Blog

Staff at the Clinic Make a Difference
June 27, 2010

When the rains hit in South Sudan this time of year, a lot of things get slowed down and halted. Because of the poor condition of the roads when it rains, the chance of getting a vehicle stuck and even lost is very high, since the roads are all dirt.

But for the staff of the Duk Lost Boys Clinic, those risks are worth taking.

It happened one night when a mother in labor came to the Clinic. She had been in labor for three days but was unable to deliver, and had to be brought to a surgical theater for a C-section (one of the few capacities the Clinic isn’t able to handle at the moment). A driver and a nurse drove the woman from the Clinic to the surgical site, getting stuck in the mud several times along the way until finally getting stuck 15 minutes from the site, unable to move, and with no other vehicles around to assist.

The husband ran to a nearby village for help, and brought back a group of volunteers with a homemade stretcher, who went on to carry the woman by hand the rest of the way. Once arriving at the surgical theater, the woman delivered a healthy baby boy. Meanwhile, the driver and nurse stayed with the vehicle throughout the night, with no food or water. The nurse eventually walked back to the Clinic after not having eaten for several days. Once the rain let up, one of the few other vehicles in the area came to assist and pull the JDF vehicle out. It wasn’t long after when the Nurse, Abraham, was back to work. “It’s all about the patients,” says Abraham, a native of Duk who was trained while a refugee in Kakuma Refugee camp in Kenya, where he also met John Dau. “They could pay me $1 and it doesn’t matter.” His fellow, Nurse, “Tall Paul”, shares the same attitude. “I love my job. I love my job,” he often says, smiling. They are what make the work going on at the Duk Lost Boys Clinic so special.

A 15-Month-Old Girl’s Story
May 5, 2010

It was a long month, but a positive one for a 15-month-old girl in South Sudan.

Her mother had brought her 55 miles from her home village to the Duk Lost Boys Clinic for treatment. She was malnourished, suffered from chronic diarrhea, and had an infection. She was received by Juma Malual, who was born in Duk and is one of the Clinical Officers (akin to a Physician’s Assistant in the U.S.) at the Duk Lost Boys Clinic. Though he is from a different tribe as the girl’s, he speaks several other local languages and conducts consultations in multiple languages on a daily basis. In this case, the girl was given medicine for intestinal worms and parasites, which were robbing the little nutrition she was already getting. She was given an antiobiotic to fight the infection, and given vitamin A supplement, which is a routine preventative measure to protect against night blindness and measles. She was also checked to make sure she had gotten her vaccinations.

One of the first differences one can notice between a healthy child and a malnourished one is that a malnourished child is inactive, tired, and sad. This was the girl’s (whose name is withheld out of respect for confidentiality) state a month ago, so much so that Juma took a picture to document it. But after returning this month for a follow-up, she was a changed girl, fussing and giggling like any healthy toddler would. Though still underweight, she had improved thanks to the medicine she had been given and her mother’s good feeding. Because of the malnutrition, her growth has been stunted and she has not taken her first steps yet. But thanks to the treatment she was able to get, those first steps are sure to come any day now. Maybe next month will be even better.

Records Break in March
April 25, 2010

March was a busy month for the Duk Lost Boys Clinic, setting all kinds of records in its three-year history. These records include the highest number of patients in a month (2,457), which meant conducting a record number of laboratory tests (1,049), a record number of pre-natal check-ups (155), and the midwives tied the record for deliveries in a month with 10, set the month before.

In addition to all this happening at the Clinic, it was a busy month for outreach activities. The Clinic’s vaccination team reached 700 children, gave tetanus toxoid vaccine to 348 mothers, and gave de-worming to 4,942 school children. The month started off with a refresher training for 25 traditional birth attendants, supplying them with safe delivery kits, mud boots, flashlights, and rain coats. These are key items that will help ensure they can conduct safe deliveries in some of the most challenging conditions one can imagine.

The high number of patients at the Clinic was due to many factors, including an increase in services. For example, the Clinic recently received a donation of an ultrasound machine, which is used for the detection of high-risk pregnancies. In just one week at the Clinic, it was used to diagnose a twin pregnancy, malpresentation, and polyhydramnious (an excess of amniotic fluids) which can lead to premature labor. This is added to the Clinic’s other prenatal services, such as laboratory screenings, counseling and testing for HIV, immunizations, and malaria net distributions.

The weather in Duk was unforgiving as well, a mix between 100+ degree Fahrenheit days and blusterings winds that brought occassional downpours. And yet the Clinic staff remains strong.

