Poole Africa Link - Wau Blog November 2009
A team of four staff from Poole Hospital recently returned from Wau in Southern Sudan, where they learnt more about the needs of the hospital and provided support to the staff there as part of the Poole Africa Link.
The team is pictured right: (L-R) Elly Holyoak (community midwife), Vivian Maidment (paediatric nurse tutor), Hilary Fenton-Harris (PAL coordinator/Nurse) and Mr Peter Richmond (Consultant in Emergency Care).
We are looking for enthuiastic Poole Hospital doctors, nurses and midwives for the teams we hope to send out in April and October next year. If you have experience in obstetrics, midwifery, general nursing, theatres, paediatrics or emergency care, can committ to at least 2-3 weeks away and would like to know more, please contact Hilary Fenton-Harris on 01202 448182. We would also be interested in talking staff who could committ to a longer time in Wau in the future.
Read a series of blogs from the team below...
Monday 30 November
Our flight from Wau to Juba was uneventful with no stops on the way. After Hilary and Peter's lack of transport last week, Dr Gabriel came to pick us up personally from the airport. We were transferred back to the Juba Bridge Hotel, it appeared pure luxury after Wau (though I discovered later that the TV did not work and the shower was so bad that I had to use a bucket for a shower!) That evening we met up with some of the Isle of Wight Team who are working in Juba, we also caught up with James, Mat and Dario which was great. It felt like we were on holiday, sitting by the river Nile, having drinks and swapping stories with friends.
We had a lie in on Saturday as we were not being picked up till 12 midday by Hillary (logistic officer at GOSS) to go to the airport. Paperwork completed, taxes paid $65, we went through a very thorough check before being allowed to go through to the departure lounge, this is actually a large room with nothing except toilets in it. This is when we discovered that our flight was going to be delayed by 2hrs, so we spent a total of 3 1/2 hrs in a hot sticky room, with no access to buy any food or water. Luckily being true Brits, we had made some 'jam butties' at breakfast, so we had jam butties and bananas for our lunch there. We used our time waiting by getting started on our reports. Thank goodness for the netbooks.
We had a pleasant, quick flight to Addis Ababa and another 61/2 hr wait before our final flight. It was time for Christmas shopping - after not doing any shopping for the last 3 weeks, Elly and I made up for it by spending a few hours buying gifts for home, this was quite impressive as there was only approx 10 shops! After a bite to eat and a cup of coffee and cake, it was time to go through to Gate 5. We were informed that it was going to be quite full. While waiting to be called through to board, a group of men came through, one was a tall scruffy looking man who had a familiar face, after discussion with Elly we both agreed that it was Bob Geldoff; unfortunately, he disappeared into first class before we could ask him to support the Poole Africa Link. We boarded the flight just after midnight, and once taken off we were offered a meal (and to think we were worried about when we would have our next meal!) Luckily we both managed to get some sleep on the journey home. Then after a refuel stop in Rome, breakfast was served (04.30 English time). Guess what our option was... omelets, after having one for almost every day for 3 weeks, our reply was no thank you!
There was one final excitement when we arrived at Heathrow. Once we landed we were asked to remain in our seats, then two policemen arrived and walked down the plane and stopped in front of a couple, who then left with them before we were allowed to disembark. But all ends well and we saw the couple as we left the plane saying good bye to the police, it was a case of mis-identity. Elly's husband came to collect us from the airport, luckily with extra coats as it felt cold for us compared to the 36C we were use to 24hrs ago.
So 25hrs later after setting off from Juba I was back home and waving to Elly and her husband. It will feel strange not to be sitting on the Veranda having a drink and talking about what happened that day, watching the Herons coming to roost by the river. The whole experience has been an exciting adventure, at times it has been frustrating but very rewarding, it has taught me a lot about myself. I have learnt a lot about conditions that I have only heard about, but overall I have learnt about another culture, experienced a beautiful country despite its lack of facilities and made some friendships that I hope will continue for years to come.
Vivien
Friday 27 November
This will probably be the last blog from Sudan for this party. Yesterday was our last day at the hospital and Wau. I think I can say for the both of us that we were looking forward to coming home, but we are going to miss Wau.
Elly spent the morning in the Maternity unit, teaching the staff neonatal resuscitation and aseptic technique. She was pleasantly surprised when she found that the trolley in the Delivery Suite and been cleaned and that staff had completed the observations on the Gyne ward. As we have mentioned, training has to be done slowly and continually and hopefully the message gets across.
