Poole Africa Link Wau Blog September 2010
A team of staff from Poole Hospital are currently in visiting Wau Hospital in Southern Sudan, to provide support and training to the staff there. You can read their blog below...
Saturday 18 September
We had lots of hassle and communication problems over getting to the airport and were getting very anxious, as there was no sign of our usual assistance to get to the airport in the morning. To cut a very long and stressful story short, eventually a driver from the Ministry arrived at 11.30 (our take off time was 1.15) Procedures with check in, immigration controls etc are pretty complicated in Juba and getting out of Sudan for a team of five costs about £250.
We eventually boarded our rather late flight to Addis Ababa, where we filled the 11-hour wait with report-writing, a meal in the Ethiopian restaurant and a few tours of the shops. Addis is a smallish but clean airport and having spent about 45 hrs there in the last 18 months, I now know the shops very well!
We were all relieved to land at Heathrow but have had an amazing time. The people are so friendly and have welcomed us into their lives and homes. We have met many interesting people, both inside and outside the hospital. The doctors in Wau have really looked after us and Alex, Majok and Peter will always be special friends. We have worked well and hard as a team and had many triumphs and challenges. We have made some good progress in Wau, both in the hospital and nursing schools, and have now got some very useful contacts in the Ministry and GoSS who are very appreciative of the link and ongoing commitment that Poole Hospital has established. There will always be a warm welcome for us in Wau and more challenges for future teams to achieve.
HFH
Friday 17 September
It’s been a very frustrating day. The confusion between Juba and Wau over the flight departure continued, resulting in us arriving at the airport with Alex, Peter and Majok 8.30am only to see our flight taking off. Alex had originally thought it was an early flight, but we had later been instructed otherwise. Alex and Majok spend a difficult two hours trying to get us booked onto the only other Juba flight today which was fully booked: they eventually succeeded, Majok having to get the fares from his bank account (he is being reimbursed as the airline caused the confusion).
We had a further three-hour wait (in the air-conditioned VIP lounge!) until our flight eventually took off at 1.30pm, only to land enroute at Rumbeck for re-fuelling. We were met at Juba airport but by the time we got to the hotel it was 3.30 and unfortunately we then had no chance of meeting the Minister of Health.
Sara has been given a smart ‘first class’ room while the rest of us are in the usual ‘second class’. Perhaps the man on reception also wants to offer cows for her hand in marriage!
HFH
Thursday 16 September
We are all well again today, but it's our last day at the hospital so we are all feeling a bit sad. There is a large group of Chinese medical workers in the OPD, they are part of UNMIS (United Nations Mission in Sudan) who are based in Wau. They occasionally come to the hospital to help.
Sara went to theatre with a Caesarean section lady but sadly the baby was stillborn: infant death is so common here. The lady will return to the ward and be placed next to patients with healthy babies or delivering live babies. At least she is well and they are using the screens we brought yesterday and seem pleased to have them. It will be so much better when they move to the refurbished unit. Ally and Mandy have been on the paediatric ward round where they have been assisting with treating a child with status epilepticus and another with severe malaria. Many relatives delay too long in bringing children to hospital, partly due to the fact that they try the traditional healers first, as they may have to walk many miles to get here.
Frankie came across a sick child, who she took for a neurological assessment; she’s also practiced Ketamine anaesthesia. The second patient with whom she, Sara and Mandy went to theatre, sadly had a baby with hydrocephalus who probably won’t survive long . Not a good end to our time here.
There has been a lot of confusion and many phone calls about our return flight to Juba, hopefully we will get there tomorrow.
Sister Gracey collected us at 4pm and took us the 24km to Buserie, a remote village a very bumpy 34km away, in her old off-roading ambulance. We visited the bridge where there is great scenery; Sister Gracey has friends everywhere, and people I would not choose to meet without her welcomed us warmly.
One man made her an offer of 1000 cows in exchange for Sara’s hand in marriage, he was very persistent and upped his offer to 1250 cows. We considered the offer carefully, but he wasn’t her type and her family wouldn’t have been too pleased, so we declined. Sister Gracey was upset, as the cows would have brought her more facilities for nurse training, and Frankie was upset as no one offered any cows for her!
