We're the end of the line, says doctor in South Sudan hospital

Ugandan-trained doctor Kalisa Yesero Wabibiye is used to roughing it in difficult-to-reach places with dire needs.

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He has worked for several relief organizations in Africa and says such work makes him feel more useful and more able to make a difference than he was in a well-staffed hospital in the Ugandan capital, Kampala, his home town.

These days he works in the 120-bed Bunj hospital, the only functional surgical facility in South Sudan’s Upper Nile State, 600 kilometres from the capital, Juba.

“When I started here, I thought I couldn’t even last a week,” says Dr. Kalisa, 47, who is married with three children.

“It was the first time that I had to live in a tent. I had nightmares. It was so difficult, so small, the roof was so near to my head. There wasn’t a door, just a zipper.”

That was two-and-a-half years ago and Dr. Kalisa is still in Bunj, largely because of Dr. Evan Atar Adaha, the hospital’s head surgeon and medical director. The two men work with two other doctors at the hospital.

“This is a place where you have to invent.”

“Dr. Atar works so much,” Dr Kalisa says with a deep respect mirrored by all his colleagues. “I don’t know of a single operation he hasn’t done. He is a person who is very indispensable to this place.

“This is a place where you have to invent. We don’t have a tool? Its so exciting to see how he can create an approximate tool with a part from an old car. He used it to unscrew plates on someone’s bone.”

The hospital recently added a neonatal section and a 20-bed tuberculosis ward. Open 24-hours a day, it serves a population of more than 200,000. Of these, 140,000 are refugees from Sudan.

“We’re the end of the line, said Dr. Kalisa. “This is a one-stop shop. There is no level of referral above us. There are no higher specialists. It can be quite stressful to make a final decision.”

The four doctors are a tight team. “We have our own world here,” says Dr. Kalisa. “We divide our work. Sometimes we have to force Dr. Atar to stop working. Once we ganged up against him. We threatened to evacuate him because he was sick and not eating. So he decided to eat.”

When one doctor has a complicated case, they quickly get together and make a joint decision. There is a heavy sense of responsibility on their shoulders. “When doctors come from a very good hospital with everything available, they are almost paralysed,” says Dr. Kalisa, who worked as a mechanic before attending medical school, a handy skill in Bunj where electricity relies on cranky generators.

“You have to be forceful here in South Sudan.”

Dr. Atar and his staff work in a difficult and dangerous environment. Since the civil war broke out in 2013, medical facilities in South Sudan have been looted or occupied, and their staff intimidated, detained, abducted and killed. Because of the insecurity in the area, the Bunj hospital has only two shifts and no one leaves the compound at night. The nurses live nearby.

“We need Dr. Atar, not just for his medical skills, but also his ability to deal with an armed public,” says Dr. Kalisa. “You have to be forceful here in South Sudan.”

Dr. Atar’s leadership style may include jokes and teasing, but Dr. Atar, who never holds a grudge, is also known to shout.

Among the staff there is awe and respect for the life that Dr. Atar has lived. In the course of a decade spent in Sudan’s civil war he unfailingly provided medical care to both sides.

Outside the hospital, the doctors try to keep up with the latest surgical procedures by having weekly presentations. Dr. Kalisa relaxes by playing the guitar and singing, often with Dr. Atar. From him he has learnt, for example, that you can use soil to stop bleeding, even with a chest wound, and how to choose wild fruits to eat by watching if the birds eat them.

When Dr. Kalisa goes back to Uganda, he misses life in Bunj.

“By living here, I have become so much more flexible,” he says. “I feel I matter. I don’t complain as much. Just having a glass of cold water or a mango is a joy. And now we have the internet.”