The Goat and the Gorilla

Why the title I hear you ask? Have Heidi and James been trekking the jungle in search of gorillas? Or even goats for that matter. The short answer to your telepathic questions is no. No, there are, as far as zoologists are concerned, no gorillas in South Sudan since they appear to prefer the cooler climbs of central Africa. However, I think you can see that the photos tell a different story. As I am sure you can see clearly the form of a large gorilla wielding a large club and spraying water from his mouth. This is ‘The Gorilla’ that bravely guards the entrance of Oasis Camp, surrounded by hoards of flamingos, elephants and, yes that is right, a goat large enough to threaten to crush the elephants that stand opposing it. But enough of this jibber-jabber. What’s been happening?


Work continues in earnest. The ward rounds continue and I continue to study tropical medicine hard. There have been some great presentations from the Junior Doctors at our weekly teaching and it is awesome to see their presentation skills improving. Not only this, but it is a great opportunity for us to learn. We have chosen a ‘top 20’ presentations based on signs and symptoms we have seen a lot of on the wards and have divided them into system categories (for example, cardiovascular system, respiratory system etc) and each week a topic is presented discussing the different symptoms or signs in general followed by a more detailed discussion about a specific disease (for example Typhoid, or viral hepatitis). They present on the ‘gold standard’ treatment that would be available with all tests and drugs at our finger tips and then we discuss the management of that particular disease in South Sudan, with the more limited resources at our disposal. It is very interesting and is actively changing my practice on the wards.

Our Acute Medicine ward rounds have wandered into some interesting obstacles. They are much longer than they are used to, and especially long if we are teaching as well, though still short by English standards; say 3 or 4 hours. We originally wanted to start at around 9am, but after a few days of turning up then it turned out the cleaners would do their washing then and this involves turning the floor into a swimming pool for a few hours so ruled out a round. Also, they do such a good job we didn’t want to get in the way. So rounds on the Acute Ward start at 10am. However, this means a finish on that ward at around 1.30pm and pharmacy shuts then. So, we started to get complaints from pharmacy that they would not issue any drugs to my patients, rendering the ward round pointless. Meanwhile, the nurses were complaining that ward round was creating too many jobs for them. Brilliant. We are still working our way to a compromise as we are reluctant to agree to the suggestion that we only see a couple of patients each day and leave the rest to battle the disease alone. We shall see if we can find a way out of this Catch 22.

As far as rest and relaxation is concerned we really stumbled in to a winner. After hearing about an up and coming trip down the Nile from the Ugandan border at Nimule to Juba we were keen to get involved and managed to join the first ever commercial trip down that stretch of the Nile. It involved a few days of bush camping in the depths of the Sudan bundu and a mixture of decent white water and long stretches of scenic surrounds. Much of the area is unpopulated and dense vines hang from deep green trees that cling to the riverside rock with long fingers of gnarled root probing the cracks to prevent them from tumbling into the muddy water. When camping it was sensible to stay near the river edge as some areas are still littered with land mines and while washing in the waters’ edge you could pull out unexploded artillery shells a foot long from Russian-made mounted machine guns at certain points along the voyage. It was an awesome trip and great to get out of Juba for a change. Thanks to Pete and Jane the South Africans who put the trip together.

A village on the road to Nimule (the Ugandan border)

Raft oreientation at the base of Fula falls, Nimule

Pete and Jane scoping out one of the big rapids

Running rapids

Heidi and her tea, bushcamp on the Nile

A local canoe from a hollowed out palm tree trunk

James putting in some oar time

Bushcamp on the Nile

Bush fire - in the distance an iron pot cooking a cake!

The impressive cake in the bush

Joining up the rafts to boil up some tea

Tea time in the rain

The Nile

Hauling the rafts up the bank - Juba

Anyway back to the grindstone!!

Have you seen this monkey?

Muddles is on the lam. It is alleged that he bit a lady as she crossed the road outside the hospital, though some say he was going in for a kiss but she moved. He has not been seen since and there has been the suggestion that mob justice punished him, and thus he fears to return to the area. Sightings of the furry fellow have been made in St. Josephs catholic church, where he was seen crouched by the alter trying to pronounce the words ‘Hail Mary’ without success.

Heidi, however, still carries ‘Monkey Stone’ wherever she goes. The smooth orb lies on the car seat overnight, and remains in her hand at all times outside of the confines of the concrete walls of the wards or offices. The staff now ask if she has it with her, and even suggest inviting Muddles for peace talks overseen by the Medical Director. Heidi has declined the offer up until now. Even when Heidi fainted after a long and hot ward round in the long stay ward, I came to find her lying on a hospital bed to which she had been carried, smiling, and with Monkey Stone placed carefully by her side, clearly rescued from the ground where she fell by the nurses.