Yesterday my day was spent completing my final ward round with Dr Peter the paediatrician. It was rewarding to see a little boy who I had seen at the beginning of our stay in a coma from Meningitis and looked very sick, sitting up and sucking on a lollipop that I gave him. After doing some updates with Dr Peter, we went round the wards and I said goodbye to the staff I got to know very well over the three weeks. In the end when we were ready to leave there was no one to say goodbye to. Majok was in Juba, Peter and Alex had left already to check the manifest to ensure we would get our flight to Juba. Our driver came to pick us up and we left the hospital, I hope a little better then how we found it. With Sr Grace's students there we hope that they will continue with their good practice and the staff at the hospital will follow.
In the evening we were invited to dinner with Sr Grace and her team, they had cooked a feast for us. We were made very welcome, and Sr Grace kept suggesting that we would like to stay longer, or come back and stay a year next time and teach there! We returned to the hotel quite early, so we sat outside for a while enjoying the scenary and reflecting on the last three weeks. As per usual the electirc power went off during the night, luckily Elly and I were more organised then Peter last week and we were packed. I enjoyed watching my last sunrise coming up over the other side of the river. With their usual usual attitude, breakfast came too late, what would have done without our muesli bars? Thank you Hilary.
Alex and Peter came to pick us up promptly at 8am. At the airport we met two other doctors who were going to Juba on a course, so they kept us organised. The plane was prompt so with hugs and tears we said goodbye to Peter and Alex and boarded. The flight was uneventful until landing and taxing back to the airport and one of the wheels got stuck in a pothole and could not get out, so we had to get off and get transport to the actual airport. Gabriel was waiting for us and took us to our hotel where we are writing this, sitting under a mango tree looking onto the river. So for now it is good bye from Sudan.
Vivien
Wednesday 25 November
Today was yet another busy day, though for Elly the morning was uneventful as the doctors disappeared so she was unable to do any teaching. However, she did teach the paediatric doctors about newborn resuscitation before lunch. After lunch she had a very successful session with the theatre staff giving them the caesarean section equipment we had brought with us and going through how to set up the table for surgery. There were about 10-12 staff there and Alex the consultant was there translating for Elly.
I spent the morning on the children’s wards seeing the children with Dr Peter the consultant. Then the rest of the morning was spent teaching on the wards about hygiene and safety. We also gave a syphgmonometer and a glucometer (a machine to test blood sugar) to the adult medical ward. Peter came with me to translate.
This afternoon was spent at the Mary Help Clinic teaching the second year students on recognising the seriously sick child and breech delivery. The students were very enthusiastic on the practical experience of delivery of a breech delivery. We were given a rousing ovation at the end when we said goodbye and told us we had to come back. Sr Grace has invited us to dinner tomorrow evening and tonight we are going out with the doctors, so we will not be having any more meals at the hotel, hip hip hooray!
Viv
Tuesday 24 November
Another early start today and ‘Manuel’ was ahead of the game, our breakfast table was already out on the ‘veranda’ (concrete walkway) which is beautiful in the mornings being next to the river. Breakfast, which was luke warm omelette today (we have had this most mornings!) was ready. Our regular fisherman arrived late, but arrive he did.
Today as with most days, the hospital was surrounded by a haze of wood smoke, originating in part from the charcoal fires used by the many relatives to provide breakfast, and also from the clearing of leaves and other foliage from the external areas of the hospital. The cleaners or perhaps gardeners keep the grounds immaculate and are often seen sweeping the dusty floor. There seems to be increased activity at present especially around the maternity ward - perhaps a special visitor is coming?
We were very pleased to find that Margaret the head matron had arrived back from her visit to Japan, where she had attended a conference about public health and management and leadership. We were to meet with her later as first we headed off to the emergency room. It was in quite a sorry state as the dust is relentless and it permeates even the smallest crevices, also the sheets on the beds were soiled, but at least this is a good sign that the room has been used. We set to work and were joined by the deputy matron Jane and one of the nurses dedicated to today’s shift. We cleaned the surfaces and replaced the sheets; we also distributed the many supplies acquired from the stores. The nurses seemed very pleased with the supplies.
Vivien and I then went our separate ways. Vivien has achieved so much on the paediatric ward and finds that the TPR and prescription charts are used often; the staff seem to like this and are very keen on her teaching. Peter, the paediatric consultant, remains a most positive influence and he often translates for the teaching sessions.
