Postgraduate Medical Education in South Sudan
“We have to sacrifice, if we are to get better.” The words were spoken in a matter of fact tone, and backed up by 50 South Sudan Pounds. By the time the rest of the staff had chipped in, we had enough money to buy bottled water for forty young doctors. With water, we could hold our meeting, and with a meeting, a cohort of newly graduated doctors could be introduced to the next stage of their training.
I’m writing this in the UK. When I travel back to Juba, I’ll take a small supply of medicines with me. Daily life is a struggle, out there, including the challenge of obtaining basic medicines. My driver summarised his experience for me, “I was born in problems, I live in problems, and I will die in problems.” I acknowledged the truth of his words by making a clicking sound. He smiled. The South Sudanese have a great capacity for smiling.
“One thing,” I find myself saying, on a more or less daily basis, “We have to do one thing, however small, to make things better.” As I write, we have no budget, unreliable power supply, limited broadband, and a myriad of practical frustrations. Everything takes time. Seemingly trivial difficulties halt progress. Our printer/photocopier arrived without anyone to install it, and with the wrong size toner cartridge. Without printing we could not provide training logbooks. Money would solve the problem, but to receive our budget allocation we needed a bank account, and with no money we could not open an account. In the end we solved both the printer and bank account problems in the same way that we solved the earlier water problem. Everything is a team effort. It is time to recognise what we have achieved1.
The building site at the lower end of Juba Teaching Hospital is now the Postgraduate Medical Education Centre, headquarters of the College of Physicians and Surgeons of South Sudan, complete with landscaping and cattle.
College staff can point to a reference library, offices, classrooms and meeting rooms. Here, we teach postgraduate doctors, sixth year undergraduates, and members of allied health professions. Since November last year we have hosted two groups of visiting clinical trainers from the UK2, and we are planning further similar visits. Meanwhile, we are arranging for two of the College staff to visit the UK, for short placements, to develop their clinical and medical education skills3. We also registered our first cohort of graduates, issued them with their logbooks, and deployed them into hospital rotations to begin their postgraduate medical training.
None of which addresses the problem of College finances; here, too, we are making progress. With our bank account now open, the transfer of our budget allocation is imminent. We are also to host a UN sponsored project, to train Associate Clinicians in clinical procedures aimed at reducing child and maternal mortality. This is a major opportunity, and not only to increase medical capacity. It will create revenue, and enable further upgrading of College facilities, including enhanced broadband, a new generator, and a fully equipped clinical skills centre. Broadband will allow for streaming and audio-visual communication between the UK and the College, opening up new opportunities for educational support by the UK network.
Last week I received an email from a young surgeon, currently studying in Kampala, “…to let you know that I am interested and committed to the implementation of the Postgraduate Medical Education Programme in South Sudan. I will be available and ready to work with you to ensure its success.”
We just need to keep doing one thing, every day, to make things better.
Dr Rich Bregazzi
Dean of the College of Physicians and Surgeons of South Sudan.
Professor of Medical Education Planning, Juba University
Visiting Research Fellow in Healthcare Education, St John’s College, Durham University.
1 ‘We’ includes the Ministry of Health of South Sudan, College staff, the staff of Juba Teaching Hospital, colleagues from Juba University, the individuals and groups that together make up the UK support network, and all those who, at one time or another, have put their shoulders to the wheel to develop postgraduate medical education in South Sudan.
2 Dr Paul Weir and a team of obstetricians from Belfast; Dr Hugh Grant and a team of paediatricians from the south of England
3 This is organised by the St Mary’s Hospital-Juba Link, based on the Isle of Wight, and funded by a grant from the Gordon Memorial College Trust Fund
All photographs © Rich Bregazzi 2016