Poole Africa Link Wau Blog May 2011
Monday 16 May
And finally...
We arrived home yesterday morning (Sunday) after a long but fairly uneventful journey from Juba via Nairobi, where we had a fairly tolerable six hours having a bit of much needed retail therapy in the duty free shops. Frankie did most of her Christmas shopping; at least that’s her excuse for Jamie!
While waiting to go to the airport on Saturday, we took a boat trip down the Nile for an hour which was a very pleasant end to our time in Sudan.
This trip hasn’t been easy in many ways, we’ve had highs and lows and some big challenges. It was frustrating loosing two days at the hospital on Wau, at the beginning being held up in the relative luxury of Juba for a day, and wasting a day in the airport last Thurs for the plane that didn’t fly.
When we first arrived at Wau hospital, we were told by the Director General that there had been big trouble over the weekend. A child with meningitis had died on the previous Friday following administration of antibiotics, and the family had come to the hospital armed with guns and spears intent on killing the nurse and doctor who they held responsible. This resulted in the closure of the hospital with all staff being sent away and the hospital had only just reopened and was eerily quiet on that first day.
The poor nurse was put in prison, partly for her protection, and her family relocated. We haven’t heard the results of the blood tests which were sent to Khartoum, and they don’t perform post mortems in Wau. During our visit there was a reassuring armed police presence around the hospital. Sophie and I were able to use this example when teaching the nurses, to emphasise the importance of good documentation and record keeping which just doesn’t happen yet.
Another day saw many wounded men brought in for surgery as a result of a tribal fight outside Wau.
There have been some major improvements since our last visit: triage is happening in the outpatient/emergency dept with children being seen in a separate room, the new outpatients is almost ready to open, the patients are in the newly refurbished maternity, gynae and one paediatric ward and the generator seemed to work most of the time. There is still no running water and the drains remain blocked but a committee has been formed to try to resolve this. A new air-conditioned minibus has been provided by GoSS to transport doctors and our team. The midwives are at last using a partograph to record progress of labours and the beds the midwives used to rest on have been removed (though they are still to be found in other areas)
We have been a great team and have had some fun, we have all played our part in making the trip a success despite the frustrations. Everyone on the team is keen to go again despite the challenges which we have tried to turn into opportunities.
Hilary
Friday 13 May
Last night we had a lovely supper followed by a show organised by the Sisters and students of the CHTI. They performed various African tribal dance acts, stand up and finished with a comic African performance of the life of Florence Nightingale – to celebrate Nurses Day – hugely entertaining. Hilary and Frankie also performed a fantastic rendition of ‘Oh wouldn’t it be lovely’ which received many whoops and cheers.
Today has been a day of two halves! We spent the morning back at Wau airport, awaiting news of our flight which was still waiting for the tyre to be fixed. We had some anxious moments when the luggage seemed to have been abandoned in the waiting room! Then a plane arrived from Khartoum and the vital piece appeared to have been delivered. However, after much greeting amongst the crew not a lot else happened. Eventually, our baggage was transferred onto the new plane and we were allowed on – fingers crossed – then the plane taxied down the runway and we were off to Juba!
We were met at Juba airport by Hillary Iomilia from GOSS and were quickly transferred to our accommodation at the Oasis - familiar ground. We had a quick lunch and then went to a market in Juba – John the driver was our body guard. We perused many stalls and items were purchased, much to the amusement of the locals. One local stall holder benefited from us trying on almost every dress in his shop, but his patience enabled us all to leave with a new purchase which we are all sporting this evening.
This evening we were greeted by the Mayor of Juba just prior to Hilary and Frankie interviewing another four medical officers with a view to them coming to the UK for experience, two of whom had flown especially from Khartoum.
We are hoping for a trouble-free journey tomorrow.
Sophie
Thursday 12 May
Probably the most frustrating day yet! We were all disappointed to be returning to Juba a day early and missing Nurses’ Day, but were hoping to join in the celebrations in Juba. We arrived at the airport just after 7am after the usual chaotic and bustling check in accompanied by Alex. We waited and eventually got onto the plane, only to be turfed off again due to a flat tyre which we were told would be fixed in 10 minutes… 10 Sudanese minutes!
