The second day began with another venue change. After a morning of lectures, group work and lots of handwashing and music demos, the midwives and other healthcare workers were asked to meet in smaller groups to discuss what sort of structure was needed and techniques that could be implemented safely and correctly in order to prevent infections, and the major challenges and obstacles facing infection prevention within their healthcare facility. They are often the most basic.

Common reasons why North American healthcare workers claim for not cleaning their hands range from forgetfulness, equipment sharing to ineffective education and “my hands are fine, they look clean”. The reasons in South Sudan are similar, but related to a context that is much more complex and structural. “The biggest challenge is the disinfectants, the water … sometimes we will not have adequate water or even running water… so we may know that we have to wash frequently, but the facilities …the things that are missing in the facilities cannot help us to wash,” said Agnes. Mental health, is another, increasing concern.

“If I am traumatized how will I remember anything that has happened in these workshops. Mental health is a real challenge … the number of (mental health) admissions is increasing, and some of them don’t even come to the hospital … You will find that in the families … people are depressed, traumatized.”

Having access to modern training methods is another. So is waste management. Mary, a midwife from Ye, explains:

“Safe disposal of the placenta for example … we don’t have a furnace at our facility, so the placenta is often given to the mother in a paper bag. She takes it home. If she buries it, or places it in a well, she is risking contamination or infection of the community, without meaning to.”

Ladu Julius,  who works for Samaritan’s Purse in Maban, speaks with a deliberate intensity. His tone is urgent, strong.

“Time is a very important factor. We have limited time. We have overwhelming patients. And you can just imagine, add to this you have limited resources. When we have enough staffing, enough human resources — activities will run easily. On the ground it is not very easy … on the front line you have to do what you can”.

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