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.

The harvest is in

Shelling groundnuts

Boy tending cows

Monday 3rd October 2011

We are having fruit every day at the moment, guavas, guavas and guavas, they are just so good. There is a very large tree in the Sister’s compound which is just laden. It’s not a fruit I have eaten before, only drank the juice. After no fresh fruit for so long, it’s wonderful!! You can have it with either salt or sugar.

Lots of activity around the market just now, wrestling competitions and dancing. No one seems to know if it is for ‘Peace’ or because it is the end of the ground nut harvest. Anyway it is good to hear happy cheerful people. Not heard a gunshot for at least 4 days…..

Lots of rain again on Friday, the worst I have seen it. A few trees came down and the roof caved in on the volunteer’s dining room. They have moved out until some tarps can be put up. It’s a thatched roof, and there will be no new thatching done until the dry season. Welcome, Ian!!

The other good thing that is happening is the hospital has received some more Hep B vaccines, so I’ve been busy yesterday and today vaccinating another batch of staff. So, all up, there will be about 60 people ‘processed’. That equates to 240 vaccines, 4 each.

As with any group of people, there was a small number (thank goodness) who were positive. They have been given counselling and will be checked again in 4 weeks. This is a big step forward for the staff at the hospital; all are at great risk of contracting Hep B, especially now we have the HIV centre in full operation.

I am now teaching the respiratory system and diseases. So frantically trying to illustrate how ‘things work’.
I found two balloons, put one inside the other (representing a lung), then blew the inner one up, then put a bit of water between the two ‘pleural membranes’ and called it ‘pleural fluid’. Think they got the picture!! Did you?

Spent a long time discussing asthma in the classroom; it’s not very common here. I suppose there are not as many triggers (pollutants, additives etc), but as luck would have it (for us, not the patient!!), a young man was admitted today having a severe asthma attack. It was good to see how the students knew what to do. I think a few ‘lights came on’ especially after giving him medications and he improved.

Another 14 students (one girl) started a new 9 week very basic nursing course today (‘the Greens’ due to colour of uniform). P is getting famous for this course - they are coming from far and wide for it. She has it running like clockwork. It’s such a shame it is not a government recognised course.

They are all put through bed-bathing, doing observations, bed making, caring for children with malaria. Then at the end of the course there is a written exam and a practical. They then return to their own clinic or hospitals with at least the grounding to become a practical nurse.

I am very happy to be able to teach and be part of this fulfilling course too. As you can imagine, there is always a shortage of teachers, but P makes this a big priority in her very busy day and is in the classroom on a regular basis, bestowing her vast knowledge of nursing in difficult countries like Sudan, India, and Ethiopia.

Anne & Pauline with compound cook & family

Recycled bucket

Hospital Security

28th September 2011

The students will be sitting the First Aid exam this afternoon. This will be a test of my teaching skills, and I do hope they all pass. If not, it has been known for students not to look kindly on the teacher!!!! Get my drift? In my first year here, a local teacher was badly beaten by a student whom he had failed!

The rain seems to be easing a little, not every day now, but when it does it comes down in buckets. A river runs between here and the hospital. I worked all day yesterday in P’s wellie boots, does terrible things to my bunions!

Found a dead scorpion in my room last week that had not been there in the morning….they get washed out of their nests by the rain and seek dry ground. So, I hope that whatever killed it will remain for any future invaders…...

Helped P on Sunday to deliver a very healthy looking baby boy; a difficult birth, but as usual those expert hands were amazing. With the addition of the extension on the maternity unit there is now running water all the time (in the past, it was hit and miss, and only if you could access a usable tap). As you can imagine, having water at the birth is very useful!

Now also, the mother can stand in a bowl in a small enclosure and wash herself, also the floor has been tiled for easy mopping...it’s called “all mod cons”!!

The babies continue to suffer, mostly with malaria and anaemia, Hb’s of 3-4, just so low. Two little ones died yesterday afternoon and a girl of about 4yr this am early. As I think I have said before, they arrive so late due to no roads, lack of transport and lack of knowledge.

In 2009, there was a fantastic malaria program running, mozzie nets given out to all the families and isolated villages, education programs given in their own language.
One person in each small community was trained to give out first-line treatment and advice.

In the middle of last year, the funding was removed (World Health Organisation), “kalas” (Dinka for finish). It has been devastating for the people. The biggest killer in Africa, and no funding.