A UN truck arrived and about 20 men crowded round to examine the tyre. Alas after an hour we learned that they didn’t have the necessary valve to do the repair and a plane was leaving Khartoum to collect us – but this took a while to organise, and as Juba airport closes at 4pm we were eventually told at 12.30 that we could not fly today. After 5½ uncomfortable hours sitting on the dirty concrete outside with little water and no food and terrible toilets (fortunately today was reasonably cool) I called Alex who came to pick us up.
The highlight of the wait for me was when Dr Majok’s wife, Alex Bol, came in a little Ruchsac (taxi) and managed to get into the airport to bring us some presents. I then spoke to Majok on the phone, he is delayed in Khartoum due to more flight problems.
We retrieved our luggage with great difficulty, as they wanted us to leave it on the plane; and then there was the problem of accommodation. We had met a very nice American (who Sophie formed a great rapport with!) who suggested we try the Juba Bridge Hotel which has clean water and a swimming pool! Having checked out their prices we opted to come back the Regency Hotel who were delighted to greet us and the manager has given us all presents of honey and some big bottles of water to have a wash in! So we’re having an early beer to raise our spirits in the middle of a huge rain and sand storm outside.
The Nuns at the CHTI are delighted that we can now attend 6 o ’clock mass and enjoy a meal with them and all their students tonight.
Alex translated my Nurses’ Day speech into Arabic and read it out at the celebrations this morning. We have now been asked to make a formal speech to the nursing students tonight.
Let's hope tomorrow is kinder to us and that we get home safely on Sunday without too many more mishaps!
Hilary
Wednesday 11 May
We are feeling really disappointed today as Friday’s flight to Juba is full (did somebody forget to book in time?) so we’ve been booked on the early flight tomorrow… let's hope we don’t miss it like last time! This means we will miss the celebrations for Nurses’ Day in which I was due to make a speech in front of the State Minister for Health, Governor and TV. I’m really sad to have missed this opportunity but Dr Alex will read my speech for me. So we will go to Juba Hospital on Friday and I’m sure they will be pleased to have Claire back again to do some sonography.
Despite a lot of nagging I’ve failed to get anybody to get some wire to attach the bins around the hospital but they assure me it will be done!
Sophie has done some teaching on the paediatric wards where the nurses were very receptive, and Frankie has continued to teach some of the doctors. Sophie and Frankie were called to the emergency department where they fashioned a cervical collar out of plaster and tubigrip for a woman with a neck injury.
Claire and Sally have been doing some work at Sister Gracy’s clinic and we are about to go and do some teaching there.
Tonight Alex is taking us out for a farewell meal at the local Ethiopian restaurant where we went on the last visit, which we are all looking forward to.
Hilary
Tuesday 10 May
Today we’ve had a productive day and achieved quite a lot!
Sally went to an ante-natal clinic with Leah, a UN midwife, which she found encouraging as women were receiving some ante-natal care and screening. Then she went back to the maternity department and observed several births, unfortunately there was a stillbirth of twins. Alex, the consultant obstetrician was also upset this morning as a baby died due to cord prolapse – a condition which could have been appropriately managed in the UK.
I did further teaching on the wards to promote the importance of observations and the recognition of the deteriorating patient, and then saw the new outpatients/emergency department and what was planned for it.
Claire has had a very productive day today, observing and instructing the doctors in ultrasound, scanning the gynae and obstetric patients.
Frankie had some difficult discussions with the contractors in outpatients but they have now started to clean up what will be a purpose-built outpatients and laboratory facility. She and Hilary also interviewed more doctors for possible attachments in the UK and gave a well-received lecture in communication.
Hilary had a frustrating start to her day, battling first with the need for observation charts, which had not yet been copied, and the lack of availability of anyone to take her to the market to buy dustbins to tidy Wau Hospital, despite several promises. After some persuasion, and an hour later, the charts were copied and Frankie and Hilary were taken to the market where they bought six dustbins. After some bargaining they got them for SDG 180 (about £7.50 each). They caused great amusement to the stall holders on the treacherous journey back to their transport in a big rain storm (the rainy season has started with a vengeance) carrying the bins with the lids on their heads!
