South Sudan Medical Journal Vol 19 No 2 May 2026

 

Dear Reader,

The May 2026 issue is online here; we thank all the copyeditors and reviewers who helped prepare these papers. SSMJ is indexed by African Journals Online (AJOL) – go here to see who reads us.


 

Editorial 

• Ebola: The Bundibugyo virus is back Edward Eremugo Kenyi
  
  

RESEARCH ARTICLES

• Risk factors in glaucoma: Insights from a prospective case–control study, Belagavi, India Asawari Kabure, Bhushan Kulkarni, Shilpa Kodkany, Murigendra Hiremath
• OV16 antibody seropositivity reveals persistent onchocerciasis transmission and cross-border risk in Magwi County, South Sudan: a population-based survey Ezbon WApary, Yak Yak, Benson Ojara, Wilson Ladu, David Oguttu, Ian Hennessee, Pita Jane, Johan Willems, Thok Chol, Kamulete Horasio, Okot William, Amanya Jacob
• Prevalence of urinary schistosomiasis in communities along the River Niger Basin areas, North-Central Nigeria Nyamngee Amase, Ikpe Raphael Terlumun, Kayode Yusuf Abel, Sulaiman Mariam Kehinde, Akanbi II Aliu Ajibola
• Developing a communicable and infectious diseases research agenda in South Sudan: A multi-stakeholder prioritisation approach Amanya Jacob, Ezbon WApary, Dhieu Daniel, Atemthi Dau, Matur T. Tieng, John Rumunu, Cicilia Konga, Bol Atem, Betty Eyobo, Robert Napoleon, Joseph Panyuon, Kenneth L Sube, Kon Alier, Joseph Lako, John Suraj, Abuelguasim M. Hassan, Mapuor Areu, Lazarus Atem, Aja Kuol, Pizzi Wilson, Achcer Adup Mou
• Determinants of disaster preparedness among public health facilities in Juba City, South Sudan Dumba Samuel Kenyi, Muthoni Mwangi Eunice, Musa Olouch
• Evaluating the role of the health information system infrastructure in enhancing data quality in Central Equatoria State, South Sudan Matur T. Tieng, Karani Magutah, Joseph Muchiri
• Impact of developmental stimulation education on maternal knowledge and caregiving practices in stunting: a longitudinal study Ning Iswati, Azizan Omar, Sukhbeer Kaur Darsin Singh, Putra Agina Widyaswara Suwaryo 
• Holding the line: lived experiences of mental health, moral injury, and organizational support among public-health professionals in the Rohingya Camp, Bangladesh — phenomenological study Md. Ruhul Amin

CASE REPORTS 

• Endoscopic endonasal repair of post-traumatic sphenoid sinus cerebrospinal fluid leak with encephalocele Justin Rubena, Khalid Coco, Francis Swaka, Othwonh Twong 
• A rare pathological feature of portal vein thrombosis complicated by portal hypertension and haematemesis Hamidine Illa, Ganiou Tidjani Kabirou, Amadou Magagi Mahamane Ibrahim, Maman Brah Moustapha, Soumaila Abdou, Habou Garba Abdoul Malik, Adamou Harissou

REVIEW ARTICLE

• Interpersonal and community-level factors influencing intimate partner violence in South Sudan: a literature review Nyinypiu Tong Chol Adong 

SHORT COMMUNICATIONS

• Letter to the Editor J. Clarke McIntosh
• Letter to the Editor Eluzai A. Hakim
• News from the Gordon Memorial College Trust Fund Eluzai A. Hakim

BACKCOVER: CDC Poster: Flu or Ebola? 

Thanks to everyone who supports SSMJ. Tell your colleagues they can join our mailing list here.

The SSMJ team
Email: southsudanmedicaljournal AT gmail.com
Website: http://www.southsudanmedicaljournal.com
Follow us on X: @SSMedJournal and our Facebook Group,

Glossaries - calques, standards and what is, or can be canonical?

Post Marrakech and WCCS26 I'm still contemplating on matters 'complex' and 'complexity', across complex systems and complex care. We humans (and this one in-particular) have a penchant for compunding complexity, adding complications. Our languages are a case in point. 

As the conference demonstrated mathematical is central to the discovery of chaotic and complex systems. Maths itself preempted the discovery of the Lorenz System, and the Mandelbrot Set.