I attended the Gynae ward to find the ward round complete and the doctors had left the students were there but as always they were very keen to attend theatre. The observations had not been done and I cajoled them into completing these, the students are very good at encouraging the staff. I attended the labour ward and no one was in labour, so we looked at the trolleys and beds (which were covered in blood) and we again discussed the need to clean. The sister Usunta said she would do this post haste!
In the evening we were again invited to the nuns’ compound where we discussed the needs of the hospital, as they are desperate to be involved . Vivien was able to wear her university hat! The meal was fabulous - almost a roast dinner with celery soup to start and home made ice cream. We think we may be in heaven!!
Elly
Monday 23 November
Today our breakfast initially consisted of stale rolls. We did eventually manage to get them to bring some processed cheese triangles which we supplemented with bananas.
First thing at work we went to the stores to see if we could get any equipment transferred to the Emergency Room. Unfortunately the fan that we hoped to obtain for the room was the store man's own property!
Elly then spent the morning in the maternity unit and theatres, teaching staff about aseptic technique and how to lay trolleys for surgery. I spent the morning encouraging staff to do complete observations and record them on the Children’s Ward, then teach them about health & safety and infection control as it is non-existent on the wards. The staff say it is a good idea, but whether they take up any of the suggestions we make is another matter.
Today I saw my first death. Peter called me to see a young girl who was very poorly and had just been admitted onto the ward, and was in severe shock. Despite attempts at resuscitation, we were unsuccessful. Though it was very upsetting, I am pleased that it has not occurred as frequently as I had anticipated.
After the hospital, Elly and I went to visit Sr Grace and taught sessions on asthma and pre-eclampsia. We have now just returned from dinner at the restaurant in the hotel, luckily all the rubbish has now been cleared away. Fortunately we have been invited to dine with the nuns tomorrow and with Drs Peter and Alex on Wed, which will leave us with the hotel restaurant on Thursday.
Vivian
Sunday 22 November
An uneventful, but very long and tiring journey back to Dorset. The logistics manager, also called Hilary (a man's name only in Sudan, which has caused some confusion) took our passports, tickets and luggage and attended to the necessary processes, passport stamping and form filling which accompany exit from Juba, and checked us in at the airport, returning shortly before our flight to collect us so that we could pay the $45 registration fee necessary to exit the airport and wait for our plane.
I did start to worry when he collected us an hour later than we had arranged, as we wouldn't have got far with no tickets or passports! After a 2hr flight we passed the 9 hour wait at Addis Abbaba, report writing, looking in the shops and chatting to an English group we had met on the journey out. The 10 hour flight to Heathrow via Rome was long and uncomfortable: we had seats that wouldn't recline (due to being against the loos) and Peter sat next to a man who took up a lot of space! My husband was waiting for us a Heathrow and we not only had a warm welcome from Sue Sutherland on the phone, but Dame Yvonne was at Peter's house to greet us.
It has been an amazing trip, very humbling and very, very rewarding. It's great to be home, but I'm already missing the hospital at Wau and of course, the endless sunshine! Watch this blog for news of Elly and Viv's continued activities in Wau - until their return on Friday. If you would like to donate, or fundraise towards future team visits to Wau in order to continue this vital work, please visit www.justgiving.com/pooleafricalink or email me hilary.fenton-harris@poole.nhs.uk (Poole Africa link coordinator) for further information. Many thanks
Hilary
Sunday up bright and early to attend the Catholic Church in the centre of Wau, we were accompanied by Peter and Alex. We were very lucky as the Bishop came especially for us (not really - he had just got back from a big conference and there were an estimated 2000 people there to hear him talk). We were regaled for the next four hours by many prayers and sermons in Arabic and much singing and dancing by the local children - all in all a most fantastic experience.
We then met a couple of very interesting nuns, one of whom gave us a tour of the cathedral which is truly beautiful, built by the Italians in around 1950 in a European style. There are many friezes on the walls and the alters are ornate in white marble.
We left the church closely followed by a procession of children who sang and carried a big drum on a bicycle which kept the beat, they were on their way back to their church some 2km away.
We were taken to Alex and Peter’s house to sit with the many tame pigeons which inhabit their mango tree and walled garden. We were served by Alex’s nephew a miscellany of local Sudanese delicacies which were all delicious. We talked at length about some of the problems we would like to address both in the coming week and over the next few years of the link.
We returned to our hotel and worked on some of our presentations for the forthcoming week.