They also visited Dr Majok’s family in their home, taking gifts. Majok is away at present.
Hilary, Sally and I visited Sister Gracy’s Nursing school to teach, whilst Frankie and Claire went to Sister Maria’s school (CHTI). Very different experiences, as the students at Sister Gracy’s struggle to understand English as well as Sister Maria’s due to a very different level of education, but they seemed to enjoy the teaching anyway.
We enjoyed some delicious home cake at Sr Gracy’s however!
Great news upon returning to the hotel, the electricity is back on mains and the air-con is now working in Frankie and Sally’s room (the rest of us hope they get hypothermia)! Mine and Claire’s room blows out warm air so have once again been turned it off and alas, Hilary has none (although all the innards are under the bed and they still try to get it working without them!) It's cooler now after the rain.
We all feel we have had a productive day and look forward to tomorrow!
Sophie
Monday 9 May
A day of mixed successes and frustrations. Sally has made good progress with the midwives, teaching them neonatal resus, which some of them remembered from our last visit. Sophie has also had some success with teaching observations on the wards.
Claire had the usual motley bunch of patients needing scanning, while Frankie’s doctors turned up 1.5hrs late for their teaching - time keeping is not one of the best points here!
Frankie and I have paid a visit to the out-patient emergency department – the contractors are not in a hurry to complete and hand it over (we think a couple of them are living there with their families)! We have arranged to pay for some cleaning ladies to clean the outside waiting area so it’s smart for Nurses’ Day on Thursday. This seems to be a bank holiday, with processions and speeches (including one from me!) The State Minister of Health and the Governor will attend; I’ve been told, though, that the nurses will not attend for teaching that day!
I am very disappointed with the pace at which thing just don’t happen. Last week I asked for observations charts to be photocopied – the wards have none - and this still hasn’t happened! The grounds are very messy with lots of litter around. I’ve suggested big bins to be installed and emptied regularly and said I would go to the market to buy them. Tomorrow I hope that Alex will take me there as he too wants to see things improved. I’m using the importance of Nurse’s Day and the visits of dignitaries in the hope that I can get this improvement by then. They will all be glad when I go back home and stop nagging!
Many hospital staff seem to arrive about 9.30am and go home at 2.30pm. It’s very frustrating, one of the points in my speech on Thursday will be to emphasise that in the UK nurses work 12-13 hour shifts!
Today we went back to the CHTI after finishing at the hospital, teaching the students there - it’s encouraging as they are enthusiastic and receptive.
We came home in a huge and dramatic thunderstorm, the rain was so torrential that we got soaked to the skin just coming from the transport to the hotel!
There is yet another power cut, it's surprising how quickly you get used to a shower (under the trickle of brown water that’s re-established itself) by torch light… it all seems so normal now!
Hilary
Sunday 9 May
Alex asked us to go with him to the big Catholic Church he attends and picked us up at 07.45am. It was fairly traditional, not as lively as the services in the Dinka church I’ve attended but the church was packed and the people enthusiastic and friendly. He then took us on a trip around the outskirts of Wau before we came back for a very late breakfast.
We have had the most amazing afternoon with Sister Esperance who drove us on the rutted tracks to rural Agok – a very poor village which houses a farmer and an almost deserted leprosy hospital. There are still a few patients camping out there receiving treatment from two volunteers from Uganda, working for a local NGO ‘AAA’. It was interesting to meet a young man with leprosy and a young woman with Noma (facial disfigurement due to malnutrition). We had a good look around and saw an old shoe factory abandoned in the war but with all the tools scattered on the ground.
The dilapidated hospital buildings form a playground for hordes of happy young boys who followed us constantly demanding their photos be taken – we soon ran out of sweets. The people there are very very poor, few of the boys had shoes, most wore dirty rags, many young children were naked. It made us realise not just how privileged we are in our lifestyle in the UK but just how very privileged those who visit Wau are to have such amazing experience of a different lifestyle and culture. None of us would experience this without our commitment to the link.
