“Senke” fractures

Anyone who steps into Juba will definitely notice that there are as many motor cycles as there are people! It is utterly unbelievable.

Long time back, motor cycles are very few. Post CPA there is a flock of imports, especially new model call Senke. The bad side is that it is the young people, barely ten or or years who cruse around town in them. And there are the accidents.

Doctors know long time back that when the mangoes are in season, many children will be admitted to hospital with mango fractures, sustained due to a fall from a mango tree.

Now the trend is in the senke. They almost make accidents every single day. One time, they were really piled up at the traffic police station. What a menace! These young people also drove them while intoxicated.

Senke has become a health hazard.

How not to woe doctors . . .

The new minister of health for the government of South Sudan is a man with a mission. After inheriting the ministry he set about making changes and getting things moving again in the South. For instance, GOSS has taken over the running of the three major hospitals in Juba, Wau and malakal from the states. Big move, but we wait whether they can mange them well.

A bigger move is to woe the Southern doctors in Khartoum. To that end the good minister had a meeting with them in the Friendship Hall in Khartoum on Friday 11th October. The meeting went well, I heard, but what is the outcome? How will you convince them to come back home?

It seems a lot is at stake apart from the problems common to all. How do you care for the medics, provide for their work, doctors mess, especially female messes are no-existant in the whole of South Sudan. The inra-structure is unavailable. The minister wants all to come bck and start rebuilding from scratch together. Will they take his call?

The best part is that reference to the Khartoumers as Jallaba has been talked about.

But the truth is there are elements in the ministry who doesn’t want others to join them in the South, by frustrating efforts to return. Some doctors have waited for jobs in Juba for months before abandoning the effort to return to Khartoum.

 Am I wrong in avoiding all these by going private?

Normeca replies . . .

Here is a reply fromNormeca AS about my previous comment. Am glad they noticed these pages! 

Normeca AS is a Norwegian company working in the field of mobile and semi permanente hospitals, mobile clinics, floating hospital, disasters and hospital management. Normeca AS has several offices in Middle East and Africa like Dubai, Addis, Nairobi, Kapoeta, Juba and Khartoum plus offices in Tokyo, Bangkok, Copenhagen, Oslo (HQ) and Seattle.

Last year Normeca AS signed a contract with GOSS to build 10 State hospitals including accommodation for the medical staff, all together 2.500 beds, delivery of 50 mobile clinics and two floating hospitals on the river Nile. It was at same time signed a management contract to run all the hospitals and clinics for 5 years.

The first 150 beds hospital in Kapoeta has already treaded more than 12.000 patients. Many lives have been saved. The official opening of the hospital is expected to take place very soon.

And the hospital is approved by a technical committee from Ministry of Health in Juba as a referral hospital on level one.

Normeca AS has brought in more than 4.000 tons of equipment by road from Mombassa, a distance of 1.600 km one way to this first hospital. The ground of the site is 90.000 m2 with close to 8.000 m2 with different buildings. Normeca AS has also build a new road on 3 km from the main road to the hospital site. The hospital is one of the best equipped hospitals in Central Africa, please see the attachment. Especially the six operating theatres, ICU, Post OP, x-ray, laboratory, sterilization, delivery room and emergency room are very well equipped. As an example can be mention our x-ray department has fixed digital x-ray equipment, one mobile x-ray, C-bow in the operating theatre and three Ultrasound machines.

The price of this first hospital with 150 beds (can easily bee raised up to 200 beds) and 160 beds accommodation for hospital staff including transport, construction, all equipment both medical and all other necessary equipment to run the hospital is only EURO 18 million including five mobile clinics. These include also electronic patient journal system, computers, printers, identification card system and a server with 400 G memory.

The price for the complete hospital is actually very cost and time effective compare to build a hospital in concrete and steel. Normeca AS expect a life time on at least 30 to 50 years for this kind of prefabricated buildings. And the best of all, then the time is coming for a fixed hospital in steel and concrete, the hospital can be repacked and eject in ten smaller clinics/health centres around the State within short time.

The separate management contract to run the hospital has a budget on approximately EURO 4 - 500.000 pr. months all included like salaries, food, fuel, medical disposables and management like head doctor, head nurse, hospital director and trainers from Scandinavia. Normeca AS has to run the procurement after same rules as the Norwegian Government. The salaries for all staff have to follow the rules from GOSS. The hospital is working in close cooperation with WFP (delivery of all food to the patients) and the Carter Foundation.

It is not correct that some newspaper has been written that Normeca AS should have received more that USD 900 million in up front payment. All contracts together including the budget of running the all hospitals, clinics and floating hospitals for five years including salaries for up to 2.500 hospital staff, medicines, diesel/fuel, maintenance, medical disposables and all other things are even not so much. Normeca AS has so fare only received EURO 22 million in mobilisation payment from GOSS.

Normeca AS has also used up to 80 % of all workers during the construction from Kapoeta and Southern Sudan. It means more than 300 local workers have been working at the site every day for many months. Many of them have been trained as carpenters, maintenance, electric, plumbers and so on during this period. The rest of the workers have been brought in from 15 different countries around the world.

If anyone want more information, please do not hesitate to contact us any time.

Prioritising health issues

I have always wondered how the ministers in the Government of South Sudan makes their priorities. We have hundreds of urgent health matters that need to be addressed, but nothing gets done. From malarias and TB and AIDS to diarrhaoes and sleeping sickness. Of course, other conditions that are part of a poor healht system come on top too. High maternal death or avoidable surgical conditions remain major problems.

