Once again into the Jubble!

So it has been several months since my last post when I was saddened by the beginning of the horrific conflicts occurring in South Sudan and by the feeling of disloyalty at having to be evacuated, leaving behind such an amazing country and so many wonderful people.

Since leaving I have been privileged to spend some quality time with my family and catch up with some fabulous friends, however the time has now come for me to return to the humanitarian effort in South Sudan.

Sitting again at Heathrow terminal 4, I am wondering what the country will have I store for me this time. I know that the experience will be quite different, not only because of the persistence of the conflict and escalating health crises, however this time I am in a completely new role and location.

I am taking up a position to assist in the coordination and communication between health partners involved in the delivery of health services across South Sudan. The role will be attached to the Republic of South Sudan Ministry of Health (RSSMoH) strengthening links between the Government, UN agencies, WHO and Non-Governmental Organisations (NGOs). It is an incredibly exciting new opportunity and the scope of the work that can be achieved is unquantifiable. 

I will be based in Juba mainly, however there are the opportunities to meet with the health programmes across the country to allow me to gain a better understanding of their position and to fairly represent them.  Being based in the "Jubble" will be a big change from Yei and whilst I am sad not to be returning to the work at the hospital and the wonders that was Yei, I am excited for the  new challenges that living in a city and working with the MoH will bring. 

This time I am nervous for different reasons, not the country, language, culture, I know I already have a group of wonderful friends meeting me for dinner tomorrow night; this time it is the expectation of the role ahead and the desire to do well for the benefit of the people of South Sudan.

So again I say so long, farewell and watch this space......

South sudan in crisis

So where to begin, firstly apologies for not blogging sooner however as many of you may have seen on the news the situation in south sudan is rather tense.

This will just be a very quick blog to let you all know i am safe and once I have time I will write up as much as I can about my time since the last blog.

As you may have seen on the news the political/tribal situation in south sudan  is extremely fragile. Sadly on sunday last week extensive fighting began, tanks were seen rolling through the capital, heavy gun and artillery fire was experienced across the country. Shelling shook houses so hard there were reports of damage to the structural integrity and devastatingly hundreds of nationals and non nationals have been killed, some reportly in extremely brutal fashion. Hospitals are overwhelmed and mass graves are planned.

At the beginning of the week US pulled out its embassy staff and subsequently other nations have followed,  evacuations occured via juba however where I live in yei, we can only access juba by at least 4 hour dirt road, which we were told we could not travel on due to the security risk of passing so many army barracks, so we had to make alternative plans.

However in the meantime sadly an expat friend, Cecilia, fractured her ankle and required medical evaluation and evacuation, with the amazing help from colleagues at yei civil hospital, other expat medics and the friendship and kindness of UN personnel we managed to get her xray'd and ankle immobilised, however getting out of south sudan was going to be hard. There was seat arranged for me on a charter aircraft out of yei at the end of the week however they could not take a patient, so I surrendered my seat to another expat who did not have any other means of getting out and I waited with Cecilia.

Many many emails and calls ( thank goodness for smart phones and our sense to stock pile phone credit when crisis started) later and we left on a flight out of yei to uganda on saturday. It was a terribly emotional time, I am still in a haze of disbelief and disgust that I have left behind my wonderful friends and colleagues in the place that will always, in my heart be, home, Yei.

To all of those who are left behind, south sudanese nationals and expat UN personnel,  I am thinking of you all and I hope for peace and that I can return as soon as possible.  My short time in south sudan has been some of the happiest and most rewarding times I have had in many years and I am empty at the thought I can not return.

I am planning on riding out some time in east africa hoping I can return to south sudan soon.

This is all for now, I will write more soon.....

Frogs, pox and resourcefulness

Well its been another fly by month and r&r plans are well underway, hopefully, if I can get a flight out, I will have a date with a cocktail on the beach for Christmas and New Years.

