When Rodney Crutcher first received an e-mail in 2005 entreating him to help a group of Sudanese-born, Cuban-educated Canadian citizens who were intent on returning to their war-ravaged homeland as doctors, the professor of family medicine thought “it was a hoax.” But instead of acting on his original impulse to delete the message, Dr. Crutcher (who heads an accrediting agency for internationally trained physicians) replied to the group initiating the project.
Three years later, in May 2008, Dr. Crutcher stepped onto a stage in Vancouver to accept an award for international cooperation on behalf of the University of Calgary’s faculty of medicine for its contribution to that project.
The award from the Canadian Manufacturers & Exporters and the Canadian International Development Agency was for the best Improvement of Social Infrastructure/Condition, and it went to the Sudanese Physician Reintegration Program – a program that inspired 80 instructors from U of C’s medical and health faculties and from the Calgary community to take part as volunteers.
At the same time and thousands of kilometres away, 11 doctors were beginning to restore one of the world’s most poorly served medical systems. Their return to the South Sudan boosted the doctor population by almost a third – to 60 doctors for 10 million people, in a country where one in 10 children does not reach their first birthday and many women die in childbirth.
In the 1980s, these physicians had been among hundreds of children sent to Cuba after they escaped Sudan’s civil wars, which left millions dead. Their rebel leaders urged them then to “put down guns and pick up pencils,” to study hard because their mission would be to eventually serve their people in reconstruction. Many of these “lost boys,” including young females, never gave up on this goal.
“I grew up with the idea of coming back to [South] Sudan. My mission is to rebuild the country and help set up sustainable health care,” said Daniel Madit Thon Duop, one of the doctors, from Juba, the capital of South Sudan.
The education they had received in Cuba included postsecondary medical training that stopped just short of postgraduate practice. Some of them came as refugees to Canada, starting in the late 1990s, and settled in Alberta and southern Ontario. Most landed jobs at meat-packing plants, manufacturers and in labs or vet offices.
With the end of the civil war in 2005, Dr. Duop – who had arrived in Calgary five years before and had been working in a food factory – approached Samaritan’s Purse-Canada, an evangelical Christian organization known as SPC, to see whether it could help him and others upgrade their training and return. The organization contacted Dr. Crutcher, who is also co-founder and director of the Alberta International Medical Graduate Program.
Intrigued by the “powerful and verifiable” tales that the South Sudanese related, he traveled there to investigate how the practice would work without such tools as lab investigation or X-rays. “It was clear that the resources were limited and that some diseases, such as malaria, HIV, TB and diarrheal ones, as well as a fair bit of trauma from stepping on landmines, are huge there,” said Dr. Crutcher.
The 15 men and women completed a nine-month customized curriculum at U of C that was simple, low tech and practical. Through presentations, group work and with supervised exposure to patients, the clinical skills upgrading was relevant to South Sudan, where a health centre may not include running water, necessary medication or consistent electricity.
Another unusual aspect of the curriculum was the 36 hours of bible study, taught by a professor from a local theological college, examining ethical issues that the doctors might face once they returned to a land rife with religious tensions. Dr. Crutcher said there was a fair bit of discussion about the partnership between a faith-based organization and a public university, ultimately “recognizing that the potential goal was to have these physicians return to South Sudan and provide care.” Other secular non-government organizations came on board with donations, but “the reality is, without SPC, it wouldn’t have happened,” he added.
After the training, the Sudanese physicians spent two years at health centres around Nairobi, Kenya, dealing with diseases common in South Sudan.
As for the Calgary volunteers, “we started with a handful of people,” Dr. Crutcher said. “The Sudanese themselves and their stories were so captivating, people would start working with them, they’d tell their friends, who’d then get in touch and ask how to help.”
Now autonomous from the north, South Sudan continues to struggle economically. Dr. Crutcher noted that East African and Canadian physicians still want to play a role there, and many will help at medical camps as well as providing collegial support and further teaching.