Note from Ian: as with last year, quite a few people have asked about donating money towards the good work being done at Mapuordit hospital.
Making a donation to the Sisters who are associated with the hospital would be the best method of achieving this (the order is the Daughters of Our Lady of the Sacred Heart - OLSH - and they have a base in Kensington, Sydney). The great majority of funds donated to the Sisters for use in Mapuordit hospital will actually be used for that purpose, as there are few of the large administrative deductions that are often associated with the international aid funds.
Australian friends can make tax-deductible donations through the OLSH Overseas Aid website at http://olshoverseasaid.org/
You may either make a 'general purpose' cash donation for use at Mapuordit, leaving Pauline to determine its most effective use, or donate an amount for any of the specific items (eg needed medical equipment and the like) listed in the website under the 'Sudan' page.
At present, overseas friends can make an EFT transfer into Anne's UK account with Lloyds Bank, and we will make an equivalent donation here to OLSH, allocating it however you may wish. Let me know if you want Anne's account details.

Sunset over the compound

Lunch in the childrens' ward

Cleaners dancing at our farewell

Friday 20th August

Well we had a good send off today. There are 3 of us on the move, Ian and I and the young Italian nurse who has also been here for 3 months.

At assembly, after ward allocation, we were all asked to step forward and receive a posy of flowers each, a hospital tea shirt, and E----- and I got some beautiful black and white beads. The beads mean we are Dinkas and we have cows. Quite an honour to be given them as they are highly sought after and not meant for the koajas (white people) to wear. They spoke about us all individually and thanked us for all our work. It was really nice. Of course we then all had to return with a few words.

Our collective theme was peace for them in January 2011 during the referendum for separation from the North. Then all the cleaners performed a dance. This was at 8-30 am!

To follow up the story with the burns dressings, I did manage to contact Prof Fiona Wood (with your help) who very kindly replied to my e mail, and reassured us that we were doing the right thing with the burns wounds, but it would of course without skin grafts take a very long time.

The other exciting news is we have an Australian surgeon coming out to Sudan to fill in for our Director/Surgeon, who has himself to leave for for surgery in Italy. Again, it is with help from you that this connection was set up. He arrives on the 1st of September, the day we arrive home, so unfortunately we will not be here to greet him, but there are others that will.

It would be wonderful if we could set up a network with Mapuordit Hospital, Sudan. In the dry season, the Brothers have a plan to build four more volunteer rooms in the compound with a bathroom attached. This just what they need as conditions are very basic there (as I know!).

If there is anyone out there that would be interested in coming, there is a great need for nurses to train our staff and students, & Dr’s to get experience in tropical medicine. Teachers for the local primary and senior high school. Plumbers, electricians, anyone who knows about solar energy, odd job man, landscape gardeners, anyone really (after all, we even took Ian!). It is expensive to get here, so 3 months is a good stint and it does take at least 3-4 weeks to get over the culture shock.

Thank you for all your words of support and help regarding the website donations. We will see most of you back in Sydney and the UK on our next visit.
Anne

A spot of rain

Thursday 19th August

No wonder the malaria is so bad, there is flooding every where it is like one giant lake. We have now lost 8 children in 5 days all with malaria. It is just so hard for the mothers to get to the hospital through the water so by the time they do reach us it is too late. Tragic.

The worst thing is that the malaria program that was run so well last year by an overseas aid group has folded, lack of funds and a promise that it would be continued by local government!!! They used to distribute nets and give education to the locals. There was always someone in the villages who had an emergency supply of medication until they could get to the hospitals. Apparently this year the local government, practically non-existent, has been unable to do anything, they just have not got the expertise yet to take projects on like this. It will all take time. In the meantime children will continue to die in large numbers....

There is talk that the water will cut the road soon to Rumbek. It is not only the rain here but the water coming down from the Congo. Just hope we can get through on Sunday. Our flight is not until Monday but don’t want to take the risk of leaving the journey until Monday.

HIV/AIDS awareness class

My new bracelet from Sister Pauline

Saturday 14th August

It’s Saturday night in Mapuordit and we are going to have a movie night. Five of us, Dr P, Ian, Pauline, an Italian volunteer and me. It’s a beautiful night, a large crescent moon seems to fill the night sky with Venus sitting by its side, and slowly the Milky Way appears, it’s almost a movie on its own.

We set up all the equipment outside on a small table. A lap top computer and a long extension lead. You have to sit quite close so you can see and hear. Every now and again the screen goes almost like an x ray, so positions of chairs and screen have to be made. No popcorn available, but coffees all round and we all share the last apple (until the next trip to Rumbek), which is cut in to very thin slices.

Tonight’s movie is Muriel’s Wedding, a bit hard for our Italian friends but with sub titles they managed to follow. It was quite surreal sitting outside as an electrical storm in the distance lit up the sky, and the words ‘You’re terrible, Muriel’ were repeated, mixed in with the very noisy frogs and gun shots just outside the compound. A very strange night.

We heard that the gun activity was cattle people who had had too much to drink, but it was a bit close.



Sunday 15th August

Well, one more week to go, then off to Kenya for a 5 day trip to the Masai Mara so really looking forward to that. Life is so tragic here.

Went to the hospital this morning just to do the dressing on the little girl with the burns (takes about 2 hrs), and ended up being there till 3pm. Short day compared to Sister P - she delivered one baby at 7am, then helped with a caesarean at 10am. Unfortunately, the baby had a very large hydrocephalus and died very soon after birth, which I feel was a blessing, as it would have had no chance of survival in these conditions. The mother seemed to take it all in her stride. It was her 5th child.

While all the above was going on, an emergency admission of a 5-6yr old girl with a short history of malaria. As the Dr was examining her she lost consciousness, then stopped breathing. It was all hands on deck. She was quickly intubated and CPR commenced. We got her heart beating but she was unable to breath. After 1hr hand bagging her (giving her lungs O2 via a tube and hand pump), she could still not breathe for herself.

No intensivist or ICU here, so we had to stop. Her little heart stopped beating within 5mins. The Dr on duty tried so hard to save her.

Her mother was understandably distressed and very soon started the wailing which all the other mothers joined her in; I think it is a mark of respect and comfort for the mother. The father is a soldier and was not around, but an uncle soon came with a malay (cloth) to wrap her in. She was carried out and was held by a pillion passenger on the back of a motor bike, to take her back to the village. Just another day in Mapuordit.

Friday 13th August

Got up early this am, could not sleep, thinking of dressings so I thought I would just watch and listen to the sounds of South Sudan. At about 6am still very dark, the first cock crows over in the father’s compound. The flutter of the hens as they do a crash land from their roosts in the trees. Dawn starts to break. Streaks of pink fill the sky as I peep over the tukal (thatched hut) towards the bougainvillea. The ringed doves now start their soft calls along with the hornbill which is quite harsh for this time in the morning.

The compound slowly awakes. I can hear the sisters starting to stir getting ready to go to mass in the small chapel just over the fence. The first children have arrived at the water pump and the clatter starts as the pump stirs in to action.

At 6-45am a clanging sound as someone hits a large piece of metal against the rim of a car wheel hanging in the tree outside. This is to remind people that mass commences in half an hour (South Sudan's way of calling to prayer a bit different to that in the North!). As no one has watches here this is quite handy. Your alarm clock.

This is the best time to see the small birds. A family of red cardinals fly overhead and land in the frangipani next to my room, The male is just so red as the name suggests. The day has begun.

