Health In Sudan

HEALTH CARE COSTS ARE ALLEVIATED BY AN INSURANCE THAT COST SD200 PER PERSON MONTHLY (LESS THAN $1) AND provides a 75% discount on treatment at government hospitals and a commensurate reduction in the price of drugs at Public Pharmacies. Every neighbourhood has public pharmacies as well as private ones. The Ministry of Health estimates that it now has a public pharmacy for every 1,000 persons.They rotate their service hours so that drugs are available within a reasonable distance round the clock. Vaccinations for children under twelve are universally available in Greater Khartoum.

The metropolis has over half of the country’s doctors (about 2,500), though it contains slightly less than 20% of the population. Over 1,000 new medical students have been entering Sudan’s universities every year since 1994. There is a teaching hospital at Khartoum University and a center for laser technology research. Many operations are now performed with laser rather than knife surgery. Great strides have been made in the field of health over the past 10 years. Hospitals and other medical services have been upgraded in terms of numbers, personnel, and equipment
throughout the country, except in areas under rebel control.

In the vast expanse of Sudan, there are inevitable variations in the diet. On the whole,Sudanese are high consumers of protein. In Khartoum and Northern Sudan, like in Egypt, the nutritious bean, called foule is the staple. It is enjoyed soaked in oil with cheese and a bean cake fried with sesame seeds, called tamia. Ram, cow, and goat meat are eaten as much as they are afforded, but fish is also popular. Gout is among the common diseases.

Obesity exists, but is not rampant. Heart disease  rates are consistent with the common habit of smoking though there is considerable incidence of congenital heart ailment. Intoxicants are banned from society and there are tight controls on community and family moral standards; that leaves excessive sugar consumption and cigarettes as the other indulgences most threatening the health of Sudanese.

HIV/AIDS prevalence is about 1.5%. Sudanese are, you might say, exorbitant consumers of sugar. Pastries are, naturally, of the typical Arab variety– sweeter than anything else in the world. A 4oz glass of tea gets at least three spoons of sugar; the 8oz glasses of fruit juice sold by vendors throughout the city taste like 30-40% sugar content. Many medical experts throughout the world maintain that diabetes is simply a result of predisposition to
eventual pancreas breakdown that has nothing to do with volume of sugar intake. But there does seem to be quite a lot of the incurable disease in Sudan– perhaps it’s coincidental.

Compared to many other African countries,Sudanese youth are not widely active in organized sports and this is reflected in the country’s lack of success in international competition. Generally, there is a conspicuous lack of health
maintenance consciousness, reflected in consumption habits and paucity of physical fitness concern.

Universal spread of adequate health care opportunities continues to elude most of the richest countries in the world, though they have made tremendous progress in the field over the past 50 years; for developing countries in the Global South, particularly in Africa, there continues to be a huge health care deficit. New problems, such as HIV/ AIDS, and increase in other diseases with lifestyle-related risk factors are mounting while old diseases, like malaria and tuberculosis, have not been satisfactorily controlled.

The impact of the health care deficit on the Sudanese population is generally indicated by the following infant mortality and life expectancy statistics. With respect to the latter, Sudan is still more than 15 years short of the industrialized countries averages.

The increases in the number of doctors from year to year are reduced by the large number of medical graduates who go abroad either for specialization or work. Also, many female graduates do not practice once married. Within Sudan, 54.2% of the doctors and 58.8% of the specialists are based in Khartoum. There are no immediate statistics available on the number of Sudanese doctors residing outside Sudan. It is estimated that over 5,000 Sudanese Doctors work in U.K. & 5,000 in Gulf countries.

The over concentration of doctors, and particularly specialists, in Khartoum attracts people from other parts of the country, increasing the burden on health care personnel and facilities in the capital city. However, this has led to a proliferation of private hospitals, now totaling more than 40. In all the rest of the country, there are only 8 private hospitals.

