Sunday, May 31, 2009

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.

Saturday, May 30, 2009


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.

Friday, May 29, 2009

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!

Thursday, May 28, 2009


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.

Wednesday, May 27, 2009


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!

Monday, May 25, 2009

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.

Sunday, May 24, 2009

From Nairobi

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

Wednesday, May 20, 2009

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 much to do!

For the suitcase (items which CANNOT be forgotten, even though some of them will be, inevitably):
toilet paper (stolen from harvard, of course)
passport pictures
bug net
more bugspray
rainsuit (thanks mom!)
umbrella (you can stand under it)
mcat books
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.