Mukako

Ok, more upbeat today! Here are some photos from our Juba city walkabout last weekend. This is basically the city centre on a dry day. The rains have started early and the pot holes become lakes which makes driving fun. You drive into the pot holes wondering if you'll need a submarine to continue your trip.










The photo below is near the Ministry of Health. The government have cleared a whole area of housing ready for an expansion of the university. It is currently just a field of flattened houses.


At the hospital Muddles (the monkey) has started to cause mischief. He has taken a liking to Heidi and follows her around trying to pull her trousers down. According to staff it is because he likes white women!? Rather less than impressed by this Heidi has taken to carrying around 'Monkey stone'. This small smooth rock is designed to act as a deterrent to the little fellow but Heidi has yet to launch it in anger. However, she does leave it in a lot of peoples' offices which means we end up with staff chasing after us to return the piece dusty granite with confused looks. Apparently Muddles often causes mischief generally, drinking coffee that is left on the ground, taking keys and even opening the office doors to go in. He (or she?) is also known to sink a few beers should the mood take it. The medical director has offered to act as mediator in peace talks between Heidi and the mukako (monkey in Juba Arabic) but Heidi is considering her options and changing her mandate to 'shoot on sight'.
We have also attempted to meet with the Under Secretary for health, largely just to say Hey! and introduce ourselves. However, we are two trips down, two hours sitting in a waiting room and still no meeting. It has been suggested that their technique at the ministry is like that of a Rabbi in the synagogue waiting to be visited 3 times by a potential convert to ensure their commitment (I think I saw that in a film). We'll have one more go.
We have met with VSO in the hospital who are considering setting up a project in Sudan which was very interesting. And we had our first visit to a Rotary meeting having been kindly invited by a group of Americans, Phil, Judy and Janet, who were out here teaching teachers. At the meeting there was a very interesting talk on the Economic situation here.
Anyway, with a monkey contributing to the bulk of our extra-curricular fun I'll leave you to read between the lines...
That said, we have become veritable cricket connoisseurs since the World Cup has started, largely because our camp is run by Indians with a Pakistani manager. He had told them that if Pakistan wins they all have to dance for him. If India wins he told them that anyone who gave him a hard time would be unemployed! I like his style.

A brief interlude

Just back from work and decided to share my thoughts. Heavy day after the weekend. Full ward on arrival, only a few left at the end- and not because they went home. One doctor showed up for work making it a long ward round. Important drugs had not been given over the weekend, or during my round. You might be forgiven looking in from the outside for interpreting the staffs' indifference as an implication that out here death has become normal; acceptable. But then you take a closer look. You see the boy lying curled up on the iron bed hugging his older brother who has been in a coma for two days with cerebral malaria, only to pass two hours later; or the entire family of a young man looking on in silent shock, squeezing his lifeless arms as a sheet is pulled over his head their only comfort the fact that his agonised screams have finally ceased; or as I walk out from the gloom into the sunlight to hear an elderly woman wailing with her face pressed close to the brick wall lamenting the loss of her husband. You see this and realise that out here, in the depths of Africa, and a war torn land, that the death of a loved one is no less painful, no less traumatic and no less heart breaking.

The Hospital

After a few weeks at Juba Teaching Hospital (JTH) the management were forced to invest in new signs for the medical wards because of the great changes that had occurred. Examples are shown above.
Now for a (very small) bit of history.
JTH was originally a British Army barracks but was abandoned by them and handed over to the International Red Cross to become a hospital in 1973. The Red Cross returned ownership to the newly formed Government of Southern Sudan (GOSS) in 2007 and JTH was born. It lies on a dusty sprawling site with multiple brick single -story buildings each containing wards, operating theatres, pharmacies, clinics and storage facilities. As mentioned before the hospital is the country's flagship hospital and acts as a tertiary referral centre for the local clinics.
The junior doctors have until now been trained in Khartoum (the capital of Sudan, in the north) where the Juba medical school was moved during the war for safety reasons due to the heavy shelling of Juba. They are slowly moving the medical school back ready for independance but since most of the lecturers were from the North there is a desperate shortage of qualified trainers. There is a nursing school newly established which turns out pristine looking student nurses in their crisp pink uniforms (see photo).
One thing that you should notice is that this place is CLEAN. Compared with other health care facilities we have seen in Africa this place is sparkling. The Chinese have been here teaching the staff cleanliness and we are not even allowed to start ward rounds until the cleaners have finished their rounds! All the beds were repainted last week, and the mattresses repaired. The latter item truly is a luxury and is not available in the government institutions of neighbouring Uganda and Kenya.