Medical officers at their teaching

But what else has been happening? We had a meeting with the Head of the hospital to discuss the doctors’ attendance and reassuringly it has improved after some form of order was sent out from the top. The wards have now been divided between me and the other consultant so I look after the men, and he the women. This is working very well as you get to know the patients well, which speeds up the ward round and improves their care. The juniors have also divided themselves into two teams and this is allowing them to see the patients improve, providing them with some reward to their work along with seeing when treatments don’t work as well and getting a chance to ask why.

Some clinical medical students have started to arrive on the ward of their own accord. As we have previously mentioned, during the war the medical schools were moved to Khartoum in the North and now they are moving them back. However, all the lecturers are Northern and thus have not returned with them. As a result the 5^th years have had no teaching for 4 months and some have emerged from the four corners of Juba city hungry for some education. We have started teaching from our office one afternoon per week to these few keen students and with great results which is really uplifting, and have offered our services to the university so we will see what happens.

The junior doctors have gradually been appearing at teaching with increasing numbers and have started to do presentations themselves with us overseeing it all giving them feedback on their presentation skills which again has so far been a real success, and will hopefully continue. Bedside teaching has started as well as we are starting to teach examination skills and this is slowly taking off.

Heidi is working hard in theatres, focussing on getting the right drugs to provide a sustainable service there, rather than one that will cease as soon as we leave. Theatres are currently being tiled so little work is happening inside and Heidi is acting as the ultimate all-rounder, seeing medical admissions and the surgical patients.

A boat of returnees

Relaxation has largely focussed around the camp, with a few beers and Tangawizi’s on the water front. On a few of the evenings we have been greeted by the amazing sight of huge barges slowly cruising upstream to the port just upriver from our camp. The boats are crammed with people, on the bows, on the roofs, down below deck, in every available inch all cheering and ululating as the boat sounds its bellowing horn. These people are returnees from the North; Southern Sudanese who are finally returning home to help rebuild their shattered country and you can hear their excitement at coming home in their shouts, having spent many days on the river. These boats are followed by other barges, creeping through the pink haze of the evening sky, crammed with their belongings, including chairs, tables, donkeys; basically their entire lives piled onto a deck.

If you look closely you can see the little shop (next to the people walking) outside our camp

This is a view from the village looking at our camp (the green sign in the distance)

A picture of James enjoying a coffee - in the background is a flattened
patch of ground where a market was just a week before.

A common sight in Juba is small fires scattered along the streets
where people burn their rubbish, including many plastic bottles.

You've been Mango'ed

The days are perishingly hot and the evenings close and humid. Heavy rain showers periodically provide relief from the steaming stickiness of the after-dark, and with it comes a gusty breeze up the Nile River, sweeping through the camp swirling dust and leaves in its wake, and toppling the umbrellas that stand over the teak tables standing out by the river. It was to the wonderful whistle and rush of this refreshing breeze that Heidi and I tucked ourselves in our tin cabin and settled down for the night. It was in the early hours of the morning that we were awakened by the sounds of ordinances striking the hut and those around us. It came in echoing clatters, striking the roof, the door, the walls with a relentless frequency. We both awoke with a start; there had been no warnings of attacks on the city, in fact even the border towns have had an element of quiet for the last few weeks.

We cautiously opened the doors with the wind howling and the rain relentlessly pouring down and stared into the night. Another strike came as we stared through the soaked air... and a soft yellow orb landed at our feet; a mango, ripe for the eating.

Gazing around we could see the sandy floor was covered with them and through the sheets of water we could see the security guards charging around the site collecting them in bags and standing in the shelter of a tree tucking into the ripe orange flesh. We joined in with our piece of fallen fruit.

The fact that the battering of our hut was not the result of a guerrilla assault was a great relief. However, with the coming of the rains so too has arrived the risk of death by mango; or at least a fairly substantial bruise for those of you less inclined to accept the drama of the situation. Granted, the risk of injury is far less than if, say, it was raining coconuts (or military ordinance for that matter), and many would agree that the resulting treat with a coconut is less inspiring than that of a mango but please accept that the situation is not risk free and the gauntlet run from cabin to breakfast has taken on a new excitement.

Work has continued in the same vein with peaks and troughs as in any work. People are still ill and we are trying to make them a bit better. We had a great turn out to teaching on Friday, which I had asked one of the junior doctors who works in a private clinic to prepare for us: he has been attending the teaching sessions just because he is interested even though he doesn’t work at the hospital which is great. He did an excellent presentation and we had one of our best turnouts, including some of the clinical medical students who have returned from Khartoum (but more of them later). Heidi and I have a lecture to the other consultants on Thursday which will be fun.

Leisure time has been spent generally relaxing around the camp, chatting to the other people here and heading out to listen to live music. We saw a Congolese band in a bar round the corner last week and had a chance to greet the lead singer, who is something of a big name in Congo music circles and sings in French rather than the local Congolese language Lingala. Last night we were out sinking a beer in the ‘Queen of Sheba’ Ethiopian bar and serenaded by an Abyssinian siren.

The Congolese band

The front of Juba Football Stadium

One of the many referendum signs in Juba

The upturned cans that line the hospital paths

More to come. Stay glued to your computer