The medical staff serving at the IDAT Hospital in Tonj, South Sudan are saving many lives. In the paediatric section of the inpatient ward, babies receive life-saving support. MAF staff, James and Phil, use their skills and experience to help repair oxygen concentrators for the hospital.
Story and Photos by Jenny Davies.
Two fragile little lives are hooked up to one Oxygen Concentrator in the inpatient ward of the IDAT hospital in Tonj. As she walks past, nurse Rebekah untangles and straightens the oxygen line.
The piece of medical equipment they’re attached to extracts oxygen from the air so patients that with breathing difficulties can receive concentrated oxygen. Across the developing world, in the absence of ventilators or a reliable supply of bottled oxygen, the oxygen concentrator is the next best thing.
A few hundred miles away in MAF’s compound in Juba, Maintenance Manager James tinkers with a broken compressor unit from an Oxygen Concentrator that has been gathering dust in the corner of the IDAT hospital. Phil Butler studies technical drawings from a website and assists as they troubleshoot and test. The pair are surrounded by a clutter of useful bits and bobs in an office that is the opposite of the orderly hospital ward. In this environment, where it looks like old electronics come to die, they too are saving lives by fixing the medical equipment that mission partners can’t afford to throw away.
A casual conversation
It started with a conversation between IDAT’s Suzy and James. ‘She said, “We have theses oxygen concentrators that are broken, do we know someone who can fix them?’
James, eyes lit up at the prospect. ‘In Papua New Guinea where I served before coming to South Sudan, I used to fix a lot of appliances, I mostly did electronic repairs and radio installations. My favourite thing is fixing things! This is my happy place, he smiles. ‘Anything that keeps me away from meetings and paperwork and dealing with difficult people!’
Both Phil and I are electricians by trade,’ James explains. ‘We’ve got people here with the skills and this is a way we can serve our partners. ‘There are four of these machines, all with different problems,’ James continues. ‘One had a blocked diaphragm. One had blocked filter and the other two had problems with their compressor units.’ The faults almost sounds like medical diagnosis.
James explains that some of the fixes are quite straightforward. ‘I had one of the concentrators back to IDAT within a week. The 110 voltage unit had been plugged into 240 volt supply which meant it ran too fast and built up too much pressure which blew the hoses off. That didn’t actually damage it, so it was fine.
‘On the same flight, I repaired and sent a machine that monitors your blood oxygen levels. Someone had plugged the plug in the wrong way and broken all the wires – so that was a fairly quick repair as well. They were happy to have that back very quickly.’
24/7 supply
‘The air we breathe is mostly made up of oxygen and nitrogen,’ James explains. ‘The oxygen concentrator has a special filter in it that removes the nitrogen from the air so what passes through to the mask which the patient wears is just highly concentrated oxygen. It doesn’t store the oxygen but is continually producing it as long as there is a power supply.’
The IDAT hospital has a reliable power supply thanks to 96 solar panels installed on the roof in 2019. ‘We’re one of the only places in Tonj that has power 24/7,’ explains Charge Nurse Rebekah Soper.
‘Three years ago, when I was here, it was so stressful because we didn’t have constant electricity. The generator would run out of diesel, and we’d be like, “Hello! We’ve got children on oxygen here! What are we going to do?” It was so stressful,’ the nurse explains.
There is an oxygen bottle in the curtained off emergency area. The oxygen mask is still lying on the treatment bed. It’s just been used to respond to an emergency. ‘We have another machine in our storeroom which you connect up to the concentrator that can then push the oxygen into this bottle to fill it,’ Rebekah explains ‘The fact that we have a few of these oxygen concentrators is amazing. At the end of the year last year, the most we got to was 15 children on oxygen. So pretty much this whole side of the ward was children on oxygen. We had to use the splitters like the one you see.’
Respiratory Infections
‘We’ve just had a season, a month with so many kids with pneumonia. These babies all have respiratory problems,’ says Charge Nurse Rebekah Soper, pointing to the babies taking up a tiny area of the full-size hospital beds along one side of the inpatient ward in the IDAT hospital in Tonj.
‘This one is new but they look dehydrated to me,’ she says, casting a well trained eye over the patient. ‘You can tell by the sunken eyes, I think they’ve just been admitted.’
‘The babies come in with bronchiolitis, it’s a viral infection, where the airways in the lungs essentially become inflamed, they struggle to breathe and their blood oxygen levels drops. It normally takes a few days from them to really improve.
