Going Home!

Tuesday November 9^th

This is the final blog entry for this trip.

 I had a meeting with one of the Namacosi orphanage committee members this morning which was less productive than I had hoped for but never mind. Then a drive along what is currently some of the worst road in Uganda between Mityana and the airport during which we went through torrential rain turning the dirt road into a red river. I wondered at times if we might get stranded but made it eventually after over 3 hours. I said my goodbyes to Patrick who drove and Pastor Kisakye before settling down for a 6 hour wait for the plane home. (we left early so that they could get most of the way back to Mityana in the light)

It’s been a very very good trip in many ways but I shall be glad to get home tomorrow morning

Thanks to all of you for your comments and encouragement. See you soon.

Namacosi update

Monday November 8^th

I left Kagando at 7.30 and only had a 2 minute wait for a bus. The journey to Mityana took 5 and ¾ hours. The buses don’t have a good reputation but it was a smooth ride. They very kindly gave me the front seat as an mzee (old man!). The most unnerving bit of the whole journey was the driver’s tendency to accelerate as he was approaching any bends!

I’ve had an opportunity to visit Namacosi orphanage briefly this afternoon and a few photos are attached I am due to meet some members of their management committee tomorrow at 9am which I hope will prove to be a helpful meeting

The new boys dormitory Still to be plastered and widows fitted

3 new classrooms also still needing floors plastering and windows

A class in progress in one of the new classrooms

A sweaty climb!

Sunday November 7^th

After church there was an organised hike into the hills. It was an energetic trek up to about 5000 feet into the amazing hill country about 10km from Kagando. We needless to say had plenty of  followers and helpers along the way!

Tomorrow I head off back to Mityana. Im hoping to pick up a coach around 8am from the junction at Kybarara about 10km away which if everything goes to plan should get me to Mityana early afternoon allowing time for a trip out to Namacosi to see building progress at the orphanage there

I‘m leaving Kagando with very mixed feelings. I have got to know some of the folks here really well over the last 3 weeks but I shall be glad to get home on Wednesday morning.

A brief refreshment stop with plenty of interetsed onlookers!

A good day out

Saturday November 6^th

After a quick round on male ward the rest of the day was free and an opportunity to travel around a little. First of all there was a trip with 2 others in a private hire to Kasese the nearest large town 40km away. Quite a squash (8 in the car at one stage) and shock absorbers which had long since worn out! There we met up with Robert the surgeon who had been in earlier to the bank and had then had to make a police statement because his phone had been taken! Once that had been sorted out we went to a beautiful spot called Kingfisher lodge which has a superb panoramic view over the Ishasha Plains. The tilapia and chips were good again and we had an enjoyable if rather wet afternoon. On the way back a number of Elephants were spotted along with Uganda kobs and Waterbuck so all in all a very relaxing and enjoyable afternoon.

                                   

Nina,an aneasthetic assistant, Robert the resident general surgeon and Kisi a fistula surgeon from Kenya working full time with AMREF

The amazing view across the Ishasha Plains from the terrace at Kingfisher. Very green at the moment due to the rains.

HIV Clinic Day

Friday November 5^th

Today has been very quiet. The wards seem to have settled down after so much frenetic activity earlier in the week. I did spend a short time with Edward one of the medical officers in the HIV clinic. There are about 600 HIV patients being followed up in out patients every 1-2 months to supervise their medication. This is by Ugandan standards low and it seems that the area around Kagando has been relatively lightly affected by AIDS compared to the rest of Uganda. Apparently in Kampala it is not uncommon for every patient on a medical ward to be HIV positive. I certainly have a great deal to learn about HIV management as we have so little exposure to this in the UK. One of the things I haven’t managed to do in the short time I’ve been here is to go out on a community visit to one of the village HIV clinics to see how these function. There are 8 of these in all which the hospital supervise. Hopefully I can do this on a future visit.

A white knuckle ride!

