ON that warm January
morning the 500-bed Juba teaching hospital, known to everyone
as JTH, seemed even busier than usual. An isolation ward had
been set up to receive an influx of suspected cholera cases.
The medical and paediatric wards were overcrowded, and in
the emergency room, the staff were dealing with the victims
of a car crash — the first of several that day.
Seeing exhausted patients lying on iron-frame beds in wards
that badly needed painting, watching the dust clouds rise
from the cleaners’ brooms as they swept the corridors,
and absorbing the myriad smells of humanity was to glimpse
the ruin that conflict can bring to an already impoverished
society long after the fighting is over.
Inpatients on the surgical wards included men with gunshot
wounds and another injured with a spear. A woman named Larisa,
whose leg had been amputated, lay in bed spraying cheap perfume
over the bandaged stump, a tiny string of coloured beads around
her neck. Next to her were a woman and her baby, both of them
wounded during an inter-tribal clash in their village.
The paediatric ward was overflowing. Mothers lay squashed
together on the scuffed beds cradling sick children; others
sat on blankets on the floor, so closely packed it was difficult
to walk around without stepping on prostrate babies. Amid
the chaos children with malaria and diarrhoea lay motionless
on grey army blankets or faded cotton sheets, attached to
drips. The sound of crying rose above the babble of voices.
A single nurse — a first-year medical student called
Patrick — was on duty.
The ICRC has supported JTH for the past 14 years. Scores
of surgeons, anaesthetists, doctors, nurses and administrators
have worked there during that time, assisting the nearly 1,000
Sudanese staff, teaching in the nursing school and providing
administrative guidance. The ICRC still supplies all the medicines
and medical supplies for the hospital, as well as reagents
for the laboratory and non-medical items such as dressing
material, surgical gloves, sheets and nurses’ uniforms.
But now, two years on from the end of the war, the ICRC has
started to scale down its support and will withdraw from JTH
in December 2007, leaving the southern government’s
Ministry of Health in charge.
It is a prospect the hospital’s director, Samuel Salyi,
finds daunting. “Rome wasn’t built in a day,”
he remarks. “People are coming out of war and it takes
time to change; they are still traumatized.”
The World Bank, through its Multi-Donor Trust Fund, is now
pouring millions of US dollars into the rehabilitation and
refurbishment of the hospital. Nevertheless, it is human resources,
rather than the infrastructure which concerns Salyi most.
“Doctors in the diaspora are still hesitant about coming
home,” he says, disappointment ringing in his voice.
He, himself, stayed in Juba throughout the war.
The hospital’s only radiographer was another one who
stayed. When fighting broke out in 1983, he took his family
to Uganda and then went back to his post at the hospital for
the war’s duration. “Today,” he says, “the
needs are growing. There are more vehicles on the streets
and therefore more accidents. Also, the population is bigger;
we are doing 30 x-rays a day.”
He also fears that the old hands such as himself are dying
off and are not being replaced by younger staff. “I
have spoken to the government,” he remarks, “and
asked them to send new people, we old ones are fading away.”
In addition, many of the staff bear emotional scars from
the conflict and seem touched by a deep malaise. “Some
of our nurses lost husbands during the war and are bringing
their children up alone,” explains Sister Christine
Akongo, a nun who has worked at the hospital for a number
Absenteeism is also rife as staff take time off to supplement
their wages with second jobs, or to grow food to feed their
families. “The war damaged people’s souls,”
says ICRC project manager Louise Vuillermin, one of 15 expatriates
currently working in JTH.
The hospital is run by the government with the ICRC playing
a supporting role. The team can do little but encourage their
Sudanese counterparts to take their work seriously. “How
do you motivate someone who has lost hope?” questions
Claire Gripton, a surgical nurse.
In an environment where a culture of dedicated patient care
is lacking, every small change for the better is a triumph.
To see a 9-year-old girl with tuberculosis sit up and take
an interest in her surroundings after a long period of lethargy,
for example, is a day well spent. To know that the infant
mortality rate on the paediatric ward has dropped from 7 to
5 per cent brings a sigh of relief. To watch the delight on
the patients’ faces as they watch an impromptu showing
of The Lion King is a moment to savour.
Twenty-one-year-old Patrick, the student from the paediatric
ward, confides that he set his heart on a medical career while
working on HIV/AIDS campaigns whilst in exile in Uganda. In2005,
he came back to rejoin a father he had not seen for over 15
years, and enrolled in the JTH nursing school soon afterwards.
“It was my own decision to return,” he says. “In
my heart I want to help people.”
Over by the emergency wing a crowd of people wait. It is
now late afternoon and the place is as busy as it was that
morning. An old woman lies dying in the shade of a veranda,
her head cradled in her son’s lap. The victims of yet
another car crash are waiting to be admitted; under a nearby
tree patients’ relatives are stirring cooking pots over
open fires, and setting up camp for the night. Seeing these
intimate scenes as the day turns to dusk brings the beautiful
words of William Penn to mind: “I expect to pass through
life but once; any good therefore that I can do, or any kindness
that I can show to any fellow human being, let me do it now.
Let me not defer or neglect it for I will not pass this way
It seemed a fitting tribute to the many men and women, ICRC
delegates and Sudanese, who have given so much of themselves
to help the victims of Sudan’s long civil war, and are
now helping them survive the peace.
Perhaps the last word in this story should come from a Norwegian
nurse, Turid Andreassen, who says, when speaking of her work
at JTH, “Doing this job, you use not only all your nursing
skills, but everything you have as a human being as well.”
Juba’s teaching hospital.
©BORIS HEGER / ICRC
An ICRC surgeon performs knee surgery.
©BORIS HEGER / ICRC
Preparing for the future
• The government of southern Sudan’s Ministry
of Health is in charge of JTH
and intends to hire a firm to manage the hospital over
the long term.
• JTH’s finances have been secured through
the allocation of US$ 220 million of government funding
for the health sector over the next three years.
• The recruitment of specialists for the main
departments — medical, paediatrics and gynaecology
— is now complete with the appointment of Sudanese
• Conditions are now set for the ICRC’s
withdrawal at the end of 2007.