On Wednesday evening, we received a letter from the staff delegates telling us that the staff was going on strike at 7am the next morning. Market prices have inflated so high that current wages aren't enough to feed their families, they say.
What followed was a furious round of meetings, phones calls, and escalations, until we had exhausted our options and time had run out. Our last meeting of the night, around 10pm was a check-in with department heads before a generalized team meeting to keep all the expats up to date on the situation.
"Will they show up tomorrow?" "Probably, we're hoping. We think so. They might not." "Is it for the office staff too, or is it just the hospital?" "We think it's a full-staff strike. We think that means the base too." "Do we call our staff tomorrow morning when they don't show up and ask them where they are?" "No, we'll just play it by ear." "What are the strike rules? Does South Sudan have much of a labor law?" "Unclear, but you're supposed to give 2 weeks notice. We think."
6:30am on Thursday, April 23rd, saw all the expats mobilizing and quietly eating a cold breakfast. We watched as the night driver took the bucket to get the morning's bread. That was a good sign. Maybe all that excitement was for nothing.
7am was the start of the shift, and at 5 minutes past the hour, the dayshift watchmen haven't shown up. The night watchmen pull me aside and tell me that they're not coming. I ask the night watchmen to stay 30 more minutes, just in case the day watchmen are running late, then they can leave. We start to get the feeling that there might actually be a strike.
8am and I've been in the hospital for half an hour. I've already done the chart for a newly admitted patient, sterilized the delivery room, and I'm hunting for a hose to fill the water points in front of one of the wards. I'm on the phone with the base log, getting an update on the security of the compound. He's locked the old compound and hired two daily worker watchmen for the rest of the compounds. We've got two drivers, and the early referral car taking a patient to Wau has left. The base supervisor has shown up. Good. I hang up and check in with the hospital log. We've nailed shut half the gates, which is really impeding traffic flow but it's all we can do at the moment, and we're trying to sort out which key goes to which door. I switch to the radio as I grab the hose and head in to fill buckets. I'm worried about patient food, since there weren't cooks for breakfast. We have several diabetic patients. I go off to find the Medical Referent to let her know about that. We may have to buy food in the market for the patients. The hospital log goes off to make sure lunch is taken care of.
Just before 9am, I pass the construction log coming in to lend a hand. I ask him to fill the last two water points, and he goes to drop his bag. I start the hose going and grab two clean aprons to give back to maternity. As I walk into the delivery room, I grab the two nearest gloves and help the midwife cut the cord of a baby that has just been born as I stepped into the room. The mother and the caretaker don't speak English, and we don't speak Dinka. I weigh the baby and start wiping her off as the midwife tends to the mother. I hope the construction log has turned off the water I started.
The next few hours pass in a haze of sterilization room runs, laundry coaching, medical waste management, sterilizing the delivery room a few more times, and constantly checking in with all staff. Are you ok? Can I help? What do you need?
At 10:30am the Project Coordinator finds me to check on logistics. I'm in the middle of taking vital signs for 23 patients. We stop to check in about patient food, hygiene, waste management, cars, base security, expat lunch, and how the strike is going. We commiserate, and remind each other about a couple points. He's happy with the report, and we part ways.
Sometime after 11am, the Ministry of Health provide us with some staff. I'm sterilizing the delivery room (again) at the time, so I do a briefing for all the cleaners about where the mops and gloves and buckets are. They have one midwife who can translate for me. She leaves after the first ward. The rest of the wards are just silent pointing. The cleaners know how to do their job. We then go to find soap.
At noon, I pass by the sterilization room for some more delivery kits, and see the base log inside the operation theater. He's scrubbed in and handing the OT nurse instruments as she changes the dressing on a burned patient. I confirm with the supply log that he's got lunch covered, and he'll bring it to the hospital so we don't have to leave. I head out front to check on the gathering of over a hundred staff members. The Project Coordinator is still there, slowly getting more and more sunburned. I buy some water, soda, and juice at the shop next door, and slip him a bottle. How's it going? Bad. Ok, bye. I leave the soda in the milk room for the head nurse, which we've agreed upon as a good centralized location to pass things back and forth.
Construction is still going on for the latrines up in the new ward area, but I pass the construction log who is down taking vitals for the general ward. He's training a MoH nurse aid who isn't familiar with our form. I wave to our Outreach nurse, who canceled his movement to Aweil West today, over in the Severe Acute Malnutrition ward. He's taken charge over there. Are you ok? Can I help? What do you need?
At 1pm, we congregate at the logistics workshop for food. We gulp water and share stories. Any gaps in planning? Any holes? The MoH staff have really helped us. Ok to continue? We eat in shifts.
Patient food has been delayed, since they started cooking late. I pass the word around to the medics and try to help or investigate in the kitchen. The three women who have volunteered themselves to be cook all yell at me in Arabic. I ask them when the sorghum will be ready. They yell at me in Arabic. Apparently they need one more salt. I go get it for them.
