Students using the library

My Mapuordit Blues!

Making groundnut paste

Winnowing sorghum

Monday 24th October

Well we have one more week to go, it has gone so fast, always something happening that you have never come across before. Two patients this week with human bites – one a marital problem, the other a drunken escapade. I thought hyenas were bad enough!

A few witch doctor treatments gone wrong - charcoal in eyes, cutting between fingers (patient died).

Malaria continues to take its toll. 14 children died last month, the death toll I think will be higher this month, as it continues to rain, so the suffering continues. It tears me apart to go on the children’s ward, which I do daily, so many babies with the complications of malaria such as pneumonia, cerebral problems, anaemia, temperatures above 39C, on top of malnutrition and some with HIV.

The nurses are flat out just keeping up with the tepid sponges to reduce temperatures, and keeping cannulas patent to give them their quinine.

At the moment there are 32 children admitted and I think 30 would be in with malaria. Never seen it this busy, it seems a never ending stream. Please someone, work hard on finding that elusive cure!

I am sitting in the library tonight as it is open three nights a week. This task gives me great pleasure, as each year there are more and more books (thanks to many of you, particularly in the UK). In my first year here, there were 3 shelves, now about 20 with some great up-to-date books.

More and more of the students and staff are taking an interest and learning how to use a library. This is a big thing in their lives, as many would never have had a book in their hands, never mind being able to take one home. Some of the TALC books (Teaching Aids at Low Cost UK based) are so good, lots of pictures and very basic English - they are always being borrowed.

Just for interest, my final dressing list with the students included:
One osteomylitis case? waiting for a skin graft when a new Dr comes next week who thinks he might be able to help
One spear wound to the chest
One hyena bite to the leg
One little girl who developed an abscess on her abdomen and was taken to the witch doctor for treatment! She has been with us now for two weeks and will be here for at least another week on antibiotics ++
One head wound of a lady who was beaten with a panga by her co-wife
And 3 leprosy cases, who have all had surgery to their poor crippled feet.

Unfortunately all the lovely dressings I was given in Sydney are well over and we are back down to the basic - cotton wool and gauze - but it’s all they expect, and when they get a new bandage on top they are all very happy.

What did throw a few outpatients recently was when they returned to have their sutures removed after surgery, and there were no stitches to be found.
We had our Australian Dr working here in the operating theatre and he has a wonderful way of using dissolvable sutures. Never seen here before, so I think the patients were a bit worried that some magic had been played on them; some were even disappointed that they were not going to have to suffer the removal of stitches!!! They are strange people.

Last day at work today, so there was the usual farewells at the assembly. They are amazing speakers, when they get going. Lots of talk about Ian coming to reclaim his wife, and how good he is to have loaned me to them!

The best bit was when they said ‘I am an old woman but I still work very hard and set a good example’. It was meant as a compliment I am sure, but I could not stop laughing.

We are old here as the life expectancy in South Sudan is around 42yrs, so we are going well. Saying that, I really don’t know how the UN worked this fact out, as there is no registration of births or deaths here.

The two lots of students also gave us a nice send off, with lots of small gifts of flowers, a small pot and we even got to plant a tree. Felt a bit like the queen, but it was a dirty old spade not jewel encrusted.

I think the tree was a ploy to try to get us to come back next year to see if the tree is growing.

We leave tomorrow morning at 6am early, just in case the track is flooded or other problems like cows blocking the road.

P is coming too, which is a big sacrifice as it is a terrible journey and I know how busy she is as the main administrator, nurse, midwife, social worker, mediator, wages officer, clinical tutor, accountant, problem solver, and I could go on but she will kill me if I do.

We plan to have a stroll around the wonderful clean town of Rumbek, have lunch at a luxury resort, lots of tears and hugs, and leave on time, on our Lear jet for Nairobi.

My impression this year 2011 of South Sudan is that the people seem happier to be free of the North but apprehensive as to how the new country can survive.

Only a small minority have paid work, that work is usually connected to the UN, UNICEF, Combonis (who run the hospital), Our Lady of the Sacred Heart, Red Cross all those organisations. As they move out over the next few years I am not sure what or who is going to take their place.

The idea of taxes paid to a government out of their wages will be abhorrent to them, but of course taxes, like death, are inevitable!! Unfortunately, over the years they are used to hand outs, don’t pay for anything, everything is given. We koadjas (whites) all feel better by doing that, but I am sure in the long run for them, it is not the best.

