Abraham Mabior Rioc, Bor
As a responsible family man performing my specially assigned gender roles at community and family level, I took my wife to Juba Teaching Hospital for check ups on complications relating to a miscarriage. I did this on the evening of 2nd April, en route home from work. In general, I have a strong therapeutic perception that human life is preciously important, and people should be cautious and attentive to sick family members.
In the sphere of health, the human is dependent on diagnosis and medication provided by qualified professionals in a medical environment. Unfortunately, South Sudan is in bad shape in terms of medical facilities, equipment, training and manpower. Despite this, I was impressed by the attractive health facilities constructed at Juba Training Hospitals by the Chinese.
I considered and analysed the brilliant diplomatic relationships of South Sudan and China, particularly in the areas of development and humanitarian assistance. Among them is the construction of a number of state of the art health facilities at Juba Teaching Hospital. Such sends out great hope to the public, as modernisation and expansion of the hospital seems possible for the general common good of mankind.
Literally, China’s donation to expand and modernise Juba Teaching Hospital demonstrates the country's strong commitment to supporting this young nation in developing its health sector. The hospital has received a 4 building expansion, specifically an outpatient and emergency sector, obstetrics and gynaecology multi-purpose departments, and dormitories for the Chinese Medical Team. The amazing China-aided project received great applause and admiration from the South Sudanese people.
The hospital has also recently received solar panels to provide 24 hour lighting systems. Equipped with batteries and metal poles, the panels ensure constant energy supply for 700 staff and 500 patients. They were implemented in support of UNMISS' Quick Impact Project. The solar panels power fully automated, energy saving lamps. The nifty devices switch on and off automatically when darkness sets in and out, and then spend their days resting, soaking up the reliable South Sudanese sun for hours on end.
While at the hospital, I met a colleague who had accompanied his brother's wife for the same purpose as mine. For a number of demographic, environmental and geographic reasons, cesarean delivery is very popular amongst expectant mothers in South Sudan.
It is undeniable that maternal and newborn health services could not function without experienced doctors, midwives and nurses. A shortage of these skilled healthcare workers will obviously negatively affect the quality of services delivered to women, children and adolescents like. Such services often risk being little more than therapeutic lip service, understaffed and under provided.
This is demonstrated in Caesarean section procedures, in which a surgical procedure is used to deliver a baby through incisions in the abdomen and uterus. It is often performed when a pregnant woman is known to have a blighted ovum.
As my wife was examined at the hospital, I keenly observed and noticed the broken English spoken by the nurse and his lack of experience in examining patients. This was demonstrated in his insistence that what was later found to be a blighted ovum was in fact a child of 5 months which did not require a Caesarean operation but instead medication.
My common sense tells me that a blighted ovum is fundamentally a miscarriage in which the foetus ceases to develop whilst the woman continue to experience symptoms of pregnancy. The best course of action here is a Caesarean section to prevent further complications. This was confirmed by another nurse, who intervened and advised the operation.
Considering the condition of the hospital more generally, I concluded that most of the health workers were akin to traditional birth attendants of unspecified medical roles. Despite the clear importance of diagnosis and medication, tests such as ultrasounds and urine analyses are often abandoned after samples and money have been collected from patients.
The public pharmacy is clearly signposted, but holds no essential drugs. Patients are expected to singlehandedly pay for prescribed drugs, privately. This is also the case with consultation and lab fees. In all instances, there is no formalised way of recording financial transactions aside from cash in hand payments. Cesarean delivery could cost up to 17,000 SSP, and this amount is collected by the nurse at the entrance to the operating theatre.
Further to this, there is a clear lack of professional medical ethics amongst staff at the hospital. This is noted in the way they talk, listen and walk. There is a clear lack of professionalism and political language as they communicate amongst themselves and with patients and caretakers. Some speak as loudly as if there were addressing a public political rally! In my observation, only medical students and trainees from medical schools and institutes were handling cases, lacking sufficient background experience.
That particular night, a woman who had given birth at home was brought to the hospital having suffered heavy bleeding. Around 45 minutes later, a police lieutenant with a heavily armed entourage entered the hospital and went to the hysteroscopy department where Cesarean operations was taking place. He summoned the nurse and was told to go to the consultation room, which he did reluctantly. I wanted to intervene, but my professional restrained me. Many patients and caretakers felt scared seeing heavily armed police personnel loitering and gazing at people, guns slinged across their chest. By threatening patients' lives in this way, they could easily lead patients to an early death.
Despite having over 520 beds, there are still not enough spaces to accommodate all patients. Spaces on wards are often shared, and I was told my wife could join another patient on a bed. However, I politely turned this down. I professionally pointed out to the nurse that patients with different diagnosed issues sharing beds was in complete violation of COVID-19 protocols. Fortunately, my wife was given a separate bed on account of my well mannered approach with the duty health worker at the time. I was forced to sleep while standing until dawn. Meanwhile, other patients and their caretakers had to lie on the floor as if they were in a cattle camp.
I also noted that there was no adherence to COVID-19 procedures by nurses, patients and caretakers. COVID isolated wards were used to admit mainstream patients. Many patients were given little other option than to take a bed in a COVID ward. My colleague's brother's wife was admitted bed-ridden, and given a single dirty bed.
The lack of medical ethics particularly effects women suffering from miscarriages. The condition often produces a lot of blood, for example. Yet, no one seems to care when this occurs. There are no emergency rooms for severely affected patients, and very little privacy when being treated by nurses. Such treatment often happens alongside numerous other patients and attendants.
In conclusion, the government's lobbying for Chinese investment in Juba Teaching Hospital's facilities is greatly appreciated. However, poor medical services and mismanagement begs more questions than it answers. In its capacity as the sole healthcare service provided to the people, the government should either either employ qualified and motivated personnel or give the facility over to either NGOs or the private sector. Combined with the the serious issue of maintenance of these facilities, I am afraid they will be useless in the eyes of the vast majority in the coming years.
The author, Abraham Mabior Rioc, holds dual Master’s Degrees in the field of Education from the University of Juba and The University of Hong Kong, respectively. He is an influential and professional writer, humanitarian worker, and researcher. He is also the author of the forthcoming book entitled: “Scaling up Education in Emergencies in the Protracted Crises: Perspectives from South Sudan”. He is electronically reachable via mabiorrioc@gmail.com
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