Surviving the peace in southern Sudan

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 of years.

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 again.”

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