Thursday November 4^th

A village near Kyumbara about 18kms from Kagando

Today I went on an outreach visit to one of the local villages with one of the German Occupational therapists. Arrangements had been made to see a number of disabled children to see if any would benefit from any medical intervention. After a white knuckle ride for 30 minutes on a Boda Boda (a motorcycle used as a local taxi) we arrived at a remote village to await the children’s arrival. The trip illustrated to me the enormous difficulties there are for these very poor people to access the hospital when they are in need of assistance. After an hour or so the children started turning up with a variety of problems including Cerebra Palsy, Spina Bifida and some unusual congenital neurological problems. It was quite a challenge to think how best to help them and their families when even a trip to the hospital can prove prohibitively expensive but I am also amazed at how happy and content people are with so little materially. It’s a real challenge to us in an affluent country like the UK despite all the cuts!

Trying to figure out how we can help Annet a 12 year old with athetoid Cerbral palsy.

Hello and thank-you

Wednesday November 3^rd

My language acquisition is very slow. Bokonjo is a difficult language which leaves non linguists like me with little hope!  I’m still getting my Wabacheery (hello) and Wasinge (thankyou) muddled up which seems to cause considerable amusement. Some words have elements of Kiswahili in them but most is very different.  There is a language book that has been produced by the American Peace Corps for their volunteers but I have yet to see a copy.

The wards have been busy. A rather discouraging day with 4 deaths none of which could be prevented but I did feel so sad for the grieving families.

There are 2 small friends pictured below who seem to frequent the area around the operating theatre building (outside it!) I know David will apprecite these!

Lawrence Lizzard

Larua Lizzard

An eager audience!

Tuesday November 2nd

This morning I did a ward round with one of the junior doctors who has just transferred from surgical ward to the medical wards. It was an interesting time. He knows, in many ways, a lot about HIV, TB ect but I do feel there may be much that I can help with in regard to encouraging appropriate communication skills, examination skills and helping a better understanding of more western medical problems such as diabetes and COPD which are definitely emerging problems.

I was then ushered to out patients to perform a chest aspiration on a patient. This seemed to attract a huge crowd for something I don’t think they had seen done before. The student nurses are very keen to learn but are hampered by a lack of books and some teaching methods which seem to rely on intimidation mostly!

This evening I am hoping to have a discussion about some organisational matters in the hospital with Benson the overall director of the hospital. He is not medically qualified but was brought up only a couple of miles away from the hospital so has a great passion to see it succeed. One of the things I want to discuss is getting all the wards to use mosquito nets. Although these are now provided free by the government only 2 of the wards (paediatrics and surgery) have some beds with nets.

This 38 year old woman has an accumulation of fluid in the left side of her chest The exact cause isnt clear at present

A crowd soon gathered!

Getting wet!

Monday November 1st

Its been very wet today with rumbling thunder in the background as I write this. I have to time my trips back and forth between the guest house and the hospital carefully to avoid getting soaked!

Its been another busy day for me having an LP, chest aspiration and paracetesis (draining fluid from someone’s abdomen) all within an hour at one stage. There are so many young people in their teens and 20s with serious problems which are difficult to get to the bottom of without suitable testing facilities. An example is a 14 year old boy jaundiced with a very large liver and a lot of fluid in his abdomen for whom the blood test for hepatitis B is prohibitive at 15,000/= (around £4.50).

One of the things I am struggling with is the approach of some of the junior doctors While very experienced  they tend to go through things quite quickly and assumptions sometimes get made about what is wrong with people and they can seem very defensive when there is discussion or some disagreement about the best management. Im trying to be very relaxed about it as I know TIA (“This Is Africa”) and everything has a feel of absolute chaos at times but my Mzungu mind still is keen to try to introduce some order and logical thought into proceedings!

This woman in 20s had very nasty herpes simplex (cold sores) all aound her left ear and upper lip

A quick test done on the ward showed she was HIV negative. Her immune system is probably suppressed due to malaria. She recovered well with a course of the anti viral drug Aciclovir.