So whats been happening in Yei you may ask, well firstly we have a new mayor and Yei river county is no more, we are now a municipality, so celebrations in town, what it actually means.... well no one actually seems to know, however an excuse to celebrate life is always a good thing.

The hospital remains as busy as ever and I have been spending time in paediatrics and outpatients. Courtesy of the little munchkins I developed chickenpox (even though vaccinated), thankfully I felt absolutely fine, just scratchy and quarantined for some time which meant I caught up on domestic goddess training, perfecting my homemade pita bread recipe and extending my dress making repertoire (pictures included). Spending time with the children here is amazing, they are so resourceful. Watching them make toys out of anything, my favourite being a strip of Winnie the pooh bed sheet tied to a stick and an empty calpol box, dragged around like a toy car. To many of the children I am “Aunty Holly/Kawadja Aunty” however gaining trust is a big thing particularly when a mum from the mountains came down to the hospital and she was “fearing” the kawadja so much that she wouldnt look at me for fear I would curse her and her children screamed whenever I was in eye sight. Getting the staff and most importantly the other patients to explain that they are not scared of me, I can not curse them and that my appearance may be different however I am a good person and the same as them, was so important.

In the outpatient morning clinic, the clinical officer and I saw anything upto 60 patients presenting with peptic ulcer disease, malaria, early pregnancy, severe malnutrition, polio, physical assault, brucellosis, hernias, sleeping sickness, worms, fractures, STI’s, HIV, Pelvic Inflammatory Disease and a plethora of other conditions some more fascinating, from a professional context, than others. I have seen my first case of nodding disease, an often fatal disease affecting under 15s, presenting like a form of epilepsy often in response to eating a meal. It is unique in that it is only found in my region of South Sudan, Northern Uganda and Tanzania, the cause and method of transmission is unknown, fascinating. WHO and UNICEF have been investigating this emerging disease, so watch this space.

The students are in the exam period, and for the first time they have had clinical exams on the wards. It brought back memories from my time as a student that I thought I had long forgotten. I have found myself using a technique I witnessed and asking “so is there anything else you would like to do before we complete the assessment????” loaded question however so many of them I have seen are competent day to day and the exam nerves just get the better of them that they forget a basic part of a procedure or process. Whilst the students in the revision and exam period I can spend more time with the clinical staff and I am really enjoying seeing them responding positively to my presence and feedback, even asking questions about procedures and conditions that they would like more knowledge on. I have also been learning so much from the staff and have found that with a little encouragement and positive reassurance that they come up with some ingenious ways to adapt to the limited resources. This experience is definitely a two way learning process, which seems to get more rewarding by the day.

Domestic life, whilst often being surreal, it becoming unusually normal to me. My walk to the outdoor shower often involves dodging slow moving lizards and frogs only to find that the shower is not working. So instead of having to descale the shower head to get it working, we had to remove the rotting frogs that had snuck into the water tank, died and subsequently were blocking the pipes. Trips to the loo are no less exciting, stepping over the wiggling tail of a lizard, when there is no body of a lizard in sight, creepy! Lack of toiletries has brought out the creative in me, using over ripe avocado to condition my hair is a particular favourite. I am loving having a pet again, especially as I never know what present moogli, the compound guard dog, will have left for me at my door, 2 dead frogs the other day – well at least that 2 less to step on or block the shower head.

I am very quickly realizing that I am normalising all these things and having to document them as I experience them, as I think when the important things like enjoying a joke with friends and colleagues, hearing a giggling child playing and seeing people genuinely caring for others, it makes all the unusual things experienced day to day fade into insignificance. 

So until next time....

The kawadja nurse who chases goats!

So how times flies when you are having fun and busy, I cant believe it has been a month since my last blog, so apologies that this is longer than previous posts!!

Well this weekend I finally settled in my permanent accommodation, my very own little one room house on a NGO compound. I am enjoying the domesticated bliss of arranging to get furniture made and fixing what little I have been given, buying material to make my own curtains and bed linen. However in the meantime I am amusing myself with the limited choice of bed linen at my disposal, at the moment I am a  professional woman in her 30’s sleeping in spongebob square pants sheets with a winnie the pooh and piglet pillow, and quite frankly loving the novelty of it. 