Efforts to look at Hodges' model mathematically has resulted in a small draft comparative glossary (4-5 terms). In addition to the history of chemistry and its adaptation of mathematical symbols, I soon came across complex numbers, complex dynamics, complex mathematics (don't worry I know my limits). But, symplectic geometry! What is that?

Apparently, 'The term "symplectic" is a calque of "complex" introduced by Hermann Weyl in 1939.'
(https://en.wikipedia.org/wiki/Symplectic).

So, over decades of ward meetings, reviews, care plans it was symplectic patients, symplectic care and situations all the time? Where am I heading with this? Probably nowhere in particular. There's still the risk of a meeting c/o gravity with the floor. I've been fascinated with the way words such as design and architecture are conjoined and added to things that do not qualify, at least from the purists perspective. This is joy of languages, they change constantly. 

Familiar with 'standard' in the clinical and informatics sense; 'canonical (form)' has come up within maths. It occurs in health too:

Graham, M., Winter, A. K., Ferrari, M., Grenfell, B., Moss, W. J., Azman, A. S., Metcalf, C. J. E., & Lessler, J. (2019). Measles and the canonical path to elimination. Science, 364(6440), 584–587. https://www.jstor.org/stable/26649426 

Sepehri, A. (2015). A Critique of Grossman’s Canonical Model of Health Capital. International Journal of Health Services, 45(4), 762–778. http://www.jstor.org/stable/45140527

Lee, H.-S., Paik, M. C., & Lee, J. H. (2009). Estimating a Multivariate Familial Correlation Using Joint Models for Canonical Correlations: Application to Memory Score Analysis from Familial Hispanic Alzheimer’s Disease Study. Biometrics, 65(2), 463–469. http://www.jstor.org/stable/25502307 

Voit, E. O. (2000). Canonical Modeling: Review of Concepts with Emphasis on Environmental Health. Environmental Health Perspectives, 108, 895–909. https://doi.org/10.2307/3454323 

 

Goddu, A. (1985). The Effect of Canonical Prohibitions on the Faculty of Medicine at the University of Paris in the Middle Ages. Medizinhistorisches Journal, 20(4), 342–362. http://www.jstor.org/stable/25803849

 In drawing up a glossary, and starting with a blank sheet (that is not Hodges' model) this is all worth consideration. Could Hodges' model find a place as a canonical form - even clinically?

The alchemy of terminology, symbols, and signs ...

Or, 'What is a nurse doing … in a chemistry class?' [Ack. See Estrada]

In reading, I was reminded that chemistry adopted mathematical symbols for its own use. Not only that, but as a core science (with physics and biology, emerging from natural philosophy) there is a historical development from the time of alchemy:

Please see (with a graphical abstract):

C.Wentrup, The Transition from Alchemical to Modern Chemical Symbolism: from Bergman and Guiton de Morveau to Hassenfratz and Adet, Higgins, Richter, Dalton, and Berzelius. ChemPlusChem. 2024, 89, e202400033. https://doi.org/10.1002/cplu.202400033

This journey matters today as the use of symbols, in mathematics or other fields can be a barrier to learning and hence personal and disciplinary progress:

Ollie Hunter. Lost in translation: Demystify scientific symbolic language to help your chemistry students overcome any potential learning barriers. Royal Society of Chemistry, 23 May 2022.

As acknowledged many times, it is easy to take a word, or concept from one discipline and 'fit' it to - or in another. Or is it? Estrada concludes:

“The complexities of modern science and modern society have created a need for scientific generalists, for men trained in many fields of science.” This is a paradigm of science in the XXI century, where the advent of such fields like the study of complex systems requires multidisciplinary approaches. But the previous phrase was not written in the XXI century. It is the starting sentence in The education of a scientific generalist” published in Science in 1949 (Bode et al. 1949).' p.161. 

'Mathematics has been defined as the science of patterns. Thus, mathematicians search for “numerical patterns, patterns of shape, patterns of motion, patterns of behavior, voting patterns in a population, patterns of repeating chance events, and so on” (Byers 2010). Once a pattern is identified either in chemistry or in mathematics, the researcher can proceed to the clarification of the systematic rule which is behind that pattern. This is evident in the analogy used here between code-breaking and structure elucidation. This attachment to patterns makes both chemists and mathematicians very prone to the use of pictures. An organic chemist hardly can say anything about the chemical reactivity (or any physical or chemical property) of a molecule from its exact quantum-mechanical Hamiltonian. However, she will construct a complete narrative about the physical and chemical properties of a molecular structure drawn in a piece of paper, even if such a molecule is completely imagined. The power of pictures in mathematics is discussed in the book Mathematics and the Unexpected by Ivar Ekeland (1990) where its value is recognized as fundamental in the early stages of the development of mathematical ideas. This also introduces a very important analogy among chemists and mathematicians. Namely, that they use a proper language in their respective fields. While physicists use the mathematical language in their investigations, chemists use the sophisticated language of chemical formulas and specific symbols to represent charges, rearrangements, partial equilibria, etc. These “invented” languages mainly appear only in Chemistry and in Mathematics, making them unique intellectual activities.' p.162.