Waiting for Sister Pauline

From the Radio Good News Diocese of Rumbek

TRAINING OF NURSES IMPORTANT FOR SOUTHERN SUDAN, SAYS TRAINER

A registered nurse involved in training Sudanese nurses has said that the training of nurses is important for Southern Sudan, explaining that the changes happening in the country call for nurses with qualifications.

Anne Jackson, an Australian national, is training nurses at the Mapuordit-based Rumbek Nursing School in Lakes State.

She told Good News Radio that Sudan has witnessed changes over the past few years affecting the health sector and would require qualified health workers to deal with health issues. She cited the example of HIV and AIDs, saying that the cases of the epidemic are on the increase.

Mrs. Jackson further said that Rumbek Nursing School is “the first stepping stone” towards capacity building of health workers, adding that if Southern Sudan becomes independent at the referendum, better education opportunities and health services may be provided and that this would call for hard work on the part of Southern Sudanese.

Mrs. Jackson also said that the Mapuordit-based Rumbek Nursing School has adequate equipment with the possibility of adapting and improvising, describing the facility as basic.

She also said that the number of student nurses has increased this year from fourteen at the launching of the school last year to eighteen this year, adding that the students admitted this year manifest a relatively higher level of education than the pioneers.

The student nurses at the Mapuordit-based Rumbek Nursing School go to the “well staffed and busy” Mary Immaculate Hospital Rural for practical lessons.

Mrs. Jackson revealed that the hospital is currently dealing with malaria cases, pneumonia, anaemia, and snake bite injuries, and amputations from accidents, adding that the hospital staff is able to respond to these cases well.

Proud Mum

Children on ward



Mapuordit Cathedral

10th Aug
Well it has been a few weeks since I put pen to paper. No time since Ian came. There has been lots to talk about in the evening, and the days are full in the classroom or on the wards. But I must say the dressing room has a certain attraction to me.

My biggest problem at the moment is how to care for a girl of about 7 years, who fell into the fire (another one), a known epileptic. She has about 30% burns across her chest; stomach, both thighs, through to her buttocks.

She is so good when we do the dressing, but she is in such a mess. We sent Ian off to Rumbek to see if he could purchase a baby bath so we could sit her in it, but not one to be had. Instead we found a large plastic bowl.

So, up to yesterday we were soaking her each morning in salt warm water, so the debriding is happening slowly. After, we are using Silver Sulphadiazine cream with homemade paraffin gauze over it. Tried open dressing, but very hard to keep the flies off her. Each day it takes me about 2 hours and then she is ready for a sleep.

The worry is she may develop contractions as she is very reluctant to move (who can blame her?). Her bed looks like a scene from Florence Nightingale’s day with our one and only very large cast iron bed cradle in place. Just wish we could get Prof Fiona Wood (Australian of the Year 2005 winner for growing skin grafts), to come over and help, that really would be wonderful. Has anyone got her e mail address?

On Tuesday there was a fight in the market which involved a man of about 26yrs being arrowed through the leg (upper thigh). He arrived with the arrow head sticking out about 5 inches, not a pretty sight. Removed yesterday, now daily dressing. An open wound of about 4inches.

I think I must have the most exciting dressing list of anyone I know!

Good news - our student has not got Guinea worm but Larva Migrans. Think it is some other worm, but she is now having treatment and her foot is a lot better. So hope they are all dead and she can get back to sleeping instead of looking out for the head of the worm popping out of her foot!

Sudan(blue) vs Uganda(red)


Sunday 8nd August
Ian here (I’m afraid Anne is preoccupied with exams at the moment, and I’m blogging, so get over it!!): also, the satellite internet connection is very slow, so that it’s so hard to transmit photos at the moment. Might be the huge amount of rain that we’re in the midst of.

My main role on this visit is as HR director. The State Ministry of Health (which pays 70% of staff wages, the balance coming from hospital funds) require summarised files on each employee, and a template approach has been adopted.

So, I’ve interviewed most staff members throughout the week (they often arrive in groups of four or five, and those waiting peer over your shoulder as you complete the template.....no Privacy Act here!!) and the information is being slowly collated.

The task gives you some further insights into what people have had to suffer here over the past several decades. Most staff members have no proof of birth date (one of the requirements of the Ministry) and some have no educational certificates “as they were lost in the war”.

When you realise that the majority were either born, or were receiving elementary schooling, during the last civil war of 1980-2005, you begin to understand that from early on in life these people were regularly fleeing from bombs or missiles, and each time simply abandoned what they had. Sobering thought.

Last Sunday, a spirited (I think the kindest word in all the circumstances.....) football match took place between a local team and a team from a large group of Ugandan builders currently working in the hospital, building the new AIDS centre.

The match started off in reasonably friendly, if robust, fashion, with little quarter given in the tackle. Amazingly, some of the Ugandans were playing without boots, not that that seemed to stop them kicking the ball as hard as possible.

Towards the end of the game, with Sudan up 3 – 1, some fighting erupted, and the referee, Father D------ brought out a red card, but was persuaded by the offending player, a Sudanese, not to show it. The same player then proceeded to commit another bad foul, and a brawl resulted, at which point the game was wisely called off.

Not sure if diplomatic relations have yet been restored between the two countries........

The handing out of the soccer jerseys I brought as prizes for Anne & Pauline’s ‘Clean Up for the Cup’ competition (thanks to all donors!!) went well on Monday. The Spanish jerseys were particularly prized by the recipients, but the jury’s still out on my remark to Dr R----- about the Italian jersey having been purchased for half-price after Italy’s demise from the World Cup.....

Food distribution was another task this Wednesday. The store, an old shipping container is stiflingly hot to work in, but, compared to last year, is really down on supplies. Half-rations are the order of the day, with supplies of a number of the staples distributed last year being simply exhausted.
Not sure when the next shipment is due, and people are literally begging for more as you hand out the little we have. Very hard, when you think that none of us in the compound is hungry.

The highlight of the week? A trip to dirty, dusty, smelly Rumbek with the passports and GOSS (Government of South Sudan) permits of the various foreign nationals in the hospital.

As a result of the Kampala bombing during the World Cup, GOSS announced that as an anti-terrorism measure, it was requiring all foreign nationals in South Sudan to register. As you can’t enter the country without a GOSS permit issued by GOSS, it wasn’t clear to me how this process would enhance anti-terrorism measures, particularly as I discovered that the registration process didn’t entail cross-checking permits against passports, or providing details of our whereabouts in S Sudan.

All became clear when 10SP per person was extracted from us as a ‘registration fee’. ‘Nuff said.............

On the journey from Mapuordit, along the very rough bush track to the ‘main road’ to Rumbek at Akot, we encountered a lone Dinka cattleman. What was unusual about him was that he was quite openly carrying an AK47 (and looked prepared to use it, if need be......).

After we left here last year, the police and SPLA made vigorous efforts to disarm the locals, but guns still seem to be around. In fact, last week in Yirol there was heavy inter-tribal fighting, probably over cows, and probably also reflecting the fact that Yirol is the ‘border’ between two different Dinka groups.

Around 21 people were killed and others wounded, and the small hospital at Yirol couldn’t cope with all the casualties. Four were sent to Mapuordit, but one died on the way and another decided to go to the witch doctor. The other two arrived here and, fortunately for them, as we have no x-ray facilities here, the bullets had passed straight through their bodies.