We drove back through a torrential rain and sandstorm which made an interesting journey!
Saturday 7 May
A bad night as no power since 1am due to broken generator AGAIN! So it was incredibly hot and stuffy and impossible to sleep. The good news is that we are all feeling well today and all attempted to eat our breakfast of omelette, processed cheese, jam, cream, marmite and rolls (actually fresh this visit!) Our lovely waiter appeared proudly resplendent in an airline captain uniform having been promoted to the hotel ‘captain’. We now call him ‘Captain Raphael’.
We’ve had a great day today. Alex first took us to Wau market, an amazing, busy, noisy, very African experience, where we were the only white people and attracted some friendly attention. We bought some spices, mangos, tailor-made shirts and a very expensive battery for the oxygen concentrator. Alex has a very large extended family and we drove out of town on the rutted tracks to visit his family and friends living in clusters of immaculate touckles (traditional mud and straw huts).
We were welcomed by hordes of excited children and distributed small gifts, balloons and whistles causing great excitement and noise. Alex’s niece provided an excellent traditional lunch cooked on a charcoal fire which we ate and enjoyed in one of the touckles.
After visiting another set of relatives and Alex’s home we returned to our hotel and enjoyed standing outside in our first rainstorm in Wau which was a refreshing experience after a very hot day in which we have had the most amazing experiences and very warm welcomes.
Hilary
Friday 6 May
The morning started with an official visit to the state Minister of Health Dr Isaac Cleto with Dr Alex and the Director General of the hospital, Dr James. We had a very warm welcome and the opportunity to discuss various issues and concerns.
Back at the hospital, Sophie made good progress on the wards. Sally and Sophie saw a ‘normal’ delivery Wau style, Frankie continued with her teaching, getting 20-30 doctors and student doctors in her audience. Claire was kept busy carrying out ultrasound on the many patients queuing for diagnosis.
I think I must be nagging a lot to get things done – Alex and James have told me I can be in charge of the hospital and do whatever I like!
I did manage to find an old screen, obtain some new sheets from the store and safety pins from the market, which was a major triumph as now the maternity unit has a screen! (The one I got them last year disappeared in the ward move). All examinations and procedures to the women in labour take place in front of the rest of the ward including any visitors! The staff were pleased with the screen and we hope will use it.
We had a visit from Naomi Pendell, a very brave young English teacher who has been working in a school in Warrap state – about 2 hours journey away – for the last 18 months. Naomi and I have been emailing for a while and it was very good to meet her.
One big improvement in the hospital is that food is now provided for patients. Deciding I must be Hillary Clinton, the catering manager gave me a tour of the kitchen and stores (housed in the old doctor’s mess). The food looked good, menus based around rice, bread, chicken stew, lentils, broad beans and tinned tomatoes. I was quite impressed.
The big store which serves primary care had lots of bicycles and mosquito nets, we think brought by UK donors – waiting to be distributed to the villages. Things do not happen quickly though, so I hope someone is taking ownership for organising that.
Frankie has been lobbying the Southern Sudan Minister of Health Dr Luka and the undersecretary Dr Olivia to get the new outpatient/emergency department opened. It is almost finished and we want to be able to assist and influence the setting up. She heard from Dr Luka that she has the authority to do whatever she wants; excellent news which will bring more challenges next week.
We finished our working day at the HTI (Catholic Health Training Institute) teaching the students. The real excitement of the day was having a shower there – a wonderful luxury! (Though Claire did get locked in hers and had to phone me to be let out!)
The nuns have had some excellent bungalows built on their compound which we may be able to use for future teams until we achieve our ambition of a house in the hospital compound. The hotel here is really pretty grim apart from the location by the river.
Thursday 5 May
One person down this morning due to illness but feeling a lot better by lunch time!
As usual a long queue for Claire with her ultrasound expertise, which the doctors are exploiting daily. Patients today sadly included a lovely lady who had been stabbed in the head and back for refusing her husband, a sad tale.
