Saturday 27th & Sunday 28th April 2013

We all had a relaxed morning on Saturday, treating ourselves to a boat trip on the Nile. Lots of photos were taken and also mangoes eaten after landing for a while on a small island where we picked them from the trees. Back at the hotel there was time for a quick shower, lunch and final pack up before the timely arrival of our car.

Juba airport is getting easier and more organised every time we travel, so it was without too much difficulty we checked in. The flight to Nairobi felt positively safe and luxurious compared to our flights to and from Wau… with a safety briefing, seats that didn’t collapse and a meal that was more than a packet of biscuits!

On hitting Nairobi we shopped and wandered back and forth for most of the time. Frankie investigated the 1st. class lounge as she was staying in the airport overnight to travel on to Zambia on Sunday morning with her husband for a holiday and then a further 2 weeks teaching with THET before cominghome to the UK.
The rest of the team arrived safely at London Heathrow Sunday and arrived back in Poole later that morning.

It has been a worthwhile trip despite the frustration of having to spend 6 of the 12 available days in Juba. We have had achievements both big and small including: the plans for the HDU have begun and there appears to be excitement in the hospital about this. Paeds have a second oxygen concentrator, theatres have a replacement one and Rob is very hopeful that their old one is fixable. The blood bank have a (daytime) working fridge and there is hope that a reliable contact has been found to provide partially used car batteries for the solar panels both in the blood bank and for the lights in HDU. We have also had productive meetings with several people in Juba on both the medical and nursing sides.

Friday 26th April 2013

Well, we have done our best to  avoid wasting our time here in Juba.  The town is full of senior ministers, we now know why, there is a major workshop to improve collaboration and coordination between health sector partners, discussing subjects well beyond PAL and what we may offer.  Unfortunately that has resulted in our appointments being dropped for meetings of far greater importance, however we finally arranged a meeting with their Director of Nursing,  Janet Michael.  We have met before when she visited Poole, and this time the girls were able to have a long, relaxed meeting.  It was reassuring that she is very aware of the challenges of training nurses against a backdrop of senior staff with Arabic only and little real knowledge.  We had not appreciated that between Sister Gracy and CHTI,  they are training 2/3rds of all the student nurses in South Sudan,  there are now 100 nurses with modern training across the country,  we must have taught over half  of them, at some time over the past 3 years. Not many people can make such a claim. We were able to reassure ourselves that the work we are doing fits in with her agenda, all in all a useful hour.

Meanwhile the boys went off with Father John to Bulus eye hospital to apply their fixing skills to a broken microscope. We met Father John at CHTI last year, he is now setting up an eye clinic in Juba.  It’s early days, but Ben is excited about the prospect of more training facilities for ophthalmology.  Unsuccessful, with the repair job,  the parts are now coming back to UK.

 We all met up again and came back for lunch by the Nile and an afternoon of r&r., writing blogs, reports and packing.

We met with Mark from Dorchester and heard that he had been invited to the meeting for the afternoon.  Imagine sitting amongst all the South Sudanese big wigs, listening to strategy discussions!  Luckily he had his shirt and smart trousers. He is going again tomorrow and will also wear his tie!!

Dinner we went a la carte, having finally had enough of the buffet, the hour long wait and then the wrong pizza was annoying, but when the right food finally arrived we were all very happy. No jimango cocktails, as all the gin has gone but plenty of local ‘Nile’ beer.

Frankie

Thursday 25th April 2013

We had a relaxing morning at the hotel with a well earned lie in. We were hoping to meet with officials at the ministry of health but were unable to as most of the staff were at a conference for world malaria day. 

We found ourselves sat next to the Nile again enjoying the view whilst also being on stand by to dodge mangoes falling from the trees above us, which are constantly dropping with some degree of force, spitting mango flesh and juice in all directions. It is only a matter of time till one of us gets mangoed!!!!.

Despite a slow start to the day we had a very busy afternoon with some very special people. 

We had lunch with Father John, a catholic priest who is helping to set up a brand new eye clinic here in Juba, funded by the Cristian blind mission. He has previous experience of doing this in other developing countries and is able to impart some invaluable information and advice to Ben.

We were also lucky to have Naomi Pendle join us at the hotel. She is a young woman from Bath who has chosen to live and work in a rural village in South Sudan for the last 3 years, she lives in a traditional tookal and can converse in the tribal dialect ‘dinka’. She has been teaching English to children at a school but is now just starting to travel around South Sudan collecting data for her PHD on the South Sudanese tradition of cattle stealing a very controversial topic at the moment.

Following lunch we headed off to the local market for a browse, it was hot, humid and hectic but good to be part of the hustle and bustle of city life. 

In the evening we enjoyed a sociable supper and discussed future pal activities.

