Being a Pediatric Intern Doctor in South Sudan: Clinical Lessons from a Resource-Limited Hospital

I studied medicine at the Latin American School of Medicine in Havana, Cuba. Currently, I work as an intern doctor at Al-Sabah Children’s Hospital in Juba, South Sudan, where I will complete my internship on April 20, 2026. Practicing medicine here exposes the stark realities of health care delivery in a resource-limited setting and has profoundly shaped my understanding of the physician’s role.

Al-Sabah Children’s Hospital serves as one of the country’s primary pediatric referral centers. On a typical day, our team sees approximately 200 patients. Many children arrive with advanced disease after long and difficult journeys from remote regions of South Sudan, where health care access is extremely limited. By the time they reach the hospital, their conditions are often severe and complex, sometimes exceeding what we encountered during medical training.

In this environment, the role of an intern doctor extends far beyond traditional expectations. After meeting patients and establishing a clinical assessment, we frequently perform procedures ourselves. These include inserting intravenous cannulas, placing nasogastric tubes, administering medications, and educating caregivers in real time. For example, after placing a nasogastric tube, we must immediately teach mothers how to safely administer feeds or medications through the tube. As a result, intern doctors function simultaneously as physicians, proceduralists, and educators.

Cultural dynamics also shape how care is delivered. In South Sudan, children are often accompanied by extended family members, including parents, grandparents, aunts, and uncles. In the resuscitation room, where there are few restrictions on the number of accompanying relatives, health care providers must deliver urgent clinical care while also maintaining clear communication with families.

Oxygen therapy illustrates this challenge well. Caregivers may remove nasal oxygen prongs from a child because they do not understand their purpose. In such situations, we must pause and explain the importance of oxygen therapy, sometimes repeatedly, to ensure that treatment continues. Communication therefore becomes just as essential as clinical expertise.

Another challenge is limited senior supervision. Although pediatric registrars are present, many are in their first year of specialty training and must manage overwhelming patient volumes. As a result, intern doctors often find themselves making important clinical decisions with limited immediate guidance.

Basic medical supplies are also inconsistent. Alcohol-based hand rub is frequently unavailable, and there are occasions when gloves run out entirely. Intern doctors receive no stipends to purchase these items independently, so we must adapt while trying to maintain infection prevention and patient safety.

Diagnostic capacity remains extremely limited. Much of pediatric care relies heavily on clinical examination and judgment. Within the hospital, the most consistently available laboratory tests are complete blood counts and blood films for malaria. Imaging studies such as X-rays, echocardiography, or CT scans are usually performed outside the hospital. However, many families cannot afford these investigations, meaning that treatment decisions are often based on clinical suspicion rather than confirmatory testing.

Access to emergency medications also presents significant challenges. Essential drugs for conditions such as diabetic emergencies or severe asthma attacks are sometimes unavailable in the emergency department and must be purchased from private pharmacies outside the hospital. For many families, these medications are financially out of reach.

Perhaps the most striking gap in care involves pediatric oncology. South Sudan currently lacks specialized cancer treatment facilities for children. Patients diagnosed with conditions such as leukemia are typically referred to hospitals in Uganda for further care. However, these children are often referred late in the course of disease after traveling long distances from remote regions. During the waiting period before transfer, they are admitted to general pediatric wards without isolation despite being immunocompromised. The absence of specialized wards and oncology medications further complicates their care.

Despite these challenges, practicing medicine in this environment has been profoundly transformative. My time at Al-Sabah Children’s Hospital has strengthened my clinical reasoning, procedural skills, and ability to adapt in difficult circumstances. More importantly, it has reinforced the central values of medicine: compassion, communication, and resilience.

Health care systems in resource-limited settings require not only clinical expertise but also innovation, teamwork, and global support. By sharing experiences from hospitals like Al-Sabah, frontline clinicians can help illuminate the realities of pediatric care in underserved regions and advocate for stronger health care systems.

For young physicians, working in such settings is demanding but deeply formative. It reminds us that the essence of medicine lies not only in advanced technology but in the commitment to care for patients under any circumstances. These lessons will remain with me long after I complete my internship in April 2026.