Poole Africa Link (PAL) team making latest visit to Wau Hospital
Blog November-December 2011
3 December: ...and finally! Nairobi airport, then home!
Yesterday morning we went to the hospital to say our goodbyes and were delighted to discover that the child we had brought in from the Eastern bank had made an excellent recovery and was smiling and laughing happily.
- Angelo, who suffered an iron overdose
We had a meeting with Dr James and Dr Alex, and James said he felt we’d achieved more teaching on this trip than on any other. Due to the time lost in Juba the teaching has been much more formal and concentrated, but also there are more doctors around now who were very keen to attend.
We then went to the Ministry of Health and had a formal meeting with his Excellency the state minister of Health Dr Isaac Cleto. We received many thanks, and were also each able to speak about the achievements of our visit, and the challenges we had met in the hospital with suggestions for areas of improvement.
- Team at the State Ministry of Health with hospital doctors and other ministry officials
We had an uneventful journey to Juba and were taken to a different hotel, as we had not been booked in in time to the Oasis, where we stayed on the way out. It was in a very pleasant location by the Nile but very noisy at night.
We were visited by John Inglis-Jones from the Anglican International Development charity, which is hoping to get involved in the Eastern bank clinic, just outside Wau. John and I were hoping to meet up in Wau so that I could introduce him to some of the people there, but he too had been stuck in Juba all week due to flight problems.
Our lift to the airport failed to arrive on time so we took a taxi from the hotel. The book in and immigration procedure passed more smoothly than ever before and now we have an eight hour wait in Nairobi airport, where I am writing this while the rest of the team have gone for some much needed retail therapy!
It has been another amazing visit; despite the initial frustrating delay we made up for lost time, and achieved our objectives as well as delivering a huge amount of teaching in the limited time available. We’ve met old friends and made new ones, and I believe the input we have had has benefitted the knowledge of many hospital staff and will lead to improvements in patient care. We have been very humbled by the hospitality and generosity we received both at the hospital and from the nuns. We have all enjoyed and gained so much personally from the whole experience.
Hilary
PS After many hours of travelling, the team arrived home safely on Sunday, 4 December. The flight from Nairobi to Heathrow was delayed by half an hour, but after waiting five days for a flight from Juba to Wau we felt that this was insignificant!
Photo captions
Angelo, our iron tablet overdose baby, fully recovered with his mother
Team at the State Ministry of Health with hospital doctors and other ministry officials
1 December: in the right place at the right time
I’d visited the remote Eastern bank clinic on Monday and wanted to take Jane to meet the midwife there, and deliver a supply of instruments and dressings for the midwife and the community nurses there. The clinic is very run down, and they have almost no supplies. I was trying to clean a young girl’s eyes, they were so sticky she could hardly see, when a mother rushed in carrying her 18-month-old semi-conscious son who had apparently eaten almost a whole box of what looked to be iron tablets, potentially very dangerous. We decided to put him, his mother and sister in our vehicle and bring him straight to the children’s ward. He was unconscious and unresponsive by the time we arrived, so I found one of the paediatricians who put up a drip and inserted a nasogastric tube. Three hours later, I’m happy to say he was looking much better - able to drink some soup. If we hadn’t been there his family would have been unable to get him the necessary treatment, as nothing was available in that clinic. The nurses there earn very little, and we were told that one of the midwives who travels many miles to get there hasn’t been paid for months.
- The unconscious 18-month-old reaches Wau Hospital
Its World Aids Day today and I was met by a group of very noisy excited nurses in red T-shirts wanting me to be part of their celebrations…their ‘union rep’ here knows I’m an RCN rep so though I was qualified to join in…he’s even told me I can have use of the union office building as my office!
- A welcome from trade union members
Dr Alex is back from Addis, so we’ve all been very pleased to see him. Jane took a patient (a displaced person from Abyei, on the border) to him who was six months pregnant but had been kicked in a fight. . He performed an ultrasound and fortunately the baby was alive and the patient has been admitted to the gynae ward.
