“Recently, a two day old baby boy, who had been delivered at home, was brought to us with hypothermia, (temperature of 31.3 degree Celsius)…” Read more below.
Many of you will have heard about and supported the ICMDA National Institute of Health Sciences (now the JHSI) which trained midwives, nurses and clinical officers for South Sudan. We have recently been in touch with some of the graduates and have been amazed by their stories.
These men and women are saving lives in highly pressured, greatly under-resourced and often dangerous places across South Sudan. Their stories demonstrate their bravery, commitment and skill as well as the excellent standard of training they received from Drs Anil and Shalini Cherian (who run the Jongeli Health Sciences Institute).
Here are their stories – thank you so much for making their training possible.
Anjeline Adeng Madholhok (Diploma in Clinical Medicine and Public Health)
Busy is an understatement for Anjeline Adeng who can see 200 plus patients a day. She works in a Primary Health Care Centre in the north of South Sudan where patients are mainly refugees suffering from the trauma of war. Fighting breaks out periodically in this region and many medical personnel have been killed.
“What encourages me is when patients are brought in unconscious and later on I discharge them when they are fully ok. I love my profession to save lives. That is why I am where I am, far away from my mum. She always told me to leave this place because of insecurity. However, I used to tell her that God will protect me and I love my job.”
“How you can pray for me: I need to be healthy to save more lives and bless all my family, bless my hands, any patient I touch to get healed, God to give me more wisdom in my career.”
Joseph Ohoya Oting Galla (Diploma in Clinical Medicine and Public Health)
Joseph works in a Primary Health Care Centre in Eastern Equatoria. He says the centre is greatly understaffed and his work is ‘multipurpose’. He uses many of the skills learnt at the NHIS including: administration, prescribing medicine, suturing, referrals and working in the antenatal and maternity wards when there are staff shortages. He says,
“Recently, a two day old baby boy, who had been delivered at home, was brought to us with hypothermia, (temperature of 31.3 degree Celsius). He was unable to breathe well and had a very low pulse rate. The mother thought that he was already dead. I checked him with the stethoscope and found the child was still alive! I started resuscitation immediately. I continued for three minutes and the child started breathing! But his airways were blocked by fluids aspirated during birth at home. I suctioned the child and after all the fluids were removed, the child started crying normally. We didn’t have adrenaline so we treated with IV antibiotics. We put the child on skin to skin contact with the mother then stimulated suckling reflexes, which was positive. We advised the mother to continue breastfeeding until we discharged the child after three days when the child recovered fully.
The following day, the father of the child surprised me with a big fat goat as a gift of appreciation for the miraculous job done to his one and only son! We taught the family the importance of delivering in the health facility rather than at home.”
Another memorable moment was when,
“A 16 year old girl pupil was brought in with headache, tummy pain and dizziness. She collapsed but had continuous convulsions. After a positive result on a rapid malaria test we treated her for severe malaria. But there was no improvement. Convulsions carried on and other symptoms developed: serious hiccups, neck stiffness and lock jaws. I did a further physical examination, using diagnostic skills I learned at the NIHS, and found the patient had severe meningitis. We were able to treat this with medicine and now the patient is improving slowly. She can now eat well and chat with people properly.”
Joseph also talks about the problems facing people in Kapoeta where he works: young girls being forced to marry old men, gender-based violence, malnutrition, cattle-raiding, looting and so on. In conclusion he says “I like working in the health facility a lot and finally I am so friendly to people irrespective of their tribes, race, locations, country.”
Rebecca Nyibol (Diploma in Registered Midwifery)
Rebecca was shot during her first job after graduation and ended up with a broken hand. Despite this she carries on serving her people by training Primary Health Care Centre staff and Traditional Birth Attendants with up to date midwifery practices. She also continues to deliver babies and care for pregnant women. In particular she remembers delivering twins and then successfully managing a postpartum haemorrhage (PPH), a serious condition in which the mother bleeds heavily after giving birth.
David Lado Chance (Diploma in Clinical Medicine and Public Health)
David works as a Clinical Officer in a Primary Healthcare Centres in Mundri West County, Western Equatoria State, about 180km from Juba. Intermittent fighting in the area makes moving about to remote villages hard.
“Soon after graduating I became in charge of a Primary Health Care Centre in a remote village where there was no medical doctor to consult. Each time I was confronted with a complicated case I referred back to the skills I gained from the Institute and clinical tools we were provided with such as books and tablets.
Just recently, a neonate (newborn baby) was brought not breathing properly and unconscious (asphyxia and comatose). The parents were already hopeless, crying for their beautiful and precious baby girl. In the midst of all this, I carefully reflected back to one of the lectures given by Dr Anil Cherian (paediatrician) and was able to follow the correct steps of neonatal resuscitation. The baby breathed again and the parents were happy.”
People often have to walk 5-10km to reach a health centre in Mundri and essential drugs are in short supply. Ongoing conflict means most people are forced into the internally displaced camps where there is a lack of food, poor sanitation and no proper shelter. With the ongoing crisis education has also suffered; some schools have been burned down and school children are left with little to do.
James Akol Manot (Diploma in Clinical Medicine and Public Health)
“I’m currently working in mobile clinics as a clinical officer (clinician) in Aweil, Northern Bahr el Ghazal, South Sudan.
The first time I made a big difference in a patient’s life was the time I did my internship in Juba. As I was on duty, a pregnant mother sneaked into a labour room before my assessment and that patient was received by midwife, examined and found to be in labour. I was called to assess the labour and to my surprise the patient was new to me. I found she had contracted pelvis (a condition in which the diameter of the pelvis is reduced and so making labour difficult). So I had to inform my doctor on call and immediately she was rushed into the theatre and operation was done successfully. If I had not found that out, the patient would have died.”