With thanks to the author, Ernesto Estrada IFISC for additional thoughts and insights:

Estrada, E. What is a mathematician doing…in a chemistry class?. Found Chem 26, 141–166 (2024). https://doi.org/10.1007/s10698-023-09497-4

RCN Congress: The Systems Table and the Missing Cog

Across two maillists: SDOH Social Determinants of Health and POHG Politics of Health Group a discussion and debate regards public health, longevity and policy, was provoked by a study:

'At least 80% responsibility for ill health in old age down to individual'

https://www.theguardian.com/society/2026/may/20/responsibility-ill-health-old-age-oxford-longevity-project-study

'... Individuals bear at least 80% of the responsibility for their ill health in old age, according to a report aimed at challenging the belief that physical decline is either inevitable or primarily the responsibility of the state.

The report, launched at the Smart Ageing Summit in Oxford last week, argues that individuals have far greater control over their longevity than is commonly understood. The authors call on the government to take legislative action on alcohol comparable to restrictions on smoking.

Living Longer, Better – the Oxford Longevity Project’s first Age-less report – was co-authored by an interdisciplinary panel of UK-based experts in medicine, physiology, ageing and education policy. It was sponsored by Oxford Healthspan.

The report’s authors, Sir Christopher Ball, Sir Muir Gray, Dr Paul Ch’en, Leslie Kenny and Prof Denis Noble, present the figure of 80% as a conservative estimate.

Ball, a 91-year-old former Parachute regiment officer who intends to reach 100, said: “Some have gone higher and said it’s approaching 90%. But I think 80% seems about fair.”The claim, however, has been described as simplistic and said to neglect wider arguments about whether people are genuinely in control of individual choices when it comes to issues including poverty, pollution and healthcare access.

Nancy Krieger, professor of social epidemiology at Harvard TH Chan school of public health, said: “The report is to be commended for rejecting genetic determinism but it problematically avoids engaging with the societal determination of health and health inequities; the role of work, economic deprivation and government policies that give corporations free rein to sell unhealthy products.”

Steven Woolf, professor of family medicine and population health and director of the Virginia Commonwealth University Center on Society and Health, agreed, saying the paper “ignores and oversimplifies the actual, multilayered root causes of the conditions that foster poor health in a population”.

Woolf added: “There are factors affecting health that are beyond personal choice. So while it’s good to give people clear guidance on how their choices affect their health, it’s taking policymakers and others off the hook.” ...'

This provides me with evidence (well it would - wouldn't it^) on the need for, the purposes, and applications of Hodges' model.

More philosophically (perhaps), I'm reminded of the work of several academics - thinkers, Michel Serres stands out for me. Serres felt that positional adverbs were important, e.g. between, above, and under.

He also wrote of life (as per many philosophers), and the universe e.g. his writings on Physics and Lucretius - as flow - a river.

For new life, the options are seemingly infinite, far, far upstream: at source - not recognisable even as a trickle... but soon a rivulet, a stream, a river of so many tributaries.

As we grow older we get closer to the sea (of the 'eternal'), the options open to us shrink gradually, but ultimately radically - inevitably.

But looking back the turbulence, uncertainty, unpredictability (trauma and joy), all contribute, not just to where we end (up) but how this came about.

Life's signature at death.

In "Hodges' Health Career Model" 'health career' refers specifically to the idea of life chances (of course) and how other careers, education, work, retirement, caring (self - others - planet) .. are impacted through life and death's course.

This morning at RCN Congress, Liverpool (the home of District Nursing) there was discussion re. nurses being engaged in preparation for the next pandemic.

So often 'Nursing' is absent from the POLITICAL / POLICY table:

• Workforce planning
• Safety
• Higher Education?
• Research funding?
• Information / Health infomatics policy?

Speaking for myself, nursing is not interested in the four-course meal, but being involved and engaged in the after dinner discourse can be critical.

