South Sudan

Real Medicine Supports Capacity Building in Southern Sudan’s Health Care Sector

February 24, 2009

Michael Lear

Real Medicine Supports Capacity Building in Southern Sudan's Health Care Sector
Michael Lear, Director International Relations, Country Director, Sudan

The recent mass exodus of aid groups in Northern Sudan at the demand of President Bashir has left tensions high in the region regarding NGO intent and purpose. While not directly influencing activity in Southern Sudan, these events have presented a new challenge to align with the Southern Sudanese government on a shared vision for the benefit of the people of Southern Sudan.

After a thorough needs assessment of the primary health care sector of Juba, Southern Sudan, Real Medicine Foundation joined with St. Mary’s Hospital, Isle of Wight, UK and the Government of Southern Sudan, to initiate a Nursing an Midwifery Training Program at The Juba Teaching Hospital. All parties agree that capacity building is highest leveraged investment in the primary health care sector for Central Equatoria State, if not all of Southern Sudan. The Juba Teaching Hospital Nursing program can simultaneously train nurses for the most densely populated surrounding states and become the flagship training program at the center of Health Care Development in Southern Sudan.

We are excited to participate in this empowering program for the people of Southern Sudan, as they move towards independence from the North in 2011. Below please find my trip notes highlighting the findings of the assessment.

Real Medicine Primary Health Care Project – Juba Sudan February 16 – 24, 2009 Michael Lear, Director International Relations, Country Director, Sudan

Background:

Three years after the signing of the CPA, many challenges remain in terms of infrastructure development across all sectors. There is still a great need for programs that harness the local human resources available to provide real solutions that help Southern Sudan move towards independence from the North in 2011 when the referendum with Northern Sudan expires.

Sanitation, Primary Health Care, Specialized Post Graduate and Primary Health Training (Physicians, Nurses and Midwives,) Public water supply, and access roads, continue to fall short to meet the needs of Juba and they are losing ground rapidly. Juba has increased in size almost 500% in the past three years according to a UN conservative estimate, while the mechanisms to deliver basis human services have progressed slowly.

Southern Sudan, and Juba in particular, has the highest infant and maternal mortality rates in the world.

“Access to Primary Health Care is worse now that it was during the war” states Andy Pendleton, UN OCHA Head Office / Area Coordinator.

“Less than 6% of Juba’s population is served by the sanitation system and even after the new public water main is completed (the existing one was built in 1937), only 20% will have access directly to water. The remaining population must access from wells and NGO tanker distribution locations.” Commentary by Ministry of Water and Irrigation official.

Trip Objective:

Real Medicine’s Mission for this trip was to assess the Primary Health Care situation within and around Juba for placement of a clinic that would have the highest leverage to serve surrounding communities without exposing it to security risks present in the outlying areas.
Additionally, the needs of the Juba Teaching Hospital were evaluated, in particular the Nursing School and MidwiferyTraining Programs.

Meetings were held with the following stakeholders at various organizations to obtain the necessary information to determine our course(s) of action:

Pre-Trip Consultations: via phone and email

  • Drs. Eluzai Hakim – St Mary Hospital, Isle of Wight UK, Consulting Physician, Medical Advisor to Juba Link (Juba Teaching Hospital, Juba Sudan)
  • Dr. Tim Walsh – St Mary Hospital, Isle of Wight UK, Consulting Physician
  • Andy Pendleton – UN OHCA Head Office Area Coordinator, Juba Southern Sudan
  • David Del Conte– UN OHCA Director, New York

In Country Consultations:

  • Andy Pendleton – UN OHCA Head Office Area Coordinator
  • Heather Dunlop – UN OCHA Field Officer – Health Emergency Preparedness
  • Sonja Nieuwenhuis – Medical Coordinator – Med Air International and assistant to GOSS MOH
  • Melissa Phillips NGO Secretariat Coordinator CRS, Juba, Southern Sudan
  • Dr. Dario Kuron Lado – GOSS, MOH Director General Juba Teaching Hospital
  • Dr. Louis Danga, Juba Teaching Hospital
  • Dr. Jamal – Kator, PHCC Head Physician
  • Dr. Samson Paul Baba – MOH Director General of External Assistance and NGO Coordination
  • Dr. Hillary – Minster of Health, Central Equatoria State
  • Dr. Loputo Loputo – Minster of Health, Central Equatoria State, Director PHC
  • Mr. Lawrence Lopula Busuk, Eng. GOSS Ministry of Water Resources and Irrigation (MWRI)
  • Mr. Franco Fava, Project Manager, OVCI (PHCC partner to GOSS/CES MoH)
  • Dr. Edwin Taruru – Medical Advisor, OVCI (PHCC partner to GOSS/CES MoH)
  • Mr. Roberto Schettino, Financial Manager OVCI (PHCC partner to GOSS/CES MoH)
  • Gary Cross, Snr. Project Manager Middle East/Africa Compass Integrated Security Solutions

Primary Health Care Summary:

Perhaps Juba’s main hope for an independent, well-developed and coherent Health Care Sector lies with the Juba Teaching Hospital, supported directly by the Government of Southern Sudan and the Ministry of Health.

