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A Typical Day in Sudan
September 26, 2010

The morning starts at different times for each person. There are a few alarm clocks one can choose from, from the soft sounds of crickets and frogs, the cock crows as the sun starts to go up, or drum beats from someone making music in the village. Usually the final wake up call comes when the Clinic’s facilities manager fires up the generator, which runs a submerged well pump and pumps water up into the storage tank in the Clinic and is used to clean the Clinic in the morning. It takes about an hour to fill the tank, which lasts the whole day. After that it’s the sweet sound of nothing, as an array of solar panels, donated by several groups and individuals in the United States, powers most of the Clinic’s other needs, such as laboratory equipment, satellite Internet, and nighttime lights.

The sounds penetrate easily through the tents where most of the staff lives. Staff who have homes in the village make their way to the Clinic by about 8am, where they take a light breakfast of tea and maybe bread from the night before. This morning it’s mandazi, a sort of fried dough, from last night’s dinner. Living together in the same place, the staff becomes very close and communal, sharing meals, jokes, and just about everything else, including the occasional hardship, and especially the successes.

Newton, one of the Clinic’s lab technicians and a skilled farmer, goes out to the garden to pull some tomatoes off the vine before they can be spotted by birds and eaten. The staff spends their weekends and some afternoons tending the garden, which is now booming and an example for the community in an area that could be the breadbasket for Africa. Mothers are taken through the garden when they come to the Clinic to learn about improved nutrition and farming methods.

There’s already a group of patients, some who set off hours ago or even the previous night, through knee-deep flood water making their way to the Clinic. Walking is the only option now with much of the entire region covered by standing water from intense rains the past month. It’s hoped that the rains have peaked now and the waters will begin to recede by November or December.

The staff spends the first half of the day with patients. The two Clinical Officers, equivalent to a Physician’s Assistant in the United States, will see 30 or more patients each in a day. Today is a Monday, so it’s vaccination day for mothers and children. Women in the area dutifully bring in their children’s health cards, a big step when record-keeping is so rudimentary compared with the West, though just as important. The midwife weighs each child and marks it on a growth chart on the child’s card. JDF is hoping to launch a nutrition program in the coming months to better manage children who are identified as being malnourished.

The reasons for visiting run a broad spectrum, from malaria to HIV counseling to an older woman with a big cut on her hand. By the afternoon, the Clinic has received 80 patients, which is generally considered a slow day. A dozen patients come for their daily treatment for tuberculosis, the only place for more than a two or three days’ walk that can treat the disease.

The staff goes for a lunch of rice and beans, a staple, since the cost of food is so high in the area. The expansion of the garden provides some diversity, including kale, tomatoes, corn, and in a month’s time and with careful tending, watermelon and pumpkin, amongst other seeds brought from the United States.

After lunch, it was a haircut day around the Clinic. The Clinic’s pharmacist, Victor, gave cuts to several of the guys under a tree outside. The staff is in and out of the Clinic tending to patients as they come in. The Clinic has never closed in its history, after more than three years and 35,000 patient visits.

Some afternoon storm clouds roll in and everyone braces for rain. The flood waters have already displaced more than 1,500 people in the village and thousands more throughout the county and region. Thankfully, there haven’t been any deaths reported, but the Clinic is on alert and monitoring the situation, responding to an increase in certain illnesses. The rain came for just 15 minutes and was gone, making way for a beautiful sunset.

It was a special dinner, with a simple but tasty beef stew and bread. Earlier in the week someone in the village butchered a cow, a rarity since cows are usually only slaughtered on special occasions. With the remaining solar power, some of the staff watched TV as they ate, usually American or African movies brought from the United States or Nairobi. Some of the staff, several of them who come from Kenya, checked e-mails from home before turning in for the night, prepared for what the night might bring—a late night delivery, which would call out of bed the midwife, clinical officer, pharmacist, and perhaps a lab technician for blood typing or disease screening.

In a place where health care is still so limited, the Duk Lost Boys Clinic is an example for what can be done throughout the region and South Sudan. It’s how day in and day out, the Clinic is transforming healthcare in South Sudan.

A Work in Progress
September 13, 2010

Over the past year, the number of women seeking maternity services at the Clinic has risen dramatically. This is because of the many initiatives by the John Dau Foundation such as trainings for traditional birth attendants, hiring of new clinical staff, and an increase in supplies brought in to the Clinic. The number of women coming for routine prenatal care checkups has grown by more than ten times what it was a year ago. The number of births at the Clinic has quadrupled, astounding numbers for an area where women have been used to only traditional practices, and where no other such services exist for more than a day’s walk.

Yet, the challenges are still great. Just last month, a mother passed away at the Clinic during a difficult delivery. This woman had been eagerly coming for the prenatal and maternity services at the Clinic such as getting her blood screened and receiving vaccinations. She needed a Cesarean section, a function for which the Clinic is still lacking both physical and human resources to handle. The loss weighs especially heavy on the Clinic staff, who are working in an area with so few resources.

This is an illustration of the amazing things the Clinic has been able to do in an area where 1 in 7 mothers will lose her life to childbirth, and a showing of the work that is still to be done.

Midwives Help Clinic
August 22, 2010

The weather in Duk is changing, but the workload is not.

Since May, the rains have become more and more intense. They paused for a week recently, but restarted with a vengeance the other day as soon as a supply plane landed on the dirt airstrip in Duk Payuel. It was a mixed blessing—good for the crops that are now growing around Duk, yet bad because of the problems the intense flooding brings. Problems such as a spike in Malaria and other water related diseases and the cutting off of travel around the region for the Clinic’s outreach team.

I landed in Duk just as a heavy downpour came in. We walked through several inches of rain to get to the Clinic from the airstrip, which was nearly flooded. The pilots of the small charter plane miraculously took off. Still suffering from jet-lag, I woke up twice in the middle of the night to the Clinic’s guard rousing the nurse and midwives. There were two deliveries in one night—a year ago we may have gotten two deliveries in a month.

I spent a good part of the first day talking with the Clinic’s devoted midwives. I was so impressed. We have one nurse-midwife, Caroline, from Kenya, who works alongside a local Sudanese community midwife, Akech. We were able to hire Akech in June. Trained South Sudanese midwives are very few, and so to have one is a great benefit to the Clinic and the community. Akech is also learning and growing a lot from working alongside, Caroline, our more experienced and trained nurse-midwife. The two have been working incredibly hard—frequently up all night for a late-night delivery, and then in their consultation room the next morning providing daily consultations to mothers. The community has become so happy with the delivery services offered by the Clinic that many mothers have named their babies Caroline.

As one of the all-too-few places in South Sudan providing this kind of quality, life-saving care, it’s an example to what the future for South Sudan’s health system can be. It’s one of the ways in which JDF is transforming health care in South Sudan.

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.