James says the main problems facing health care in South Sudan are a shortage of health workers and facilities, lack of pay for health workers, insecurity and flooding.
Kenedy Lucky (Diploma in Clinical Medicine and Public Health)
Kenedy is already working as deputy in charge of a Primary Health Care Centre in Juba. As with many of his fellow graduates, his role is extremely varied. Kenedy supervises staff, reports to the County and State Health Department, treats patients, performs minor surgery, gives antenatal and postnatal care and delivers babies.
One frustration for Kenedy has been working with traditional birth attendants who often use techniques that can cause harm to the pregnant woman. For example he says they inspect progress of labour without using gloves and so spread infection to the mother. But he has been able to teach some staff things he learned at the NIHS.
“I trained my midwives how to detect complications in labour and how to administer magnesium sulphate in pre-eclampsia and eclampsia.”
He tells of one night when a mother brought in her children after part of a building had collapsed on them whilst they were sleeping. One was 6 years old and not breathing. Kenedy examined the child and detected a faint heartbeat. He was able to revive the child through CPR and giving adrenaline and oxygen. He saved the child’s life and they are now 10 years old.
Francis Maluak (Diploma in Clinical Medicine and Public Health)
Francis carries out a range of responsibilities in his role as a health officer in Warrap State, Tonj North Country. There is still inter-communal conflict in this region, making it an insecure place to work, but Francis is committed to staying and helping the most vulnerable people. Two stand out moments:
“I managed to diagnose a child with nephrotic syndrome (a kidney disorder that causes your body to pass too much protein in your urine) and I managed to treat the child until the child recovered after a 3 month period. Another time I was on leave in my home village and I visited a friend in a Primary Health Care Centre. To my surprise, I got a mother who delivered 10 hours ago in the village brought in with retained placenta and bleeding badly. There was no health care provider in the facility. I managed to remove the placenta and the bleeding stopped after 10 minutes.”
Some of the challenges Francis has experienced include a resistance in the community to accept medical care rather than traditional techniques. He also talks of the problems of a lack of trained medical personnel, gender-based violence and early marriage.
Tereza Angelo (Diploma in Registered Midwifery)
Tereza has worked with two NGOs as the senior midwife as well as doing tutoring in obstetics and gynaecology and working as a matron to care for sick girls.
“I made a difference in a patient’s life when I diagnosed a patient with ectopic pregnancy. In the late moment when it was about to rupture, we referred her. Within 30 minutes, I got a call that she had been operated on, this saved her life. Another example, when I was working as a senior midwife, it was midnight when the junior staff conducted a delivery and the mother developed vaginal bleeding. They called me to help and I found her with cervical laceration. I managed it and controlled the bleeding.
The challenge that I can say is that most of the mothers that come to the antenatal clinic do not come for follow-up. They come when they feel sick and even sometimes when the condition is worsening. Most of the mothers prefer home delivery and if complications arise then they will come to the hospital. Sometimes there is a delay until complications arise and saving foetal life is then difficult.”
Racheal Achol Deng Angoh (Diploma in Registered Nursing)
Racheal is working hard carrying out a variety of tasks in a clinic in Juba.
“There are patients that have been appreciating my care, especially the one that I nursed his gunshot wound for one good month and he was so happy after the healing. There was a time a patient came in and he was diagnosed with malaria and he started demanding for IV medications but I convinced him that his condition required oral medication. In Juba, people are facing a problem of low standard medical facilities.”
Ghai Tuor Mabiei (Diploma in Registered Nursing)
Ghai has been working as a nurse in a paediatric ward of Marial Lou Hospital in the very insecure region of Tonj North, Warrap State.
“My time in Marial Lou Hospital has been a blessing from God to save some children from death and I will never ever forget what He has done to me through you to have the training (at the NIHS). Those children are breathing now because of that very training.”
Ghai was also able to train staff at the hospital in how to us an ‘Ambu bag’ to give oxygen to newborn babies safely.
He tells the following stories:
“This boy came with severe anaemia with his mother and the grandmother but the mother was breastfeeding a 2 months old child and the grandmother was too old to donate blood. I had donated my own blood to another child a day before. So I ran to the gynaecologist and he wholeheartedly accepted to donate his blood. It took me the whole night to resuscitate him and every staff in the hospital was surprised to find him alive when they came to duty. His father was sick and couldn’t make it to the hospital and other relatives were fearing to come to the hospital to donate blood because of being killed on the way by the community they would pass through.
Another baby presented with oral candidiasis and severely wasted (malnourished). The mother was married to an old man who later gave her to his elder son who already had his families and he couldn’t give care to the woman with her daughter. We managed her (the baby) until discharge.”
He talks of how glad he is that they have been able to teach communities the “importance of seeking medical attention in hospitals and abolishing traditional”. Sadly the hospital where Ghai has been working closed in July 2021 due to fighting.
“The hospital was looted on that day, all the mattresses, medical supplies, beds, other equipment for the hospital were all looted and some buildings broken down. So all the staff were evacuated to safer places.”
Ghai is now working in a different hospital in the State.
“I have to thank Anglican International Development for the support you have given to us, it has been so helpful to South Sudanese.”
Again and again the NIHS graduates speak of the huge lack of health workers across South Sudan, the lack of training and the shortage of medical resources. They also see the lack of health education in the community and the disastrous effects this can have, particularly for pregnant women and young children. We are continuing to support the Jonglei Health Sciences Institute which is training up more clinical officers and midwives for South Sudan. Find out more and support this project here.