This sort of fighting is a constant undercurrent here. Apparently, many of the Yirol dead were from a minority Dinka group, the Jur, who are despised by the majority because they are more agriculturalist than pastoralist. A man we know, a Jur, has fled to Juba (abt 300k away): apparently, only the men are targets, and the Jur women & children are safe from attack. Comforting.

It's hot in this!!









July 28th
Well this might be the last blog from me for a while. Ian arrives
tomorrow in Rumbek so this time I better be here to meet him and not
get sick as I did last year. I know how much Ian likes to talk so he
will be able to do a few entries so you will get a different angle on
this place.
Hospital-wise, still very busy, with more different cases admitted.

Yesterday a small child of about 4yrs old was sick at home. She lives
in a village about 5ks away. The father thought she had malaria so he
put her on a small seat on the back of his bicycle and set off for the
hospital. Not sure how far along the track they were, but the child
fell asleep and her foot got caught in the wheel of the bike and
amputated her big toe.

Poor little thing, when she arrived the father had wrapped her foot up
in an old rag and somehow held her to him at the front of the bike.
She was so brave. She was taken into theatre and cleaned up. Luckily,
she had not lost much blood but she will only have 4 little piggies on
that foot. Today, she was a little brighter and she was having
treatment for her malaria as well as antibiotics for the toe.

On Tuesday a woman of about 20+ was admitted with burns to the left
hand and right leg, second and third degree. She had fallen in to the
fire when she had an epileptic fit. She has old scars on her body from
other old burn sites. As you can imagine there is no chance of skin
grafts in this neck of the woods. Saline dressings are just about the
only thing you can do.

This seems to happen quite a lot here. Last year there was also a
similar patient, but she had been holding her baby so he was burnt
too; they were in hospital for months. The epileptics, once diagnosed,
are given medication, but they run out or they don’t take it, or live
too far away from the hospital to get help.

The students had their first practical exams yesterday and today. P
and I took two students at a time for one hour. They were so nervous
poor things. So often, you knew they knew what to do but they just
could not seem to get it right. BP cuffs on upside down, listening to
the heart beat when they should have been trying to hear the PB,
unable to read a mercury thermometer (yes we still use them); anyway,
in the end only one needs to re-sit.

It’s probably a good job that most are passing, because sometimes
there are problems in the schools when students don’t get good marks,
or papers get lost. Last week, at one of the schools a boy brought his
bow and arrow ‘to get the teacher’ for some error with his exam paper.
He started firing it into the playground. He was soon cornered and
taken to the police. No one was hurt, thank goodness. They are very
proud people and don’t take failure well!

The students sit their anatomy and physiology exam next week, so hope
they do well in the urinary system questions, or I will be hiding
under the desk.

Last week, in an exam I asked a question about the ear. The question
was: a) ‘Where is the auditory canal? And b) what is at the end of
it? (For those of you who are not medical, answers are outer ear and
the tympanic membrane)

Answer:-a) in the lungs b) the anus! Oooops!! I should stick to
nursing Thank goodness all the others got it correct.....

One of the students is not well this week - she has been diagnosed
with Guinea worm. The other name for it is Dracunculiasis, do check it
out in Google. It is a bit unusual in this area, so if it does turn
out to be this it will have to be reported. It was thought to have
been eradicated by the UN some years ago.

The cycle goes something like this. The person drinks some unfiltered
water, the water contains very very small Guinea worms. They then make
their way into the gut then bore their way into the top of the leg or
arm. They then slowly grow, which could take up to a year, boring
their way down the leg or arm until they get to the top of the foot or
hand. By now they are the length of the limb.

The person then may be walking through water or standing in water
doing washing and the worm will bore through the skin and expel out
hundreds of very small worms. So the cycle starts again. The only way
to treat it, I am told, is to wait till it pops out of the foot, catch
it, and fasten some string around it with a stick and slowly every day
turn the stick and wind up the worm. If it breaks, you have to wait
until it re-grows then start again. The thought of it gives me the
shivers. So at the moment the poor girl is waiting for the worm to
appear. Will keep you posted.
Let’s hope she has been mis-diagnosed and it is an abscess or
something. She is due to see the Dr tomorrow.

Friday 30th July

Ian here: I arrived in Mapuordit late today after around 48 hours ‘on the road’ – Sydney/Dubai/Nairobi/Rumbek/Mapuordit, including a brief overnight stay at Bethany House in Nairobi. Not the easiest place to get to, but, there again, not huge queues of people wanting to get here!!

A couple of the Mapuordit sisters I had met last year were also at Bethany, and over dinner the three of us and one of the fathers polished off a nice Barossa Shiraz I had brought for Anne – sorry dear – all in the interests of reducing luggage weight, of course! They all have to come ’out’ on a regular basis, and this was such an ‘outing’.

Sister W---- told me that July is known as the ‘hungry month’ in Mapuordit. People have usually exhausted their supplies from last year’s harvest, and the new harvest is not due until August. So, there is a lot of hunger about and it can therefore be a depressing time to be here.

Anne’s probably mentioned this before, but because S Sudan has no postal system, ‘stuff’ piles up in Bethany House, and anyone coming into Mapuordit is gently persuaded to fetch mail, needed equipment & a host of other things (I’d better be unspecific.....!).

True to form, when I crept downstairs at 5am for the journey to the airport, there was a small mountain of ‘stuff’ on the dining table for me to take ‘in’ (people talk about going ‘in’ and coming ‘out’ of Mapuordit, and this perhaps says volumes about the experience!). Fortunately, nothing too heavy to add to the 30kg I already had....

One of my ‘parcels’ worth mentioning, and which illustrates the difficulties of a lack of postal system, was an envelope of documents needing the Bishop’s signature (administration is done in Nairobi but he’s now based in Rumbek).

I was greeted by him on the edge of the airstrip at Rumbek (and also by some strange gaunt woman who said she was my wife....), he relieved me of the envelope, signed the papers and handed them in the envelope to one of the Sisters who was going ‘out’ to Nairobi on the plane I had arrived in, its propellers still turning!!

True express mail! Ink on the papers was probably still wet when they arrived back in Nairobi 4 hours later!

Anne had various ‘jobs’ to do in Rumbek, ranging from produce shopping in the market to delivering cash to one of the outlying units of the hospital (HIV) to a banking task.

The banks, however, were closed for a public holiday to mark the anniversary of the death of John Garang. He is a local hero, the former leader of the SPLA (Sudan People’s Liberation Army), killed in a mysterious helicopter crash shortly after hostilities in the civil war ended in 2005. Huge event here.

We visited the orphanage run by the Sisters of Charity who had looked after Anne so willingly last year when she fell ill in Rumbek, coming to meet me - some of the severely malnourished babies we saw last year are now a picture of health!

Next door to the Sisters’ compound, we were waiting at Pan Door (House of Peace), a Church conference centre; another of Anne’s ‘jobs’ was to take some passengers, who had been on a conference, back to Mapuordit. A Father who works for Radio Good News, an FM station run by the Church, asked to interview Anne about her experiences in Mapuordit – all in a day’s work!! Even I scored an interview, based on my extensive knowledge of Sudan, one hour after my arrival.....

Now, back to this gaunt woman who was there to greet me at Rumbek...................yes, the photos you’ve already seen on the blog do not lie and the beans & rice diet has taken its toll. But she’s well, if tired – long days, and a good deal of misery around, especially with malaria affecting children.

