South Sudan

Restoring a ransacked hospital

When violence started to spread in South Sudan in December 2013, Bor was one of the first towns to be hit. During December and January the town shifted hands several times between government and opposition forces, and 70,000 civilians from Bor took refuge in camps within South Sudan or in neighbouring countries. The State hospital was ransacked and all the staff and patients fled. 

Brima Vandi is a nurse from Sierra Leone. He was part of the very first MSF team that started working in Bor State hospital in June 2014.

Bor State Hospital, FEB 2015
Brima Vandi, MSF nurse from Sierra Leone.
Karin Ekholm

“MSF came in at beginning of June with a team of four. We set up the project to give technical support to the Ministry of Health hospital in five key areas: pediatric, pharmacy, emergency room, waste management and immunisation.

At that time all patients were treated in the same ward, the surgical ward. The pediatric ward didn’t have any medical activity – it was in an unusable condition when we arrived. So we started to clean the pediatric ward, to take out all the garbage, set up beds and equipment, and we moved the children that were in the surgical ward. Then we started the activities together with the nurses that were assigned there by the Ministry of Health.

Vaccinations were given under a tree in the hospital grounds three days a week only. The programme was run by a volunteer, David. He was really committed and doing his best, but he was doing it as a volunteer without benefits from the Ministry. MSF implemented an expanded programme on immunisation (EPI) and moved the activities into the out-patient department. Now, whenever children come to the hospital they get vaccinated. I’m pleased to see that it’s working smoothly. And I’m proud to say that David, after some training and coaching, works independently and he is now employed by the Ministry. 

It has not been easy to get this project going because we have a different approach than in other projects. MSF is principally here to provide technical support and capacity building, and we don’t employ our own medical staff. This can be a challenge but you have to use your skills to inspire and motivate people, and get them to understand the strategy behind MSF’s project here. This is not easy when there are language barriers and differing levels of technical knowledge. But we try different kinds of training, we do on-the-job training and in group sessions with the help of a translator. It’s challenging but I like it.

MSF also identified the Emergency Room as a particular area where support was needed. For instance, we saw that the space for emergencies in the out-patient department was very small and not adequate for examination and stabilization of patients. That’s why we have renovated a new space for the ER in another building, and we are hoping that this will also be an inspiration for the staff.

Bor State Hospital, FEB 2015
Chol is 2 years and 7 months. He has been admitted to Bor State hospital with malaria, as have the majority of the children in the pediatric ward.
Karin Ekholm/MSF

I think we can already see some of the benefits of this project.  For me it’s clear when I compare the figures for admissions to the pediatric ward now and when we arrived in June. There are many more admissions now. That means the population trusts the services being given there. Regarding the quality, we have implemented MSF guidelines and protocols and the staff as well as the hospital management are realizing that it’s good and it’s working. And the team in the pediatric ward is really cooperative. They see me as part of the team now. I teach them new skills by doing it myself, when they see me participating and working by their side, they understand that they need to follow my example. It’s my way of encouraging and inspiring them.

Unfortunately some patients arrive late to the hospital, and in very bad condition. This is because they first go to private clinics in the market. There they are given sometimes the wrong medication or the wrong dose, and only when the condition has deteriorated too much, the clinic sends them to the State hospital. So when they come here, sometimes it is too late and there is little we can do. This could lead people to think that the services here are not good, because some patients don’t survive. There is a need for sensitization and education about this, because when patients arrive in good time they get very good care here.

One of the moments of satisfaction for me was to practically involve myself in the movement of the immunization programme. Me and the rest of the MSF team were really working hard to get all the rubbish out, cleaning and arranging the space in the out-patient department for the vaccination activities. It felt good that my strength could allow me to do that and I saw it as a good way of inspiring the Ministry of Health staff to join in the organisation of their hospital. Even though it is not their actual job to do that, some of them came to realize that they should join us in cleaning up. After all, it’s their hospital, not ours.  I felt I was doing what I came here to do – to support, to let people know what to do and then train them in giving quality medical service. The movement from under the tree to a assigned space inside the hospital was a big achievement I think.

I like the humanitarian work, and I believe in independency, not dependency. Things will not last if you are always dependent on others. What MSF is trying to establish here is independency, by letting people know that this is for them and they need to take ownership of it.  Gradually it will make a big difference, I really believe that. Maybe not immediately visible over a period of weeks, but in the long run it will have an impact.”