Mama Obama!

This past week, our team ended up in Western Kenya for a final stint to round up our time in East Africa. Our work followed a similar pattern to that in Sudan, but we had one additional bonus!

Our dear President Obama, who has brought us fame and love from this end of the world, hails from a village not far from where we were working. Thus we had the opportunity to meet and visit Grandma Obama.

In reflection of the complaints I've been receiving...

...that I did not include enough detail about our actual work in Sudan. I am out of the country now, so this is a retrospective glance at our work there.

(in spite of my extensive descriptions on our living and fun times, we actually did work also...)

We have spent time at the three teaching hospitals in Southern Sudan. This usually included getting acquainted with the staff, hospital layout, services rendered, and problem areas. Our doctors' expertise is in pediatric health, so the morning involved rounding with the staff, and the afternoon included some type of teaching- most importantly a two day seminar in neonatal health and resuscitation. For my non-medical people (or those who can't use google), this translates roughly into "saving babies directly after they are born if they can't breath or have a low heart rate") Close to a fourth of all deaths in children under the age of five are caused by neonatal asphyxia (inability to breath), so our training modulus helps train staff on how to help prevent those deaths. It's a fairly straightforward workshop (I've even taught it a few times), and it's really cool to see the impact that it can have.

The picture shows a medical officer (the equivalent to a Resident in the US), and a nurse-midwife practicing neonatal resuscitation.

Additionally we had lectures in a wide range of topics (including HIV/AIDS, acute respiratory illnesses, diahhreal illness, etc etc) and staff at each hospital chose which they wanted to hear.

Feel free to post a comment below or email me with any specific questions about our work, but that's the cliffs notes version!

Yet another reason to hate Pinocchio.

Outside of the really fulfilling work in the hospital, life in Malakal is a bit difficult. I’ve lived in some tough circumstances before, so I am not a stranger to roughing it, but this is at a whole new level. We are only at the very start of the rainy season, but every morning we wake up to a city melted into a soupy mess. You literally cannot move anywhere without wading in mud up to your shins. The streets, sidewalks, lawns, everything, turns into a thick quagmire that takes hours to wade through and even longer to extricate from your footwear and clothes.

So it’s muddy, no big deal, right? The mud is annoying but tolerable. It’s the crickets I can’t handle. One day we came back from work and saw some crickets hanging outside our door. There was one in my shower. I didn’t want to kill him so I helped him out and got him to higher ground. Cute little fellow.

The next day, I went into my room and found it covered with crickets. Big crickets. The size of my pointer finger. They are thick and gnarly and their legs fly everywhere when you squash them. After a short killing spree, my room looked like a bomb went off. I crawled under my mosquito net, slightly satisfied with my work, and fell asleep.

2am. Something landed on my head. It actually made it through my net (false sense of safety). I freaked out, and threw on the lights, only to find the place (once again) covered in crickets. You have to be kidding me. Went through another killing spree.

The next day I asked my colleagues about their cricket relations, and while they had sighted a few in their room, they certainly weren’t dealing with the full frontal attack, and definitely not the air raids. Highly suspicious. They came to check out my living arrangements and we determined that the crickets were coming from the gaping hole in my ceiling, which unfortunately is aligned directly above my bed. Awesome. My colleague thought it would be a good idea to poke his head up there. He screamed and bounced off the bed. I have never seen a grown man freak out like that before! There was a whole nest of crickets, living right there in my roof. How tender.

He threw the mosquito net over his head and, like any stubborn man, tried to close off my ceiling for the better part of the hour. I did what most women would, and went to ask for a new room.

Malakal Midwives.

Malakal is a city in the north of Southern Sudan, and lies on a point of intersection between the country’s three main ethnic group territories. It is also located right on the Nile, making it an easy destination for the transport of goods. Oh also, it has oil. Quite a dangerous combination of factors.

We arrived here last Sunday, and have been working hard on trainings in the hospital. The hospital administration and local NGOs have been so helpful in finding us trainees. We had over thirty-five midwives attend our afternoon sessions, every day of the week. Some came in from other regions and far off rural areas just to attend. I was able to teach two lessons this week- a review of neonatal resuscitation, and a lesson on pediatric diarrheal illness (appropriate, given my current gastrointestinal distress resulting from my overambitious decision to eat the local salad).

Our morning sessions were for medical officers (equivalent to Residents) and head nurses. Most of the medical officers are from the North, and have contractual agreements with the Government of Southern Sudan. This is great because there is a serious lack of physicians in the country, but bad, because the government has neglected to pay them for the past nine months or so. Most are planning to leave.

Farewell Wau

We finished up our trainings at Wau teaching hospital and are back in Juba. We leave for Malakal tomorrow. I was so sad to leave Wau, and absolutely loved the hospital staff there! Pictured here are (1) the hospital director, pediatric chief, and medical students we worked with, (2) hospital incubator, now up and running!, (3) me driving the ambulance :) and (4) the fake baby's fan club strikes again!