The top photo is outpatients or in English terms, the Emergency department.
Below that shows the families waiting outside the medical ward for their loved ones inside.

Below this writing is the female medical acute admissions unitAbove shows the main general theatre 1

Decades of war have left the hospital in desperate need of investment and development. As private clinics spring up around charging extortionate amounts for even the most simple tests the locals from the surrounding villages travel often great distances for care here. Patients even arrive with referral letters from other NGO's such as MSF and Merlin, most, I imagine, not realising the facilities at our disposal here.

We spend much of the day either doing ward rounds, theatre or writing and giving presentations to the juniors. Above is a picture of Heidi meeting the hospital's local monkey, named by us 'Muddles'. There appear to be no other monkeys anywhere, as most have been killed and eaten, but Muddles appears to have escaped this fate. He (maybe she?) strolls the hospital grounds, in and out of offices and cars generally chilling his boots.
Below is one of the chefs at out camp, with his pet bay deer. It was brought to him by locals a couple of weeks ago who were trying to sell it for meat. Clearly no-one could actually kill the cute little thing so he was purchased and now lives here trotting behind the guy following him like its mother!

And what about us over the last couple of weeks? Well, Heidi is fully recovered, much to the relief of everyone at the camp. There was a real feeling of camaradarie here with staff and guests asking daily about her progress. We haven't really been out and about. We sunk a few 'White Bulls' and 'Nile Specials' at the local Ethiopian bar but have generally chilled by the Nile. Nothing else to report really. Except we did head over to church last Sunday, only to realise too late that we had attended the local language service! The singing, however, was incredible.

All machines great and small

Two weeks and no update- how did you cope? Well we are back! The delay has been due to illness unfortunately. On the plus side Heidi is now fully recovered, but only after I bought us two tickets for the following morning to Nairobi to see a specialist there! Well, you can’t put a price on your health and we had used up the 2 available blood tests at Juba Teaching Hospital (malaria and typhoid screens) and a further one at a private clinic (a full blood count). But as it turned out random fire with broad spectrum antibiotics and an IV drip in our cabin saved the day. She is now set for a return to the hospital tomorrow.

I have been battling along without her which is not easy. You quickly realise how important the moral support between us is. Getting to bounce ideas off each other, complain about any problems, and talk over plans or diagnoses is vital. Not to mention the weight I have lost through worry (and I wasn’t the sick one!). It will be nice to be back at work together.

Before the bug struck we were actually progressing well. Heidi had done an inventory of all the anaesthetic drugs and equipment in theatre and then took delivery of a brand spanking new anaesthetic machine for the obstetric ward- the first one in JTH! It was a generous donation from the Rotary club in Devon. The photo is of her with Robert Neighbour who is the Managing Director of Diamedica who made the equipment and had flown out to install it. We will keep you updated with its use, which will only be as an oxygen concentrator at present as we have no inhaled gases. Next stop procurement of halothane in Uganda!

I was strolling round the Emergency Unit and Long stay ward casting my less-than-specialist eye over complex tropical disease with a variable number of junior doctors. My plans for a fully functioning emergency medical unit (EMU) are in the pipeline and Heidi and I have run off a few rounds of data collection to prove that it needs improvement. I also rummaged through a cupboard in outpatients to find 3 fully functioning observation machines collecting a unique colour of dust in the corner. Why these valuable and useful pieces of kit had been banished to the dark depths of the wardrobe was beyond me and I am too polite to question them on what misdemeanour they performed to be punished in such a way. Anyway, they should come in useful once I have permission to get them out. We also ran our first teaching sessions for the doctors on the management of acutely ill patients which went down well. They have requested stroke disease for next week.

The aviation-minded amongst you will have noticed the MI-26 Helicopter with Heidi in the pilot’s seat. One of our Russian pilot chums, currently contracted with the UN, took us on an unofficial tour of the world’s largest helicopter last weekend. This dude has flown the helicopter all around Africa and in some pretty out-of-the way places. One of the other pilots told us of an emergency landing in December when they had an oil leak up in the border towns. They were subsequently attacked by the locals who thought they were flying in guns or contraband and they had to fight them off for 2 hours waiting for relief! Sitting in the ‘copter was very cool and it certainly is huge! Many thanks to Alex.

Well, that is all I’m afraid. Rather less than riveting for you but believe me, the most stressful week of our lives. Fact.