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.