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WHAT: Mustard Seed International is presenting a dinner program open to the public to share the story of the Akot Medical Mission in South Sudan.WHEN: 6:30 p.m. Thursday.WHERE: East Cooper Baptist Church, 361 Egypt Road, Mount Pleasant.COST: Free, but reservations are required. Call 388-9314 or email info@mustard seed.org

Mustard Seed origins:

Two Presbyterian missionaries, James and Lillian Dickson, settled in the city of Taipei (today part of Taiwan) in 1927 to run a seminary. But World War II forced them to evacuate the island after years of hard work.After the war, the Dicksons returned, and Lillian became involved in ministry activities that eventually would become Mustard Seed International. The name derives from the Gospel of Matthew, in which Jesus refers to the power of "faith as small as a mustard seed." Her mission was "to present Christ to all we meet, to heal disease and all manner of suffering and to love sincerely and deeply those whose lives we are privileged to touch."In the 1960s, Lillian Dickson began to extend the organization's reach beyond Taiwan. Working with indigenous Christians in other parts of the world. Dickson died in 1983, and the organization began to languish, said President Bill Deans. He took over in 2002 and restructured the organization, which today is active on four continents.

Provided

Life in Sudan

Dr. Clarke McIntosh of Mustard Seed International said he was particularly moved by the determination of young children who have witnessed tragedy, then forged on with life.On one occasion, a mother of two small children died on the way to a hospital in the region. "She died right in front of everybody's eyes," McIntosh said. Her 4-year-old daughter was holding her 1-year-old sibling as a look of horror spread across her face.The transport returned to the Akot Medical Mission to deliver the body to the family. "Everyone is weeping," McIntosh recalled. "Then the 4-year-old takes the 1-year-old off to feed it. This is the picture of Sudan to me."Death is pervasive, and the people of South Sudan have adjusted to it."Instead of any bitterness, they are all very gracious," he said. "It's an amazing culture in that way. They are vocal in their mourning, but the next day they are ready to get back on with life."

Ann Rao, a short-term team member from Tampa, Fla., and registered nurse, administers medication to a young girl believed to be suffering with cholera.

When William Deans asked Chief Dut of the Dinka people if he could extend the property of the medical clinic to the little airstrip, the chief thought for a moment before he replied.

"Bill," he said in accented English, "if you can think it, it is yours."

And so the Akot Medical Mission in South Sudan ensured it has easy access to the small aircraft that swoops in with supplies and, periodically, personnel.

Begun in October 2006 by Mount Pleasant-based Mustard Seed International, a Christian, all-volunteer ministry, the Akot clinic has become an all-consuming focus of Deans, Mustard Seed's president, and a vital player in the lives of South Sudan's residents.

Since 2009, its medical director, Dr. Clarke McIntosh, has contended with South Sudan's 25 percent child mortality rate, malnutrition that affects about half the population and a high demand for basic medical care in an impoverished country that lacks infrastructure and basic social services.

Christian faith is what drives Deans and McIntosh. The men are responding to a clear calling, they said, and have devoted themselves to the task at hand: to improve the lives of the region's people and introduce them to the word of God.

Missionary's life

The clinic has served people of all ages, male and female, providing inoculations against disease, treatment for injuries, surgeries for cataracts and other maladies, pre- and postnatal care and, when possible, preventive medicine, according to Deans.

It's the largest project undertaken by Mustard Seed International since its founder, Lillian Dickson, died in 1983. And since Deans took over, it has relied on individual donations and volunteerism. The organization has no payroll, he said.

But it does have friends and collaborators.

Volunteer doctors and nurses have traveled to Akot from the U.S. and other parts of Africa. Volunteers worked together to expand the clinic compound in 2006, laying the foundation, making 1,000 bricks out of dirt with a little cement mixed in and assembling roof trusses from mahogany imported from Uganda and Kenya.

Before Deans joined Mustard Seed in 2002, he had spent many years doing mission work in Africa and Bosnia. He has been associated with the Billy Graham Evangelistic Association since the 1970s and befriended Graham's son, Franklin Graham, who is the longtime president and CEO of the Christian aid organization Samaritan's Purse.

