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!