Mission in south Sudan

Going to south Sudan is never easy, it’s even worse when you only get 2 days’ notice. I needed to stay in Nairobi, Kenya waiting for a special travel permit for South Sudan for 4 days before departing to Juba, where I stayed 2 more nights. My final flight to Aweil, our project site, was on an MSF plane which was sent there before the referendum in preparation for the possible conflict in the region. The project in Aweil is basically a maternal & child health care project. We provide antenatal care, delivery care, neonatal care, vaccination, paediatric care and feeding centre for malnourished children. The town itself has a population of 70,000 and the surrounding area of 400,000. In normal situation, we need gynecologist and pediatrician and ER doctors for the project, but with the worry of increasing conflict, surgeons with obstetric skills is called for the potential increase in surgical care especially injuries. The town is very primitive with only one paved road just finished, so travelling around is not that easy. Walking from the living compound to the hospital takes less than 10 minutes, which is more or less the same for you to take an MSF car. Basic needs to the population like clear water supply and sanitation are not that satisfactory, not to mention public electricity…...It’s hot and dry in the afternoon, but a bit cool in the early morning, dusty and sandy all around. My first impression in the health situation of the place is a bit sad. There are many children suffering from tetanus and even rabies in our wards and one just died yesterday, to the worst those that are under respiratory support they are under constant threat of electricity broke down, where by we need to in constant alert for manual resuscitation. There are many accidental injuries like burn, not just by hot water but direct fire, sharp injuries to eyes are also common. There is a child which I am worrying that I may need to take his eye out, if the infection is not controlled in the coming few days. Life for pregnant ladies are not better, stillbirths are common and even after successful delivery, many children died early. My first caesarian section here was for a lady with 2 previous caesarian sections yet no live child, what a sad situation. The baby girl is now doing fine and I hope all will be well for her in her wonderful future. Last evening, another pregnant lady giving birth to a stillbirth had lacerated her vagina badly, all the way to the rectum. It is unthinkable in the developed world, but it is actually not that uncommon in places like Aweil. If she is not properly treated, she will end up having a fistula from the rectum into the vagina which will become a curse for the lady. At the moment, we don’t have surgical program in the area, so we are planning to assess the need and the capacity of local doctors with surgical skill to handle the problem. We are planning to visit the existing centers that are providing surgical care and see if we can provide support and training to the staff. We would want to provide better care for the population.