South Sudan

Juba Teaching Hospital is the only referral hospital in the whole country of South Sudan and is located in Juba City, Central Equatoria State. With an estimated population of 9.58 million basing on annual population growth of 3% from a population census conducted in 2008 and lack of proper functioning primary health care facilities upcountry, many South Sudanese have nowhere to go to but to this national referral hospital. Military and police hospitals, if any, are non-functional country wide, forcing soldiers and officers to share the limited facilities with civilians.

A student nurse attending to Mr Solomon before referral to Addis Ababa (Ethiopia)

Juba Teaching Hospital is directly funded by the central government through the National Ministry of Health. Medical supplies and maintenance are handled through the National Ministry of Health of South Sudan with supplements coming from United Nations agencies and NGOs. The supplies are irregular, forcing patients to buy most of the consumables and pharmaceuticals from private pharmacies. Due to the high level of poverty, most vulnerable patients are not able to afford modern medicine hence increasing patient mortality in Juba.

Our primary goal is to improve the quality and sustainability of medical and surgical services provided in the Juba Teaching Hospital.

Project Objectives:

• Improve patient wards and build infrastructure within Juba Teaching Hospital starting with the Pediatric wards.
• Assist in improving conditions for providing health care at Juba Teaching Hospital, including the policies and management of regular and medical waste.
• Rehabilitate and/or purchase new medical equipment.
• Provide basic medical supplies, disposables and pharmaceuticals for the Pediatric Department, complementing those provided by the Ministry of Health.
• Organize on-site clinical training, beginning with general equipment usage.

Summary of RMF/MMI-sponsored activities carried out during the reporting period undereach project objective: 

• Renovation of one of the Pediatric Wards, Ward 5 (see Photos in Appendix), painting interior & exterior, plumbing repairs, roof and floor repairs, window and door replacement.
• Facilitated the removal of a large portion of one year of accumulated garbage and medical waste from Juba Teaching Hospital grounds (see Photos in Appendix).
• Provided technical support during drafting and finalization of waste management policy guidelines for Juba Teaching Hospital.
• Continued support of high speed WIFI internet services for Juba Teaching Hospital Resource Centre (JTHRC).
• Introduced basic aspects of Respectful Maternity Care (RMC) to maternity staff (Consultants, Medical Officers and Intern Doctors).

Results and/or accomplishments achieved during this reporting period:

 The Health Systems Strengthening project at Juba Teaching Hospital has achieved many notable milestones within the reporting quarter through the committed leadership of JTH, especially the Pediatric Department and Real Medicine Foundation, MMI, and the entire staff of Juba Teaching Hospital. 

• The renovation of the Pediatric Department, Ward 5 began, starting with the surgical side, now fully renovated and already reoccupied, and with the medical side renovations slated to be completed in mid-August. Ward 5 is one of the largest wards in the hospital with a total bed capacity of 120 beds, and bringing it back from its very dilapidated state has been a big achievement.
• Waste management policy guidelines, including segregating regular waste from medical waste in color coded plastic waste bins, for JTH finalized, and the implementation/training process is going on well.
• A large amount of the waste that had accumulated over the course of a year has been removed and disposed of properly and with MOH approval, hence improving the condition of providing quality health care at JTH.
• The janitors and all medical staff working at JTH were trained on the importance of waste segregation, transportation and safety precautions.
• Basic aspects of Respectful Maternity Care were introduced to the maternity staff by RMF Coordinator, Maternal Child Health Programs: Cindy Stein Urbanc.
• Drafted and submitted two study proposals to the ethical committee of the Ministry of Health for approval aiming at researching midwifery stress and burnout at JTH, and the perceptions of the community in Juba regarding maternity care at JTH.
• Support of high speed WIFI internet services for Juba Teaching Hospital Resource Centre that provides internet access to doctors and nurses at the hospital.
• Drafted and signed MOU with the National Ministry of Health and JTH.

Impact this project has on the community:

• The renovation of the Pediatric Ward 5 will reduce re-infection rates among children on admission and will also improve working conditions for doctors, nurses and JCONAM (Juba College of Nursing and Midwifery) students who are on their clinical rotations, and, above all, increase the quality of care patients receive and thus increase the number of patients coming for medical treatment in time.
• JTH premises and the surrounding areas are preserved through removal of the accumulated waste which had posed a threat to the health workers, patients, surrounding community and the environment.
• The working condition of the hospital’s janitorial workers has been improved through implementation of the waste management policy, developed with the support of RMF staff.
• The high speed WIFI internet services for the Juba Teaching Hospital Resource Centre that provide internet access to doctors and nurses at the hospital facilitate research and improve continuous medical education.
• The negative attitudes of the maternity staff towards patients have been changed through the introduction of the basic aspects of Respectful Maternity Care (RMC).

