Juba and the beginning…

This was written when I first arrived in South Sudan. Again, this may be taken down by MSF but this had almost the final approval of the communication team. I think the person I was corresponding with must have ended her mission. I do not speak for MSF but only share my experience.

I have now been in South Sudan for three weeks and I am anxious to let everyone know what my experience has been thus far. As a recap – I interviewed for Médecins Sans Frontières / Doctors Without Borders (MSF) last spring 2021, after a patient asked me to complete an employment physical form for her and she encouraged me to reapply (I had applied in 2019 and was politely rejected for not speaking French). The very next day after the patient encouraged me to reapply, MSF emailed me and suggested I reapply. Even though I was quite happy with my job at the time with Planned Parenthood, it felt like the Universe was setting me on the MSF path.

I started questioning that path after waiting almost six months for a visa to Myanmar, my first assignment and trying to work remotely (in the middle of the night because of the time difference). I had the Myanmar contract cancelled in October 2021 due to “no end in sight” for what I affectionately called #visawatch. There had been a military coup in the country and they were not approving anyone’s visa. I was devastated and exhausted from living out of my suitcase, waiting to be approved to enter the country. 

In December 2021 I told my recruiter that I needed a break from the limbo. It felt like my suitcase was mocking me whenever I walked by it in my bedroom. She said, alright, but then secretly put my name in the running for my current role with the MSF Academy in South Sudan. I interviewed on January 9th, 2022 and a month later, I’m in South Sudan.

The MSF Academy is a relatively new program, starting in 2017 (https://www.msf.org/academy). It has taken several years to earn the trust of our National staff, but it seems like it is taking off in South Sudan. One of the silver linings of the Covid-19 pandemic is that it allowed the MSF Academy to teach infection control to everyone to help prevent the spread. When the National staff and Ministry of Health saw the results of the trainings, they understood better what the MSF Academy was trying to achieve. It is an ~18-month program where nurses, midwives and nursing aides strengthen their skills through classroom didactic education and hands-on skills work with mentors on the nursing units. 

We have skills labs at all our project sites with mannequins so learners can practice and check off the skills that are less commonly used and so harder to practice in a clinical setting, like nasogastric tube placement, urinary catheters and sterile dressing changes. The learners themselves are encouraged to hold each other accountable to continue the skills on the units and to use an assessment tool to see that all the steps have been performed correctly and in the correct order for each procedure or skill.  The aim is to give our South Sudanese colleagues access to training that will build their skills and allow them to offer high quality care, even without MSF in the country. We are also working on a scholarship program where we help pay tuition to the main nursing school so more South Sudanese can become nurses! This is in the early planning stages, so I am excited to see it in action.

My role is Senior Clinical Mentor, and I, along with two others, go to the different project sites where the program is being taught and help check off the skills and monitor the teaching of the tutors. I have not been out into the different sites where we do train yet but am excited to get started and see the program firsthand. This approach is exactly why I chose to work with MSF. I wanted to be part of an organization which works with local staff to strengthen healthcare systems. 

My travel to South Sudan started with a little drama but was worked out quickly. Due to COVID, South Sudan, like many other countries require a negative PCR COVID test. When I showed up in Washington DC to get on the flight to Ethiopia, they informed me that my test result would be too far from my arrival date to be valid. I rushed to the airport COVID testing site, hoping that my neurotic arrival time would pay off and I could get the result in time to make my flight. My heart sunk when I saw the line of people waiting for the testing site to open. Luckily MSF quickly changed my flight to the next day and got me a hotel room. The next day went by without a hitch. The flight was 13 hours and they even fed us several times! I had an eight-hour layover in Ethiopia and then a short flight to Juba, the capital of South Sudan.

At the customs office, a stern man reviewed the paperwork with my e-visa, had me lower my mask and I was pointed in the direction of another building. Here, all the paperwork was reexamined, and I began to feel nervous that I would not be approved. Luckily everything was stamped. Outside the airport I jumped into MSF’s jeep-like vehicle and was brought to the house I would be staying in while at the capital.

The Luna House is owned by MSF and almost has a dormitory feel, but a little nicer. There is a cook during Monday through Friday that prepares delicious food with lots of fresh vegetables and a variety of meats. We receive a stipend and there are markets where we can get food for our breakfasts and weekend meals. There are also fairly nice restaurants we can eat at. I am trying to appreciate the city accommodation as much as I can because I’m told it will be simpler when I arrive at the project sites. There’s Wi-Fi in all the MSF projects and buildings but it isn’t good enough for face-time. However, I can message with family easily and do voice chats on WhatsApp. 

There has been some fighting amongst the different South Sudanese factions near some of our hospitals and clinics which has affected some of our work in MSF Academy. Intercommunal violence and cattle raiding are common throughout the country, but this particular incident affected our staff. One of our National staff nurses was killed during this incident and one of our tutors had to run for his life and hide in the bush with his family. All the houses were burnt to the ground as well as the central market. It will take a while to rebuild and for the South Sudanese from that area to return. We are putting our Academy on hold while an emergency team has taken over the hospital. Luckily the hospital was not attacked but they did have to evacuate the hospital (with all the wounded from this attack) for a short time. I was told this comes with the dry season and that when rainy season comes, a shaky peace is assumed due to the flooding and focus on life-sustaining measures. It is incredible what the South Sudanese must put up with. Sometimes the water is chest-level and people must sleep in flooded homes. All their crops are ruined, and food is limited. Mosquitoes bring malaria and poisonous snakes are numerous. While the violence in the area has a complex history, this detail reminds me of the Freakonomics podcast episode in which they describe the correlation of gunshot wounds in the United States and 100-degree weather. Heat makes everyone miserable (especially this cold-weather-loving Mainer). MSF takes security very seriously and I feel very safe.

I am still learning the history of this new country (founded in 2011) and all the local conflicts. Like most countries, it is complicated and nuanced. I look forward to updating you next time with life at the different project sites and my work with MSF Academy.