Nursing in Sudan

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by Jonathan White

As the referendum gets closer for Southern Sudan in January of next year to gain independence from Northern Sudan, our new Nursing & Midwifery College in Juba, awaits the results anxiously.  The College will be closed between November 15th and January 15th to allow students and staff to safely register to vote and return home to await the results of the election.

The Nursing & Midwifery students with the staff of College and RMF project manager

Our partner in this initiative at the UNFPA in Sudan sends us these weekly media summaries as everyone prepares for the voting:

Below are series of short articles written regarding Senator John Kerry’s involvement and the Obama administration’s stance on the upcoming elections.

CPA partners receive Obama’s road map
Al-Rai Al-Aam 8/11/10 – The Sudanese Government is currently studying phased proposals conveyed by Chairman of the Senate’s Foreign Relations Committee John Kerry to lift sanctions imposed on Sudan, to write off debts and to remove Sudan’s name from the terrorist list in exchange for NCP’s concession on the Abyei territory.

Sources said the Government told Kerry that it had agreed to the South’s self-determination in return for peace and is ready to accept the referendum result but it would not make concessions on Abyei.

AFP 7/11/10 reported that US Senator John Kerry said during a visit to Sudan on Sunday that he delivered a roadmap aimed at resolving disputes between the North and South before a January referendum that may partition the country.

“President (Barack) Obama asked me to come here with his special envoy General (Scott) Gration and White House security adviser Michelle Gavin to offer his own proposal,” said Kerry.

“President Obama offered a roadmap to solve Abyei and other issues,” he told reporters of the disputed oil-rich region straddling north and south.

Kerry, who provided no details on the Obama proposal, met presidential aide Nafie Ali Nafie in Khartoum before leaving the country.

Sudan Tribune website 7/11/10 reported Kerry as saying “Sudan can find itself off the list of states that sponsor terrorism as early as July 2011 should it facilitate the self-determination votes in Abyei and South Sudan and recognize their outcome”.
The “Politico” magazine quoted unnamed senior U.S. officials as saying that President Barack Obama attached several conditions to the offer including that Khartoum facilitates the conduct of a transparent and on-time referendum on the status of Southern Sudan and respecting its result.

Additionally, Khartoum must implement “all appropriate post-referendum agreements – related to border agreements, currency, citizenship and other matters,” to fulfill U.S. conditions to be considered for accelerated removal from the state terror sponsor list, the official said.

The administration proposal Kerry carried to Khartoum “decouples the state sponsor of terrorism issue from Darfur,” a second senior U.S. official said Sunday. “But doing this in no way undermines the importance of the resolution of humanitarian and political problems that have plagued Darfur for the last decade. The comprehensive sanctions that have been in place [on Sudan] since 2003 and 2004 remain in place until we see a resolution of the Darfur crisis.”

Obama’s offer moves up by at least six months the date by which Khartoum might come off the list. But the U.S. officials emphasized a final decision would still be contingent on Sudan halting all sponsorship of terrorism for at least six months before the July 2011 target date and pledging not to resume such assistance in the future.

“President Obama made clear in the proposal conveyed this weekend that if Sudan’s leaders take concrete steps to implement the Comprehensive Peace Agreement, including recognizing the results of the referendum in January, he is prepared to immediately take significant steps to begin to transform the bilateral relationship. This would be the beginning of a new roadmap for addressing key bilateral issues as post-referendum issues are resolved,” he added.

Obama’s carrots to Khartoum may include more than just getting of the terrorism list. On Saturday Kerry met with Sudanese minister of Finance and National Economy, Ali Mahmood Hassanein to discuss the country’s $35.7 billion debt and ways to get a relief.

Sudan state media said that the US Senator promised the establishment of a committee comprising the Sudanese and US sides to deliberate and arrive at a resolution to Sudan’s foreign debts.

A well-placed source in Khartoum told Sudan Tribune on Friday that Western diplomats in the capital believe that Kerry may also offer U.S. support for deferring the arrest warrant against Sudanese president Omer Al-Bashir through the UN Security Council for one year that can be renewed indefinitely.

But U.S. officials today emphasized that separate U.S. sanctions imposed over Darfur — which Obama extended for another year on Nov. 1 — would remain until Khartoum improved conditions in the region, where the United Nations estimates up to 300,000 people died following a revolt in 2003, they said.

“Those … sanctions remain in place and they are the ones that have a significant effect on Sudan’s economy and on the government of Sudan itself,” said another official, who added that future steps such as debt relief and an exchange of ambassadors would all depend upon progress in Darfur.

Real Medicine Foundation, in collaboration with the Government of South Sudan, the UNFPA, the WHO, St. Mary’s Hospital, Isle of Wight, and the Japanese International Cooperation Agency (JICA), and in partnership with and with financial support from World Children’s Fund, is establishing the first College of Nursing and Midwifery. The consortium aims to provide a scalable working model for this college that will offer a 3 year diploma for Registered Nursing and Midwifery and may be extended to other strategic locations within the country.

Read more about Healthcare Sector Capacity Building – College of Nursing and Midwifery, Southern Sudan

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Program Director Bilha Achieng with the Principal and first class of students

The new Juba College of Nursing and Midwifery that Real Medicine supports and helps manage in South Sudan has finished with the foundation level courses for it’s first class of 40 students and getting ready to begin the diploma program next week.  In honor of this milestone, the Southern Sudan Medical Journal has published an article focused on the new College and it’s mission.  This is a unique project for Real Medicine as we are focused on building the actual capability of Sudanese to help themselves through their own resources in the future.  Graduating 40 new diploma level Nurses and Midwives every year will go a long way in helping South Sudan rebuild after decades of neglect.