Just a little surprise :)

Coming back to our tent after breakfast this morning, we saw that there were people inside of it! We quickly zipped open the door all the way, and once inside, found two of the hotel staff had pulled out our fake training baby, laid it on the bed, and were giving it kisses!

Pictures from Wau

I think this is a Sudanese water purifying system- but that could be wrong. (left)

Hospital building in Wau (right)




Two of our team members in a Southern Sudanese rickshaw!


























Group of midwives training in neonatal resuscitation. Note the fake training baby: whenever we carry it around it's in a plastic bag, and everyone on the street freaks out because they think its real; they run over to pick it up and see why the heck we are suffocating the baby. When they realize it's fake, it's hilarious (right).

Two of the doctors from our team helped resuscitate a baby after an emergency c-section following our training (hands on learning!) The baby wasn't breathing and had no heart beat for ten minutes after she was born, but with a lot of work, she is now alive! Her mother had given birth to three children before her, all of whom died almost immediately (Left).

Wow Wau!

Crazy few days...here is the update:

1:00am, Juba: I fell asleep reading, and awoke to the smell of smoke.  I unplugged my phone and felt the wall for heat.  nothing.

1:15am: smell of smoke gets worse.

1:20am: explosion!  my light burst, reigning down sparks in the darkness.  I fled down the hall to my colleague's room.  There is no superintendent, no fire department, no authority around here.  And it's the middle of the night.  Shoot.

1:25am: still knocking on the door trying to wake him up.  Fail.  Periodically checking for flames.

1:30am: He wakes up.  We go back to the smoke filled room to investigate.  He dissects the light.  I am terrified.  Smoke seeps out into the hallways.  I picture the UN officials ablaze in their rooms.  

1:45am: Colleague says its a short circuit, and I should go back to sleep.  Ha!  I stay up to wait for signs of the fire spreading.

2:30am: still waiting for signs of fire.

3:30am: still waiting.  Calming down.

4:00am: sleep.  

9:30am: call from our other colleague, indicating that the only flight out we can take (going to Wau) leaves at 11am.  We do not have tickets yet.  Can't miss this flight.

9:45am: frantically packing.

10:00am: last minute driver finds us.

10:15am: roll into airport.  Wrestle my way to the ticket counter.  I hate being pushy.  Must be pushy.

11:10: attack of illness. Must use airport bathroom.  Gahhhhh.  Airport bathroom is hole in ground.  Realize too late there is no toilet paper.

11:20am: board plane.  African time.

1pm: arrive in Wau.  I love it here.  It's sort of like an old Hispanic town in the Caribbean- everything is made of red earthy clay consistent with the ground and surroundings.  There is a slow pace of life- people and small rickshaws flood the streets to reach their final destinations.  There are beautiful low lying trees with red buds, interspersed with clay huts covered by thatched roofs.  There is an actual town center (unlike Juba), and a light breeze to counteract this oppressive heat.

To make everything even better, the hospital administration is absolutely wonderful. We met the dentist on the plane ride over, and he got us through the airport logistics and to the hospital, where a meeting convened so we could discuss plans.  The staff was so receptive to the idea of trainings and were so excited with the equipment (especially the oxygen concentrator that we lugged all the way from Boston!) So worth the trek.  I would love to stay here longer than a short week!

Pictures soon!

Paradise Found!

We made friends with one of the NGOs in the area and they showed us to the Bedouin Bar, which is a romantic little oasis in the middle of Juba. One could say it feels a bit unethical to enjoy such a place, if the neighboring conditions are taken into consideration. But it was really nice to find such a peaceful getaway.

Training!

We worked with two student clinical officers (physicians assistants) today, teaching the cardiovascular system. They know so much about anatomy, but haven't had an opportunity to get their hands on equipment, and consequently have not learned how to take pulses, or listen to the heart and lungs with stethoscopes. It's amazing what a difference access to resources can make in terms of the care provided! The picture above shows one of the doctors on our team working with one of the students.

blue skies, cloudy internet...

The hospital has a resource center with computers and internet that we are allowed to use, but the server is down (all the time), and the admins like to blame it on the cloud cover :) (note: cloud cover has nothing to do with internet availability. In addition, it's bright and sunshiny out).

We went on more rounds today. A few of the children were better from yesterday and were sent home. The hardest thing to deal with, however, are the cases in which we can do very little. For example, there was a baby with cerebral palsy, who could barely support his head. There are so few resources here that conditions like his are left with very little opportunity for intervention. In the US he would have access to different forms of therapy. Here, his only ally is his mother, who will struggle to keep him alive and breathing for the rest of his short life. She was crying in the bed, although he remained silent.

Sometimes the pediatric ward is so overbearing that I have to go outside for real air and sunlight. I am in awe of the staff here. I don't know how they cope with these conditions- the thick air which wreaks of human waste, children crying, children too sick to cry, a general sense of despair- no amount of reading or preparation could have equipped me to deal with this. It is my hope and my fear that I will grow so used to it that it no longer phases me.