Vivian
Saturday 21 November
This morning was luxury - having our first lie in since leaving home. Alex had invited us to visit his sister and family for lunch, so after picking us and Peter up, we drove to his sister’s going the scenic way, which is lovely but very bumpy. They have extended families with Alex’s sister living with her father-in-law, daughter and grandchildren. The father in law had brought the pound years ago so each of his children would have a plot. They live in Tuckles, which are mud brick huts. They have one, two or more rooms. The one we were invited to see was just one room but lovely and cool compared to the heat outside. It was spotless with bed, dressing table and a cupboard for one adult and three children.
We had lunch sitting outside under the mango tree tasting yet more Sudanese dishes, although Alex’s sister asked why we were eating children’s food, as this is what they normally give to their children. He explained that we wanted to sample all different foods. The afternoon was spent back at the hotel catching up on bits and pieces and coping with the daily power cuts.
We returned to the hotel to find Peter’s room occupied by two Lebanese men who had just arrived from Juba, where they own and manage a 5 star hote! They were a little surprised at our hotel which we affectionately refer to as Fawlty Towers complete with our manager (Basil) and the waiter (Manuel)! We were pleased to find out that the hotel had been recommended to them as the best hotel in Wau.
Vivian
Friday 20 November
We were sad to leave Elly & Viv in Wau but they will be well looked after by the doctors and nuns and have plenty to keep them occupied! We were seen off by Alex the obstetrician and James the Director General of the hospital, ensuring we were given seats in the VIP deaprture lounge ( a small office with some very old chairs- we were grateful as they general waiting area is not too comfortable).
Our flight in the small UN/WFP plane was uneventful but as our flight was late, our driver in Juba had given up and gone away! After some fruitless phone calls and waiting half an hour in the 40 deg heat we took a taxi, fortunately we were booked into the same hotel as on the way out. The Juba bridge hotel is quite 'luxurious' compared to the one at Wau; the showers work well (cold water only) with clean water intead of a brown trickle, the beds are new and comfortable, air con works, a fridge in the room and the hotel is well maintained and clean.
Apart from the creatures that tend to share the room - I had the usual bevy of cockroaches, a grass hopper, ants, a big beetle, and a small lizard, not to mention pesky mosquitos - it was all very nice and GOSS paid. The only real problem was lack of sleep - there are many mango trees around the hotel, my room had a tin roof and mangos fall regularly sounding like gunshot overhead! They are also pretty dangerous if they hit you on the head outside. Strangely although the food is good they dont serve fresh mango or mango juice!
In the evening we were visited by Dr Gabirel Loi, director of curative services for GOSS and the English doctors, James and Matt, working in Juba hospital. We were able to report the problems at Wau to Dr Loi eg lack of running water, blocked drains, no oxygen, poor condtions of bulidings/equipment etc, and we will be providing him with a written report of our recommendations. He told us a major refurbishment of Wau hospital is planned for 2010, we will wait and see!
Hilary
Friday was a sad day as we had to wave Peter and Hilary goodbye as they started the journey home. We then jumped into the transport and went to the hospital. As we had arrived a little earlier then usual, Elly went to the Gyne ward and encouraged the staff there to complete the observations on the patients before the doctors' round. She then did a couple of teachings on how to do observations and aseptic techniques to the students and midwives. During this time I joined Peter the paediatrician on his round then went to Ward A, the paediatric ward which I have been working and training on. I was delighted to see that they had completed observations on the children with high temperatures, and not only that but the doctors had used the prescription charts that I was trying to encourage them to use, instead of the bits of paper they tended to write on.
Later Elly did some training with the midwives on how to set up the trolleys for normal deliveries focusing especially on hygiene. After she did a tour of the outpatients and was pleased to see that the emergency room was being used. While I taught the nurses and students about basic life support and how to use an ambu bag.
That evening it was not the same returning to the hotel - we did not even have our daily shandy!
Vivian
Thursday 19 November
Sister Maria from the Sisters of Solidarity picked us up at 4pm yesterday and took us to the market. It is a big, permanent market, lots of shacks stuffed with everything from shoes to fish, meat, spices and pans. Very noisy and a bit scary, I kept close to Maria who seemed to know every stallholder: definitely not a place for us to go alone!
We then went round the Health Training Institute; this building became derelict during the war, but the nuns are having it renovated for their nurse training school. This is a huge undertaking, but they have made progress since my last visit – Sister Maria is a very determined lady. We enjoyed a good supper with the nuns: they told us there had been an intruder in their grounds the night before - a naked man who seemed to have caused them more amusement than fear and who was sorted out by their security guard.
