Off the Beaten Track: Inside South Sudan

Dr. Lanice Jones is a Canadian family physician, world traveler, and adventurer in every sense of the word. She recently spent two months as a medical volunteer in South Sudan, and on the eve of that country’s historic vote, she shares her experience with us.
 

While I have had the privilege of working and studying medicine on several continents, my last two months volunteering in South Sudan have been a life-changing experience. South Sudan is the poorest country with the highest maternal and pediatric mortality that I’ve worked in. It is isolated by lack of roads and infrastructure, lack of supplies, and lack of skilled staff. Yet the culture is vibrant, passionate, and filled with hope that the vote on January 9th will result in independence and a better future.

South and North Sudan suffered a 17-year civil war that ended five years ago with the signing of the Comprehensive Peace Agreement. The civil war was complex, as North and South Sudan have different ethnic groups, different religions, different languages, and in the middle of the conflict, oil fields that span the border. With the signing of the CPA, South Sudan was supposed to have more autonomy, better resource allocation and a greater political voice, but most South Sudanese would state that their hopes with the CPA have not been realized.

At the heart of the separation conflict lie the border communities that contain the oil reserves. The oil from South Sudan is sent by pipeline to refineries on the coast of North Sudan, and from there, the bulk of the oil is shipped to China. China has been trading oil from South Sudan for weapons for North Sudan for over a decade. The president of North Sudan, Omar Hassan Al-Bashir, has been indicted for war crimes against Darfur. He has a long history of military aggression. Meanwhile, South Sudan has military support and training from America, although this is a more covert operation. 

Lanice assisting Dr. Benjamin with a
gunshot wound to the foot

The doctors I was working with are some of the Lost Boys and Girls who fled South Sudan during the war, seeking refugee status. Cuba had accepted many of these child refugees, educating them in preparation for returning to help rebuild South Sudan. Unfortunately, when their education was completed, Sudan was still at war and these young adults came to Canada and America. In Canada, they worked in menial jobs as our government doesn’t recognize their medical education as being valid.

When North and South Sudan signed the CPA in 2006, a group of Cuban-educated physicians approached the University of Calgary, asking for help to return back to South Sudan. My university created an education program in Canada and Nairobi to upgrade their medical knowledge and skills, and I’d been one of their teachers. Now it was my turn to be the student.

I spent two months in South Sudan working alongside my colleagues in three different hospitals, and I was part of a one-week educational camp with specialists from Sudan and Canada focusing on obstetrics, pediatrics, and anaesthesia.

Patients and family members with

their makeshift tent at the

Marial Lou hospital compound

On a daily basis, I was humbled by the skills of my colleagues, as they ran hospitals with minimal laboratory support, no x-ray facilities, limited supplies, and minimal staff. Yet they saved lives each and every day. One day in particular, a 13-day old baby arrived with a fever of 102 degrees, comatose with infection from a difficult birth in a mud hut. In an American hospital, that infant would have been in intensive Care, with round-the-clock, expert nursing staff, an infectious disease and neonataology specialist, and continuous oxygen and monitoring. We had no nursing staff, and I and my colleague Dr. Ajak took turns every six hours to check on the infant and administer intravenous antibiotics. This may not sound so difficult, but imagine getting up in the dark, with no electricity, pulling on gum-boots to avoid snakes and scorpions, creeping by flashlight along a flooded pathway to the hospital, beating off swarms of malaria-infested mosquitoes to attend to the infant curled up under a mosquito net with his mother, and no one speaking English! Within three days, the little one was alert and nursing well and was discharged a week later with no obvious ill effects.

Another afternoon, I was called to see a woman in labour, and was told that a doctor who was not part of our education program had indicated that she had a huge abdomen from extra fluid in the uterus. As it was her sixth delivery, which is another risk for bleeding, I was teaching the community health worker how to prevent bleeding after delivery. We turned our backs to get the medication ready, and out shot a tiny baby, clearly not at term. I grabbed the infant and rushed to a rickety table with a dirty ventilation bag, mask, and re-usable suction bottle. The infant was blue, not breathing, and had a very low pulse. I ran through a resuscitation protocol while the “nurses” watched in amazement. Most didn’t know anything about resuscitating sick newborns. I peeked back at the woman on the broken old delivery table, and her abdomen was still huge – clearly not just from extra fluid!

I rushed back, put on a clean glove, and examined her, confirming that she had a second twin waiting its turn to be born. I requested that they call in the other doctor, as I was still attending the first sick infant. He returned, re-examined the woman, announced that she had a twin, that the mother was not contracting, and walked out of the room! There I was, having never delivered twins before, with one unskilled community health worker, one sick twin, a second one on the way, and the other doctor simply walked out. In our hospital, any twin delivery would be attended by a team of doctors and nurses for each twin and the mother.

Once I had the first twin stabilized, wrapped in a skimpy rag and passed off to a family member to hold, I prepared to deliver the second twin. This little one came out pink and screaming, a blessing, but by the time I’d delivered the placenta and ensured that the woman was stable and not hemorrhaging, the second twin was grunting and in distress. I had to bludgeon my way into the operating theater to “borrow” an oxygen concentrator, and I insisted that they keep running the generator to keep the concentrator on until the little twin’s breathing returned to normal. Having just got the second twin sorted out, with both getting a mixture of sugar water for feeding as there was no formula in the hospital, I was called back to see the mother, who was now comatose, feverish, and seizing from presumable malaria, which had likely triggered the labor!

A month later when I returned to this community, I managed to track down this mother and her twins, and visited them in their tukel, or thatched mud hut. Both babies were alive, and while still scrawny, they were nursing, taking extra formula, and gaining weight.

While the world watches, South Sudan will vote this Sunday, January 9. My sense is that the majority will vote for separation. With oil revenues at stake, while President Al-Bashir states he will abide by the vote, I fear that conflict will erupt. My colleagues will continue to provide the best care possible under horrendous conditions, but I fear for them and their communities. And I hope to return to help.