Appendix A:  Success stories

Joshua, a 26 month old boy from Gumbo (Juba), was admitted to the JTH Pediatric Ward with high fever, convulsions, vomiting and generalized body malaise.  A diagnosis of severe malaria was made following laboratory investigation; and he was then managed using I.V. Quinine, Paracetamol syrup and convulsion control with rectal Diazepam. The child significantly improved within 48 hours and the doctor on duty discharged him after 72 hours to continue with oral anti-malarials at home.

The mother of the child narrated to RMF staff that she greatly appreciated our support for creating a clean and conducive environment for the patients which is now bright and clean, and every patient is happy to stay there. This is helping remove the negative attitudes of the community towards the reputation of poor hygiene of JTH, and she promised to tell the community about the new clean environment of JTH. She also thanked all the nurses for their hospitality and the good work they are offering to the people of South Sudan and the foreigners that, despite all the challenges and difficulties, are still present.

Mother of Joshua explaining to the nurses her story and experience in JTH

Mr Solomon Geu, a 28 year old man, South Sudanese from Gumbo (Juba) was involved in a car accident, found unconscious and then rushed to Juba Teaching Hospital. He sustained a closed head injury and was put on conservative management of the head injury without performing basic radiological investigation. Services like x-ray and CT scan are not available at JTH; hence patients are forced to do radiological investigation from private diagnostic centres. At the time RMF saw Mr. Solomon, the relatives were not able to afford a CT scan, hence RMF decided to cover the CT scan cost so as to obtain a clear diagnosis. A CT scan done on June 28^th revealed multiple basal skull/vault fractures and epidural hematoma. This helped the surgeons tremendously to reach a final diagnosis and the patient was later referred to Addis Ababa (Ethiopia) for further management by neurologists. The relatives of Mr Solomon thanked RMF for the great financial support; without it, the final diagnosis of the patient wouldn’t have been reached and the patient wouldn’t have been able get proper management from a better centre.

Renovation of Pediatric Ward 5

Men at work during renovation of Pediatric Ward 5

Working on the toilets of Pediatric Ward 5

Working on the inside of the Pediatric Ward 5

Painting the exterior wall of the Medical Unit  Pediatric Ward 5

Plastering the wall of Pediatric Ward 5

Painting the inside

A painter working on the windows

Washroom connecting the Surgical (L) and Medical (R) Section of Pediatric Ward 5

Front side of Pediatric Ward 5after painting

Medical Unit of Pediatric Ward 5

Nurses on duty in the newly renovated Surgical Unit of Pediatric Ward 5. They were very happy for the support of RMF/MMI.

Waste Management

Juba Teaching Hospital has been operating with no clear waste management policy guidelines and there was an accumulation of wastes (medical waste mixed with non-medical waste) over the period of a year, no proper waste segregation, and inadequate fuel supply for the incinerator. All these were due to the implementation of austerity measures imposed by the government in 2012. The huge amount of accumulated waste became health hazardous to the health workers, patients, community and the environment.

Photos before Waste Removal

RMF decided to facilitate both the removal of the waste, and the provision of technical support to develop a better long term waste management policy for JTH.  These policies were printed and disseminated to the entire department and a training of the janitors in proper waste segregation, transportation and safety precautions was conducted.

The Director General for JTH, Dr. Kajomsuk Abdalla Moi, on behalf of the hospital, acknowledged the support offered by RMF in waste management and ensuring the environment is conducive to health care. The entire hospital staff were extremely happy for the good work done and recognized RMF as an important partner of JTH. The DG said that without the support and commitment of RMF all this wouldn’t have been possible.

Public Health Officer Brian, Okang Wilson, RMF Finance and Project Coordinator, and Dr. Kajomsuk Abdulla, DG for JTH.

Photos before waste management initiated by RMF

Activities

We hired a company in the week of May 30^th to remove waste from the dumping sites and analyzed the amount left over to quote a price to remove the remaining waste. This enabled the removal of about half the wastes compiled (documented in photos below).

Other Project Photos

The father taking care of this child who was admitted due to complications of malnutrition

A neonate admitted because of a skin condition in Pediatric Ward 5