Tag: Sudan

Tackling mycetoma: A medical success story in Sudan

Behind the brick walls of the Mycetoma Research Centre trying to unravel the mysteries of the infection is a rare story of medical success in impoverished Sudan.

With bandages on their swollen, deformed feet, patients from across the vast country arrive at the spotless facility set in a garden in the southern Khartoum district of Soba.

For more than 40 years, British-educated researcher Elsheikh Mahgoub has been searching for answers to the mysteries of mycetoma, a bacterial and fungal infection which can spread throughout the body resulting in gross deformity and even death.

Sudan is particularly affected by mycetoma, which is also endemic in a geographic belt including regional neighbours Chad, Niger, Nigeria, Ethiopia, Somalia, parts of Saudi Arabia and Yemen, experts say.

The belt also stretches to India and parts of Latin America.

Mycetoma is “a badly neglected disease”, the United Nations’ World Health Organisation (WHO) says on its website.

Yet in Sudan, researchers have been studying the condition since British colonial times, and the Khartoum centre has been globally recognised for its work.

Such acknowledgement in the health field is unusual for a country which ranks near the bottom of a UN human development index measuring income, health and education.

Mycetoma is characterised by swelling of the feet but it can eat away bone and spread throughout the body, causing grotesque barnacle-like growths, club-like hands and bulging eyes.

The traditional treatment was amputation – something the Sudanese centre tries to avoid.

Elsheikh Mahgoub, supervisor of Sudan's Mycetoma Research Centre, shows a picture of an infected foot on his computer. (Pic: AFP)
Elsheikh Mahgoub, supervisor of Sudan’s Mycetoma Research Centre, shows a picture of an infected foot on his computer. (Pic: AFP)

“Most patients who get it are farmers, or animal herders, and these are poor people,” says Mahgoub (78).

“They are poor, and they get poorer.”

Mahgoub says he established Sudan’s first mycetoma centre in 1968, working with a British nurse and a British technician.

“Many people thought: Why should I be concerned about this disease which is not common, which is difficult to diagnose, and difficult to treat?” he told reporters on a tour of the facility, which opened at its current location in the 1990s.

The centre offers diagnosis, treatment, training and research as part of Soba University Hospital under the University of Khartoum, which funds it along with some donors.

It has its own laboratory, two wards, and is served by seven part-time doctors as well as Mahgoub, the research supervisor, and its director A.H. Fahal, a professor of surgery.

Though its resources are limited, they have been used effectively, Fahal has written.

Patients come and go – with 6 400 registered so far – but Fahal remains and so does Mahgoub, challenged by the puzzle of why mycetoma is so prevalent in Sudan and neighbouring countries.

“I think there’s two things,” Mahgoub explains, pointing first to the organism’s presence in soil.

He says people who make their living from the land are more likely to get pricked by thorns, for example, from the Acacia trees which are widespread in the mycetoma-prone region and provide a route for infection.

Secondly, the patients have been found with weakened immune systems. Some not only have mycetoma but also Aids, leprosy, tuberculosis or other conditions, Mahgoub says.

“Why? Why these people? Is it nutritional, because of malnutrition? Is it because of the other diseases they get at the same time?”

He does not yet have the answers.

“But we know that they have got some deficiency in their cell-mediated immunity.”

Thorn jab 20 years ago
Mohammed al-Amien Ahmad is a typical case.

The farmer tells Mahgoub that a thorn jabbed him about 20 years ago.

“This thorn came out and it seemed to be OK. Later on the swelling came up. It was a bit itchy,” says the goateed farmer, who is in his 60s and wears a traditional white jalabiya robe.

Ahmad, his enlarged left foot oozing pus, has travelled more than 500 kilometres by bus from Umm Rawaba where he farms about 70 acres of sorghum.

His condition worsened over the past two years, he says, forcing him to reduce the amount of land he can work, and cutting into his annual income of 30 000 – 40 000 Sudanese pounds ($4 300 – $5 700).

In a majority of cases mycetoma is painless, meaning patients like Ahmad delay seeking medical care.

This makes treatment more difficult, Mahgoub says.

“The main thing we tell them is to come early… Because if the swelling is small it can be excised in total,” with follow-up medication, he says.

A patient's infected foot. (Pic: AFP)
A patient’s infected foot. (Pic: AFP)

The Mycetoma Research Centre provides diagnosis and any surgery patients may need for free. But patients may require months of anti-fungal medication, which they must buy themselves.

