Wau Hospital’s new HDU

United we stand

 

 

 

 

 

Wau hospital’s new HDU

 

Sunday 21st April 2013

The day started a bit overcast but soon the sun burnt through the clouds to leave another hot, sunny day. We all knew that today we needed to make a decision about our flights back to Juba: go on Wednesday and loose precious days here but play safe or risk leaving on Saturday and missing the 5:30 flight from Juba to Nairobi.

DORCAS, the place we are staying have been very good to us and this morning we had an omelette to go with the bread and mangoes. The mangoes here are amazing, beautifully sweet and juicy with the bonus that they are not falling on our heads!

It had been arranged that our good friend Dr Majok would collect us and take us to the episcopal church, as it turned out to the Dinka service. The church was packed (they are in the process of building a new, bigger building) but we were graciously given seats at the front near the door which were slightly cooler. It was a long service by UK standards (2 hours or so) but we were made to feel very welcome and during some parts of the service. Dr Majok kindly acted as translator for us. Frankie was invited to say a few words and so took the opportunity to thank our hosts, the people of South Sudan for their hospitality. Ben had also been asked to speak and spoke well, weaving in some of his life story, his faith journey and the humbling story of Bishop Moses’ upbringing to illustrate how, although there are differences between us, we are part of the same Christian family.

After the service there was meetings with old acquaintances with Frankie speaking with some of the people from the university. We were then invited back to Dr Majok’s home for a banquet of a lunch and to meet his family. We had brought some balloons and bubbles and these went down well with all but the youngest child, he had been to Wau zoo recently and when he saw us for some reason shrieked about hyenas and us coming to eat him! He refused to come close and there was some gentle teasing by his siblings and cousins about his reaction. We all let him off, he is only about 2 years old!

Dr Majok then took us to Dr Garang’s home. Dr Garang is away working up near the disputed border with Sudan and it was clear that his family missed him. His wife and children were very welcoming though and were grateful of the photos we brought from this time last year as well as for the bubbles and balloons for the children.

It had been a full day so we then headed back home to discuss our leaving day. It was decided that we had better play safe and leave on Wednesday as missing the Saturday flight would have both financial and work consequences. It was a hard decision to make as our hearts were calling us to stay and take the risk.

We have been having much difficulty with internet access (hence these blogs being very tardy!) and so were kindly driven by our host at DORCAS over to Amarula Lodge to use the bar and the internet (in that order!)

Mission accomplished and home again Frankie and Rob decided that we needed to get the 12 lead ECG machine that had Frankie had wrangled from customs in Juba up and running ready for teaching tomorrow. Kate was not quick enough to find something else to do so became the guinea pig for the event. Much pressing of buttons ensued with Ben and Maddy lending a hand and soon they had figured it out much to Kate’s relief.

There is a very full day planned for tomorrow so watch this space!

Saturday 20th April 2013

We are in a game of snakes and ladders,  some of us climbing upwards at a rate of knots,  others keep finding the snakes that take them back to the beginning, but surely  all of us are making some progress?

 Today we had a great day.  After a very leisurely start (it was Saturday!) we ran a surviving sepsis workshop. We had invited doctors and nurses but it was their day off and we weren’t optimistic that anyone would turn up.  Dr Marcello was meeting Ben at the airport,  so he wouldn’t be there either.  We were thrilled that 5 doctors and 2 nurses arrived.  They seemed to stay engaged for the 2 1/2 hours of interactive short talks from all of us and scenario based teaching. The aim of the course is to help doctors and nurses to identify sepsis early,  using the ABC approach and also to give early antibiotics. All important if the HDU is to be successful  They stayed alert despite the fans not working and using our laptops for a screen. On the ward, our patient was improving but had had no Obs since the students left yesterday.

With Ben back the team were complete. 

Back to Dorcas for a change of clothing and into civilisation with an afternoon and BBQ supper at Amarula Lodge, check it out on trip advisor.  We had a long swim, a few beers, good food and good company with our friends from the UN. We stayed till curfew and had a coolish night.

We are looking for a team name,  we need votes please,  ideas include  The plan B’s  Team Solar Seen!

