GWEN IFILL: Next tonight: the health care challenges that threaten to overwhelm an African nation as it prepares to cast a critical vote on independence.
Special correspondent Jeffrey Kaye reports from Southern Sudan.
JEFFREY KAYE: On the banks of the Nile River in South Sudan, entrepreneurs pump water to fill up tankers. Private water collection and sales from rivers and wells is big business here, particularly during the dry season. But, for customers, the water often comes at a high cost.
DR. JUSTIN BRUNO, Al Sabah Hospital: It is a good business for them, but this is spreading diseases.
JEFFREY KAYE: Dr. Justin Bruno directs the Al Sabah children hospital in the town of Juba.
JUSTIN BRUNO: The water is not treated. It is just flowing naturally. And then it comes into the tanks and the tankers sell it to the people. And the people just drink them. It's not boiled. It's not treated.
JEFFREY KAYE: And what happens as a result?
JUSTIN BRUNO: Diarrheal diseases. People get acute diarrhea. People get what are bloody diarrhea and typhoid fever. And that is rampant in this town and in Southern Sudan.
JEFFREY KAYE: And you can trace that right back to those tanks?
JUSTIN BRUNO: Right back to the river water.
JEFFREY KAYE: Patients suffer not only from preventable diseases, but, even if they make it to a health care facility, often from inadequate treatment.
This is essentially the waiting room of the only children's hospital in South Sudan. The health care system, such as it is here, is barely functioning. Most people have no access to health care. So, the challenge is not so much to improve the system. It's to create one.
JUSTIN BRUNO: The most pressing medical need is lack of medical supplies. The medical supplies is not enough for the patient.
JEFFREY KAYE: What do you mean?
JUSTIN BRUNO: The medications are not enough for the patients.
JEFFREY KAYE: Besides the lack of drugs, the hospital's single X-ray machine is broken. It shares a storage room with a busted blood bank refrigerator. There's no ultrasound or C.T. machine. And even though there's an emergency ward, the hospital has no anesthesia.
Inpatients here, most suffering from malaria, malnutrition, respiratory infections and diarrhea, often share beds or sleep on the floor.
Mary Camisa (ph) walked here barefoot from her village 50 miles away, carrying her 3-year-old son suffering from convulsions brought on by cerebral malaria.
JUSTIN BRUNO: They are very far distances to walk in. Some, they often drive two days to arrive here to get health care services here. So, we need to decentralize more these health centers, so that they're closer to the people.
JEFFREY KAYE: South Sudan's dire health conditions are reflected in a recent United Nations compilation of what it calls ‘scary statistics.' Most people have no access to safe drinking water or sanitation. Malaria is hyperendemic. A 15-year-old girl is more likely to die in childbirth than finish school.
Katie Morris is a program manager for Catholic Relief Services, which, among other projects, provides support for 43 health facilities in Southern Sudan.
KATIE MORRIS, Program Manager, Catholic Relief Services: If you look at it by the numbers, it paints quite a grim picture. Maternal and infant mortality are among the highest in the world. Vaccination coverage is among the lowest for children and -- and pregnant women. It's a very sad picture.
JEFFREY KAYE: Changing that picture will be among the biggest challenges facing an independent South Sudan if, as expected, people here vote to separate from the North in a referendum that begins January 9.
Even now, South Sudanese officials are planning how to build a medical system, virtually from scratch. Member of parliament Dr. Martha Martin heads the legislature's health committee.
DR. MARTHA MARTIN, Southern Sudan Legislative Assembly: So, we need to think about rural areas to be developed. Develop them through the primary health care.
JEFFREY KAYE: A family doctor trained in Cuba, Martin says family health centers can be used as building blocks of a national system.
MARTHA MARTIN: If have primary health care, you won't have difficulties when you have somebody. You receive first the patient in the center. You give them the first aid and then you send them to a big hospital. The patient will be saved.
JEFFREY KAYE: So the first thing to do is develop a primary health care system?
MARTHA MARTIN: We have to have a good, big hospital, well-equipped.
JEFFREY KAYE: It's an ambitious undertaking. Clinics like this one, the Saint Kizito primary health care center in the town of Juba, are scattered throughout the country. But less than 30 percent of South Sudan's population has access to health care services. And, like the hospitals, many clinics also lack resources. When we arrived at the health center, women were waiting to have their children vaccinated. The mud floor clinic has no running water, no toilets, no delivery routes, no doctor. Medications were running low, and the staff of 10 shared two stethoscopes.
This clinic is funded by the Catholic Church. Outsiders, including the U.S. government, the U.N., evangelical groups, and aid organizations, pay for most of South Sudan's health care.
KATIE MORRIS: Over 60 percent of the health facilities in Southern Sudan are supported financially and in some cases operationally by international or national non-governmental organizations. So, the idea is that, over time, the government capacity will grow and that they will be able to absorb some of these facilities and take staff on to their payroll.
JEFFREY KAYE: What few services the government currently provides are inefficient. After several hours at the Saint Kizito clinic, many women had given up waiting for vaccinations. The serum hadn't come, so patients had drifted away.
Some clinics are trying to reduce maternal and child mortality rates by sending community health workers into villages. In the shanty neighborhood of Lologo on the outskirts of Juba, midwives from a U.S.-funded clinic visit huts to provide women with pre- and post-natal instructions and care. One in seven pregnant women in South Sudan is likely to die as a result of the pregnancy. Fourteen percent of children die before their fifth birthday.
Midwife Rajibia Ahmad says simple lessons can save lives.
RAJIBIA AHMAD, Midwife, Lologo Clinic: I will come here to see the baby, to see the mother, to check them, and to give her -- answer the question again, give them hygiene, how to eat, how to birth the baby.
JEFFREY KAYE: Breast-feed.
RAJIBIA AHMAD: Yes, breast-feeding.
JEFFREY KAYE: Ahmad had delivered baby Emanuel (ph) seven days earlier. That's a rare occurrence in South Sudan, where only 10 percent of births are attended by a health care worker. The midwives urge pregnant women to deliver their babies in the clinic, to use clean water, and to avoid putting ashes on severed umbilical cords, a traditional treatment.
Officials say they are optimistic about building a health care system in South Sudan. South Sudanese professionals who trained abroad during decades of civil war are returning to the country to practice medicine, among them, Dr. Bruno, who attended medical school in neighboring Uganda, where, as a teenager, he had fled by foot, a yearlong trek from his home. Bruno believes that independence might lead to less spending on the military and more on health.
JUSTIN BRUNO: At the moment, more than 50 percent of our resources, of our budget go for security.
JEFFREY KAYE: To the military?
JUSTIN BRUNO: For the military.
If independence comes, the reverse will be true. There will be less spending in the army and then there will be more spending in health care system and other service delivery. So, independence will mean a lot of development coming in, a lot of health care system improving, because the fact the money that go for security will have been put in development, the special health care system.
JEFFREY KAYE: How much South Sudan spends on its military is likely to depend in part on whether the independence vote and its aftermath will be peaceful. In any event, economic development should go a long way to help reverse the abysmal health statistics by spurring the creation of water and sanitation systems. South Sudan's interim constitution guarantees free primary health care to all, clearly a long-term goal.
For now, officials and health workers are combating preventable diseases with more basic steps: education, better nutrition, and simple drugs.