A laast visit to Ekiwumulo

Saturday July 9^th

Our last day in Uganda which was spent travelling from Mityana to Entebbe but with a stop off at Ekiwulumo to see what further progress there had been

The 4^th house seems to be progressing well and only one of the rooms in the vocational training block still needs finishing although that will take some major earth moving to get the floor level right

It’s been much more like Africa temperatures the last couple of days so hope its warm when we get to Heathrow tomorrow afternoon. It should be pretty hot and dry for the team coming out to Mityana in just 3 weeks.

Thanks for following the blog which I hope has both informed and amused you through the last 3 weeks.

The 4th house now waiting for its roof

Some of the children with a new water filter waitng to be assembled next week

3 of the new solar lights which are proving very useful already

Netball and football

Friday July 8^th

We had an uneventful journey from Kagando to Mityana apart from some baboons drifting across the road at one point! After some refreshments and a chat with Pastor and John Bosco we headed off on boda bodas for a school football and netball competition in which the school at Ekiwumulo were competing. The girls were runners up after a couple of exciting matches and we left the boys football at half time with the score at 2-1. It was about 6.45 by then with the sun just about to set. The children all played brilliantly and it was great to see how much pleasure they got from the semi-final netball win

The Ekiwumulo netball squad

Much rejoicing after the semi-final victory

Goodbye to Kagando

Thursday July 7^th

Today was a last working day. The morning continued until 1.45pm but this afternoon Ive done a case based discussion with Rachel for her GP training so this afternoon wasn’t quite so intense. Ann spent some of the morning doing a rerun of Jonah and the Big Fish to 600 children at Kasinga Primary School about a mile away. This afternoon we were able to enjoy a last walk along one of the local tracks though banana and millet plantations.

Reflecting on our time what have we achieved? I hope we have been able to contribute something to the life of the local school and hospital. It’s certainly been a very intense 2 weeks but we are pleased to have been here and certainly we have learnt a lot about appreciating what we have in the UK and take so much for granted. Particularly the locals are always so grateful for the rain so we need to make sure we don’t grumble on a cold wet day in the UK! We are looking forward to apples, a long hot bath and some clean towels!!

Fortunately there hasnt been any Ebola virus otherwise we might have been stuck here for several weeks as all movemnts are stopped!

 

And goodbye to Bertie who lives in the corridor of the guesthouse

The mission begins

Wednesday July 6^th

Today started with an amazing time in the chapel. A mission is just starting with a choir from Congo, preachers from Congo and Zanzibar and 5 friends form Dave and Helens church in Scotland who arrived last night. The choir was amazing singing in Swahili which most of the locals can’t understand but they were excellent. The missioner from Zanzibar spoke as well. He is from a Muslim background very well versed in the Koran and spoke about its legality and that in Islam there is no provision of forgiveness. I have rarely heard anyone speaking with such clarity and authority about the contrasts between Islam and Christianity

Jonah in the boat soon to be swallowed by the big fish!

Ann has been busy at the school helping with some parachute games and the story of Jonah and the Big Fish which they thought was great!

A parachute game under way

I lead a CME session this morning looking at malaria treatment It is such a challenge to get people to accept change particularly trusting the rapid diagnostic tests when they are already not trusting the malaria blood slides the lab is producing So often malaria treatment is started or continued in the face of a negative malaria slide whereas the RDT kits could produce a more reliable answer more swiftly. I shall battle on!

Today has been anaemia day on the wards with a boy of 14 arriving with a haemoglobin level of 1.8 (instead of 12) and another aged 6 with a haemoglobin of 3.4. One of the things the lab is good at here keeping a ready supply of blood for cross matching which is so important in these cases.

The famous international speaker

Tuesday July 5^th

Ann became a famous international speaker today giving a short message on Psalm 121 a the start of the mission that is taking plce in the village over the next few days There were several hundred listeners who gave her warm applause at the end! She also taught a physics practical lesson on the refraction of light and the pinhole camera. She hadn’t taught many physics lessons before and the last would have been over 30 years ago The only slight problem was, to her horror the prism was knocked off the table so it produces rather more refraction than it did before!

This is the stage Ann spoke from It visibly rocks when the group are singing!

