It's Monday morning and I am on duty for the early ward round at the Therapeutic Feeding Centre (TFC). There are two big mud huts where up to 100 severely malnourished children (< 70% of normal body weight) can be admitted with their care givers. The children receive medical care and high-energy foods. Malaria, respiratory tract infections, tetanus and diarrhoea contribute to the high child mortality rate due to minimal operating health services. Yet causes for malnutrition are vast. Therefore, we conduct participatory health education sessions, where mothers can reflect on their weaning and hygiene practises as well as their traditional beliefs about childcare. My role mostly involves capacity building through training and supporting of local staff as well as supervision of the feeding centres.

Alongside the TFC our nutrition team (two expatriate nurses, eleven local staff members and about 100 volunteers) runs a Supplementary Feeding Programme (SFP) for moderately malnourished children (<80% of median weight). From Mondays to Saturdays, we drive to our feeding centres and distribute a dry premix of Soya and maize flour, vitamins, sugar and oil. After a one to two hour journey on a bumpy dirt road, we arrive at the centre where about 200 mothers and children welcome us under a tree. Our volunteer mothers sing songs with health education messages and dance, which reflects traditional ways of communication. One of our Sudanese workers explains one health topic including disease prevention, feeding practises and immunisations. Afterwards children's weights and heights are measured and recorded and they receive their weekly take home ration-.

Yet, things do not always go smoothly and sometimes we are suddenly reminded that we are still in the midst of a civil war. One day an Antennov just circled above our SFP, ready to release 18 bombs. As we all lay down flat under the tree we felt them dropping about seven miles further south in the middle of nowhere, leaving us overwhelmed by God's protection over us.

Radio call: ‘Foxtrot Delta for Bravo November... We were wondering whether you could help out in the community health programme in the Upper Nile Region...’ After a few radio calls and discussions with the team, programme director and God, I flew over to Shilluk Kingdom in order to help in a community health programme. Even though I am still in the same country, things here are very different. Again, I have to get used to new people, a new language, new customs, water shortages (and hence amoeba/gardia experiences- ouch!) and very few people speaking English.

We oversee nine primary health care units and one referral centre. The team is involved in establishing an Immunisation Programme and continue to facilitate preventative health education with waiting patients at the clinic. However, the lack of infrastructure makes access very difficult and settlements are far of the main dirt track (there is no road), which is impassable for many months, as rains have turned the black cotton soil into a mud trail.

How am I a missionary then? Long working hours, the heat and insecurity often restrict involvement in midweek church fellowship; and due to the short-term nature of our projects, I can often only begin to understand the local language and culture. Still - I am taking part in people's suffering (I. Corinthians 12) and working with them to make a difference, even if it sometimes seems small.

On our car journeys, we started listening to sermon tapes, as a result of which one of our local staff members asked how he could become born again. One evening our car was stuck in deep mud for the sixth time that day and because all of us were exhausted, we started blaming each other. Eventually our nutritionist stopped all our efforts of trying to pull out the car and prayed for the situation. Afterwards we continued to struggle - but this time in unity - and once the car was out, we sang songs of praise, thanking God for his help and protection over us.

Through our work in Southern Sudan, we were also able to pray for different local needs more specifically. God answered in an amazing ways and one day we saw about fifteen soldiers baptised in the small local church. Afterwards they burnt their amulets in a little fire in front of the church. We can all be part of God's global work through prayer, which is essential for the work to continue.

...Time span...
Well, I am back in London now. At first, I experienced a reverse culture shock where all the normal things in life such as shopping in a big supermarket, washing in a washing machine and sleeping in a bed, all felt strange. Yet it has been such a privilege to see friends and be part of a church family again, rather than listening to sermon tapes in my mud hut by myself. However, now a few months later, I sometimes wonder whether this other world is still out there, too. My one and a half years working experience in Northern Kenya and Southern Sudan were certainly challenging in many ways:

Firstly, spiritually. I found it quite hard to be so limited in actually talking about my faith, as I could not speak the local languages. Yet, through this, I learnt so much about depending on God and spending time with Him. In ten months I was able to read more Christian books than ever before. I realised that quite a number of prophets and Jesus himself spent time in solitude in the desert, which encouraged me to use this time really to concentrate on my relationship with God. Reading the Old Testament accounts in a village when shepherds pass by with their goats and sheep made these historical events come so much more alive. As I read about the Israelites in the desert, I was amazed at God's provision for them, especially when I looked at how many complex logistical issues we had to deal with, as all project items had to be imported by plane.

Secondly, personally, I found it tough at times to have very few people around whom I was able to really talk to and pray with. I so often wished to talk to the local women, and learn about their interests and culture, which was difficult as most interpreters were men. Once we sat in our kitchen for lunch, a lovely mud hut with a grass roof (which we had named 'the farm', as it looked like an old farmhouse). Two of our water carriers passed by outside whilst chatting to each other. I asked my Sudanese colleague what they were talking about and he translated the important advice the older water carrier had just given to the younger one:

‘My friend married a man who lives far away from the well. Now her life is very hard, as she has to walk very far to get water and her children are not clean, because she has to wait a long time in the queue and she can't carry more than two jerry cans for the long way... So always, remember whenever you plan to get married - marry a man, who lives close to water’.

This short conversation amazed me, as it gave me just a minute insight into what mattered to the women I was working with. In fact, the moments where I could listen to local people's stories or learn from my local colleagues were the most enjoyable ones: Once we walked through a village whilst conducting a nutritional survey and my local colleague just picked up a huge handful of ground nuts a mother had just roasted for her toddler. I told him off and said he should not do that because they were meant for the child. He looked at me rather puzzled and asked me if I knew God? He then asked if in my country, people died of hunger. The mother with the child somehow understood our conversation, laughed, and put more groundnuts on the fire inviting us to eat. Whilst we munched the freshly roasted groundnuts, my colleague explained that in their culture people do not have to ask for food, especially people who are on a journey. If you walked through the bush for days, you could eat anything found on the way. How would you survive otherwise?

In some ways, I was ashamed that my colleague, who believed in his ancient idols, had to teach me these Biblical principles.

Yet getting to know these issues are of vital importance for our work. How, otherwise would we understand why our food rations for a particular malnourished child are shared with every family member? How could we facilitate appropriate hygiene discussions without the understanding the water problem? Working within the complex situation of a civil war was certainly a challenge in itself. As my role changed constantly, I gained experience in various areas including the supervision of supplementary and therapeutic feeding centres, staff management and training as well as logistics and undertaking medical consultations. I learnt a lot during this time, yet it also made me realise that there were specific areas in which I needed to enhance my knowledge. For example when the local doctor was absent, I was responsible for the primary health care referral centre and I often wished I had more medical and managerial knowledge and skills.

Therefore, I came back to further my studies and I am currently undertaking an MSc course in 'Mother and Child Health in Developing Countries' in London. I am grateful for the MMA HealthServe grant that has assisted me in my studies. I am enjoying the course, as it offers a wide range of modules including teaching and curriculum design, management skills as well as public health and research methods. It is my desire to apply my new knowledge within community-based programmes focusing on child health in developing countries. The course provides a great mixture of gaining theoretical knowledge as well as practical skills that will be very useful for future placements abroad.

For more information about Sudan or working opportunities in developing countries, check http://www.tearfund.org or http://www.healthserve.org/vacs

Joy Lael  is a paediatric nurse. She has worked in several African countries, the South Pacific as well as in Germany and the UK.