Antoinette and Ally have been caring for a very small premature baby, giving advice on fluid management and temperature, but sadly the baby died. Teaching of doctors and student nurses has continued and is very successful. The students were delighted to receive their certificates and watches.
Tonight we had the amazing experience of a group of a hundred or so children from the ECS Church singing and dancing at our gates; when they learned that we were friends of Bishop Moses we received a fantastic response; they were all so excited and all had to shake hands! I’m sending this perched on the steps of the CHTI, trying to get an internet connection; it is totally deserted and quiet except for the squeaking sounds of nature and the distant hum of a generator – it’s about to be turned off as we have had our three hours daily ration of electricity! Small lizards and frogs are jumping over my feet, it’s warm, calm and dark, and overhead is the most amazing display of stars I have ever seen.
Sadly it’s our last full day here; we’ve achieved a lot in a very short time, but if we had longer we could do so much more. We will all be sad to leave tomorrow.
- Hilary
- A familiar sight on most days, this vulture seems to have taken up residence in the hospital grounds.
30 November: some sad news today
We arrived today to find the child with meningitis had sadly, but not unexpectedly, died during the night, but another boy with encephalitis was very much better.
Jane has been on the delivery ward, where a lady having her first baby was in the second stage of labour for over three hours; the baby was alive but must have become severely asphyxiated shortly before delivery. The midwives had tried to call the obstetrician but no one came, so the woman did not get the forceps delivery, which would have probably saved the baby. Both Jane and Antoinette tried to resuscitate the baby for half an hour but it was too late. One obstetrician has been in Addis for six weeks and is now stuck in Juba and the other we haven’t seen since we arrived!!
The maternity patient who received our antibiotics is improving, however.
- Ally give a sick baby fluid
I managed to persuade the administrator to release a trolley from the store to use as a resuscitation area in the delivery ward. The Ugandan midwife who is working here for a year…and doing a great job, was delighted. I did see two midwives asleep on the beds this afternoon though!
We have been distributing the various items of donated kit to the wards and Antoinette and I discovered a child on one of the paediatric wards, very sick with malaria, who had been fitting for three hrs while the nurse took no notice and appeared to be busy washing her feet. There is a big lack of effective nurse leadership. There appear to be only two senior nurses here at present and they spend a lot of time in their offices and little time on the wards teaching and leading the nurses: its very discouraging, as I spent some time on the last visit trying to persuade them to get more involved in ward management and teaching.
The newly refurbished emergency department seems to be running well, and they have a reasonably effective triage system set up to prioritise the sickest patients.
- Hilary and Antoinette with one of the nurses babies on the new emergency department
The teaching programme for the student nurses and the doctors is very well attended and going well and they all seem to be really enjoying it. Although we started late due to the plane delay, as far as the teaching programme is concerned, we have had a far better attendance and taught far more doctors than on previous visits.
- Antoinette and Ally teach nursing students
We have also been to visit our friend, Sister Maria in her newly built Comboni hospital (the former military hospital). At present just the outpatient department is running, but its already an amazing centre with excellent facilities, rivalling many hospitals in the UK and will eventually house inpatients and a maternity unit.
- Hilary
29 November: another day of progress at Wau
Having heard of the atrocious weather in the UK, the weather update from Wau is very hot , calm and sunny with no rain. The locals are feeling the cold though, as it’s certainly not as unbearably hot as previous trips. When I gave a talk to the doctors on intensive care/infection control in the UK this morning, they were very shocked at the thought of being ‘bare below the elbows’ and said it was too cold!
Ally has been very involved in the care of a child of seven months who has symptoms of acute advanced meningitis: he was very, very sick and would have been in an ICU if in the UK. She called a paediatrician and gave him fluids, and involved the student nurses in his care, who assisted with her communications with the patient’s family. We have done all we can and can only hope he survives.
The patient in maternity to whom Jane gave our antibiotic drugs has improved, and is out of bed following a blood transfusion. Blood is normally donated by relatives, as there are no blood banks or storage facilities.
