SSMJ August 2021


Stop Killing Healthcare Workers in South Sudan

As South Sudan marked the 10th anniversary of independence from Sudan on 9 July 2021, the healthcare professionals were mourning the brutal murder of a medical doctor at his duty station. Dr Louis Edward Saleh, who was working at the Ganyiel PHCC in Panyijiar County of Unity State for the International Rescue Committee (IRC), was killed in cold blood within the health facility on 21 May 2021.

News, Reports and Policy

Medical Training Initiative (MTI) interviews for South Sudanese candidates

The Global Team at the Royal College of Physicians in London would like to host a half-day of virtual interviews for MTI applicants from South Sudan on 20th September, 10:00 – 13:00 South Sudan time (09:00-12:00 GMT). The timings mean that Team will be able to interview 4 candidates only. As this is a fairly small number of candidates, they can open applications for up for 1 week.

Obituary: Dr Pastore Alphonse Kwajok

Dr Pastore was a very outgoing person, a community organizer, the first president of the Equatoria South Sudanese Community in Iowa, and a loving and devoted father and husband. Family, relatives, and friends will greatly miss him.

Humanitarian and healthcare workers killed in South Sudan

In recent months, several humanitarian and healthcare workers have been threatened, beaten, arrested, detained, tortured and even killed in several parts of South Sudan. The South Sudan Doctors’ Union has condemned these acts and called on the government to protect healthcare workers, investigate these incidences and bring the perpetrators to book. SSMJ remembers some of the health workers killed or found dead in their duty stations below.

MSF Report on South Sudan

MSF report on South Sudan’s first decade of independence

Kwashiorkor – ‘revisiting the evidence’

Kwashiorkor malnutrition affects hundreds of thousands of children and kills tens of thousands each year. Although recognized as a unique form of malnutrition since the 1930s, its etiology is still unclear.

Clinical Guidance

The MAMI Care Pathway Package: A resource to support the management of small and nutritionally at-risk infants under six months of age and their mothers (MAMI)

Globally, millions of infants under six months (u6m) are small and nutritionally at-risk, but many do not get the care they need to survive and thrive. Although the 2013 World Health Organisation (WHO) guidelines for severe malnutrition management recommend outpatient care for clinically stable infants u6m, most national guidelines still recommend inpatient care for all infants u6m. To help put the WHO recommendations into action, the MAMI Global Network has developed the MAMI Care Pathway Package – a resource to facilitate the screening, assessment, and management of small and nutritionally at-risk infants u6m and their mothers.

Back-to-basics. Cough: causes and diagnosis

Cough is a common complaint and may be a feature of serious underlying disease. A working knowledge of the mechanisms and differential diagnoses is crucial. A carefully taken clinical history followed by a thorough physical examination will often lead to a correct conclusion and confirmatory investigations and in turn to appropriate management.


Pulmonary tuberculosis among young children with severe pneumonia at Al Sabah Children’s Hospital, Juba, South Sudan

Tuberculosis (TB) is a major public health problem globally. It ranks fourth among the top infectious disease killers, after acute respiratory infections, diarrhoeas, and human immunodeficiency virus (HIV) infection/acquired immunodeficiency syndrome (AIDS). According to World Health Organization (WHO), approximately 10 million people developed TB in 2017, of which 1.0 million (10%) were children.

Hearing loss among patients on treatment for drug-resistant tuberculosis in Uganda

Tuberculosis (TB) still accounts for the highest mortality from any infectious diseases worldwide, even surpassing HIV/AIDs. Uganda has an incidence of TB of about 20/100,000 population where the prevalence of Multi-Drug Resistant TB (MDR –TB) in 2015 was estimated to be 1.6% among newly diagnosed TB cases and 12% among previously-treated cases.

Ectopic pregnancy managed medically at St. Paul's Hospital Millennium Medical College, Addis Ababa

An ectopic pregnancy (EP) results from implantation outside the uterine cavity. It is an obstetric emergency. Undiagnosed it leads to rupture and haemorrhage. Despite the improvement in diagnostic techniques haemorrhage from EP remains the leading cause of pregnancy-related maternal mortality in the first trimester, accounting for 4% of all such deaths. The recurrence rate is as high as 15%. Studies in Ethiopia reported a higher incidence among 20 to 29-year-olds and unmarried and nulliparous women.

What can be done about adolescent pregnancy in South Sudan?

The World Health Organization (WHO) defines ‘adolescents’ as individuals aged 10-19 years. The national family planning policy of South Sudan states that “by the age of 19, one out of three girls is already married or in union; and the same proportion has already started childbearing”. The causes of adolescent pregnancy can be attributed to social, cultural, political and health systems gaps. This review article looks at the contributory factors for adolescent pregnancy in South Sudan, the effects of these pregnancies and describes some solutions and recommendations.

Case Reports

Giant pleomorphic adenoma of the parotid gland: a case report

Pleomorphic adenomas account for the majority of parotid masses, typically arising in the tail of the gland and enlarging slowly. Most are 2 to 6 cm in size when resected. We report the resection of a benign mixed tumour of the left parotid gland with a history of bleeding. The resected tumour measured 21 cm in diameter, weighed 1.81 kg, and on pathologic examination was a benign mixed tumour without malignant degeneration. The implications of this unusual case for the management of mixed tumours are discussed with a review of the literature.


Wessex connections with South Sudan

Even before independence, there have been links with Sudan, the Salisbury Diocese link going back decades. A medical link was made in 2007 between St Mary’s Hospital on the Isle of Wight and the main hospital in Juba, the capital of South Sudan. As a result of initiatives by Dr Eluzai Hakim at St Mary’s, further hospital links developed

SSMJ’s interactive data on African Journals Online (AJOL) site

The graph and maps shown here are from SSMJ’s interactive data on African Journals Online (AJOL) site. Similar data are available for every quarter since 2017