Deans was in Rwanda in 1994 during the civil war, helping on medical missions. The next year, Graham asked him to travel to Bosnia, where the two men wondered at man's inhumanity to man, Deans said. In Rwanda, the Hutu people, armed with machetes and other manual weapons, slaughtered 800,000 Tutsi's with brutal directness. In Bosnia, during the civil war, the violence was a constant, insidious threat, he said. Snipers positioned atop hills fired randomly at Sarajevo's residents, picking them off with detached precision. Bodies would lie in the streets for days, untouched for fear of another sniper attack.

Deans was there to refit the intensive-care unit at Sarajevo Hospital, receiving and coordinating the distribution of supplies, he said. He paid visits to the children's wards and asked a local doctor about conditions there.

"What are some of the things here that children can't be treated for?" Deans wanted to know.

"Everything," the doctor replied.

"What about congenital heart defects, what happens?"

"They just die."

In 1996, Deans met two children, Majo and Nasiha, not more than 10 years old and each with heart failure. Nasiha couldn't walk to school. Majo's lips and fingernails were deep blue; his heart could not pump a sufficient amount of oxygen-rich blood.

Deans, who had connections at the Medical University of South Carolina Children's Hospital, made arrangements to send the two children to Charleston for emergency treatment and secured funding to cover the travel costs from Samaritan's Purse.

Terrified, the children flew to South Carolina for surgery. When Majo woke up, he demanded a mirror. Deans and the hospital staff were bewildered: a mirror? Someone gave him a compact, and when the boy gazed into it, a broad smile stretched across his face.

Later, Deans and the others discovered the significance of that smile: On the airplane, Nasiha had reassured Majo. "After your surgery, your lips will be as pink as mine," she had said. Today, the children are doing well.

Taking charge

The improvised transport of sick children was repeated, and other hospitals started to help, Deans said. By 1998, he had arranged stateside medical care for 65 Bosnian children.

He had been traveling back and forth between the U.S. and Eastern Europe every couple of weeks, finding host families through his church, East Cooper Baptist, and churches in other cities.

In November 1999, exhausted, he returned from Bosnia for the last time. A few months later, he was contacted by someone in Toronto. "We've heard about you," the man told him, then invited him to become president of Mustard Seed International, then a languishing Christian nonprofit based in Pasadena, Calif.

Deans demurred, citing family obligations. But three years later, another invitation came his way from Mustard Seed, this time with a special offer: He could move the headquarters to the Charleston area.

"How can we not do this?" Hope Deans asked her husband. "It's everything the Lord has prepared us to do."

In 2002, Deans took charge, moved the organization to Mount Pleasant. Two years later, a Florida doctor who sat on the board of directors asked if the organization would take over the Akot clinic. Deans traveled to South Sudan, witnessed a medical mission in desperate need of improvement, then returned to recommend that the charity take on a new challenge. In December 2004, the board agreed.

A year was spent planning the upgrade, and crews worked nine months building and furnishing the structures. A construction company from Spartanburg provided consultants; a dozen craftsmen from Kenya worked with about 60 Sudanese laborers. Small planes delivered badly needed supplies. Solar-power generators produced electricity. Cement was mixed by hand. The whole project cost about $1 million, Deans said.

That October, the first volunteer medical team arrived from Dawson Memorial Baptist Church in Birmingham, Ala.

On the ground

Clarke McIntosh of Anderson has felt the pull of Christian mission work since he was an adolescent, he said in a satellite telephone interview. But then a medical career took hold. He attended MUSC and worked in academic medicine and private practice.

In the mid-1990s, he accompanied Deans to Sarajevo on a weeklong mission trip, then returned to his career. More than a decade later, mission work once again was on his mind when Deans asked him to visit the Akot clinic for a couple of weeks to check it out.

It was a perfect fit, McIntosh said. "I enjoy the people. I get the chance to do some teaching and preaching as well as the medical part of it, and I enjoy that aspect. ... I do enjoy being with them, and they respond to someone who enjoys being with them."

When his tenure in Akot began in 2009, the clinic served one to three patients a day, he said. In September this year, the daily average was 25.