As mentioned in the article, Bilha Achieng is Real Medicine’s program director for South Sudan and is doing an amazing job managing the launch of the College.

Full text of article below:

PDF link to the full the full August journal here: SSMJ August 2010

Southern Sudan Medical Journal: August 2010

Nursing and Midwifery in Southern Sudan – Undersubscribed in a High Demand Environment

Author(s): Julien Bucyabahiga UNFPA Communication Officer

The Present Situation

The first ever College of Nursing and Midwifery in Southern Sudan has been established. This comes at a time when Southern Sudan is recovering from more than 20 years of civil war, which resulted in decay of the available infrastructure, human resources and systems in the health sector. As well as the lack of qualified personnel, the health care infrastructure including hospitals, primary health care centres and primary health care units also lay in total ruin.

Most practising health professional cadres received limited professional health education during the war that ended in 2005. Of the more than 4600 health workers who are presently operational, less than 10-20% have received more than 9 months of any form of professional training. This situation is made worse by the severe mal-distribution of health workers. More than two thirds are working in 3 of the 10 states, and there is a severe urban-rural bias. As a consequence, Southern Sudan has the highest maternal mortality ratio in the world standing at a staggering figure of 2054 maternal deaths/100,000 live births1.

In response, the Government of Southern Sudan (GOSS) has sought assistance from donors and neighbouring countries (e.g. Kenya, Uganda, Ethiopia) to support human resources for the health care system. “We have to learn from experiences…, we are not ashamed about our situation. Our people must access a better heath care system” stressed Dr Olivia Lomoro, Acting Undersecretary in the Ministry of Health during a recent workshop. With the support of United Nations Population Fund (UNFPA) and many other donors, existing structures are being renovated.

Training midwives

Starting in 2006, the training of Community Midwives was the first UNFPA initiative in the support of skilled birth attendants (SBAs). 96 students have graduated since 2007 from different institutions.

A further 110 Community Midwives are being prepared to begin training in 2010. UNFPA is looking into the possibilities of recruiting about 150 International Volunteers/Midwives by the end of 2010 to help the South Sudan Government to face the challenge of lack of qualified health cadres.

Juba College of Nursing and Midwifery

Because of the urgent need to develop a cadre with acceptable knowledge and skills, several stakeholders have joined hands by funding the first ever Nursing and Midwifery College.  These include UNFPA, Real Medicine Foundation (RMF), World Children’s Fund, the World Health Organization (WHO) and St Mary’s Hospital, Isle of Wight-Juba Link. The United Nations Development Programme/ Global Fund (UNDP/GF) and Japan International Cooperation Agency (JICA) are providing additional funds to renovate /construct student hostels, a kitchen and mess hall, additional classrooms and a recreational facility.

The Juba College of Nursing and Midwifery has been operational since May 2010 and will be fully established in its new facilities by the end of 2010. It is expected that the college will have trained over 100 nurses and midwives from all states of South Sudan by 2015.

The College is temporarily being hosted at the Juba Public Health Training Institute as JICA start construction and renovation work at the intended site at Juba Teaching Hospital (see Figure 1).

The students

The school opened with 30 students including 18 nursing and 12 midwife trainees (see Figure 2, 3 and 4). Of these, 10 are male and 20 are female. Trainees have come from Eastern Equatoria, Central Equatoria, Upper Nile and Western Equatoria states. The highly motivated and enthusiastic students are currently taking foundation courses in mathematics, biology and English. “Some of us have been working as nurses in various state hospitals. We are very happy to be here. The courses will help us upgrade our knowledge and skills” said a student.  The school is supposed to take students from all states but it is difficult to get candidates with all entry requirements.

Training and tutors

According to Dr Dragudi Buwa, UNFPA Deputy Representative in Southern Sudan, the intensive training will take three years. “The training will lead to a Diploma in Nursing and Midwifery based on a curriculum recognised by international standards”, says Dr Buwa. The school will help contribute towards the achievement of the Millennium Development Goal 5 (reduction of maternal mortality) as well as improving access to family planning and basic and comprehensive emergency and obstetric care.

When they have finished training in 2013, the qualified nurses and midwives will repatriate to their respective states to offer professional support to the health facilities. “Having attained adequate skills to work relatively independently in state hospitals, Primary Health Care Centres and Primary Health Care Centre Units, they will be expected to mentor and guide the other lower cadres’ staff prevalent in such health facilities. They will organise the work of the health care institutions and bring quality assurance to the care processes undertaken in their respective heath care units” says Ms Bilha Achieng, Project Assistant Manager with Real Medicine Foundation who is currently running the day-to-day operation of the school. She adds, “Real Medicine Foundation has also agreed to fund tutors; St Mary’s Hospital Isle of Wight-Juba Link will provide volunteer tutors temporarily to support the college tutors”. Eventually the management of the school will be handed over to the Ministry of Health. Ms Petronella Wawa is already designated as the Principal of the college.

Challenges

The main challenges of the college are:

  • Lack of national qualified nurse and midwife tutors,
  • Shortages of applicants for the diploma programme with an acceptable entry-level of education. South Sudan’s high adult illiteracy rate (due to two decades of war) especially among women has affected the candidate selection process and requires a re-assessment of the interview and selection criteria2.
  • Lack of funds for students’ housing and transport3. Some students face challenges in learning English. Mary Lupai UNFPA’s National Programme Officer for Gender is helping to tutor the students in communication skills.

Fore more information, please contact Ms Bilha Achieng at achie.bilha@gmail.com

References

  1. Southern Sudan Household and Health Survey, 2006
  2. Information from Jonathan White, RMF
  3. Informal information from Janet Michael, Director of Nursing and Midwifery

Thanks to Bilha Achieng and Jonathan White for the photographs in this article.

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