It is now up to the South Sudanese government to do it. The new government has not yet been able to form any polices on malaria management, and I am sure it will remain that way for a long time. Meanwhile the death rate is increasing, there are no nets to be bought in the market, and many people are still sleeping outside in the open, since their houses were burnt out in March –April.
A sad, sad state of affairs.

We have just heard that the two roads from Juba are flooded and impassable so there are no supplies coming through. It has been like this for one week but just heard. That will account for the shortage of food like sugar, tea, coffee (not grown in this area) in the market. There is nothing there to buy and supplies of everything in the food line are very low. Can’t wait for a cup of tea, we have run out, and coffee is very low. Stick a loo roll in your bag, even these are going down fast. No lorries are coming through.

The poor local people - if there is anything in the market, the price is very high.

Yesterday the roof of the dining room in the Volunteers’ Compound collapsed - water everywhere! There was so much rain. P is frantically trying to find a new place for us all to eat.

There was only one place in Rumbek you could get petrol and he only had enough for 2 more days, that is up to today, then nothing.

I just hope the Brothers have a little in a tank to get Ian here and both of us out!!! Help!

Walking Wounded

Student at First Aid

Sudanese stretcher

Tuesday 27th September

Just finished the First Aid block of lectures, all 14hrs plus 6hrs practical sessions.

It has been a good opportunity to get to know the students; there are now 3 girls, one repeating as she did not get through last year. So, she is back to try and sit again. I do hope she makes it, as we need females in the health care setting here.

Already she has missed many lectures as one of her two children is in this hospital with complications of malaria (fitting); she sleeps by her side at night then tries to come to lessons.

One of the other girls is pregnant, due in 4 weeks. The third girl has a small son of 3 years, who she has not seen for 6 months as she lives in the Nuba mountain area of the country (it would take at least 3 days to get there) - if she had transport.

I have learnt so much from them! How to scare off lions - but only if there are more than 3 of you, otherwise you climb the nearest tree! What to do if there are hyenas around, how to do bone setting, what plant to put on what wound.
I think they all should have been at the front of the class, not me! We did have lots of fun doing bandaging and slings.

It was very hard to show them how to fight a fire (as if they do not know). I found one (empty) water fire extinguisher. At least it was red and they could see how it would work. The only place to get it filled would be in Nairobi, Kenya.

There are no buildings of any significance here in Sudan to save, nor any insurance (sorry, Ian!). No fire blankets, I could only find one small, very old, piece of hose pipe, with lots of kinks and no connections. Anyway, we did lots of role play, of moving patients on mattresses, blankets, away from the fire. They do have quite big grass fires here as in northern Australia; they ‘burn off ‘after the tall grasses have been collected for thatching.

I will try and make some signs for ‘Assembly Point’, ‘No Smoking’ (picture sign). Perhaps I will find a bigger hose so we could put it on a bracket with a sign saying ‘Fire Hose’. Ian is going to do some Googling for me to see what he can find.
No chance of purchasing a fire blanket in the market here, but we do have some quite thick blankets which I think would smother a small fire if necessary.

Since last year we have got about 4 more power points in the hospital, so we now have 7 in total!!! Up to now, these people have never seen electric burns from electrical appliances (only from lightning strikes). There is no electricity apart from the solar panels in the hospital. There are no electric irons only charcoal ones, no electric kettles, only pans for water to go on an open fire, no TV.

So, they have no idea about how dangerous it is. They try to stick round plugs into square holes. Force two pins into three holes using a pencil for one hole.
Slowly, some are getting mobile phones: there is no reception but they use them to play music and they all need recharging, so you can see the problem it is starting to cause with the little electricity we do have. It is a country where the people want to develop faster than the new nation can.

There is just no infrastructure for power, sewerage or water. Never mind roads, postal service, banking, birth and death certificates, passports. It has just been released that this new nation of the Republic of South Sudan is now definitely the poorest in the world. Prior to this, I think it was second poorest, with Somalia first.

Our compound cleaner & family

My zoot suit (knitted by friends in Oberon NSW)

Traction Sudan-style (patient who was attacked by hyena)

Wednesday 21st September

The temperature during the day is terrible, about 40C and high humidity. Last night it was 30C when we went to bed, not had it this hot before.