Education is the only way forward and at least here at the hospital that is what is being achieved.

As I write this, the final year students are sitting their final exams to become certified nurses (these are the ones I helped to teach in 2009,) the first in South Sudan. So they don’t know what to expect, no past exam papers to study.

I do hope all 11 get through. It is a fantastic achievement for this hospital, in particular Dr R and P. They are the ones who pushed for it and found the sponsors (CISP an Italian organisation) & they had the vision for the hospital's future.

The plan is that the newly qualified nurses will come back and start taking up the more senior positions in the hospital and slowly replacing the Kenyan and Ugandan workers (and koadjas like me!).

One already is booked to work for a 6 months period in a Ugandan hospital in a radiology department to learn the ropes so that next year when we open this type of department in the hospital there will be a local there to take over the running.

This young man is very happy as he is being sponsored by two very good friends of ours, so all this can be achieved. Thank you so much, it's a huge gift to South Sudan. Slowly, slowly this country will grow if the people, men and women, are educated and the tribal fighting can be eventually eliminated.
Here endeth the last lesson! Hope to see you all very soon. Thank you for following the blog, put together with the help of Ian and the girls.

Maria, Hyena Lady

Sunday 23rd October

An update on the hyena family. Michael, the little boy, was discharged home last week. He is able to move his hand, but cannot flex it back. So, if he ever learns to write, which I am sure he will, it will be with his left hand (nothing wrong with that, many in my lot are!).

Since he went home his little sister, about 2 years old, has come to join his mother in hospital. She is just so quiet and shy, and looks like her Mum. I think the grandmother has been finding it hard to look after all the children on her own.

Mum should be going home this week. She ended up having the first two digits of her left thumb removed after a lot of persuasion with her husband. If we could have acted earlier, we could probably have saved one digit. But that was the way it was.

We remove the stitches tomorrow. Her heel has healed but it is still a little painful to walk on so she has a slight limp. When I think back as to what it was like that first day I saw it, it’s a miracle it could all be stitched back together again.

She says I am not allowed to go back to Australia until she has gone home!!
Her father in law did not have an amputation in the end, we changed the way his traction was rigged so his thigh is now at 90 degrees to his body and the bones seem to be knitting together quite well. The pressure sore he was developing has now healed, thanks to a lovely air ring donated by our Aussie followers and delivered by Ian. He was thrilled when we slipped it under him. I wish you could have seen his face, he says a big ‘thank you’.

He has another two weeks in this position, when we will see if the bone has healed. He has lost a lot of weight and muscle tone has gone in his good leg, so he will have a very slow recovery.

When I think what happened to this family, and the way the mother fought with the hyena to save her child, she is the bravest women I have ever met. Incredibly she told me that her mother and her baby sister were taken and killed by a hyena when she was a small child and she was brought up by her grandmother.

If this had happened in Australia, especially with what happened to her mother & sister years ago, she would be on the cover of every magazine, and on every talk-back radio show and news channel around. She also could have made a small fortune for her story. Instead, she goes back to her little tukul and picks up the pieces of her life, as best she can with her terrible injuries. The children have all received Target tee-shirts and shorts, but that is where it ends. Perhaps it is for the best, but I will never forget this family.

I like hospitals!

Sun 16th October 2011

Well what a night we had last night, party, party, all to celebrate the killing of our goat! On Thursday, a lady arrived at the hospital with a little boy pulling a goat on a short rope, asking for ‘Anne’.

It was the sister of one of my patients (a paraplegic soldier injured on a mission in the civil war) - it was to say ‘thank you’ and to greet Ian. They did the same thing last year; it is so kind of the family, as they could do with the protein more than us. She explained it is their custom in their tribe (not Dinka) and wanted to give the goat.

So Ian and I left the hospital that evening with our goat leading the way, bleating for its family. Meat is a rarity here, so we decided to invite the whole compound and the Sisters and Brothers.

Now, to be honest, it would have been very nice to have gone into a butcher and chosen the beautifully prepared meat and taken it home and cooked it in the oven, BUT we are in South Sudan!

When we arrived back at the compound we had to find somewhere to tether it so at least its last few days on this earth it would be able to eat grass. The gate keeper tells us there are hyenas around, so we better put it for the night in the chicken house and he will let it out in the morning.

