South Sudan: Juba College of Nursing and Midwifery

The fighting in Juba which erupted on December 15^th, 2013 and later spilled over to other states in South Sudan made it difficult for the JCONAM college staff and the students to return to their various homes for the break, as it happened right at the time the college had just closed for Christmas holiday.  Many of the students were stranded on campus or within Juba, but are all now back on campus after the break completed and a ceasefire has held.  The school is still waiting for all of the teaching staff to return but has been able to start the semester again with less staff.

Implemented activities in line with RMF sponsored activities and project objectives include:

1. Supported two JCONAM students who were badly affected by the fighting between government and opposition forces which took place in January 2014 in Malakal and Balliet counties, Upper Nile State.
2. Continued support of high speed WIFI internet services for JCONAM.
3. Developed Respectful Maternity Care (RMC) supervisory checklist to be used in maternity unit of JTH and neighboring PHCCs within Juba city.
4. Formed joint JCONAM-JTH committee aimed at improving the clinical skills of the students during their practice in different departments of JTH.
5. Prepared next steps to hire a second RMF supported national clinical instructor in the second quarter of 2014.
6. Facilitated the visit of RMF CEO Dr. Martina Fuchs during the reporting quarter.
7. Facilitated the reprinting of JCONAM partner’s signboard.
8. Support to the National Ministry of Health, Republic of South Sudan and project partners in the coordination and implementation of project activities over the reporting period. Also in line with the approved College annual work plan. 
9. Continued facilitation of inter-linkages with UNFPA, MOH, IMC and other stakeholders in ensuring quality assurance in the implementation of both nursing and midwifery curricula in the diploma program.
10. Coordination of RMF activities with other organizations and UN agencies supporting the Juba College of Nursing and Midwifery by participating in meetings and conferences.

Sponsorship of second and third year nursing and midwifery students at the Juba College of Nursing and Midwifery through provision of uniforms, skills laboratory equipment, clinical training equipment, books, stationery and Information Technology (IT) equipment.

Results and/or accomplishments achieved during this reporting period:

1. The two college students who were badly affected by the fighting which took in place in Malakal and Balliet are now settled and concentrating on their studies following emotional and monetary support offered to them by RMF.   
2. All the tutors and the nursing/midwifery students are able to access internet services at the College without interruption, providing them improved access to online learning materials and communications.
3. The college students are now getting good support and mentorship from JTH staff and college tutors while in clinical practice following the formation of joint JCONAM-JTH committee which enhances relationship between JCONAM and JTH administration.
4. The third year midwifery students trained on RMC in 2013 continued to practice and disseminate the basic concepts of RMC to other students and maternity staff hence improving patient’s outcome positively.
5. RMF and its Donor World Children’s Fund (WCF) are better represented in the JCONAM partner’s signboard following RMF’s support in reprinting the sign.
6. The college students and the tutors are still benefiting from the essentials medicines provided by RMF, this reduces the financial burden on the tutors/students/implementing partner (IMC) in purchasing essential drugs for simple medical cases.
7. Created student database for easy monitoring and follow up.
8. Coordination of RMF activities and participation in meetings/workshops together with NGOs and UN agencies supporting JCONAM and other National Health Training Institutes (NHTIs).
9. The visit by RMF CEO Dr. Martina Fuchs during that critical moment when most partners left the country due to deteriorating security situation generated hope and confidence among the college staff and the students.