It is busy now I have started the teaching. My first class is in 10 minutes time at 8am, was teaching till 6pm last night. Then dinner, then bed, no time to blog! Their first exam on First Aid is next Tuesday, so am busy setting papers, and scenarios.

The next morning after the peace agreement was signed, a young woman was walking from her village about 10ks away to come to the ante-natal clinic here at the hospital. Her baby was due in the next few weeks. On the way she met two men, one a soldier. She was beaten with large sticks and left for dead. Luckily a group of women were not too far behind her and carried her to the hospital.

Her back was very badly beaten; she had two large lacerations across her head. She had lost quite a lot of blood and her right arm was lacerated.
She was very quickly stitched up by one of our very experienced nurses and the baby was checked out. All was well. The next day she was delivered of a beautiful little boy, 3 weeks prem but doing well.

I know if I was at home I would be reading every day of people being bashed and shot, and we seem remote from it normally. But somehow here, everyone seems to know each other and the staff find it very hard because it is always someone’s relation that is brought in.

No one seems to know who did it; I don’t think it will even get reported, it was to a woman after all.

Now I need a big hug myself. I’ve just been working on a small baby boy for about an hour. I was doing the cardiac massage and we got him going for about 5 mins then cardiac arrest.
We all did our best, I know, but the poor parents, they had travelled a long way with him.
Look after our babies….

Child in the Poor Compound

Home, in the Poor Compound

Heavy Load

Sunday 18th September

Only went up to the hospital for a short time today, so had a bit of free time afterwards. I went with one of the sisters to the Poor and Blind compound just behind the hospital.

They are definitely ‘the poor’, and just so many children. Hardly any clothes and what they had were falling off. It was quite cold today too, as we have had so much rain. Their huts are quite poorly made and must let a lot of rain in.

Some had big pieces of plastic they were sleeping under which were given out during the recent troubles. BUT the kids were very happy to see us and all had smiling faces, playing together in the dirt. Not a book or toy between them.

One mum was quite sick with malaria, so I sent her off to the hospital - the Dr on call will look after her.

The blind people were all sitting around under a tree talking and greeted us warmly when they heard the sister’s voice. If they want to go anywhere, they have a long piece of bamboo. A child takes hold of it at the front, then everyone gets hold of the stick, any number 1-10 and off they go, often with another child at the end to help guide them to the church or the market. After happy hour at the market they are a merry crowd!!

The rain started late this year and is still coming down; thought I had seen it bad here in past years, but more this year, good for crops to grow, but the ground nuts are still in the ground and need to be taken out and dried. They are a staple food here.

There is a car going to Rumbek tomorrow, but the chances of it getting through are pretty slim. There has been a lot of traffic on the track due to the ‘peace talks’ so the water holes are just so deep and wide. Glad I am not going, just hope it dries up before Ian comes. Working in wellie boots all day is playing havoc with my bunions!

Along with the rain comes the mozzies and malaria. An abundance of both. They seem to love my Tropical Rid and Bushmans… Just felt along my neck and I must have at least 5 bites, red and swollen, never mind how many I have on my bum!! Just hope my anti-malaria tablets keep working!

Cooking for Peace

Drummers


SPLA Soldiers












Friday 16th Sept

Just an update on the family who were attacked by the hyena.

The little boy is now happy and smiling, playing with the other children. Before, he just had a terrified look on his face and would not let go of his father’s hand. He has not yet had a dressing change, as there is a fracture and torn ligaments and it is well splinted. Middle of next week, we will see how things are healing.

The mum is slowly improving. Most of the teeth marks on one arm have healed but her foot, hand and the other arm and hand have a long way to go.

The grandfather is struggling because of his weak state of health prior to this.

A make-shift pulley has been rigged up to keep his stump leg straight to help the double fracture heal. We have some sand bags attached to some string hanging over the end of the bed, fastened to a pin through his leg.

It may sound primitive when you think what fancy equipment there is in the big orthopaedic wards. BUT the principle is the same….traction!
There is something good about getting back to basics; it’s very easy to teach, too!

Well, the peace talks are well under way, but unfortunately the State governor did not come, only the deputy, but there are about 1000 extra people around the place and lots of soldiers. We had two helicopters bringing in the VIP’s and lots of trucks coming on the flooded tracks from Rumbek: many got bogged on the way.