My place is nothing flash, just a 2 ring portable gas stove, 2 cupboards, 2 lights, glass in 4 out of the 7 windows,  single bed, mosquito net and a sofa however for the time being it is all mine and it is bliss. I have no running water, so I have to use water from a borehole and share an outdoor toilet and shower with the other residents of the compound, which is absolutely fine except during the current rainy season the residents also include an abundance of  mosquitos, who seem to love the fresh blood I am providing! I have a small garden space where I  am excited about growing my own vegetables and fruits, so any of you green fingered people, I will welcome any advice how to get started.

Work life continues to be an amazing challenge that has fabulous rewards (just not the financial kind). As I mentioned before Yei hospital is not unlike any other, there are staffing issues, often surrounding pay and conditions which ultimately impacts motivation and attitudes to work. As in hospitals around the world, it is the qualified staff that support students during their placements and give them the clinical experience and guidance that they need to become well rounded practitioners. However when education levels of the staff vary dramatically from no formal training to college trained and then add pay and staffing number issues this has meant students are often lacking in appropriate support and clinical teaching, meaning there is a significant theory/practice gap and worse still  they are frequently learning by observing poor practice. This has meant my job has two sides one, supporting the students to learn the correct, current clinical skills and two, supporting the existing staff to recognise areas to develop and improve the skills they already have.

So the past few weeks I have spent time in the wards observing the staff and looking how I can best support them, generally this has involved getting them to trust and respect me which is hard with language barriers. Most nurses and patients first language is kakwar or juba Arabic and often english is limited, which has meant me being very patient and asking for translations whilst I slowly learn Arabic. I am still getting laughed at when I test out my vocabulary however I have noticed lots  of people here full belly laugh mid conversation when nervous, awkward or grateful and pleased about something, so I am learning quickly not to take offence and that laughter is a sign they are pleased I am attempted to use their language….. well I hope that’s the case, it could just be that I am talking utter gobbledy goop!!! Or it could be because I am, yet again, ushering a goat out of the ward, this always seems to amuse people, particularly children, who with their fingers it seems permanently wedged up their noses, think it is hilarious to see a “kawadja” chasing round after a bleating, leaping goat.

The staff on the wards have been very welcoming and once they adjust to the fact that I am not here to relieve them of their workload by doing their job, which to be honest can sometimes be exceptionally frustrating as I witness things daily that I know I could just whizz round and do in no time at all, whipping the ward into shape, however me doing that and taking the direct clinical work away from the nurses will not build their capacity, however me using every power of suggestion, reason and diplomacy, that I have, to  encourage the nurses to improve their practice and patient care will hopefully have a longer lasting effect on care provide in the future.

With the staff I am having to take a gently gently approach and develop new techniques as how to best help them however with the nursing and midwifery students it is much more clean cut. I am their clinical tutor, I am on the wards with them each day, teaching them, watching, supporting and assessing them carrying out procedures and patient care. Wow it amazing to see how they come out of themselves with a little encouragement and support, the level of knowledge and skills varies dramatically between students and sadly many have already developed bad practices, which I am trying soooo hard to break. However I get a lump in my throat on a daily basis when I see, hear or read a student conducting themselves in a professional and safe way.  I was unbelievably chuffed to receive the compliment from the rounding doctor who said he could tell which students I had previously supervised, as those wards where they are working, no matter how busy, were calm, well organised and prepared, honestly could not have been more proud of the students!!! 

The students are very sweet and there is that old style respect for senior colleagues, so much so one of them brought in some plastic wrapping to cover a textbook I keep on the wards for the students reference, as he said, they use it so much he did not want my book to become damaged……. Ahhhh it damn near melted my heart. And when I had to take time off due to typhoid, upon my return several of the students came to find me on the ward to say how they had missed me and worried when they heard I was unwell, it all feels very 1950s inspirational movie-esque, however I cant quite believe it is me who is the central character!