The hospital was down to 4 qualified Doctors today as Rachel was ill and wasn’t working. Somehow everything seemed to get done largely thanks to some final year Ugandan medical students who are on attachment here before starting work in various places in August. One of them called Simon is from a village only a few miles away and his parent still live very near so hopefully in time he will come back to work at the hospital which will be a real bonus as he seems very willing and competent.

I spent some time with Benson the project director discussing a number of issues I’ve picked up on since I’ve been here and spent an hour typing a detailed report of our discussions so I do hope that that will be help in the months ahead.

A tragic accident

Monday July 4^th

Tragically one of the junior doctors here Marvin was involved in a road traffic accident at the weekend which has left him with a fracture of one of the bones in his neck (odontoid peg) and has been transferred to the neurosurgical unit in Kampala. That’s a significant blow personally to him and his family but also has an impact on the manpower situation here. We are hoping there may be some better news later today after he has had a CT scan. For the moment Im running the male and female wards which are both pretty full with patients on the floor.

The hospital has been very busy today with much to do. The 28year old woman from Saturday died last night which was so sad. There is another young man who has been admitted with TB and HIV who is having pus drained from his chest each day at present so I hope and pray we will be able to do more for him over the next few days and weeks. Another young woman of 16 has developed a widespread cancer of her abdomen (juvenile granulosa tumour) which might be amenable to chemotherapy but when I discussed this with the father there was utter dismay in his face at the impossibility of being able to take her to Kampala for the chemotherapy she would require.

Ralph Settatree, a retired gynaecologist left today-he was the person who had given us a lift on our way up here. He has worked tirelessly to talk to so many people about the situation here. For a whole host of reasons there is a large financial deficit which somehow will need dealing with but I think it’s a huge challenge to everyone here in much the same way people are finding the financial difficulties at home so difficult to deal with. We were sorry to see him go as he had been a very cheery person to have around. We now are the sole residents at the guest house at least for a night or two.

Exciting Elusive Elephants

Sunday July 3^rd

Today was our first full day off so we took a trip to Queen Elizabeth National Park. We had a superb day despite the 5.45am start.

These hippos were only about 10 yards from the shore-you can just see the bow of a fishing boat in the foreground

There was much to see but the one of the two major highlights of the day was watching a huge group of 42 elephants across the Kazinga Channel from Mweya lodge. We weren’t able to take the boat trip we intended until 16.15 as the 14.00 boat wasn’t going to go so we were able to watch the herd move around over a 3 hour period which was truly amazing. The boat trip that followed was equally stunning. We took a small boat carrying 8 passengers including ourselves which was able to get in extremely close to the bank of the channel with some spectacular views of the birds and animals. Unfortunately the herd of elephants had moved on by that stage but there were still a couple who remained behind

All in all it was an amazing day and one we were very grateful to have experienced but it is such a contrast to the environment we are currently living and working in.  

This elephant looked as if he had had a problem with toothache!

Trip to the river

Saturday July 2^nd

A sight which really moved me this morning was the last patient I had to see on a ward round I was keen to get away for lunch but was confronted by a very wasted young woman of 28 with HIV. I doubt she weighs more than 30Kgs and had several features of very advanced disease including obvious Kaposi’s sarcoma. It saddened me so much to see such a young life being slowly destroyed and made my hurry to get to lunch seem rather inconsequential.

At lunch we broke into our fruit which in Lukonzo is named Echamba. An interesting blend of flavours which we are glad weve experienced but we probably won’t look too hard for it again!

This afternoon we took a walk to a river nearby which amused the locals no end. At the river people were washing clothes and bathing at the river edges but drinking and collecting water from the middle of the river. Given the colour of the water its easy to understand that typhoid could affect so many here. We did pass one smallholding where the owner was growing vanilla pods. Apparently a German exporter pays them UgSh9000 per kilo which I should imagine leaves the exporter with a handsome profit judging by the cost of vanilla in the UK but the grower obviously felt this was a fair price

Down by the river

Guess the name of the fruit

Friday July 1^st

Trying to set up a chest drain for a patient today was an interesting challenge. The ward felt the equipment was in theatres and the theatre staff thought it was in the ward. Feeling I was not getting anywhere fast I compromised on doing a chest aspiration to draw fluid off the man’s chest. Back to theatre to ask for the 3 way tap I needed to be told it was locked in a cupboard and yet again “The man with the key has gone”!! Indeed he had because when I phoned I discovered he was in Kasese about 40 Kms away with the key!! Such is life in this part of the world….

