South Sudan: Child and newborn care in Aweil

“As a young country born out of civil war, South Sudan has inherited a legacy of over 50 years of violence and instability. While Aweil is in a relatively stable region, the health system remains under established – meaning many people face challenges to access medical care.

Since 2008, MSF has been supporting a hospital in the region to provide emergency obstetric and newborn care, paediatric emergency care and in-hospital management of severe acute illnesses.

The team has recently taken full responsibility for paediatric surgery in Aweil, providing care for children with burns, fractures and abscesses, as well as laparotomies (surgery involving the abdomen) and amputations. Once they have received surgery and recovered from the severe stage of their injury or illness, most children are stable enough to run and play around the front of the surgical ward.  Play is an important part of their recovery, allowing them to regain their physical strength. Our physiotherapist also provides essential rehabilitative care for these patients.

Recently, we treated a baby who required high-risk surgery to save her life. We initially thought the baby had meningitis, but it then became apparent the problem was with her intestines. The conversation with the mother was difficult; without the surgery, the baby would not survive, but she would also have a slim chance of making it through the operation. The mother had travelled far to reach us and had no one to support her, and her baby was severely sick – yet she found it within herself to smile throughout the day. I felt we had no choice but to fight for this little life.

Although our operating theatre isn’t equipped for such a tiny 1.6 kg body, the operation went well. We found the cause of the problem: a significant narrowing of a section of the small intestine. When we delivered the baby to the neonatal ward in the evening, the whole team was on board to provide care. She is now stable, but the recovery process is still hazardous, with the risk of infection and other complications.

Comprehensive and lifesaving care

The hospital is always busy. In January, we saw 2,355 emergency room consultations, 894 inpatient admissions, 146 neonatal admissions, 584 deliveries and 326 surgeries – and that’s not even during the peak malaria season. Sometimes, the hospital gets so overwhelmed that patients must sleep on mattresses on the floor.

This is the only facility providing comprehensive paediatric care in the region. The most common conditions we treat in children are malaria, lower respiratory tract infections, gastroenteritis and meningitis. Like in Australia, we face seasonal variations of diseases. We prepare for these outbreaks through increased surveillance of suspected cases, re-training our health staff and working closely with the World Health Organization and other regional partners to share resources and information.

I visit our neonatal ward every morning, where we can care for up to 40 babies. These tiny patients are commonly affected by neonatal sepsis (severe infection), respiratory distress syndrome and skin infections. In a low-resource setting like this, we don’t have incubators or CPAP (continuous positive airway pressure) machines. But we do have low-flow oxygen, antibiotics and kangaroo mother care, a technique of newborn care where babies are held skin-to-skin with the parent: all lifesaving tools.

Long distances by foot or motorbike

Worldwide, most children depend on their families, particularly their mothers, to reach care. Therefore, the challenges for children are mostly a reflection of the challenges that women face – and in Aweil, these barriers are huge.

When children become sick, women often require permission from their husbands to go to the hospital. As women are usually one of several wives to one husband, their husbands may be in another village, meaning women put their sick children on their back, travel to find their husband, receive permission and then try to reach the hospital before it’s too late. Roads connecting villages are often in a terrible condition, so women must travel long distances by foot or motorbike, sometimes for days.

Many women have a low level of literacy and an even lower level of health literacy. I realised that mothers in my ward were unable to follow hospital feeding times for their babies because they did not know how to read the time.  We also do health education to inform women on the importance of antenatal care, like good hygiene practices.

The most rewarding part of my role in Aweil has been training other staff. Our South Sudanese staff are very articulate and keen to learn, and I enjoy encouraging them to build their skills. Most of my training is done bedside, during the ward rounds, and we hold education sessions for nurses and clinical officers at least once a week.

I am missing home, my clothes are wearing thin, the temperature is soaring into the 40s, and there are an overwhelming number of days when we cannot do everything we want to do – when we cannot keep all our patients alive. Despite this, I am so grateful to be doing this work.”