Keeping mothers safe during coronavirus in South Sudan

My name is Rose Nanu, I am a nurse midwife working for Save the Children in Juoljok clinic in the Abyei region, in the north of South Sudan. I lead a team and together we work to increase the number of women who give birth safety in a clinic.

Abyei is a difficult place to work.

It is a contested state between Sudan and South Sudan, and there is limited funding. Services only cover a third of the population.

There is ongoing conflict between Northern Arab communities and South Dinka communities that involve burning of houses and abduction of children. There’s also a long rainy season which limits outreach services and access to some communities and clinics. In the last two years we have experienced floods and measles outbreaks. Food insecurity is high here, we treated 8500 children and 2,500 mothers for malnutrition last year and continue the same level of care this year.

Now we are also facing the threat of coronavirus on top of all of this. We are worried it will not only bring great health risks but also threaten the progress we have made.

Currently, Save the Children support six clinics in Abyei, reaching a population of 140,000. We work very closely with partners - including MSF Switzerland and Goal - supporting each other to improve skilled birth attendance and health services in the area, and supporting the Ministry of Health who are severely underfunded.

In October, we started working to support women to give birth in our largest clinic, Juoljok. This is our first delivery clinic and it hasn’t been easy to increase the number of women who come to the clinic. Traditionally women give birth at home but slowly we are making progress. In April we delivered babies from five women; last year only 22 deliveries were conducted in clinics in the area. We have promoted our services through traditional birth attendants and outreach visits and promoted newborn care and advised on newborn danger signs. We see 400 women a month for antenatal care and support women to have birth plans and support to come for delivery.

It is not easy for women to come to a facility to deliver, especially women at high risk. Last week I supported a women to deliver at night who came on her own. The woman is 29 years old, in a polygamous marriage as the 3^rd wife, and this was her sixth child. She arrived with nothing and had to leave her children completely alone to come for delivery. She had to be given a wrap for the baby, clothes for herself, soap and transportation home after delivery as her children were alone. She comes from an insecure area, we encouraged her to come back for postnatal care and made one home visit ourselves. We will do this increasingly during the COVID -19 outbreak to keep women safe.

South Sudan has the highest maternal mortality ratio in the world, 1,150 deaths per 100,000 live births. Neonatal mortality is also extremely high with 40 deaths per 1000 live births – the third highest in the world. We don’t know what the data for the region of Abyei but feel this could be a similar rate here given the challenges women face.  

Now we have to ensure we can continue our services and protect ourselves from COVID-19. We have one confirmed case in the MSF hospital and two suspect cases. This normally how our clinic looks in the morning so we have already changed how we are working to keep our mothers and babies safe.

We have set up a double triage system to separate patients with fever. We have spaced out our antenatal care and postnatal services, and moved our nutrition services out of the clinic to make space and support social distancing. We have increased our handwashing points and wear surgical masks for consultation and deliveries. We have new guidelines to follow and have attended online trainings.

We are fortunate to have the support of MSF who support an infectious disease unit for COVID-19. Still we worry for ourselves, PPE is in very short supply but more is coming, we worry for our patients who lack the ability to practice social distancing and we worry for our colleagues in clinics close to the border of Sudan where cases are high. My colleagues in this clinic will be cut off from us and from the MSF unit during the rainy season. That’s why we must do everything we can to prevent the spread of coronavirus and keep the community safe.

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