Ann had a visit to the market and purchased an interesting specimen which we have christened a Tortoise Fruit. She did ask someone when she was buying it what it was but the person didn’t know the name only that it is sweet.

Managed to plough through my NHS emails this afternoon as the internet has recovered for the time being. No thunderstorms or powercuts so long may that continue!!

This 10 year old arrived in out patients today Any offers from the medics?

Guess the name of the fruit. A Tortoise fruit??

Xrays to look at

At long last some xrays to see!

Any guesses??!!

Internet problems

Thursday 30^th June

Apologies for all those eager to look at xrays! The internet is so slow at times it’s difficult at present to download pictures. Whenever the mains power goes off which is several times a day at present then the internet seizes up. Also when the power is down the xray machine can’t function. There is one you man who has been waiting for 3 days to get an xray done because of this.

The typhoid protocol has been looked at by everyone and suitably tweaked so hopefully we are nearing the finished article.

Ann did a revision class for P7 who she taught back in February. The school was shut today because of a teacher’s conference but the P7 form are boarders so were free all day. They were very pleased to see her and the lesson was much appreciated by those who stayed awake!

David and Goliath

Wednesday 29^th June

Today has been a busy one at the hospital with many sick patients on male ward. In particular there are a number of patients with cardiac failure and a boy in his teen who is failing to respond to his TB treatment and on whom we haven’t been able to get a CXR done because of difficulties over the power supply which has been very erratic. I’ll post some xrays I’ve copied for the interest of the medically inclined!

Ive had an opportunity to discuss the guideline for abdominal pain with fever which needs tweaking but everyone seems very enthusiastic.

Ann taught about David and Goliath. She used a long stick with a balloon on to represent Goliath and the children were highly amused when he fell down and the balloon burst! This afternoon she went to another nearby school where she heard a recorder recital including Joy to the World and the local Bokonzo anthem.

Another wet day

Tuesday 28^th June

When Ann arrived at school this morning there weren’t many children around She wasn’t sure if it was because they hadn’t paid their school fees or just because it was too wet! Its certainly been very wet here today so quite envious of the UK heat wave. It was difficult at times teaching over the heat of the roof.

The medical students seem to be gradually finding their feet but we now have 3 from Makere University who have just appeared in addition to the Ugandan students from Mbarara university and the UK students.

We have been writing and typing up a guideline for treating abdominal pain with fever which I am going to get the other doctors to sruitanise to try to make sure that any early typhoid cases presenting to the hospital are promptly treated.

Marching round the walls of Jericho

Some of the children in Ann's class trying to keep warm

Shades of The Constant Gardener

Monday 27^th June

At school Ann lost her red pen. Absolutely essential for marking as no other colour will do! After looking for it for some minutes one of the children offered to lend her her pen which Ann found very touching. The children thoroughly enjoyed acting out the story of the Israelites leaving Egypt particularly the ten plagues of Egypt.

One of the issues regarding the Typhoid epidemic here is whether the ciprofloxacin we have is of adequate quality. So one of today’s missions was to the pharmacy to get samples of the ciprofloxacin (the main antibiotic being used to treat typhoid) being dispensed. One of the brands is rather discouragingly named Ificipro which doesn’t fill you with confidence!! Reminds one a little of The Constant Gardener for those who have seen the film.

On the ward round this morning I had no less than 6 medical students in tow which I think I would find very frustrating but Im doing my best to stimulate their interest and get them motivated to do some learning Today I also did a session for them on typhoid and dysentery.

Getting wet!!

Sunday 26^th June

The sermon in church today was about having a good marriage using the text of Samson and Delilah! Also apparently marriage is like an orange! I’ll leave you to work that one out!

I did say to Ann thus morning that I wasn’t going to the hospital today but a couple of phone calls later and I was needed by some of the medical students!

This afternoon involved much wetness. We set out for the waterfall and after walking for 15 minutes we were stranded in a downpour fortunately sheltering under a tin roof of a nearby shop. The walk to the waterfall proved challenging for the 7 of us (including Rachel and 4 of her friends from UK). We walked through the river for around 20 minutes lead by Rachel with the river  in full flow because of all the recent rain and some strong currents needing to be negotiated. Once at the waterfall we had a very welcome swim in some freezing water. We are still trying to warm up 2 hours later.

