He is one of the few known as the ‘doctors’ of Southern Sudan. In a country with only 39 doctors, 20 of them in private practice; clinical officers are playing a crucial role in healing their battered country as it recuperates from a 21-year civil war. Some of those who fought for the political liberty of their country are now fighting a different enemy – disease.
Second Lieutenant Marin Admin Thom has known war all his life. Born in 1982, just months before the Sudanese People’s Liberation Movement came into being; Thom grew up surrounded by soldiers and fighting. As a young boy, he carried food and other supplies for the soldiers. It was a difficult childhood, he says, because they often went for days without food, surviving on any edible leaves they could find. Luckily for him, Thom got a scholarship for poor boys to go to school in Kenya. After his ‘O’ Levels in 2003, he returned to Southern Sudan. He wanted to go to university, but his family could not afford to send him there, so Thom rejoined the army in Rumbek, his home region.
Finding Purpose
The turning point in his life came in 2004, when his little sister died.
“She was only three years old. I was told that she was ill in Juba, so I traveled to see her. The doctor told me she had severe dehydration as a result of malaria and diarrhoea. I did not know what that meant. Three days later, she was dead. I felt so helpless because there was nothing I could do to help her.”
Then he heard that the Maridi National Health Training Institute (NHTI) was enrolling students, Thom jumped at the chance and sent in his application. If he managed to get into Maridi, it would not only solve his problem of lack of fees for higher learning, but would also enable him to learn skills to enable him to help people like his sister.
Thom joined Maridi NHTI in 2005. The three-year course was very comprehensive, ranging from paediatric, orthopaedic and psychiatric care to public health, gynaecology and obstetrics. Upon his graduation, he joined the Medical Corps of the Sudanese People’s Liberation Army (SPLA).
“I felt very good to be able to help the soldiers. During the war, they really suffered because there was no-one to care for them when they were wounded. Though the mission of the soldiers is to take care of the country’s people, they too need to be taken care of. Soldiers are human beings too, you know. After fighting in the war for Southern Sudan, I am now fighting diseases using the knowledge, skill and attitude that I acquired in Maridi.”
Now stationed at the 120-bed SPLA hospital in Juba, Thom spends his days caring for both the military and civilian families. When he finishes his shift in the hospital, he works in a small community clinic on the outskirts of the town.
Healing the Future
At the hospital, Thom has a chance to fulfill his dream – to help children like his little sister so that they do not die from treatable or preventable causes. Seventy per cent of the patients who are seen at the outpatients’ department are children, mostly suffering from malaria, diarrheoa and pneumonia. Thom also sees many cases of women with complications in pregnancy. Most mothers admitted in the Gynaecology Ward have malaria in pregnancy, typhoid fever or urinary tract infections.
“One big problem is that many patients do not seek treatment early. They wait until the condition has become serious, then they come to hospital. Some come from far, and some are just ignorant – they do not know that they need to bring the sick children to hospital immediately. There is a lot of work to be done. There are few health centres and very few qualified clinical officers and other health personnel.”
The best student in the class of 2008 in Maridi, Marin brings that same zeal for excellence to his daily routine, be it examining patients in the Outpatient Department, prescribing drugs, sending patients for laboratory tests, recommending admission or doing ward rounds. After a morning of meeting patients in the Outpatient Department on a hot December day, Marin walks to the maternity ward and confidently strides through the door, over which a huge sign declares: ‘No men allowed beyond this point’.
There are three women in the ward with two midwives – Rebecca Maluks and Mary Atem – in attendance. He examines each of the mothers, and prescribes intravenous fluids for 27-year-old Achol Bul, who is dehydrated from diarrhoea. Pregnant women with complications such as diarrhoea, malaria, pelvic inflammatory disease, urinary tract infection, bleeding, abdominal pain or sexually transmitted illnesses are normally admitted to the Gynaecology ward for treatment, but Achol must be kept in the maternity ward because she is due any time now.
“Patients often come for treatment when the infection is advanced,” says Marin, “after the efforts of traditional herbalists have failed. That is why the cases we get are usually chronic. Some don’t bother coming at all, so they die in their homes. There is a lot of apprehension about hospitals due to ignorance; many people do not believe they will get better here. We need to do a lot of education to tell our people about the benefits of health services.”
Rebecca arrives with the fluid, and Marin proceeds to inserts an intravenous line into Achol’s hand, A government employee, Rebecca is a former soldier, having attained the rank of 2nd Lieutenant. She laments the shortage of drugs and other necessary equipment in the materninty ward. “We ran out of special delivery kits a long time ago. In fact, there have been no supplies since 2007. We are forced to improvise, and make do with what we have. For instance, we have only one small pair of scissors for the whole ward which we have to keep sterilizing. We also ask mothers to come with their own new razor blades.”
Rebecca is full of praises for Marin and the other clinical officers working at the Juba Hospital. “They are the ones we call when we encounter complications, and they are usually able to handle the problem. If we did not have clinical officers in this hospital, many women would have died.”
Health Workers Needed
Mr Stanley Yonama, the Director-General in charge of Human Resources and Development in Government of Southern Sudan’s (GoSS) Ministry of Health, appreciates the role that AMREF has played in training health workers in the country, particularly clinical officers.
“AMREF began training clinical officers in Maridi during the war. Though training was disrupted during the fighting, AMREF continued to train clinical officers and community midwives in rebel-controlled areas.”
Following the signing of the Comprehensive Peace Agreement (CPA) that granted Southern Sudan semi-autonomy, AMREF developed standardised curricula for training of community midwives, clinical officers, nurses and Community Health Workers for the Government of Southern Sudan. The standardisation has helped the government to harmonise the training system. Now, all training of health workers in the country is guided by these curricula.
“With the continuing training of community midwives and clinical officers, the situation is slowly changing. Clinical care has improved and increasing numbers of pregnant women are attending ante-natal clinics, so complications are being arrested, says Mr Yonama, “Across the country, Primary Health Care Units are being staffed with Clinical Officers as they are produced in Maridi, and the population is beginning to feel that their needs are being met at the grass roots level.”
“The production of competent Clinical Officers is definitely having a positive effect on the health status of the people of Southern Sudan, and I hope that when the next Household Health Survey is done in 2010, the figures will show that there is an improvement,” he adds.
Clinical Officers and other health personnel trained by AMREF, including public health officers, community midwives and nurses, are helping the GOSS to move towards its goal of taking good quality health care to the ground so that the people can be healthier and more productive.
“In this way we will be able to improve the quality of our citizens’ lives and to develop our country,” he concludes.