Another hot and sunny day today, and this morning we've been doing some stocking of the emergency room - the hole in the floor has been filled in!
We noticed a man plastering a wall opposite the hospital and I persuaded one of the hospital workers to ask him to fill the hole in. He did this very well and was delighted with his tip for doing it. Things move slowly here, and I’m unsure if it would have been done once we go home.
There have been two maternal deaths here in the last 48 hours, there is nothing we can do to help in these situations. Two emergency caesarean sections took place this morning and Elly was the scrub nurse for one. She's trying hard to improve some of the current midwifery practices, but it is a very hard job. As I write this in the resource room, Peter has been here teaching his loyal group of nurses; these have been replaced by three house officers. Initially he found it difficult to get them to come along, now we are going they are realising they will miss some excellent teaching! Viv has been busy teaching on the paediatric wards as well as seeing one of the caesareans. At 3.30pm we will go to teach the keen student nurses at the catholic clinic, today it's obstetric emergencies and triage. We hope they have made more cake!
The roads here are pretty bad, all dirt tracks and some VERY bumpy, whoever is riding in the front has to shout out to those in the back when we approach a very big hole! Fortunately we are in a big land cruiser which can cope with most things. The driving is crazy and we've seen many near misses. Yesterday a girl was knocked down by a taxi (little three-wheeler known as an 'amjat'), she seemed ok, but it's no wonder there are so many serious RTAs.
This will probably be my last blog from the Sudan, as Peter & fly back to Juba tomorrow morning; I’m not sure of the time, someone has to check the 'manifest' (a list pinned up at the airport) this evening to find that out! We hope to see the Director of Curative Services for GOSS in Juba, also to meet up with James and Matt again (the English doctors working in Juba hospital). We fly to Addis Ababa Saturday morning, have nine hours to wait in the airport there and at midnight (9pm UK time) fly to Heathrow via Rome. Viv and Elly will be here for another week, and will have plenty to keep them very busy, though they hope to manage to blog sometimes.
I will be happy to be home and see my family, but I’ve had an amazing time here, and will really miss these lovely people and being able to make just a bit of difference to the hospital at Wau.
Hilary
Wednesday 18 November
Last night two of the consultants took us to an Ethiopian restaurant. It was in the garden of one of the patients. This was an amazing experience and we enjoyed great food.
This morning I’ve achieved quite a lot, having completed the sorting out of the emergency room. The sink has been emptied but more dirty water is coming up it again, so it’s still not useable. The live electricity has been cut off and we are trying to get a safe supply installed. We will put drips and other equipment in there tomorrow. There is still a big hole in the ground and Peter wants cement from the market to fill it in! He’s been teaching most of the morning and is still working on his prototype splints - there are none in the hospital at all!
Elly has got the student nurses and deputy matron to clean up the delivery area, they’ve made a good job of it. Elly and I were called to theatre to see a caesarean section of a woman having her 11th child, a girl who was very healthy. I was told some people here have 18 pregnancies!
Viv has been to work in the wonderful clinic run by Sister Gracey; if only things were more like that here. Still, her student nurses will be an asset to the hospital.
When we finish here today we will go to see the nuns (Sisters of Solidarity) at the Health Training Institute. They tell me their building work has progressed since we were last here in April, and they hope to open their registered nurse training school next year. We are hoping their home made cake will be as good as at the Catholic clinic!
Hilary
Tuesday 17 November
Another busy day today. Peter has a loyal following of nurses who have become very keen to have his teaching, and he and Viv have spent some time teaching three paediatricians on the recognition of the sick child. The nurses are delighted with their certificates of attendance and RCN pens! Viv is learning lots from the paediatricians too. She has introduced a fluid balance chart to the paediatric wards and we obtained two big clocks with second hands from the market (the only two clocks available in Wau which cost us 50 Sudanese pounds, about £12 sterling) to ensure the nurses have no excuse not to take pulses!
There are no splints here so Peter and Dr Alex set about making them from old pieces of wood!
Elly has spent time on the labour ward and my task today was to take a video. When I arrived on labour ward a patient was about to deliver, so Elly and I witnessed that. The management of the labour and infection control was pretty awful, however I did get to video the new baby.
While I was videoing in the grounds I noticed a lot of armed policemen around, so hastily put my camera away as although we can take pictures freely in the hospital, the police and army are very sensitive where cameras are concerned. I later discovered that the police had left the body of a murder victim on the ground outside the mortuary, so there was quite a lot of fuss over that! Apparently there is only room for one patient in the mortuary and no refrigeration. The deceased are taken straight home by relatives unless the death is suspicious.
