How does someone survive in South Sudan, where the most recent civil war is entering its fifth year? It is the world’s most failed state, where famine is raging and the refugee crisis is the biggest in Africa. Unfortunately, many do not survive. Tens of thousands have been killed, and millions have become refugees.

Thus far, 92 aid workers have been killed during the war. Others have been kidnapped and held hostage. How does someone make a positive impact in the most dangerous place on the planet for working humanitarian aid groups? Through a lot of hard work, guts, and touch of craziness… for which Alaskans are well suited.

In November of 2007, I was flying in a Cessna caravan to Old Fangak, a village in South Sudan located in the Sudd, the largest swamp in the world, and one of the most remote and impoverished places in Africa. I had been flying for hours with few signs of civilization, only the occasional and scattered mud huts. As the plane banked left I caught site of the village on the banks of the infamous Nile River. After a bumpy landing on a dirt strip, I was greeted by dozens of Sudanese children, curiously crowding around to see this stranger from a faraway land.

I was met by Dr. Jill Seaman, a physician from Bethel who had been working in Sudan for many years. Together we climbed into a waiting skiff for a short trip up the Nile and arrived at a village of about 5,000 people, which lacked roads, running water, electricity, sanitation, or infrastructure. There was very little food in the market and only one well for clean water, with long lines of women waiting for their turn at the pump. Simple mud huts provided the most basic of shelter.

Shortly after arriving, I was taken to the small clinic, which was really just a room with 10 beds. It was in terrible disrepair, filthy and overflowing with the sick, injured, and suffering. Some were moaning. Others were too weak to cry. Most of the patients had to sleep in the dirt outside. A lucky few got a bed, but a blanket was rare.

I witnessed unmet humanitarian needs everywhere I went. There was a lone doctor, but where were the aid groups? I soon learned that the aid organizations felt Old Fangak was too remote and inaccessible to easily help. There was no infrastructure, and even basic operational needs were too expensive. The Sudanese government, and the world, had turned their backs on this forgotten place. My heart was torn. Who is going to stand up for these people?

I spent a challenging nine days in Old Fangak, assessing the situation and caring for hundreds of patients. During this time nine children – one for every day we spent there – died of malaria, kala azar, diarrhea, and malnutrition. When I boarded the small plane to depart, I looked at Dr. Jill, tears threatening to well up in both our eyes, and I pledged that I would return with help. Alaskans would build the village a new and bigger health center.

I had no idea how difficult it would be to fulfill that promise. I had lived in Swaziland, Africa, for 15 years, where I worked and raised my children, at times achieving nearly impossible things. But nothing in Swaziland had prepared me for what I was about to embark upon in Sudan.

I returned to Alaska and immediately started recruiting friends to help. Incredibly, people that I had never met also came to help. An amazing team of tough and persistent Alaskans was put together, and the Alaska Sudan Medical Project (ASMP) was born.

Plans were drawn up for building a clinic, but obtaining building materials, supplies, generators, welding equipment, and fuel would be a challenge. There was absolutely nothing in the village, not even a hammer and nail. We turned to Nairobi, Kenya, to purchase the needed supplies and equipment, loaded it all into a couple of 20-foot containers on some old beat-up trucks, and had them driven through Kenya and into Sudan. It was a long, difficult, and somewhat dangerous trip. From Juba, the capital of South Sudan, the containers were loaded onto a barge for a four-day trip down the Nile to Old Fangak. Ours was the first barge to arrive in the village since the 1950s.

Construction on the clinic began in 2010. We started a Sudanese building team, teaching local boys everything from how to turn a screwdriver and shovel to how to operate a generator and weld. The building season was short during the dry season, which lasted from November to March. Then the heavy rains came, frequently bringing flooding. If something needed to be replaced or if we could not make repairs in the village, we often had to wait until the next year to bring in supplies. There was no hardware store down the street, and the flight from Juba to the village cost $5,000. That didn’t even count the cost from Kenya to Juba.

The clinic was nearly complete in 2013 when one early morning the clinic tragically caught fire. One third of the structure was destroyed. Our team and the villagers were devastated, our dreams of a new health center nearly crushed. The locals thought ASMP was going to pull up stakes and leave the village as so many aid organizations do when hardships strike. But urgent pleas were sent out, and immediately money and supplies came from individual donors and international organizations. The clinic was rebuilt by April of 2014 with the dedication of ASMP volunteers and the villagers. Old Fangak finally got their new health center.

ASMP expanded its mission. We started an agricultural program where people could learn to feed themselves. In one of the few countries in the world where the United Nations has declared a famine, we started small, teaching a few men proper farming techniques. We made simple hand implements for them and gave them seeds. If they could show a commitment to getting their crops to grow six inches high, we would “microloan” them a foot pump to irrigate their gardens. This helped small gardens grow into multiple-acre “farms.” Crops were then sold in the expanding village market.

War had been the only thing that the men had ever known, introduced to killing as child soldiers. But trading in their guns for garden tools, they found that learning the skills to plant and grow food was life-changing. One man told me, “Now that I have a garden, I will fight in the war no more.” With that small investment, the number of farms has grown to well over 100. To help guide this amazingly successful and growing project, the community has taken the lead and established a Farmers Council. It is now their program and supports many single women farmers.

In a region where diarrhea caused by contaminated water is one of the main causes of death, especially for young children, ASMP understood that clean water was also essential to saving lives in the region. So we expanded our mission again and brought in a well-drilling unit. It took time, but recruiting the right people proved successful, and just this past month we have completed our sixteenth well in a total of five villages, providing the first clean water most villagers have ever tasted. Clean water is flowing and lives are being saved by the hundreds, if not more. And we now have a fully trained African well drilling team for both drilling and well maintenance.

Due to its remoteness and relative inaccessibility, the village has remained free of the violence and civil war that has plagued the rest of the country. When word got out that Old Fangak had a new health center, wells for clean water, and small farms producing food for the market, thousands of refugees fled to Old Fangak for safety. Some walked for two months or more. All were hungry and tired, many were sick and wounded, and some died along the way. Our once quiet village of 5,000 grew to over 50,000, and more continue to come. ASMP was in the right place at the right time.

ASMP is now entering its eleventh year in South Sudan. The war continues, but ASMP remains committed and continues to move forward. Plans for the years ahead include building a second clinic for infectious diseases, expanding the agricultural project, drilling wells in more villages, and training more local men and women.

We have certainly accomplished much more than our original mission of building a health center. As we saw the needs before us, we expanded our mission, not really knowing how to make it happen either logistically or financially. It is nearly an impossible place to work, but as the project grew we held on tight and never let go. We dreamed. We persisted. And we succeeded.

How does one survive in South Sudan? With a never-ending supply of hope and faith.