So, it has been a mammoth effort to pull it all together. Lots of cows and goats have been slaughtered for the occasion.

We went for a walk to the High School where all the food was being prepared by the women. All on large open fires, with goats tethered nearby, waiting for the pot. The women had been brought by many different organisations to help.
It was good to see them all sitting together talking and laughing, all from different parts of South Sudan, getting on well. As women do when there is a job to be done, some singing some traditional songs.

After the first meeting held in the ‘Cathedral’ (which now has walls and a proper roof), there was lots of dancing drums and wrestling competitions.
Everyone seemed very happy and relaxed. They said they were dancing for peace.

More talks today, seem to be going very slowly, struggling to get to some agreement. Most of the unrest and fighting has been over cows, and where they can and can’t graze at different times of the year. Anyway, I just hope they can come to some arrangement to reduce the fighting.

Catch of the day

Big feet


Monday 12th September

The small child with HIV who I mentioned on the maternity ward and who was so wasted and sick died today.

His father was distraught, as of course was his mother, but she is very sick too. Their main concern was how the father was going to get his son back to his village which was a long way away to bury him (no undertakers here).

One of the staff offered to take him back on his motor bike. So that is how they went, the father sitting pillion with his poor son’s body on his knee. The road apparently was terrible, so flooded they had to wheel the bike through many areas.

It was only yesterday that I gave the boy a little Dinky toy racing car. He took it, looked carefully at it (I don’t think he knew what it was, there are no toys here) then put it under his sheet. And for the first time ever, he gave me a very small smile, then it was gone in an instant.

That was the last time I saw him. The sad thing in this case is that the father refuses to be checked for HIV…..so the cycle continues.

It sounds as though the meeting will be going ahead this week, the one for peace in the district (there was a lot of tribal fighting here around Easter, with many deaths and much damage)! There will be about 200 people at it, with lots of important people, so let’s hope it works. The number of soldiers and police around will increase this week because of it.

At the same time there will be another attempt at disarmament, so all those with guns will be asked to hand them in. The last time this happened, it was very violent and children were beaten to make them tell the soldiers where the guns were hidden.

So hope it will not be like that this time round, in this new country...
The soldiers I saw yesterday had nice new uniforms on and red hats - must be a new battalion looking after the ‘big wigs’ - but on their feet they had red thongs (flip-flops), not quite got it yet, but they have to start somewhere, boots are next.

Boy with goat, Mapuordit
Hyena (photographed last year in Masai Mara)


Thursday 8th September

Arriving at work on Wednesday morning last week, we knew something had happened, there were so many people hanging around the gate, and in front of the surgical ward. Rumours abounded. A lion attack, two people dead, a pack of hyenas, many injured!!!

Eventually, I fought my way through the whole village who all wanted to see what was going on, and found four people in bed admitted at around 5am.

Slowly we got the story ...more or less. For those of you that get easily upset, don’t read any more!!

A family of about 5-6 had been sleeping in their hut (about 10mins walk from here) with their goats. They had left the door open as it was a very hot night. A single hyena had entered and tried to take one of the goats. The grandfather had woken, and had seen what was going on and tried to get up from the floor, but he is an amputee (below knee) and he fell and badly fractured his femur.

The hyena turned on him and bit into the broken limb and tried to drag him away.

Then a small boy of about 7yrs, not quite sure of his age (no one knows their age here), he started screaming so the hyena turned on the child and grabbed his left arm and tried to drag him away. He has torn ligaments, fractured ulna, many puncture wounds.

The mother who was sleeping in the hut next door came in and tried to rescue her son. From the state of the poor mother, it then turned on her. Her right leg is fine but both her arms have repeated puncture wounds and one hand is pretty badly mauled with broken fingers. She tried to fight it off, such a brave woman.

I will not go into too much detail about her left foot only to say she is going to be in hospital for some time, as indeed they all are. I don’t know what happened to make the hyena release the lady, but it did and ran out and away. The locals were worried that it would return the next night but no one has seen it again.
The poor nurses on duty had done an amazing job to stem the bleeding and do some dressings. And I thought I was going to teach them first aid, they are so good.

The three patients are next to each other in the surgical ward, and are being supported well by their extended family, but the psychological trauma they will be going through must be huge. The little boy is just so sad and he must be in so much pain. Well all of them are, as we don’t have any strong pain relief here.