Peter gave the presentation on his ideas for triage to James, the Director General, who seemed responsive.
The cleaning in the OPD started off well this morning but seems to have been abandoned, and the blocked up sink is still waiting for attention.
At 3pm we went to the Catholic nurse training school where Peter and Viv took two groups of student nurses through paediatric resuscitation (with scenarios) while Elly and I taught normal labour. I haven’t taught on that for many years and it was a lot of fun, needing a lot of actions to assist with the language difficulties. These students will make a huge difference when they work in Wau hospital.
We were rewarded with coffee and delicious home made cake!
We are treating the doctors to a meal out tonight…destination unknown, meanwhile Peter is going to clean out the lizard droppings from his sink!
Hilary
Monday 16 November
We had our usual 9am meeting today, this time the hospital director Dr James Okello Morgan was present. We were delighted to find that a group of second year student nurses from the Catholic clinic and nurse training school run by Sister Gracey and the Salesian sisiters have arranged to work in the hospital in the mornings. This will be a great help to us, as they speak some English and are motivated, bright and enthusiastic.
Peter spent the morning teaching triage to the nurses. The medical officers didn’t turn up for teaching as they are so demotivated , they haven’t had their incentive pay for two months, in contrast with the doctors in Juba. We will be discussing this with GOSS in Juba on our return. Viv was teaching on the ward round on the paediatric wards.
I spent some time talking to the hospital administrator/finance manager who is also a dental assistant. We are still trying to get him to get the cleaning completed in the emergency room, unblock the sink and sort out the live electric cables…it may happen tomorrow! I did manage to get hold of some new sheets for the emergency room and much needed sharps boxes, which I distributed to the wards.
Elly and I, assisted by the new nursing students, had a productive time teaching BP and temperature recording in the gynae ward. We’ve given one of the doctors money to buy ward clocks, so they have no excuse not to take pulses!
Six patients returned from theatre, and recovery took place on a blanket on the floor, so they wouldn’t fall out of bed!
We are frustrated at times by the general apathy and lack of motivation here and the time it takes to get anything done!
This afternoon we visited the amazing Sister Gracey, probably the most inspiring person I have ever met, who runs the excellent ‘Mary Help of Christians’ clinic, a registered nurse training school and a general school for 1800 pupils which we also visited. The contrast to Wau teaching hospital is huge, everything being very clean, organised and an inspiration to see. We have agreed to come here tomorrow afternoon to teach, and then will be working with Sr Gracey and the students to improve the ‘flagship’ areas of Wau hospital. This is a great encouragement to us as the task is so huge.
We’ve had a very hot ten-hour day today but still have to find the energy to dispose of cockroaches before supper!
Hilary
Sunday 15 November
We were taken to the Dinka tribe’s church service by Dr Majok Ruom, the medical director, himself a very tall Dinka. Outside we were greeted very enthusiastically by many of the children from the Sunday school. The three-hour service was quite an experience: very lively, very happy and a sermon translated for us by an energetic preacher who leapt around all over the place!
We were asked to speak so Peter and I addressed the congregation of nearly 500, and the team received much applause and had to shake nearly everyone’s hand afterwards! The Sudanese are very big on handshaking.
We came back to our hotel to meet with some of the nuns from the Health Training Institute and a lady from a UK aid charity.
The doctors then took us out to Bussera, a remote village about eight miles away, which necessitated a hot, bumpy ride. Everyone there lives in the traditional toukle, a mud and wood hut, many adults and children came out to shake hands and greet us. We saw a new bridge being built following the war, also much of the surrounding countryside. We were unable to take many pictures though, as the area has a strong military presence. We were then taken to lunch in a local restaurant. They are taking very good care of us and are really appreciative of all we are trying to do. Their gratitude is constantly humbling.
Dr Majok told us Ellie would be worth a dowry of 200 cows here; Viv is worth 150 cows but I’d only be worth 50 and that’s only because I can cook! The younger and taller a woman is, the more value Dinkas attach to her worth, apparently!
We seem to have adjusted to the discomforts and inconveniences of life here: the frequent power cuts, lack of air con, basic conditions, the cold trickle of brown water that is the shower, no towels and very annoying bugs. The heat is hard at times especially when we are working. Our compensation is in the spectacular sunrises, the bird life (kingfishers, herons, vultures and kites), the big lazy lizards lying in the hot sun and the fire flies that light up the darkness like fairy lights. Our welcome by everyone is so humbling and we are beginning to feel rewarded too as we make progress in the hospital.
