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Judy, a New Zealand Red Cross nurse from Auckland, is working for the International Committee of the Red Cross in Juba, South Sudan.
Her main focus is helping set up primary healthcare clinics across the country but she inherited about 20 patients who were evacuated during fighting in April 2014 to Juba Teaching Hospital. Now there are only three left, one of them Lucia, who she visits weekly.
“I talk to them and their caregiver. I give them a weekly incentive (money for food), just keep an eye on them. I work to get them discharged then put them on an ICRC plane and send them home. The three left now are long term and complicated cases.”
For six months now, 55-year-old Lucia has been in a bed in a hospital corridor, looked after by her daughter in law. She has suffered gunshot wounds to both legs – her right leg has been amputated above the knee. Judy is trying to get her other leg strong enough to support her weight so she can be fitted with a prosthesis and become mobile again.
“I try and make sure she does her exercises. Every time she sees me she starts swinging her leg like this (swings lower leg). She’s made a big improvement – when I first met her I couldn’t touch the sheet without her jumping. Now I can rub the stump and have showed her how to do it herself so she can get it used to sensation. In a few weeks she’ll go to orthopaedics, and hopefully be fitted for a prosthesis. She needs another x-ray but the hospital has no operating theatre or x-ray machine at the moment because there’s refurbishment going on.”
Lucia tells us she is fed up. She’s been away from home for six months and misses her five children aged between 20 and nine years old. She had six other children but they died of illness and diseases like malaria.
“I’m not happy as I cannot move, cannot work, cannot do anything. But Judy has given me a lot of help, she has given me a wheelchair and some drugs. She comes and checks my condition and gives me money for food. I’m hoping to walk again.”
Later Lucia tries out the wheelchair Judy has provided for her, and looks happy to be sitting outside in the fresh air. By the time we leave she is smiling and her mood has improved markedly.
Judy’s other patients include a man, Oban, with a broken leg which has healed bent at the knee because he didn’t get physiotherapy at a crucial time. His external fixator will be removed in about six weeks but unless he can straighten his leg he will not be able to walk. A group of nursing students spends time asking Judy medical questions and she tries to show them the exercises he has to do.
Her other patient, Mary, also has a broken leg, with an internal fixator that became infected. Judy organised for the wound to be cleaned out and is keeping a close eye on it to make sure it doesn’t become infected again.
All of this is done via Judy’s translator and field officer Evans. He is a highly skilled clinical officer – somewhere between a doctor and a nurse, and often has to translate the conversation into more than once language at once – for the caregiver and the patient. Judy says it’s these people and the children who she will remember when her time here is finished.
“I had a little girl in the field a few weeks ago. She was six years old but looked about four. She was really sick so they gave her IV fluids and within one and a half hours she just sat up. She’d had a high fever and she had malaria but she was just dehydrated. Usually when kids see me they cry - I think it’s the white hair. But every time she saw me she grinned. She was cute – she followed me around the hospital for the rest of the time I was there.”
Judy says the fragile health system in South Sudan is made worse by the lack of doctors and ongoing fighting.
The rainy season is about to finish and the situation is unpredictable. People are dying of preventable diseases like malaria and cholera, and she hopes the primary healthcare clinics she’s helping set up will make a difference.
ICRC is also doing food drops to areas where there is a lack of food, because many people, including children, in the violence-affected areas that are hardest to reach, are suffering from malnutrition.
“I know that what I’ve done so far has made a difference. Primary care is the backbone of any healthcare system. Primary healthcare is routine health, anything you’d see a doctor for at home. We set up a primary health clinic in Waat, Jonglei state, and supported similar services in Kodok, Upper Nile state and soon in the other parts of the country.They vaccinate kids, do antenatal care, outpatients, malaria cases, chest infections, nutrition, first aid, monitor things like Marburg’s disease. In Waat there is a disease called kala-azar (visceral leishmaniasis) caused by sandflies. It is endemic in four states. There have been more than 4000 cases and 102 deaths so far this year. We keep an eye on things like that.”
Judy says she has enjoyed her 35 years as a New Zealand Red Cross aid worker, and knows she has a unique set of skills that enables her to make a difference.
With Judy’s help people like Lucia, Oban and Mary can hopefully soon start rehabilitation, and the long journey back to independence.