With another snake seen today the snake score so far stands at 4! Fortunately only one alive-a green tree snake seen yesterday!

Had to shelter from this downpour!

Swimming under the waterfall

Our first sunny day

Saturday 25^th June

The morning started with a further discussion about tackling Typhoid here. I may be able to help by constructing an acute management pathway for the staff in out patients to use. Also it can come down to money. There is a hope to obtain 30000 water filters at a cost of £500000 so its an ambitious target. I then went to the hospital for “5 minutes” and ended up tied up for 2 hours!

This afternoon has been hot and sunny for the first time since we have been here and we enjoyed an outing to the nearby orphanage to see further developments there and on to Queen Elizabeth pavilion near the entrance to the park for a soda. We had hoped to see some of the nearby craters but they were inside the park and didn’t really justify the $30 each entrance fee to the park.

The boy with the psoas abscess is making good progress but he has to have the gentamicin (an antibiotic) he needs purchased from the nearby shops as the hospital is out of stock!

Im sure theres a lion out there somewhere.....

Ann keeping in touch with the world on facebook!!

Typhoid is a big problem

Friday 24^th June

Today has been focused on typhoid. Dave Lyth one of the surgeons here is starting a coordinated campaign to tackle the typhoid epidemic there is here. Last month there were 32 patients requiring surgery for gut perforation which is a staggeringly large number.  There needs to be a coordinated and multifaceted campaign to tackle the problem involving clean water supply better education alleviating poverty as well as striving to achieve the best possible management when patients arrive at hospital.

The hospital has a substantial number of medical students who seem to have been very much left to get on with things. I took pity on them today and ran a session on malaria for them which seemed to go down OK and I’ve promised to do something around lunchtime each day next week so hopefully by the end of it all they may have some grasp of what is going on in the medical and paediatric wards

Ann managed to teach the remainder of lesson 1 this morning and this afternoon had a very successful trip to Kazinga market. There is certainly a lot more fruit available at present. Pity I don’t like mangoes!

A big avocado pear 4p!

large finger bananas cost about 15p - delicious!

Children children and children!

Thursday June 23rd

Ann has been busy this morning teaching 2/3 of lesson 1 to P6  a class of 62. There are some colouful names such as Muhindo Happy Edwin, Capacity Scovia, and Simple Baby!! She is having to go slowly beacause the childrens english isnt quite so good

Todays event at the hospital was Elijah aged 8 who was brought to outpatients where I was helping out this afternoon. For the medically minded he had a psoas abscess which needs surgery this eveing. This is something I have never actually seen before and would be rare in such a young person. It was confirmed within about 15 minutes by ultrasound which is rather quicker than it would be in the UK

.                                                Elijah with left sided psoas abscess

This evening we had an interesting walk accompanied by a young man with learning difficluties named Samuel who seemed to enjoy wandering along with us. There was so much to see with pineapples mangoes avocadoes millet bananas maize casava sweet potatoes all growing in profusion following the rain of the last couple of months.

If you are interested in Ann's alternative blog then email her and she will send you a copy!

We have arrived.

Wednesday June 22^nd

Today was a day of travelling with a 6 hour journey from Mityana to Kagando.  All went smoothly thanks to a lift from a kind friend. We travelled with a couple one of whom works for send a cow so we had some interesting discussions about cows and how to look after them!!

Everywhere is incredibly green and its obviously been raining a lot so we look forward to a downpour tonight!

The internet is quiker here in Kagando so here are a couple of photos from yesterday.

The deserted railway station

No risk of being run down by the Kampala express!!

The last train from Mityana-missed!!

Tuesday June 21^st

This morning we headed off to Ebenezer secondary school where there are quite a large number of Esuubi sponsored pupils studying. We arrived during a mid-term exam so all was quiet. The head teacher Richard was once again stressing the need for a good attitude to work, a goal to strive for and to believe in themselves. During the interval between exams Ann and I gave short speeches exhorting them to use the opportunity they have. I almost sounded like a teacher!!(Ann did!!)

A lengthy 4 hour delay followed while we waited to have an important Esuubi meeting but it was worth the wait with a very useful discussion ensuing.

