Thursday, May 3, 2012

May 3rd, 2012



Since starting work as a consultant on the Emergency Medical Ward in January I have had my fair shares of ups and downs. But what makes the inevitable frustrations of working in such a resource limited setting as South Sudan worthwhile, is the hope I see in the people we are here to train and support. In this blog I will try and share some of these day to day stories whether from our ward, the classroom or from the many people we meet every day who are also striving to improve the health care system in this brand new country.

This week I gave blood. There is an unreliable blood supply at Juba Teaching Hospital. A family sized fridge, with a fickle power source supplies blood transfusions for over 500 patients including elective and emergency surgeries, paediatrics and obstetrics – a major need when it comes to emergency transfusions since bleeding in pregnancy is the most common cause of death. MGH has set up a ‘Virtual Blood Bank’ and now over 100 internationals in Juba are signed up to give blood at short notice for patients who do not have family members to donate or to keep a small emergency supply for when every minute counts. Since November, the blood bank has always had enough to supply transfusions for these critical cases. As the lab technician Ahmad set me up for my donation, I asked him how things were before the VBB existed. ‘It was terrible working here before’ he told me ‘there was always a demand I could not meet. I remember once there were 4 children who needed urgent blood at 3 in the morning. I came in, put a needle in my own vein and donated enough blood for them all.’

One of the many big challenges we’ve faced on the emergency ward is a very poor capacity to deal with ‘emergency’ cases such as diabetic ketoacidosis (DKA). This often affects young people, is a life-threatening condition and in well resources settings with adequate nursing care is relatively easy to manage. I can think of four young lives that have been wasted on the ward due to DKA so it’s been a focus of our training sessions with both nurses and junior doctors. Residents Ne and David developed a protocol during their month long rotation which simplifies the management in recognition of the situation – little ability to measure blood sugars, urinary ketones, no fridge to keep insulin in, no nurses capable of managing an insulin infusion etc. And we have started to see the management of DKA turn around. The junior doctors are carrying these protocols around in their back pockets. They stay on the ward until late in the evening making sure patients get the right treatments. There is still a long way to go I realized when the head nurse told me there is no way that drugs can be given hourly on this ward. But today I found a house-officer sitting with this nurse, explaining the protocol and the importance of hourly insulin doses. So much better when it comes from the South Sudanese doctors.

One of the most rewarding groups to teach that I have worked with so far are the Clinical Officer Students. These guys have 3 years training before they work in some of the most isolated areas – often as the only medical personnel in a health facility dealing with every kind of problem imaginable. The students are bright, enthusiastic and super dedicated to the ward – the first ones there in the morning, coming in on their days off to check on patients, coming to all our teaching sessions and asking hundreds of questions. I had a ‘heart-sink’ patient today. An emaciated lady who had travelled from far out of Juba, unable to communicate with anyone on the ward in her local dialect, dehydrated and malnourished with horrible bed sores and no money to pay for any tests or treatments. Godfrey, one of the students stepped in to save the day. ‘She really needs to be washed and have the sore dressed’ he whispered in my ear, ‘I will go and buy her some things’. And off he went, visiting 3 private pharmacies to find the right stuff, refusing to take any money from us, instructing the nurse how to care for her. I can only hope this student keeps this incredible sense of justice and compassion as he enters in to the real world of work in a years time. 


- Dr. Rae Wake

Learn more about Ujenzi Trust at www.ujenzi.org