Judy has spent the day in theatre, and is relishing in skin grafts following snake bites, and huge hernia repairs not often seen in the UK.
Teaching is going remarkably well, both the doctors and student nurses are all attending lectures with great enthusiasm; its very encouraging.
After finishing our teaching at 4.30 we visited the wonderful Sister Gracey at the Mary Help Clinic. We had an amazing and humbling welcome from her students, many of which we had taught in May, and saw her great clinic and school which is attended by 1,800 pupils.
Personally, I see so many people I have met after my five visits here, and their welcome back is truly amazing.
- Hilary
28 November: a great start to the week!
It’s been a very productive day for us all. Jane delivered her first Sudanese baby and has struck up a very good relationship with the midwives. The midwife from Uganda, who was here on our last visit is still here, and has made good progress; there is also an excellent male midwife from Kenya working here. There is a big drug shortage here in Wau, and often patients can’t afford to buy them anyway. Jane has taken some of the drugs we have brought with us for emergency team use for an extremely sick lady, who had a Caesarean section nine days ago and has sepsis: without them she wouldn’t have had the drugs she desperately needs.
I’ve been to the Episcopal church (Episcopal Church of Sudan) again and made a presentation to the Mothers Union (I was presented with a local necklace) and took footballs to the headmaster of the school there. I then went to the airline office and paid for our tickets…a great relief to get these, and a good job the hospital here had booked last week for our return on Friday, as the flight is now full!
- Children queue for the clinic
I’ve been anxious to see the community clinic on the Eastern Bank (supported by ECS) and went with Father Andrew from the ECS and our driver. It’s about a 20 minute, bumpy drive to a fairly remote spot. There was a long queue of children waiting for immunisation (someone goes around the village with a loudspeaker to get people to come along). I talked to the midwife who does ante-natal care, and also delivers babies in a dark little room. She had some very ancient instruments, no drugs and no blood pressure machine. I’ve promised her some instruments and a couple of BP machines by the end of the week, as we have a few spare.
- Children from the Eastern Bank
I’ve also made contact with the consultant ophthalmologist of the dental department, and delivered some drugs and books to the HIV clinic. The doctor there was delighted and wants to make contact with the Sudanese HIV consultant at the Royal Bournemouth Hospital.
Judy has made contact with the surgeons and seen some interesting cases on the wards. Her great success is getting the hospital carpenter to make some crutches for an amputee.
Antoinette and Ally have seen some very interesting cases, but there is a huge challenge with the nursing care on the paediatric wards, and they are unlikely to have enough time to make much impression there.
The doctors have been coming along very enthusiastically for teaching, and we are also teaching nursing students who are working here at the hospital, finishing out teaching about 5pm. Jane delivered her talk on family planning and sexuality, an interesting challenge with these students who include several ex-soldiers in their 40s! We are aiming at two or three talks a day at the end of their working day, in order to catch up on our programme.
- Hilary
27 November: what a difference two years make!
It is now Sunday afternoon and the team all feel very settled in Wau. Despite our extremely frustrating start stranded in Juba, we are now feeling extremely positive about the work we can do in Wau. As Hilary described we had a full and varied study day on Saturday with excellent attendance and enthusiastic participation from the junior doctors and nurses. The consultant medical staff were most supportive and several attended the study day too. We have planned a full teaching programme of practical and lecture sessions for the junior doctors and nursing staff, along with ward teaching in the remaining available time.
For me personally, it is now exactly two and a half years since my last visit. What a change in Wau hospital since then! There is a new out-patient block with a bright and shaded waiting area with a smart reception desk. A new laboratory has been built which although remaining limited in resources and available tests, is now bright, airy and three times as big as previously. There is also a refurbished paediatric ward and maternity unit. There are considerably more junior medical staff, with 20 pre-registration house-officers. There are also many signs of improved organisation and care: for example we noted rosters for the surgical doctors, common antibiotic doses posted on the children’s ward and proper sheets on the children’s beds. There continue however to be major deficits including lack of piped water and only one currently non-functioning oxygen concentrator.
