Written by Dr David Attwood
There are some big advantages to working in Juba Teaching Hospital (JTH) for two, four month sessions. During the first time with James, I grew used to the culture, the healthcare systems, the way of life and most importantly I got to know the people in the hospital. Coming a second time is much easier as this experience can be applied.
Despite this much has changed in the last three years. There are an abundance of interns (house officers) and medical officers (senior house officers) in the departments. Obstetrics and Gynaecology and Surgery are leading the way with their departmental structure; they have a hand over meeting every morning and weekly structured departmental teaching. Power is on 24/7 and there are no goats roaming the hospital. When I had a patient who was in a coma, I was told that I could refer for a CT brain. Although the family would have to pay the equivalent of £70 (almost prohibitively expensive for most people here), the fact that they have a CT is definitely progress.
However, some of the old problems remain in our medical department. There is a shortage of supplies and most of the equipment was broken. Furthermore some of the changes begun in 2008 were not evident on our arrival. The nurses were not recording vital signs and the EMW cupboard was empty of many useful medications. Nurse training ended two weeks after we left in 2008. There is a complex interplay of reasons that I will not fully go in to but I suspect the most important component was the lack of support from the medical profession.
Hope still remains and we often feel that JTH is on the cusp of a renaissance. There has been a change in attitude towards the nursing profession. Doctors cooperate with them more fully and we are told that they will stick up for themselves if the doctors are rude. This is a good sign. It is the sign of a profession that is beginning to believe.
On Wednesday 21st September, an important meeting took place between ourselves, Dr Elijah Lewis (my Consultant and Head of the Department of Medicine), the deputy Matron Lucia, Sister Anna, and all of the nurses on the Emergency Medical Ward (EMW). The title of the meeting was “how can we improve working conditions for the staff and the healthcare of the patients in the EMW?”
Several key themes emerged:
1) The role of the nurse in JTH is very different to the nurse of the UK. In JTH, they are nurses, cleaners, transporters of patients (live and dead), house officers (in the sense that they do all the running around chasing tests), and they take blood and cannulate patients. Furthermore there are less nurses than in 2008.
2) There is no equipment or medication. Despite three years of work, South Sudan’s leading hospital is still short on essential supplies.
3) The burden of disease is greater and anecdotally, malaria accounts for at least 50% of our inpatient workload. Unfortunately lives are being lost because sick malaria patients are not getting to the ward in time and too many well malaria cases are being admitted.
4) There is a need for continuing professional development- teaching.
During the meeting, the nurses had the chance to voice all of their concerns. It was really good to have the Consultant Physician there. He is a good man and really sympathised with the situation. We both made it very clear that the doctors were going to do whatever it took to support the EMW and stand shoulder-to-shoulder with the nurses. It was a productive meeting and as well as problems, we identified solutions and team leaders were appointed for each activity.
Our tasks (by “our” we mean ourselves, the ward sisters, the matron, our Consultant and the nurses) have been set for the next four months:
1) Develop triage of our medical patients
2) Get the drugs back to the EMW and get it to the state it was in three years ago
3) Develop a malaria protocol that will allow us to admit the patients who need to come in and not those who don’t
4) Hospital attendants will be employed that will take all the transporting/running around duties away from the nurses, freeing them up to nurse
5) Restart the nurse training (to commence the week after next) starting first on management of malaria and its complications and then rotating to HIV awareness.
Clare and I both want to work with the medical officers to undertake a malaria audit which should be very interesting.
There are plans underway for medical education but we will leave this for another blog. We thought we would instead leave you with a slightly random photo of a water feature from outside our accomodation. It makes us chuckle every time! All the best x
our accomodation. It makes us chuckle every time! All the best x