A seven-year gap between assignments in Aweil, South Sudan, proved revelatory for obstetrician-gynaecologist Dr Alan Hughes. In 2010, he arrived as a novice—in his own words, “starry-eyed”. But the project too was young, opened not quite one year earlier as a collaboration with the Ministry of Health to improve the survival rates of women in childbirth, and their newborns. On his return in April 2017, Alan shared his impressions of the high-performing maternity department in Aweil State Hospital.
“Personally there were many challenges the first time, but clinically I was extremely busy, with many women at risk of death because of the complications they faced in delivery. Some of them arrived after having already laboured for a long period at home. Some of them developed fistulas. Their babies were dying too. In comparison this time there were very few women who had laboured at length, and no uterine ruptures (a life-threatening complication for mother and baby requiring immediate surgery) for example. Women were not only coming to the hospital earlier—the maternity service better known throughout the community—they were also receiving prompter and more skillful care from the midwives at the frontline of their care.
"The team of midwives are the backbone of the free maternity care and its life-saving results in the ward in Aweil"
The obstetrician-gynaecologist position has almost become redundant, apart from occasional emergency surgery. The team of midwives are the backbone of the free maternity care and its life-saving results in the ward in Aweil. Fifteen midwives—a team of South Sudanese women and men, some of them locally educated and trained—work with eight nurses, nine nurse assistants, five attendants and five translators to manage more than 4,000 deliveries per year around the clock. I often only needed to stand back, observe and ask a few questions as they managed patients that once would have had required my direct care. Even though the workload is arduous, divided into two 12-hour shifts each for three midwives, it is impressive how potential problems are picked up early and intercepted before they become serious complications. The midwives’ clinical judgement overall is good, and they meet twice a week to review their work amongst themselves and broader staff. When they’re on duty they also rotate, multitasking and acting as team leaders.
The cleaners proved another high-performing team. The concrete floors are washed and mopped several times a day, and there are multiple hand sanitiser units. Cleaner morale is high; their value is appreciated and they are accepted as essential team members. When I was briefed I was told the project had matured, but I didn’t particularly lock down my expectations. It turned out a privilege to see the developments, thanks to the dedication of the whole Médecins Sans Frontières team.”