Dr. Fathia Abdul-Mamoud, a gynecologist and chairperson of the Society for Women and AIDS in Africa, is emphatic about the need to overcome poverty and avoidance of extravagance. She sees these two extremes as the traps
of social decadence, noting that the highest HIV/AIDS risk populations in Sudan are those displaced by the war in the South and children of the affluent who have assimilated Western latitudinarian values. The government acknowledges that while there are only about 8,000 HIV/AIDS reported cases in Sudan, actually there could be as many 600,000 people infected, given the cross border flows of people from neighboring countries in a region that, outside of Sudan, has the highest infection rate in the world. Dr. Fathia suggests the figure is actually closer to one million–about 3%, citing Gadarif near the Eritrean border, Juba, the major city at the southern tip of the country, near Uganda, and Khartoum, particularly among the displaced persons communities, as the places plagued with the highest infection rates. However, recent studies show high HIV/AIDS prevalence among university students.

The Sudan Intelligence Review claims Sudan has the highest number of internally displaced persons in the world, about 4 million [1]– a consequence of the 46-year-old war in the South. Uganda and Kenya, which border Sudan
in the South and serve as havens for rebel guerrilla fighters and politicians, are both among the countries with the world’s highest HIV/AIDS infection rates– though the rate in Uganda has substantially reduced owing to deaths and a moral education campaign against promiscuity. Dr. Fathia rejects the popular contention that HIV/AIDS is a problem confined to non-Muslims and nominal Muslims, insisting that unless it is faced as a collective Sudanese challenge, the country might eventually find itself among those with 10% plus infection rates.

SUDAN HEART CENTER
ESTABLISHMENT AND VISION

The Sudan Heart Center, which opened its doors to the world in the early part of 2000, is focused on provision of first class cardiac, pulmonary, and general medical services, comparable to what one would expect from any similar
hospital in the world. On April 23, 2000, SHC performed the first ever cardiac bypass operation in Sudan. Two months earlier, the country’s first cardiac catheter was performed at SHC. The center has the capacity to perform 500 operations and 1,500 catheters a year.

As Sudan accelerates its development pace, attracts home a greater number of its professionals from the Diaspora, and the number of expatriates  working in the country increases along with foreign investment, establishment of state of the art cardiac treatment facilities is essential and timely. A team of architects from Switzerland has already planned SHC’s expansion and the first phase construction work is now underway. In addition to expansion of the administrative facilities, there will be increased ward space, a lecture theater, a laundry, and a CSSD, including an
Ethylene oxide sterilizer.

The steps to upgrade and expand SHC are in consonance with the management’s determined goal of a Medical City with an array of specialized hospitals.

FINANCING HEART CARE

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Prior to the establishment of Sudan Heart Center in 2000, nowhere in this country of 33 million people could open heart surgery be performed. This prolonged backwardness in vital health services could be attributed to nothing
less than inadequate investment in the field. Hospital and Clinic operators considered that those who could afford open heart surgery equally had the means to travel abroad. The capital layout and cost of such operations was
commonly feared as too risky for a country where the few people who could afford to pay would most likely continue preferring treatment elsewhere in the world. With SHC having now performed several hundred successful operations , a new era in the evolution of medical services in Sudan has dawned. But, in a country where the annual per capita income is less than $500 and cardiac ailments are not confined to the well off, the problem of financing heart care remains a major health sector concern.

At SHC, the policy is to treat any patient in urgent need of cardiac attention, irrespective of whether or not the means of payment can be clearly identified. To offset the cost of this humanitarian policy, SHC has formed a Cardiac Patients’ Friendship Society to collect donations. This charity has received wide support and counts among its founding members two former presidents of Sudan. However, other means of financing world class heart care for
Sudanese are being sought.

To further strengthen SHC’s position in treating patients from the low income population, who constitute the vast majority of Sudanese, a private insurance scheme is being planned by the hospital. Consistent with the SHC vision of
eventually providing medical services to all Sudanese at the highest world standards, this scheme is to be national.

