Martin Griffiths on training in South Sudan

Our register member, Martin Griffith answers questions on taking part in a training trip to South-Sudan.

Can you please introduce yourself?

Martin Grifiths I’m a vascular trauma surgeon. I’m a Londoner. I work in a major trauma centre in vascular surgery and my skills set aligns me to acute care. I’ve always been drawn to humanitarian work, working with communities on violence reduction so it’s a logical line to expand that practice to provide support to more challenging areas. I heard about UK-Med from colleagues that had worked with them before and had great things to say about their mindset and what they delivered in these areas and so I was sold and needed to explore.

Can you tell me about your experience before travelling to South Sudan, your journey there and the remit of the trip?

Interesting, when you get the application to go you get really excited and then when you speak to your family they’re like “You’re not going there”. You read the government guidance and it kind of says “Don’t ever go there” and so I had to say to my family don’t worry it’ll all be fine, it’ll be all good. You feel anxious and you meet the team online and you have phone calls – you’re not familiar with the individuals and are wondering whether you’re going to mesh as a team of individuals. You get to the airport and then you meet these amazing people who are all really excited about the prospect. They’ve all got these incredible skills but then there’s this underpinning narrative of wanting to support people and share knowledge and expertise.

Flights were straightforward, we spent time chitchatting, playing cards, getting to know each other. Then you arrive in South Sudan and you realise you are in a challenging environment, there’s lots of military hardware around, lots of people in uniform, lots of repressed emotions, lots of young people with weapons and you recognise the change in culture – there’s less adverts, promotional materials, people are much more careful around you. And that’s something that you pick up on and it’s initially quite unsettling. And until you meet the workers in the area, until you meet the people… then you start to understand the area a bit more carefully and that anxiety disappears. And it’s great. The briefings were superb, the staff are incredibly knowledgeable and committed, the environments we stayed in were fantastic.

The UK-Med team were so brilliant. You couldn’t hope to meet more inspiring individuals and every single turn. You are working with a team of people: they’re all top-notch, they’re all great clinicians in their home environment, they’ve all got this great ability to teach. They’re all great communicators, and they’re wonderful people. You worry about egos and frictions and back story and fitting in and your previous experience of being deployed but actually you’ve got incredible support from the team around you and they understand the area we’re working in. Within minutes of arriving you feel comfortable and able to share your skills, and feel able to share any challenges you’re having.

One of the big challenging things was having a set view of how you’re going to teach, you’ve got your very British way of doing this, and then you encounter some real challenges – is there kit? Language issues, levels of training, cultural sensitivities around gender, about deportment, about how you handle yourself, being perceived as an outsider in terms of your own demographics and about how to transfer information. Talking at people in a hot room is very difficult, but sharing skills and empowering people is the way to move things forward. Once you start energising a crowd and sharing real stories from your life – magic starts to happen. You go from a dead room to people who are engaged, sharing information and teaching each other, sharing their own skills.

You need to be agile in your mindset. You need to unlearn some of your own prejudices about how training works in the UK system, that hierarchies can be a barrier to transferring information. You’ve got to find the connection between yourself and the group, often through practical demonstrations, got to get past the embarrassment of making mistakes in public. When you’re working with people who have lots of experience of working within a particular scenario but have never had the training of how to deliver it appropriately, understanding that those skills are there is important. You can see people used to working in silos work together, producing phenomenal work. Very different in Juba hospital where it’s a more formal system, compared to Nimule – it was an absolute revelation. I cannot say enough good things about Nimule, the Medical Director and Chief Nurse there were the most amazing people I’ve met in my entire life, they run one of the most beautifully kept hospitals I’ve seen in my life: amazing notes system, incredibly motivated staff who are delivering high quality care in the face of many challenges. Such incredible culture and behaviours – staff would look to their leaders for that example. They embraced the training and inspired the staff to dare to be wrong. You could see the momentum building over the course of the training and it was wonderful to be part of that learning experience – learning is a two-way street. We’re teaching a model of care completely tailored to a local situation. We’re learning how to deliver excellent clinical care in a challenging environment. Even faced with the most significant challenges you can produce the most excellent care.

Can you speak about a colleague that you remember most?

Two people that stick in my mind are the Medical Director and the Chief Nurse at Nimule. I loved the model of leadership they exemplified – and felt privileged to be in the presence of people who had such a great grasp of how to run a service, to commit to a service. The qualities you need to be an amazing leader aren’t based on resource – they’re based on integrity, mission, proficiency, in your compassion and your ability to communicate those things and seeing someone with the humility to embrace something from an alien system and to show that to their colleagues in a way that made it meaningful and purposeful was incredibly inspired.

What would you say was the most difficult bit of the trip?

A bit about home and being away. Saying goodbye to what you’re used to. A bit about unlearning who you think you are. Adjusting to a different relationship with a different team and acknowledging different skill sets. Being agile – we wrote a programme and realised after about an hour that it wasn’t working, it was very prescriptive and it wasn’t right; we needed to change it completely and teach in a different way. The well selected, well balanced team, made it easy to move forward. Being challenged to think differently about something you know really well is pretty cool. Learning from your other colleagues, changes the person who you want to be. Totally life-changing, it’s completely re-framed my view of humanitarian work. People have the view that they’re going to be this great person parachuting into scenarios and doing this great work – that short-termism when you’re doing something ‘to’ people or ‘for’ people. But this is about doing something ‘with’ people or empowering them to take their skills forward – which is a very different experience. And then you see someone with confidence they’ve gleaned from your training and they know they’ve now got the skills to deliver care. The individuals that are left in their institution will be doing things better without you being there – that gives you a strong sense of achievement and you feel connected to that community. The idea that you’ve shared something that will be utilised on a daily basis: a bit about legacy, culture, behaviours, how you learn to learn. They’ve taught me a huge amount as well about what humanitarianism really means, what engaging with challenged communities really means. Such an uplifting experience. It’s more strategic, it means that learning and models can be shared with other institutions.

What would you say to someone to encourage them to support this type of work?

To support people who are committed to delivering that work locally is a fantastic experience. I think we’ve made a game changing difference in the experiences of patients and practitioners in that environment and we’ve set in place a momentum for a legacy that’s entirely appropriate for that place. That’s more than you can ever hope to do. You are empowering people to do what they love better. It’s not transactional – it’s about having a shared vision of what healthcare looks like. It allows someone who’s deeply committed to delivering care to do so in a better way, safe in the knowledge that they’re not offering substandard care, they’re delivering the best care.