OWEN Seymour Arthur, the enigmatic Barbadian politician who was Prime Minister of Barbados from 1994 to 2008 once said, “...for he who has health, has hope, and he who has hope, has everything.”
Of course, not everyone can be as eloquent and philosophical as Owen Seymour Arthur, and I will not even attempt to be. However, his powerful and provocative public health dictum rang loud in my head when I heard that for a third successive year, the Save the Children supported Nimule County Hospital in South Sudan had been awarded a Certificate of Recognition for, and I quote, “Outstanding Performance in HIV Testing and Counseling at Antenatal and Maternity”.
It is quite easy for anyone who doesn’t know the story of Nimule County Hospital to dismiss the recognition it got from the Ministry of Health, the Centre for Disease Control (CDC), and Columbia University as insignificant.
However, if you delve deeper into the hospital’s history, and see the tough socio-economic and political challenges that it has to overcome every single day to offer quality basic healthcare to a needy population, then you will appreciate the significance of the award.
Built in 1983, and located about 198 kilometres on the Uganda-South Sudan border, Nimule County Hospital started life as a health centre, and remained so until 1994 when it got hospital status. Today, the hospital provides approximately 50% of all health services offered to communities in Eastern Equatoria state, as well as in the Magwi County catchment area which has a population of over 300,000 people – 103,000 of whom are children.
The hospital’s clinical facilities are basic. It cannot afford to run its electricity generators for 24 hours, it only has two doctors, six clinical officers, 27 nurses, six midwives, and three delivery beds – although only two are functional.
On average, the hospital handles 11,000 pregnancies every year, and about 144 babies are delivered by Caesarean Section. According to the Medical Director of the hospital, David Nyuma, up to 172 babies are born at the hospital every month using three makeshift delivery beds.
“...Sometimes we get overwhelmed and deliver babies on mattresses laid on the floor.” said Nyuma.
Stretched to limit
When conflict broke out in 2013, Nimule County was overwhelmed by approximately 35,000 internally displaced people (IDPs) who settled in and around Nimule town where the hospital is located. The huge number of patients, and the painful and yet necessary austerity measures instituted by Save the Children to manage the funding gap have stretched the hospital to its very limit.
In spite of all those constraints, in 2015, the hospital provided various health services to over 80,000 people in Nimule and the surrounding areas through static and mobile health care.
Over 5,000 children were vaccinated against childhood diseases, and another 50,000 were reached with preventative and curative health care. Over 11,093 people were tested for HIV in several testing centres, and 64% of the 522 who tested positive were immediately put on anti-retroviral treatment.
It’s only when you hear from HIV experts like Mitchell Besser that you truly begin to appreciate the significance of what Nimule County Hospital is doing for children. According to Besser, a renown scientist who developed a ground breaking program to prevent mother-to-child transmission of HIV, “...in resource-rich countries…98% of babies are born HIV-negative, yet, in resource-poor countries, in the absence of tests and treatment, 40% of children are infected.”
In 2014, the hospital was also rated as a “model hospital” and a “centre of excellence”. How then, one might ask, does a hospital with seemingly insurmountable challenges manage to register that level of success in what is essentially an emergency situation?
A quick chat with the hospital’s Medical Director, David Nyuma, soon reveals that the answer lies in the dedication of its staff who, like Owen Seymour Arthur, believe that “...he who has health, has hope, and he who has hope, has everything.”
And from that belief amazing things have happened.
The hospital regularly organises outreach activities to carry out vaccinations, outpatient consultations, and screening for malnutrition so that some of the cases are managed at the community level.
Reacting to news of the hospital’s recognition for “Outstanding Performance in HIV Testing and Counselling at Antenatal and Maternity”, Save the Children’s Director for Global International Programmes, Imran Martin said, “...achievement and recognition is truly significant in the face of the overall South Sudan narrative of failure and despair…it signifies hope, and the possibility of delivering quality despite the challenges, and without using the (war) context as an excuse.”