We then went to a local school on the hill top in Wau where Sister Gracey produced a picnic which we enjoyed protected on the covered patio from a huge thunderstorm. The next team out here will have lots of teaching to do with both groups of nuns.
We now have many friends in Wau. I have met several influential people who have approached me saying they had heard us speak in church on Sunday, and we often find people approach us at our hotel, curious to know why we are here. We have been made very welcome during our visit by the very friendly people of Wau, whom we have begun to know and love.
HFH
Wednesday 15 September
Frankie has made a good recovery and has been chatting away normally today! Sara has gone down with a tummy bug and has rested at the hotel but is feeling better tonight.
The rest of us visited Sister Gracey’s clinic, which is extremely well run and an excellent example of how an African clinic should operate.
Ally continues to make steady progress on the paediatric wards. The nurses on these wards are more motivated than on some of the others. Mandy taught the paediatric doctors about pain control and she and I have spent time on the gynae and obstetric wards: fortunately things have quietened down there today. We managed to find a screen and made covers from two new sheets. We delivered it to the maternity ward and hope they now think about patient dignity and use it!
Frankie has been in the Outpatients department and theatres, and was impressed by the anaesthetic assistant’s skills and timing. She has taught the junior doctors the oxygen cascade.
We did our last teaching for Sister Gracey’s students. Our days are long, hot and intense and we are all quite tired now. Our job is hard but very rewarding; we just hope the small changes we make will last.
The hospital grounds abound in wild life: chickens, goats, dogs, cats, lizards, huge magpies and the odd vulture attracted by tasty bits of rubbish!
We are now good friends with the relatives who live in the grounds and sleep and eat there; the children are beautiful and love to see the pictures we take of them
It’s our last day in the hospital tomorrow,and we will make the most of it before we start the long trek homewards. Sister Gracey has offered to take us on a trip to Buseri, a village a few miles out of Wau, when we finish tomorrow to show the team some of the surrounding area.
HFH
Tuesday 14 September
Our teaching programmes have continued with Mandy tackling the surgical wards and Gabriel, an elderly ex nurse tutor, as interpreter.
Sara and Mandy decided to do a big clean of the temporary delivery area (a curtained-off ward area) assisted by two of the midwives.
The maternity unit has been horrendous today, reflecting the high infant death rate here. Late morning a patient arrived from Bussere (a remote village we visited last year). She arrived in the back of a truck (they unloaded a couple of chickens first!) with a rural health visitor and her relatives: she had been in labour with this, her seventh child, for four days. Sara and I examined her and it was clear that the baby was dead and she was in the second stage of labour but unable to have the baby. At the same time a lady delivered noisily from behind the curtains with a live baby but had a retained placenta. Another lady who was having an induced delivery for a still birth delivered a breech baby on the ward with complications which Alex dealt with.
There are no screens in the ward, and most of these tragedies happened within seeing or hearing distance of other patients and relatives. Sara and I were in theatre when Alex delivered the other dead baby by Caesarean section; he works very hard under very difficult circumstances. The beds on the ward have little space between them: hopefully this will improve when the ward moves to the new buildings. Tomorrow our mission is to get a screen for the maternity ward and get the nurses and doctors to use it.
Frankie has been very poorly today with severe sinusitis, and we all know she’s ill as she’s not talking much!
The rest of us went to teach the nursing students, getting back at 6pm… another busy day but we hope tomorrow is more cheerful.
HFH
Monday 13 September
We started the day in the office of the Minister of Health, who then came with us and Dr Alex to meet his Excellency the State Governor. It was a bit like being received by Royalty, and I was invited to sit next to the Governor on his huge black leather sofa. He made a speech, the Minister of Health made a speech and I made a speech. Then the rest of the team introduced themselves. All this in front of the Sudanese TV cameras! The Governor expressed great gratitude to the team and to Poole hospital to their commitment to Wau. He admired our maroon scrubs: I told him that we chose them so that they would hide the red Sudanese dust. There is no doubt at all that our link with Wau is appreciated and held in high importance, both by GoSS and the Ministry.
