Aweil, South Sudan: Life in "Paradise"

14 February 2017

I’ve been here in Aweil, South Sudan, for nearly two weeks. Somehow, it feels like much longer. Not in a bad way, just that the days start to blend into each other easily, especially when you work nearly every day and see the same people every day.

I already feel that I will enjoy this assignment, but I am trying to pace myself. I agreed to be here for nine months – that’s a long time. My first assignment in Afghanistan was six months, and my second, in Pakistan, was just a short one-month visit. But so far, so good, although everyone got sick this past week and I was not immune, so I’m at home nursing a very sore throat…figured I would take this opportunity to write my first blog.

Aweil often gets labelled “Aweil Paradise” among MSF-ers who have been here…and I am starting to see why

In South Sudan – arguably one of the most unstable countries in the world, with decades of unrest and poverty – most of the MSF projects are in areas where there is active conflict, so that we can provide emergency medical care to those directly affected by conflict, or to displaced persons. However, the situation in Aweil is quite different. It is relatively quiet here, compared to other parts of the country.

Three people walking in Aweil town

Out for a walk in Aweil town

For me, as it is my first time in South Sudan, I find I can easily forget what is occurring elsewhere. It is similar to the feeling I had in Afghanistan –I was in a suburb of Kabul that was quite safe and had lower risk than elsewhere in the city and country. You kind of start to feel safe and happy in this little bubble… but although the situation in your area (Kabul, Aweil, wherever it may be…) might be calm, elsewhere, it is not. And then you start to notice the ripple effects. 

For example, if there is fighting in Juba, where much of our supply is located, this can impact our supply chain, delaying our access to important medical and logistical items. Or even though the patients we see are not war-wounded, they are children who have lost parents in fighting, have never been able to go to school because of instability, and who lack access to food and – the big reason we are here – health care.

The project MSF has in Aweil is a big…actually, huge project

We operate the maternity and paediatric portion of Aweil State Hospital – it is the only centre for comprehensive paediatric care in the whole of the state.

Right now, it is the ‘low season’. This low season is referring to the off-season for malaria, which I have come to understand hits around July and can last as long as the rains last, sometimes until October/November. The 2016 peak was the biggest malaria peak ever seen at this project since it’s opening in 2008 – the team was extremely busy, the hospital packed – on it’s busiest day, they admitted around 130 children in one day – compared to a usual of around 20!

So, as I said before – right now it is low season. The hospital is still busy, but not over capacity. The staff seem to be a bit relaxed…but we are trying to remind the staff that although it is less busy, we cannot relax – we still have to do our best at our job and provide quality care for our patients. But, when you’re used to hundreds of children being admitted per day, and suddenly you have empty beds – I can see why they want to relax!

My job here for this mission is as a ‘clinical support nurse’. This hospital has national supervisors, so rather than me coming in as a supervisor, I am here to support the current supervisor, and focus on clinical activities and training for the nurses and nurse aides. Of course, being a supervisor in an MSF project (especially one as large as this) is a big job, and so if the national supervisor needs help, I’m here to assist. But I’m really trying to focus on clinical activities and adherence to the MSF protocols.

One thing I love about MSF is the protocols

Why? OK – Imagine if you worked in a very low-resource hospital. You may not have a complete education. Every 9 months or so, a foreigner from Canada, France, Japan, Australia (etc…) comes to help you and train you. Imagine if each new expat came and wanted to do exactly what they do in their home country. And then 9 months later its another thing. And so on… it would get so exhausting and frankly, annoying! Not to mention, unsustainable. The MSF protocols are made for low-resource settings, and are simple to follow. The point is that in the absence of a member of international staff, our national staff should be able to use the protocols and continue providing high-quality medical care.

Back to being a clinical support nurse (I’m really bad with these tangents eh?) – for now, I’m placed in the ICU & neonatal ward. I breathed a sigh of relief at this, since my professional experience lies in the care of neonatal intensive care.

I will spend a few months here, and then possibly switch to another part of the hospital – we also have a triage/ER, general inpatient ward, an ITFC (intensive therapeutic feeding centre), and a surgical/orthopaedic ward. But – like I said above – everything changes once the peak hits. Usually we have IPD (inpatient departments) 1 & 2, and during peak, we can have IPD 1, 2, 3, 4, 5, 6, & 7. So you just do what needs to be done!

Because it is a bit slower right now, we are trying to focus as much as possible on training – to get the staff ready for the peak, when we will likely have no time to train.

There are two other clinical support nurses; David (French) who has been here over 8 months and is leaving soon, and Edith, (Aussie) who just arrived yesterday…so is fresh like me! There is also Rebecka (Swedish), who is the deputy head nurse. David, Rebecka, and I have worked on a full-day training for all the nursing and nurse-aide staff.

We plan to train all of them (over 200) once a week for the next four months, on basic nursing skills – infection control and hand hygiene, drug calculations, vital signs, blood transfusion (a common treatment for severe anemia – a complication of malaria), and maintenance of biomedical equipment – and – the underlying theme of the day – TEAMWORK :-)

It is a lot of work to organize training this size, and David has definitely worked very hard on it. I hope that once he leaves, Edith and I can continue it as well as he has! Only time will tell!! 

Sign saying Aweil Paradise