Rückblick und Abschied von Pierre Jordaan

An old wisdom says that we live life looking forward, but we only understand life looking backwards.

It has been an immensely satisfying and a privilege to lead the medical services of Mudiro from 2021 under the ever watchful eye of Barbara. She has a wealth of experience navigating the complexities of the conditions and structures in Namibia, and a seemingly endless source of energy and activity, both essential ingredients not only to survive but to actively improve the health services of the remote and somehow neglected Kavango region of Namibia, the primary focus of Mudiro’s commitment.

It was a rollercoaster ride; Namibia is a bocking horse intent on bucking and exhausting everyone and anyone who wants to work for change to improve local conditions, and the onset of the Coronavirus Epidemic certainly didn’t make things any easier. Without constant input the status quo returns and wipes out any input in no time.

The highlight was no doubt experience the selfless service of the Mudiro volunteers, many of whom sacrifice their annual leave to support Mudiro to work in Andara and in the region. The Covid epidemic took a huge toll on the socioeconomic stability in Namibia, like on many other African countries.

When Mudiro was approached to provide medical cover in Mariental in the south of Namibia, two young medical persons, a doctor and a nursing sister who had never even been to Namibia were willing to replace the local staff who had Covid in their Covid clinic – what bravery and dedication! There were many others like them that I had the honor of communicating with and/or working with, each of them leaving behind special memories.

Over this period, we were able to plan and launch two major projects, both of which are milestones in health for Namibia and with the potential of making a huge impact in the health or the peoples of the Kavango:

The first was screening for cervical cancer, a treatable cancer if identified early, and preventable with the HPV (Human Papillomavirus) vaccination at an early age. Currently screening is performed with acid staining, a test which should be repeated approximately every 4 years in women over 30 years of age. Currently screening focusses on women living with HIV, as the incidence or cervical cancer is higher in this population but ultimately also as healthcare system is not able to cope with the workload screening all eligible women. Mudiro is embarking on a PCR-based HPV screening, a superior once-off test. HPV-PCR tests do not require retesting but is more costly than the current acid screening. Moreover, and with the help of sponsors, we hope to offer this screening to all women living in the Kavango. The population-wide cervical cancer screening and prevention program could become a lighthouse project for Namibia. Furthermore, the Namibian Ministry of Health and Social Services (MoHSS) are taking the first steps to vaccinate all young females against HPV. This offers lifelong protection against the Papilloma viruses that cause cervical cancer. If this were implemented at all schools, cervical cancer may well all but disappear from the top of the list of female cancer in Namibia in future.

The second project is the population screening of Tuberculosis. Tuberculosis, one of the oldest diseases in man is still a huge health risk in Africa. The Mycobacterium that causes Tuberculosis (Tb) is widely prevalent in the population, and during my time in Andara Mission Hospital the number of admissions for Tuberculosis (Tb) doubled over three years. The availability of portable X-ray machines and automated diagnosis, in combination with internet access for complicated cases to identify early cases, in other words patients who do not yet have severe lung damage, while protecting the children and those living in the same homestead with whom they have close contact. The project is already in advanced planning and is rolled out in collaboration with the German Fraunhofer Institute who have an in-depth knowledge of remote and self-sustaining medical services.

In parallel the Mudiro medical volunteers enable regular trips with the Mobile Clinic that was launched a year ago to the more remote regions. The population in remote villages have a 2-4 hour or more one-way trip to reach the nearest medical clinic due to the deep sand and absence of transport. This is a huge burden for the elderly and very sick who need it most. Taking the clinic into the bush has met with an overwhelming response, and around 100 patients were seen per day for medical attention, vaccinations and other basic but important services.

Time and time again I was impressed by the dedication of the local doctors, nursing staff and support staff. The sisters and doctors of Andara, Nyangana and other hospitals and clinics who take care of patient care for year after year, often under suboptimal conditions, with no recognition. And others like Mr. Ndara who is willing to perform urgent laboratory tests 24/7/365. It is easy to come from the comfort of Europe where all systems work to spend time in Namibia for a limited period, but to work there year after year takes special dedication. There were many who touched me personally– Sister Els and Sister Lovely and their staff who dedicate their lives to facilitate healthcare in the Kavango and have been there for almost 20 years now, and Dr Laura, an advisor to the Ministry, who travels the whole country to establish cervical cancer centers and instills enthusiasm and a positive attitude doing so. Namibia is a special place, and there are many who make extraordinary contributions to help the sick and needy.

There were also hurdles, of course. Many obstacles only become apparent after trying in vain to improve something. The 1200 km between the Andara Hospital, Katutura Hospital and the MoHSS and UNAM medical school is not only a geographic barrier but also a cultural one, and layers of administration between hamper communication and sometimes create distrust.

Meeting with the administration and sharing ideals and discussing ways to overcome hurdles (either real or perceived) requires time and patience, and while I have the patience, I neglected spending more time in Windhoek to spend more time in Andara so many promising interactions did not come to fruition as a result.

As I lay down the position of Chief Medical Officer it is time to hand the baton to a younger generation with time and energy and the vision to build Mudiro on a solid foundation, to bring these and other initiatives to fruition. I would like to raise my hat to the Barbaras, Hermans and Innocentias who give their time and hearts to Mudiro. May all their efforts bear fruit in abundance.

Dr. Pierre Jordaan