South Sudan: Juba Teaching Hospital Support

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

1. Procured and delivered and coordinated distribution of medical equipments, medicines and consumables worth $110,000 to Juba Teaching Hospital during the critical time following the fighting which erupted in Juba in mid December 2013, and later spilled over to other states (See Photos in Appendix and refer to more detailed separate report on the shipment).
2. Procured and delivered blood bags and lab reagents worth $5,000 to the Wau Teaching Hospital (See Photos in Appendix).
3. Identified and trained two medical officers working in maternity unit as master trainers for Respectful Maternity Care (RMC).
4. Facilitated and conducted the training for maternity staff from Juba Teaching Hospital and neighboring primary health care centers on Respectful Maternity Care (See separate report on RMC training)
5. Continued support of high speed WIFI internet services for Juba Teaching Hospital Resource Centre (JTHRC).
6. Continued to provide cleaning materials to Pediatric department regularly to keep the wards clean.
7. Conducted the assessment of Pediatric ward 5 emergency and derived next steps awaiting implementation.

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

1. The $110,000 worth of medical equipment, medicines and consumables delivered to Juba Teaching Hospital on January 10, 2014, greatly stabilized the situation after the conflict/crisis in December when the hospital was running low of urgently needed supplies.
2. The lab department was able to start a large blood donation/transfusion program for many patients after receiving the blood bags and lab reagents from the December supply delivery.  Many lives were saved most of the patients admitted to JTH in late December required blood transfusions following gunshot wounds and other injuries suffered during the ongoing conflict.
3. The radiology department in JTH was able to resume performing X-ray services after receiving a resupply of X-ray film.
4. Malakal and Wau Teaching Hospitals also benefited from the shipped medical supplies following a division and distribution of the supplies by the National Ministry of Health.
5. Wau Teaching Hospital was able to initiate a blood donation/transfusion program after receiving blood bags and lab reagents worth US$5,000 from the second consignment following a request from Ministry of Health.
6. Respectful Maternity Care Training Program (see separate report for more details):

• Recently, maternity experts and global stakeholders have turned attention towards the presence of disrespect and abuse (D&A) by staff within health centers and hospitals as a deterrent to women seeking potentially lifesaving maternity services. Literature indicates that there is a strong correlation between how respectfully a woman is treated when receiving antenatal care and giving birth with how likely she is to utilize these services in the future. Negative experiences and perceptions of providers and health facilities also can spread across communities and deter large numbers of women from seeking care by skilled birth attendants. This is particularly alarming because the World Health Organization (WHO) recommends that a skilled attendant be present at every birth since they can prevent up to 90% of maternal deaths where they are authorized to practice their competencies and play a full role during pregnancy, childbirth and after birth.
• Transforming maternity care into a welcoming and supportive experience through the systematic introduction of Respectful Maternity Care (RMC) will increase utilization of services, improve community and health system relationships, and improve staff morale and job satisfaction. RMC is possibly one of the most significant interventions that can be introduced in order to approach the goals of Millennium Development Goal (MDG) 5. Additionally, respectful care should not be viewed as a privilege but as a human right that needs to be guaranteed for vulnerable populations such as pregnant women and their families. Addressing this problem should be a priority because if women are not willing to seek lifesaving care, then improving training, equipment, medication stocks, and financial barriers will fail to reduce the number of women dying.
• The RMC training program at Juba Teaching Hospital, designed and conducted by RMF Coordinator, Maternal Child Health Programs, Cindy Stein Urbanc and RMF Master Trainer, Reagan Turner-Bell, consisted of 6 modules facilitated over a 2 day period with the following learning objectives:

  • Analyze caring behaviors and culturally sensitive interactions in the maternity setting

  • Discuss and practice therapeutic communication skills that lead to compassionate and humanized care

  • Examine professional role expectations and standards of practice when providing care

  • Describe key features of dignity

  • Describe the methods of collaboration with other health facility staff and community members.

• The training program was facilitated for 29 third year midwifery students from the Juba College of Nursing and Midwifery (JCONAM). The students represent both males and females from a variety of ethnic groups that came to study in Juba from different states in South Sudan.
• 4 Master Trainers were selected by the Ministry of Health and JCONAM administration: 2 practicing physicians and 2 midwifery tutors at JCONAM.
• The Master Trainers facilitated a 2 full day RMC training for 19 maternity staff from Juba Teaching Hospital and two local Primary Healthcare Centers (PHCCs), Munuki and Kator. The staff was comprised of: community midwives, nurse-midwives, physicians, lab technicians, and nurses.
• There has been a dramatic shift in attitudes among the maternity staff regarding best practices following RMC training, improving service delivery at maternity unit.

