Ms. Prossy Namuli
Matron of Saint Francesco D'Assisi Hospital in Marial-Lou

Can you tell us something about yourself?
I am a Ugandan with a diploma in registered comprehensive nursing. Since I completed my course in 2005 I worked as a registered nurse in different public hospitals and health centres. Later on I worked as a research nurse in a research unit in Makerere University on HIV related issues. 

I started with AAA May 2006, first in Gordhim as Matron (TB & Outpatient) was then transferred in October 2007 to Marial Lou rural hospital as the matron/field coordinator.

Which was your first impression of Sudan?
The first impression was not very good. I compared Sudan with my own country and I realized these people need a lot of help. People were just in the bush, they did not have enough health units (had to walk over 100km just to get to a health unit), no qualified health workers, some did not have shelter, shared small houses with animals, no latrines, no roads (the car passed through the bush to reach the centre) no enough food, and some were walking naked. I thought if there is any place some one needs my help as a nurse, it is Sudan. I kept wondering how people could survive in such an area. Time went on and I started coping better with the situation. 

Which are the main challenges for the people as far as health is concerned?
Communication is one of the main problems here: the distance from the homes to the health facilities is a big limitation. Sometimes patients have to walk for distances of up to 80 km or more to reach our hospital and access health services.

Another important health challenge is the fact that many people are illiterate and ignorant; they are not informed about the importance of seeking medical care from health facilities, so they go to the traditional healers instead of seeking medical help. They seem to trust them more than medical staff. I think it is because they don't have the knowledge, they simply don't know which could be the result of coming to hospital. Fore example, we receive many pregnant women with obstructed labour, ruptured uterus, macerated still births simply because they were labouring at traditional birth attendant. Almost 99% of the mothers report to hospital when their children are in very poor conditions (about to die) and they are asked why they took so long to come to hospital; they say they had taken the child to the witch doctor.

Can you describe the Marial Lou Hospital?
Marial Lou Hospital is a rural hospital, it is in the middle of the bush and quite cut off from any town around. Particularly during the rainy season, you can't move out of the hospital unless you are flown by a plane. It runs an Out patient department, In-patient department, 24 hour emergency surgery, maternal health clinic, nutrition programme and laboratory services. It is serving almost the entire Warab state. In Wau there is a government hospital but quite often patients there are referred to our rural hospital. There is another hospital in Turalei but I got the impression people prefer to come and be treated here since we get patients even as far as Gogrial and other far areas. In 2008, 2636 patients were admitted among these, 293 had gunshot wounds,12709 patients attended OPD after it was handed to AAA from CCM in June to December and 4200 pregnant women attended Antenatal Clinic at Marial Lou Rural Hospital. Am tempted to say that it because of the quality services delivered to the people, this is the reason why they walk many kilometres just to get medical care from Marial Lou Hospital. When I interact with people in the community, they say as well that medical staff and doctors working in the hospital are doing an outstanding job; people are sometimes brought in a deplorable condition, people think they are going to die, but in the end of it they walk out happy, energetic, healthy and they go home. We have a case of a patient who came with gunshot wound, his abdomen, bladder, bowels and rectum were injured. Even the relatives had lost hope but the doctors and nurses managed to restore his body. I would say, this is a God-given hospital to save the poor community of Warab state. Apart from the adults also children are also brought with severe pneumonia, malaria, water diarrhoea, severe malnutrition, severe anaemia, to mention but a few but the doctors and the nurses work tirelessly to see that they improve and are discharged in good condition. I was compiling the statistics of 2008 we had a cure rate of 92.1%, death rate was 2.1% and the rest were referred to other hospital (like TB hospital, Juba Hospital, Khartoum) because the hospital does have capacity to manage such conditions . It is really a hospital to help the poor. 

Do you really think your work is making a difference?
We are definitely having an impact on the community and making a big difference because without this hospital I can imagine how many people would loose their lives or have disabilities. Through the continuous on job training, the nurses have increased and improved their knowledge and skills. This has been reflected in their performance. The community is also responding positively to the health education talks given to them. This has been reflected in the number of patients seeking medical care in the hospital, the increased number pregnant women attending ANC and coming for hospital delivery. The Local authorities are really happy about the services offered to the community and they say that. In that sense I do feel rewarded when a patient comes to the hospital especially when the family has lost hope and the patient goes back in a good shape.

Which are the main challenges and priorities you face as AAA in the field?
One of the biggest challenges is staff. We have few human resources. One person is loaded with lots of work (theatre, delivery room, ward, administrative work... etc.) also local staff and doctors are overloaded with work. Another challenge is the supplies both logistics and medical, most of the times are not enough or don't arrive on time. A third challenge would be the salaries, since we have lots of complaints from the staff about salaries. In January we lost ¾ of the staff due to lack of salary increment. AAA as an organisation gives what it can depending the funding available and it is trying to get also government involved in the support to the hospital. Government officials have promised to come around and have a look at the hospital, interview staff and so on but since October 2008 when they promised this, nobody has come.