda or Kenya. That gives me hope and strength.

By Diamante d’Alessio