Some of that misery was seen on the road from Rumbek to Mapuordit. An important government official in the Roads Dept crashed his Land Cruiser into a mahogany tree on Wednesday and received serious injuries – he was taken to Mapuordit (which, by far, provides the best care in a wide area) but succumbed.

On our journey, the grieving relatives were fetching the body back in a car bedecked with tree boughs; we then passed the scene of the accident – the mahogany tree barely dented, but the Land Cruiser V-shaped.

By the way, for lovers of Anne’s blog style, don’t despair – I won’t let her off the hook! We’ve yet to agree how to keep it going whilst we’re both here – I’m amazed she’s been able to keep it going whilst here on her own as there is just so much sickness around. Pauline was called out twice last night for difficult births and Anne assisted with one.

Birthday cake



Monday 26th July

Pauline and I marked the exam papers last night for the course ‘Professionalism’ for our nursing students - they all passed, top mark 85% and lowest 51%, all very happy!! Good to see your words coming back to you on paper. They really are a bright group, I do hope they will all do well. Let’s hope this course will be a launching pad for them.

They will probably all need to go to another country to further their education; as far as I know, there is only one university in North Sudan and a new one in the South in a place called Wau (think that is how you spell it), but it is just starting up, so not sure what faculties it has yet.
I hope that perhaps some of the local students will stay on here at the hospital and help to build up the nursing side. It is a constant battle to get the nurses to understand what ‘nursing‘ is all about.

Two students are already asking if I can take them home with me so they can get some education. I try to explain about visas, passports, university entrance exams, funds. Don’t want to be negative but it is a big ask, to sponsor. The hospital at the moment (with funding from donors in Australia and Italy), is sponsoring 5 people who all worked here.

One, a nurse (Daniel), who has gone on to do a diploma in ‘public health and clinical medicine’, is getting to the end of his first 9 months (3 yr course). When he finishes he will be able to diagnose, treat and prescribe. It’s in a place on the border with Uganda called Meridi. He is doing really well, we are told. Last year he was the nurse that always wanted me to show him the different anatomy and physiology programs I had on my computer. Such a bright man! He will come back and work here for at least 2 years when he has qualified.

Then another boy has been sent for a 2yr course to get a laboratory qualifications; he is due back for a practical period next Monday, so we are all looking forward to greeting him and seeing how he is going to go, and what new tests he can now perform which he could not do before. We are very limited in our pathology investigations. One reason is, up to now there has not been the training and another which still exists, is the lack of reliable electricity. We cannot culture anything to see what is growing, so just have to treat by looking, smelling and ‘gut feel’ as to which antibiotic to give. If, after a week, things have not improved, we change the antibiotic. Perhaps not very good for the immune system but it’s all we can do here.

The other three are all nurses from this hospital doing this course I am teaching. Two are in their second year and the other is a man called David who was the in-charge on the Children’s ward last year, and who has joined the school this year. So, the hospital is still paying their salaries while they do the course. Then, we hope they will come back to work here. Eventually, it has to be a hospital that is run by Sudanese people, for their people.

It was the boss’s birthday yesterday, so he held a party for all the expats, brothers, fathers, sisters - there were about 30 of us. It was lovely, one of those balmy African evenings, warm, red sunset, lots of loud frog sounds, some drumming from the drum practice in the school.

Some interesting food - one dish, I asked one of the brothers what it was, as it was getting dark so hard to see. He said ‘intestines, and this one is beans, this one is lentils.’ I sort of just had the gravy which was tasty on the beans…..

When it was time for the cake (the brothers have a wood oven, so they can bake), it came out from the kitchen, African style in a procession. All the Africans sang and danced it to the birthday boy. With lots of those loud African ‘cat calls’ - sound much better than a cat - it was great!! I did not know how well the brothers can dance, great movers, particularly the locals.

Late night, 11pm.

Improvised signage at the Liberty Loo

'A way to go!'

Zebra poster










Thursday 22nd July

This week has flown by - so much to prepare for lessons and work on the ward. After working 3 days a week for years in Sydney, to at least 6 long days a week here, I can feel it.

I am feeling so tired, and there is so much misery here, I don’t know how Pauline does it, day after day, she needs a medal! She did get a gold one for the football, but not quite the same!!

The repeat anatomy and physiology exam went well. They all passed - there were 10 retakes. Next week, I am teaching the renal system…I wonder why me?!

The children’s ward looks great - all the posters are up, so colourful they really brighten it up, hope you can see the photos. Some of the children were a bit frightened to begin with, as they have never seen these animals even though they live in Africa. Most will never have seen a picture book, never mind a poster. They really enjoy getting their height taken, there is a bit of a competition going at the moment!! Thank you, Chantelle of Kids Art, it was a wonderful gift.

The lady with the snake bite has a daily dressing with normal saline soaks and antibiotics IV; I think she will be here for at least 6 months. Her new baby is beautiful, but so small, it lies with her in its goatskin all day. Never heard it cry. The only time you hear any of the children is at medication round when they have their injections.

The new buildings are moving forward despite the rain. The shelter for the baby clinic is nearly completed, so they will now be out of the sun and rain while they wait for the Doctor to see them.

There is also a tea room for the staff being built, as there is only a small hut at the moment, where about 10 people can sit. As there are now about 70 staff, that’s including cleaners & outreach staff, it is a little cramped.

We have a young health worker here just now (for 4 weeks) from Slovakia, so she has taken on the task of trying to explain to the patients and the co-patients how to use the new latrine. We might think this is an easy job, but these people are used to squatting in the bush. To go into a small room and balance over a big dark hole is all a bit strange. Washing also, is another past-time many do not understand, especially the ones from the cattle camps. They normally put dirt and ash on themselves to stop the mosquitoes, so to wash is quite alien. She has a hard job ahead of her.

We found a good visual image on the web which she copied with and without the cross in the circle and put it up appropriately - one at the latrine side, and one at the wash side. Again another problem, we all know what a circle with a red line across it means and we understand stick figures, but this is not the South Sudan world. So, every day, there is a group of people around the latrine, having a talk with a translator, discussing spread of disease and risk of infection. This will have to continue for a very long time as patients, of course, are changing all the time.

Lovely local!

Glamour in the dressings room

Thursday 22 July

Pauline and I were doing teaching with the greens today on the wards, bed baths was today’s lesson. We managed to find two towels and two face washers, the co-patients had the hot water ready. We even had two washing up bowls. This was just so hard last year to do that; you would spend half the lesson time trying to find the equipment - what a difference small things make.

The new medical ward that now has 22 beds is full already (there used to be 16) and we are expecting a car-load of HIV patients today from Yirol a small town about three hours away that has no treatment centre - not sure where we are going to put them.
The last patients that came were so advanced in their disease, there was not a lot we could do for them, in fact 3 have died. Until the people come to terms with HIV and admit that it exists, this problem will continue. Early intervention is essential.

Just had two hours teaching in the dressing room, one patient took about one hour, a man with two gunshot wounds to both legs & upper thighs. Luckily for him the bullets came out the other side without hitting the bone, don’t know how, must have been so close. But what a mess to the legs. It’s surprising what you can do with cotton wool, gauze and bandages. I did have some ribbon gauze, courtesy of a friend of mine back home, which has come in very useful, but alas used the last one today.
Next dressing was a spear wound to the back.

Just when we thought all the dressings were over, a young woman with a new baby arrived (sitting in the wheelchair you brought last year, Ian) with a terribly gangrenous leg.