Things don’t seem to be slowing down either. During the first week of April, the Clinic set a record for total visits in one day with 205, many people coming from 50 kilometers or more away. This time of year is at the opposite end as the harvest season, meaning a spike in malnutrition, which can perpetuate other common diseases such as pneumonia, malaria, and diarrhea. This month, the area in which the Clinic serves was classified as very food insecure by the World Food Program, with up to a quarter of the population there severely food insecure.

This comes at a time when South Sudan will hold its first elections in more than two decades. With life beginning anew for the Sudanese here, one thing that they won’t have to worry about, thanks to the generous support of people a world away, is where they can find healthcare.

Ultrasounds Offered at Clinic
April 12, 2010

Dr. David Reed, one of the John Dau Foundation’s Medical Directors, made a delivery of all sorts last week.

Thanks to a generous gift from SonoSite Corporation’s SoundCaring program, Dr. Reed delivered the first ultrasound machine ever to be used in Duk County. Dr. Reed, who volunteers his time to advise the Clinic and JDF, traveling to the Clinic on his own expense, spent several days training the Clinic staff in the use and maintance of the equipment. In the United States, he routinely trains medical students in the use of ultrasounds as a professor in the SUNY Upstate Medical system.

The equipment is portable and durable, and so it works well with the climate of South Sudan and for the needs of the Clinic. In its first week at the Clinic, staff used it to detect a gut obstruction in a woman, allowing them enough time to refer her for surgery, and likely saving her life.

Ultrasounds will allow for the improved diagnosis of high-risk and complicated pregnancies and will be incorporated as a routine part of prenatal care. Last month alone, the Clinic received over 100 prenatal visits, and the number is quickly rising thanks to the Clinic’s midwives and medical staff. It will be a tremendous boost to the Clinic’s maternity services, in an area where a woman is more likely to die from pregnancy than to finish school. The equipment can also be used for trauma victims to detect internal bleeding.

It is one more step towards the John Dau Foundation transforming health care in South Sudan.

Donating Blood Saved A Life
March 31, 2010

On a visit last week to deliver ultrasound equipment to the Duk Lost Boys Clinic, John Dau Foundation Associate Medical Director Dr. Reed was called upon for something not requiring his medical knowledge.

The evening of Dr. Reed’s last night in Duk, a young mother and her husband came to the Clinic. She had given birth in her village several weeks ago, and had post-partum hemmorage. In several weeks time since the delivery, her anemia had worsened and she was at risk of dying.

One of the Clinic’s goals for 2009 was to develop the capacity for emergency blood transfusion. Dr. Reed sat with the Clinic’s laboratory technician early in the year and wrote out the needs on a scrap piece of paper. He and other members of JDF’s Board of Directors and Advisors worked for many months to make it a reality, and thanks to generous donors, in November the supplies were delivered to the Clinic.

This was just the third tranfusion to be done, yet each one is done only when a life is at risk, as was the case.

The woman’s blood type happened to match with Dr. Reed’s. It was too much of a coincidence. That moment in the hot Sudan night represented everything coming full circle. After a few moments of reflection and with no other prospective donors immediately available, Dr. Reed donated a unit of blood, just as it would have been done in the United States: with proper screening, cross-matching, and even juice afterwards. And though there were not any stickers like the ones given at blood banks to say so, everyone in and around Duk knew that he had donated blood, and by doing so, saved a life.

Displacement Occurring in Duk County
March 25, 2010

When the John Dau Foundation constructed the Duk Lost Boys Clinic in John Dau’s home village of Duk Payuel in March 2007, there were just a handful of people living there. In the three years since then, the population of both the immediate village and the entire county of Duk has grown immensely to more than 70,000 people.

Yet things are still not settled in Duk, evidenced by a recent report from the United Nation’s Office for the Coordination of Humanitarian Affairs. This report reveals that in the past year, 52,266 people were displaced within Duk County. This means that these people were forced from their lands due to violence, instability, draught, hunger, or other reasons outside of their control. Even though Duk is one of the smallest counties in the country, more people are being displaced from Duk than any other county in all of South Sudan. Duk was one of only two counties with more than 30,000 displaced persons in all of South Sudan, illustrating the huge need still present in John’s home village, more than two decades since he himself was forced from there.

Many of these people have resettled closer to the Clinic. The Clinic is considered a safe place since it treats all patients without regard to race, religion, tribe, or other factors and is well regarded by the community. Others are forced to move to a new place, leaving behind few possessions including food, and forced to literally rebuild in a new place. The Clinic works hard to reach these people through its routine outreach programs, which provide vaccinations to children and pregnant mothers, de-worming, trainings of community health workers, and education campaigns.

The Clinic operated continuously throughout 2009, and is the only reliably-operating health clinic for more than 100 miles. The assumption amongst the community and humanitarian agencies is that 2010 will not be any better. The need remains, though eased by the sustainable work of the Duk Lost Boys Clinic and the John Dau Foundation, pushing on in a place where others aren’t, and where the need is among the greatest.