"Things have changed a lot," McIntosh said. "The community has really responded to having a doctor here. Nurses have been here and doing a very good job, but having a doctor gives the clinic prestige in the eyes of the community and the eyes of the state."

The challenges are immense, and death is ever-present, he said, but satisfaction abounds.

"It's always very gratifying to see these patients, who are very close to death, who you do bring back," McIntosh said. "And that is a routine event for us here. We've probably, in the last two weeks, have had 12-15 children with cerebral malaria, and without us being here, they would have died. It's not that we're brilliant, anyone else could have treated them." But McIntosh and his team were there and ready.

Much is improvised, he said. McIntosh has become adept at conflict resolution. He has struggled to ensure the operation is sufficiently funded and stocked with medicines and equipment.

The clinic is very much a work in progress, "so it's much more palpable living by faith," he said. Sometimes, "if God does not intervene for us, we're in trouble. I'm put in positions that are just way beyond my experience, way beyond what I know, and I'm learning that I'm just growing inside."

Impacts

"The biggest single impact is improving the lives of women and children," Mustard Seed volunteer and former MUSC administrator Ed Kaylor said.

Armed with 19,000 doses of the vaccine to protect children from meningitis, the Akot Medical Mission launched a program to combat the deadly infection, Kaylor said.

And the women's prenatal program has helped to keep pregnant women and their unborn babies healthy.

Rose Mayol, who lives in Akot and works at the clinic as a supervisor, is one of thousands served by the medical mission. Growing up in South Sudan has been a struggle, she told a film crew recently.

"In Sudan, I don't know whether it's good or bad, but that's where I grow up and I grow in the time of war, we move from place to place, we run from place to place, but as of now we are independent, we are OK, no fighting anymore, no fear. But the life is still tough, the life is still not good," Mayol said.

Her oldest child, Kout, died of meningitis. When Mayol's 10-year-old daughter Joy also fell ill, she was taken to the Akot clinic, and treated successfully.

"And that makes me to give great thanks to God and the Akot Medical Mission." Mayol herself was treated for an ovarian tumor, first at the clinic and then at a hospital in Tenwek. "Now I am healthy and my prayer is that Akot Medical Mission ... can do wonders and develop, and develop, and grow."

Journal Entry -- 18 February 2010

Clarke McIntosh, Medical Director, Akot Medical Mission, South Sudan

A most discouraging outing to Mapuordit. When I think about it, not many of the outings I have taken to Mapuordit have been encouraging. We have had a couple of mothers have C-sections and successful deliveries, and there is one acute abdomen of which I do not know the outcome, but the rest have been discouraging.

This one began when Elijah dropped into my room during the clinic hours and asked me to take a look at Mary at the end of the wards. She was admitted with abdominal pain and failure to stool for 48 hours. After clinic, I checked on Mary. Her pulse was 150, her BP 90/45 and her abdomen was rigid. I ran in a liter of saline and her pulse did not come down. As I examined her, I noticed a little girl (3-4) carrying a baby (2-3 months), Mary's infant son. That is a very normal Dinka occurrence. Often very young children, around this girl's age, are assigned to care for a younger sibling or cousin. That was very clearly this young Nya's role and she was good at it. I talked with Elijah and we decided to transfer her to Mapuordit with an acute abdomen and bowel obstruction.

As we were discussing this woman, a family came in saying that a woman had delivered the head of her child but could not get the rest out, so Elijah went to get her. Elijah and Mary Aleck (one of our TBA's) went for her and brought her back. She was in labor and fully dilated, but no body parts were showing. We watched both women about two hours and then decided to take them. The woman in labor had been pushing for 3 hours without success. We then learned that she had lost two children in this manner, so we decided to transport both.

As we were getting into the car, I held the baby for Mary, but the Nya looked at me and I transferred the baby to her. She smiled. She has a very pretty smile. There were some U.S.-like problems, however. Though we do not charge our patients, Mapuordit does, so they needed to find this husband and get some gurus (money). That delayed us another half hour and in the end there was no money, but a promise to send some the next day. Finally, we were on our way, but then we realized about 45 minutes down the road that we had forgotten umbilical cord clamps, scissors, and IV fluid. IV fluids are hard to hang in the Land Cruiser because the road is so rough, and we had given Mary a lot of fluid in Akot.

