One Week In South Sudan

Monday, March 26, 2012

It's Monday, and I've been in South Sudan for a little more than a week. Which, seeing that it became a country only this last July, means I've lived here for about 3% of its history.

I would like this to be a very thoughtful and detailed blog entry about my initial impressions of South Sudan. But we've been keepin really busy, and I haven't really had the energy to put my thoughts down along the way. This will have to do for now.

South Sudan is about the size of France, which means it's smaller than Texas. Actually, to put it into perspective, it's about 17 Rhode Islands smaller than Texas. It broke off from the rest of Sudan on July 9th, for many many reasons (more than I understand, and too many for a short blog entry).

So it's the newest country in the world, and it has its share of problems.

Maternal mortality, for one, is what some would call high. Actually perhaps it's the worst in the world. Women have about a 2% risk of dying each time they get pregnant. Compare that to the US, where the rate is almost a hundred times lower. So for a South Sudanese woman that has 5 babies over her lifetime, that's a 10% risk of death during pregnancy. And some think that is a conservative measurement.

I've been in Juba since last Sunday. This time of year, the weather is hot. Mostly over 100 degrees hot. It's humid, and at the same time looks and feels a bit like a desert. The rains are supposed to come this month, which should cool things down a little (crossing my fingers for the upper 90s). And the rains should also help settle the dust and clear the air. And there will soon be mangos. Lots and lots of mangos.

There are many different groups of people making up South Sudan. I heard there are around 71 languages spoken by the South Sudanese. I think that might not include the languages spoken by the immigrants, mainly Kenyans, Ugandans, and Ethiopians. The language used on rounds in the hospital is English, but most people communicate with Juba Arabic, a simplified form of the Arabic language. Many patients on the wards speak neither English nor Arabic, and sometimes the South Sudanese health workers cannot communicate with a patient. Most patients come with a "co-patient" that helps communicate for them, goes on runs to the commercial labs and pharmacies when our facilities don't have the necessary tests and drugs, carries them to the bathroom, swishes away flies, and other tasks that the nurses can't or won't do.

South Sudan has about 10.5 million people, and while 250,000 was the estimated population of Juba in 2008, that number is certainly much higher now, after Independence and its associated migration. Besides the walk between my house and the hospital, I haven't seen much of the city. I see the local guys hooping it up on the basketball court on my way home from work. The men of the Dinka tribe are so tall! I've heard that the NBA occasionally has scouts out here...looking for the next Manut Bol or Luol Deng.

The food has been pretty good. Lots of beans, which makes this Mexican a happy man. The Sudanese food so far has been mediocre, though the Kenyan restaurant at the end of my block (I think it's called California Kitchen), with it's delicious chapatti has been pretty good. The main savior has been the Ethiopian presence. Considered the best cuisine in Africa by many, I'm blessed with two restaurants mere yards away from our house.

I've been at the hospital every day since arriving. We are working to train midlevel practitioners, interns and general practitioners on the emergency ward. Basically two long rooms, one each for men and women, these wards hold all the patients with non-surgical issues that are admitted to the hospital, until they are stable enough for transfer to the chronic ward or discharged home. The pathology has been as fascinating as it is tragic. The excitement felt when a patient presents with a physical finding that you rarely see in the States is quickly dampened when you realize that the finding often signifies prolonged pain and suffering due to a dysfunctional health system.

The deaths way heavily on the soul. Many patients come in febrile, breathing fast, with low blood pressure and a look in their eyes that reveals their fear. Some we are able to save. The others die as I stand there, wishing I had more diagnostic and therapeutic measures at hand. Wishing I was a better doctor. It's challenging.

We've had some saves. A woman that we thought had severe anemia due to malaria, did indeed have malaria but also had an abdomen full of blood from ruptured ovarian cysts (picked up on by one of the local docs). She was rushed to surgery, and while in critical condition with a hemoglobin of 2, she was still alive this afternoon.

Another woman came in jaundiced, febrile, and with right upper quadrant abdominal pain. With the help of an ultrasound we performed at the bedside, she was diagnosed with an infection in her gallbladder. She also was hypotensive and confused due to the systemic infection and poor blood flow to the brain. With a lot of fluid, IV antibiotics, and luck, she was well enough to shower today.

All in all, things are good. It was a tough first week, but this week I'm feeling more comfortable in my role. Lots of work to be done here. Hopefully things can change some small bit for the better. But off to bed now.