Impact this project has on the community (who is benefiting and how):

1. The Diploma in Nursing/Midwifery Curriculum approved by the Ministry of Health will be used as a model document alongside the College structures for replication in other states.
2. The Ministry of Health through the support of RMF and other stakeholders is working on replicating the College in other states. This will translate into the continued growth in the number of nursing and midwifery diploma institutes in South Sudan and potentially new Nursing/Midwifery College partnerships for RMF.
3. Stakeholders in nursing and midwifery education and services are undertaking the development of a bridge course for Community/Enrolled Midwives for acceptance into diploma training to complete the course in less than 3 years.
4. It is currently estimated that it will take close to 66 years for South Sudan to establish a professional and sustained capacity to address maternal mortality issues in a region with the highest ratio of 2,054 for every 100,000 live births, as per the MOH. In addition to establishing other diploma institutes in South Sudan, the MOH is working on bilateral agreements with neighboring countries to send out qualified South Sudanese to train as nurses and midwives in order to establish a critical mass in the next 10 years.
5. Several years of experience derived from working with JCONAM and other partners has enabled RMF to develop a vision of increasing its level of support in South Sudan. By virtue of its registration and autonomy, RMF will seek to partner with organizations/agencies, and most importantly, government elements in the areas of health systems strengthening and sustainable economic empowerment as witnessed in its projects in other countries.

Number served/number of direct project beneficiaries:

1. Through the support of the consortium of partners, currently 84 students are fully sponsored for the three-year education program. This includes the provision of school uniforms, books, stationery, tutors and monthly allowances. Year one students were recruited in December 2013 following rigorous interview conducted by MoH; department of training and professional development together with partners involve in training, 60 nursing and 60 midwifery students were selected and are to report in June 2014. The table below shows the actual number of students present at the college during the reporting quarter.
2. 
3. The project provides employment opportunities for both the teaching and non-teaching staff. This provides economic sustainability for the staff and their families.
4. JCONAM was established in 2010 by the consortium of partners on behalf of the Ministry of Health, Republic of South Sudan. To date, project activities have been implemented with a planned exit strategy, working toward turning over complete implementation of these projects by the Ministry of Health. This is to ensure each project’s sustainable development and continuity by the relevant office in the Ministry of Health.
5. Upon graduation after the three-year course, the registered nurses and midwives will provide a much-needed service within the states and counties at facilities level. The services offered by this cadre of graduates are also expected to extend into the community through health education, community mobilization and home care, among others.
6. With the inclusion of the second year midwifery students into the maternity ward delivery roster, the students are able to conduct/participate in 10-20 supervised deliveries per day. These numbers are however meant to increase as the College looks into expanding the number of practice sites in the near future.

Notable project challenges and obstacles:

1. The fighting in Juba which erupted on December 15^th, 2013 and later spilling to other states made it difficult for the college staff and the students to return to their various home states during the First Quarter since this happened at the time the college had just closed for Christmas holiday.
2. The deteriorated security situation in some parts of Jonglei, Unity and Upper Nile States following the fighting which erupted in Juba in mid December 2013 caused some students not to report to college and has been very difficult tracing them due to poor communication network.
3. Following the selection of 2014 intake in early December 2013, the final list of the successful students couldn’t be circulated to all the States in time due to the fighting in some parts of the country, this caused delay in all the process and now the year one will report in early June 2014, four months late, which may affect the quality of the training.
4. Frequent electricity interruptions, making work difficult for RMF coordination office.
5. Lack of new commitments from the partners in health for JCONAM creating many unmet needs for the College.
6. Lack of qualified personnel within the hospital to supervise the students when they are conducting clinical rounds, i.e. the students are occasionally supervised by traditional birth attendants leading to a discrepancy between skills taught and what is witnessed.
7. Lack of a medical plans/insurance for the students with consideration of their exposure to infections and other general illnesses in the workplace.
8. Lack of extra-curricular activities for the students to engage in during their free time and weekends, i.e. outdoor sports and games.
9. The College lacks critical support and administrative staff, such as a finance officer and an administrator.
10. Limited technical and financial commitment and support to the Ministry of Health by the stakeholders for the review of the diploma nursing curriculum.
11. Lack of financial commitment by stakeholders for the construction of an urgently needed classroom block, students’ hostel, tutors’ residence and recreational hall.

Annex A: Success stories
 
Deborah Mathew
 
Deborah Mathew is a 25 year old South Sudanese national from Malakal, the State capital of Upper Nile State. She is the current second year midwifery student at JCONAM.
 