7. Facilitated and performed regular monitoring and supervision of the JTH healthcare workers and janitors on the implementation of waste management policy guidelines.
8. RMF continued to work closely with JTH administration and public health officers to ensure regular waste removing following the signed MoU with Juba Town Council.
9. Performed regular monitoring and supervision of the healthcare workers and ward cleaners on implementation of developed strategy for keeping Pediatric wards clean.
10. The Pediatric ward 5 is well maintained and clean as a result of the regular supply of cleaning supplies.
11. Carried out assessment and submitted proposals for establishing a mini blood bank in the the Maternity unit and procurement of a new Ultrasound for maternity department.
12. Continued to follow up with prospective donors on our proposal for improving water and sanitation situation at Juba Teaching Hospital.
13. The medical unit of fully renovated Pediatric Ward 5 is now fully occupied by wounded soldiers following the deteriorated security situation in Juba and some States.
14. Support of high speed WIFI internet services for Juba Teaching Hospital Resource Centre which provides internet access to doctors and nurses at the hospital.
15. Prepared the next step for renovation of Pediatric Ward 5 Emergency following our second assessment of the ward.

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

1. The medical supplies delivered to Juba Teaching Hospital has reduced the financial burden on patients who now get most of the essential medicines, radiological and laboratory services from the hospital instead of purchasing them from private facilities.
2. The delivered medical supplies also saved the life of most vulnerable patients who wouldn’t have made it without the essential medicines since are not able to purchase them from private pharmacies due to poverty. 
3. The renovated Pediatric Ward 5 coupled with provision of cleaning materials has reduced re-infection rates among in-patients and also improved working conditions for healthcare professionals and JCONAM (Juba College of Nursing and Midwifery) students who are on their clinical rotations, and, above all, increased the quality of care patients receive and thus will increase the number of patients coming for medical treatment in time.
4. The JTH premises and the surrounding areas are preserved and kept clean and safe through regular removal of the waste which had posed a threat to the health workers, patients, surrounding community and the environment.
5. The working condition of the hospital’s janitorial workers has been improved through implementation of the waste management policy, developed with the support of RMF staff.
6. The high speed WIFI internet services for the Juba Teaching Hospital Resource Centre that provide internet access to doctors and nurses at the hospital facilitate research and improve continuous medical education.

Number served/number of direct project beneficiaries:

1. Direct project beneficiaries are approximately 372,141 people who live in Juba and the immediate surrounding areas as per the 2008 Sudan Population and Housing Census.
2. The JCONAM students who do their clinical rotations in Juba Teaching Hospital are also direct beneficiaries of the project.

Number of indirect project beneficiaries (geographic coverage):

1. 9.6 million South Sudanese as per the 2008 Sudan Population and Housing Census from all the ten states of South Sudan as Juba Teaching Hospital is the only referral hospital for the entire country.
2. The entire business community from neighboring and other African countries, the working class from INGOs, UN Agencies etc

Appendix A: Success Story

Delivery of Medical Equipments/Consumable/Medicine to JTH

Following the eruption of fighting in Juba from mid December 2013 and ongoing fighting in other States, the only national referral hospital, Juba Teaching Hospital, became overwhelmed with an enormous number of patients; seriously wounded and severely ill civilians and military personnel. The hospital was running desperately low on urgently needed medicines, consumables and equipments to do its life saving work during the crisis. At that time, most of foreign government an non-governmental organizations and personnel were leaving Juba due to deteriorating security situation.

Despite the tense security situation the teams from RMF Uganda and RMF South Sudan together procured medical equipment, medicines and supplies worth US$110,000 in Kampala and transported by truck directly to Juba Teaching Hospital. This helped to greatly stabilize the situation in early January and up to the time of this reporting, the hospital still has adequate supplies according to the Director General, Dr. Wani Lolik.

RMF was the only organization which provided supplies to JTH during this critical moment.

Charles Naku, RMF Uganda Coutnry Director, standing among packed RMF consignments

(L) loading in progress, (R) JTH pharmacist Dr. Gismalla, RMF's Richard Ambayo, Dr. Taban Martin Vitale, Okang Wilson Ezekiel, JTH DG Dr. Wani Lolik Lado

(L) Managing Director at Medicare Company and Lab Technician at JTH, (R) Portion of the supplies being transported directly to Malakal Teaching Hospital

(L) One of the wheelchairs delivered by RMF has been allocated to Surgical Ward 3, (R) Blood drive using new equipment