South Sudan: Juba Teaching Hospital Support

Photo: Newly renovated Female Ward in the Accident & Emergency Department

Project Goals:
 
To improve the quality and sustainability of medical and surgical services provided at Juba Teaching Hospital.
 
Juba Teaching Hospital is the only national referral hospital in the whole country of South Sudan and is located in Juba City, Central Equatoria State. With an estimated population of 9.86 million based on annual population growth of 3% from a population census conducted in 2008 and lack of proper functioning primary health care facilities upcountry, many South Sudanese have nowhere to go but to this national referral hospital. Some of the military and police personnel also share these limited facilities with the civilians.
 
Juba Teaching Hospital is directly funded by the central government through the National Ministry of Health. Medical supplies and maintenance are handled through the National Ministry of Health of South Sudan with supplements coming from United Nations agencies and NGOs. The supplies are irregular, forcing patients to buy most of the consumables and pharmaceuticals from private pharmacies. Due to the high level of poverty, most vulnerable patients are not able to afford modern medicine hence increasing patient mortality in Juba.

(Left) Siama, RMF Master Trainer conducting training on Health eVillages devices for nurses, midwives and doctors (Right) Jemelia, RMF Master Trainer conducting training on Health eVillages devices for nurses, midwives and doctors

Dr. Taban Martin Vitale demonstrating to the trainees the use of the  devices which are preloaded with medical information

(Left) Consultant Gynecologist, Dr. Mergani using the provided device as a medical reference guide to access information (Right) Consultant Gynecologist, Dr. Kuma Chol, current head of Obstetrics and Gynecology at JTH using the provided device to obtain medical information

(Left) Joice Chrispo, a midwife in the ANC, educating pregnant women and showing them birth in different positions (Right) Judith Cinea, a midwife in the Labour unit, attending to a pre-eclamptic woman who is at term

Project Objectives:

1. Improve patient wards and build infrastructure within Juba Teaching Hospital.
2. Assist in improving conditions for providing health care at Juba Teaching Hospital, including the policies and management of regular and medical waste.
3. Rehabilitate and/or purchase new medical equipment.
4. Provide basic medical supplies, disposables and pharmaceuticals for Juba Teaching Hospital starting with the Pediatric Department, supplementing those provided by the Ministry of Health.
5. Organize on-site clinical trainings, beginning with general equipment usage and Respectful Maternity Care.

(Left) Jacqueline, a nurse, using the device to get the right dose of a drug before administering to the patient (Right) Amani Kaku, a nurse, educating a mother on prevention of malaria using the device as a guide

(Left) Joice Naku using the device to provide guidance on nutrition to a mother whose child is malnourished (Right) Joice Naku using the device as a guide to provide evidence based care for a child on treatment for pneumonia

Lead investigator Fekadu conducting orientation workshop for the team who is to conduct Maternal Near-Miss Audit at JTH

Summary of RMF/MMI-sponsored activities carried out during the reporting period under each project objective (note any changes from original plans):

1. Facilitated the coming of RMF Founder and CEO Dr. Martina Fuchs to Juba, South Sudan to support the in country team as several new programs were launched, and facilitated her visit to Bor, Jonglei State, to sign agreements with the State Ministry of Health.
2. Facilitated the coming of RMF Director, Global Programs Cindy Aliza Stein to Juba to launch our new Health eVillages project.
3. Conducted training on Health eVillages tablets for the two RMF Master Trainers.
4. Trained nurses, midwives, and doctors on application of Health eVillages tablets particularly on how to use the preloaded devices to access medical information.
5. Provided tablets preloaded with medical materials to the trained nurses/midwives, doctors and consultants working in JTH Pediatric and Obstetrics/Gynecology departments.
6. Installed high speed WIFI internet services in Maternity block serving both Pediatric and Obstetrics/Gynecology departments.
7. Conducting Maternal Near-Miss Audit at Juba Teaching Hospital (studies still ongoing).
8. Renovation of the Accident and Emergency Department at Juba Teaching Hospital (successfully completed).
9. Facilitated the repainting of the external walls of the Accident and Emergency Department worth $4,000.
10. Procured and provided adequate cleaning materials to Pediatric department to keep the wards clean.
11. Continued implementation of waste management policies and waste removal at JTH.
12. Continued support of high speed WIFI internet services for RMF office.

Participants attending the Near-Miss workshop

Participants attending the Near-Miss workshop

(Left) A small group of data collectors discussing the challenges and the way forward to ensure the quality of the ongoing study on Maternal Near-Miss (Right) Fekadu (Front-R) taking the team through the questionnaire and addressing areas of concern to ensure quality and to avoid errors in data collection processes

(Left) Fekadu, Jennifer and Judith with the three JCONAM students who are helping in quantitative data collections (Right) Jennifer (L) checking the quality of the completed questionnaires provided by midwife Elizabeth

Results and/or accomplishments achieved during this reporting period:
 
The Health Systems Strengthening project with focus on Juba Teaching Hospital has achieved many notable milestones during the reporting quarter through the committed partnership with the National Ministry of Health, JTH administration and its staff.