Midwife Comes to the Clinic
March 15, 2010

The Maternal Child Health (MCH) services at the Clinic have been growing exponentially over the past several months, thanks in large part to the work of the Clinic staff led by its Nurse Midwife, Heryne. Since arriving two months ago, Heryne has been both doer and teacher. She unhesitatingly gets up in the middle of the night for a delivery or an emergency, or runs off to a village to attend to an emergency such as a miscarriage or post-partum hemmorage. She has also spent her time passing on her skills to the other Clinic staff as well as Traditional Birth Attendants, who sit in with her on consultations, exams, and antenatal care (ANC) check-ups. These check-ups include a full lab screening for anemia, malaria, and other conditions, and most recently, HIV/AIDS counseling and testing. Next month, the Clinic will be able to offer ARV medicines to prevent the spread of HIV from mothers to their children. With her experience in HIV/AIDS services in Kenya, she will be a great leader in beginning this program at the Clinic. In a few weeks, the Clinic’s Associate Medical Director, Dr. David Reed, will be bringing over ultrasound equipment which was donated by Sonosite Corporation, and training staff in its usage.

The midwife’s efforts at building trust with the community through the Traditional Birth Attendants has shown big results. Prior to her coming, many women were hesitant for various reasons to use the Clinic’s birthing room and services, and often just a handful of women would deliver at the Clinic in any given month. In February, Heryne set a Duk Lost Boys Clinic record for deliveries with 10, plus she helped over a half dozen other women who came in with complications. Most were brought in by Traditional Birth Attendants with whom Heryne has now developed a great relationship. “These Traditional Birth Attendants, they’re so smart,” she says. She ended the month of February by dashing off in the Clinic’s new vehicle to attend to a woman with post-partum hemmorage, whose husband walked three miles to the Clinic to get help. The vehicle had just arrived the day before, and is the Clinic’s first.

March started off even faster, with two deliveries on March 1st alone—the first just after midnight, and another one 21 hours later. Right after the second delivery, Heryne and a Clinical Officer attended to a woman with a miscarriage, working into the night, and waking up the next morning for routine consultations.

The John Dau Foundation is now working to raise funds to complete the Clinic’s maternity ward, including constructing a recovery room for mothers who have recently delivered. The Clinic recently built a bathroom and shower for this as well. Thanks to its current donors, the Clinic has purchased a variety of important items for the delivery room including sanitary buckets, bed linens, and educational materials.

These are huge steps for an area where Maternal Child Health is considered priority number one—with maternal and child mortality rates among the highest in the world. With such services not available for more than a hundred miles, and in no place as remote as this, what is happening at the Duk Lost Boys Clinic is truly a model for what can be done to make a difference.

Important Meetings Held in Juba
March 5, 2010

At the time when the John Dau Foundation constructed the Duk Lost Boys Clinic in May 2007, South Sudan was deserted—there were few non-governmental organizations (NGOs) operating, the Ministries and government infrastructure was extremely limited, and the country was just starting to rebuild itself. Juba, the capital of South Sudan, is not what many would consider a capital city in today’s world. Only its main roads are paved, most houses are “tukuls” or shacks fashioned with iron sheets, electricity is very sparce, and there is no central water or sewage system. However, work is continuing, and John Dau Foundation staff and the DLBC’s Clinic Manager spent several weeks in Juba last month. They spent their time there networking and coordinating resources with other NGOs, meeting with Ministry officials, and picking up the Clinic’s first vehicle. The vehicle was recently purchased in Nairobi with funds generously provided by our supporters.

The meetings included talks with the World Health Organization (WHO) to provide testing supplies for diseases such as Kala Azar, meningitis, and cholera, all of which are potentially endemic diseases that the Clinic works hard to monitor. There have been dozens of cases of meningitis throughout South Sudan in recent weeks, including one in Duk County. The Clinic staff reported the details of the case to the WHO, and in that same week, the Clinic’s outreach team was in the area where the case occured conducting immunizations. JDF also participated in the monthly South Sudan Health Forum, a meeting of health NGOs in South Sudan.

Also during the trip, staff worked out procurement for yearly supplies of fuel, construction materials, and other items, all of which will be delivered to the Clinic by truck, a journey that can take up to three days. This procurement is especially important now, as the Clinic works to pre-position supplies ahead of the rainy season, which runs from May until October. It is also in preparation for the January 2011 elections in Sudan, where services and supply lines could be interrupted or delayed. During those times, the only supplies that can reach the area must come by charter plane to the dirt airstrip next to the Clinic.