Then we had an exciting cultural expedition into the African bush to discover the whereabouts of Mityana Railway Station. Alas no trains just a scene of dereliction but still very recognisable after over 30 years of disuse. Only the Maribou storks and a cow seemed to be patiently waiting for the next train!

Ekiwumulo is growing

One of the houses with the glass in place

Monday June 20th
Today we have had a long visit to Ekiwumulo where much has changed since we were last here 4 months ago. The windows are in the classrooms and glass now in the windows of 2   of the houses. The water tank for the site is in position with the piping being laid from the bore hole and the vocational training block is nearing completion. The foundations of a 4^th house are nearly complete and this house should be completed in the next 2 weeks. It really is remarkable how the site has developed since the first group visited in 2007

 The children as always were very welcoming to the “visitoors” with many songs and specially written poems being performed. There are now 203 children in the school.

Football was a great diversion for the older boys thanks to the kind donation of footballs from a company in Eastbourne.

Footbal match in progress with the vocational training block in the background nearing completion

John Bosco who is doing alot to coordinate Esuubi's work

A wet start

Sunday June 19th

The warm heart of Africa turned into a very wet one for our arrival! It was so wet the plane had to circle Entebbe for 20 minutes before attempting a landing which is unprecedented!

Yesterday was spent meeting up with people in Mityana. We spent some of the afternoon visiting Bob who we have sponsored for a number of years.

 It was the first time Ann had visited the place where he lives It was very humbling to see him living in a room shared with 4 others and all his possessions in a small tin trunk. The pastor’s pigs are growing and there were rabbits wandering freely around the compound!

One small boy found texting home very interesting as he has to sit at Kolping all day while his mother works here.

The Map Office

Tuesday March 8^th

Today’s final cultural experience was a trip to the map office in Entebbe. We arrived at the locked door of a very run down building before discovering the back entrance helped by a Ugandan working for the red cross and a security Guard. We had forgotten that today is yet another public holiday for “Women’s Day” but fortunately Richard was at work. We were led to an office which is pictured below where we spent a very hot hour obtaining a map of Mityana District and eventually a computer image of the map around Kagando because the paper version was “out of stock”. The office was a picture of terminal decay with maps strewn everywhere! Richard has worked in the office since 1983 and has obviously been dedicated to the work despite all the difficulties.

The Map Office

After doing a few touristy things we met up with John Bosco from Mityana who updated us with some Esuubi bits and pieces. He is such a good and willing person to work with and we are extremely fortunate to have him working with Esuubi.

We had a final supper here at the airport guest house with the entertainment of 2 guinea fowl chasing around the garden at high speed.

We are both sorry to be leaving Uganda but looking forward to a hot bath and some cold weather!!

Chimps using sticks to fish for termites

By the seaside-after 300+miles

Monday March 7^th

It was a long and rather tiring eight and half hour journey to Entebbe so we were very relieved to have arrived safely. The first part of the journey goes through some of Queen Elizabeth Park and low and behold some of the elusive elephants put in an appearance which was decidedly a bonus.

On the lake shore at Lake Victoria

To get rid of all the aches and pains from sitting all that time we found a way from where we are staying to walk to the shore of Lake Victoria which is the first time we have managed that. It looks very tempting to swim in but as you can see there were numerous snails on the shore which are the little chaps responsible for Bilharzia in the water!

Numerous snails on the shore line carrying Bilharzia

Dodgy roads and beautiful birds

Sunday 6^th March

This weekend has seen me driving in East Africa for the first time in 26 years! Robert the surgeon very kindly loaned us his car for the weekend. We came back to Kagando through Katwe which allowed us again to pass through the game park. There were some amazing animals but more especially the birds and it was great just to stop and wait and watch things without any need to rush on. The second part of the journey from Katwe was along a dirt road which after some heavy rain this morning was interesting in a saloon car without 4 wheel drive but we made it OK (Ann says just!!)

The food where we were staying was excellent. We were particularly entertained last night when it was announced that the vegetatrian option instead of pork chops was chicken!!

The Lyths have arrived back after a month in the UK so it will be good to catch up with them over supper this evening.

I think we have both enjoyed our time here very much and hope we have been able to contribute in some small way while we have been here.

View from the veranda of the tent we were staying in

Back to nature with outdoor showers!