Still lacking the necessary funds to establish adequate primary and post-graduate training for medical professionals of all specialties, it is the only major health facility in the southern region. Approximately 10 physicians, 5 registered nurses and two qualified midwives comprise the core of its staff, which are responsible for the nearly one million residence of Juba.

Clearly the future of Juba’s Health Sector development is dependent upon the Teaching Hospital’s capacity to train new and existing staff, in particular nurses and midwives. Southern Sudan has some of the highest infant and maternal mortality rates in the world.

Findings:

Upon my arrival to the Juba UN OCHA Offices (Office of the Coordination of Humanitarian Affairs) I met with Heather Dunlop, Health Care Coordinator, who quickly identified the districts of Munuki and Kator as needing better quality, and more consistent access to Primary Health Care.

Both regions have epidemics of Malaria during the rainy season and Munuki recently had a large Cholera outbreak, also an annual occurrence. According to Dr. Dario Lado, Munuki, is the fastest growing district in Juba. The Carter Center’s Trachoma program in Juba is based in this area. Contact with the Carter center was not made during this trip.

Nearby Nyokuron, is a challenged area with the smallest and least capable PHCC yet serving the perhaps the largest community, approximately 150,000. All locations have relatively new state run PHCC’s, constructed within the past two years by OVCI, yet appear underutilized. Children and pregnant women make up approximately 90% of patients seen at all centers.

These three PHCC’s comprise the first tier of the Health Care Sector Expansion to the outskirts of the city. PHCU (Primary Health Care Units) are smaller in size and function and “dot” the area as well however are staffed with even less qualified personnel. It should be noted that only one of the three PHCC’s, which are staffed by the State Government, has a Physician. As a result many just travel to the teaching hospital for treatment.

Kator PHCC

This center is under the direction of Dr. Jamal and is visited on average by 70-80 patients per day. The JTH Drs. hold him in high regard and explained that he has been central to the development of the facility.

The Kator center, like Munuki and Nyokuron is located in a dramatically impoverished section of Juba. These photos typify the areas surrounding the centers. Again lack of publish sanitation is evident throughout Juba.

  • New Ward Rooms – Patients do not stay overnight – only until late afternoon when staff goes home.
  • New Building Construction Possible Site for Short Procedure Theater
  • More of the Surrounding Area A village resident pumps water.
  • Munuki PHCC – The JTH Drs. all stated that the Munuki center had only one Medical Assistant and that is was not functioning to full capacity. The new ward constructed by OVCI at the center has yet to be opened. The guard at the center stated that recently a woman had to give birth in the new latrines because she came to the center and there was not doctor or staff available to assist her. 
  • PHCC Sign Access Road Family Living Nearby
  • Maternity Ward New Latrines Community Well
  • Preparing for Polio Outreach Munuki Night Guard
  • Nyokuron PHCC
  • Nyokuron Center Partners Surrounding Area

Nyakuron PHCC is operating during the day and sees approximately 100 patients per day. During the rainy season it increases to 150 patients per day. There are 3 Medical Assistants on duty but no physician. Their birthing center delivers approximately 8-10 babies per month, however Mr. Celestino explained that if the center were to go back to 24hrs a day deliveries handled at the center would triple. This center is the least modern facility of all three centers.

Despite the lack adequate facilities, which Mr. Celestino did not see as an obstacle to providing care he felt that the center was meeting the needs of the community. He didn’t ask for much when I inquired as to what the center needed most. All he said was better access to water. Their bore hole is weak and can only fill 4 Jerry Cans at a time. He explained that most of the patients travel from far away and need water when they arrive and to take with them when they leave.

Electricity would also help.

Juba Teaching Hospital:

At the center of the PHCC sector is the hospital: Understaffed, under funded, and overwhelmed, the hospital remains dependent upon the government to develop its HC resources.

The hospital campus is a temporary home for many who travel a great distance for care. Family members who cook food for in patients also have to reside on the campus during their hospitalization.

Drs. Danga and Lado expressly requested support for training of more staff, as they see this as the core need of the Primary Health Care Sector. Central to their capacity to attract educated presenters and resident trainers from the UK, US and Australia was a residence center that is to be constructed on Hospital Property. This facility will serve as a visitor’s residence, training center, and office. The estimated $100,000 is a small investment relative to the average $4000/month per person required via hotels, and housing rentals. Within the first year this construction project would likely pay for itself.

Drs. Lado, Danga and Me Proposed Site for Residence

Juba Teaching Hospital Nursing Program:

Formerly sponsored by the ICRC, the Nursing program remained at the top of the list for support. Having skilled nurses to run departments, oversee PHCC’s and PHCU’s, and provide quality health care could not be overstated.

Juba Hospital Nursing School Course Rooms Nursing Library

Country Page: South Sudan Initiative Page: Juba College of Nursing and Midwifery