Winchester- Yei Hospitals link

This article is an update about the partnership between Yei Civil Hospital (YCH) and the Martha Clinic in Yei, South Sudan with Hampshire Hospitals NHS Foundation Trust (HHFT), in particular the hospital in Winchester.

Our hospital to hospital link began in November 2010 with a fact finding visit set up by a couple from Winchester, John and Poppy Spens, who have been connected to Yei and the Martha Primary Health Care Clinic for a long time.   We found YCH had been running with only one doctor.  During our stay new doctors arrived and over the three years since then they have become extremely experienced.  We greatly admire their dedication and skills.

We returned a year later with a group of two doctors, three midwives, an electrical engineer and a chemical engineer.  (The midwives described their visit in SSMJ May 2012).  The clinicians worked on the wards and taught nursing and midwifery students in the training college which is also on the hospital campus.  The two engineers fixed hospital equipment.  A special aspect of the link group is that those who feel they are on good salaries buy their own tickets and visas leaving any funding for those who would otherwise find it difficult to come.  In the UK a small amount of money became available to support links through the Tropical Health and Education Trust (THET).

We obtained funding for a programme over two years looking at how observations were made and used to manage treatment and also a grant for 18 months to repair equipment supporting the clinical work. The two programmes have run side by side so although the clinicians were funded to come more frequently on every visit they collected information to prepare for the next visit of the engineers.

We focussed on maternity with visits from midwives and an obstetrician, paediatrics with paediatricians and a neonatal nurse and surgery with an orthopaedic surgeon and a surgical nurse. Two physicians worked on the medical ward.  In every clinical area both national and visiting staff learned from each other.

In maternity we concentrated on newborn resuscitation and care of sick babies with our neonatal nurse teaching how to pass a nasogastric tube if a baby had feeding difficulties and the method of calculating how much they should be fed.  In paediatrics our doctors supported the difficult work of diagnosis without the full range of laboratory tests which are available in the UK coupled with speeding up treatment as much as possible.

Figure 1. Practising resuscitation (Nancy MacKeith)

In surgery our orthopaedic surgeon and accident and emergency nurse concentrated on management of fractures on the first visit, but because general theatres were undergoing refurbishment on their second trip they ran an assessment programme for patients with long term orthopaedic problems found by two iNGOs working in the field of disability in Yei.  Our group is constantly impressed with the standard of x-rays produced by the radiographer.

General Practitioners (GPs) (family doctors) from the UK have spent time at the Martha Clinic working with staff and teaching and at the training college covering subjects such as public health.  Examination questions set by them have been put into the national list of questions that can be set in training colleges anywhere in South Sudan.  The British Medical Association (BMA) bought books for the library and funded one of the GPs to come out and do family planning training.  This doctor did a before and after assessment of the level of knowledge of these staff and students.  We are very encouraged by their enthusiasm for learning.  UK staff also have enjoyed going out with the Martha Mobile Clinic to see village health care.

Timing of visits can be difficult for the UK volunteers having to book holiday a long time in advance and then circumstances change in Yei, We paid for (but are still fundraising!) the renovation of three tukels or little houses that can take two beds each in the hospital staff compound so that we can stay near the hospital to make best use of our time.

An inventory of equipment at the hospital was carried out including the contents of a container of second-hand medical equipment from the United States not compatible with the voltage in South Sudan which is like the UK. Two transformers were bought including one for a sophisticated ultrasound scanner which was then used for management of early pregnancy problems. Vital sign machines were made to work, and we had brought out two oxygen saturation monitors from the UK charity LifeBox, one for the hospital and one for Martha Clinic.  This encouraged staff to follow the WHO Surgical Safety Checklist.

On the second funded medical equipment visit the engineer, who is also an electrician, came back with a new volunteer with plumbing skills.  The new volunteer brought out plumbing tools and equipment and worked with the new hospital plumber and his apprentice on mapping the water supply as well as identifying and fixing faults.  The electrician engineer continued to work with our main South Sudan colleague Moses.  His growing confidence means he now tackles jobs like electronic repairs that before were outside of his main skillset as an electrician.

Figure 2. Fixing the plumbing

Over the time of our link the United Nations Population Fund (UNFPA) has sent long term volunteer staff nurses and midwives, and AMREF (African Medical Research Foundation) has sent specialists in surgery and ultrasound. The British organisation, VSO (Voluntary Service Overseas), have a health programme and three volunteers came to work in Yei health services over the time of our project.  One is in County Health, one in the training college at YCH and the one who works on the wards will soon be joined by another colleague.  We are pleased to have taken part in the process of supporting YCH and its staff.