On the trip down, the mother in labor provided all the distractions. She kept moaning and pushing (against our instructions, though I am not sure it matters when those contractions hit). Mary spit a lot, held her baby and nursed her regularly. When she got tired, she handed the baby off to the older sister. I kept expecting Mary to vomit. The road down is hard-baked clay potholes. There are spaces of road between the potholes, and the truth is those spaces may technically be longer, but it feels like one continuous jarring bump. I cannot imagine anything more miserable for a patient with peritonitis.

At one point I was called back to check on the woman in labor. I felt that the head had progressed some, but nothing dramatic, and by that time we were 10 minutes from Mapuordit. Mary appeared sick, weak, but okay. We drove to the pedestrian entrance of Mapuordit hospital. In reality both of our patients needed to get as close to the hospital as possible, but we have had the experience of sitting outside the ambulance entrance blowing the horn for over half an hour, so we made sure we had someone going to help us. We drove in, backed up to the out-patient registration area (theirs is covered) and felt good that we had made it down safely and intact.

Elijah got a wheel chair for the expectant mother, but that was the only one available. As Mary started to climb out of the Land Cruiser, she handed me her child and I again handed him off to his sister. I helped Mary out of the back, along with her sister. She took three or four steps and then went limp. We eased her to the ground and then Elijah and I carried her into the "waiting room," a raised cement platform with cement benches and a roof. (We aspire to have such a waiting room one day.) She started vomiting fecal colored fluid. I went to try to find some IV fluids, but by the time I returned (without the IV fluids), Mary was dead. The baby, of course, started crying, but it was the fear and despair on the face of the older sister as she broke down that touched me the most.

The aunt had a baby almost the same age as Mary's baby. She was trying to console all three of the children. I walked over to labor and delivery and Elijah and the pregnant mother were on the concrete floor, the head this time was out and Elijah was calling to the mother to push. I applied some fundal pressure and the shoulders were delivered, followed by the rest of this 3.1 kg boy (dhok). Besides a severe cone head and slightly low 1 minute APGAR score (4/8 were her APGAR's), the child did well. We dried off the baby and delivered the placenta and then were faced with a dilemma. There was no real reason for the family to stay. It would cost them money to stay there and then they would have to find transportation back. Of course, the other family also needed transportation back. The aunt and young children needed to get back to Akot, and so did the dead body.

Death, particularly death in the hospital, is also a tragedy in the U.S., but it is a sterile tragedy. The doctor goes in to the room where the patient died, we talk about what was tried and what went wrong and I console them. The family cries, grieves over the body, and then those in the funeral business come, take the body and make the arrangements. That is not how it happens in South Sudan.

Mary's body was placed on the mattress where the pregnant woman had lain during the trip down and everyone else (the same crew as coming down) arranged themselves around. I had picked up the dhok and carried him around as they were cleaning mother off and preparing her for the trip back. I handed the dhok to his parents as we got started, but they sent him back to me several minutes later with the request that I hold him. I did not mind. The trip back was quieter, but otherwise the same.

When we got back to Akot, we took Mary's body and family to the home of her sister. As she got close, the aunt started yelling to the neighbors the tragic news and twenty half dressed Dinka women were wailing behind our car as we finally reached the tukul. Elijah and I got out, though there were no English speakers there and neither of us spoke Dinka well enough to say any words of comfort. I could not help but notice the older sister. When everyone else was wailing and comforting one another, her time of crying, at least for the moment, was over. She was carrying her charge on her right hip, doing her best to console him. We did pray (longko) for the family. They did not understand my words, but they did understand the meaning.

As Elijah pulled the Land Cruiser up to the back door of the ward, we heard this brief, regular beat that persisted after the car was turned off. The right rear tire was leaking air in a manner I had never seen before. It was a deflating end to a deflating trip, but I feel that what we did was important and honoring to God.

A Q&A with Dr. Clarke McIntosh

Q: What made you decide to embrace this particular challenge to spend years in South Sudan at the Akot Medical Mission?