A day to remember

Sunday October 31^st

It was a special Sunday in church for the local people as they were praying for the Primary 7 children and also the final year nursing students. The P7 (end of primary school) have their exams on Tuesday and Wednesday. The whole service was rather like harvest festival with each child or student bringing an offering mainly of fruits but including a chicken and a goat! The goat had to be removed to stop it disturbing proceedings by its bleating! I was summoned out of the service after 2 and quarter hours to attend to some patients on the medical wards. The young man with tetanus unfortunately died this morning leaving his family very distressed. Another lady needed a transfusion organising and another man in his 20s was admitted unconscious so everything carries on and will continue to do so after I have left. This is a busy place serving half a million people, equivalent to the whole of East Sussex or put another way all the services provided by Eastbourne DGH and Hastings Conquest hospitals combined.

This evening a surgeon working with AMREF in Kenya has arrived to help over the next week with fistula surgery. Had a brief chat with him and it seems he was at school in Iten which is about 30 miles from Kapsowar where Ann and I were in the early 1980s. It’s a small world.

Dirty Water !

Saturday October 30^th

Today has been an extremely educational one for me. After spending the morning in the hospital, I went for a walk with a US undergraduate, who has been here for 5 months, and his Professor to a nearby village. He is studying the people who have suffered bowel perforations to look at why these are occurring so frequently here. We visited a man who had survived surgery 3 months ago He looked well but was rather drunk (!) He showed us where he needs to take water from when the standpipe outside his house isn’t working. It isn’t difficult to see why people so easily fall ill when their water supplies are so polluted. Interestingly no one seems to collect the rainwater from their roof which seems crazy in an area having over 500cm rainfall per year. There is a scheme being developed to try to encourage the use of sand filters to purify the water for drinking. Prevention has to better that cure!

This man survived an operation for bowel perforation due to typhoid 3 months ago

This is the small polluted water source the family have to rely on half of the time

Keeping in touch

Friday October 29^th

Today has been dominated by caring for some very sick people A young man of around 20 was admitted early this morning with severe tetanus and Im afraid the outlook for him is not that good. The medical wards do seem to have become much busier over the last few days. I do feel more confident managing the varied problems we are seeing notably typhoid and severe malaria compared to a week ago.

One of the amazing things about being here has been the internet and phone links I hadn’t expected everything to work so well because we are in a very mountainous area and I had expected that to cause more problems.

Despite eating large quantiites of local food such as Matoke(mashed green bananas) Beans Sweet Potatoes Peanut sauce ect I seem to be losing weight which seems hard to believe but Im not exactly wasting away!

Some happy new Mums

Thursday October 28^th

3 of the 4 Ugandan medical officers have gone off to an HIV course in Kampala which has left the hospital a little thin on the ground I spent the first half of the day doing rounds on the medical wards but ventured onto the paediatric wards for the first time today. Some amazing situations there including a 1 year old who presented with an Hb of 1.6 about 15% of what it should have been. Some very tiny babies to see to as well. I have to say there is something very special about looking after small children. I had a chat with Dave Lyth, who is the retired urologist who is working here, this afternoon about various aspects of the hospital which was very helpful. Tomorrow evening there is to be Scottish county dancing in the chapel!  It will be interesting to see how the locals cope with the Gay Gordons!

Smile Please!

What do you think he is writing about?

TV stardom? Unlikely!

Wednesday October 27^th

The nursing school was opened today by a number of dignitaries. I’m afraid I missed it all but there was a cameraman wandering round the wards so who knows I may make it onto Ugandan Television tonight! Ive spent some of the day preparing something to discuss at next Mondays education meeting which I hope will be helpful Ive chosen the topics of “When to do a lumbar puncture” and managing heptosplenomegaly”(patients with large livers and spleens). I am beginning to come to the conclusion that to try to stimulate debate and discussion about how things are currently being managed may be my most helpful input. While some of the skills and practice are amazing given the scarce resources that are present the widespread use of up to 4 antibiotics at a time is one amongst a number of issues that could be improved.

