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.