Last night at the hospital Alex had delivered a patient who had been in labour for four days in her village and came to the hospital with the baby showing foetal distress. He performed a ventouse delivery and all seemed well, but the midwives found the baby dead this morning and the mother comatosed (the nurses said they had called the duty doctor, but had not, and it is likely that they had not checked on mother or baby over night). When I saw her on the ward, the dead baby was still lying wrapped up in a cot by her bed; this on an open ‘Nightingale’ style ward with no screens - there is no patient privacy and women frequently deliver in the beds in full view of the rest of the ward and visitors! Frankie and Sara have been keeping an eye on her all day and she was slightly improved when we left the hospital. The relatives here do all the nursing care so Sara has been teaching them what to do.
Frankie has had a good response from the doctors today who are really enjoying her teaching. The others have been concentrating on teaching observations, but apart from Paediatrics, they are reluctant to do them when we are not there, and say they are ‘too busy’…. Not too busy for long tea breaks under the trees and plenty of rest on the nurses bed! One of them announced she had pneumonia yesterday and had to lie down for most of her shift - she made a full recovery by the time she was due to go home!
At 3pm we went to see Sister Gracey’s student nurses, and have agreed to teach them for three days this week. As we were leaving at 6pm, a child suffering from febrile convulsion due to malaria was brought to her clinic; after stabilisation we all piled into her little ambulance with the mother and child, a couple of other relatives and came to the hospital. No doctor was to be seen in the emergency dept, so Sister Gracey, Mandy and Sara drove off to the doctors quarters to bring one back - and at the same time collected a head injury patient who was wandering around the grounds.
We got back to the hotel just in time to get ready to go out for Mandy’s Wedding Anniversary meal. Alex and Peter took us to the excellent Ethiopian vegetarian restaurant which we all really enjoyed.
HFH
Sunday 12 September
This morning Majok (General Physician, Wau) took us to the Dinka church service (held (in Dinka, Arabic and a little English) in the Episcopal cathedral Bishop Moses Deng Bol, who has recently visited Poole, had invited us to the service; however, his wife had just had a baby in Nairobi and he was there with her and not in Wau.
We were made very welcome to the three-and-a-half-hour service, and Frankie and I both addressed the congregation of about 300. About 600 people attend the various church services each Sunday, many of them having to remain outside due to lack of space: very unlike the half-empty English churches. Sunday school children from the school for children of the military gave an unforgettable performance about the referendum* in song and mime .
The Church is anxious to promote peace during the January referendum, which will be a difficult time. During the service I also went to visit the Arabic service being held outside where I was again asked to speak to the congregation…with an interpreter of course, as I only have a very few words of Arabic!
Following the service the Mother’s Union choir performed some lively entertainment for us and we then had a meeting with the acting Bishop, Dean, Elders and Council of the Church. After five hours at the Cathedral Majok took us for a well deserved pizza and beer. We just had time for a quick shower before going to see Sister Gracey and the Salesian Sisters of the Mary Help clinic. She is keen for us to teach her 60 students after we finish at the hospital and has given us a long list of requests; we are feeling everyone wants as much from us as possible and know we can’t do it all this time. We worked frantically on the preparation of new teaching plans last night - Frankie, Sara and Ally were up till 1am!
HFH
* There will be a referendum for all Sudanese in January on whether or not to formally separate North Sudan from South Sudan.
Saturday 11 September
We had a very entertaining evening with the nuns last night, and their good home cooking made a welcome change from the hotel menu. They even had an 8% lager to offer us! Next week the HTI students have exams so we won’t see them, but there is no doubt that the students enjoyed our input hugely, and the nuns were very grateful.
Alex took us to the local market this morning, it’s a huge, bustling African market selling clothes, food, kitchen ware etc. We bought African clothes and Ally bought her husband an unusual culinary birthday present (sorry, no details as it’s a surprise!) We had one or two persistent followers whom Alex took great pleasure in shooing off!
It was a great experience. Next Alex took us to visit his brother and many grandchildren in their toukle (traditional thatched hut). Their area is beautifully clean and well tended, with a small productive garden; the interiors of the toukles were cool and cared for. The grandchildren enjoyed the small presents we had bought, but there were few other relatives there as Alex’s uncle had just died and tradition demands that the family sit with the body for three days in his village a few miles away.
