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At night, in the emergency ward of the Old Fangak clinic, a medical worker prepares to treat a young girl with malaria. Photo/Frederic Noy/Supplied

The Tauranga midwife providing care in war-torn South Sudan

Janet Coleman of Médecins Sans Frontières tells of the challenges providing healthcare to patients in Old Fangak.

South Sudan remains a dangerous place to live, with one in three people reported to have fled their home since renewed conflict broke out in late 2013. In the northeast of the country, the Sudd wetland area around the Phow and White Nile rivers provides a refuge for people forced to escape fighting. Here, Médecins Sans Frontières (MSF) is one of the only medical humanitarian actors providing healthcare to local communities.

Almost 40 years ago, Janet Coleman had just completed midwifery training in Scotland and was travelling through Asia on her way back home to Tauranga, New Zealand. In Thailand, she heard about the Khmer refugee camp on the Thai-Cambodian border and was told that MSF had opened an obstetrics project there. Janet saw this as the perfect opportunity to put her professional skills and experience to the test and found herself working with the organisation for six months before returning home.

Years later, Janet returned to MSF and now has nine field placements to her name. She has recently returned from three months’ working in Old Fangak, in the Sudd wetland area of South Sudan, where MSF runs a 41-bed hospital.

An MSF mobile clinic team travels down the Phow River. Photo/Frederic Noy/Supplied

“Old Fangak is a very isolated village, with no roads in or out: the only access is via helicopter or a small fixed-wing plane, boat, or of course, walking,” she says.

The remote location of Old Fangak means people needing medical aid, including heavily pregnant women, often have to walk or row for hours to reach care. As the midwife activity manager, Janet provided care to mothers and their newborn babies in the hospital.

“I was responsible for the provision of antenatal care, delivery, gynaecological care and postnatal care. The role also included recruitment and training of South Sudanese staff and identifying training needs, and I was often on call 24/7 and available for emergencies.”

Janet also lent support to the MSF outreach teams delivering medical aid, including antenatal care for pregnant women, to people in the surrounding region.

“Our outreach teams travelled in speedboats up and down the Phow River, to reach people in villages where care was not available. We would pick up pregnant women who were at high risk of complications, or required urgent care, and take them by boat to the hospital. Sometimes villagers along the river would wave and call out to us as we drove past in the boat, signalling they had someone who needed help. We would stop and transport the patient back to the hospital for clinical review.”

Janet Coleman in Aweil, South Sudan, with colleagues from a field placement in 2010. Photo/Frederic Noy/Supplied

In Old Fangak, many pregnant women arrive for care at the hospital in advanced labour or with birthing complications. The normal practice in the region is for women to deliver their babies at home with the assistance of a traditional birth attendant, with little or no antenatal care. With no surgical facilities in Old Fangak, and no health facilities nearby where patients can be referred quickly, Janet and her team needed to be well equipped to deal with emergencies.

“One case that sticks out in my mind is that of a woman who had already had two obstructed labours, during which both babies had died. She arrived at the hospital with a third pregnancy in obstructed labour. With the support of one of our doctors, I managed to deliver her baby. Unfortunately, however, the baby didn’t survive,” says Janet.

“The woman sustained a fistula [a tear between the vagina and rectum]. It took three days to refer her to another health facility for further care, and another five days to negotiate consent from her family for the surgery she required. But, thankfully, she was eventually able to get the care she needed.”

As there is a low level of health literacy in the region, one of the main challenges was gaining the understanding and trust of patients and families, says Janet.

Consultation in the antenatal ward of the Old Fangak hospital. Photo/Frederic Noy/Supplied

“We had to work hard to communicate about the services we were providing. One important part of my role was establishing close relationships with traditional birth attendants in the community, to explain the need for women to seek medical care. These partnerships also helped to develop the community’s understanding of why MSF is there, and to build confidence in our services.

“Women and children in this part of South Sudan have such high health needs compared with those in many other parts of the world. MSF is providing one of the only medical services in the region; without the hospital and outreach teams, many people would have no access to healthcare.

“The women in Old Fangak are incredibly resilient, and it was rewarding to be there for many of them during their pregnancies and feeling that we were making a difference,” Janet says.

“This resilience was also true of my South Sudanese MSF colleagues. They live and work in adverse conditions and without them there would be no hospital.”

Janet intends to return to work in the field. “I love travelling and experiencing different cultures. Working with MSF has allowed me to combine this with my work. What could be better?”

This article was first published in the September 14, 2019 issue of the New Zealand Listener.