Slowly, South Sudan is rebuilding after the 21-year civil war that ravaged the country and forced out much of the population. Thanks to the efforts of JDF and other groups, the people of Sudan are slowly rebuilding their lives. It’s a process that no doubt takes time, but as proof of all the great things happening at the Clinic, in the words of John Dau, “Hope is never lost.”

Developing An Awareness of HIV/AIDS
February 10, 2010

It all started with an idea last summer, across 8,000 miles, from South Sudan to the United States. Gabriel Manyok, the Duk Lost Boys Clinic Outreach Coordinator, had an idea to begin a youth drama club throughout Duk County, that would teach about HIV/AIDS to the community using drama, a popular medium in South Sudan. Working closely with the John Dau Foundation staff, they developed the idea.

On Sunday, January 24 what began as an idea officially turned into reality. After having collected the youths from the county, 22 in all and nine of them girls, they began a week-long training. Gabriel sat with them under the shade of an old tree in the middle of Duk Payuel, prepping them for what was going to be a big week ahead. South Sudan may be the last untouched pocket of HIV/AIDS in all of Africa, but with its population returning from countries like Kenya and Uganda, where HIV prevalence is above 7%, it could quickly spread across the region.

That makes these youths and teachers the first line of defense in their communities. Several Clinic staff, who gave presentations on various topics throughout the training, told the youth that they were being sent out to spread a very important and very new message.

The training covered issues such as prevention, cultural attitudes, community mobilization, human rights and acceptance of people who are living with HIV/AIDS. It also covered other issues, including vaccine importance, hygiene and sanitation, and respiratory illnesses, which are very common in the area. For the youths, who were selected to participate by their communities, it made for a great source of pride to be part of the training, as well as a time to meet new people from across the county. They stayed in several ”tukuls”, which are traditional mud and timber huts, getting treated to sodas at the closing ceremony, in which they presented several dramas and heard speeches from Clinic staff. They also designed their own t-shirt, which will be printed in Kenya and distributed to them in the field as Gabriel follows up with each group. The students will also go out and train their peers, creating mobile theaters. All have their work cut out for them as this very important program moves forward, but it will move on as a community-based effort, which all began with an idea out of a small village in South Sudan.

New Blood Bank at the Duk Lost Boys Clinic
January 26, 2010

It happens all too often around the world, especially in underdeveloped countries: A patient suffers and too often dies because of a lack of something simple, something available in the wealthier countries but not for the rest of the world, a medicine, an instrument, equipment, or trained personnel. All too often health workers in these places can only look around and lament how they wished they had the abilities of nations with established health care. Thanks to worldwide efforts to reduce medical drug prices, develop medicines for neglected diseases, and raise money and support for impoverished nations, countless lives have been saved over the past decade. Unfortunately, these changes come little by little.

For the Duk Lost Boys Clinic, help came in the form of a Directly Observed Treatment Short-course (DOTS) program to deliver complicated treatment for Tuberculosis, mosquito nets, a cold-chain supply to enable the delivery of vaccines, and an HIV/AIDS testing and counseling program. This spring, thanks to a generous gift by Sonosite Corporation’s Sound Caring program, the Clinic’s medical advisor, Dr. David Reed, will be delivering and training the staff in the use of ultrasound equipment.

Last November’s charter plane brought supplies for a blood bank, specifically meant for emergency, life-threatening cases such as postpartum hemorrhage and trauma. The package consisted of simple basics such as a water bath and centrifuge, and costs less than $2,000. It will save countless lives in the region.

A 23-year old mother came in recently from about 25 miles away. She had been vomiting for a week, and had severe anemia. She hadn’t recovered well enough yet from her recent pregnancy, and, combined with a limited diet, she was in serious condition. Her hemoglobin level was below the point at which many people die. The staff, most of whom have been trained in blood transfusion elsewhere, called a quick meeting and talked the issue over. They sent an aide out to collect the women’s relatives in order to find a donor. Several were screened and matched, and two people each donated a pint of blood. The next night, at around 10pm, the staff began the first blood transfusion ever in Duk County. The next nearest blood transfusion site is 93 miles away, and transporting her there would have surely been fatal given her condition.

Abraham, one of the Clinic’s nurses, sat in the room with her the entire night. Her six-year old daughter waited at the foot of the bed and wandered the halls of the Clinic as her grandmother sang her baby brother to sleep in the next room.

By the next morning, her appearance hadn’t changed much, but her breathing and blood pressure had improved dramatically. The following afternoon, she finished the second and final transfusion and was recovering well with her children.

She or her daughter may never know everything that went in to providing the capability that saved her life, or how fortunate her timing was, but they know better than anyone the value it presented.