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….