From 6th October 2012 – 28th November 2012
By Peter Pal Chol Nyan


The visit

I visited UK on a 7- week clinical attachment in Poole hospital, mainly working in the department of diagnostic imaging (Ultrasound) .The grant for my visit was secured from Gordon Memorial College Trust Fund with the help of Dr. Frankie Dormon, a Consultant Anaesthetist at Poole Hospital and the Medical Lead of Poole Africa link. In fact this link is between Wau hospital and Poole hospital but I came to know Frankie through Dr. Louis Danga who is a specialist Paediatric Registrar who once visited Poole.

I was lucky to be introduced to Dr. Frankie when she stopped over in Juba Teaching Hospital on her way to Wau. She conducted an interview with me and some medical doctors and asked us to write our CVs.

Then after a long delay associated with despair, Dr. Frankie at last wrote to me that the funds had been secured and that I could to be attached to Poole hospital for several weeks.

What I learned during my visit

As soon as I arrived at Poole, I was introduced to the imaging staff by Dr. Dormon and taken to Human Resources by Mrs. Hillary Fenton to have my photo ID as required. This took place after having undergone free screening tests for infectious diseases in the Occupational Health Department where the results were negative. Then during my attachment I learned a lot about scanning though I was not actively involved hands-on most of the time. I was shown how to hold and manipulate the prob, where to place it anatomically with the help and cooperation of the Imaging staff. In rare instances, I was allowed to have a go with consent of the patients.

I was engaged full time watching in the general USS and obstetric scanning.

Now I have learned how to measure the Nuchal Translucency (NT) which is a prelude to the screening for Down’s syndrome and part of the anomaly scan, a technique which nobody does in South Sudan or, if it is being done, it is rare. In this process consent is first obtained from the couple before carrying it out.

I learned how to recognize common abnormalities such as cardiac anomalies and renal abnormalities. I was able to see what conditions like liver cirrhosis, fatty liver, liver tumours and hydronephrosis look like to mention but few.

Also how to do a routine fetal growth scan, by measuring the head circumference, abdominal circumference and femoral length, which gives you the expected date of delivery in weeks and days.

I spent  5 weeks in Poole Hospital, one week in Bournemouth Hospital and one week  in the St. Mary’s  Isle of Wight hospital in the department of general and obstetric Ultrasound where I also had a wonderful time with the staff in the Diagnostic imaging Department who were very cooperative and helpful.

Pahchol November 2012 Peter Pal leaving party

I felt that my visit was very worthwhile and beneficial even though the time was not sufficient.  However the knowledge I have gained in UK will be quite useful at home.

While I will not be able to recreate something like this in South Sudan, I hope my experience will serve to develop a sense of service delivery appropriate and relevant to the situation in my country.

Here are a couple of examples of some ultrasound cases which I have observed.

In the Isle of Wight there was a 60-year old woman who was sent for USS on query gallstones but later on was found to have her common bile duct obstructed by a stone measuring 3.5cm.

In Poole there was a 65 -year old woman who was sent with suspicion of gallstones as well but later discovered to have a liver metastases and indeed multiple gallstones which are less significant than the liver lesions.

Is the 7 weeks period enough?

The 7 weeks clinical attachment period is not enough and I would suggest that the period can be extended to four months so that one can have plenty of time to learn. I spent half a day in CT and was supposed to go to Medical Physics Department and MRI but I could not make it because the time was limited.

One interesting thing I noticed in the department of CT and MRI was that the whole machine was run by a team and each and everyone knows his/her area of responsibility.

I don’t think one would be expected to learn all of the USS or any of diagnostic equipment within 7 weeks as the process involves a lot of technicalities and practicalities and as such each imaging modality needs a separate visit.

The future plan

My future plan and aspiration is to help to provide readily available radiographic services and to be a pivotal part in that process in South Sudan. This requires outside help from people of goodwill and well wishers like the GMCTF with its trustees who offered the first grant, and commitment and enthusiasm from our people.
I hope there will be further opportunities for visits and that I can come for another visit over an extended period to learn Computed Tomography and Magnetic Resonance and Imaging and to have plenty of time in other diagnostic departments.


In conclusion, I recommend that:

  • The period of clinical attachment be extended from three to four months for various specialties and most importantly radiology because medicine without diagnostic services lacks accuracy.
  • Assistance be given to us to take the International English Language Testing System (IELTS) so that those on attachment may communicate directly with patients and undertake examinations under supervision. Medicine is now more of team work and needs non-doctors who work alongside doctors to cooperate closely.
  • Clinical attachment be considered for the following grades of healthcare professionals allied to medicine: physiotherapists, laboratory technicians, clinical officers, occupational therapists.
  • When training doctors on postgraduate courses, we need  focused courses to train clinical officers and senior nurses in specialized fields such as diabetes, epilepsy, stroke and anaesthesia and to offer short visits to those who are enthusiastic and of course willing and competent.

Vote of thanks

First and foremost and on personal level, I am very much indebted to GMCTF for having provided the funds for my UK trip. I am also most grateful to Dr. Frankie Dormon who helped secured the funds and facilitated my visit here.

I owe her my heartfelt thanks along with her husband James Pride for giving me accommodation in their beautiful house in the first week of my visit before moving to Parkstone house.

I would also like to thank Dr. Eluzai Hakim of St. Mary’s Hospital, Isle of Wight which has a link with Juba Teaching Hospital for having been also instrumental in making sure that I visited UK. Without his coordination and cooperation with Dr. Dormon, this visit would have not been a success.

I am as well thankful to Claire Chauncy who through Frankie has been very helpful in some of my visits outside Poole (especially London).

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