Lockdown

Two weeks before the newest country on the planet is born and we have lockdown. Juba was closed for business as the Southern Peoples Liberation Army (SPLA) conducted searches for guns throughout the city. And let’s be fair here, they are understandably keen to get rid of as many random firearms as possible before the world’s dignitaries arrive for the inevitable motorcade across town to the celebrations in the fields around the grave of Dr John Garang, South Sudan’s liberation leader who died in a plane crash after the same number of days in power as he spent years leading The Struggle in the bush.

Not having our ear quite close enough to the ground we were unaware of the lockdown, and as we hitched a ride in to work at 0700 on Saturday morning with a farmer from the camp we did find it odd that we were almost immediately pulled over by some gentlemen wielding fully automatic rifles. A quick ‘we’re doctors and heading to the Teaching Hospital’ allowed us through to the next blockade 500 metres further on. This happened 4 more times before we reached the hospital gates. We had passed many cars with their boots opened and bonnets up in the search for hardware, and pedestrians spread-eagled against the walls having a compulsory pat-down in case they too were ‘packing heat’. The hospital was like a ghost town: no doctors and no patients. It makes you wonder what happened to the 500 sick people that usually appear every morning. We asked the gate-warden who explained about the gun searches and expressed his surprise that we made it in at all. The roads had certainly appeared empty...

However this was not a day not to make it in. After a number of meetings we had managed to arrange a joint clinical meeting between the UN military hospital from Bangladesh and Juba Teaching hospital. We had started attending their Saturday meetings in the UN Mission (UNMISS) base both for the interesting talks and the amazing hospitality shown by the staff there, and after another filling, tasty, if very (spicy) hot, chicken toasty with tea it seemed that this had to happen; an exchange of knowledge and cultures. The Bangladesh doctors rarely get out of the compound to meet the local Sudanese, and the doc’s at JTH (Juba Teaching Hospital) need some structure for a clinical meeting. So the event was born and I was to present on ‘chest pain’ at the UN base which would be followed by food prepared by the Bangladesh team. And JTH was empty. Brilliant. We hopped an ambulance to the base, after failing to rouse any interest from the junior doctors living across the road from the hospital, and with lights flashing were ushered swiftly through the blocks. The UN guys were very disappointed by the turnout from the hospital, but understood the difficulties due to the road blocks and the day was saved when two of my juniors from medicine strolled in, having endured I don’t know how many full body searches just to get down there. Everyone was pleased and the meeting went very well. Next month it’ll be hosted at JTH and we’ll serve the local specialty of fuul. The ride back was an experience as well, as the dusty roads were almost totally empty and gangs of armed military lined the street corners, sheltering from the blistering midday sun and we cruised through unscathed in our own UN military 4x4.

We were back down at the UNMISS base again today helping with the teaching of the SPLA doctors after being invited to join the Bangladesh team to teach them there. It was great to see the army doctors playing about with manikins (which they had never seen before) with a below knee blast injury and severed hand, out of which poured fake red blood that eventually covered everything.

What else?

Well, Freddie the kitten is still alive- we have had a number of concerned emails regarding the little biting horror. He is as bitey and bouncy as ever and I miss him, and even though she won’t ever admit it, Heidi does too! And now I get sent for ‘time-out’ in the sin-bin instead.

Muddles has been keeping a low profile after word got out that a hit squad from the Department for the Environment were out to get him. I’m sure he’ll be back when the heat is off.

And fuel has arrived in Juba- by boat. With all the aerial bombing in the borders trucks have been unable to pass down safely, hence the shortage, but the barges cruised in last week with tankers on them to supply the town.

And finally...

Our teaching sessions have changed somewhat, as we have been reduced to a zero doctor turnout to any sessions! We have been overwhelmed with their disinterest! However, the medical students have been arriving in droves and each week more and more appear so the little office is overflowing with them, so much so that we are doubling the number of teaching sessions for them. It is great to see such interest and enthusiasm when it doesn’t even count towards their degree, as the University is officially shut, has been for 8 months, and shows no sign of reopening any time soon. These guys are like sponges and have a real keenness to learn. When you quiz them on something tough the following week they remember the answer! Work is afoot to get something more secure and consistent underway for them so we’ll keep you informed. These young men and women are the future of this new country and with that in mind you have to believe that they will drive it to a bright place.

Well, that’s a little update. The next will not be such a long time coming, I promise!

Fuel being transported on the Nile

Proper pizza being made by an Italian at the International Red Cross!

A rare view in Juba

The Bangladesh UN doctors coming to JTH to donate some drugs

James presenting at the joint UN JTH Clinical Meeting

Sharing some traditional Bangladesh food afterwards

James experimenting with traction!

Stephen being a good sport and trying out the pelvic traction

James relaxing with an Ethiopian coffee

Freddie back to full fitness playing in one of our bags

Some baking before we leave the house - yummy

A view of the football pitch walking to work - the middle of it is the road!

Increasing success of teaching for the medical students

Some practical small group sessions

The First South Sudan Specialists Conference

An Artis Story

Prepare yourselves, I’m not going to lie to you this may be long, rambling and let me warn you most likely not worth it! So good luck x

I am lying in bed trying to get to sleep while noises alternate between the strained acceleration of a Landcruiser, the racket of frogs competing for airtime and the wind whistling though the reed fences which sounds like women and children screaming. When I eventually get to sleep it makes for some interesting dreams I can tell you! So why the new bedtime noises? Well, we are house (and kitten) sitting for a month, which means we have cooked roast chicken and eaten food hot for the first time in four months; this really has been a treat – although a good BBQ with a variety of meat is still a craving.