Keeping busy

Tuesday October 26^th

Another full day. There has been much to see and do on the medical wards which are definitely becoming my main area of responsibility. One man admitted this afternoon almost certainly has a brain tumour but there is no CT head scanner (in fact there are still no xrays due to the kamikazee rat who shorted out the transformer for the machine) here so one has to do the best that one can. On a happier note a 14 year old boy who was admitted last week with cerebral malaria and a haemaglobin of only 2.8 (should be 12 or more) at admission went home today and seemed fully recovered.  I was hoping to do a caesarean section myself today but the woman proved to have a ruptured uterus and bladder requiring a complex repair most of which was undertaken but someone at the same level as ST1 (that is just over 2 years since qualifying!) It is certainly amazing the level of skills and competence of the junior doctors here at the moment. Overall there is a very good and supportive relationship between all the doctors which is very encouraging to see and very helpful to me trying to fit in in a useful way for such a relatively short time.

A busy start to the week

Monday October 25^th

The day started with a 2 hour meeting of all the senior staff to discuss issues at the hospital A lot of it is common to the NHS with emphasis on quality and education but just with a lot less resources. I spent the rest of the morning on the medical wards including doing a paracentesis (draining fluid from a woman’s swollen abdomen due to heart failure). The afternoon saw me helping with 2 Caesarean Sections. Its all a  steep learning curve for me. Its amazing what you forget after 25 years! This evening we are having a medical education session (something for my appraisal!!) so all in all a very full day

The Beach Resort!

Sunday October 24^th                 

Today has been a rest day The church service was at 8am and at 1 hr 20 minutes was very short by African standards. The sermon today was from Luke 6 vs 46-49 about the wise and foolish builders and relating this to how prepared or not we are when stress comes into our lives. Much emphasis was given to the times when we can react like “a bomb going off “ when stress comes so that even the rats in your house get  scared!!

For lunch I went with 5 others from the hospital to the gloriously named Pan Afrique Hippo Resort at Beech Kayanja which is a beautiful spot on Lake Edward about 18km from the hospital. A lovely place to go but not a hippo in sight! Talapia and chips for 7000/= and a restful fun couple of hours playing pool and volleyball.  We were the only ones there when we arrived so not really a major tourist attraction but a nice change from the hospital.

Fishing boat on Lake Edward

Robert the resident surgeon and I

                        PanAfrique Hippo Resort Beach Kayanja!! Absolutely deserted!

An orphanage to comapare with Ekiwolumu

Saturday October 23rd

Most of the expats have gone away this weekend Spent this morning on the medical wards again th but all pretty quiet as it’s the weekend. This afternoon I went with a couple from Derbyshire to the nearby orphanage around 10km away Very similar in concept to Ekiwolumu but it has had more time and funds to develop. The houses there have 2  mothers to around 12-14 children I think. A photo of one of the houses is below. It was an interesting visit with some things to think about which might apply to the Mityana orphanages.

Back to the theatre!

Friday October 22^nd

Spent this morning on the female medical ward.  There is a lot to think about that is less familiar. A young woman with advanced AIDS and newly diagnosed TB with Haemaglobin of only  5.6 was one of several complex patients . The common in patient problems seem to be malaria typhoid pneumonias and other varied infections. Spent some time talking to a US biology undergraduate who is looking at the high incidence of bowel perforations. It seems this has, after many doubts had been raised, to be all typhoid related.

This afternoon has seen me reintroduced to the operating theatre helping with a vesicovaginal fistula repair (hole between the bladder and vagina causing the woman to constantly leak urine)Hopefully there will the opportunity to do some caesarean sections over the next few days to get me competent to do these again The last one I did was 25 years ago!

Too many cooks?