She had been bitten by a snake 10 days ago in a remote village. Two days later she delivered a baby, much more important. Then we’re not sure what happened, think she might have gone to the local witch Dr, but history poor. Her brother who lives here heard about it and went off to bring her to the hospital. Thank goodness he did, as I’m not sure if she would have survived if she had been left.

With the help of two other nurses, we debrided the leg and dressed it as best we could; she will go to theatre tomorrow to see what can be done. She was just so brave with very little pain relief (no schedule 8 drugs here…).
She has now been to theatre. Good news, I think we can save the lady’s leg, but she will be here for a long time.

Prester John


The ordination









Sunday 18th July

Well, what a day we have had. E------ and I were invited to the ordination of a priest in Rumbek; why not?? I will never get another such invite again, I am sure. He was to be the first new indigenous priest in South Sudan for 29 years. He has been studying in Rome for the last three years, and now has got a degree in theology and masters in divine something, not sure what. He has now returned to his home town to serve the people. It was such a big thing, the people really seem to respect him and are so proud ‘he is one of us’.

His life story was read out from the altar, both in Dinka and English.
He was caught up with the war and found himself in a refugee camp in Ethiopia, where he got a few years of education. He then worked in the cattle camps, then in a shop and studied at night. Both parents had died, so he was helping to feed the other children in the family. He then went to the Comboni School in Rumbek, showed great promise, and joined the seminary. Next, he was sponsored to go on to university in, I think, Kenya.

There must have been at least 1000 people there. Lots of blessings on the new priest John by many, including the bishop. People had come from USA, Canada, and Rome. His sponsor family were there, a middle aged couple from Italy, the smile on their faces said it all.

It was a lovely service and they included his remaining family, who found it hard to accept that this is what their brother wanted to do, be a priest instead of looking after the family cows.

The service started at 10am, so we were up early. The car left at 6-45 am; the problem was that there were only 3 cars going, but there were about 50 people waiting to leap in to the cars as soon as the doors were open!! We had been booked into the brothers’ car, so they made sure we were squished in first. Each car managed to get in about 15 people.

There was a lot of water on the track, as we have had a lot of rain lately. All cars got through, although one got a puncture, one was leaking oil, and our dynamo needed attention when we arrived. The cars have to be so strong on this type of ‘road’ here!

We managed to find a seat under some shade, as it was all outdoors in the grounds of the local school. The excitement in the air was electric, carnival-style. There was a man walking around with a long cow horn with a piece of garden hose on the end of it, blowing it and trying to get a tune out of it (Sudanese version of the vuvuzela!!). Lots of coronation-like flags and plenty of very smart plastic flowers decorated the large stage, which was the altar for the day.

There was quite a lot of laying-on of hands, and blessings from all the saints. This took up about 3 hours, then there were the speeches, another hour. So at about 2pm there was a break to have a feast. We were all allocated classroom numbers where we could get food from.

Guess what was on the menu? You got it!! BEANS and RICE! But there was also beef in a stew and a chapati each, very tasty. I had a chat with the Bishop, who seemed very happy to meet me, with the remark ‘Anne, my special goalkeeper, good to see you again’

After our meal, it was marching bands, hallelujah dancers, choirs, plays, all took place around the altar in front of the new Priest John, who kept jumping up and joining in the dancing, much to the locals’ delight. By 5pm we hit the road home; luckily there had been no further rain, so the track had dried up a little. Late to bed that night, let’s hope that the good priest John can bring some harmony and peace to this country - it sure needs it to face the years ahead.

Anne on Childrens ward

Childrens ward with poster donated by Kidsart Qld

None shall pass!!















Friday 16th July

The rain today is so loud that at the moment you cannot hear anything.
Will try and send some photos: this one is great - he is on guard, and the roof he is guarding is on the right, awaiting attachment!!

Sad just now on the wards with so many sick ones.

We are having 150-170 outpatients every day just now. It apparently has never been this busy, maybe yes on a Monday after a weekend, but not these high numbers every day such as we are experiencing now.

The majority with malaria, quite a few with typhoid, and children continue to be admitted with pneumonia and anaemia.

Three days ago, a small baby came in with mother and two siblings; the baby had pneumonia, very congested lungs, and could hardly get its breath. Apex beat uncountable.

The baby has been struggling here for 3 days now. Oxygen from our oxygen separator machine (which only gives a small percentage of oxygen from the atmosphere), and even then it depends on the quality of the room air from which it has to extract the oxygen.

The room air quality must often be low, when everyone wants to get into the room to see a baby in distress. Every drug we have this baby has had, and we have prepared the mother for the worst, but today she had had enough of us all doing things (IV cannulation, oxygen masks strapped to her baby’s face, drugs). She wanted everything removed so she could comfort her child.

Guess what?? The baby is so much better. A mother knows!

'Me & my bruvver'

'Bees around a honeypot'









Monday 12 July

We were a sad looking bunch at work today. Walking wounded. P---- has a large bruise on her ankle, Sister Pauline has a bandage round her foot, J---- has her calf strapped, and the red area on my left leg is not showing today, so I got away lightly. But proudly around our necks we wore our medallions.

The Bishop had come to the hospital early on Sunday morning straight after Mass to bless the new medical ward. Unfortunately, the ‘Liberty Loo’ was not on the list, so it missed out on a blessing. But I will send you the latest pics - it has now been painted, looks good.

I just wish the patients had a path to get to it - at the moment they have to walk across a sea of mud and builders rubbish. I am sure fixing that will be in the plans somewhere.

Our lovely felled tree has been another source of entertainment this week. The children found a honeypot in it, so have been having a great time, all getting sugar hits - see photo.

Our new students started working on the wards for 1hr every morning, just making beds and damp dusting. It’s good to see them interacting with the patients. They were saying they are feeling like real nurses now. This group are so different from last year; there are 3 girls and 13 men. All have had at least 4 years education, some more. Most are used to studying, just finished school, so they don’t find the exams they have most weeks too challenging.

Pauline and I have been doing some extra teaching these last 2 weeks as they needed revision on a few subjects. It is years since I opened an anatomy and physiology book, never mind teach it. My topics were the ear, the skeletal system, bones, joints and all that is attached. Pauline was covering the digestive system and the skin. They sit their exam next week, so we will wait and see!

Once again, thank you Ronnie, Joan and others for your presentations on many topics. We seem to find one for most of our subjects, so then we just have to simplify them, add extra pictures, and make sure we are covering all that is written in the curriculum.

Yesterday, I was teaching ‘last offices’, or ‘care of the dying and the deceased patient’. It was a really interesting two hours, because I did not pretend to know what the Dinkas do with their loved ones. So I learned heaps. It was a very interactive class.

When you read this, you should realise that they face death so much. Death is so commonplace in Africa and a high percentage happens in South Sudan.

People prefer to die at home, so they are buried close to the house, but in an area that you do not walk past every day. They could not understand the concept of cremation, thought that it was terrible, as was a post mortem – why do you need one? They also believe that if someone dies owing cows, the family will be punished in some way until the debt is paid.

If someone is struck by lightning, it is because the gods are angry with you, you must have done something bad, and the parents cannot grieve for them, or look at them after death. Many believe that they will come back to earth as something else - a tree, or a cow - a bit like the Aboriginal people having a totem. It is the family members that wash the body and wrap it in a cloth.