We each sit next to a kerosene lamp for another night of low lit reading; work has had to be abandoned again as it is too hard writing in pretty much darkness. Fuel in Juba has become a BIG issue the last couple of weeks and hence we have spent more time without electricity than with. Thankfully we have generally been able to charge the computer at the hospital, but today even that failed, so we treated ourselves to a drink at a restaurant that had generator power. The lines for fuel are getting on for half a mile and a friend with a vehicle had to drive miles to find a station with fuel on Saturday. So perhaps us feeling frustrated that since we returned from holiday we lost the use of the car is not going to be such an issue very soon if no one can drive anyway! But seriously being without a car here has been a struggle. We are walking to work which is fine from the house we are in at the moment, but it means that after dark, there is no real safe way to be mobile. The motorbike taxi’s, which we are reluctant to use except for one guy we know who drives very carefully, stop work around eight o’clock and there are no regular taxi’s to speak of, so unless we are with someone who has a car it means ‘curfew’ at 8ish! It is an exciting life we are leading!!

Heidi by her Kerosene Lamp.

So theatres, how are they? As we have said on an earlier post, well before we went on holiday they were all but closed except for emergencies because they were being re-tiled. When I heard this I asked the surgeon why? He couldn’t answer; the floors were actually pretty good. A cynical view I heard was that it was probably someone important’s relative that had some surplus tiles. So we waited for the tiling to finish, the speed of which is demonstrated that in one of the rooms when I went to check on progress there were only eight tiles left to lay. I returned two days later to see that room still hadn’t been finished! Finally theatres reopened, after a one week closure lasted a month.

For those of you who would like a technical update of things here goes: apologies for the jargon to everyone else. Anaesthetics are done by medical assistants who have been doing the job for varying lengths of time. Currently there are zero physician anaesthetists in Southern Sudan; except me that is. So there are three main theatres, one is used for minor procedures, generally done under local anaesthesia or nothing, this includes pulling wrists, plastering various broken bones and debriding wounds. The most disturbing I’ve seen is a 13 year old girl who had had an epileptic fit into her family fire. She had significant burns from the accident two weeks previously, which smelt awful and she was in so much pain it was terrible. She did get a bit of Ketamine but there were no intravenous pain killers in the hospital.... So as you might imagine various cries and screams often escape that room.

The other two theatres generally run at the same time and depending on the day will either be gynaecological cases or surgical cases. Until the orthopaedic surgeon arrived (he is here for one month) there was only one surgeon doing general, urology, orthopaedic, ENT and anything else that came along. He is trained as a urologist but works hard and tries to train his juniors despite being on his own. The anaesthetics will generally be Ketamine with some spinals. There is no long acting muscle relaxant so we give Suxamethonium (which is out of date but thankfully still works) boluses if required. There is a five litre oxygen concentrator with the option of nasal specs, but no standard face masks. The kit such as tubes, guedel’s, and face masks are woefully inadequate in variety and number (something else I am working on). However, there is a working saturation probe and blood pressure cuff in theatre which is now used on every patient – Hooray.

So I have been trying to get drugs, equipment, encourage more spinals and teach some peri- and post-operative thinking like giving antibiotics and analgesia which, granted, is at times impossible when you don’t have any but you can only do what you can do. So supervision has been the main thing, plus anaesthetising a few scarily small babies....

I hope this gives a bit of a feel for theatres and all from my kerosene light at 8.30pm! Now I will head to my bed for the chorus of noise; maybe the car sounds will have decreased tonight...

Oh, one last thing! So we thought house sitting would be easy, but the little eight week old kitten had other ideas! For the first week he was very excitable and ‘bitey’ and a little bit of a pain so we, well I actually, started a 10 minute timeout for him whenever he got too much for me, which of course wasn’t very often: you know how tolerant I am! I also decided that him getting up on the table to join in breakfast and dinner was no place for a kitten, so there has been a lot of lifting him on to the floor. James is very helpful in this exercise, not. I also read that clapping and shouting NO may stop the biting, but when at 7am I was doing this repeatedly James thought it maybe too much for the neighbours and put a prompt stop to it.... Then last Friday night we thought how cute he was being, curling up on our laps and being very chilled out. This continued on Saturday and then we realised he hadn’t eaten or drunk anything despite our efforts of ‘tasty’ food – oh dear. So followed a stressful few days building up until we got home from work and he couldn’t stand up – oh my goodness the cat is going to die on our watch what shall we do! The only vet we knew about was closed and so we decided to go in the morning and keep our fingers crossed overnight, plus a phone call to England to the owner to check the origin of the scamp – she was suitably reassuring and as a public health consultant pragmatic too. The next day thank goodness he was a bit better and has continued to improve and get stronger. Who knows what it was but he is well enough tonight to be play biting, charging me whilst I write and being generally ‘kitten-like’, I think the kerosene and torch light is confusing him with the shadowing and flickering. But if he bites me again it’ll be time for another ‘time-out’ shut in the other room.

Freddie the kitten pre illness

Freddie when ill - cuddling up to sleep.

OK done. Well done for those who got this far x

p.s. I almost forgot that damn monkey is back....

Muddles back on patrol.