elcome to JTH

It is hard to sum up my first month back in Juba but I thought this lovely bit of tinsel adornation of the hospital conference room did quite a nice job.

Juba Teaching Hospital has welcomed Michele and me to cover the Emergency Medical Ward full time, supervising a (variably small/reliable) team of junior doctors and teaching twice a week. As with the lovely tinsel sign, JTH is broken and lacking in many ways. The broken and lacking resources, systems and infrastructure combined with the bruised morale of under or unpaid health workers and the very often too unwell patients with unfamiliar diseases has made this my most interesting, frustrating, traumatic, rewarding etc. working month in life, so far!

But on to the shiny bits – the highlights so far. It is in the end all about my South Sudanese colleagues who, while I get a taste for how difficult a working life it is here, have a much deeper understanding of the countries hardships, feel the pain of watching their own people suffer, and for whom this is real life, and not just a sabbatical. My favourite moments have been attending an excellent lecture on ECGs by the registrar Stephen (under tinsel sign). Bearing in mind there is no ECG machine at JTH I was amazed at the ease with which he explained concepts consultant cardiologists have never managed to get me to understand at home, and the enthusiasm he drummed up in the junior doctors for interpreting a diagnostic they will rarely come across.

Then there is Angelo. A clinical officer, who does not actually have a medical degree, but stepped up into a senior doctor role during the war and is one of the most compassionate, dedicated doctors I have worked with. He found me tearing my hair out and getting cross with the nurses when a young alcoholic girl was left outside lying on the floor in her own diarrhea with no one to buy the IV lines and antibiotics she needed. He calmly crossed the road to the pharmacy, bought the meds himself, cleaned the girl up and carried her into the ward. He chose not to do the minimum, shrugging shoulders and saying what a pity, but went beyond his job description to sort this girl out. He was rewarded when she was revived back from her unconscious state, sat up and promptly fell out of bed. Although it was a sign of her recovery, it also made me realize why the nurses had kept her on a mattress on the floor.

Lastly I’ll mention Martin, a student nurse who also went beyond his job description. I have been coaxing and nagging my house officers to come to the ward early and clerk the new patients before I arrive. Occasionally they do. I was a little taken aback when Martin began presenting a patient to me on ward round. It was a perfect doctors’ presentation: a detailed consultation, examination findings, impressions and management plan. ‘Thanks Martin’ I said ‘that was a great presentation, I have nothing to add… but which doctor saw this patient?’ I looked round at the house-officers who were looking sheepish – ‘no doctors’ he replied, ‘just me’…

Michele looking happy during a successful ultrasound guided pericardiocentesis (needle drainage of fluid around the heart!!)

Chris perplexed at the random imported goods store