Today is Good Friday. May I wish you all a happy Easter Holiday. We have a meeting with the Coordination Team to confirm the direction of the project early this morning. The Team came from Paris and Juba on Monday. During the l ast four days, they had visited most of the programme, including outreach service and IDP camps, and had many meetings with the Ministry of Health. There is tremendous need of MSF services in Aweil. The maternity and child health, nutrition and malaria programmes are confirmed. But the issues on human resources and how to motivate the local staff to cooperate with us need to be settled. We do not want MSF taking over all the hospital services without any training and commitment from the local staff. Once MSF leaves, there would be another vacuum in the service. Philip is always complaining about MSF's commitment to maternity. I understand him very much. There are not enough facilities and staff supporting him and the service. I always comment that the service is maintained by his individual effort not by the system . In fact, once Abdul, the anaesthetist, and I leave on next Monday, they have only three persons in the team, one obstetrician, one anaesthetist (s he is a German doctor, just arrived today.) and Stephane, the OT nurse. It would be very difficult if not impossible to have surgery at night . Thus Philip is asking for one expat to help. But Caroline is concerned that all other expat staff are working long hours in the day. It will be impossible to ask them to work at night. The best solution is of course employing some local staff who attach to the team and also could be trained. I agree with Philip that they do not see the extent of work and complexity of obstetric care at the start of the programme. Like the Coordinator Head said, the news of good and safe obstetric service provided by MSF has already spread among the local people. It is also why the number of cases seen in last two weeks increased so much. I think the need of the service is absolutely certain. As Philip said, most of the women here have multiple pregnancies and many children, live or dead. They are prone to have severe obstetric complications. One woman's death may affect the family and also endanger their children's lives . Hence our service should target at reducing the Maternity Mortality rate (MMR) with comprehensive services from the antenatal to postnatal period. The MMR in similar situations in Africa is estimated to be close to a thousand mother deaths per 100,000 births, which in HK and Germany are well below ten. I hope this programme will be a successful one, and that many more women and families can benefit . Tonight I had a long discussion with Philip on abdominal surgery. I share with him my experience on colonic surgery, in particular the use and construction of colostomy. Perhaps, that's the small thing I could return for his teaching. My departure plan is fixed with departure from Aweil on 24th and will be back to HK on 29th. See you all next week.     Au Yiu-kai

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