The old man will have to have some form of traction applied with a pin through his knee. All these things are so difficult with no X-ray facilities here. The Dr does it all with feel. If anything good can be said, it’s a good job it was that limb and not the one he gets around on with a stick! Poor man.

They have all had tetanus vaccine, and today the anti-rabies vaccine commenced. With strong antibiotics and a lot of support and dressings we hope they will all pull through. They will all have some terrible scars to remind them of that night in September.

Mapuordit HIV Centre (only one in a wide radius)


Friday 9th September

There’s a problem with the internet in that there are only 3 connections and then P’s and as you can imagine she is at her desk a lot of the time. There are more people and students with computers and they are all trying to get on Face Book (!!), and as soon as one succeeds, the others all crash.

The children’s ward remains busy with mostly malaria cases. Two who arrived very late last night have cerebral malaria, not sure how they are going to be, early days.
As their diet is so poor, many have malnutrition, and are very anaemic - they become so sick. It’s amazing that most survive One minute they seem to be at death’s door, and then with some quinine and fluids they slowly come round. Those beautiful big cow-like brown eyes looking up at you get me every time!!

The infra-red thermometer (with extra batteries) that I brought is a great success as it takes a temperature in 2 seconds, instead of the old mercury ones that are just so old and worn they are hard to read.
Last year, I gave out many digital ones that I’d brought, but like most things the batteries go or they walk. The only batteries here in the market are double A and the big fat ones. I also brought lots of small medicine cups and scissors donated by the hospital I work for. All in use every day, they think all their Christmases have come at once!! Thank you Longueville!!

There are many HIV positive patients throughout the hospital, most at least getting treatment which is wonderful. Last year, we were only seeing the really sick ones that were at the end of their lives, but even ‘early stagers’ in the disease are receiving treatment.

In Rumbek, the biggest town from here, there is a local radio station and sometimes you can pick it up here, but good reception in the town. Anyway, once a month someone from the HIV centre here goes into Rumbek, and for 2 hrs they have talk-back radio on STI’s, Hepatitis B, HIV - it is spoken in English, then translated into Dinka. People can ring in and ask questions, it’s a great innovation and very new in this ‘neck of the woods’. It was only last year that they got a communication tower, unfortunately the signal does not reach us.

Also, some funding has come in to provide a mobile unit to go out to the communities spreading the word (on HIV, not Christianity). One of the downsides is that there is very little written in Dinka or even posters with pictures only. You have to bear in mind that 80% of the population here is illiterate, rising to 92 % for women. So more pictures are needed.
Ian is on the hunt with the Sudanese community in Sydney.

My first thought was we could make some ourselves, but first find an artist, paper, and laminator. Hmmm! Let’s record some messages instead, first find a recorder, then electricity, or batteries, and so it goes on. But I am sure we will come up with something, things certainly are moving forward in this area.

What happens here is if a man dies, possibly of AIDS, then his brother inherits his wife or wives, who are very likely to be HIV positive too. If there’s no brother then someone else close in the family, so the man’s name is carried on. The wives have no say in this. So, you get to see how very quickly HIV is spreading. Also, there are more soldiers around who are more than likely to be HIV positive too.

In the maternity unit, there are at least 3 mums all positive, with babies also HIV positive and older brothers and sisters in the same situation. One little boy is about 4 but looks like an old man, and moves like one. All bone, no fat or muscle, with big sunken eyes and a very stooped back. His mum is really too ill to look after the new baby, but there is a lovely grandmother who is doing her best to provide food for them all. Because they are all HIV positive, there is a special feeding program for them and they are all on treatment, even the new-born....heartbreaking.

Cow jam on the road to Mapuordit



Monday 5th September

Sunday night was movie night here at the compound.

We had dinner early outside under the African stars with mozzie coils surrounding the small table. Their exotic aroma adding to the smell of the beans and tomatoes and open fire. Simple meals, but with a bit of spice and a few dried herbs its amazing what can be produced (back to basics, no preservatives here!!).

We cleared all the pots away, switched on the solar power and set up P’s computer. Tonight we had a treat: ‘Inn of the Sixth Happiness’ - I remember seeing this film back in the 60’s and loved it once again!