CHARITIES
With Sudan being an underdeveloped country, with a per capita GDP of about $400 and a minimum monthly salary as low as $40, it was evident from the outset that the great majority of patients would require some form of support
to be able to pay the costs of procedures done at Sudan Heart Center. This has been achieved through several  means, including the hospital-based Heart Patients’ Friends Society, the Ideal Donations Project, donations from
the Federal Ministry of Finance Social Department and the Zakat Fund.

Early after its inauguration, Sudan Heart Center’s administration recognized that although it could function profitably by just concentrating on patients who could pay, there was a moral obligation to the great majority of patients who came seeking treatment but could not afford to pay. Bearing in mind the cost of procedures, Sudan Heart Center approached the Federal Ministry of Finance in the person of the then Minister. After being told about the situation, he immediately responded by allocating a sum of money from the newly formed Social Department in the Ministry to
needy patients.
The procedure for this sponsorship is by means of an office in Sudan Heart Center, which does a social study for any patient who says he cannot afford the costs of any procedure. This study is then forwarded to the Federal Ministry
of Finance, which responds by sending a letter sponsoring the patient to between 25% to 100$% of the cost.

The Zakat Fund is a government body that collects the obligatory 2.5% of the disposable savings of Muslims in Sudan. The money is thereafter spent on specific charitable activities. A social study is done by the Heart Center
and forwarded to the Zakat Fund. The Zakat Fund responds with a letter sponsoring the patient up to 25% of the cost of the procedure.

THE CARDIAC PATIENTS’ FRIENDSHIP SOCIETY

The Cardiac Patients’ Friendship Society is a voluntary charitable organization. Registered with the Humanitarian Aid Commission on August 14, 2000, its main objectives are to assist indigent cardiac patients and support efforts
to maintain the highest standards of heart care in Sudan. The Society also seeks to encourage support for scientific research on cardiac and arterial diseases. Equally important to the Society is the encouragement of prevention
awareness programs.

For SHC specifically, the Society is committed to affording advice and information relevant to the institution’s progressive development. In this, the Society establishes contacts with people and institutions of interest, internally
and externally. Training opportunities, locally and internationally, for the technical and administrative cadres, to enhance the Center’s services, are another concern of the Society. The Center is strictly committed to maintaining
the state of the art heart care SHC has introduced in Sudan.

Prominent members include former Sudanese Head of State General Abdur Rahman Swar Adahab and the renown Islamic leader, Sheikh Abdul Rahim El Boria. Other prominent members are Dr. Ahmed Sayed Ahmed and Mirghani Al Nasri. The society raises finances for indigent cardiac patients through donations and bed sponsorship, which is usually provided by corporations and major institutions. Fund raising programs, such as sports events and social occasions, are other means by which the Cardiac Patients’ Friendship Society aims to support heart health care in Sudan. The society is now seeking to attract donations and bed sponsorship from friends and sympathizers outside
Sudan. Donations are received in kind (material inputs required in heart care) as well as cash.

The Society is now reaching out to heart care professionals and institutions around the world with a view to establishing mutual cooperation programs. There is also such cooperation with concerned people and institutions within Sudan.

In order to operate efficiently, the Society has established an administrative framework. The Administrative Council carries out the executive functions, in line with the policies of the Society. The Administrative Council is responsible
for preparing the annual budget, ordering the audits, and publishing of the annual reports.

In November 2001, at the Society’s 4th meeting, financial audit procedures were approved. The Society operates account number 8827at Omdurman National Bank in Khartoum, where it accepts donations. It also operates an account (number 53042) at the Bank of Khartoum, Parliament Street. The members of the Society, the Administrative Council [and its consultants], all work on a voluntary basis.

The executive administration is composed of the Executive Manager, a Sociologist, and a Financial Manager. In keeping a steady focus, the AC makes monthly assessments of its work and achievements in relation to its plans.

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