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BACKGROUND: The Republic of the Sudan is a country whose boundaries were formed in the early 20th century as a result of European colonialism. Like many countries, it achieved independence following World War II and was governed first by a king, then by a military dictatorship that overthrew the king in 1964. , however, has recently emerged from 15 years of civil war between three major population groups: The Sudanese Arabs in the north who were the historically dominant people; the Nubians in the center of the country; and the Bedawit in the south. All three groups are religiously mixed.

The historical dominance of the Sudanese Arabs has been reinforced over the years by a rich agricultural economy in the basin of the Sudan River. For many years the Sudanese Arabs mandated that people in the country learn the Sudanese Arabs language, and asserted that they had a right to rule because of the long line of Sudanese Arabs kings. Foreign investment and aid had generally been hoarded by the Sudanese Arabs at the expense of the rest of the country. However, 15 years ago – coinciding with the beginning of the civil war, oil was discovered in the central region controlled by the Nubians, in land that was dry and not suitable for much agriculture. The Nubians were once nomadic cattle herders on that dry land and could not effectively compete for power with the Sudanese Arabs, even though there were some Nubians members of the National Assembly. But with the discovery of oil, a Nubians People’s Party soon followed, with a military arm called the Nubians People’s Army. Foreign investment rushed in to Nubians territory to help in developing and extracting oil, giving the Nubians a huge new source of wealth and power. The Bedawit people in the coastal south, while not matching the Sudanese Arabs in historical power, enjoyed a relatively productive economy based on fishing and trade in several spice products. They are also the predominant population in the port city of Bedawitadi. That port, at the mouth of the Sudan River, had long been the primary shipping point for Sudanese Arabs agricultural products, so the Sudanese Arabs had cultivated a reasonably accommodating relationship with Bedawit peoples and their political leaders over the years. Now, however, with the emergence of Nubians oil power, the port was becoming a major shipping point for oil expo.

So, the civil war involved: 1) an effort by the Nubians to gain some power in the country and in the government (and in doing so try to gain some benefit for their long-neglected and impoverished people); 2) an effort by the Sudanese Arabs to quash the emergence of the Nubians, gain control of Nubians oil territory, and solidify their relationship with the Bedawit to offset the Nubians; and 3) an effort by the Bedawit to stay out of the Sudanese Arabs-Nubians conflict as much as possible while still retaining the benefits from shipping that they get for running the port.

The civil war, however, led to a reduction in foreign investment throughout the country,

as well as the destruction of infrastructure in all regions of the country. A somewhat fragile peace was brokered by international agencies, and at the moment it is holding, though many animosities remain. Political groups from all three peoples are involved in a coalition government.

HEALTH PROBLEM: A key health problem is cholera, an infectious disease spread by contaminated water. Its spread throughout the country is the result of the following factors:

The Nubians traditionally obtained water from wells, but water was generally a scarce commodity in their region. With new oil wealth, the Nubians were able to secure foreign funding and some domestic funds to build more wells at a rapid pace, and to run some water pipelines from the Sudan River, at least for major towns/villages. But they have not built water treatment plants to handle the increase in economic activity and population that has occurred in their area, nor have they distributed household or well purification technologies, so well water was one of the first water sources contaminated by sewage and thus cholera.

The major government construction company in Sudan is controlled by the Sudanese Arabs-dominated Ministry of the Interior, and they have stalled and otherwise been slow to help the Nubians build treatment facilities – sensing that if cholera became a problem, they could blame the Nubians as the cause and gain political advantage.

Because of the rapid increase in oil activity in recent years, migrant labor has been coming in from both Sudanese Arabs and Bedawit areas of the country. When these people are infected and return to their home areas, they also bring cholera. At this point, awareness about the causes of cholera is not widespread, nor is knowledge about simple household practices (e.g., water purification, clean water containers, handwashing) that could at least stem the spread.

Waste water has also been increasingly been dumped into the Sudan River, a source of drinking water for the Bedawit who live in the south. Cholera has now spread in that way as well.

RESOURCES: There are several national media channels that could be sources of prevention information. The main government channel is controlled by, again, the Sudanese Arabs- dominated Ministry of Information. However, there is a popular channel owned and run by an Bedawit company (Bedawit National Broadcasting) that has a national audience. Given the precarious political position of the Bedawit, trying to use this channel as a source of information about cholera may be difficult, though not impossible.

There are popular regional newspapers as well, and in recent years the Nubians People’s Party has established a newsletter and website for public information. Two national festival days are very important gatherings – in the hot summer, there is the huge River Festival, with music conce, spo competitions, and other events. Because it is based around the river, it has not traditionally involved the Nubians as much. Then, there is the National Independence Day festival in the fall. This is a nation-wide event, though many festivities are locally-organized and controlled. The Nubians still hold an annual Cattle Festival and elect a Cattle Festival “king and queen.”

Key community/local groups in the country include the National Traditional Healers Association, a broad-based group of spirit and herbal healers in all regions. Another common type of organization is the civic groups associated with animist religious leaders. There are also soccer clubs all around the country who engage in lively inter-regional competitions. In terms of government, each region of the country has a Regional Council, who elects members to the National Assembly based on population. The Prime Minister is elected by the National Assembly and must have the blessing of the (now ceremonial) king.

YOUR TASK: You have to mount a communications campaign, a media advocacy campaign, and a community mobilization campaign that together will: 1) Increase awareness in all regions about cholera and prevention; 2) mobilize resources (from domestic and international investment sources) to improve water treatment facilities for sewage going in to the river and for water purification (chlorination) of water drawn from the river; 3) disseminate water purification technologies for wells and households (e.g., sodium hypochlorite liquid, iodine, calcium hypochlorite powder); and 4) attempt to coordinate political support for government resources to be devoted to building better treatment plants.

The class will first talk about the overall situation and on how to achieve the four listed goals, then divide up into teams – one team for each campaign. The teams will then report back on their strategies.

A final grade will be determined on the basis of demonstrating the following competencies:

• Demonstrate mastery in methods of population health research to assess, describe,

analyze, and evaluate determinants of health in Sudan.

• Demonstrate knowledge of current governance and culturally relevant leadership skills to address global public health issues, including: agenda setting, program planning, data management, surveillance and reporting systems in Sudan

• Employ critical thinking and appraisal of the literature to explain the influences on determinants of health.

• Apply community development and program planning skills to create effective and culturally relevant communication strategies and interventions to promote health.

• Apply knowledge of international health law, standards, and regulations to advocate for culturally acceptable solutions to improve health status and conditions in Sudan.

• Evaluate efficacy and cost effectiveness of public health interventions, programs, policies, and health care systems within international setting and global health context.

• Communicate and collaborate effectively across cultures and national boundaries to create and support effective and sustainable health interventions.

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