We had our first training session with some of the staff today; it went really well and we are excited to continue with the series.

Pictures coming soon, I promise!

Rounds

Today was our first day of clinical rounds. We shadowed the head pediatrician through the emergency pediatric ward.

Childhood illness here is at a level of intensity I never could have imagined. Almost every child we saw was malnourished, indicated by a large head and eyes but a tiny frail body, reddish colored hair, and lack of responsiveness. Malnutrition has a tendency to complicate all other health needs; we saw everything from typhoid fever, pneumonia, TB, malaria, and so on. One child had consumed a large amount of kerosene, which has complicated the diagnosis of his chronic breathing problem (already difficult to assess). Another girl had a protruding belly, caused by a swollen spleen (most likely malaria).

Walking through the ward is so overwhelming. There are 2-3 mothers with their babies on every bed. Some are crying, some just sit and wait for the doctor to arrive. I am learning how to analyze a child first with my eyes and individual scrutiny. In this health center, there are very few diagnostic tools other than skill and intuition. Some children bring in chest xrays, but other than that, we depend on what mothers tell us, family history, visible signs from the child, and expressed pain.

The head pediatrician is one of the most incredible doctors I have ever met. He works entirely from his intuition. There is much that western medicine can learn from this system, although the intensity of disease and number of patients is something we are not used to (nor would we be equipped to deal with it). There is no time to wait for lab results- the child must be treated right away or risk death. We are not allowed much of a margin of error.

On a brighter note: we found the NGO grocery store yesterday and splurged on frosted flakes.

Juba!

Some basic background to update people on our project here in Sudan: there is a team of doctors from MGH who have formed a partnership with the Government of Southern Sudan to help bolster training in newborn and maternal healthcare. We are here to do trainings, and I am working mostly on assessments of the hospitals and training curriculum.

Brief background on Southern Sudan & the war: Sudan has been at war for some 20 years. It reached a relatively stable peace in 2004, but much of the infrastructure and systems have been destroyed (or never had a chance to be built). This is a vast oversimplification, but the war pitted the north against the south, in a fued for oil, land, and religious rights (a Muslim regime in the North vs. a Christian/Animist South). Today, Southern Sudan is fighting for autonomy from the North, and the right to profit from its own vast oil reserves, which the North has saught to own and exploit. Southern Sudan has the highest rates of maternal and infant morality in the world.

I am writing from Juba Teaching Hospital's resource center. We got in yesterday afternoon, and have been meeting with different administrators and touring the town and hospital facilities. One of the Ministers of Health (there are 6 total) picked us up from the airport. He is warm and jolly, and wears orange crocks with a matching Africana shirt.

Juba is much smaller than I thought it would be- I definitely would not refer to it as a city, although it's possible that the population is dispersed and I have been deceived.

The hospital itself is very big- more than 10 buildings altogether. Initially it's pretty overwhelming. The pediatrics ward has so many beautiful children, who are able at the same time to inspire, and bring a great sadness with this pervasive inevitability of disease. There are mothers and babies all over the hospital grounds. Many are outside washing the clothes and bedding. The waiting line for the ER is more like an extended crowd pushing towards the end of a long, winding hallway. A western government recently donated five incubators, which remain unused and sit in the maternity ward taking up space. One of our tasks is going to be to train people in their use. I am fascinated by how western technology is given and received in such settings. Equipment without proper training is a burden rather than a relief effort.

We are staying at UNFPA housing, which is enclosed in a giant UN compound. It is filled with overland vehicles and office buildings adapted from shipping containers. My room has AC but no lights. Not a bad trade off!

Pictures are coming soon, but internet is really slow so maybe not with this posting. I'm also trying to be sensitive to taking photos in the hospital and don't feel comfortable with it at this point.

Tomorrow we will start rounds and trainings. I will write more as I am able!

red tape cutting

Southern Sudan isn't exactly a country yet, so getting there can be kind of tricky. We spent almost all of today in and out of the Southern Sudanese consulate in Nairobi, trying to get travel permits. We finally succeeded, but weren't able to get flights to Juba until tomorrow.

Now for the good news: with all of our extra time we were able to go to a nature reserve and see baby elephants and rhinos. They have been orphaned for various reasons (poaching, natural disaster, etc), rescued, and raised on the reserve to be released to the wild when they are ready.

From Nairobi

I have running water, electricity, a swimming pool and wifi = luckiest girl on earth.
yesssssssss

T-3 days and counting...

and I still need to pack up my room, finish with finals, and spend copious amounts of time with the people I love.

so excited.....so much to do!

For the suitcase (items which CANNOT be forgotten, even though some of them will be, inevitably):
bugspray
toothpaste
purell
toilet paper (stolen from harvard, of course)
passport pictures
bug net
more bugspray
rainboots
rainsuit (thanks mom!)
umbrella (you can stand under it)
mcat books
soap
deodorant (very hard to find in certain places on earth, do not forget)
flashlight, reading light
candy bars (thanks mz janani!)
i think that's all. i'm sure i'll add more later.