To let people know that there has been a death in one village, a drum call goes out with a special beat. As it is so flat here, the sound travels well. People will walk to the next village to attend the funeral, so they are big affairs.

The students said that old people (life expectancy in South Sudan is 42 yrs) seem to know when they are going to die and will gather the family around the fire and tell them as much history as they know, so it will be passed down to the next generations.

Nothing is written down. Jewellery is passed to the women in the family, no written wills. When someone dies in the hospital there is no death certificate to give to the family. It is just recorded in the hospital stats that there was a death. At the end of the lesson, I think I learnt more than them - they should set me an exam!!

Team Australia

The vanquished & the Bishop

Sudan v Australia










Sunday 11th July

E----, Pauline, and I all met up at the hospital to clean up after our ‘clean-up’ party; it’s strange that you can have so many people at a function, but it’s always the same ones that end up clearing everything away (the same the whole world over, I think!). Also, not a good tall strong Dinka in sight………

The chairs were returned to their rightful places. All the cups were washed in the laundry and returned to the sack for the next function, all feeling quite pleased with the event.

After a bit of interneting and a few Skype calls, the three of us headed for the market for our two-Sudanese-pound plate of beans and bread. A bit oily today but still tasty, all washed down with a warm Fanta (all we could get). A bit of excitement, I managed to get some double A batteries for my little water sterilising wand (unable to use for the last week).
This is a first for the market – batteries; not sure how long they will last, not quite the Panasonic but are called Panashiba. The stallholder is the same one that had biscuits last week, a Ugandan, so he is bringing in different goods, not sure how the locals will take it.

On our walk back to the compound, many people are heading to the football field to watch the girls play for their final World Cup game, then the final boys’ game. It has been running for the last 4 weeks and the Bishop was going to be there to present the trophies.

After a little bit of ‘I am tired, such a busy week, could do with a rest’, we decided to head on up to the field too. E---- is wearing shorts and her flip flops, P---- is in thin shoes and ¾ pants, Sister P is in her skirt and sandals, I am wearing pants and my light sneakers. No hats at all. The sun is beating down, about 40C at 4pm. When we arrive there are about 500 people, mostly children + the Bishop, all waiting for the girls’ teams to come on to the field.

Suddenly, one of the brothers who had been doing most of the arranging is waving to us to come over to the table where the trophies are. There is a problem, only one team has arrived!!!!!

We are 8 they are 8 so ......... guess who played the goal keeper for Australia in the World Cup???!! You would have been proud of me, girls. Pauline was in the action too, running away from the ball mainly!!! She said that they did reduce the size of the pitch for us to half size.

There was a bit of a problem, apart of course from the fact that we were not fit - no good footwear or clothes, some of us old, and we did not know who was on our side. The 8 Sudanese were good players, so they were split up 4 and 4, but no one was wearing a strip, it was difficult to kick the ball to a member of your team when you were not sure who was who!!

It was Australia V Sudan (Pauline was on the Sudanese side, traitor!!)
When Brother asked who wanted to be goalie I put my hand up, thinking I will be reasonably safe. I thought at least I will not have to run (which I can’t), but there again, I can’t dive for the ball or kneel down (due to two knee replacements a few years ago).

None of us had water with us, as we had none running in the compound that morning, so our bottles were empty.

We all ran on to the field singing OI! OI! OI! OI!.......or however it goes. The Bishop follows to toss the coin, pose for photos with ‘Australia v Sudan’, and the game begins.

There must have been about 50 kids around my goal telling me where to stand, so I am dancing backwards and forwards, just how they do on the telly. Then, suddenly, the ball is coming, and this very tall Dinka girl is thundering down the pitch towards me, I am terrified when with one almighty thud she kicks the ball....... right over the goal! I live to fight another day.

The game continues, I save two, pure chance. By now P---- is limping, Sister Pauline thinks she has broken her toe. One Dr is so red in the face I think she is going to have a heart attack. The whistle goes for half time. Still no water, we must be mad.
Brother, Father and the Bishop + the entire crowd think this is the best entertainment since sliced bread. No, can’t say that - they don’t have sliced bread! Anyway, the crowd has now reached about 700 (not my numbers) - word has got out that the Sisters from the hospital are playing.

Whistle blows for next half. Bit quiet at my end of the pitch, so I have got the crowd to start shouting, ‘Aussie, Aussie, Aussie!!’ It does not help, another ball is coming my way, I think the same girl; I duck for cover and the ball just misses the net. YES!!
The whistle blows, end of game, no goals, Sudan 0 Australia 0.

I start to walk off. The ref blows his whistle and announces there will be a penalty shoot off!!!! No one told me about this!

By now everyone is running towards my goal area, they are on the pitch, down the side. All jostling for the best position to see the action. I am getting instructions from every one. In Dinka. The players were all lined up in front to take it in turn to shoot. I think - 'this is not a profession I would choose in another life!'

So, five times the other goalie and I have to face the ball.

It’s all a blur, but it goes a bit like this: first ball hits my left shin no goal, second ball misses the goal, and third ball goes in. Sudan 1 Australia 0.
Fourth ball, I bat it with my hand – saved! Sudan misses, and now 1-1.
Last ball hits my left shin again, but goes in. Sudan wins 2-1, what a game!!

The bishop really enjoyed it - called it ‘the best entertainment he had seen for a long time’, he also said something about sportsmanship, willing to give things a go, being part of the team.

The provincial governor was there and other dignitaries from Rumbek, all talking about how the World Cup has brought people together and there has been less violence during the 4 weeks than any other time (not sure about that....see my shins!!!). That people are beginning to enjoy peace and are finding other ways to settle disputes. I do hope it is all true and it will continue.

We were all so tired, we went home before the football cup presentations. But not before the bishop gave out the participation certificates to all our 7 cleaning teams at the hospital, and presented the shield to the Children’s ward.

Award ceremony
















Sunday 11th July

Well what a weekend it turned out to be!

On Sunday, judging went well. Two areas decided to put flowers in jam jars in the ward area (trying to gain those extra points…..!!). Everyone was out cleaning leaves off roofs, mattresses out in the sun, using the water hose, washing down walls, mops flying. Felt sorry for the poor patients that were in theatre that day. Perhaps they did not get the attention they deserved!

Bumped into Pauline – panic!! The lady that said she could make the 160 mandazis can’t make them... help, no food!
In the meantime, I am doing dressings and scrubbing beds, wondering what we are going to do.
Don’t panic, another mandazi lady has been found in the market, will deliver at 2pm.

The hospital is certainly shining. The mops are worn out, the bristles have gone from the brooms, and the rags are now definitely rags. As Sister W---- says, the only people who are unhappy are the spiders as they have no web to go home to!

So the judges had a difficult task. After much discussion, the cleanest ward was thought to be the Children’s Ward. Runners up were Out-Patients Department and Surgical Ward.

Pauline has run around all day, helping cleaning, moving chairs arranging the washing of cups for tonight. Amazing - the mandazis arrive!! There was a suspicion that the bucket they were brought in belonged to the lady that cleaned the toilets, but it was a rumour, I am sure. Well, nearly sure…

P arranged for someone to put a teaspoon of jam in each donut; she thought everything was going well until she went off to check and found them pushing a blob of jam in with their fingers!!! They had washed their hands. P to the rescue again!

By 5-30 we are all set. The video chosen is ‘Ice Age’ a cartoon, safe. It’s a hard job finding something that is suitable for everyone.