We had an African lunch, cooked by his niece, in Alex’s house. He was evicted from his previous home as GoSS had not paid the rent. Now he has an allowance to rent a very simple small house which he shares with his nephew. Water is usually delivered by a donkey, there is no shower and little furniture but for a couple of beds, a small table and plastic chairs. Consultants in Wau are typically paid the equivalent of only about £500 sterling per month, this is supported by some private practice
HFH
Friday 10 September
Sara and Mandy went back to the gynae and maternity wards this morning to continue their teaching, only to find that the nurses were so pleased with their efforts in completing the obs charts that they had taken them home! Not too much importance attached to data protection here! However, the teaching is progressing. A patient in maternity went into labour with a placenta praevia and her baby was born alive, sadly she was only 28 weeks pregnant and as there are no facilities here to support premature babies, the child who would probably have survived in the UK, later died, which Sara has found very upsetting
Frankie has successfully treated a sick child with status epilepticus and also done a presentation to seven of the doctors on status.
Ally and I did some teaching in the paediatric ward on observations, most of the nurses seem much more enthusiastic to learn this time than last November. They are probably learning that we won’t give up easily!
We have looked at the doctors’ quarters which are absolutely horrendous: the conditions are really appalling. Another building is being renovated for them which would be great, but as the contractors have been slow, the bills have not been paid so the work has stopped… stalemate!
I was delighted to see the baby I resuscitated on Wednesday being discharged with his mother. Alex insisted on sitting me in the local taxi with them to take our photos!
The teaching sessions with the nursing students at the catholic health training institute went really well and Sister Maria has invited us to supper tonight - a welcome change from the hotel food!
HFH
Thursday 9 September
It’s been a busy day, we’ve been out for 10 hours and worked hard in the heat and humidity. We always look forward to a shower when we get back but my trickle of brown water has turned into a brown drip!
We feel we have broken the ice with some of the nurses who have responded well to our teaching of basic observations in Paediatrics and Gynae, also basic life support in maternity. I think the watches and certificates we are giving the nurses are a good incentive! Maternity has been busy today and Sara and I saw a normal delivery - very different from Poole. Frankie has talked to the doctors about ITU in the unit and has also formed the basis of a small audit on the outcome of triage
At 3pm we went to the nursing school where Mandy gave a lecture on pain control to 16 students and we then taught them emergency scenarios, which they really loved. It’s been a very productive day.
HFH
Wednesday 8 September
The state minister of health, Dr Isaac Cleto Rial , arrived to greet and welcome us and invited us to visit him at the Ministry this afternoon.
It was a day of mixed successes; Sara has been trying to get the midwives to take blood pressures but they say the are ‘too busy’….but not too busy to sit about, chat on their phones, buy clothes from a passing salesman and have a sleep on a bed they keep for just that purpose! They seem to have made no progress with observations since our last visit, though they like the charts. Ally has been on the paediatric wards teaching physio, which was well received. Mandy and I had arranged to meet the matron but she didn’t turn up.
Dr Alex called me into theatre to watch him do a caesarean section, The tiny baby didn’t breathe when it was born and the midwife clearly had dubious resuscitation skills. I decided to intervene, positioned the head correctly and ‘bagged’ the baby. He soon began to cry so the midwife then picked him up by his feet and smacked his bottom! She was quite hostile towards me and it was clear she resented my interference, which probably saved his life.
At 2pm we visited his Excellency the new Minister of Health. We had a long and very productive, yet frank talk with him. He is also a surgeon and operates at the hospital once a week. He seemed an extremely nice man who we felt really has the needs of the hospital at heart. He has asked us to submit a report to him on our recommendations and ideas for the hospital. He is arranging for us to meet the State Governor.
After that I went back to the hotel to bed as I seem to have a stomach upset. The others went to the health training institute to lecture the nursing students on basic life support and fetal development.
HFH
Tuesday 7 September
Today started with bad news. A maternity patient we had seen yesterday with eclampsia post delivery had died during the night leaving her baby to be cared for by her family. There have been 4 maternal deaths here since Dr Alex returned from the UK in May. The good news was he had performed a successful ventouse delivery using the ‘kiwis’ we have brought with us.