Politicians, policy makers, business, management consultants and lobbyists are so quick to point to and extol the 'SYSTEMS' perspective, and the need for 'systems thinking'.

Guilty of systemic neglect, they clearly have no idea of what a system is, an inability to appreciate and apprehend scope, scale and the 'whole'.

In mitigation (or not), for all groups: voice matters. Especially the voices of foresight, balance, advocacy, Their ability to ascend always proves an issue. 

Related papers listed in the sidebar:

Jones, P. (2008) Exploring Serres’ Atlas, Hodges’ Knowledge Domains and the Fusion of Informatics and Cultural Horizons, IN Kidd, T., Chen, I. (Eds.) Social Information Technology Connecting Society and Cultural Issues, Idea Group Publishing, Inc. Chap. 7, pp. 96-109.

Jones, P. (2009) Socio-Technical Structures, the Scope of Informatics and Hodges’ model, IN, Staudinger, R., Ostermann, H., Bettina Staudinger, B. (Eds.), Handbook of Research in Nursing Informatics and Socio-Technical Structures, Idea Group Publishing, Inc. Chap. 11, pp. 160-174.

Jones, P. (2012). Exploring several dimensions of local, global and glocal using the generic conceptual framework Hodges's model. The Journal Of Community Informatics. 8(3). Retrieved from https://www.academia.edu/3794699/Reflecting_on_the_glocal_through_the_conceptual_framework_of_Hodges_s_model

^Because these days you need to make every kernel - found or created on the continuum of evidence - count.

Previously: 'life chances' : 'health career' : 'Serres' : 'APPGs'

Liverpool, UK. RCN Congress 2026 - 
n.b. See you in Liverpool 2027?

June 4-5 'Ecologies of Care' - London, UK

With more to follow from RCN Congress, this morning I received the agenda for next month's conference 'Ecologies of Care'. I am speaking, first session on the Thursday, which is a good to know and see the broad range of presentations. 

The focus on attention, is helpful for a possible further event in October. In the meantime, the Call for Papers began:

Chancellor’s Hall, Senate House London

June 4 & 5, 2026

Keynote lecture by Professor Yves Citton

How do increasing demands on our attention influence what we know, and how we act, in response to climate change? Despite a strong scientific consensus that climate change is ongoing and anthropogenic, political and legal action remains fragmented. Ecologies of Care asks to what extent the environmental crisis is a crisis of attention. Speaking to the dynamics of the attention economy, Yves Citton notes that “the new scarcity is no longer to be situated on the side of material goods to be produced, but on the attention necessary to consume them.” The word ‘attention’ is etymologically linked to the notion of care, or that which one attends to. This relationship (of subject and object) is fundamentally collective, insofar as collective attentional regimes influence what each one of us pays attention to on a daily basis, and how we navigate the barrage of informational flows from popular media.

Terms such as "the Anthropocene" and "planetary boundaries" function both as scientific descriptors and attempts to provoke action commensurate to the urgency that scientists believe their research demonstrates. The recent decision not to formalize the Anthropocene as an official geological unit, for example, highlights growing unease concerning intensifying media attention directed at scientific expertise. Under conditions of increasing disparity between what we know, and how we act, in response to climate change, the role of scientific expertise plays an increasingly normative, and not only informative, function. Scientific expertise attempts to direct what we attend to, and consequently, how (or if) we care. This is a collective practice of narrating and internalizing mythologies, whereby informational flows draw attention to some thing that needs to be cared for: Earth, the planetary, capital, or each other.

Continued ...

 c/o Law and the Environmental Humanities Network

n.b. With little time, I'm not going to transfer the pdf text, but may add here.

#RCN26 RCN Congress - Nurse Education

If you think hard-enough all the debates at RCN Congress connect to 'education', but two are laser-focussed:

Protecting nurse education

Resolution submitted by the Education Forum
That this meeting of RCN Congress asks RCN Council to lobby UK governments to protect nurse education from university sector economic pressures.

Quality of clinical placements

Matter for discussion submitted by the Students Committee
That this meeting of RCN Congress discusses ways in which the quality of clinical placements can be ensured and consistent across all 4 countries.

For more senior colleagues, you may momentarily think back - all rose-tinted - to the pre-undergraduate Schools of Nursing, but you also realise change was needed and inevitable. A new millennium was fast approaching.