Deborah is an orphan who lost both of her parents at the tender age of 4 and has been raised by her uncle who had three children and has been living with them happily before the war broke out mid December 2013 in Juba.
 
During the fighting between the government and opposition forces for the control of Malakal town, all of the family of Deborah’s uncle were killed in front of her (the uncle, wife and their three children), with the  uncle’s wife being killed after she resisted being raped. In a similar incident four of her relatives were burnt inside their houses, while others were drowned in the ferry accident which sunk in Nile River on the 12^th January with more than 200 people.
 
Deborah managed to survive by hiding in a dilapidated pit latrine which had been abandoned for some time.  She survived there for three days without food or water. On the fourth day she heard voices of women passing by and she screamed for help, lucky enough they came to her rescue and one of them, Nakenisa (a Dinka woman) escorted her to UNMISS camp. Deborah then reconnected with the principal of JCONAM, Petronella, through a phone and the principal worked very hard in collaboration with to ensure that she was booked on a UN flight and flown to Juba.
 
Deborah has been very frustrated and said in front of us while tears were rolling through her cheeks,
“Now I have lost everything, my parents, uncle and family, my relatives; I am left alone in this world, God why me? My intention was to study and go back and help my community, now where do I go?
 
After hearing Deborah’s tragic story, RMF South Sudan responded initially through provision of emotional and social support continuously to enable her concentrate on her studies and achieve her dreamed goal and later monetary support of 1,000SSP ($330) to help her purchase essential items like clothes and other basic necessities. Through this support, Deborah has managed to come out of that tragic moment and is now fully concentrating on her studies. She deeply appreciated the support given to her by RMF and promised to work hard in school and conduct delivery professionally with dignity and respect regardless of any ethnicity because “we are all South Sudanese”.

Peter Atiep
 
Peter Atiep is a South Sudanese national from Upper Nile State, Baliet County. He is married, has 5 children and is currently a second year nursing student at JCONAM. When the fighting broke out in Juba in mid December 2013, Peter and his family were in his home town Baliet, which was eventually overrun by the opposition forces on January 11^th, 2014.
 
As everyone took cover and ran for her/his safety, Peter got separated from the wife. Peter ran with the first three children while the wife ran separately with the last two children. Peter finally made his way to Palogue (Malut County in Upper Nile State) then to Juba on January 19^th, 2014 and immediately proceeded to Kakuma refugee camp in Kenya where he left the three children with a relative and returned to Juba to continue with his studies. Fortunately Peter managed to connect with his wife who had taken refuge in Renk County (Upper Nile State) and requested her to come to Palogue where there is operational airport with regular Dar Petroleum flight. Peter desperately wanted to reunite with his wife and children but was unable to afford to air fare for them all.
 
During this critical moment, RMF stepped in and facilitated the transportation of Peter’s wife and the two children from Palogue to Juba by air on March 28^th, 2014 and then to Kakuma refugee camp by road on March 30^th, 2014.
 
March 28^th, 2014 was a turning point for Peter, on seeing his wife and children at Juba International Airport, the depressed Peter was full of joy, and his wife and children equally delighted to see him. Peter then gathered the family members housing his wife in Juba and said:
 
“God bless RMF for doing all this to his family and prayed that RMF grows bigger and bigger. I now know that we the South Sudanese are ONE people, it does not matter where you originate from and one’s ethnicity should not be a factor when delivering services.”
 
He couldn’t believe this, his fellow South Sudanese from different regions and ethnicities had coordinated all of this and made sure his wife and children made it safely to Juba and were now going to facilitate their travel to Kakuma Refugee Camp in Kenya. He now believes in really believes in unity and says:
 
“Every individual is a child of God. God bless you all, the donors and RMF as a whole. Now will concentrate on my studies, will keep updating you about the condition of my families. Thanks and God bless you.  Peter then confirmed to RMF the arrival of the wife and the children to Kakuma and the family is doing well after reunion. Peter is now a happy student concentrating on his studies without further disturbances.