Wednesday 24th April 2013

Well sadly this is was our last day in Wau. As mentioned before I think, there has been a bit of a mix up with our flights both to Wau and now in our leaving. There were various reasons for this but some appear to relate to the austerity measures in place here in South Sudan at the moment.

So all packed with bags in the courtyard of DORCAS and hearing a car, we opened the gate to be greeted not by our driver but by Dr Majok who had come to wish us safe travels. It was lovely to see him. We also sent our greetings to Dr Garang through him as Dr Garang is due back in Wau soon to see his family.

The next car was Hassan our driver, packing was quickly done as we had only 5 bags between us instead of the 10 of the outward trip. We drove off only to see another car racing after us, this time it was Dr Marcello! He followed us to the airport and we said our goodbye’s there. Dr Marcello has been very welcoming and we have worked well with him this trip in the temporary absence of Dr Alex.

The checking in was going very smoothly, the bags were all now underweight so no trouble there then Frankie was asked for departure tax (£20 ssp each). Well we had given all our South Sudanese Pounds to pay our bill at DORCAS and so only had dollars! The airport official couldn’t accept dollars so we had a problem. After some asking around we thought we had found a man who would change the money but after a 15 minute wait he came back with a much lower exchange rate than Frankie had originally negotiated. Frankie said ‘no’ to the chap but this left us back at square one. She then had a brainwave and rang DORCAS. Florence duly arrived on the back of a motorbike and changed Frankie enough money for us to leave.

Our departure from Wau was on the same South Supreme Airline plane that we had come in on: an interesting and in some aspects, unnerving flight. This wasn’t helped by a lady in the front of the plane screaming at every little bit of turbulence! We did get a packet of orange cream biscuits each this time instead of the banana creams of the previous flight.

Landing and getting through the airport went without a hitch. Our driver here in Juba met us and took us back to the same hotel, most of us even have the same rooms as before: a bit of an odd feeling! We were all tired from the journey but after a wash and brush up we had a late lunch. While eating we were delighted to see the familiar face of Mark an Anaesthetist from Dorchester. He is here on a fact finding mission, looking to set up a link like ours with Rumbek. Long conversations ensued over the rest of the afternoon.

We did achieve a lot during our brief time in Wau with the surviving sepsis saturday, the continuing work on Maternity and Paeds as well as teaching at the 2 schools of nursing, We feel that we have set some firm foundations with staff and equipment for the new HDU that is being developed in conjunction with THET and the Pharo Foundation. Of course it would have been good to have had 2 weeks in Wau instead of the 1 but time has certainly not been wasted! Time here in Juba is already allocated for meeting with Ministers, report writing and Blog updating! (Sorry that this blog has been a bit hit and miss by the way, our internet has been a challenge so posts have arrived in an odd order!)

Some photos from this visit (titles on mouseover)

 

 

Tuesday 23rd April 2013

Our last full day in wau, with so much to do. We arrived at the hospital overwhelmed with the task in hand. Rob was a man on a mission…..to get oxygen flowing in theatres. He started with  fixing a  power stack in theatre, so the new O2 concentrator can be used without concern it will be fried by a power surge !!.

Following that he checked on the blood bank fridge and found it working now the solar panel is getting sunlight but the current battery is 13yrs old and struggling to hold its charge and will need replacing soon.

Ben was busy in theatre, observing and operating with DR Paul. 

Kate continued with her clinical teaching on paeds ward B. Teaching was focused on how to use the new O2 concentrator and how to look after it, Kate also taught nurses on how to use the haemacue and gluocometer. 

Frankie delivered more teaching sessions to the nurses she hope will work on the new HDU.

After observing a ward round, I taught student midwives how to plot fetal heart rate’s and maternal vital signs on the partograph (labour progress chart). I also had a meeting with the lead midwife and junior doctors to discuss eclampsia and the use of magnesium sulphate.  They  reported to me there has been three deaths to eclampsia in the last month.  There are currently no guidelines for maternity care at Wau and the women attending the hospital have had little or no ante-natal care. Together we read  WHO recommendations and considered how they can be applied to practice in Wau. 

The baby that was transferred to paediatrics yesterday survived the night and the mother had started to express colostrum into the babies mouth, the baby is not not suckling yet but is showing interest in the breast. The Mother has been giving sterile sugar water to the neonate via a nasogastric tube every couple of hours.  There is no infant formula available in the hospital,  formula milk is expensive to buy here and there is no where to sterilise bottles correctly so artificial feeding is out of the question for this baby. The baby appears content being nursed by its mother in kangaroo care and there are no no signs of respiratory distress and its observations are stable. The climate also helps the baby to maintain its temperature!

In the afternoon the team reunited at the office from our separate departments to sort out the last of the items we had brought out. Taking an exercise bike to physio, suture sets to out patients, books to HIV department, hats and blankets to maternity,  haemacue to theatres, syphygmanometers and stethoscopes to the wards and distributed some nurse watches to staff that had attended training.

