Second Week Stuff

Hi there. So here we are again – I’ll give some updates from the last week. A couple of amusing anecdotes and some other issues.
 

We always liked this old truck. It’s a nice feature in the hospital.

We’re doing pretty well in general and are settling into the hospital routine nicely. Matt and I agreed that it’s best not to rush headlong into any programmes or modifications, so we’ve been working hard in more a ‘shadowing’ (with participation) role in the medical department and elsewhere to get a feel for the hospital system. Obviously I have 4 months of experience last year but things aren’t always the same and time spent understanding and observing in the early stages is never wasted. So we’ve been working in and understanding outpatients, the emergency medical ward, chronic wards, pharmacy etc. We’re making progress, and seeing a lot of really interesting pathology.

Some interesting pathology...

In a lot of ways the last couple of weeks have been quite atypical in the life of JTH for a couple of reasons. Firstly the junior doctor’s strikes: this is certainly public information in Juba so I’m sure stating a few of my observations will be ok. I know there’s been some rumours, circular emails and anxieties back home about the current situation, so I thought I’d comment:

Since Monday last week (our first day!) a number of the house officers and medical officers (F1/HO and SHO equivalent in the UK) have been on strike in protest to not having been paid their incentives by the MoH for the past few months (a sum of several thousand US dollars each). In the very early stages there was apparently some nurse participation but this seems to have resolved. This has lead to the hospital being run by skeleton staff which is not ideal for patient care, but it’s still generally functioning. However, news/rumours of the situation have permeated Juba and is generally leading to fewer admissions as patients aren’t bothering to present to the hospital at all. I was looking at some admissions figures from the Emergency Medical Ward (EMW) today and a couple of weeks ago admissions were 30-50 per day, whereas for the past few days it’s been only a handful, and the chronic wards are virtually empty.

Some nice weaver birds in the hospital (to break up all that text).

There have been several negotiations between the Ministry and the Junior Docs but as yet I still don’t believe the situation to be fully resolved. This was further complicated by an unfortunate one-off episode last Thursday afternoon when some policemen turned up at the Doctor’s Mess (where we live although we weren’t there) and allegedly beat some of the doctors that weren’t working. Now I haven’t actually met any eye witnesses/victims so I don’t know the full details, but it seems to have been a relatively minor affair, although all the doctors clearly felt the threat of any violence completely unacceptable, which didn’t generally help matters in general. There have been more negotiations since and it’s unclear where the edict to the police came from, but everyone seems to condemn the actions and there’s certainly been no more trouble of that nature on the ground that we’ve been aware of. In general the senior directors in JTH are doing exceptionally well at holding the hospital together and still managing to provide emergency care to patients under these difficult circumstances.

Matt enjoying a fine lunch at the Sister’s excellent (cheap) restaurant.

A separate issue that’s been registering more on the NGO radar over last week but has less implications for us was a GoSS curfew (one day only) and military operation searching households and compounds seizing illegal firearms from civilians in Juba. Most of the hospital staff approve of the operation and it seems to have been conducted professionally.

From one report:

"Thousands of illegally and privately owned weapons including RPGs, PKMs, Kalashnikovs and pistols were retrieved in the town’s residential areas. Among them also included 12.7 anti-aircraft weapons privately owned by individuals.

The minister of Internal Affairs, Gier chuang Aluong, said the operation was aimed at freeing the town from armed criminal activities. Speaking to Sudan Tribune by phone, Majak Kuol, a resident of Juba in Atlabara B, said they started a cordon and search operation in the town early this morning. He added the joint operation by the SSPS and SPLA was a peaceful exercise acknowledging having been restricted movement."

Also anecdotally it seems to have worked. Chatting with some of the surgeons they tell me that they haven’t admitted a single gun-shot wound so far since the operation, so it seems to have been effective, which can be no bad thing. (Last year I was certainly seeing a few gun-shots per week.)

So on the lighter side of things, we’re making the most of the place. Our accommodation basically backs onto the Tearfund compound (with whom Dave and I made many friends last year) so we’ve been hanging out there a bit in the evenings playing badminton with a couple of their guys. Also they’ve kindly agreed to provide our evening meals which is just a real blessing, as the hospital is willing to pay and it’s good value all round. Recently we also tried our hand at some vetinary medicine...

Jasper the friendly dog.

So they have a puppy (rescued from marauding monkeys apparently) who’s a lovely little dog. Anyway, he needed an urgent blood test doing for quarantine regulations one day, and the vet couldn’t come (due to the aforementioned curfew.) Not afraid to try new things, we agreed to have a stab at it, so to speak. We didn’t have any knowledge of how best to go about it, so consulted the AQA text service, which astoundingly works here in Southern Sudan. They recommended the jugular approach, but we rejected this on the grounds of a) complete ignorance of the relevant anatomy and b) proximity of his teeth. A bit of exploration revealed a decent looking leg vein and with two assistance on restraining duties (which Jasper thought was a great game) I manned up and got 10mls without too much trouble at all. So there’s a first for us, but I always like learning new skills.

The tempting veins...

I generally like animals but I had a bit of a shock the other night when bedding down I felt something exceedingly strange scurry up my leg. Turned out a lizard had crept up there into my sleeping bag earlier and was probably just as indignant as I was at having it’s sleep disturbed. Anyway, we chased that out and now I’m more careful about tucking my mossie-net in firmly in the day time as well as night.

That darn lizard.

That’ll do for now. This week’s going pretty well and we’ve achieved most of our planned objectives for the week already, and some ideas and strategies are germinating so we’re feeling pretty good. More to come soon...

James & Matt