Inside a Neonatal Clinic in South Sudan: ‘In Some Ways, It Felt Wrong to Be Here’
JUBA, South Sudan — We noticed the quiet first. As we removed our dirt-caked sneakers, slipped on flip flops and entered the nursery in Juba Teaching Hospital’s newborn ward, a hushed tension washed over us. A bulb flickered relentlessly above the dozen or so newborns in the room.
Many of the babies here weighed less than 3 pounds, their delicate frames swaddled in colorful blankets.
We were two journalists with four cameras, a microphone, a tripod and notebooks trying to be unobtrusive amid the fragility and life-and-death moments.
We had come here — to the top public hospital in South Sudan’s capital city, Juba — intending to document the maternity ward. (South Sudan, the world’s youngest country, remains one of the most dangerous places in the world for women to give birth.)
But we soon became fascinated with the building next door to the delivery wing, where the most critical newborn cases were brought.
There we met Dr. Rose Tongan, a pediatrician tasked with saving them.
As we asked Dr. Tongan what a typical day in the clinic was like, and followed her through one of her rounds with the tiny patients, she explained the facility’s limitations.
It had intermittent electricity, no lab or X-ray equipment, and no neonatal specialists. Illnesses that would be considered treatable anywhere else could be a death sentence here. Many of the babies were born prematurely, with underdeveloped lungs and respiratory ailments.
Dr. Tongan pointed out a modern-looking machine in the corner. It was a CPAP, or continuous positive airway pressure machine — a lifesaving device for babies suffering from lung problems. With a shrug she said it had been donated by an aid organization but the clinic didn’t have the specialized oxygen hookup needed for it to work, so it sat limply in the corner, unused.
Yet mothers here had nowhere else to turn. This was the best care they could get in this war-torn nation.
Before we knew what was happening — just minutes after we arrived — Dr. Tongan and a nurse, Juma Lino, were hovering over a small baby as the child’s mother, Restina Boniface, looked on. It took us a moment to discern Dr. Tongan’s fingertips pressing into the infant’s chest in steady rhythm. The room was quiet. The baby had stopped breathing.
As journalists with more than two decades of experience between us, we were used to developing trust with a subject before filming intimate or harrowing scenes. Though we’d explained our intent and received permission from the mothers to chronicle them and their babies, we couldn’t help but feel unsure about whether to proceed, and we didn’t have an opportunity to ask.
When we fully realized what was happening, we both took a step back, allowing the doctor and mother room to move without getting in the way.
Restina paced, alternately hovering behind the doctor and moving to a metal chair a few feet away. She drew her hand to her neck and let out a short sigh that seemed to fill the room.
After about three minutes the doctor took out a manual respirator and asked Restina to go outside.
Then the two of us split up.
I followed Restina outside, along with our local fixer, while Kassie stayed behind in the clinic with her camera rolling.
Restina sat huddled in the window, sobbing, and I took a single photo, as a couple of other mothers walked by to comfort her. Then she sat alone.
I decided to stop filming her, instead recording only the sound of her sobs. I tried to offer what little comfort I could, unable to imagine what she was feeling. With shaking hands, I stroked her back while we waited for news. We all thought these were the baby’s last moments, and I wasn’t entirely sure what I should do.
In some ways, it felt wrong to be here. This young mother’s incredibly personal trauma was playing out in front of me. Unlike her, I would eventually have the ability to leave and go back to a life far from this place. At the same time, I knew that being here and bearing witness was important. People needed to know what was at stake for women here.
My heart was in my throat.
I stood about two feet away from Dr. Tongan and Mr. Lino (the nurse), and kept filming as they worked in tandem trying to resuscitate the baby with the manual respirator pump. Three pump squeezes by Mr. Lino to Dr. Tongan’s single thumb press to the baby’s tiny chest. They said nothing to each other as they worked.
Through the sound of the compressions I could hear a mother’s sobs on the other side of the door, and fought back my own tears. I tried to make myself as still and small as possible, as if that would strengthen the collective focus on saving the newborn. I no longer considered turning off my camera or walking away. To do so would disturb the determined energy in the room.
They continued 10 more times. I kept my eyes focused on Dr. Tongan’s face for any sign of hope, but her expression never changed. Finally she grabbed her stethoscope and placed it on the baby’s chest. She didn’t say anything for a moment. Then she looked at Mr. Lino and nodded silently as her eyes widened.
It had been just over five minutes since the baby had stopped breathing.
I could still hear Restina weeping outside the door, in that terrible place of not knowing her daughter’s fate. I lowered my camera and stepped back, noticing for the first time that another mother, 17-year-old Monica Akuoth, had been sitting a few feet away silently watching the scene unfold, her face expressionless. I sat down next to her, put my camera on my lap and took a breath.
We later learned that Restina’s baby needed that CPAP machine Dr. Tongan had shown us. The machine is routinely used on premature newborns to keep the air sac in their underdeveloped lungs slightly inflated to prevent the sudden halt of breathing.
The reality here is a difficult one to comprehend: Despite millions of dollars coming into the country for humanitarian relief, the clinic has almost nothing.
“Would you have your baby here?” Dr. Tongan asked, reminding us that many South Sudanese women choose to give birth at home — or in Uganda or Kenya, if they’re women of means — to avoid the hospital entirely.
The facility is sparse. The mothers — who must remain nearby to breast-feed their babies every few hours — stay outside, finding shade under a sprawling tree when the weather is good or sleeping in a tent (erected during a cholera outbreak) when it rains. The water drips in and pools in the middle of the floor.
Some of the mothers have given birth just hours or days before and are still healing, but they have to sleep on the hard ground, out in the open.
They pass the time by embroidering colorful blankets to sell in the city’s markets or by braiding each other’s hair. Many are teenagers.
Dr. Tongan and her staff are at once resigned to the reality of the ill-equipped facility and determined to offer the best care they can.
It seemed at times that the nursery was being held together by the sheer will of the doctor and nurses who work there, many of whom had not been paid in months because funding for public services had dried up.
We never heard mothers coo or talk to their babies. And most, including Restina and Monica, decided not to name them until they were well enough to be taken home. Dr. Tongan said it reflected an unspoken understanding of the odds of survival: One in 10 babies in the clinic dies.
On this particular day, she’d saved a child’s life. After five minutes of intervention, Restina’s daughter began breathing again. Dr. Tongan and Mr. Lino stepped back from the incubator. Someone went outside to get Restina and the doctors explained to her what had happened. We breathed sighs of relief.
But we knew that the baby was still at risk, and there was little the doctor could do.
After we left the country, we checked back in with Dr. Tongan by phone and asked about Restina’s daughter. She told us that a few days after our visit the baby died. She had not yet been named.
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Megan Specia and Kassie Bracken were 2018 fellows with the International Women’s Media Foundation’s African Great Lakes Reporting Initiative.