Now, however it seems within the university ecosystem, nursing is a threatened subject and discipline. Nurse education is exposed and itself vulnerable. In the 21st century fitness-stakes - finance wins:

individual

|

INTERPERSONAL : SCIENCES

humanistic ------------------------------- mechanistic

SOCIOLOGY : POLITICAL

|

group

mental fitness	physical fitness
SOCIAL VALUE  & VALUES	FINANCIAL FITNESS

 

At RCN Congress, the status of nursing as a profession in the USA, was raised. Looking online, I found the following at the U.S. Department of Education: Myth vs. Fact: The Definition of Professional Degrees.

In January 2025 I posted about the situation at Cardiff University. At Congress the matter of the quality of clinical placements, became a resolution. The protection of nurse education provoked an impassioned and emotional debate. Student nurses seeing what is happening to nurse faculty. Nurse faculty seeing the years of experience 'walk' be-pushed out through the door. It seems there is no collective noun for a group, or collection of redundancies. Mass comes to mind, especially in this instance. A 'rash' seems appropriate. But, the condition is more serious and bears further investigation:

As a Google search demonstrates - https://share.google/SViFPWuJovKWhErEE

IT doesn't stop there ...

How many of us (nurses, and other 'professionals') are seeing job offers(?) such as:

Remote
Contract

$35/hr - $80/hr (this is lower than others ...)

About the job

Nursing Informatics Specialist (AI Training)

About The Role

Your clinical knowledge is more valuable than you think — beyond the bedside. We're looking for experienced nursing professionals to help train and evaluate AI systems built for healthcare. As a Nursing Informatics Specialist at Alignerr, you'll apply your frontline expertise to ensure AI understands real-world clinical workflows, EHR systems, and nursing documentation the way actual nurses do.

This is a unique opportunity to work at the intersection of nursing practice and cutting-edge AI — on your own schedule, from anywhere.

• Organization: ---------
• Type: Hourly Contract
• Location: Remote
• Commitment: 10–40 hours/week
  
  

What You'll Do

• Evaluate AI-generated clinical content for accuracy, safety, and alignment with real nursing workflows
• Review and annotate EHR documentation scenarios, flagging errors or gaps in clinical reasoning
• Translate nursing practice knowledge into structured feedback that improves AI model outputs
• Assess how well AI systems reflect clinical informatics best practices across areas like documentation, data integrity, and care coordination
• Provide expert insight on health IT tools, including EHR platforms such as Epic or Cerner
• Work independently and asynchronously on task-based assignments
  
  

Who You Are

• Registered Nurse (RN) or equivalent clinical background with hands-on experience in a healthcare setting
• Familiar with EHR systems and clinical documentation workflows
• Able to analyze clinical scenarios and communicate clear, structured feedback
• Detail-oriented with strong written communication skills
• Self-motivated and comfortable working independently in a remote environment
• No prior AI experience required — your clinical expertise is what matters
  
  

Nice to Have

• Experience in clinical informatics, health IT, or nursing informatics roles
• Familiarity with data annotation, quality review, or evaluation processes
• Background in quality improvement, patient safety, or clinical education
• Exposure to health data standards (e.g., HL7, FHIR, SNOMED)
  
  

Why Join Us

• Work on cutting-edge AI projects with leading research labs and AI teams
• Fully remote and flexible — set your own hours and work at your own pace
• Freelance perks: autonomy, variety, and global collaboration
• Apply your nursing expertise in a completely new and impactful way
• Contribute to AI that could meaningfully improve how healthcare technology serves patients and clinicians
• Potential for ongoing work and contract extension

You might think (no pun intended!): 

'Well this all about informatics. Don't worry - it will all work out fine!'

But, please notice, the clinical and nursing requirement:

"Registered Nurse (RN) or equivalent clinical background with hands-on experience in a healthcare setting."

Not exactly, Hodges' model is it? Even if specific to this role, what does it say:

• about :: the title of 'Registered Nurse'
• about :: Nurses and Nursing as a Profession
• and :: to search engines and agentic AI?

So be aware, and concerned (worried even!) for nursing and nurse education ... 
for the humanity of healthcare:

individual

|

INTERPERSONAL : SCIENCES

humanistic ------------------------------- mechanistic

SOCIOLOGY : POLITICAL

|

group

de-humanisation	BIG TECH
"Where has everyone gone?" Social values Social justice What about research, debate, evidence..?	Nursing Faculty Universities as Institutions that reflect Society Why is there an echo in here? It's been hollowed out.

P.S. I am not a technophobe. Previously: 'AI' : 'SOCIO-technical'