‘It’s hard to tell if its bronchiolitis or pneumonia here. Pneumonia is a bacterial infection whereas bronchiolitis is more likely to be caused by a virus. We don’t have X-rays and blood tests to be able to test for those things so if a child is really struggling to breathe we’ll cover them with IV antibiotics and then we’ll give them oxygen.
Fragile Lives
Kids die from pneumonia,’ Rebekah says seriously. ‘It is one of the most common causes of death, particularly in infants. So for us to have oxygen is really critical. We also have a CPAP machine, a device that pushes air into the lungs to support their breathing if they are working really hard.’
The sickest babies are separated off in incubator at the ends of the ward. ‘This is a really poorly baby that we just resuscitated this morning. I’m not sure how well they’ll end up doing,’ Rebekah says, pausing in the open doorway of the first room.
In the second room, the incubator is empty and the mother cradles her tiny infant on her lap ‘This baby weighs 1.3kgs,’ Rebekah explains – ‘and it isn’t even the smallest we have. At home in New Zealand this baby would be in a neonatal intensive care unit with one-on-one nursing care and all the gadgets. But we do the basics here. We keep them warm, we keep them fed, and we put IV’s in them because usually if they are this small, they can’t breastfeed. Their mouth physically doesn’t fit on the nipple and all the energy it takes them to feed, they’re not using it to grow. So we will often support the mother to express milk or if they’re not making enough then we top them up with formula. The tube goes through the nose and we feed them with a syringe. They have the tiniest little hands to put IVs in.’
Winning the battle
Back on the ward Rebekah greets parents and celebrates the progress their babies have made. If they can reach the hospital, for many the prognosis is good although it often takes a couple of months of dedicated care.
‘This one, this little baby was so sick –when they first came in. I was surprised the baby even survived. When they came in they were just skin and bone. And now they are nice and chubby. The comparison is incredible. They actually have some meat on them. They are finally growing! Their main problem is that they were struggling to feed well.
‘Just in the last few days we’ve discharged two other babies that were like tiny, tiny babies, both were in the incubators when they came but we were eventually able to discharge them home.’ Rebekah has many such stories. The hospital’s Facebook feed is crammed full of posts celebrating patients who have beaten the odds.
1 in 10
At the opposite end of the ward in another private room another small baby is hooked up to an oxygen concentrator. The baby is the size of a new-born but is actually nine months old. ‘This is what severe acute malnutrition looks like when you’ve got tuberculosis as well,’ Rebekah says with tears in her eyes. ‘The mother is so lovely but she is also malnourished and she also has TB.
‘The baby is on oxygen and tube feeding with a special therapeutic milk. It’s really challenging with these kids because they’ve got a disease which is making them lose weight and we’re trying to feed them, but this one has diarrhoea as well which is really common when you start refeeding kids. They get diarrhoea and they get dehydrated,’ Rebekah explains.
‘So you can just see how they are so wasted,’ she says, carefully lifting the blanket to reveal the child’s skeletal legs and saggy skin. ‘You see their legs, they’ve got joints that are sticking out because of the muscle wasting and their arms are just so tiny.’
‘This is the thing that just breaks my heart,’ Rebekah says honestly. ‘Seeing kids like this, I find this the most difficult, I get upset talking about it,’ she says, taking a minute to regain composure and offer the mother a warm reassuring smile. The soft hearted compassion that makes her good at her job takes a personal toll. ‘Because it just doesn’t need to happen, it’s just so treatable. Kids shouldn’t have to end up looking like this!’ She says, unable to hide the frustration in her voice.
Maintaining a Lifeline
‘Recently, someone made a simple error plugging one of our machines in 240v instead of 110v supply. Without any technical support, live saving equipment like these oxygen concentrators can quickly become nothing more than expensive paperweights as the result of even minor faults,’ Rebekah notes.
Thankfully, IDAT have spares and this particular mistake was quickly remedied by James. Less than a week after it was sent to Juba the concentrator was loaded back on the MAF plane for the flight to Tonj where Dr Jono was there to receive it at the airstrip and take it straight to the hospital.
The oxygen concentrators are not the only freight that MAF brings for the hospital. All kinds of medicine and medical supplies including nutrition supplements for malnourished children are loaded on the plane for our weekly shuttle flights. The IDAT staff are frequent passengers on MAF shuttle flights as they travel out for a well-deserved break. ‘IDAT is a hard place to work, it’s the hardest work I’ve ever done and I’ve worked in emergency departments and ICU’s and all sorts of places,’ Rebekah finishes.