- The new laboratory
As Hilary mentioned, we are staying at the bungalows of the CHTI . Here also is a fantastic improvement since my last visit. At that stage there was just a shell of building which has been transformed into a fully functioning modern nursing college. The second year students are already half-way through their training!
On Sunday there is no opportunity for us to teach. We joined Dr Majok at the Episcopal Church of Sudan early this morning for the English service. We were particularly proud of Hilary delivering the sermon at the request of Bishop Moses! Following this Dr Majok took us to visit the old Leprosy hospital at Agok. The whole hospital is currently being completely renovated and converted into a new medical school! Following separation from North Sudan, medical students from Southern Sudan were evicted from Khartoum and urgently need facilities to continue their medical education.
- Antoinette
- Hilary delivers her sermon
26 November: in Wau at last!
We are here at last. After considerable hassle at Juba airport we eventually boarded our plane, although our five kit bags had to come on a later plane. It was wonderful to touch down on the dirt runway of Wau airport, to be greeted by Dr Majok and other hospital staff. 'When we landed in Wau at last the captain let Ally's sock monkeys have their picture taken in the flight deck!!!!'
At Wau hospital we received more warm welcomes from the Director General, Dr James Morgan, and others from the hospital and local church
There have been considerable problems of food shortages (eg bananas no longer available) and huge rises in prices following independence in July, and since my last visit six months ago, there is a huge problem in that the road from North Sudan is now closed, and new infrastructures are not yet set up for transportation. Juba doesn’t appear to be suffering but the people in Wau certainly are.
The hospital still lacks water and drainage: water is still brought here by donkey. There is generally electricity in the hospital from a generator for eight hours in the day, and a few hours at night there is no electricity in the town. Malaria has increased hugely, and many more people are dying from the disease due to lack of basic drugs to treat it. There are very few drugs in the hospital now. We have also learnt that there are big problems in environmental health, and that there is no public health set-up. The hospital has big problems with security at night and the nurses are so frightened they have to hide or just don’t turn up.
The new emergency department is functioning now, which is very good news, and the doctors and nurses are very anxious to learn . Many nurses and doctors came on their day off for teaching - the resource room was packed with about 25 staff (on a Saturday morning too!!!) who rotated round different workstations for paediatric resuscitation, family planning, surgery and suturing. It’s very exciting indeed, and just what we are here for.
There have been definite improvements on the surgical ward. It’s clean and seems much better organised than previously. They now have folders for notes, are doing observations (using the sphygmomanometer we brought last time) and recording them, though only on a scrap of paper: we will take them some charts on Monday. A smartly dressed male nurse has the job of doing all the dressings. There were some interesting cases….several snake bites, a young girl with an attack Guinea worm who has been in hospital for seven months, and a family of seven who had all been travelling on the same motor bike before the inevitable accident - this sort of accident is very common here.
We are staying at the CHTI (Catholic Health Training Institute) with the very friendly Sisters of Solidarity. The accommodation at the hotel was very bad on the last visit; this is so very much better, and also cheaper. We have the use of two bungalows with clean water, our own rooms, comfortable beds and we eat with the nuns. There is only electricity for about 3 hours a day from the generator from 7-10pm but we have candles and torches! Tonight we will go to an end of term celebration… a ‘feast’ and cultural celebration. The students are organising the feast (though I’m not eating the goat as I met the poor condemned creature yesterday!). We will present them with a letter and some gifts from the Florence Nightingale Foundation, which I’m sure they will be very excited about, as she is quite a heroine to them.
It’s very good to be here at last, and the response from the doctors and nurses is very encouraging.
- Hilary
25 November 2011: the team finally arrives in Wau
The PAL team has this morning eventually arrived in Wau after days of frustrating delays. We'll bring you more news as soon.