The next step was to find someone who was willing to kill, skin and cut it up on Saturday morning. The two gate keepers seemed willing after a small payment was made. Lots of middle men here!
Next find fire wood, as cooking a whole goat on our cook’s little kerosene burner would be an impossibility. Two possibilities here, pay someone to go into the forest to cut some wood or purchase it from ‘the poor and blind’ compound down the road (who also get it from the forest (mostly mahogany wood!). The latter seemed the best option.

OK, we have the live goat and some firewood. Who is going to cook it? A little persuasion and the 3 cooks in the compound all say they will help as long as they can have the goat skin, head and any other bits we don’t want + a little extra cash (the skin is used to carry babies in, a bit like a papoose or a billum). What a bargain!

BUT, what else do we need? Cooking oil, onions, beans, rice, tomato paste, ungali (maize flour mixed with hot water). It makes a stiff paste that tastes of nothing but stodge, but it is great for soaking up the gravy of a goat. All the above ingredients we were able to get in the market, in fact that is all there is in the market!

As for vegetables, someone said they could get some pumpkin leaves, which when cooked taste like hairy spinach. Perfect, all sorted!!

We all were at work on Saturday until about 3pm, but I did manage to quickly visit the compound around 11am. The deed had been done, the goat was no more.
One of the cooks was painstakingly washing the intestines out then turning them inside out and cutting them up in to small pieces to go in the pan with onion and tomato paste to make the gravy. Sometimes better not to see these things!!

It was a beautiful evening, the African sky was full of stars and the moon shone very brightly. It was a good job as we only had 3 small candles for the tables.
We took one table from each dining room and joined them all up. There were so many dishes on the table, and some of the goat had been barbequed too, so that was another big plate.
The Sisters arrived with a Mapuordit version of fried rice which was delicious, and the best fresh fruit salad you can imagine. It had the first pawpaw of the season and lots of guavas, just so refreshing.

Everyone had to bring their own plate and fork, in quite short supply here.

There were 30 people there from 12 different nations. We ended up with 4 extra as we had had trouble with the new water system at the hospital, so the technicians from Rumbek joined us too.

It was great, we had a song from every country, the Aussies of course ended up singing ‘Waltzing Matilda’ we had Gospel singing from Kenya, rap from Uganda, singing & dancing with beating sticks from Sudan, and folk from Malawi. It was a night to be remembered, so many countries joining together to eat, sing and dance and not a drop of alcohol between us.

Rumbek main street

Anne and Tabitha

16th October 2011

Well Ian has been here for 4 days now and I am a bit worried about him, he came to mass this AM. It is held outside in the outpatient waiting room area in the hospital, underneath the Lulu tree (Google it!). Always a good gathering, the patients come and many locals and twice as many children. Most of the service is in Dinka, with lots of singing, drums and clapping and waving of hands. Nothing else to do on a Sunday morning at 7-30am.

Ian is already into making new spreadsheets for the hospital. Inputs and outputs, to go in a financial report to potential sponsors. Think there is more output than in!

A follow-on from the cows for Comboni day. The two men that were arrested for selling the cows that did not belong to them are in big trouble, well one of them is. On Friday morning I had just finished giving my first lesson, and went to the surgical ward to check on a patient. There was a lot of activity, soldiers, a truck with a machine gun on the top, men in uniform, police and of course every person who was not tied to a bed by a drip or drain.

My heart missed a beat, as at that time we were without a surgeon (Dr R had left to go to Juba for an important meeting for 9 days). Our wonderful volunteer Australian surgeon and his wife who were coming to replace him were not arriving in Rumbek until mid afternoon, so would not be here until late evening.

The word ‘gun-shot’ was being shouted. I managed to push my way into the dressing room to see what we were going to face. Most of the people near the patient had uniforms on and weapons over their shoulders, so I got rid of them outside quick sharp.

Someone called our lovely young Slovakian Dr to come, and between us we slowly unwrapped our new patient’s left lower leg, which had been wrapped in a nylon jacket which was heavily blood stained. Thank goodness Ian had brought some more large dressings (donated by Molnlycke Health Care) and some splints - we needed them.

His lower leg had just about been blown off.

As staff ran around getting tetanus injections, antibiotics, and keeping the marauding crowds from the door and windows, we carefully triaged his leg. Will not go into too much detail, only to say we used most of the dressings and a very large splint as, we thought, a temporary measure until our vascular surgeon arrived that night.

Trying to get a history from the man proved difficult as the captain of the police kept interrupting (all this through an interpreter). Eventually we learnt that this man was one of the cattle rustlers. The two were being moved from one area to another and one had grabbed a guard’s gun and tried to run away. He was then shot through the leg.