A: My first interest in medicine came as a result of feeling some call to missions. My father was fine with me going into missions, but he wanted me to take a useful skill and from there I started considering medicine. But things came up and I got side-tracked. It was some bad times culminating in separation and eventual divorce that opened the door for me to consider missions again. I knew Bill Deans from going to Bosnia together in the late 90s and I found out about the need for a doctor in Mustard Seed Internationals hospital in South Sudan. Bill encouraged me to go over for a week; I opted to go for 3 months instead. I felt a kinship with the nurses and people there from the start. By the end of a month, I had committed for 5 years.

Q: Do you plan to remain there much longer?

A: I have learned the wisdom of James 4:13-15 through experience. Therefore I am cautious in stating what my plans are, but I do hope to be here much longer. I have had a lot of good experiences in medicine, but nothing as rewarding as my work here. I hope to be in South Sudan for the remainder of my life, or at least as long as I am productive. I am sure of this: when I die, South Sudan will still be in need of more doctors.

Q: Could you describe the conditions of the place and its people?

A: Akot is in the geographic center of South Sudan. We are about 8 degrees latitude above the equator and have virtually no elevation, so we are quite warm. We have two seasons: rainy and dry. We have great trees, beautiful birds, and fertile soil. The dominant people group here is the Dinka Agaar. I have heard from 13-20 different sub-tribes of Dinkas. The most famous Dinka is Manute Bol, the 76 center. He is a picture of the Dinkas. In our small village, we probably have 20 people 69 or above, and most are as thin as Manute and very black. Everyone farms in addition to whatever else they do. Cattle are their most prized possession and many of their names come from the color of cows. I find it telling that the Dinkas have one word (arabia) for all forms of vehicles (bicycles, cars, pickups, trucks) and 99 different names for the various colors and patterns of cows. As many challenges that they have from external issues, the greatest problem in South Sudan is revenge.

Q: What sort of staff do you have assisting you?

A: The hospital opened in Oct 2006 and has been staffed by nurses from Kenya. Two of the three original nurses are still there and the third has been there 4 years. They have persisted through years without a doctor. They are bright and dedicated, committed in their personal faith and to the work we are doing and the people they are serving. Their language skills are excellent. We have a fair number of Sudanese staff, helping with translation, maintenance of the buildings and grounds, cooks, pharmacy, accounting, etc. We are hoping soon to start having some Sudanese nursing students.

Q: How much of your time is spent at the clinic and how much is spent making "house calls"?

A: The majority of my time is spent in the clinic and wards. Though we only have official clinics 5 days/week, we find that our weekends are becoming a continual walk in clinic and we have discussed making some changes to adjust to the needs. We do some clinics in surrounding areas. There is a great need for more, but we need more staffing to do that well, and we find transportation and insecurity often as rate limiting steps in those pursuits. We do go to homes in emergencies, and those arise unpredictably.

Q: What's the political situation in South Sudan now that its a country recognized by the U.N.? Has the conflict with the north cooled down? Is assistance (material aid, etc.) making its way into the region?

A: The government in Khartoum appeared cooperative during the referendum and independence, but its true character has not changed. The atrocities are now in the Blue Nile region, Nuba Mountains, and Abyei. The main effect since independence has been the disruption of supplies, causing a substantial increase in the general cost of living (COL): food, fuel, supplies. Because of the bombing in the Nuba Mountains, thousands have fled into South Sudan, creating refugee camps and problems. We feel none of that in our area except for the rise in COL, but there are no palpable positive differences in the lives of the people since independence. Despite that, optimism remains high.

Q: Finally, describe briefly who you are, the connection you have to Charleston and your former experience as a doctor. What do you think you'll be doing 20 years from now?

A: My father is from Charleston. I attended MUSC, graduating in 1981. I was in academic medicine for several years at the University of Alabama at Birmingham and Duke, and then in private practice for a number of years that followed. Though I have enjoyed all phases of medicine, I have never felt the satisfaction I have in Akot. The needs are basic, but we see every week people who would have died without us going home. There are plenty of frustrations in South Sudan as well, but I hope and believe I will continue to be a part of the future of the worlds newest country for a long time to come.

Reach Adam Parker at 937-5902 or on Facebook.