Frankie provided lectures on head injury and gave the junior doctors pointers on how to present themselves for further promotion in their careers and for possible secondments to the UK.
Hilary and Sophie spent a fruitful morning teaching basic observations on trauma and medical wards. Despite some reluctance from staff, most warmed to their presence and will hopefully take on-board certain recommendations.
Hilary has been addressing a few of the nursing management problems within the hospital with the matrons, tutor and the director general.
This afternoon we have visited the health training institute of the Sisters of Solidarity. Sister Maria has gone to Italy today but we got a great reception from the other nuns and students who recognised members of the team from the previous visit.
Here we presented to the student nurses several lectures on infection control, basic observations and critical care. Hopefully, we will be influencing these new nurses early in their career.
I personally now have a trickle from my shower but sadly the other girls are still on bowl washes!
Wednesday 4 May
Everyone woke up very tired this morning after a very hot night with no air con, inefficient fans and uncomfortable beds! Still no running water but they are providing a bucket of murky water to flush the loos and drinking water to wash. Frankie has the constitution of an ox, and is the only one who hasn’t had diarrhoea!
However, the day has improved and we’ve achieved a lot: Claire has been in great demand, and has scanned a lot of sick children, diagnosing two renal tumours and portal hypertension. Sophie and I talked to the three matrons and have arranged to do some teaching on the wards tomorrow; we are trying hard to get them motivated, explaining that if they don’t keep up the teaching and standards we are trying to demonstrate we will be wasting our time.
As Sophie has completed the Diploma in Tropical Nursing she is looking forward to spending some time in the lab and learning how to do malaria screening on a large scale.
Sally spent the morning in the labour ward where she followed a very young mother into theatre who had been in labour for three days. Unfortunately after a very difficult caesarean section the baby did not survive but the mother was saved. Tomorrow she will be teaching the doctors and the midwives how to deal with pre- and post-natal emergencies.
The oxygen concentrator which Frankie and Ally mended last time has broken again, and we are hoping to get it fixed this week. Frankie also spent time in the operating theatre and the emergency department.
I’ve spent some time trying to track down the sisters at the two nursing schools to agree a teaching programme with them. Our driver took me to the impressive new Catholic clinic in town and the two nurse training schools. At Sister Gracy’s school I received a very warm welcome from some of the students whom we taught last year, and Sister Maria has visited us tonight, prior to going to Italy tomorrow. We will be arranging teaching programmes at both of the schools.
We are all feeling better tonight and in good spirits again. At least the hotel has cold lager!
Hilary
Tuesday 3 May
The team arrived safely in Wau this morning, and received a very warm and friendly welcome. They are safely installed in the Regency Hotel – safe, but with mixed feelings. The hotel has no running water: no showers, no washbasins, toilets cannot be flushed or hands washed – three of them are feeling queasy already. Apparently there is a burst water main somewhere in the middle of Wau.
There is no internet connection at the hotel or hospital – Hilary is dictating this by phone – and the electricity supply is very intermittent. The air conditioning does not work. You can understand why feelings are mixed!
The hospital is not as busy as usual, and there are fewer patients. However, the new maternity unit is open and in use – a great improvement on the old unit, apart from needing a thoroughly good clean. All their baggage travelled with them; the government paid for any excess baggage, so all the kit and supplies are safely in hand.
The team hopes to be able to work in the hospital tomorrow – no running water there, either. However, everybody is very pleased to see them, and they have been very warmly welcomed – in more ways than one: current night-time temperature is about 40 degrees C.
Monday 2 May
We started the day with an excellent breakfast, omlettes to order and Frankie poached a mango fresh from the tree. We are making the most of this time in Juba as it will be a very different story in Wau.
Our first task was to assist the under Secretary of State and the Minister of Health for Southern Sudan with a high profile task of televised litter picking. Armed with big black rubber gloves and bin bags we picked up all manner of unmentionable items. When we finished this much photographed task (we did more work than anyone else) we were taken to Juba Hospital.