At 6-30 the only people present were all the Drs, Sisters and the volunteers. Panic, the thought of all those donuts and buckets of juice. Unfortunately for us, the governor from Rumbek had arrived and was giving information to the locals about a new road that is to be put in and new buildings that may be built.

Also about the collection of information, like individuals’ age assessments. At the moment, no one knows when they were born or when someone died. This is not collected, so if next year South Sudan splits from the North, a government needs to know ‘their population’. So, there is a hard road ahead.

Because of these dignitaries arriving, a few cows had been killed, and, as I said, any free food and people will come. So, by 7pm, we were starting to get a few people arriving at our function.

The short PowerPoint presentation went down well, showing every one cleaning; they love that, seeing themselves on the big screen. They have no mirrors so don’t know what they look like. So, after a repeat performance of the slides, we moved on to the presentations.

All the cleaners and laundry staff received some jewellery; luckily, I had thought ahead and taken with me some of my ‘fun’ type earrings and bracelets and a few extra scales. The man who cleans the grounds of the hospital received a small digital radio, so now while he is pushing his cart around he has his earpiece in, listening to the news. Very happy!

The Children’s Ward were the winners, so received ‘the Cup’ full of sweets + some fantastic posters of African animals which were kindly donated by a great company called Kids Art in Queensland (www.kidsart.com.au).

The Children’s Ward has nothing to identify it from any other ward. There are two posters I put up last year, but no books, no bright paint on the walls, nothing. So, on Tuesday, I will help them put them up.

All the staff on the Children’s Ward received a fob watch (one has a flat battery already) - very sought after as not many people have watches. The second ward team to win was the Outpatients Department, who had really done well with cleaning their very old area. I think you saw the photo of one of the nurses sweeping the cobwebs down. They all received a very smart shoulder bag. This group of people are a little older and attending adult education classes, so that was perfect for them.

Third placing was the surgical ward and they all got nurses’ scissors and a pen. They probably would have preferred the watches, but realised they came 3rd, not first. It has made a difference already - I can keep my pen and scissors for a whole day without them being borrowed, great!!

More speeches were made about how hard every one had worked and we had achieved our objective by reducing the bacteria, and making our hospital a safer and healthier environment for our patients and staff.

We were just settling into Ice Age 1 when the Bishop arrived, which was a great honour for us all. He is a very loved and respected man in the community. He then said a few more kind words which they all lapped up, and then left, I hope to sleep, as he had had a very busy day.
It was all over by 9pm, just in time to close the door (we will clean up tomorrow) and head for the finals of the real World Cup.

As I have said before, it was up on a big screen in ‘the cathedral’. It was packed, hard to find a hard bench to sit on, but we did. The excitement was high, but I think most thought it was a poor game. The Sudanese are quite good at being impartial - they clap and shout equally for both sides. Unless, of course, it had been an African team! Going into the second lot of extra time, I thought I was going to fall asleep!!

The corpse

Compound cook & family

Students on the ward with new toy!









Friday 9th July

Our green nurse, who has been in prison all week, is now allowed out during the day to work, then goes back in the evening. He has now been joined by another one for a similar offence - it is hard to keep up with what is happening to them all....even harder to teach them about bed-bathing and hygiene when you know they will not have seen water or had a change of clothes for many days. Never mind not having eaten....

Well, the tree I wrote about is down after lots of drama, but the man who chopped it down has now refused to move it. A slight altercation in the office and a few threats with the axe, then he took his money and left!!

So this once-magnificent mahogany tree lies like a giant corpse across the path and outside the children’s clinic. Already the children are playing there, and mothers are sitting on the trunk. On the large branches they hang their babies in their goat skins, it’s becoming quite a feature! It’s a shame, as the workmen had planned to build a shelter for Mums and babies in that very spot. It will now I think be built around the fallen tree. Unless Ian you could get a chain saw in your bag....!

Malaria continues to be a major reason for admission to hospital, but as the weather is now colder, respiratory infections & pneumonia are a close second or a combination of both. Most people have very little clothing, so get very cold at night.

Two more admissions for scorpion bites during the week, both fine now, discharged after two days. A poor lady was admitted who had been to see the local witch doctor with her inguinal hernia - he just chopped it off. Now we have a strange infected colostomy type arrangement. The things these people put themselves through before they come to hospital never cease to amaze me.

The new medical ward will be opening tomorrow. We will start moving patients in during the morning, and it has been extended to increase the bed numbers due to all the HIV patients that are now coming in for treatment. It is very smart and has two single rooms for the very sick patients, a nurse’s station, and a shower.

The shower will not be used until Nov time when we hope the hospital will be able to put in a new water system with a new solar pump. It will be the nearest thing to a modern ward South Sudan has ever seen!! Very exciting, when the lorry arrived there were 10 new beds (with back rests, five pillows, 6 new lockers, and an examination couch). Once again, some of them came from funds raised in Australia and in Italy. Many thanks to all.

Final judging tomorrow of the cleaning, so the mops will be out first thing, I hope. Already there is a bit of jealousy about who they think is going to win. Deep down, they all know who the real cleaners are. A band of about 8 who take pride in their work and do it willingly and often, not just for ‘The Cup’, a mix of nurses and cleaners.

So, think of us at 6pm on Saturday night serving a cup of orange juice out of a large dustbin (a powdered type with added sugar). For food, we have asked a local lady to make 160 mandazi - not sure if that is correct spelling - it is like a deep fried donut found all over this part of Africa. Very solid!! You get 4 for one pound, so the cost is about A$20.
With it we will serve some jam (but still looking for jam) - bet you all wish you could be here! You might even get a toffee too.

It would have been nice to serve something healthy, perhaps to have killed 4 cows, 2 goats and 10 chooks, but the practicalities of all that would be too great and it would have been Pauline, the other volunteer and me doing all the arranging. The problem here also is if the rest of the village hear there is free food around there would be a riot. So the juice and donuts are fine.

Pipes for sale


Cleaning out-patients dept

Wednesday 7th July

We are hearing the Bishop may be coming next week, perhaps on some official business, but I think that he is going to bless the new medical ward (not yet quite completed), and may even give his blessing to the new latrine block, which I think will be in use very soon (the “Liberty Loo”).

A lovely man, I am looking forward to meeting him again. A man with such warmth, dignity and understanding of the Sudanese people.

Sister Pauline never ceases to amaze me how she continues to work so hard in this very unforgiving environment. She is the quiet achiever; some nights, while we are all sleeping, she is up at the hospital delivering babies through difficult births, bilateral episiotomies, breech births, you name it, she does it.

The only light is a small spot light; the only water is in a bucket, the only cloths are rags. This girl is a miracle worker. All mothers and babies are doing well. Her days are full to the seams too. And always, she has time to check on any staff that are sick, or put some flowers in the rooms to welcome the new Dr’s. Her standards never slip. My admiration for her work, dedication, and generosity is overwhelming.

Doing a lot of teaching just now, so full on. Just finished and it's now 6-30pm. My subject was 'Bones', so my skeleton I brought last year came in very well. But it is needing a little repair, perhaps Ian could bring some fuse wire and a small pair of tweezers or small pliers which might do the trick - the legs have come off, poor man. The students liked the story about me bringing it over last year and being 'found out' at Nairobi airport!!