Frankie

Friday 19th April 2013

Everyone managed to get a much better sleep last night – there had been a thunder storm on Thursday that dropped the temperature dramatically, it was welcomed by all. The day started with us taking some of the masses of equipment, that came with us, to WTH where we divided it up to be distributed to the appropriate departments, this included theatres, HDU, and the Eye unit.

After it had been delivered, the team went their separate ways, Kate to Paeds, Maddie to Obsetrics whilst Frankie and I went to the male surgical ward and HDU. We checked in on a post op patient (bowel resection) who we had seen a couple of times and were pleased to see he was doing extremely well. We were even happier to see that his observation charts were being completed correctly and in a timely manner as we had gone through this with some of the staff the previous day.

We were then asked to see another patient who had come in the previous evening having been stabbed in the chest. He seemed to be doing ok and his obs confirmed that he was not too sick. We helped implement a care plan and did some teaching with a variety of staff from Doctors to student nurses. I have been very impressed with a number of the students who seem eager to learn – asking all the right questions. They also seem to be taking ‘ownership’ of their patients care, it all seems very promising.

After this Frankie went to lend her expertise during the morning surgical ward round, and I set about installing the lighting equipment. It was not without its challenges, not least the heat. I managed to install two of the lights and was then surrounded by nurses wanting to be taught about HDU, 14 in all! Most of the nurses didn’t speak much English so a nurse called Cecilia kindly translated for me. At the same time as this Frankie was giving a similar talk to some of the doctors elsewhere.

When we all met up for lunch, Kate was disappointed to say that she’d not managed any training and was felt that she needed a bit more input from the paediatric nurses  – she soon had this remedied as some training slots were arranged with the ward seniors so she’ll be teaching for a number of hours on Monday with them. Kate also managed to show some of the paediatric nurses how to use the haemoglobin monitor for two children who needed it checking.

Maddie also came to lunch a little frustrated at not being able to impart her knowledge to the qualified staff but had managed to teach a large group of students (around 12 I think) so a good morning really.

After lunch Frankie and Maddie went to teach at Sister Gracey’s for the whole afternoon and were thoroughly worn out when they met Kate and I back at Dorcas where we are staying. Kate and I spent the afternoon sorting out more equipment and then went to finish putting in the lights. Kate was then amazed to find that I’d put two up by myself as they’re a bit fiddly – they have very small nuts that I was trying to put on blind whilst propping up ceiling tiles at the same time! (there was a pun to be had there somewhere but I didn’t have the energy by the end of it) Needless to say Kate’s help was greatly appreciated!

In the evening we were very kindly invited to the UN base by Aswilla, one of the UN doctors, who also came to pick us up! We had a lovely meal that had chips with it, I’m fairly sure everyone enjoyed them as much as me. A couple of beers and some dancing (I didn’t join them for this) and a lovely evening was had by all.

On Saturday we’ll be hosting a sepsis course, in line with international recommendations-  hopefully some attendees will appear, then we’re going to Amarula lodge for a much deserved afternoon off! With a pool, barbecue and perhaps a few drinks!  

Rob

Thursday 18th April 2013

Following a terrible night’s sleep we headed off for the hospital with our objectives, enthusiastic about our first full day.

Rob got straight to it with fixing lights in the operating theatre, giving light (when the generators on !) so that operations can be carried out safely in the evenings and over night.

 He also was able to teach some of the surgical nurses and student nurses on the importance of regular vital signs monitoring, using the new ministry of health paperwork. Observations are rarely taken here and even more rarely documented.

I did two hours of solid teaching with the student nurses and midwives in maternity as labour ward was very quiet. We covered assessment on admission to labour ward. Teaching appeared to be well received and they enjoyed using the teaching aids I had bought with me.

Kate networked with IGAD nurses on paediatrics and found the oxygen concentrator bought last year being well used.

Frankie liaised with the doctors on the running and management of the new HDU.

A highly successful first day. We were exhausted by the end of it, and enjoyed a well earned beer after a very interesting trip with our driver to the local market to buy it !

Maddie

An update on the highs and lows of the last few days.