Some who cannot bear the financial burden stop taking their medicine, Mahgoub says.

“In that case the disease will just go back to where it started. That’s a real problem,” he says.

Drug prices in Sudan have climbed over the past two years as Sudan’s currency plunged in value and inflation soared.

Sudan’s health ministry has expressed concern about the emigration of doctors and other health professionals seeking better salaries and working conditions abroad.

Nationwide, there were 1.3 health workers per 1 000 people in 2011, against the WHO benchmark of 2.3.

Many primary health care facilities in Sudan “lack appropriate medical equipment and supplies, have inadequate infrastructure or are understaffed,” the United Nations said this year.

In contrast, the Mycetoma Research Centre “is recognised globally as a world leader”, an informal group of experts on the disease wrote after their first meeting this year in Geneva.

Ian Timberlake for AFP.

Ramadan in Sudan: The tie that binds

There’s nothing like Ramadan in Sudan. To be more specific, from my personal experience, there’s nothing like Ramadan in my hometown of Khartoum.

This year marks my second Ramadan away from home and, like they say, you never really realise what you had until it’s gone. There are so many things that I miss, but I mostly miss the sense of solidarity that binds the people of my country during such a month.

I used to spend many hours of my fasting days in the streets of Khartoum. There is something majestic about how people carried themselves around; walking around the various streets, markets and bus stations, going about their daily business while bearing the grunt of the staggering heat of Sudan’s sun, trying to eke out a living in today’s harsh conditions.

It is not the lanterns and well-lit streets and alleys that make Ramadan so special, rather it is the scope of distinct practices and traditions that are ever so unique. It is the call for Maghreb prayer and the events that follow. It is the people gathering around the mosques minutes before the sun sets, some worshipping in silence while others converse about their families, the weather and politics. It is that first sip of cool water that quenches the thirst of a hardworking bus driver who spends his entire day driving a rundown vehicle with no air conditioning, and suffers blasts of hot air coming from a broken window. It is that group of volunteers who stop you in the middle of the road at the sound of the azaan (call to prayer) to offer you water and dates to break your fast.

Men break their fast on the first Friday of Ramadan in a mosque at Umdowan Ban village outside Khartoum on August 5 2011. (Pic: Reuters)
Men break their fast on the first Friday of Ramadan in a mosque at Umdowan Ban village outside Khartoum on August 5 2011. (Pic: Reuters)

It is family. My grandmother, may she rest in peace, would light up at the sight of my sisters, mother and I entering her warm home just in time for Iftar (breaking of the fast). She would kiss each one of us and ask Allah to protect us. It is her blessings, her smile and the wisdom in her eyes. It is tasting the food made with love; the aseeda (porridge), mulaah (sauce) and delicious soup just before we set off for prayer and later on commence our first meal of the day. It is the sugary gongolez juice, helo mur (a drink made with sorghum and spices) and hibiscus poured into enormous glasses. It is the long Taraweeh prayers that I used to always struggle with on the first week of the month after stuffing my face like it’s the last day on earth.

So no, it is not the lanterns and well-lit streets and alleys that make Ramadan what it is in a place like Sudan, a place that lacks the kinds of festivities that other neighbouring countries have the privilege of exercising. It is the kind of love that is portrayed in the simplest of conduct, and in the crudest of times. It is the tie that binds.

Maha El-Sonasi for 500 Words Magazine, an independent online magazine about Sudan. It is an amalgamation of various thoughts and opinions on Sudanese society, culture and life, and provides a platform for discussion among Sudanese youth. Connect with 500 Words Magazine on Twitter and Facebook

Sudanese fashion: The Darfur Sartorialist

When I came to Darfur in 2009 to work with a United Nations agency that supports internally displaced people (IDPs), I spent a long time in IDP camps. There I grew increasingly intrigued by the incredible variety of colours and patterns of women’s clothes. Like many westerners, I had a preconceived idea of Darfur and Muslim women in general, and was amazed at how different reality turned out to be. I started photographing their fashion to show my friends back home. Eventually, it became apparent that this was a story waiting to be told from an angle the media rarely shows, and so I created The Darfur Sartorialist.

In Sudan, men’s fashion mostly consists of a white jalabiya (arab tunic) with or without a turban, and white or sometimes leopard-patterned shoes. Urban Sudanese men will often wear westernised outfits with pressed trousers and un-tucked shirts in soft colours.