We had just got to the bit where the ‘foot inspector’ unwraps the first feet and it started to pour down. It was a mad scramble to get everything under cover. The long electric cord was hurriedly rewound. 10 minutes later, the downpour over, we were all miles away again in China. It was a memorable evening. Simple pleasures…

Back to the real world……things are hectic here, as there was a big hyena attack last night, and all the victims are in theatre as I write.

Tobacco sellers

Scorpio loses!





Sunday 7th August

I can’t believe that this time last week we were in Mombasa relaxing by a pool; it seems so long ago, a different world, yet in the same region.

Food is in very short supply here - there is nothing much in the village market to buy I am told, and if there is it is very expensive.

We are OK, as in the compound the Sisters have established a small garden now, growing beans, tomatoes, a little lettuce, some sukuma wiki (a spinach look-alike, very high in vitamins), supplemented with some rice, beans and lentils purchased in Nairobi, Kenya (others don’t have the luxury of that).

There are a few reasons the price is up for all the food:
1) the crops burnt out in March during the tribal fighting
2) more Southern people returning home from the North to their new country
3) fewer supplies coming in from Kenya on the lorries because the growers can get a higher price from the UN, and World Health Organisation who are purchasing food for the starving in other parts of Africa (Somalia)
4) late rainy season

It’s very tough for the locals here. Because of the troubles in March, the container of food in the hospital which gets distributed 3 times a week to the very poor in the hospital is almost empty, and no sign of it being replenished any time soon…..

On a lighter note, the students had their final first block exam yesterday; I think only 3 have failed out of 13, which is not bad and they will have a chance to re-sit the exams that they have failed next term.
I start my real teaching in the class room on the 17th (term 2), beginning with 14 hours of first aid. That should be fun, as most times you read in the First Aid textbook, “don’t move the patient, wait for medical help”, “call an ambulance” (!), ‘apply a sterile dressing’. Think I will have to do a lot of improvisation……..

At least I have been able to get hold of a ‘Resusci Annie’ doll and thanks to Justin (doctor friend in Sydney), who also gave me some manikin face shields, so I should be able to teach CPR.
Not quite sure if anyone would survive here after a cardiac arrest, as there is no oxygen or ICU, of course, but the students need to know.

Was just preparing some food in the kitchen this afternoon when a lizard and a scorpion had this big fight, just in the corner of the kitchen under the bench. The scorpion lost the battle, all the lizard did was kill it but before he could eat it a chicken ran in and pinched it. All in a couple of minutes but I did manage to catch it on camera.

On the march
Welcome smile
September 2nd
Spent some time in Rumbek with P today, helping to interview people who have applied to do a new midwifery course, which is a 3 year course in Wau (about 6 hours by rough road North of here). There has been a lot of interest in this course as it is the very first one in South Sudan. All the midwives in the country currently are Ugandan or Kenyan, with a few Sudanese who have done their training outside of this country and come back.

Only one girl, and 6 men. I really wanted the girl to do well but with 3 children and no family support and very little schooling (gleaned when she attempted to do the written exam), she did not stand a chance. We have identified 2 candidates, so all the papers will be sent to Wau, and the Diocese of Rumbek will try to find sponsors for them.

At the moment, I am sitting in a class room invigilating, while 13 students sit their end of introductory block exam. This one is Professionalism and Fundamentals in Nursing. The first student has just left the room after 2hrs (2 1/2 hr paper): O dear, first question, what is a low temperature called?
Answer:- Hypotension!!!! Hope the others improve.

During this exam session, there was a lot of noise outside, stamping of feet, whistles blowing. It was, I think, SPLA (Sudan People’s Liberation Army) training, running around the outside of the hospital compound in full gear + guns. There seems to be a battalion of them ready for the big meeting. BUT we heard yesterday that it had been postponed as some of the governors in Juba (capital) are too busy. We will see if these people get a peace agreement. At least the grounds are free of rubbish after the intensive clean up!!

One of the students started to tell me about the fighting that took place here in March/April this year and how it had affected his family. It was inter-tribal fighting, but no less vicious for that.
He lived in a small compound (an area of land that is surrounded by a small fence, where the family had 3 thatched huts and a few chickens and 6 goats; they also had a small store for grain). Located in behind the hospital with 10 of his family members. On the outside area they had planted some sorghum, and maize. Close by were the family’s 8 cows, their pride and joy. So they were quite a wealthy family as things go around here.

