Clouds of depair broken by rays of hope (and some very cute babies!)

Standards have been slipping in our department.  After one month of fair practice the junior doctors have once again slipped into old habits.  Attendance to teaching has been steadily falling over the last two weeks.  Doctors are once again not coming to work and not giving reasons for their absence.  A shadow is falling upon the Medical Department.

With this in mind I thought that I would bring some order to the Medical Department by having some “compulsory teaching” on Medical Ethics.  In it we would visit the qualities of a good doctor and look at the attitudes and ethics involved in good medical practice.  We would also unveil a new medical staff rota and introduce some care pathways for the Medical Department.

Full of hope, I went to the conference room for our standard departmental teaching, which for the past four weeks had been taking place every Tuesday afternoon. Out of a department where I might expect fifteen doctors. However, after three quarters of an hour of waiting only three doctors came- my consultant, Dr Elijah, and two medical officers.

Words could not able to describe my sorrow on this day. The papers on the table were the Hippocratic Oath. I didn't sleep that night.

That day, for me, was the darkest day of Juba Teaching Hospital.   My disappointment was not because attendance was poor.  It was not because of the teaching I had taken time to prepare.  It was because I realised that no one cared.  A doctor is nothing without medical ethics.  They are simply a person who has bought a stethoscope.

However, hope floats.  Dr Elijah and the CEO, Dr Wani, had a chat with me and they decided to organise an emergency meeting of consultants.  I received a few phone calls that evening from medical officers who knew how upset I would be.  That demonstrated to me that empathy and compassion were not lost.  The next day, more medical officers expressed their sadness and asked if teaching would still be possible.  “This is what we will do,” I replied.  “I would like you to gather the doctors, organise a teaching slot on Friday, and if you are all there and on time, I will teach.  Otherwise, I will focus on the few doctors who are interested.” We shall see what the future holds for our juniors but in the meantime, I shall pass you over to Clare to continue the story.

Clare here:  So the story continues…. the meeting with the consultants went ahead.  8 consultants turned up (a very good outcome) and after a few introductory slides the floor was opened to debate.  Issues relating to junior doctors were honestly and openly discussed, as well as the reasons for the problems.  It became very obvious that these people cared deeply about their hospital and were not blind to its faults.  The consultants declared their desire to regain control of their hospital and to grasp this opportunity with both hands.  Dr Wani, especially, spoke with passion and displayed his abilities as a leader.  He received several rounds of applause as plans for change developed.  We left the meeting with a strong sense of hope…. and a plan for a 2 day workshop for all consultants within the next 2 weeks.  What an outcome!

The Ents go to war. The senior doctors are very Entish in nature. They are well- meaning, kind, and unhasty individuals who have a wealth of experience in life, their country, and their specialty. However, once roused they set in motion events which happen swiftly and with devastating efficacy. Today was one such day. It was a day where they single handedly rewrote the history books for Juba Teaching Hospital and the people of South Sudan. It was a privilege and a pleasure to watch them do it.

Aside from this positive meeting, I have had yet another week of rollercoaster emotions….  Samaritan’s Purse, an NGO, has been at JTH this week, performing cleft lip surgery on around 45 of South Sudan’s residents.  A lot of work went into finding patients from all around South Sudan and great expense went into flying them here and back safely (no roads!).  It has been a slick operation from start to finish.  The lead, Karen, has managed to organise staff (nurses, paediatricians, surgeons, anaesthetists, technicians, translators…..), equipment, drugs, food, drink and patients to all be in the same place at once.  Luckily, JTH was that place.  Even more fortunate was that they were so keen to teach us.  It has demonstrated to the staff here what we are capable of, with the right drugs, equipment and expertise.  The anaesthetic medical assistants were performing safe general anaesthesia on babies by today.  So was I!  I have never seen them so enthusiastic about their work.  I have never seen them better at their work.  I have never enjoyed working in JTH so much.

Chatting to the lead anaesthetist, Dr Mark, a US trained anaesthetist who moved to Kenya in the late 1990s was also pretty inspiring.  His hospital was once like ours, but he had set up a training course and had trained up and fully staffed a whole anaesthetics department, with 8 functional and productive theatres.  Mary, one of the nurses that he had trained was also there.  Anaesthetically, she kicked my butt!  What an inspirational pair.

The guys at Samaritan's Purse had worked with JTH staff to organise 45 patients to be flown in from around the country. There are two teams operating side by side to max out their ability to heal people. They are also training the JTH surgeons and anaesthetic nurses.

