Some Things Never Change.

Over the last week, I've started going across to the teaching hospital (where I was as a medical student 5 years ago) on ward rounds with one of the consultants who also works at the hospital where I work.  Having seen the huge changes elsewhere in Juba, I was intrigued to see what had happened to the hospital since I was last there.

On my few visits so far, it seems the last 5 years haven't been so kind to the hospital. When I was last there, basic medications were available for patients free of charge, and there was an air of optimism around the hospital. Now there are no drugs or fluids, and often limited electricity. There are hard-working doctors and nurses, but they have very limited resources. Patients have to go and buy any medicines that they need, and apparently they often need to buy their own cannula and the gloves for the staff who are inserting it - which adds even more pressure if its a difficult cannula.

It's strange to see all the change in Juba without a corresponding improvement in government healthcare. I'm sure there are lots of reasons why, although I think part of it is that there has been lots of private investment, without much government investment. It will be interesting to see if anything changes, as the ongoing problems between north and south over oil revenues seems to be less problematic than it has been, so hopefully the country should get some money.

My work at the private hospital is going quite well, although it's often not very busy, which means that shifts can drag a little bit. The rounds at the teaching hospital are a huge contrast from the private one - there are lots of patients in the teaching hospital who have presented late (for various reasons) and who are very unwell. The prevalence of TB is huge, and it presents in a huge variety of ways. Thankfully, basic TB and HIV (which is also quite common, when people are actually tested) is free thanks to the WHO, among others.

Apart from all the tropical conditions, which are rare in the UK, we also have our share of patients who have more "common" conditions such as strokes and heart failure. We currently have 3 patients who have had strokes, all of whom have a very different future compared to similar patients in the UK. Here we don't have stroke units with intensive physio and OT input, specialist nursing and doctors who walk around looking important. There are some pyshiotherapists around, but they seem pretty stretched, if they are at the government hospital, and expensive if they're private. Even after the acute "rehabilitation" they receive in hospital, there are no government funded carers or specialist equipment; their families have to look after them without any formal outside help. Compared to many other places, disability doesn't have as much stigma attached to it, and family groups are often close-knit; but on a practical basis, having someone who isn't able to earn money or run the home, who needs to be supported, is going to make it pretty tough for a family who is probably only just managing as it is.