How do you chose which problems to tackle first? When the GOSS came on, they promise quick fixes for lots of things like building hospitals, clinics and health centers where none existed before. Old hospitals will be rehabilitated. Health surveys were done in all the states. What happend next?

It is unfortunate that many of the promises have fallen down the drain. The much publicised building of hospitals in each of the states of south Sudan turn out to be a huge scandal that caused the GOSS Minister of Health his job. Normeca turned out to be a small company that has no experience in such matters, only out there to milk the funds from south Sudan, at the cost of more  than a half of the whole budget!

We need priorities in health. It is evident that we cannot do everything at the same time. There should be a focus, a base from which much can be done. Do we have such plans, or we are just doing what comes to mind? 

The scourge of AIDS (1)

Now let us talk about AIDS.

I have been involved in anti-AIDS among the youth for a long time. I have seen how the young people think about the disease. Unsurprisingly, many take the situation with a lot of humour. I remember once giving a talk about AIDS and some guy mentioned that old line that AIDS, actually is standing for American Invention Discouraging Sex! He was so serious that he never smiled!

That was an easy one to challenge and we did handle it nicely. The other side of the AIDS awareness is that many young people see that here is nothing new. We got lots of pain trying to insert AIDS education evrytime there is a youth event, but they coplained there is nothing new: the same ABC’s basic facts etc. Uhm.

The down side is always that apathy sets in and many young people just shrag it off as just another disease too. But is it? Long time ago in the mid 80s, it is considered a disease of Congolese in Sudan, mainly prostitutes etc. Only those who visit these places get it. It is a sad fact which is still the case in South Sudan.

The Abstinence is impossible in the young, the Being faithful hard for the married, and the Condom? It is not always available! Well, there are those who think it takes the “sweetness” out of the sex!

Next time, we talk about another side.

Queen of Sheba 2

And then it happened . . . Yes that was where I was with that story.

As I mentioned earllier, that Queen of Sheba is one hell of a place. With the smell of Njera mingling with the aroma of burning goat meat, it was all set for a dramatic event about to happen.

A tall slim chick stepped into the place. She was all African beauty piled into one person. God was so generous to have given her all these qualities! However her face did not register the fun the place was set to see. You can tell she was out on a payback trip. She surveyed the place with her eyes, scanning the tables in one round sweep and settled on a group sitting in the far corner. Man you could tell fron her face tha radiated hatred in that semi-dark palour that a great event was about to be witnessed by men!

True, she walked over to the group, gripped a lady by the shoulder and pulled her out the way. She focused on her man and looked him straight in the face. Well, not a word was spoken, as he stood up slowly and left the table. She followed him outside.

Uhmm, a cheating husband caught in the act! Well, we were denied the drama by his cool act, but what the hell. Nothing bad happend! Sigh. I disappointed you.

It is one hell of a thing that is happening in the town. Where there is money, what men do best with it is is marry another wife! It is an unnecessary side effect of wealth, unfortunately. An unhealthy one too!

By being a frequent user of such places and picking on ladies of the night, there are also underlying bad sides. For one thing, AIDS is a real thing. I will leave that for next time! I seem to have lots of them these days, don’t I?

Going private

And now I will tell you why going full private is the way for me . . .

 A lot of colleagues know that going full private means you have nothing to do with hospitals. You go to your clinic in the morning and hope patients come. You do what you can and go back home, only to return again in the evening. Cool. You are in control of yourself. No headaches about nurese not reporting to duty, no missing stuff in the theater, no gloves available in the OPD. Sounds familiar?

I had a rather bad experience while working once in the hospital. It had nothing to do with luck of stuf, but bad practice. You see this hospital is almost like a private one, people have to pay for everything, from entrance fees to surgery and beds. Unfortunately they had a no tolerance rule for unpaying clients who regularly turn up at the hospital not knowing about the costs expected.

So one day a woman turned up at 12 mid-night with bleeding, clear an abortion and she needs quick assessment care less she bleeds to death. Imagine my utter dismay when the hospital staff turned her away because she couldn’t pay. She sat there in her pool of blood, an impending shock. They were adamant, even refused my offer to cover some of the cost when she couldn’t afford. It pains when money comes before life!

Many people would think I went private for the money. Not at all. Maybe I was not cut to be a medic? Maybe I am too faint hearted, couldn’t bear to see the inequality in tretament? Maybe. My reason may sound flimsy to you, but not for me! But I guess sitting in my own little OPD is my way of contributing towards the whole. Oneday, I am going back there.

You maybe wondering what happened to the lady? At least the hospital got her into an ambulance and carried her to another hospital. She survived. Could we call that a happy sad ending?

Queen of Sheba

Just the other day . . . 

Yes I was talking about the unhealthy boozing culture that is creeping into our society. The situation I was talking about happened at one of the coolest places in town: the Queen of Sheba.

You know with the advent of peace Juba has become really vibrant. There are lots of new hotels,  some in tents, others in prefabricated strutures and some are just putting up concrete ones, and the commonest thing they share: a bar! And they serve food too.

I was chilling out at the Sheba the other day. The place is in Hai Malakal, just near MSF offices. (If you are Juba bred person, it is opposite house of  Abel Alier). The place is cool man. It has a resort atmosphere, designed in wooden structures and thatched roof. There is Ethiopian DVD playing out of a TV screen in the corner, as the smell of “Njera” floating from my neighbours table tantalizing the tastebuds. And the beer was flowing . . .

Outside NGOs cars were parked: UN, UNMIS, MSF etc. There were also lots of cozy new SUVs with GOSS number plates. You know then there are big government people in here.

And then it happened . . . (To be continued)