Women’s clothing is much more diverse (as is often the case!). There is a mix of the traditional abaya (arab tunic), the toub (many metres of colourful cloth wrapped around the body and head), and western-influenced fashion such as long dresses with tight shirts underneath to cover the skin, or denim jackets and skirts to match the headscarves. You often see cheap versions of designer clothes, even in IDP camps, like this fake Chanel belt on a young woman.


Most of the photos I take are of either internally displaced people living in IDP camps, or Darfuris working with humanitarian agencies to assist them. It’s not always easy to distinguish between the two. I know most of the people in the photos, either because they were working with me or because I spent a long time in the camps and became friends with some of the residents.

Culture plays a big role in the expected behaviour from women, so if you ask someone you don’t know directly for a photograph, their natural reaction is to refuse. Curiously, if I photograph children, it’s the mothers that come and ask enthusiastically to be photographed as well! For the most part, though, I have not encountered any problems – people are often flattered that a foreigner wants to photograph their clothes. It’s true that government is often suspicious of foreigners, and I was indeed questioned a couple of times for taking photos. However, most of my photos were taken in the camps where I worked side-by-side with security officials who were fine with it.


I did not expect The Darfur Sartorialist to be a success. I thought it would be a short-lived curiosity; people would see it and then move on to the next novelty. The fact that there has been constant media interest since its inception in June 2012 has come as quite a surprise. I’d say the highlights of the project so far have been the four-metre-tall exhibits of my photos at the Sines World Music Festival in Portugal in 2012, and a recent feature in the Guardian.

The fact is that my photos do not fit at all with the image most of us have of Darfuri African Muslims. I hope this will launch a discussion within us about whether the reality most media convey about the world is correct or complete. I hope the project gets people to question the reality they know. When we assimilate entire countries to one single idea (of Sudan, of Afghanistan, of Africa), we lose a lot of the complexity and paradoxes that exist in those societies. We forget that Burkina Faso, a poor country, has a thriving cultural scene with some of the best jazz and film festivals in Africa, or that Somalia and South Sudan have produced world-class rap musicians.

Click on the first image below to view the gallery. Pics: Pedro Matos

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Music, spirituality and Islam in Africa

Zanzibar City, Tanzania

A crowd of young women in burkas and some men gather outside a café in Zanzibar, bewildered by the sight: an African woman, in a West African mumu (kaftan) and covered head, playing Ghazal poetry as an Islamic call to prayer.

Sitting on the café terrace and accompanied by an acoustic guitar, Nawal’s clear voice captivates the audience – until it is broken by the cry of a visibly upset street vendor. “How dare you use the name of Allah in a song?” he shouts.

“You use keyboards in your praise of Allah,” Nawal retorts calmly.

Striking a chord with the community: from sandy Zanzibar to sunny Sudan

In 21st century Zanzibar, as in much of Africa and the Muslim world, music has the power to inflame as it did in ancient Persia when music, mosaics and poetry were created to be ‘nearer to Allah’. And the old divisions – between the more tolerant Sufi branches of Islam, which believe that art and music can be expressions of meditation, and the more conservative branches, which believe devotion should be silent, personal, and contemplative – continue to raise existential questions about the nature of faith and spirituality.

Although there is much disagreement over the role of music or prohibition of it in Islam, Nawal, a practising Muslim from the Comoros islands, is adamant that there is nothing in the Qur’an that forbids singing.

“I sing for my hopes, my values,” she says. “It’s like a communion. I want the public to forget I am an artist. I don’t say ‘Let’s go pray’, I just say ‘God is big, there is nothing that is not God’. So if someone kills me for saying that, they kill me for praising God. I am not here to change people – I am here to shine.”

She continues, “The Western media must show me as I am [and] show Islam as vital, spiritual, productive, subtle and positive – not just extremist.” She recounts a story at an international festival in Belgium when the predominantly Muslim crowd complained and nearly revolted. However, after the gig, she recalls, Turkish, Palestinian, Tuareg and Syrian Muslims – both men and women – came up to her with tears in their eyes, saying they had found her songs moving and profound.

These divergences also reverberate in Sudan, where the vibrant and dynamic musical group Camiraata uses music to address social issues. Far from seeing music as unreligious, the group uses music to bring together families, tribes and clans in Sudan, north to south, to sing their way through serious political and domestic challenges.

