23 September 2012
Last updated at 19:53 ET
Juma James is a one of the few qualified nurses in South Sudan – the world’s newest nation and one of the least developed countries after decades of civil war. He works in a hospital in the remote town of Aweil in Northern Bahr el-Ghazal, one of the poorest regions in the country. According to the 2008 census, more than 700,000 people live in the state, but those numbers are higher now as many people have returned from Sudan since South Sudan seceded last year.
Many of the patients in the paediatric ward in which he works have suffered quite traumatic injuries, and need regular doses of painkillers. Nurse James says some of the young patients were attacked by a hyena. There are also snakebite cases, and one child was bitten by a crocodile as he was bathing in a river. But he says the most common problem is burns, as thatched huts in which most people live often catch alight.
Mr James works in a tent that has been set up as a ward because of a lack of space at the Aweil State Hospital – the only hospital in Northern Bahr el-Ghazal. Dr Garang Thomas Dhel, who runs the hospital, says the staff see about 10,000 patients a month. He says rural clinics are sometimes not functioning as they often lack qualified staff, and even medicines. Patients often undertake difficult journeys to the hospital as there are hardly any tarmac roads in the area.
The hospital in Aweil is operated by six medical doctors. "As for nurses, I am afraid to say we only have seven registered qualified nurses – the others are assistant nurses,” says Dr Garang. “It is because of war - most of our people were scattered and they had no chances to get qualifications.”
Dr Garang (pictured) says that like Mr James, who works for the medical charity Medecins Sans Frontieres, which runs a small project at the hospital, qualified South Sudanese medical staff prefer to work for non-governmental organisations. “Most of our nurses who are qualified are not working in public service - they are working in NGOs because our payments are limited.” At state hospitals, doctors are paid about $250 a month and nurses between $75 and $200. But MSF says it also struggling to find staff – and needs to hire another three nurses. At the moment it has six nurses for 130 patients on a shift.
Mr James is from Eastern Equatoria at the other end of the country. He was a little nervous before he arrived in Aweil, because the town is near the disputed border with Sudan. But he says people are really welcoming and he has not had any problems. “Sometimes patients don't understand what I am saying to them, but the organisation hired translators to help the locals and the expats.”
Malaria is a big problem here, as it is elsewhere in South Sudan. All of the 70 beds on Nurse James’s ward have mosquito nets, which make a big difference. Nets are also given to the patients when discharged to help protect them once they leave, and spread the nets throughout the community.
The medicines to be used each day are piled up on a table in the corner of the tent. Aweil hospital is often short on essential drugs – and even in the MSF section with a rise in malaria, Nurse James says it has become difficult to get some drugs, in particular the injectable anti-malarial ones. Treatment in this part of the hospital is free – and for this reason many people try to get referred from other sections. The fee is not much, but Northern Bahr el-Ghazal is poor, even by South Sudanese standards. It has the highest rate of poverty - 76%, according to official statistics. Mr James says the patients often arrive with nothing, not even a bag.
Most days in Aweil are very hot. This fan helps to keep the patients and their families a bit cooler. But despite the fan's best efforts, the temperature on the ward is still fairly high. During the rainy season, it is also difficult to keep the tent clean as anyone who comes into the tent tends to spread mud and dirt over the floor.
The families of the patients often come to the hospital too. Only just over a quarter of the population over the age of six has ever attended school in Northern Bahr el-Ghazal, so many of the children end up working in the fields rather than studying. It is a further indication of the range of problems facing South Sudan.
It is not easy, and not particularly well paid, but Nurse James says he is proud of what he does. He trained as a nurse in Juba – and says had he stayed there, he would have earned more. “The payment here cannot be compared,” he says. “But I like my job, I like to save lives so much... We are emerging from a war, we are a new country, and we are starting from zero.” (Photos and text: BBC's James Copnall)