Working as a children’s nurse in impoverished rural Africa would be hard enough, but when your place of work is a war zone in which food, water and medical supplies are at a premium, grabbing an extra hour’s sleep could mean the difference between life and death for the patients in your charge.
This is the daily reality for Bosco, a male nursing assistant in Kapoeta, South Sudan, a gateway for refugees fleeing the conflict that has torn the country apart since 2013, involving multiple opposition groups and covering much of the country.
Not only is he trying to save lives in the world’s most dangerous country for aid workers, he has to battle with parents who lack fundamental knowledge of basic hygiene, and for whom follow-up visits for their children seem unnecessary and inconvenient. On more than one occasion, he’s been forced to enlist village elders to convince errant parents that the dangers to their children aren’t solved with one visit to his under-resourced health center.
The humanitarian crisis in South Sudan is almost beyond comprehension – armed conflict, economic hardship and food insecurity have torn the country apart. This year, an estimated 5.3 million people face acute food insecurity – a 40 percent increase on 2017. For Bosco, however, these are more than mere figures – children are left in his charge with barely enough medicine to see them through the night. Alternatively, he can send them to a hospital several hours away, with the hope, only rarely realized, that they will survive the journey.
However, some good news for the country as a whole arrived last month in the form of a peace deal, with South Sudan’s president Salva Kiir signing a power-sharing agreement with rebel leader Riek Machar and other opposition groups in a bid to end five years of brutal conflict. How long the halt in hostilities lasts is anyone’s guess, but for Bosco, life – and the struggle to keep his young patients alive – goes on.
This is his story in his own words.
I work seven days a week, 24 hours a day. There’s no time for rest and there are few days off. In other places, nurses usually work in shifts, but I can’t because we don’t have enough staff.
When it’s busy, I wake up every hour during the night to do rounds because if I miss one hour I often find three or four children who have fallen sick with fever or diarrhea. There’s a bed inside the center where I usually sleep if there are a lot of children, otherwise I live across the road so I can run over and do checks in the middle of the night.
When I feel exhausted I think about the African saying: “An elephant tusk is heavy but it can carry,” which means that the work is tiresome but you have to do it to save lives. This is why I do what I do.
I’m the only nurse in one of the stabilization centers for malnourished children in Kapoeta, which is run by the aid organization Save the Children. I’ve been working as a nurse for six years and have been in this center for almost a year, together with one other doctor’s assistant. We work with malnourished kids who have medical complications such as edema, and children who are underweight for their height.
It’s not easy and things are getting worse here due to climate change and poor crop cultivation. This year, people have nothing to eat in Kapoeta and I’ve seen more babies in our center now than the same time last year. In May we had 36 children in the clinic and as the only nurse I had to make sure they were all OK and that their mothers and caregivers were properly tending to them.
The level of hygiene is alarming in this community. People aren’t aware of basic personal hygiene and so on top of looking after the children, I teach health education to the mothers so that when they’re discharged they know what to do because infection can lead to sickness.
There are so many challenges in doing this job. For example, sometimes the mothers are stubborn and once you discharge their children they refuse to come back for follow-up care. They’ll tell you they’re busy or they have to clean the house or look for food. Medically you can’t force someone to come in, you can’t just grab the child from the mother. So what I have to do is find their house in the village, knock on the door and ask if their child is still alive. If so, I have to convince the village chief and the mother to bring the baby back to the center for a checkup.
I think men need to be more deeply involved with their children in this society. They need to step up and be more responsible and complement the women’s capabilities. Women have so much to do and as a result they’re often in a rush and so they only think short-term. Men can provide a longer-term vision for their families.
Another issue we face at the center is the unnecessary death of children. Sometimes children die because we don’t have the resources. We run out of oxygen and the child needs to be referred to a major hospital, but in the process of moving them they die en route. Often the car can’t make it through a stream when the water’s too high during rainy season and so children die instantly. This month three children passed away.
A lot of the time the deaths have to do with late or poor referrals. For example, children show up to the center once they’re already too sick or they arrive on the back of “boda bodas” (motorcycle taxis) or in the back of lorries.
Imagine putting a child less than 1 year old on one of those things, often traveling for days at a time before arriving at a clinic?
But there are cases for me that make this job worthwhile.
Today I’m tending to a little boy named Bosco, a baby who was named after me because I helped save his life.
One week ago Bosco was brought to the clinic after a woman in the community found him abandoned, lying in the forest across the river. He was less than a month old and we didn’t think he’d survive. He was dehydrated and malnourished, tired and shriveled, even his voice was gone. But we started feeding him milk and after a rocky start his health began to change and now he looks like he’s on the road to recovery.
Christine Nakai, the boy’s new mother, is sitting on a straw mat under the tree outside the stabilization center. She’s been here since bringing little Bosco into the clinic and I’ll keep her here until I feel like the baby is stable.
“Bosco is just like God, he saved this child. If everyone had a heart like him we’d all be good and have no problems,” smiles Nakai.
When I hear this, it makes me feel like God has chosen me to do the right thing and that I’m actually helping my community by being a nurse. What I really want to do, though, is to become a pediatrician. I want to help children because of what I’ve seen, but I don’t have the finances.
While the war has greatly affected most of the country, the fighting hasn’t really come to Kapoeta. A consequence of the conflict, however, is the effect it’s had on NGOs. When fighting breaks out in the capital Juba, aid agencies are cut off from the rest of the nation and it makes it harder for everything to get here, including food like sorghum, as well as supplies. There used to be a lot more NGOs in Kapoeta before the war.
But I also think that people in South Sudan have become too dependent on international help.
South Sudanese people, especially those in the medical field, should not sit back and they shouldn’t rely on the work they can get done within the allotted hours. Too many people think that if they work eight hours a day they should be paid and then they can relax.
Even though it might not be within people’s scheduled hours, I think we should all work for the purpose of saving lives. Don’t look at what you’re getting out of it, look at what you’re doing for the community, because being part of the medical profession means doing more than what you’re earning, it means going beyond personal interests.
I love this job because I can save the life of someone who’s dying and that alone will build something healthy between me and the parent and me and the community.
As told to Sam Mednick.