The afternoon passes in a similar routine, of vital signs, dumping medical waste buckets, filling water, and slowly daily workers get identified to fill the gaps. MoH has sent its cleaners, and we get a steady line of workers in front of the workshop who have heard that there's work available. I keep making rounds, and hand out a bunch of soap. I refill the water chlorination system, and try to be useful. The department is starting to roll forward again, and the gaps are closed with these workers. I see a wheelbarrow of dead branches going past. Wow, these daily worker outside cleaners are serious about their jobs.
The latrine construction is going well, and the third general ward is a bit hot. I make some minor adjustments of fans, and go find water. Are you ok? Can I help? What do you need?
At around 6pm I go back to the base to do the security briefing for a new expat who arrived today. I tell her, if you can get through this next 24 hours, you can get through your mission, no worries.
At 7pm I head back to the hospital for the evening shift change, to see if perhaps the night staff showed up. A day of negotiations and rhetoric seems to have swayed some people's minds. We tried to tell them that minimal care needs to be assured. Health care professionals can't just walk away from their patients. The PC and I sit outside the hospital, watching the ebb and flow of staff. There are some threats as some staff try to come to work and are repelled by others. The police get involved. There are some arrests. By 7:30, no one else is coming in to work. I go check on the cleaners.
After a few more passes through the wards, which are as supported as they can be from a non-medical standpoint (we found daily worker watchmen, and the MoH cleaning staff is on point). I head back outside, and catch up with the PC. The news isn't good about getting the hospital functioning for the night. The Medical Referent will be our midwife all night. She's been working since 6am. We meet up with the head nurse just as one of the few national staff supervisors excuses himself. He said he's been threatened and can't stay to work tonight. He's very sorry, but he has to leave. After he steps out, we stand around brainstorming, commiserating, and planning.
A half-naked pregnant woman stumbles out of an ambulance that has pulled up. Wait, she's not pregnant. That's a newborn in that blanket in the caretakers' arms. We point her to maternity. The shell-shocked group doesn't move. I turn around and start leading them. As we're walking the 100 feet to maternity, the woman's placenta falls to the ground. She's now leaving bloody footprints on the concrete. I walk the group to the delivery room and hand her off to the midwife students who are on duty. I look around for the cleaner, but don't find her. The car radios to ask if I'm coming back to the base. I grab a mop and say no, come back for me in 15 minutes, around 9:30pm.
I sigh and start to sterilize the delivery room one last time, thinking about the bloody trail all the way back to the entrance to the hospital.
What followed was a furious round of meetings, phones calls, and escalations, until we had exhausted our options and time had run out. Our last meeting of the night, around 10pm was a check-in with department heads before a generalized team meeting to keep all the expats up to date on the situation.
"Will they show up tomorrow?" "Probably, we're hoping. We think so. They might not." "Is it for the office staff too, or is it just the hospital?" "We think it's a full-staff strike. We think that means the base too." "Do we call our staff tomorrow morning when they don't show up and ask them where they are?" "No, we'll just play it by ear." "What are the strike rules? Does South Sudan have much of a labor law?" "Unclear, but you're supposed to give 2 weeks notice. We think."
6:30am on Thursday, April 23rd, saw all the expats mobilizing and quietly eating a cold breakfast. We watched as the night driver took the bucket to get the morning's bread. That was a good sign. Maybe all that excitement was for nothing.
7am was the start of the shift, and at 5 minutes past the hour, the dayshift watchmen haven't shown up. The night watchmen pull me aside and tell me that they're not coming. I ask the night watchmen to stay 30 more minutes, just in case the day watchmen are running late, then they can leave. We start to get the feeling that there might actually be a strike.
8am and I've been in the hospital for half an hour. I've already done the chart for a newly admitted patient, sterilized the delivery room, and I'm hunting for a hose to fill the water points in front of one of the wards. I'm on the phone with the base log, getting an update on the security of the compound. He's locked the old compound and hired two daily worker watchmen for the rest of the compounds. We've got two drivers, and the early referral car taking a patient to Wau has left. The base supervisor has shown up. Good. I hang up and check in with the hospital log. We've nailed shut half the gates, which is really impeding traffic flow but it's all we can do at the moment, and we're trying to sort out which key goes to which door. I switch to the radio as I grab the hose and head in to fill buckets. I'm worried about patient food, since there weren't cooks for breakfast. We have several diabetic patients. I go off to find the Medical Referent to let her know about that. We may have to buy food in the market for the patients. The hospital log goes off to make sure lunch is taken care of.
Just before 9am, I pass the construction log coming in to lend a hand. I ask him to fill the last two water points, and he goes to drop his bag. I start the hose going and grab two clean aprons to give back to maternity. As I walk into the delivery room, I grab the two nearest gloves and help the midwife cut the cord of a baby that has just been born as I stepped into the room. The mother and the caretaker don't speak English, and we don't speak Dinka. I weigh the baby and start wiping her off as the midwife tends to the mother. I hope the construction log has turned off the water I started.