We then finished arranging HDU. We all felt very sad to be leaving it unfinished , but it represents PAL’s commitment to the hospital and acts as a reminder for the local staff that a PAL team will return and help them to develop the unit in just a few months. 

The day was finished with a trip to the catholic health institute for afternoon tea with the nuns. We enjoyed delicious paw paw cake made by sister Dorothy and had an opportunity to reflect on a very bust week of motivation and mentor ship.

Monday 22nd April 2013

Today we all set off at a frenetic pace in the knowledge we are going to be leaving Wau on Wednesday – we’re all a little frustrated but extremely eager to try an achieve as much as possible.

After sifting through yet more kit to be distributed to a range of areas around the hospital we all headed off in different directions.

Ben set about taking lots of equipment to the eye unit, including their new microscope which he helped set up and then he spent the rest of the morning teaching/ learning with Dr Paul (Prof). It was a very productive morning.

Kate went off to paediatrics, also with lots of kit, including an oxygen concentrator for paeds ward B. She managed to do lots of teaching on each of the paeds wards on the use of the oxygen concentrators and Lifebox oxygen saturation monitors.

Meanwhile Maddie was finding things to do in the maternity unit – over the weekend there had been a new arrival in the unit, who had turned up early, a baby born at around 28 weeks (guestimated) and managing to hang on in there! Maddie contacted Kate, and with the family and doctor’s blessing, they moved the child to the paediatric ward. With just a few minor interventions the child seemed to be doing well and there was a little bit more of an optimistic future than if nothing had been done. Well done ladies!!!

My day started off very differently, having delivered bits of equipment I went to check on our post op/ HDU patient from the previous week. I was really disappointed to find that the Obs charts hadn’t been filled in over the weekend as the students who’d been managing this weren’t there. It wasn’t all bad news though, the patient was looking much better and I was informed that he was mobilising and starting to drink (and maybe eat a little) which was fantastic news.

After my brief visit to the ward I went to the blood bank to see if I could fix the solar fridge as it had been out of commission for 6-8 months! So current practice was to take blood and give it almost immediately. I was very pleased to find two men on the roof dismantling the panels for me. It meant I didn’t have to clamber around up there in what was becoming a very hot day. I went and checked on the internal system and discovered it needed completely re-wiring and all the bits that weren’t a blood fridge disconnecting from the system. With the system re-wired, the panels cleaned and connected and some minor tinkering with the fridge, it fired back to life! They do however need a new battery- the one in situ lasted a very impressive 12/13 years! Oh and I even made sure to show the local sparky how to do it for future repairs, all in 40*c + temps!

In another part of the hospital Frankie lent her expertise to the morning ward round and shortly after started some formal training on using and interpreting ECG’s. A group that included doctors, nurses and nursing/ midwifery students attended. It started with a practical demonstration on how to setup and use the ECG within the HDU area and they then went to do some theory training in the resource centre. It was all very well received and caused quite a buzz!

So morning over (yes really, that was all just the morning!) we set about getting things done for the afternoon. After sorting through more kit I headed off to check on the fridge in the blood bank, sadly there was no one there so I couldn’t gain access, tomorrow then! So instead of this I went to check the HDU lights but couldn’t get them to play either and with no bits on the horizon someone from the next team may have to finish the installation.

Ben then asked if I could help him sort out the new microscope as there was some rather suspect wiring. So we headed to the eye unit and were lucky to catch some of the team before they called it a day. I manage to take the affected cable apart and discovered that a soldering iron would be extremely useful! As I didn’t have one, I sured it all up as best I could with the bits I had, and made it all a bit more stable. We plugged it in and powered it up and all but one (not essential) function seemed to be working.

If any of us had felt like we hadn’t quite done enough we reconvened in order to go and do some teaching at Sr Gracie’s and at the CHTI. Frankie, Kate and Maddie went to Gracie’s, Ben and I to CHTI.

Kate taught about Respiration obs, Oxygen and saturation monitoring, Maddie taught about the use of partographs in maternity/obstetrics and Frankie taught about HDU management and setup.

Across town I taught a large group of CHTI students about Leadership, team-working and their importance in medicine and nursing practice. I was pleased it went down very well, the students were engaged and participating, I even managed to get a few laughs. Ben used the time to have some discussions with the tutors about the future for healthcare in South Sudan and had a rare opportunity to send some e-mails. Oh and he got some photographic evidence of me doing some teaching!

After an exhausting day we had a lovely dinner back at DORCAS and then went to Amarula lodge for a dip in the pool (which was heavenly!) a few well earned beers and the rest of the team tried to use some internet with mixed results. I don’t think anyone will have trouble getting off to sleep tonight, especially me!

 Rob