So you might have noticed I slipped in that I got typhoid, yes unfortunately when you eat out at all in a place where typhoid is endemic, it was bound to happen sooner or later.  To be honest it wasnt that bad, room bound for best part of a week, didn’t eat for days and too weak to do much more that walk to the bathroom however as the fever and malaise broke I did get all creative and manage to hand sew a skirt and dress from material I had brought at the market during the previous weekend shopping extravaganza.

Shopping in Yei is an experience in itself, it all happens in the market and the majority of clothes are secondhand. A couple of the other NGO workers and I like to spend Saturday and Sunday afternoons trawling round the markets checking out the amazing array of “unique” items for sale, occasionally trying on dynasty inspired frock or unwanted fancy  dress costume, which I hasten to add locals will often buy and wear with all sincerity out and about round town.  I have seen a heavily pregnant woman walking in the midday heat with a felt santa hat on and an under 5 year old boy with a full size white adult chef hat on.  I get a chuckle everyday and I like to think of it like a version of “pooh sticks” that I used to play with my grandmother, if you donate clothes in the UK they will eventually arrive in Yei market, it just depends how long, and from the look of most of the clothes its taking about 20 years!!!

Life in Yei is good and other than the lack of variety in eating/drinking venues, the curfew and restricted movement round town when the heavens decide to open for 2 days straight, it is made up by the lovely people and willingness not be taken too seriously, whether it is playing dress up in the  market or prancing around in the sweltering heat, with an uninvited audience of local children peering through fence, to a davina mccall fitness DVD with other NGO workers, or the juice stall woman asking for help with her homework (she has enrolled in primary school, she missed out due to the war)  or the amazing bravery and strength of character of my new friends and colleagues who  witnessed and experienced horrendous atrocities and hardships throughout and following the conflicts and yet whom still  greet me with a big gleaming smile, a strong  hard shake and an optimism that things will improve. To be honest I am falling for the place, I keep having those moments of clarity when I am doing my commute work down dusty road, avoiding the herds of cattle with the huge horns, waving to groups of children screaming” kawadja kawadja” and bantering with the boda boda (motorcycle taxi)  drivers why I “foot it” so fast and never let them take me to work  I realise, THIS PLACE IS CRAZY, I MISS MY  FRIENDS AND FAMILY, HOWEVER……I LIVE HERE……AND I LOVE IT!!!

An alien in South Sudan!

Wow what a couple of weeks…..... so I am now officially an alien of south sudan, I bet sting didn’t sing about that!!

After our little detour via Nairobi we land at juba airport a day later than planned, the smallest airport of  a capital city I have ever been too. The one small room for all arrivals displays the usual melee of queues and confusion for immigration and then if you are lucky your bags are dumped in the middle of the room. Sadly our bags did not arrive, as with most of the flight, however we only have to wait one day for our bags to arrive and thanks to a little forward thinking by packing a change of clothes, mini toiletries and the kindness of  another volunteer for my first few days in south sudan I wasn’t too smelly!!

So I spent one week in the “Jubble”  for in country training, I got to spend time with the other lovely volunteers, and meet the staff I have been emailing for weeks. We were registered with the government and passports stamped as aliens in south sudan, i quite like that title!The training was as expected, dos and donts of volunteering, paperwork completion, security briefings and advice for travelling round the newest country in the world plus we had the bonus of wifi in the building so managed to get a skype call out to the uk, whoo hoo novelty. Each morning and evening consisted of the people who run the guest house becoming guineapigs for my minimal Juba Arabic, I reckon I must be improving because by the end of my week the manager no longer laughed as me when I said good morning!

Thanks to two wonderful fellow graduates of the Diploma of Tropical Nursing I was treated to a fabulous evening of good company, good food, free flowing G&T’s and few other essential treats… Thank you Ali and Andrew, you are legends, looking forward to seeing you in Yei!!

