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……..