Frankie and Hilary spent a couple of hours interviewing would-be candidates for potential placements in UK hospitals. All appeared very enthusiastic and promising.
Sally and Claire went to the midwifery department and had a look around and then Claire (Clara to the locals) used her sonography skills to assist diagnosing patients whilst teaching the staff – including an ante partum haemorrhage which later went for an emergency C Section. I accompanied Louis, one of the paediatric doctors who has worked at Poole, on his ward round and saw how the children are admitted and looked after – lots of malaria, hepatitis and pulmonary TB, very different to the UK.
Then we were taken on a tour by Anita - the very efficient matron of Juba Hospital, which included the various wards, the emergency department and midwifery. All were very welcoming and explained their areas. We also saw the nursing school and met one of the tutors. Both Frankie and Hilary have noticed a huge difference in the streets of Juba and morale at the hospital which has improved tremendously. Those of us who haven’t visited before have been told that it will be vastly different in Wau, but we are looking forward to the challenge ahead.
We are now relaxing and toasting Frankie’s birthday, all packed, e-ticket has arrived and ready to travel to Wau tomorrow, although concerned how extra 100kg of kit will get there too!
Sophie
Sunday 1 May
The team arrived safely at Juba today, after 24 hours of uncomfortable travelling. This time we flew by Kenya Airways via Nairobi, which involved a long wait in Nairobi airport – somewhat dismal and uncomfortable as we were all pretty tired.
However, it was a different story when we arrived at Juba airport. We were all wearing our PAL T-shirts, which apparently marked us out as important people. We were moved into a reception queue of our own, and the arrival of Hillary Hakim (Ministry of Health Administrator for Southern Sudan) to welcome us only served to confirm to the airport authorities just how important we were!
So no waiting, a speedy dealing with all our documents, and an added welcome from Dr Louis Danga, Administrator for Juba Hospital made for a very friendly reception all round.
We discovered that 1 May is a public holiday, which is fine, but means that there are no internal flights taking place tomorrow, Monday, so we cannot get to Wau until Tuesday – four days travel instead of three! So we are planning to do some teaching at Juba Hospital tomorrow.
We are staying at the Oasis Hotel in Juba, where the first team stayed on our initial fact-finding visit. It has improved quite a bit: accommodation is still in the individual metal Nissan-type huts, but they are clean, the air conditioning works, and there is actually clean, warmish water in the showers!
There has been a big clean-up programme in progress at Juba, and tomorrow a lot of the government officials will be televised sweeping the streets and removing garbage. Guess what – we have been invited to join them! Our experience at cleaning up Wau Hospital on a previous visit is clearly widely known, so we expect to be next to GoSS ministers joining in the great clean-up.
The weather is pleasantly warm with the occasional rain: not too hot. The hotel is fairly quiet, and being beside the river, has fewer mosquitoes – stagnant water in the township tends to attract them more than running water. Everyone is very friendly, and we have all been made to feel extremely welcome. It’s a good way to start!
Hilary
Pre-visit update
The next team to visit Wau has now been finalised. We leave on 30th April to fly first to Nairobi and then on to Juba the capital and finally Wau.
The team will be headed up by Hilary Fenton-Harris,now on her fourth visit, Frankie Dormon is on her second trip and hoping to build on the triage and early recognition work leading to the formation of a high care area.The addition of a sonographer, Claire Taylor is eagerly awaited by the doctors in Wau, while Sally Loven will continue to work with the midwives to improve infant and maternal survival. Sophie Guiness, with her skills in Emergency Medicine, will be a great addition to the team.
There is so much work to be done and all of us, old hands and new, are preparing teaching material to use for the doctors and nurses at Wau teaching hospital. As our relationship with the Sudanese people develops we feel increasingly confident that the skills we have to offer are what they both need and want. With a recent referendum leading to a separate Republic of Southern Sudan the pace of change is likely to increase dramatically, and we are all very excited about the future for our link and the part we can play in the development of medical services.
Please read our blog while we are away and support our fund raising efforts. Without charity money these visits would not be possible.