Last Saturday, after a strangely emotional farewell with the other volunteers , I set off for a 6 hour, African back massage, road trip to Yei, cheesy music blaring and beautiful countryside made for a fab journey. I was  truly and warmly welcomed into the Yei  expat life, when I was shown to my accommodation and handed a G&T within minutes of arrival.  This has been reflective of how my first week in Yei has been, a fab group of  ex pats working for various organizations, who meet regularly to run, play volleyball and rugby, go to the market together and share dinner, even a movie and a beer together. Its like a little family, everyone looks out for each other.

I have a fabulous 20min walk down an undulating dirt road to the hospital from my guesthouse accommodation.  In the dry, the road is solid as a asphalt, however when it rains, which it does most days, the road turns muddy and full of mini streams (imagine commuting through a festival), however the call of Kawadja ( white person) from all the smiling children and curious adults makes it a much more engaging commute than a London train! At the guesthouse I am lucky to have my own room, with own bathroom, ok so the sink doesn’t work, the toilet leaks and sometimes there is no water however the mosquito net has no holes and for the next month this room is home and I love it… and thanks to my trusty trangia meths burner, I am able to rustle up a variety of wonderful rice and bean dishes including Yei’s plethora (relative for Africa) variety of fruit and vegetables.

My first week working at Yei Civil Hospital has been surprisingly productive and I am really excited about the 2 years ahead. I have meet with the senior members of the hospital, the training institute, county health department and visited each of the 8 wards and outpatient clinics. The hospital is trying so hard to do the best it can with the limited resources at their disposal, however issues with intermittent running water, insufficient medication supplies and equipment, infrequent staff salary delivery, limited staffing numbers and level of education and experience mean that I know I will be pushed harder here than anywhere I have worked before….. and I CAN NOT WAIT!!! I don’t want to bore the non-medics with endless tales of hospital life, so for anyone who wants more medical related info please let me know.

For now I’ll sign off and just say don’t be strangers, I can access emails most days however texts and wifi based things are a challenge, well at the moment impossible, however hopefully this will change when I, fingers crossed, move into a NGO compound in a month.

Nursing with my backpack to be continued…….

Slight hiccup in the plan..

So I am in africa, nairobi kenya to be precise and unexpectedly am making use of the free wifi in the four star hotel kenyan airways have put us up in as when we arrived into nairobi it was chaos! Immigration was in a marque on the tarmac and no one had any idea about flights arriving and departing, people waiting 24 hrs for flights that dont exist. You have to give it to the airline staff, smiles on their faces and willing to help, impressive! It took less than an hour for me to hear the phrase t.i.a, this is africa! Love it!

So after waiting in various queues for best part of 6 hours in the shadow of the still smoldering international terminal, avoiding the journalists and news crews filming the events, we were told that there no flights to juba until tomorrow, no worries, creature comforts of a hotel here we come, thank you very much kenyan airways!

So off to bed early as we have to head back to the airport at 4am to try our luck getting onto the morning flight to juba. fingers crossed however not holding our breath as numerous reports today of overbooking of flights and non existent flights.

Well adventure is what I wanted and I am starting it in true style!!

So long farewell....

So thats all folks... I'm off!

Im am at the airport and having a glass or two of champagne with my Wau ladies. However I almost wasnt flying my planned route as I was woken to the bizarre news that nairobi airport was ablaze (I have to route through nairobi) however with a bit of clever moving around we are arrivibg in domestic terminal.

Its been emotional saying my farewells to so many lovely people, some more dramatic than others-physically running phoebe from friends stylee, down embankment on saturday night to avoid the tears of others was a funny one!

So if you ever fancy heading to central africa then let me know! I'll be intermittently available on email and I'll try to post regular updates of all the Yei news, which is by the way pronouced Yay and Wau is pronouced wow, how good are these names!

So for now I will just say see you soon xxx