The big dippers of the rollercoaster came when I was required to work in the next door theatre.  Mostly in order to manage emergency cases.  This just served to remind myself and the other anaesthetists that the high standard of care that we had been part of was not “normal” for us.  Back to broken machines and absent drugs and missing equipment.  Back to no supply chain.  Back to no electricity and no oxygen when you have an anaesthetised patient.  We don’t have a back-up generator.  We don’t have a back up anything.  In anaesthesia, it is important to always have a “Plan B” for in case “Plan A” doesn’t work.  Its hard enough getting together a Plan A in the first place a lot of the time.

Samaritan’s Purse have been generously sharing their time, their expertise, their drugs and their equipment, when we have needed it; in order to treat our other patients.  However, they are only here for this one week.  With the permission of the JTH anaesthetists, I have written to the Ministry of Health, explaining our situation and asking for help.  The  Samaritan’s Purse team are leaving us a lot of their left-over drugs, which is great, but this will only last so long.

I’ll finish on a high note…..  We have been part of a wonderful team this week.  We have changed the lives of many people and their families, in a relatively short amout of time.  Newborn babies with cleft lips are often left outside of villages, to die, but by demonstrating that there is another option, we can save lives.  We have also improved the quality of many lives.

Today, I anaesthetised Margaret, a 7 year old girl.  Obviously bright and very cheeky.  The translators explained that she had been kicked out of school.  My first (naiive) thought was that she had been badly behaved.  Oh no, she was a good student.  It was because her teacher thought that her cleft lip was a sign of witch-craft.  Margaret and her 5 siblings had also been abandoned by their mother, because she could not cope with the stigma associated with having a child with a cleft lip.  Margaret was brought to hospital by her dad.  He looked at her with such love and pride.  We returned her to him with no cleft lip and with the chance of an education and a brighter future.

One day, mothers will not be encouraged to abandon their babies and adults (especially, I hope, teachers)  will be educated enough to understand that a cleft lip is not a child’s fault.  Programmes like Samaritan’s Purse are offering education and, to those affected, they are also offering hope.

African babies are beautiful and this baby boy is making an unremarkable recovery thanks to the skills and equipment of the people of Samaritan’s Purse. Critics may argue about sustainability but you tell that to the people of JTH who, for this week, have seen a glimpse of what their hospital could be like and will now try to fight for it. Tell it also to the patients who, prior to this surgery were outcasts from society. Well done S.P.!
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6 Responses to Clouds of depair broken by rays of hope (and some very cute babies!)

  1. R&I says:

    How lovely to read such a positive report and to hear of the life-changes brought about in such a short but intense peroid of time. So proud of you both and all that you are achieving and helping others to achieve in so may ways. Vive la difference! Much love. R&I

    • Cheers Rosemary and Ian,

      Your comments- everyone’s comments mean a lot to us. All the best to you both,
      D+C xxx

      • Frankie Dormon (also Mrs Pride!!) says:

        Dear David and Claire, Just hope your enthusiasm beats their apathy!!. When I was last in Juba, I left a small plastic T-piece, if you attach it to the oxygen concentrator you can get 2 flows of oxygen from one machine. I have found a couple more to take to Wau this time, but it is a simple way of doubling the oxygen availability, as the concentrator will produce 10 litres and 5 litres is enough for most situations., You may be able to find someone to cobble something together locally.

        Really interested to see the material that worked well on your leadership course, we could do something similar next April in Wau, as we will be taking 2 nurses and 3 doctors. Leadership is definately the key for bothe the nurses and doctors, but it needs to reflect their leadership needs, not UK ones.Keep it up

        Frankie Dormon, Poole Africa Link

  2. Stu says:

    Seriously, stupendously, ridiculously proud of you both.
    X

  3. Mrs Frances Smith says:

    Hi Claire and Dave,
    When I think of all the home visits and support one of my clients received from the CLAPA nurses at Addenbrookes it highlights what high expectations we have and expect in the UK.We have all prepared christmas Gift Boxes at church and school recently to be sent off around the world which were organised through Samaritans Purse. I am going to forward your blog to our local organisers. It’s great hearing first hand what wonderful work they are doing and in such an efficient way! And you two of course!!
    Love Frances.

  4. Don Attwood says:

    Hi David & Clare.
    How lovely to read your blog when you are both in more jubilant and positive mode.
    It brought tears to my eyes to hear that children, through no fault of their own other than a quirk of nature, found themselves outcasts of society and left to fend for themselves.
    Thank goodness there are still some sensible and caring parents out there who do not subscribe to this wacky dark magic and we have visiting medics like the Samaritan Purse to show them that there is another more humane way.

    What a lovely article and a joy to read which I will certainly be sharing with my fellow Rotarians.

    Love to you both.

    Don Attwood

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