For Sudan's uninsured, a dose of Facebook is the cure
In response to Sudan's weak health care coverage, one organization has learned how to successfully use social media to crowdfund medication. More activists are turning to Internet-based initiatives as development alternatives.
Khartoum, Sudan — It is 9:52 on a Wednesday night on Sharia' al-Hawadith, a bustling road of medical clinics. Sitting on the curb, 25-year-old Mujahid Abdulla al-Haj picks up a call from a doctor inside the nearby Jaffar Ibn Ouf Children's Hospital.
A six-month-old girl named Rahud has gone into life-threatening convulsions, the doctor tells him, and needs 10 doses of five different drugs. But the hospital doesn't have the medicine on hand, public health insurance won't cover it, and the family can't afford the $435 cost.
Mr. al-Haj springs into action: he runs into the hospital to pick up the prescription letter, then peels off in a waiting car to fill the order at a nearby pharmacy. But who will pay for the drugs?
"Facebook," smiles al-Haj, as he bags the medicine, signs an IOU for the pharmacist, and races back in time for the doctor to stabilize Rahud.
At work is Sharia' al-Hawadith, a three-year-old initiative which aims to meet Sudan's child health insurance gap by crowdfunding medical care online. Named after the street on which it was founded — which translates indirectly to "Accidents Lane" —Sharia' al-Hawadith is the largest organization in a new wave of Internet-based initiatives set up to fill in the holes left by inadequate infrastructure in Sudan.
It is also simple. Doctors treating children can call volunteers available 24/7 with requests for medicine that parents can't afford. The volunteers then post appeals on Facebook, and Sudanese citizens at home and abroad either send the money by phone or bring their donation directly to curbside teams found in all of Sudan’s 18 states.
Parents unable to pay their children's medical bills are the norm in Sudan, where public hospitals are routinely short on basic drugs. Even the most comprehensive private Sudanese insurance plans are limited, forcing patients' families to buy drugs from pharmacies themselves. Rahud's father, a policeman, has public health insurance, but it didn't cover the drugs' cost.
Sudan’s weak public healthcare infrastructure is largely the result of 26 years of conservative economic policies under newly re-elected President Omar al-Bashir's National Congress Party (NCP). In trying to expand the healthcare system beyond Khartoum, the government’s drive towards privatizing healthcare has largely failed, doctors and economists say. And without a strong NGO community in place due to strict laws, millions have been left without access to health care and insurance.
The overwhelming re-election victory of President Bashir drove home that the Sudanese cannot bring change with their vote. Instead, like with Sharia' al-Hawadith, activists are putting their political views aside, and using technology to step in where the government has not.
"The government has failed in its obligation toward Sudanese society," says Albrecht Hofheinz, assistant professor of Arabic Studies at the University of Oslo, who studies online social movements in the Middle East. "This is why Sudanese society had to find other ways of surviving where the government has retreated."
Navigating the politics
In most countries with weak infrastructures, NGOs offer the only alternative to many citizens. But Sudan is one of the most difficult places for humanitarian organizations to operate thanks to harsh regulations of aid agencies. The government has expelled Doctors Without Borders from parts of the country. For most of last year, it suspended the work of the International Committee of the Red Cross.
Sharia' al-Hawadith has avoided such fates by labeling itself as merely an "initiative", not an NGO, and existing only online.
"We don't have a bank account. We are not a formal NGO. We don't have a legal recognition. We don't have a headquarters. We don't pay taxes," says al-Haj. "This is our offices," he laughs, gesturing to the street corner on Accidents Road.
In this way, Sharia’ al-Hawadith is part of a trend that has its roots in traditional Sudanese self-help groups that mobilized communities to help in times of need, Mr. Hofheinz explains.
These initiatives also include Nafeer, a volunteer team that provided relief to flood victims, and Education Without Borders (Ta'lim bila hodood), a group that crowdfunds school supplies. The groups are mostly apolitical so as to ensure their ability to work without official inference.
Still, Sharia’ al-Hawadith has faced pressures. National security agents sometimes show up to the curbside vigils, accusing the group of communism. Members arrested for unrelated political activities have been interrogated about Sharia' al-Hawadith's work.
The group's mere existence is an implicit critique of the NCP government, says Hofheinz. "If they continue to operate on a scale without the state trying to make them register as an NGO that would be ... in a way unprecedented."
But al-Haj doesn't think authorities will close them anytime soon. “They can't because we are providing and helping a huge number of patients," he says.
Crowdfunding a system
Today Sharia' al-Hawadith receives roughly 1,000 daily prescription requests, which are funded so consistently that they no longer need to post all the appeals online. It has about 2,000 volunteers in Sudan, including some 300 in the Darfur region, and more than 100,000 likes on its various Facebook “chapters.”
It is far beyond what al-Haj and his six co-founders expected when they came up with the idea in 2011 while volunteering in a cancer ward.
"There were cases where the parents would just leave their children and disappear because they didn't have money to pay," he says. "That's the moment we realized that the children didn't need entertainment, they need medicine."
Dr. Khada Bela Osman, who also works at Jaffar Ibn Ouf, says more than half her patients need some kind of donation to cover their treatment. Without Sharia' al-Hawadith, "we would just watch our patients and cry, or spend all our [own] money on medicines," she says.
The group has also begun to address the government’s controversial trend of closing public hospitals for the private sector to take over. Last year, to counter the closures, they funded a renovation of the pediatric intensive care unit at Jaffar Ibn Ouf. This year, a new $500,000 children's ward opened in a public hospital in Omdurman, a large city that sits across the Nile from Khartoum. It was fully funded by Sharia' al-Hawadith donors.
"We think the priority is just to cover the gaps instead of just complain about the health services," al-Haj says.