This was a blog post I was working on while on my mission. I have changed the tenses (basically due to laziness and I trust my readers can figure it out). Again, this may get taken down because it hasn’t been offically approved, but wanted my people to know what it is like. I also do not claim to have a worldwide readership, so I think I’m safe…I do not speak for MSF but am only telling my experience.

Old Fangak

    As I looked out the window of the large helicopter I shared with 6 other passengers, I could see the beauty of the South Sudanese landscape but also the continued effects of the previous year’s rainy season. The land was still covered with water in places I was told were never covered previously. There were tukuls (the typical mud huts) clustered in tiny villages. Even with all that destruction, the beauty of the flat landscape shone through and the fortitude of the people living in such remote homes. It took me a plane ride from Juba to a dirt runway and then the helicopter ride, which landed on a dirt soccer field for me to get to Old Fangak. Although I was extremely excited to finally be able to start my work with MSF and the Medical Academy, I had a claustrophobic feeling, knowing that if I needed to leave for whatever reason, it would not be easy. Flights only come into this small village twice a week and do not land when it is too muddy. I have been told over and over how lucky I am to be visiting during my 6 weeks in the dry season, with minimal mosquitoes and dry land. The temperatures are unlike I have ever experienced, however, reaching 110 F some days, without any air-conditioning. At least the heat is dry, and the temperature drops at night, leading to comfortable sleeping weather. 

    The project team members get to the hospital which are just large tents, by motorboat, a short 5-minute ride down a tributary off of the Nile. We are also able to walk through the village, beside the river for a 15-20-minute walking trip. I choose to do the walk at the end of the day when the temperature is cooler, and I have less risk of becoming a sweaty mess for the rest of the day. The boat ride is a lovely reprieve from the heat, with the breeze made by the boat’s speed. Walking allows us to see the people living in Old Fangak, and the young children all run to us, saying hello in their Neur language and trying to shake our hands. Their exuberance is contagious, and we all say the greeting back and touch their hands. Many times, at the end of the day, the whole family is swimming, washing or cleaning clothes in the river that we walk along. It is a nice way to feel a part of the community. Once, we were able to watch some young boys catching fish by throwing a sharpened stick in the water. We saw bunches of these fish held together by lily pad stalks across our path. The project team members eat fresh fish a few times a week, buying them from the fishermen that pass by our compound. We also get goat, chicken and cow meat by bartering with farmers and hiring a butcher to prepare the meat for us. Unfortunately, it is easy to get attached to the livestock, since they usually roam our compound for at least a few days and sometimes weeks before they are butchered. The rest of the food is flown in from Juba, which means it is contingent upon space in the plane and good weather.

    We sleep in safari style tents that are placed on raised platforms (to prevent the water from coming in during the rainy season. There are concrete steps all around that are also raised above the ground, which I’m told is to prevent the water from getting into rain boats when the water extends over the dikes. Everyday the project team members share what it is like during the rainy season and how difficult everything is. This is partially why the town people that live in Old Fangak are migratory, moving when the waters kill their crops and livestock and flood their homes. Many make do because our hospital is here, but they suffer the consequences of the increased malaria and limited food as a result of the flooding. There are usually 15-18 MSF staff that live in the compound at a time, but there are frequent changes to the staff due to breaks and staff turnover because it is the end of their mission. The Project Coordinator and Log Team constantly must shuffle people to different tents to accommodate the frequent changes. 

    A typical day for our staff is to get up around 5a-6:30a (the sunrise wakes me up) and get coffee, tea and breakfast before leaving for the hospital. Due to our numbers there are three different times the boat comes and goes from our compound and we each sign up for what time we want to take. We work from 7:45a-noon and then take the boat back to the compound for lunch, again with three separate shifts for the boat. Then we go back to the hospital around 1:30-2 and work until 5:30p or so. My day varies because I sometimes go to the Medical Academy building, which is a 10-minute walk through the little, busy market to somewhere they call “Alaska”. This is due to a physician who has worked in Old Fangak for over 20 years, who people affectionately call “Dr. Jill”. She is from Alaska and makes trips back during the year to work in a remote ER and to fundraise. She has her own non-profit called South Sudan Medical Mission (SSMR) and cares for chronic conditions for patients. She has allowed the Medical Academy to use her facility for our teaching and some of her nursing staff are our students. She is adored by the people living here due to her longstanding commitment and advocacy of Old Fangak. On other days I spend time in the hospital, assessing the skills of our students with patients or in the outpatient clinics, doing the same. I like the variety and getting to know so many of the staff. 

The Academy curriculum in Old Fangak for the Basic Nursing Care Curriculum is soon to be completed, after 18 months of classes and mentorship. This would be the first graduating class in South Sudan. However, we have found since it is such a small hospital, many of our students have not been able to prove proficiency in the skills since some of the skills are not seen often. My aim is to creatively have them show their skills so they can complete the course, but also ensure they meet the standards of each unit. I have worked as a clinical instructor for many years as a second job at Duke University, so the work is familiar, while the setting is not. There are no electrical IV pumps, so the students must count the IV drops to ensure medication goes in at the correct rate. There are no surgeries performed at this hospital, so patients who require this must be taken by boat up the river 5 hours to Malakal, a larger hospital. The patients vary in Old Fangak, but a majority have malaria, upper respiratory infections and malnutrition. There is also a maternity ward where women come to give birth. 

So far, I have adored my time here. The staff and people of Old Fangak are friendly and welcoming. Every six weeks or so we all get a break, stagger, and go to the capital. It is a reprieve from camping life, but I always feel a little guilty knowing I can leave, and my students and our patients cannot.