Of Soap and Scarification

Yuai is larger than I expected: tukuls stretch across the flat earth, reaching out beyond the compound perimeter for about a kilometre in each direction.  The epicentre of the village is the runway, the primary connection with the rest of the country, carefully maintained by the community.  When it is dry it is possible to drive from Juba to Yuai, but it is a two day trip, mostly through the bush and areas that have not been properly demined.  Not the most appealing of prospects.  In the rainy season even that option is unavailable, so the runway is the sole entry and exit point, enabling the transportation of supplies – both commercial and humanitarian – and people. Little flippy flappy planes ferry NGO workers into and out of the village and, in the occasional event of an overlap between a medical emergency and an available plane, transport patients to the MSF (Médecins Sans Frontières) hospital in Lankien.

As the county capital Yuai is home to the Commissioner’s office and entourage, while the South Sudan Relief and Rehabilitation Commission (SSRRC) have a basic operation here as well.  In spite of this honour there is little in the way of infrastructure, essential services or commercial trade in Yuai.  MSF Holland run outreach activities in Uror County, so there is limited access to basic healthcare, but as their nurses split their time between three villages the clinic is only staffed ten days a month; the rest of the time services are provided by semi-skilled local staff.  There are no roads here, no electricity, no shops.  This is the first place I have been where the seemingly infinite reach of Coca-Cola’s grubby corporate tentacles has not yet penetrated.  There is, however, a weekend market, presently understocked and overpriced due to the logistical difficulties presented by the rainfall.  The recent revelation that it may be possible to buy a – London priced – beer may well expedite my first exploration.

Action on the Runway

Nevertheless, while facilities may be basic Yuai is a lively place.  On my first Sunday there was cheering and the sound of rhythm outside the compound.  It sounded much like a crowd before a football match – urgent, pulsing.  It transpires that, with the rains subsiding somewhat, my arrival coincided with the resumption of an inter-community gathering, a combination competitive dance and marital selection ceremony.

Before I go any further, a brief explanation of the administrative structure of South Sudan is necessary.  South Sudan is made up of ten states, of which Jonglei is the largest and most remote.  There are six counties in Jonglei, which are further broken down into payams (sub-county districts, of which there are eleven in Uror), bomas and, finally, villages.

On what appears to be alternating Sundays people from three payams come together in celebration and competition.  On this particular Sunday I ventured out, feeling distinctly conspicuous and equally curious.  Now I am not very good at estimating the size of crowds but my colleagues and I agreed that there were over a thousand people present.  There were flags and sporting uniforms and young men running and dancing in unison along the runway.  The County Commissioner was leading the way with the chants and ceremony, welcoming the competitors and spectators alike with patriotic evocations.  The soldiers, present to maintain order, seemed coolly removed from proceedings.  Of course, as soon as I started taking photos a large group of kids gathered, mugging for the camera and generally showing off.  There was a sense of community, of identity and civic pride.  Unfortunately I was unable to stay to watch the completion of the competition and the following marital selection elements but I hope to catch those next time around.

Global Handwashing Day, Yuai

One civil institution which Yuai does have is a primary school.  Last Monday was Global Handwashing Day, and our WASH (Water, Sanitation and Hygiene Promotion) team organised a celebratory event at the school.  The event was charming, well attended, and tremendously impressive.  The pupils and teachers had evidently put in considerable effort, conjuring up drama, dance and song to mark the occasion.  One MC wrote a sort of beat poem which he delivered in English, directed towards the County Commissioner, the guest of honour who sat centre stage in his suit and sunglasses, watching over proceedings.

And this, alongside the apparent quality of the education the children were receiving, was the most encouraging element of the event. This was not just a token gesture organised by a few teachers.  There was evident buy in of community and government leaders, a genuine recognition of the scale of both the problem and the possibility of progress through relatively simple – if fundamental – behaviour change.  Present were members of the SSRRC, senior county health and civil officials, representatives from other NGOs, and various community and tribal leaders.  All at an event encouraging the use of soap and latrines.

For while it may not be glamorous, diarrhoea is the leading cause of child mortality in Sub Saharan Africa.  It is estimated that one child dies from the illness every 20 seconds, and as 87% of people in Jonglei do not have access to adequate sanitation facilities there is still a long way to go indeed.  (For further information, in collaboration with PATH Tearfund have recently released a report, the Diarrhoea Dialogues.)

The Commissioner again took an active role in proceedings, demonstrating how to use a simple homemade tap – a ‘tippy tap’ – and made a speech emphasising the importance of good sanitation practices.  He spoke about how he, along with many others, used to practice open defecation in the bush, but how they always did so at night – which was evidence, was it not, that the practice was inherently shameful and detrimental to the health of one’s community?

The use of shame to drive behaviour change is something which doesn’t sit comfortably with many in the West, especially those like myself from a country whose national psyche is in many ways marked by a very Catholic sense of guilt.  However, when it arises naturally as a result of a recognition of the consequences of one’s actions – rather than being externally imposed – it can be a tremendously effective driver of positive change, and it plays a central role in many sanitation behaviour change efforts.  In aid speak this is known as fostering a demand-led approach – for what good is it if an NGO spends time and money building facilities that nobody uses and quickly fall into a state of disrepair?

In order to build sustainability – another buzz word.  Durable, lasting results, in normal language – agencies strive to ensure that the impetus for change comes from the communities themselves.  One of the processes that we use to do this is called CLTS – Community-Led Total Sanitation.  Or as one senior colleague memorably put it, Community Leaders Talk Shit.  With CLTS you take, as the name suggests, community leaders for a walk where you visit open defecation sites, examine the stools, their proximity to water sources, where the flies might go next and how such things contribute to the spread of disease.  Then you run sessions where you teach people how to dig a suitable pit for a latrine using locally sourced materials.  As an incentive Tearfund will provide the cement slab that covers the latrine, and soap and jerry cans for handwashing facilities, but only to those that have constructed the rest of the latrine.  An element of competition is also injected into proceedings as whichever village has the most latrines is rewarded with a bull and a celebratory party is held.  All very ingenious, and it is proving encouragingly effective.  This really is only the start of the process, but seeing the tangible results of several years work played out in drama and song was most gratifying indeed.

One final thought.  In his address one community leader spoke out against tribal scarification.  Himself marked with the deep parallel lines that denote that he is Lo Nuer, he spoke of the birth of a new nation and of the need to move away from old tribal divisions.  Scarification is both a signifier, a mark of belonging, and a rite of passage for young men.  It is becoming less common in much of the country, but in some places it continues to be practiced.  In an area such as Jonglei, however, where tribal conflict is an ongoing and ever-present threat such sentiments, when expressed by a respected community elder, are a welcome and encouraging sign indeed.



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