The next few hours pass in a haze of sterilization room runs, laundry coaching, medical waste management, sterilizing the delivery room a few more times, and constantly checking in with all staff. Are you ok? Can I help? What do you need?
At 10:30am the Project Coordinator finds me to check on logistics. I'm in the middle of taking vital signs for 23 patients. We stop to check in about patient food, hygiene, waste management, cars, base security, expat lunch, and how the strike is going. We commiserate, and remind each other about a couple points. He's happy with the report, and we part ways.
Sometime after 11am, the Ministry of Health provide us with some staff. I'm sterilizing the delivery room (again) at the time, so I do a briefing for all the cleaners about where the mops and gloves and buckets are. They have one midwife who can translate for me. She leaves after the first ward. The rest of the wards are just silent pointing. The cleaners know how to do their job. We then go to find soap.
At noon, I pass by the sterilization room for some more delivery kits, and see the base log inside the operation theater. He's scrubbed in and handing the OT nurse instruments as she changes the dressing on a burned patient. I confirm with the supply log that he's got lunch covered, and he'll bring it to the hospital so we don't have to leave. I head out front to check on the gathering of over a hundred staff members. The Project Coordinator is still there, slowly getting more and more sunburned. I buy some water, soda, and juice at the shop next door, and slip him a bottle. How's it going? Bad. Ok, bye. I leave the soda in the milk room for the head nurse, which we've agreed upon as a good centralized location to pass things back and forth.
Construction is still going on for the latrines up in the new ward area, but I pass the construction log who is down taking vitals for the general ward. He's training a MoH nurse aid who isn't familiar with our form. I wave to our Outreach nurse, who canceled his movement to Aweil West today, over in the Severe Acute Malnutrition ward. He's taken charge over there. Are you ok? Can I help? What do you need?
At 1pm, we congregate at the logistics workshop for food. We gulp water and share stories. Any gaps in planning? Any holes? The MoH staff have really helped us. Ok to continue? We eat in shifts.
Patient food has been delayed, since they started cooking late. I pass the word around to the medics and try to help or investigate in the kitchen. The three women who have volunteered themselves to be cook all yell at me in Arabic. I ask them when the sorghum will be ready. They yell at me in Arabic. Apparently they need one more salt. I go get it for them.
The afternoon passes in a similar routine, of vital signs, dumping medical waste buckets, filling water, and slowly daily workers get identified to fill the gaps. MoH has sent its cleaners, and we get a steady line of workers in front of the workshop who have heard that there's work available. I keep making rounds, and hand out a bunch of soap. I refill the water chlorination system, and try to be useful. The department is starting to roll forward again, and the gaps are closed with these workers. I see a wheelbarrow of dead branches going past. Wow, these daily worker outside cleaners are serious about their jobs.
The latrine construction is going well, and the third general ward is a bit hot. I make some minor adjustments of fans, and go find water. Are you ok? Can I help? What do you need?
At around 6pm I go back to the base to do the security briefing for a new expat who arrived today. I tell her, if you can get through this next 24 hours, you can get through your mission, no worries.
At 7pm I head back to the hospital for the evening shift change, to see if perhaps the night staff showed up. A day of negotiations and rhetoric seems to have swayed some people's minds. We tried to tell them that minimal care needs to be assured. Health care professionals can't just walk away from their patients. The PC and I sit outside the hospital, watching the ebb and flow of staff. There are some threats as some staff try to come to work and are repelled by others. The police get involved. There are some arrests. By 7:30, no one else is coming in to work. I go check on the cleaners.
After a few more passes through the wards, which are as supported as they can be from a non-medical standpoint (we found daily worker watchmen, and the MoH cleaning staff is on point). I head back outside, and catch up with the PC. The news isn't good about getting the hospital functioning for the night. The Medical Referent will be our midwife all night. She's been working since 6am. We meet up with the head nurse just as one of the few national staff supervisors excuses himself. He said he's been threatened and can't stay to work tonight. He's very sorry, but he has to leave. After he steps out, we stand around brainstorming, commiserating, and planning.
A half-naked pregnant woman stumbles out of an ambulance that has pulled up. Wait, she's not pregnant. That's a newborn in that blanket in the caretakers' arms. We point her to maternity. The shell-shocked group doesn't move. I turn around and start leading them. As we're walking the 100 feet to maternity, the woman's placenta falls to the ground. She's now leaving bloody footprints on the concrete. I walk the group to the delivery room and hand her off to the midwife students who are on duty. I look around for the cleaner, but don't find her. The car radios to ask if I'm coming back to the base. I grab a mop and say no, come back for me in 15 minutes, around 9:30pm.
I sigh and start to sterilize the delivery room one last time, thinking about the bloody trail all the way back to the entrance to the hospital.
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