MAF South Sudan’s maintenance manager and former electrician, James Mollenhauer, always knew his skills would come in handy on the mission field, but little did he know he would be fixing breathing apparatus for newborns. MAF’s Jenny Davies finds out how some simple repairs have transformed the work of In Deed and Truth’s (IDAT) maternity hospital…

Two fragile little lives are hooked up to one oxygen concentrator in the in-patient ward of IDAT’s ‘Noah’s Place Maternal Child Healthcare Hospital’ in Tonj, northwest South Sudan.

Oxygen concentrators extract oxygen from the air removing the nitrogen, so that patients with breathing difficulties can receive concentrated oxygen through a mask. In the absence of ventilators or a reliable supply of bottled oxygen, oxygen concentrators are the next best thing.

‘Pneumonia is a very common cause of death in infants – for us to have oxygen is critical.’
Nurse Rebekah Soper, Noah’s Place Maternal Child Healthcare Hospital

According to the UN, for every 1,000 births in South Sudan, 39 babies die compared to 3 in the UK. South Sudan has one of the worst neonatal health outcomes in the world.

Patients can walk two days to reach IDAT Hospital

Most of IDAT’s patients are pregnant women, breastfeeding mothers and children from remote villages. Patients will often walk two days to reach the hospital. They sleep on the road with their children and arrive on the second day.

Charge nurse, Rebekah Soper, explains how oxygen concentrators are vital for supporting sick babies who are admitted with respiratory infections after such a gruelling journey:

‘Recently, we’ve seen so many babies with respiratory problems. Bronchiolitis is a viral infection where the airways in the lungs become inflamed – they struggle to breathe and their blood oxygen levels drop. It normally takes a few days for them to improve.

‘Pneumonia is a bacterial infection but it’s hard to tell if it’s bronchiolitis or pneumonia here. We don’t have X-rays and blood tests to test for those things so if a child is really struggling to breathe, we’ll give them intravenous antibiotics and oxygen. Pneumonia is one of the most common causes of death in infants, so for us to have oxygen is critical.’

‘It breaks my heart – this doesn’t have to happen’

As there is no healthcare within their local vicinity, it’s rare for patients to present just one problem at IDAT’s hospital – they usually have multiple health issues, which have accumulated over time.

At the opposite end of the ward, another baby is hooked up to another oxygen concentrator. The baby is the size of a newborn, but is actually nine months old. Rebekah carefully lifts the blanket to reveal skeletal legs and saggy skin:

‘This is what acute malnutrition looks like when you’ve also got TB. The baby is on oxygen and special therapeutic milk via a tube. It’s really challenging because they’ve got a disease which is making them lose weight, We’re trying to feed them, but this one has diarrhoea too, which is common when you start re-feeding. Diarrhoea causes dehydration.

‘The baby is so wasted – their leg joints are sticking out because of muscle wasting and their arms are so tiny. It breaks my heart. This doesn’t have to happen – it’s so treatable. Kids shouldn’t have to end up looking like this!

‘Back home, this baby would be in a neonatal intensive care unit with one-on-one nursing care and all the gadgets. But we can only do the basics here – we keep them warm and feed them intravenously if they are too small to breastfeed.’

Oxygen concentrators can be temperamental

Without technical back-up, oxygen concentrators can quickly become an expensive waste of space as Rebekah testifies:

‘Recently, someone made a simple error by plugging one of our machines into the wrong voltage supply. Without any technical support, lifesaving equipment like oxygen concentrators can quickly become nothing more than an expensive paperweight – even as a result of a minor fault.

‘Thankfully, IDAT have spare parts and this particular mistake was remedied by MAF. Less than a week later, the concentrator was loaded back on the MAF plane bound for Tonj Airstrip, where it was received and taken straight to the hospital.’

‘Fixing things is my happy place!’

A few hundred miles away in South Sudan’s capital, Juba, MAF’s maintenance manager, James Mollenhauer, tinkers with a broken compressor unit from one of IDAT’s oxygen concentrators. He’s surrounded by a clutter of bits and bobs where it looks like old electronics come to die.

James is saving lives by fixing medical equipment that MAF’s partner cannot afford to throw away, but how did this lifeline come about?

IDAT’s co-founder, Suzy Kuj, began by asking the question:

‘We have these broken oxygen concentrators – do we know someone who can fix them?’

James was delighted to help:

‘We’ve got people at MAF with skills and this is how we can serve our partners. Before coming to South Sudan, I used to fix a lot of appliances – mostly electronic repairs and radio installations. My favourite thing is fixing things! It’s my happy place – anything that keeps me away from meetings and paperwork!

‘There were four oxygen concentrators with different problems – one had a blocked diaphragm, one had a blocked filter and the other two had problems with their compressor units.’ 

Technical support requests increasing

Fortunately, the fixes were quite straightforward and the equipment was flown back and forth on MAF’s weekly shuttle flights to Tonj. James continues:

‘I had one concentrator back to IDAT within a week. The 110-voltage unit had accidentally been plugged into a 240 volt supply, which meant it ran too fast and the pressure blew the hoses off. There was no damage – it was fine.’

James says there is an increasing demand for technical support in South Sudan’s remote areas:

‘More and more people are needing help with technical issues in the bush. They might need a part for a generator, which MAF is able to source in Juba and we’ll fly it to them on an MAF plane.

‘We want to help people in the bush with their medical or mission work, especially if they can’t get help any other way. We really want to spend as much time as possible helping people in remote communities – it’s what MAF is here to do.’

MAF essential to IDAT’s ministry

Whether it’s transporting faulty equipment, medical supplies or people, IDAT make good use of MAF’s shuttle flights to and from Juba most weeks. IDAT doctor, Jonathon Macleod, considers MAF to be an essential support to their ministry:

‘Road transport to Juba is not an option for us due to distance (three days driving), lack of proper roads and high risk of ambush from rebels on the way. Having a weekly shuttle from Juba has massively improved our effectiveness.’

IDAT employs 90 staff including medics, pastors, chefs, cleaners, assistants and administrative staff.

Dr Macleod continues:

‘It’s been such a privilege to watch God grow IDAT over the past seven years. We’ve seen the number of patients triple, a new outpatient centre open and a new ward completed. God has healed so many children physically and spiritually. We’ve got such an amazing team.’

As IDAT’s ministry grows, MAF will continue to support them for the foreseeable future.