'The old mahogany tree'













Monday 5th July

Within the hospital grounds are some beautiful mature mahogany trees that provide nice shade areas for the patients and co patients. Just before I arrived in June, there had been a big storm and it had brought a large branch of one of these trees down, narrowly missing Dr P---- by a few seconds. She says she heard the crack, looked up and ran. This particular tree overhangs the children’s clinic, so is now looking very unstable.

The ‘Ministry’ says it must come down. Word soon gets around that work needs to be done and the price is good. Now - forget health and safety in the workplace!!
A man who is a relative of someone that knows someone, will do it; he also happens to have a child in the children’s ward (quite sick) so while he is here, he will take the job on.

One old axe is found, and some rope, and the chopping begins. Branch by branch, it is piling up around the clinic area, the wood is just so hard, chips of this beautiful red wood are flying. What a wood turner would give for this wood at home I can’t bear to think about it!! This wood will all go to firewood.

The sun is beating down, how he keeps going I just don’t know. By 7pm only one main branch is down, he promises to have all felled wood cleared by the morning so the clinic can run.

We arrive at work the next morning - the wood is as we last saw it. We all were muttering about ‘he promised’, ‘so unreliable’, etc. It transpires that his poor daughter died that evening on the children’s ward. How bad did we all feel!!!! Despite all this he said he would come back this weekend and recommence where he had left off. The clinic went ahead with the mothers sitting in the felled branches and the children enjoying their new mini jungle.

We are still thinking of a good movie for our cup night ‘Bend it like Beckham’ or ‘Madagascar’ would be nice!

But unfortunately we have neither. The new Slovakian Drs have only Italian speaking movies. We will keep looking. The cleaning goes on; it is really amazing how they are rising to the challenge - the main out-patients and out-patients’ pharmacy is one of the oldest buildings, very high ceiling, open beams. Covered in cobwebs - well, they were.....

Father A------, one of our judges, last week commented about them, and said it’s a pity that area could not be cleaned, so a few days ago, Saturday (Dept closed), one of the nurses came in on his day off and climbed up there and brushed all the cobwebs down. See photo, it is just so high. I was having a fit wondering about if he falls. Great job, he will definitely get a prize, scoring system or no!!!

Living dangerously in the kitchen (the kero stove is for all Anne's cooking!)!!


Sunday 4th July

This week just seems to have flown by - there has been a lot more rain, so internet connection has not been good, hence the gaps in my postings to Ian.

At the hospital things are busy; one day last week there were 160 patients seen in the outpatient clinic in the morning. Amongst them all, was a small boy that died of malaria before he was seen by a Dr. His parents (local) had taken four days before they brought him, trying other medications first. His mother was so distressed, she was just throwing herself in the dirt, rolling and screaming.

Death here is never a silent affair. Crowds gather and other women join the wailing, giving the mother support and perhaps ‘permission’ to grieve. The father, sobbing, carried the child in his arms out of the hospital, the same way he had arrived a few hours earlier. The boy would have been buried the next day in or around his family compound.

There is no A&E department, or triage, so it is hard to assess each and everyone’s condition immediately, they just sit en masse and wait. Most parents would have pushed and insisted to be seen, but it did not happen in this case, very sad.

Each morning Pauline or I have the most junior nurses for one hour to try and teach them the basics of nursing. A ‘background’ course in helping others, communication, ethics, understanding your patients, supporting your fellow nurses.

There are six nurses who attend, but on Wednesday only 5 arrived; I questioned the others to see where he might be - no response, no one had seen him. Later in the day, we hear he is in prison (quite common here) - reason –‘stealing cows’. So we are really succeeding in changing their thought patterns.....!

Most disputes are regarding cows, not enough have been paid for a wife, too many being asked for a wife, a certain number to pay off a bribe, pay a fine, anything really will, in the end, involve cows. Let’s hope he is back next week and we will re-give the lesson on communication skills……………

Another student signs up!

Locals

The Jules Rimet Cleaning Cup











Saturday 3 July

We have been struggling with the internet for 2 days now – the heavy rain plays havoc with the satellite signal, it has been ages since things were up and running. A row of people waiting, so sorry can’t stay long.

Pauline and I are panicking, hoping we have enough prizes to give out for all the cleaners at least for our ward-cleaning competition; I brought a few bits of jewellery with me and a few scarves which they will love. Fob watches and scissors for the nurses who have really worked hard. The team that wins will have to have an IOU until Ian arrives with soccer shirts and caps.

Thank you all who contributed into Pauline’s 'emergency drawer'. Some was used yesterday. It was for a young girl who came to the hospital about 6 weeks ago - she was having a ‘fistula repair’ after female circumcision.

Try and read ‘The Hospital by the River’, can’t remember the author, then you will know what I am talking about. A surgeon came to operate on a group of young women and this one girl has taken a long time to heal; she is now OK but had to get home. Home is a long way away, and there was someone going that way by truck, so with some of your cash she was able to make that journey and be reunited with her family, after having been an outcast for so long. Thank you.

The fund was used again only this afternoon. A man with insulin-dependent diabetes, and known to Pauline, arrived at the gate. We had not seen him here for a long time - he has been abandoned by his family (very unusual here....so not sure why?) - and he was in very poor shape.

He had had nothing to eat, no-one to cook for him (we generally don't provide food at the hospital, unless there is a great need) and he was very emaciated.

With money from Pauline’s ‘emergency drawer', we were able to get him a meal from the local market.....meat stew and bread rolls, to tide him over till tomorrow, when we will get a woman from a nearby village (also in dire straits) to come and cook for him twice a day, with food supplied by the Hospital, and she will be paid in food for her family. Hopefully it will work, and then we will try to sort through his social situation.

Over the past few weeks there has been quite a lot of tribal fighting going on. Two weeks ago it was between the Nuer (farmers) and the Dinkas (cattlemen). Very big fight, many killed about 20ks away. Other Nuer and Dinkas from other areas came to join the battle and, in the end, the police came in, a court was set up and the dispute was sorted, for now.

No one seems to know exactly what it was about, but no doubt it would be cows that were at the bottom of it. One of the Jure (another tribe) staff was too frightened to come to work in case he was attacked by the particular Dinka tribe. We had four patients admitted with gunshot wounds, two have been since discharged and two remain.
Just at the weekend there was another fight, at Mvolo about a 2hr walk away, again with automatic weapons; two killed, a man and a women. Cows again.

We are all feeling quite good this week as one of the medical officers has just come back from a workshop in Juba (S Sudan capital, about 300k away). The topics? ‘Clean and safe environment’, ‘the risk of infections to staff and patients’; he spoke about it in assembly, so it really followed on to what we have already started - ‘Cleaning up for the Cup’ and beyond. Very pleasing!

Then yesterday, three new Slovakian Dr’s arrived. One specialises in public health (here for 5 weeks), so again the same message. Clean, safe environment – Yippee!!

I think when I started this ‘Cup’ thing, the staff thought “it’s just Anne on her latest thing”, but things are changing. They are all cleaning like mad on Saturday - that’s their big day off, too. Fierce competition though, neck and neck some teams!! The really sophisticated scoring system is a closely guarded secret!!

Poor theatre staff are getting upset, as we can only inspect one area of the theatre, as they operate on a Saturday. I tried to tell them that they are just so clean anyway. We will inspect on Friday instead. Outside judges now, pressure on.

Back on all burners again from a bug that knocked me about this week - not sure what it was but all is well now. One of the Drs who has just arrived - been here for 5 days - has got malaria, it must have been the first bite. She is taking medication too!!!
Still want to come, Ian……..