Indeed, for many Muslim Sudanese, music is integral to community dispute-resolution, initiation rituals, the unusual and the everyday. Da’Affallah, director of Sudan’s Music and Culture Academy in Khartoum and band member explains, “Music and culture is about understanding. If you know my music, my religion and my culture, you respect me.”

“We never ever stop singing!”, Da’Affallah continues, before breaking into song. “Music in Sudan is absolutely everywhere, and has been for many, many centuries. Music is life in Sudan, from birth to death. When a woman makes tea or coffee in the morning she has a special song [he starts singing]. She has a song and she grinds out the pestle in time as she grinds coffee. Then we have special ‘albaramka’ for tea – this is a group song.”

He demonstrates – and it sounds like Mongolian throat-singing – before continuing, “We sing love songs to our camels because we depend on them. We sing to the desert so it won’t kill us. If we have problems in the community, we bring together everyone to solve the problem, we consult the elders, we talk, we sing, we talk more!”

Facing the music in northern Mali

A couple of thousand miles west of Sudan in Mali, the tensions between contrasting interpretations of the role of music for Muslims was been brought into particularly sharp, and often tragic, focus following the takeover of the north by Islamist militants last year.

Khaïra Arby, looking regal in her striking head wrap and plush blue dress, her face lined and tired, just got off a plane from Mali. “Yes, it’s true, I’ve seen it myself; they will cut off your tongue if you sing,” she says. “I’ve seen friends who’ve had their hands cut off for the ringtones on their mobile phones.”

Arby, adored across Mali, is affectionately called the nightingale of the North. Born in the village of Abaradjou, north of Timbuktu, her parents came from different ethnic backgrounds – her mother Songhai, her father Berber. Arby’s music, which is more popular at home than the music of her internationally famous cousin Salif Keita, captures northern Mali’s diversity of ethnic groups, styles and poetry.

Malian musician Khaïra Arby. (Flickr/Rare Frequency)

After persistent threats and attacks from Islamists militants – including smashing up stereo systems in markets and people’s homes, confiscating radios and even SIM cards with music on them – Arby escaped to Bamako to stay with Salif Keita on his island on the river Niger just outside Mali’s capital of Bamako. Many Malian musicians are among the thousands who fled south since the crisis began.

Keita is also resigned. Before the international intervention against the Islamist rebels, he commented, “If there’s no music, no Timbuktu, it means that there is no more culture in Mali.” Indeed, Timbuktu is regarded as part of a chain of African kingdoms that had a long history of education, literature and intellectual life. It was the site of one of the largest Islamic libraries in Africa and a meeting point for scholars who debated and interpreted the Qur’an.

However, last year the Islamist rebels who took over the towns declared the shrines to be idolatrous and restricted forms of expression, such as music, that had been part of the fundamental fabric of everyday life. Like many Malians, Arby was bewildered. “There’s not a single part of the Qur’an that forbids music,” she says. “I’ve read it all, I can tell you honestly, there’s nothing in there that says don’t sing. I’ve never seen, never, that music is forbidden.”

In fact, Arby is highly sceptical as to the importance of religion at all in the motives of militants. “This war is about drug-running and arms trafficking. It’s about controlling important routes through a very long term trade area. It’s about money, politics and control. It’s not about religion,” she insists.

Cheikh Lo, a Senegalese veteran and arguably the Miles Davis of African music, is also angry about the rebels’ attempts to ban music in northern Mali. Lo is a devout Muslim of the Baye Fall Sufi tradition. “These people misuse the name of Islam,” he says. “They are nothing to do with Islam, they are terrorists and we must have the dirigence [direction or composure] to drive them out.”

Clearly, Africa’s Muslim musicians – from Senegal’s Cheikh Lo to Mali’s Khaïra Arby to Sudan’s Camiraata to Zanzibar’s Nawal – are not about to give in and succumb to pressures against their singing. In fact, to the contrary, they see music as the very means of social change.

“The real musician does not go out to nightclubs, but he stays in the community, and leads to the right way,” says Da’Affallah. “This means peace, unity, understanding, communication.”

Meanwhile Arby states defiantly, “We have an obligation to sing, to dance, to respect, and to show appreciation for the suffering and the endurance and bravery of the people who are fighting for us, for those who cannot sing. We must compose beautiful songs before the war, during the war, and after the war, to celebrate what we have.”

This piece by Thembi Mutch was first published on Think Africa Press.