After about an hour of triage we persuaded the captain that this patient must be admitted and operated on as soon as possible or he will lose his leg. It was agreed and an armed guard was to sit with him, but only for 3 days then they would take him back to prison. The nursing staff seemed very angry about this patient and say they have a bad feeling about this!

About 5 mins later his brother arrives, and there is another massive big argument between the different groups. The brother wants him to be taken to the witch doctor and bone setter in the next village. We do our best to persuade them otherwise, but to no avail. So he departs, carried to the back of the armed truck .The cost of this exercise was great for a small hospital, when what this man needed was not achieved.

We have not seen the last of that man - he will be returned for a full leg amputation or full blown sepsis, in the next few weeks.

Sunday 16th October 2011

Ian here, just a few first impressions, having arrived back last week. Don’t worry, I won’t crowd out Anne’s blogging!

We stopped in Rumbek to do some shopping before heading off on the last leg to Mapuordit. While having lunch in a small restaurant (menu: ‘rice & meat', 'chips', or rice & beans’, sorry no chips!!), there was an altercation outside and we went to investigate. A drunk was driving erratically around the restaurant compound in a Chinese 4WD, saw us in the doorway, and headed straight for us, braking only when we scattered. He drove off, and we heard that he later cleaned up a UN vehicle, injuring its six passengers, some seriously. Welcome to South Sudan................

Lots of beneficial changes in the hospital since I was here last year, with huge improvements to the water system (although, as luck would have it, the new pump broke down on Saturday, so no water at all throughout the day and intermittent in the evening. Serious problem in a hospital.....).

Anne graciously moved into a room in the Volunteers Compound with me, vacating her luxurious pad in the Sisters Compound..............

The internet connection is very slow, a combination (in my inexpert opinion) of weather conditions (storms) and inadequate server for all the new users. The solution in a new server is expensive and outside the hospital means, yet with the increased student intake it can’t be seen as a luxury.

No one’s quite sure if the two are related, but there do seem to be ongoing celebrations in the village involving dancing and wrestling by men from different cattle camps, after the ‘peace agreement’ reached last month between warring local tribes. The wrestling in particular is keenly followed and quite a spectacle – unlike the pseudo American version. There's lots of strutting, posing and athleticism that is clearly not posed like the TV stuff.

Couldn't quite work out the rules, but I suspect there's more than a little bit of 'boy meets girl' in it, as the girls dance inside the outer circle, whilst the wrestling takes place in the centre.

Ian presenting the donated chairs to Tabitha, donated by niece and friends

The wrestling match

Watching the match

Saturday 8th October

Only 4 more days before Ian arrives so quite excited to see him, and the staff that were here last year keep asking about him so he will be greeted well when he arrives.
Comboni day today, a big celebration here in Mapuordit, as it was here in South Sudan that Daniel Comboni first set up a community back in 1800’s.
The build-up to this day has been going on for ages with lots of people going to committee meetings working out the logistics as to how many cows to slaughter for over 1000 people.
What competitions to have. So lots of football games going on, and the final is tonight, the hospital v school. A spelling bee is lined up with lots of children taking part and some are girls! They usually have a couple of short plays, and the theme this year, as you might expect, is ‘Peace’
The usual dancing and singing will go on long into the night.

The primary school bought 2 cows in the market a few weeks ago and have been fattening them up in the playground, no problem, but the senior school heard that they could get two cows a bit cheaper in the next village (price of a cow is anything from 1000-1300 pounds – around US$330-430.

So, off two teachers went to purchase two cows. Paid the money and brought them to the village, put them in their playground. Very soon two men came and said the cows were stolen, they were their cows and they had not sold them! The two teachers were arrested and put in to prison. It took a lot of talking before they were released. Eventually the two men who had sold the cows were caught but they had already spent most of the money. This was happening on Friday only 3 days before the big day. In the end, I think they were able to buy one cow and a few goats instead.
This is probably equivalent back home when you hear the story of people purchasing a car through the Manly Daily only to find out when they try to register it that it has been stolen!! Difference is you would not be thrown into prison (prison here in the village is a large shipping container, in which one prisoner suffocated last year).

I am sitting in my room and it is about 10pm and the party is still going, the cow horns and drums are still beating and the crowds sound very happy, good to hear. There is too much misery around so I am glad they are having a good day/night.

Here is a good news story. About 2 weeks ago a small boy was admitted with severe cerebral malaria. Temperature of 40C fitting, respiratory problems, unconscious. We all worked as a team to pull him through. The little foot pump was working overtime; it was a good test for my knees!