There had been some tribal fighting just before Easter in some villages about 10k’s away but this night it came to Mapourdit. An armed gang burst into his compound, shot his uncle and started burning their huts. The rest of the family fled into the surrounding bush terrified but unharmed. Their cows and other livestock were rounded up and stolen along with their grain. They lost everything, as did other compounds in the area. A small child was also killed that night.

The next day when the families returned there was nothing left. Everything burnt to the ground and two dead and many injured. Hundreds of people were without shelter. The Brothers’ compound was opened, the hospital and the school, so displaced people could stay there, as they felt safe. Most of the patients left to travel to see if their homes were attacked. Some of the staff left fearing for their lives, as they were from the same tribe that had attacked (many still have not returned).

All available emergency supplies of food, mosquito nets and blankets were given out. The UN came a week later to help distribute other supplies. The sisters gave as many families as possible some cash to help with clothing, containers for water etc.
The nurse who was telling me this story, is still sleeping rough with his family until they can get at least one hut built again. They have started re-planting a crop around their compound. His mother has been very disturbed by this experience, as it rekindled many memories. She had been pregnant with this boy when she had to flee from her home 23 years ago, during the war with the North of Sudan.

First day back
30th August
The holiday is behind us now and we have completed all the shopping for the hospital in Nairobi, which was somewhat of a nightmare. Perhaps we should have had the holiday last…..

It went something like this. You have 6 envelopes with different department names on + the items required and cash enclosed could be in $US, Euros, Kenyan shillings.
The items were: - Sing along with “and a partridge in a pear tree!”
1 generator
1 printer,
1 computer
2 gum boots
3 door mats
4 gaskets
5 memory sticks
6 loo brushes
7 ink cartridges
8 maids uniforms
9 test kits
10 CD’s
But there were many more items, all over Nairobi. Also, many things to purchase from the OLSH website that people had donated. We now have some lovely towels and face-cloths that disappear quickly and are always needing to be replaced!!
By 4pm Sunday we were done, and had a few hours to relax before our flight to Rumbek early in the next morning.

Well, we have arrived in the new Republic of South Sudan. A few things have changed, a few more check points on the road, more guns and soldiers around. BUT the people themselves seem to be a lot happier. As soon as you mention independence a big smile appears.

The unsealed road to Mapuordit was as bad as ever, and the only bridge has been hit by a lorry and is closed, so there is a very dodgy makeshift bridge that is constructed of 3 large sewerage type pipes placed across the river. You then have to line the wheels up and race across, fingers crossed!! The river has about 3-4 inches to rise then the bridge will not be passable. So Ian, you might not get through (watch this space)………..

This week there will be a big meeting here in the market with a lot of government officials, chiefs, and VIPs to discuss the peace agreement between the 3 tribal areas which border Mapuordit. Everyone today had to clean the area they worked in, in readiness for the visit. This was done by soldiers walking around with loud speakers telling everyone they must clean and cut the grass. It seemed to work. The staff thought it was funny that it coincided with my arrival. After last year and ‘Clean up for the Cup’………I’m notorious!

I was welcomed warmly by all the staff, and was so surprised to see all the changes.
A new dressing room at the side of the surgical ward, with a nice new trolley. It even has a tiled floor so it can be mopped at the end of the day.
The HIV clinic is now open, unfortunately receiving many patients but at least they are now coming for treatment, unlike last year when they were too frightened to come. So the education the staff has been giving is paying off.
For the students, there is another dormitory, as we now have 1st , 2nd and the final year students here. They also have their own canteen, with a cook and a nice new kitchen. At least the beans can be cooked on the premises, instead of going up to the market. (not a big variety, beans or lentils, lentils or beans, beans with lentils, and so on!).

At last the maternity unit has a new birthing area, which was badly needed. The women can now wash in a small tiled area, AND there is running water all the time not just now and then.
After many generous donations, all these things have happened, including a new solar panel system which is connected to a pump and a new very high water tower, so all the hospital has somewhere to access water. On top of the tank, flying proudly, is the flag of the Republic of South Sudan. So many great changes, in just one year.

My first day has been spent having hugs from the staff and injecting 24 of them with the Hep B vaccine we collected in Nairobi. Was only able to give to the most at risk: I think everyone is at risk, but not sufficient to go around….