Sudan: Juba Teaching Hospital then and now
The ICRC began working in the 512-bed Juba Teaching Hospital (JTH) in southern Sudan in 1993 with an expatriate surgical team that treated casualties of the then still-raging ten-year civil war. JTH has since been completely transformed and gone on to become the hospital of referral for southern Sudan.
Back in 1993, the ICRC set up laboratory facilities in JTH and provided an X-ray machine, with the aim of delivering proper emergency surgical and post-operative care to the population in and around Juba town. The ICRC has maintained a strong presence in the hospital ever since, and currently has a team of 16 expatriates in Juba, including two surgeons, an anaesthetist, a paediatrician, and a general practitioner. In 2001, in response to a request from the local health authorities, the ICRC began developing the capacities of the Sudanese staff through training programmes and coaching for nurses and medical assistants. This remains a major focus of the work today.
The Juba Teaching hospital has 400 nursing staff including 230 students from the nursing school. Four ICRC nurses – the head-nurse, teaching nurse and two ward nurses – are in charge of the daily coaching of students on the wards. The teaching nurse and the Sudanese nurse tutors give theoretical and practical lectures in order to refresh and expand the knowledge and skills of students on the In-Service programme. New teaching methods are being introduced in the classroom, staff rules and regulations are being reinforced, and practical work is an integral part of every student's training.
Since 2002, the ICRC has also been doing skills training at the Health Science Training Institute (HSTI). There are two components to the programme, which is intended for general medical assistants, laboratory assistants, and assistants working in the operating theatre (OT). The ICRC medical doctor and surgeons are involved in the students'practical training on the paediatric, medical, surgical and other wards. The ICRC has helped set up and stock medical libraries in the nursing school and HSTI in collaboration with the local authorities.
With the generous support of donors, the ICRC continues to supply the hospital with pharmaceutical, medical and surgical supplies on a monthly basis. Equipment and chemicals for the laboratory, including a blood bank, are also provided. Tests performed include blood smears, parasitology of stools, basic haematology and all the serology necessary to perform safe blood transfusions. In addition, the ICRC provides JTH with hygiene material, bed sheets and staff uniforms on a regular basis, as well as covering the cost of two meals a day for the patients and food supplements for those needing extra protein. All 850 hospital employees receive food incentives.
Over the years, the ICRC has played a major role in the hospital's rehabilitation, and is currently involved in helping to refurbish and maintain the water and sanitation infrastructure. Since power cuts are frequent, the ICRC provides fuel for the hospital generator.
A distant memory
Margaret Sitti (53), a Sudanese assistant head nurse on the surgical ward started her career at JTH as a trainee medical assistant 30 years ago, and remembers the situation well. " Before the war, there were around 50 doctors working in the hospital, " she says, " but because of the security situation during the war very few of them remained in Juba. There was no support to the hospital, and the situation deteriorated. Patients had to bring their own medical supplies, there were problems with sterilization, electricity, and water supply, and the staff weren't paid. "
Margaret has seen the hospital change from the unfortunate place described above, to a facility where people come knowing that they will get the best treatment available. Since the signature of the Comprehensive Peace Agreement in January 2005, access to the hospital has improved and JTH has become the referral hospital of southern Sudan. Between January and May 2006, there were 7,720 admissions to the hospital, of which 6,400 were medical patients. During the same period, 1,314 surgical operations were performed.
During a recent visit to JTH, a first-time visitor was struck by the sheer number of people crowding the corridors and grounds. Dozens of women shouldering sick babies crowded around the nurse who was making outpatient appointments. Their husbands looked on with curiosity from the doorways. The wards were full, and visiting relatives wandered in and out or sat picnicking in the garden. In the midst of all the clamour and noise, the ICRC's tiny office near the entrance gate was a haven of calm. Despite a sudden power failure, the routine work of hospital management continued uninterrupted. It is this perseverance, together with the support of donors, the dedication of hospital staff and students, and good collaboration with health authorities that ensures the current quality of care and makes Nurse Sitti's comment about JTH during the war seem but a distant memory.