Our oxygen separator machine was on the highest reading we could get. Twice the mother started her wailing, in preparation for his death, but he survived. Three days later he was discharged on oral quinine. Unfortunately, the mother did not give the child the medication, so he arrived back in hospital in an even worse condition.
So it was all of the above and more. I did not want to go to the children’s ward on Sunday morning as I was sure he would not be with us. Then there was a knocking at the gate. It was our only other Dr (apart from the surgeon) shouting ‘Anne, Anne he is alive’! Now this was a miracle!! This was one week ago and he was discharged yesterday, this time after he had finished his course of treatment. What a lucky little boy.....

Saturday 8th October

Well the rain is still coming down. I really wanted it to stop for at least a few days before Ian’s plane touched down as the tracks out of here are terrible & the road to Juba is impassable - still no trucks can get through, which means the food situation in the market for the local people is quite desperate.

Ground nuts they now have if they got them out of the ground, but sugar and oil comes in from the south. What there is in the market has doubled in price. Even here supply and demand operates. The cooks and cleaners get paid only about 180-220 Sudanese pounds a month, which is about $67-$80 US. They get advances in the market, so as soon as they are paid they have to pay up their ‘slate’ and are left with nothing to start the month.

Nurses and teachers do get paid a bit more, but not a lot. The government pay them, but last month they did not come until half way through the month, so most of the staff were hungry. That is when the hospital introduced beans and bread for all the staff at around 11am, free, and instead of just tea and mandazi. It has helped a little. But energy levels are still quite low! ‘Nurses must be quick’ does not exactly apply here..................

Long day yesterday. Started teaching at 8am until 1-30pm. Came from teaching thinking I can rush home and do my washing and grab a drink before the next session, but the rain came in buckets - trapped for 1hr in the office!!

Thought the coast was clear, when yet another baby needed a blood transfusion. Father was the donor and he had good veins, so it did not take too long to do.

Then back to class for another 2 hours.

It’s not like this every day, but the other tutor was having malaria so had to double up a bit.
Only 4 more days before Ian arrives, so am quite excited to see him, and the staff that were here last year keep asking about him, so he will be greeted well when he arrives.


Brothers

Tabitha's Shop

Just a normal load

Sunday Best

Hospital securityman & daughter

Friday 30th September 2011

Just finished marking the First Aid exam - all passed, so I will survive another day!!

Start my 15hrs of lectures on the respiratory system and diseases this week. I had better warn them it is not as easy as First Aid…..

Since I was here last year, there is a new shop opened by an amazing Sudanese woman called Tabitha.
She was given permission by the payam (parish council) to build it just opposite the hospital. So she set to, and made the bricks, the Sisters helped with some metal sheeting for the roof, and she built it all by herself.

Now, for a woman to do this here is amazing, all the other women are looking up to her and feeling perhaps they can do things and are not just in this world for breeding. She employs a few other very poor women, and together they bake lovely bread, sometimes some mandazi (East African doughnut).

I think she has also started to cook beans for sale. The next thing she would like to do is put a cover out at the front, and have a few chairs and a small table so she can make it into a small restaurant. Will try and get a picture to you. A very strong woman, we need more of them here.

Update on the family attacked by the hyena.

Michael, the little boy, is doing very well - took his dressing down for the first time on Friday, still a small wound on his arm. Considering his tendon was severed and wrist almost wrenched off he is amazing, due to the skills of the surgeon of course.

He can move all his fingers and make a fist but can’t bend his hand back, and may never be able to do that. He has a small tube he squeezes to do his exercises. We are doing ten at a time & all the students are helping with the physio. Along with this, he is learning to count in English. At first he would repeat after me very quietly ‘one, two etc’, but now with a big loud voice. Great to hear and see, when I think what he was like when he came in. A frightened little rabbit.

His grandad is struggling with his traction, and I think on Saturday he will be going to theatre to have a higher amputation on his very fractured femur. He is anaemic, so trying to find a blood donor in the rest of his family is proving quite difficult, if only we had a blood bank.

Mum is doing well. The teeth marks up and down her arm have healed. Starting to walk on the heel, still a wound there but improving. Right hand almost healed, full movement. Her problem is her thumb on her left hand. This is the hand that she used to prise the jaws of the hyena’s mouth open to save her child.

There is a big chance she will have to have it amputated in the next few days. I will keep giving you updates.