Since the novel coronavirus started to spread globally in early 2020, overwhelming the world's best healthcare systems one after another, countries like South Sudan were bracing for what was yet to come.
Exhausted by the years of violent conflict, political instability and economic decline, it was feared that South Sudan's fragile public healthcare system - which is largely reliant on international organisations - would not be prepared to prevent or respond to a health emergency like COVID-19.
Concerned that an outbreak of the virus would cause significant impact on an already dire humanitarian situation, MSF began integrating COVID-19 measures into existing projects across the country, while starting a specific response in Juba, the capital.
Since March 2020, we have worked in various locations across Juba, focusing on strengthening infection prevention and control measures in existing health facilities, training healthcare workers and providing health promotion activities targeting the community.
Empowering local healthcare workers
At the National Public Health Laboratory in Juba, MSF is supporting healthcare workers with training and technical support on how to screen patients and work safely to protect themselves. Rebecca, a 26-year-old biotechnologist at the lab laughs when she recalls that she used to hide from her family where she works.
"It was only because someone saw me working in the lab and told my family that they found out," she says.
In early 2020, the government of South Sudan started looking for specialists in biology, microbiology and pathology to test suspected COVID-19 cases. With Rebecca's expertise in microbiology, meeting job requirements was easy, telling the family was not.
"When coronavirus came, everybody was scared, thinking people would start dying like flies," she remembers. "But I reassured my family that I would do my best to protect myself and said they should do the same. I just want to give something back to my country."
Training and educating healthcare workers about COVID-19, and how they can protect themselves, is of critical importance in fighting the pandemic.
"Health workers are really at the frontline in fighting COVID-19." says MSF emergency coordinator Tish Shaw. "It is crucial that they are empowered with the knowledge and the tools, not only to identify patients and to protect themselves, but so they pass this information on to the community. People will listen to their health workers, the people they meet every day, and so it's really important that the health workers understand what the virus is, how it presents, how they can protect themselves."
Like Rebecca, Giir, a 29-year-old microbiologist from Wau, a town in northwestern South Sudan, is now at the forefront of the pandemic response despite his family's disapproval.
Giir supervises a team of eight biotechnologists of the reception area of the laboratory, where the samples are brought for testing from all over the country.
When Giir's parents learned about his job, they asked him to give it up, as they were worried he may bring the virus home.
"If others can do it, why not me. This is my area of specialisation and I cannot run away," was his reply to his parents.
At the beginning there was no system in place and the work was very difficult. Everyone was scared and it was stressful for each of us here. Giir, microbiologist
After the first COVID-19 positive patient was confirmed in South Sudan on 5 April 2020, and tracing and testing of contacts began, working in the laboratory was challenging, Giir remembers.
"At the beginning there was no system in place and the work was very difficult," he says. "Everyone was scared and it was stressful for each of us here. Since MSF started supporting us, things have improved. Today, if we receive a sample, the result will be ready next day. Previously, it could take two to three days or even get lost."
In Juba, MSF continues to work with the government of South Sudan to strengthen infection prevention and control measures and to train healthcare professionals like Rebecca and Giir on how to screen patients and protect themselves.
In addition to providing technical support to the National Public Health Laboratory and supporting eight biotechnologists, we are also supporting Juba Teaching Hospital - the largest hospital in the capital.
We also installed 12 handwashing stations in health facilities, densely populated public areas such as Konyo Konyo market and informal internally displaced persons settlements, as well as provided health education and hygiene promotion within the community and health facilities.
To date, there have been over 2,600 confirmed COVID-19 cases in South Sudan. While the numbers have not reached the alarming proportions of those seen in other countries around the world, and despite the improvements in the National Public Health Laboratory in Juba, limited testing capacity across the country, and therefore possible community transmission, continues to be a concern.