Dispatch from Aweil, Southern Sudan

Registered Nurse, midwife and NSWNA member Janine Issa is working for six months in Southern Sudan with Médecins Sans Frontiéres (MSF). Janine is keeping a blog while she is there and, after two weeks in Aweil, this is her first letter home.

I’ll try to fill you in, but it is so different from home that it is hard to know where to start! My first stop in Sudan was Juba. It is a city that is trying to rebuild itself after 20 years of civil war and you certainly see that all around you. A few main roads are sealed but most are potholed dirt roads, and if it rains they are awash with water, mud and refuse.

By wonderful coincidence I met a Kiwi whom I had met in Sydney last year. She recently arrived in Juba to work with a cholera project. I stayed with the small, friendly MSF France team in Juba. This compound was another step away from Australia and was a great way of preparing, by degrees, for life in Aweil. Being a young team, it reminded me of flatting days – piles of dishes sitting dirty in the sink!

I flew to Aweil on a World Food Programme (WFP), 12-seater plane – they provide a humanitarian transport service. Luggage allowance on the WFP plane is 15kg, so I had to leave all my heavy items like shampoo in my backpack in Juba to come by road. Unfortunately, the truck was delayed for a couple of weeks, so it was such a joy when it finally arrived in Aweil.

The compound in Aweil is pretty basic, with tukuls – mud huts with thatched roof – for the expats. The showers are bucket washes and the loos are fragrant latrines – a squat hole in the ground! The food is rather monotonous, with little variation from day to day, but at least there is always fresh tomato and often fresh carrot and coleslaw, which are my staple. Otherwise, it is warm bread like Turkish bread in the morning with egg or peanut butter and jam or banana and then usually eggplant, meat, bean, potato, noodles or rice for lunch and dinner. At lunch today I saw the cook nonchalantly pick up the chicken that had been traversing the compound for a couple of days after it was bought at the market. Chicken in one hand and knife in the other – the chicken appeared at dinner.

The expats are mostly French, as well as an American, an Aussie/German, Japanese, a Salvadorian obstetrician and me. Most are in their 30s, although a couple are about my age; most are on their first mission, and we’re predominantly women. MSF uses half the Aweil Civil Hospital to run a maternity unit, paediatrics and a therapeutic feeding program. The Ministry of Health runs the other half of the hospital and they share the operating theatre.

The maternity unit has an antenatal clinic, which currently sees about 110-120 consults a day. Most women only have one antenatal visit and many we see in maternity have had none. The fertility rate is high, with many women having seven or eight pregnancies, and most have lost at least half their children either in pregnancy, during childbirth or within the first one to two years of life.

The Sudanese women are the most stoic women you can possibly imagine. They endure incredible pain, chronic severe anaemia, incredible sadness as well as hardship. They are sweet and appear unbelievably resilient, laugh easily and love their children. The children are gorgeous and mischievous like children all over the world – if they aren’t sick.

I’ve been here two weeks on Tuesday, and I think I’m starting to get the gist of things. The maternity unit can be overwhelming at times, with labouring women lining the floor of the antenatal/postnatal ward when there are no beds left. The delivery room has two beds, but we have had one woman in each bed delivering and another on the floor, while people come in and out looking at what is going on. The beauty of the culture is that women are always supported by the other women in their family. As soon as they give birth, they get up off the delivery bed, walk out to their bed in the ward, helped by relatives, and start breastfeeding. No problem breast feeding here! Today I caught (literally) a tiny breech baby who was the twin of its brother who was born at home about 36 hours earlier. The wee boy was about 2.3kg and when I checked the mum a few minutes later in the ward, she was breastfeeding the first one and within half an hour the second one, too!

Miscarriages are very common, possibly partly due to the prevalence of malaria and/or syphilis or other conditions. There are lots of procedures to remove retained tissue, and so on. I was on call for the first time this weekend and was called twice, once for a placenta praevia and once for a retained placenta of a poor woman who came in after a homebirth where the baby died and then she had another twin inside who also died, and then she couldn’t pass the placenta. We see lots and lots of blood!

As you can imagine, I have loads to learn, but also feel well supported with two other midwives here as well as an obstetrician. It all takes a little adjusting to everything in 38-40 degree heat – but that’s the least of my worries and, in fact, often I don’t really notice because there is so much else going on.

For information about Médecins Sans Frontières, visit www.msf.org.au