1. The improvement work of the Accident and Emergency Department was successfully completed (refer to separate A&E final reports).
2. RMF continued to work closely with JTH administration and public health officers to ensure proper implementation of waste management policy guidelines and regular waste removal, and facilitated and performed regular monitoring and supportive supervision of the JTH healthcare workers and janitors on implementation of waste management policy guidelines.
3. Monthly provision of adequate cleaning materials to Pediatric department and special wing ensures proper cleaning and hygiene maintenance in the wards and their surroundings.
4. Health eVillages project introduced to JTH.
5. Two master trainers (national tutors from Juba College of Nursing and Midwifery) identified and trained on Health eVillages project, now able to train more healthcare professional at JTH.
6. Nurses, midwives, doctors and consultants working in Pediatric, Obstetrics and Gynecology departments were trained on Health eVillages tablets and provided with tablets loaded with medical information to serve as reference guide.
7. Collection of monthly report from the healthcare professionals on the usage of the preloaded tablets and patients’ response on how the application of the tablets influenced the care provided by the healthcare professionals, this is to evaluate the impact of the Health eVillages project (evaluation still ongoing).
8. Recruited and trained staff to conduct the Maternal Near-Miss Audit at Juba Teaching Hospital (studies still ongoing, results will be published after completion).
9. Support of high speed WIFI internet services both at the Maternity department and RMF office provide internet access to doctors, nurses and RMF team.

Number served/number of direct project beneficiaries:

1. Direct project beneficiaries are approximately 444,680 people who lived in Juba and the immediate surrounding areas projected basing on 2008 Sudan Population and Housing Census.
2. Students from JCONAM, Juba Nursing School and Juba Health Science Training Institute are also direct beneficiaries of this project since all do their clinical practice at Juba Teaching Hospital.

Pediatric ward 5 renovated by RMF in 2013

(Left) A child recovering well in surgical unit of Pediatric ward 5 after amputation following a gunshot (Right) A child recovering well in surgical unit of Pediatric ward 5 after amputation following a chronic limb infection

(Left) A child recovering well in surgical unit of Pediatric ward 5 from open head injury following RTA (Right) A child recovering well in surgical unit of Pediatric ward 5 from open head injury following bomb blast

(Left) An energetic looking child in Pediatric ward 5 responding well to treatment for pneumonia (Right) A child fully recovered from malaria, discharged on oral medication to continue at home

(Left) A child recovering well in surgical unit of Pediatric ward 5 from severe scalp infection (Right) A child on traction for fractured Lt. Femur following a trauma, he is responding well under the management

(Left) A child (L) well recovered from burns now together with the brother (Right) A child with second degree burns on care in Pediatric ward 5, supported by the father

(Left) A 2-month-old infant born with congenital anomaly, awaiting referral to Uganda, mother seeking financial support (Right) A woman in Pediatric ward 5, sustained knee injuries following RTA

(Left) A woman in Pediatric ward 5 on care for severe burn following domestic violence (Right) A woman in Pediatric ward 5 on palliative care for breast cancer

(Left) A counselor giving education for mothers at ANC (Right) Angelina Paul, a midwife, attending to a mother in Maternity unit

(Left) Regular waste at JTH awaiting to be transported to the designated site (Right) A company contracted by MOH loading the waste to be transported to the designated site

Cleaning company slashing the JTH compound

Janitors performing general cleaning of the hospital

(Left) A janitor cleaning around the A&E Department (Right)  A janitor (R) assigned to clean in the A&E Department

(Left) L-R: Dr. Makur (Undersecretary MOH), Dr. Martina and Dr. Taban during the final evaluation of  the A&E Department (Right) Surveyor (L) from Ministry of Housing congratulating RMF on well job done 

(Left) The joint team pointing to areas which needed more improvement (Right) Jacob (R), Pan Koung Company engineer, committing to the team that they will fix those areas needing more improvement

(Left) Dr. Martina interviewing the Undersecretary of MOH at the end of the tour (Right) Dr. Wani Lolik (R) discussing with the surveyor the quality of the work done

(Left) Dr. Taban touring the A&E Department with medical team from USA (Right) Dr. Taban touring the A&E Department with medical team from USA

(Left) Dr. Taban in the A&E dispensing pharmacy, the staff are happy for the improvement (Right) Dr. Abraham (L), Director of the A&E Department, thanking the team for visiting JTH

(Left) Exterior wall of former lab block after repainting with weather guard (Right) A janitor washing the exterior wall of surgical block after repainting with weather guard paint

(Left) Exterior wall of Surgical block after repainting with weather guard (Right) Exterior wall of Surgical block after repainting with weather guard

(Left) Interior of one of the rooms after repainting the areas identified during the last evaluation (Right) Interior of one of the rooms after repainting the areas identified during the last evaluation

(Left) A triage area which is also used for resuscitation of critically ill patients (Right) Well cleaned triage area, flow of patients now controlled to ensure privacy

(Left) Operating table procured by MOH placed in one of the A&E theatres (Right) Patient examination bed and screen procured by MOH placed in one of the consultation rooms

(Left) Patient trolleys procured by MOH (Right) Furniture procured by MOH

(Left) Weighing scales and furniture procured by MOH (Right) Waste collection bins procured by MOH

(Left) SINCO Medical Supplies, company contracted by MOH to supply beds and mattresses for A&E Department (Right) SINCO marketing manager (L) with his colleague in front of the mattresses supplied by them

(Left) R-L: SMO, DG, MOH representative, marketing manager-SINCO & a technician assembling the bed (Right) SINCO technicians assembling the beds

Beds and mattresses in surgical unit of A&E Department

Medical block of newly renovated A&E, male unit fully occupied

Medical block of newly renovated A&E, female unit fully occupied