24 November 2011: ...more disappointment
I can’t believe we are still stranded in Juba! We were told yesterday’s flights were full, and the Sudanese Airways flight we were booked on yesterday after the Tues one was cancelled, was also cancelled and no one seems to know why. Charter flights are too expensive... around 40,000SSP (south Sudan pounds which are about 5 to 1GBP, so that’s about £8,000). We are all very frustrated and disappointed as it’s such a waste of valuable time to be stuck here, although the surroundings are pleasant enough. There seems to be unpredictability about when and if flights will go, and it’s very frustrating as we are powerless to influence this. Dr Loi came to see us yesterday evening and the Ministry appear to be trying hard to get flights sorted. Dr Majok in Wau tells me he has already booked our return flights to Juba for next Friday, but the staff at Wau hospital and the training institutes are very disappointed that we have not yet arrived.
We’ve been making the most of the spare time and have been working on teaching programmes etc and today Judy has gone to Juba teaching hospital to spend the day in theatre. Antoinette has the inevitable tummy bug, and the rest of us took the opportunity to walk to Juba market this morning: very bustling and busy and full of interesting sights and smells. We were told it was quite safe to go there, the main and real danger being from the chaotic traffic!! On the walk back we got talking to a young man of 21 (who had been a boy soldier at 9) and whose father had been killed in the Sudan civil war; he had gone with his mother to California so that he could study. He is now a qualified engineer, and was on his way home from an unsuccessful job interview. There seems to us to be a desperate need for skilled people to work here, and yet this qualified young man, who is desperate for a job, is unable to get one.
We are keeping our fingers crossed for tomorrow’s early flight on a different airline... so watch this space!!!
- Hilary scores 9/10 at Judy's practice suturing workshop, using chamois and adhesive cork tiles!!!!
22 November 2011: delayed in Juba!
We left Poole at lunchtime on Saturday, and after a long and tiring (but fairly uneventful) trip via Nairobi, reached out hotel in Juba at lunchtime on Sunday – Sudan is currently 3 hours ahead of GMT. Our rooms are basic Nissan type huts with rather odd plumbing, but by Sudanese standards the hotel, situated on the Nile, is very pleasant.
That’s just as well as we are still here in Juba, 200 miles from our destination Wau: we have been told that we could not be booked on to the Monday internal flight; we were hoping for a standby flight today but the plane broke down…this seems to happen to us here with predictable regularity! We made the best of yesterday, visiting the Ministry of Health to see our friend Dr Loi, the Director General, and received a very warm welcome. We then spent some time at Juba Teaching Hospital where Antoinette, Ally and Judy went to observe some excellent teaching to community health workers, carried out by Dr Louis Danga (paediatrician). The four months Dr Louis spent with us in the Poole Paediatric Clinic appears to have reaped benefits. Jane (our midwife) and I went to see the labour ward: it’s Jane’s first visit to Sudan, so she was surprised at the volume of deliveries (12-14) two midwives may have to deal with in one night. Back at the hotel we met up with David and Claire Atwood and caught up on all their news.
It’s pleasant enough sitting by the Nile working on our teaching programmes , but we are feeling very frustrated that we are not yet in Wau, and still waiting for news of our flight…as I have been told many times “you see that’s how it is here”!!!
- Hilary
- Judy blows up a football for Louis Danga’s sons
- The Director General insists that Hilary sits at his desk
21 November, 2011
The team has now touched down in Juba, the capital of South Sudan. Next stop, Wau.
19 November, 2011
A five-strong team from Poole Hospital flew out to Southern Sudan on Saturday (19 November, 2011) for their latest visit to support the work of Wau Hospital. The team includes Hilary Fenton-Harris, PAL co-ordinator, nurse/midwife, Dr Antoinette McAulay, consultant paediatrician, Dr Judith Mella, associate specialist surgeon, Alison Ahvee, deputy paediatric sister and Jane Griffin, senior midwife. We will be continuing the teaching and training of hospital nurses midwives and doctors and students nurses at local training schools.
- The team are set for departure and the long journey to Wau.