I have been instructed by David to write about “happy endings”. Currently sitting on a comfy sofa, in a comfortable ambient temperature, having spent the day yesterday with my extended family, eating good food and drinking good wine, I can vouch for a very happy ending! However, David obviously means the Juba-related happy endings and there were plenty of those too.
I’ll start with a “mixed ending”…. The week before last, I informed the office of H.E. Dr Yatta Lori Lugor, the Deputy Minister of Health, that I had completed my anaesthetic study and budget proposal for Juba Teaching Hospital. I offered to come and present my findings and was invited to see him the next day. I presented my findings to H.E. (I was nervous anyway and had also just heard him berating the person before me), but it went swimmingly well. He found my data spreadsheets interesting and said that no other department had been able to provide such a detailed breakdown of costs. He also liked the ordering system that I had designed. He then listened to my request for new “Glostavent” anaesthetic machines (the current ones are unsafe in many different ways and Glostavents are designed for use in developing countries and inhospitable environments), suction machines and the quarterly budget requirements for drugs and perishable equipment. He asked some pertinent questions and then said “yes”, agreeing to try the system out in Juba and to roll it out nationwide if it was successful. A-m-a-z-i-n-g! I let my (very happy) fellow anaesthetists know. I explained that they would need to pursue this in the future, but that this agreement was a fabulous break-through.
However, I said this was a mixed ending….. You may remember that I applied for and was rewarded an “emergency budget” for the anaesthetic department, as we had run out of most drugs and equipment. The cash arrived (no such thing as cheques or bank transfers here) and Simon, our head medical assistant went over the border to Kampala to buy the supplies. Sadly, whilst in Kampala, Simon was robbed and he came back empty-handed and very upset. We had all been so excited about receiving the drugs and equipment and were devastated by this news.
Tuesday afternoon afforded us a very happy ending; the nurses’ graduation ceremony. The nurses had organised some beautifully bright decorations and the Director for Nursing and the Director for Training from the Ministry of Health attended. Some great speeches were made and the nurses were so happy to receive their certificates (their hard work is so rarely acknowledged here) that some of them danced up to receive them! There were many calls of “yeyeyeyeyeyeyeye” and lots of food and drink. David and I were presented with tinsel wreaths and they then tried to teach us to dance! We managed to train 112 nurses in “Triage and Malariology” and the senior sisters are planning to continue nurse training now that we have left. Fingers crossed!
We obviously spent much of the week saying goodbye and giving presents to many of the people that we had developed firm friendships with over the past four months. It is testament to the fact that we had become part of the team that most peoples’ immediate response when told that we were leaving was to say, “Oh, have a nice holiday! We’ll see you in a few weeks”. Explaining to everyone that we were leaving and didn’t know when we would be coming back was difficult. It felt like we were deserting them. When combined with a lot of our work bearing fruit at the same time, it caused a real conflict of emotions. Explaining that we were going back to the UK to continue our training was frequently met with “But you are a consultant”! One of the nicest compliments was when a medical officer (whose wife is expecting their first baby) told me that he had found out that he was expecting a girl and that she was going to be called “Clare”! The obstetric anaesthetist (and egotist) in me has always wanted a baby named after me and I was very flattered.
On Thursday, Dr Wani Mena, the CEO of the hospital, arranged a goodbye party for David and I. It started with the usual shenanigans of locked halls and lost keys and a lack of electricity to the one room that we needed to use, but ultimately turned out to be a lovely event. Many of our consultant colleagues attended and we gathered in the conference hall that had been the venue for so much of our work (both successful and not) over the past four months. Dr Wani gave a lovely speech and then opened the floor to others. In true South Sudanese style (no-one does pomp and ceremony better), almost everyone made a speech. Some lovely things were said and we were very touched by many of the comments. David and I both gave brief speeches explaining our gratitude to the people sat with us and how much the experience had meant to us. It was at this point that I realised that this was it. The most eventful and life-changing four months of my life were really coming to an end. I may have hated some moments, but I had loved many more. We had actually made a difference to this little corner of the world and now it was time to go back to “real life”. We then shared our last meal of local food with everyone (I already miss kissira and aswad) and went back to the shed to pack.
Now, you may recall the “mixed ending” at the start of this blog. I would just like to turn this into maybe my most happy ending of all. On Thursday, having found out about the stolen money, I went to commiserate with my colleagues and say one final goodbye. I was so sad to be leaving at a time of such disappointment and a big part of me just wanted to skulk off and pretend that the whole thing hadn’t happened. After all, I had already said goodbye to them, before we had heard Simon’s news and when we were all still excited for his return. Leaving on a high is always preferable and although this would have been the easier option, it did not feel like the right thing to do. So, reluctantly, I went to the theatres and sympathised with the medical assistants there. I then went to the office and found Simon and some of the other medical assistants poring over some papers and making plans. When I looked closely, they were examining copies of my anaesthetic budget proposal and planning who was going to follow this up with the Ministry of Health. My work had provided the tools for change and they were actually going to use them! I truly believe that everything happens for a reason: I think that the money was stolen so that the anaesthetists would still be in a situation of need. Not good in the short term, but without this need they would have lost the drive to pursue the budget. They would have used the “emergency” supplies and by the time that they were used up, the Ministry’s promise would have been forgotten. However, the quarterly budget plan and ordering process is a long term strategy, that has the potential to change anaesthesia in South Sudan for good. Only time will tell, but I think that we may have actually achieved the holy grail of sustainability!