A White Fronted Bee Eater

Elusive Elephants

Saturday March 5^th

Today has been spent first looking around some of the local places of interest. Elephants proved unfortunately elusive as has most other wildlife but we did see a crested guinea fowl which was a first.

This afternoon we have just been relaxing at the place we are staying. It is very peaceful with a view over the Kazinga channel which joins Lake George to Lake Edward, 2 of the major Rift Valley Lakes. It’s a wonderful place for birds and it’s been very relaxing just to sit and watch the amazing  selection here. We had a particularly good view of a Goliath Heron from our tent's veranda. I’d love to post a photo but the internet connection here is a trifle dicey!

We shall be back at Kagando tomorrow afternoon before travelling to Entebbe on Monday.

Time to relax

Friday March 4^th

Ann had a successful last morning teaching. She was given a thankyou letter, a bracelet, farewell a speech and given millet porridge and mandazis! So all in all you can tell they were very grateful for all she has done and Ann is also very grateful to God to have been able to teach each morning without her foot becoming too problematical.

We came away this afternoon for a 2 night break at Queen Elizabeth Bush Camp which is a random tented camp on the edge of the park with many birds and an outside shower but it will be lovely to have a weekend to relax after such a busy few weeks.

A stormy day

Thursday 3^rd March

It is 6.50pm here and Simon has just been called down to the hospital to see a sick child so he has said, “it’s your turn to do the blog today!”

I went to teach Bible Explorer lesson 4 armed with a resuscitation “baby” wrapped up ready to be nearly cut in two for the story where King Solomon shows his wisdom and a balloon masking taped to a very long pole as Goliath. The lesson went well and the kids enjoyed it.

The sign to the school

This afternoon we had a splendid storm for about an hour which has cooled everything down a bit which is pleasant.

Simon has been working at the hospital and talking to some nurses who have come out from UK for a few months. One of the problems here is that new things such as oil for generators and anaesthetic agents are not re-ordered until they have run out. It is a cultural issue. However running out of coffee for a week would not matter but a generator which supplies oxygen for intensive care and lack of anaesthetics can be life threatening.

The walls of Jericho

Wednesday 2^nd March

The walls of Jericho came down today! Also Ann was looking for a volunteer to act as Gideon and didn’t have a “fleece" to use for the story. The children were very insistent that a sleepy looking child should act the part. Not only was his real name Gideon but he was wearing a pink anorak (in the current heat!) which when turned inside out had a fleece lining! God provides things in mysterious ways!

The Ark of the Covenant going round the walls or Jericho

The main event at the hospital was a doctors meeting this afternoon. This was dominated by so many of the issues that dominate meetings at home and in some ways felt equally inconclusive!!

Three Xrays for the medical people out there! Any answers post in the comments section!!

70 year old woman with persistent cough It took a week to persuade her to have a chest Xray done!

13 year old girl with past history rheumatic fever

70 year old woman with a stroke and ESR of 106

New cookers

Tuesday March 1^st

Today Ann has been busy teaching about the Israelites leaving Egypt and spying out the Promised Land. I think the children are really getting into the drama as so much of what they have to do is wrote learning at their desks. One of the questions in today’s work book was which the hardest commandment to keep is. One pupil answered Trust God only because some people go to the which doctor!

The spies!

There are a group of 5 people here this week that are based in Lira who are promoting the use of fuel efficient stoves. They bought 50 fuel efficient stoves which use half as much charcoal and these sold out to the staff in only a few minutes with a waiting list of those who didn’t manage to secure them They cost 17000 UgSh and with charcoal at around 22,000 UgSh for a bag which is a month’s supply you can see that the stoves could very easily pay for themselves in around 6 weeks. They are also refurbishing the hospital kitchen stoves with more efficient stoves which are constructed around a special brick core which is very efficient at retaining the heat. This is a major exercise which many people were enthusiastically joining in with!

The brick centres to the ovens are then covered in mud which all helps toretain the heat

The food cooked on these stoves is a little varied. Matoke (cooked green bananas) Posho (solid maize porridge), Sweet Potatoes, Irish Potatoes (normal potatoes!), Cabbage, Ground nut sauce, Beans, rice and occasional meat (usually grisly and fatty!). But it is generally very good and a very low fat diet.

Matoke, beans and rice!