Thursday October 21st

Spent a first morning in the hospital firstly on the male medical ward There aren’t a huge number of patients at present and quite a few expat visitors with 2 doctors just finished FY2 and another completed GP training who are from Brighton and here for a couple of weeks more. Then I went to help out with the diabetic clinic as the doctor who normally does this is away in Kampala. People seem to be called back every 4 weeks on the whole which seems rather excessive! This maybe an area where things could be effectively modified and free up some doctor time. There was a choice of 2 insulins, soluble and lente. Mixtard which most of the insulin dependent patients are on is out of stock at present. Seems to be quite a common problem Too much sugar cane and too many sodas I suspect.

This afternoon has been quiet. Just one new male admission a man with Motor Neurone Disease for whom not much can be done. Diagnostic facilities are limited. There have been no xray facilities for several weeks as a rat got into the transformer and died there causing a short circuit(!) which has blown out one of the circuit boards which they have been struggling to replace from Kampala. Some blood tests available (blood count HIV testing syphylis testing and widal tests for typhoid) but no biochemistry. Overall an interesting but quietish first day.

Photos of Ekiwolumu

                                   These are a few photos from my visit to Ekiwolumu on tuesday

Some of the younger children practicing their agricultural skills

                                             While the older ones were busy doing an exam

                                                         The latest house now has a roof

                                                         Meet the sites fierce guard dog

Leaking taps

Wednesday October 20^th

Woken at 2.30 by the sound of gushing water The tap in room had suddenly decided to disintegrate A real challenge as no one around mossies everywhere and no electricity! Eventually  I managed a temporary repair with a handkerchief which kept it to a slow trickle the rest of the night.

Travelling has been smooth today and arrived at the hospital here at Kagando around 3pm. Looks as if I will be given the medical wards to work on to start as a couple of the medical officers who are responsible for those wards are away at present. Its good to be here after a very full and tiring couple of days.

progress so far

Monday October 18th

I’m on the move at last. Didn’t enjoy the farewells I hate the waiting to set off bit!! But lots of further encouragement from many people over the weekend which has been a great help. Chatted to Kate tonight and looks as if all the arrangements for tomorrow are in place so hopefully Patrick will be there to meet me and hopefully get to Mityana by lunchtime. Ill have time in the afternoon to get out to Ekiwolumu (around 7 Kms out of Mityana) to see how things are progressing and have a chance to talk to Kisakye and mebers of the Uganda Esuubi committee about a meeting about the future of Namacosi on the morning of November 9^th on my way back home. Lets hope I get a good zzzzzz on the plane tonight.

Tuesday October 19th                        

Slept a little on the flight. Arrived early but was picked up after wait of 2 hours as Patrick and Henry were slow to get there because of the road conditions between Kampala and Mityana which are really dreadful at present 3 hour journey for just over 60 miles

Went to see progress at Ekiwomulu this afternoon The classrooms were I use for exams so a very quiet atmosphere pervaded the site The 3^rd house is progressing well Still no water tank and the generator has yet to move to its new home. A subsequent rather frustrating time trying to get mobile internet activated. Not sure its yet worked!

Hope to get away at 8am for the final leg of the journey on to Fort Portal and from there to Kagando

Getting Ready

Friday 8th October
This week has seen me gathering books clothes equipment to take with me Feeling a little apprehensive and not looking forward to leaving Ann behind for 3 weeks but really certain this is right thing to be doing. Thanks to so many of you for you encouragement, good wishes and practical support. Off to see Kate and Jonno this weekend to finalise a few items to discuss while I'm in mityana on the way home.

Getting Ready 2 weeks to go!

Monday October 4th

There is much to get together to take as well as organising visas updating yellow fever ect. Ive accumulated quite a selection of books to take and some suture materials to come
I'm trying to organise some travelling arrangements to make for an easy transition to Kagando at the moment
It all seems rather unreal that in 2 weeks time I shall be setting off. Stranger still that I'm already part time even though I'm working even longer at present at work over the next couple of weeks