Hilary
Saturday 14 November
We decided to spend this morning cleaning and preparing the room we want to use as an emergency room in OPD. We managed to obtain a roll of gauze and some cleaning fluid, but there was no water in the hospital this morning!
Eventually our water arrived from the Nile in a big barrel pulled by a donkey!
We spent the morning assisted by two consultants and a deputy matron washing and scrubbing walls, floors and equipment, though I think the Wau staff think we are completely mad at times! I don’t think any of us have ever had such a cleaning challenge - it was incredibly dirty and very hot, very hard work. Next week there will be more to be done and we will stock up the room ready for use.
After a much needed shower we were taken to the market to buy some shirts en route to the house where the gynae and paediatric consultants, Alex and Peter, live. We sat in their garden under the mango tree and enjoyed an excellent African lunch made by Alex’s niece. We are constantly being made very welcome.
The other highlight of the day was being given new toilet rolls. Two of us also got clean towels, though as the hotel only appears to have six towels the other two will have to wait until they dry; they were eventually given a table cloth instead!
Hilary
Friday 13 November
6am
We are still trying to adjust to the pace at which things move (or don’t move) here. We are collected to go to the hospital at 9am and they want to take us back to our hotel at 3pm as the senior doctors all finish then, we have so much to do and want to keep working! It's Friday today which they tell us is half day, that will mean the resource centre, our only internet access, will close at lunch time so I'm writing this on a memory stick at 6am to make best use of the time at the hospital today - I then hope to send it during the morning if electricity permits! We’ve had lots of power cuts and thunder storms so torches at all times during hours of darkness are a must - it's very dark here but the glo worms are amazing!
Yesterday Peter spent some time teaching 1 to 1 in the OPD emergency dept with the house officer, which was really appreciated. This morning he will give a presentation to the senior doctors on his views re the future organisation of the dept, assessment and triage etc. Elly and I are off to the gynae ward again in the hope we can develop it into a ‘flagship ward’. We want to get the nurses doing basic observations in the morning and other basics such as changing dressing. The gynaecologist is very keen for this to happen. At present nurses traditionally site venflons, put up drips and give medication, little else and no documentation. The relatives who live in the grounds nurse and feed the patients, supplying the food. Nurses and midwives in the UK work far harder - but then they get paid regularly. Viv has spent quite a bit of time on the paediatric wards where she is also trying to set up a ‘flagship ward'.
Yesterday we did a major inspection of theatres with doctors and a GOSS official in preparation for the IOW surgical teams visit. We will go back today to see what has been done so far!
12 noon
A g ood morning! Peter's presentaion went well and it's been agreed he'll start teaching the junior docs triage next week. We have identified a room in OPD which they have agreed we can turn into a room for sick patients to be examined and treated prior to going to the ward. They have cleaned it (sort of) and we have identified lots of kit in a big store which they will let us use in there, we just need to get it released to us and we will set the room up. Quite an exctitng and productive morning!
Hilary
Thursday 12 November
I have managed to get my netbook plugged in to the Resource Centre, which is a great help as I no longer have to contend with Arabic computers and Keyboards! It’s still very hot in here, although the air conditioning is working now (sort of). I spent much of the morning in the theatres on Infection Control Patrol. We brought up the subject today; the Isle of Wight team are about to visit us to do some surgery, and we made use of their forthcoming arrival to push hard for some radical improvements. I covered most of the nooks and crannies, making frequent comments and suggestions, and now there is a plan to try and get some of it sorted out. The theatres need a good clean and paint, accumulated rubbish and old equipment needs to be disposed of, and the windows need to be repaired. Hopefully some of this may now take place.
We are targeting the gynae ward and a paediatric ward in order to make them ‘flagship’ wards as an example to the rest of the hospital, beginning by trying to get the nurses to do obs and chart them at least once a day. Currently the only documentation is a small piece of paper which the doctors write on. It’s a very difficult process to change things: most of the doctors are very keen, but the midwives and nurses seem to prefer resting! We are starting our teaching programme today – hopefully. In this kind of situation no plans are ever definite until they are fulfilled!
Hilary
Wednesday 11 November
I’m writing this in the new resources room at Wau Hospital: they have five PCs donated by the UN, and there is great demand for them – it’s difficult to find an opportunity to use one. It’s also difficult because the keyboard defaults into Arabic, and even when I can get Latin script it wants me to write from right to left. It’s very hot and humid in this room – 32degreesC – as all the fans are broken.