We have all had a very productive day. Frankie has been in her element in the emergency dept where triage is now being performed very swiftly - we hope that our efforts last Nov have contributed to this. Sara is getting on really well with the midwives who want her to demonstrate a UK-style delivery! Today she diagnosed an unexpected breach baby. Ally has spent time in paeds and Mandy and I have spent time with the new matron, Rita, planning a training programme for the nurses. There are now 5 qualified nurses in Wau
Later we were welcomed by the nuns from the Catholic Health training institute whose building has been totally renovated since out first visit here, They can now take nursing students and we are looking forward to carrying out a training programme with them each day this week when we finish at the hospital
We feel its been a really productive day and we are encouraged by the changes that are happening in Wau. It's hard work and at 11 pm we are still working on tomorrow’s teaching plan and battling with mosquitoes which are having a great time biting us all despite sprays, arm bands and vitamin B!
HFH
Monday 6 September
Yesterday was a busy day with a tour of Juba Teaching hospital by Dr Louis Danga, the paediatrician who spent four months with us in Poole last winter. This was my third visit to JTH and there have been many improvements there in the last 18 months. Liz and Corby Gaere then joined us at our hotel for lunch. Liz works for UNDP as presidential advisor and Corby is a well known Sudanese musician, they have a home in Poole. Corby’s cousin is the state minister of health in Western Bahr El Ghazal so we are hoping to make contact with him.
Our flight to Wau today was in a 18 seater Fokker 228 which we shared with just 2 other passengers. We had an early start arriving at Juba airport just after 7am; the normal chaos ensued and although GoSS had booked our flights, we had no tickets so couldn’t get into the airport! We were very relieved when after a frantic phone call to Dr Loi, the GoSS administrator arrived and whisked us round the back with our luggage ( including quite a lot of excess baggage-kit for Wau) bypassing the normal queues and onto the tarmac where our plane was waiting to take off. It was a great flight which we all enjoyed
Arriving in Wau at 10am we were met by Dr Alex Bakiet (the obstetrician who spent 7 weeks with us at Poole earlier in the year) and had a very warm welcome from the other doctors at the hospital. We presented Alex with the ILS certificate he gained while at Poole and then made a guest appearance at a big nurses conference.
Alex then took us on a tour of the hospital. It was wonderful to see that since my last visit last November GoSS have stared to renovate the wards. New water supplies and drainage are being put in and the builders happily accompanied us on our tour, explaining what they were doing! Although behind on schedule, it will be a real transformation when it’s eventually completed and gives new hope for the hospital.
Back at our usual hotel, which is small and very basic (we are the only guests), we have had a huge and very long thunderstorm. We watched anxiously as the raging river rose rapidly up the steps outside. Fortunately the storm has now passed and we hope for a peaceful night, though the frogs outside are making an incessant racket!
HFH
Sunday 5 September
The team have had a hot and busy day today: a tour of Juba Hospital with Dr Thuou Apac (Gabriel), the Director of Clinical Services for the Ministry of Health, followed by lunch with Liz Gaere (UN) and her husband Ras Corby, who appeared on the UK national news a few days ago.
This afternoon they met with Dr Olivia Lomoro, the Under Secretary of State for Health in GOSS and Dr Loi, Director of GOSS. This was followed by discussion with some people from Medair, followed by repacking luggage to conform with the 15kg baggage allowance - all the supplies they have taken must go separately as cargo. Leaving for the airport at 7am Monday. Blog direct from Sudan tomorrow - if the local internet is working!
HFH
Saturday 4 September
The third team from Poole Hospital to visit Wau in Southern Sudan left Heathrow on Friday evening, and arrived safely at their interim destination at Juba on Saturday afternoon, having changed planes at Addis Ababa.
Team leader Hilary Fenton-Harris is on her third trip, while the others - Frankie Dormon, Sara Barton, Mandy Layzell and Allison Ahvee - are all first timers. They are safely settled in their hotel at Juba: the intricacies of putting up mosquito nets was an interesting and novel experience!
They expect to meet Gabriel (Director of Clinical Services for the Ministry of Health in the Government of Southern Sudan, GOSS) tomorrow morning (Sunday) and will be having lunch with Liz Gaere, UN policy adviser to the President. The final stretch of the journey consists of a 200 mile flight from Juba to Wau, and will hopefully be concluded on Monday, 6 September. Meanwhile, all are well, and will be sharing their experiences directly in the blog.
HFH