It has been thrilling to see that 4 more cataract surgeons are being trained in Juba eye unit by Dr Wani. Every week there is a dedicated training list with fewer patients and more time for teaching and I could see what a huge benefit the teaching microscope will be to the unit. I had a very useful discussion with Wani about the support he is receiving from Christian Blind Mission in terms of consumables and other equipment. There is an opportunity for me to help him with upgrading another of his microscopes to the specification required for teaching. The unit could then have 2 teaching microscopes and double the number of surgeons who can be trained safely.

Tuesday 16th April 2013

We heard today that we have got a flight tomorrow morning which we are all relieved about. To make use of the day Frankie went off to customs to release/ collect 2 parcels and had quite a time of it (check out her Facebook entry on the PAL site for the full story!)

Maddy went to maternity to see their set up to enable her to compare with Wau, get ideas etc. She saw the senior midwives teaching the students in practice.

Rob went to theatres where he was closely questioned by 4 Chinese medics who were working there, but did see both a ketamine and a proprofol anaesthetic.

Kate was allowed to shadow one of the paediatric consultants, Dr Lokiri who was very informative and showed her all the wards and discussed the common diseases that caused admission.

Ben continues in Juba eye department for the rest of the week and is due to fly to Wau on Saturday. He is putting the final touches in installing the new microscope that he was able toobtain for the hospital due to a lot of hard effort fundraising.

So tomorrow there is an early start (5:40 get up time) for our flight. Next stop Wau!

Kate

Monday 15th April 2013 (part 2)

Day 1

Team 9 arrived tired on Sunday morning to a hot sticky Juba. Customs took a little persuading that we were not there to sell medical equipment rather than train doctors and nurses! Our cause was helped by the arrival of Wani Mena, Consultant Ophthalmologist, and soon we had our 10 massive cases loaded in and on the roof of his Christian Blind Mission (CBM) Land Cruiser.

Checked into Juba Bridge hotel on the banks of the Nile and spent the rest of the day sorting out our mobiles and speaking to local contacts. It transpired that onward travel for the team to Wau had not yet been organised, and I would have company in Juba for longer than originally planned. The day ended with lethal but delicious coffee freshly roasted and ground, served with popcorn and an incense burner. Fortunately the only thing which kept us awake that night was the sound of mangos crashing onto the tin bedroom roofs!

Day 2

Frankie, Maddy, Kate and Rob were pleased to catch up with Peter Pal in Juba Hospital. He spent 2 months in Poole last year with the link learning ultrasound, and clearly had benefitted greatly from this experience. He took the team on a tour of the hospital and new nursing school. The first intake have almost finished their training, but are lacking in ward and clinical experience.

The team also had useful conversations with the Minister and Gabriel Loi at the Ministry of Health regarding long term strategy and goals for healthcare provision in South Sudan. Consideration was given as to how links can be used to best effect and the possibility of the ministry providing accommodation to support longer term visits.

I was met by Wani at the hotel and taken on a tour of eye facilities of Juba. We visited an impressive peripheral clinic and small eye theatre which is undergoing renovation. I was delighted to find that the project manager was Father John, a catholic priest accountant. He has moved there from the catholic health training institute in Wau where I met him last year.

A little later I met up with friends in JTH eye unit, John, Helen, Abdullah and others. The outpatients was hectic as usual for the rest of the morning. I saw many patients including babies and children with infections and injuries. The operating lists for the rest of the week are now almost full, with cataracts, trauma repairs and other procedures.

Wani is running CBM funded programmes training cataract surgeons and ophthalmic clinical officers (OCOs).  OCOs are previously nurses and medical assistants. Later in the day I gave an hours lecture to a class of about 16 OCOs and trainee cataract surgeons on corneal disease. The projector was a little dim, so the class had to huddle round my mini iPad screen to see some of the images!

I finally presented Wani with some surgical instruments kindly donated by Nick Astbury, Consultant in Norwich Hospital and Vision 2020 chairman of the royal college of ophthalmologists.

Looking forward to a meal by the Nile and an evening meeting with Eluzai Hakim of the St Mary’s IOW link, drinks may be involved!