I can now give you a few more details about our flight from Juba to Wau. I was delighted to meet Sister Esperance at Juba airport: we have been emailing regularly since January, and met during our April visit.
Our flight, due at 8am, eventually left at 10.30am in a De Haviland Dash 8, it seemed okay until we landed at Rumbeck with engine problems – apparently they had been trying to repair it for days and this was its first flight! We piled off the plane into intense heat, and were shepherded into a pen with tin roof and wire sides known as the Check-in Lounge: from here we watched our luggage being ferried to and fro. We were able to get some water, but nothing else. Some people had been waiting in this shack since Saturday for a flight to Juba – 100 miles – the roads are now too dangerous to travel on. We were lucky: we were able to leave in another plane for Wau after an hour, leaving the passengers for Juba still waiting hopefully.
Back to the present time.
Yesterday afternoon we went around the paediatric wards – lots of sad and unusual cases. We also visited the surgical ward and the maternity department. Peter and Viv spent some time in the Outpatients emergency department: this nearly caused a riot as they picked the most acute cases for Peter to see – no triage here!
This morning we met with the doctors again, then Viv, Ellie and I met with a social worker and Deputy Matron: language presented a problem as sometimes they gave the impression of understanding when they really hadn’t a clue. Following this, Alex Bakiet and I went to the airport the four bags of medical supplies which had come in as cargo: it was released to us after waiting for about an hour and a half. We are so pleased it has arrived.
Our next job is planning our teaching programme. We have a problem in that the government has decreed that all government employees must register for next year’s elections in their home towns within the next week (shades of the Christmas story here!) so most of the doctors will disappear. Fortunately Alex was born in Wau so will be with us all the way.
It is so very hot, none of the air conditioning is now working, we have had another flood and lots of powercuts. There is so much to do here, and I wonder what we can achieve of lasting value in the brief time that is available to us.
Hilary
Tuesday 10 November
When we eventually arrived in Wau, we had a wait a while for our transport, as the reception committee had arrived at the expected time and gone away again. We were greeted enthusiastically by Dr Alex Bakhiet, and were confronted immediately by a TV crew demanding an interview. This we did, and a reporter has been following us around ever since! We were taken to Wau Hospital where, with great ceremony (typically Sudanese!) we met various doctors led by Dr Majok, Medical Director, on behalf of Dr James Okello Morgan, who is also in Wau at the present time.
We were taken to the Regency Hotel – the same hotel we stayed at last time – where we were not surprised to encounter a few problems. The usual trickle of cold water from the showers was expected, but I had a flood in my room caused by a faulty air conditioning unit. This not only flooded the floor but also leaked into an electric point! Elly then had a flood, and Peter’s aircon didn’t work at all. We have had two power cuts since all this – again, typical of the Sudanese system. The hotel staff eventually mopped up my flood, and promised to get the aircon fixed today (perhaps). The night was extremely hot without any air conditioning, although I was supplied with a very noisy fan which tried to impersonate a jet engine!
Nothing moves fast here, but we are being made extremely welcome by everyone. Today (Tuesday) after the usual breakfast of dry rolls, jam, cream and processed cheese we were picked up by our driver for another welcome meeting at the hospital. We have spent the morning going round the hospital: outpatients is very busy as usual, but the wards are less busy than when we were last here. We plan to start our teaching programme soon, but need to do some practical work and observations re the care in various departments first. We are hoping that our baggage with medical equipment and teaching aids will arrive from Juba soon.
Hilary
Saturday 7 November
After an uneventful but tiring flight, we landed safely at Juba via Addis Ababa on Saturday morning. After settling in to our hotel, on Saturday night we met with Dr Gabriel Loi, Director of Curative Services for GOSS (Government of Southern Sudan) and Victoria, the director of Nutrition for GOSS. We had some good discussions with them and James and Matt, two British doctors currently working in Juba.
On Sunday morning we were shown around Juba Hospital by the British doctors and Anna, one of the Sisters; we were able to talk to Dario, Medical Director of Juba Hospital. On Sunday evening we met with Liz Gaere, Senior UN representative and her husband, who works in Wau. Today, Monday, we expect to be flying to Wau, although the timing of the flight is, at the moment, uncertain.
We are a bit concerned about the medical supplies we are carrying with us, as at present we can get no definite information as to how we get them to Wau. Look out for the next blog, by which time we hope the problem will be resolved!
Hilary