Off to School

Monday 28^th February

Ann started teaching today which seemed to be appreciated She spent some time marking this afternoon One of the questions the children had to answer in their booklets was to list animals beginning with each letter of the alphabet. There were some superb answers including Beer, Canal, Forks, Hair, Junior Pig(!), White Aunts, Xylophone!! I’ll leave you to work out what they all were!

Ann marking lesson 1

There has been some encouragement from the hospital today. The baby resuscitated yesterday was crying today and looked much better. The child with pneumococcal meningitis from last week is just about to be discharged. Even so there was a boy of 13 brought in unconscious today who also has pneumococcal meningitis. There does seem to be alot of meningitis here so encouraging the doctors here to be more suspicious and do lumbar puncutres more often is very much on the agenda.

The baby resuscitated yesterday afternoon

The child who had pneumococcal meningitis about to go home

Sabbath rest?

Sunday 27^th February

Awake early for chapel at 8am. The message was “Don’t be afraid Just believe” using the passage in Mark chapter 5 about the raising of Jairus’s daughter. This seemed very appropriate when Rachel who is the Doctor working in paediatrics called for some help a couple of hours later with a 1 month old twin who was brought in nearly dead from malnutrition. Rachel had already done a lot to start resuscitating the child but it still had a very low heart rate of 60 and breathing very erratically when I arrived. Between the 2 of us we performed bag ventilation and cardiac massage for half an hour finally helped further by Catriona a specialist anaesthetic registrar who happens to be here for 2 weeks. I did pray for this child while we were working on him and it was wonderful to slowly feel his hand grip you finger then start to move both arms before he started to breath more spontaneously and the heart rate increased to 90. He has a long way to go but there is at least hope. It seemed to echo very strongly what the sermon had been about earlier.

We needed a walk this afternoon to unwind which was very pleasant as we tried to retrace the route of a walk I had been on when I was here in October. There are some beautiful views taking a circuit around the hill behind the hospital

With Catriona on our walk this afternoon

A couple of photos to show you where home is for us currently! It is somewhat dark but thankfully bug free unlike the room I was using for the 2 weeks before Ann arrived.

Note much needed fan and mosquito net!

A trip to the waterfall-nearly!

Saturday 26^th February

Saturday is the day for a lie in as there isn’t chapel at 8. However this morning we were awoken at 5 (ugh!) buy some people staying who wanted to get to Queen Elizabeth National Park early so no late start for us today!!

Ann spent a considerable time this morning cleaning our room which it was much in need of while I spent a couple of hours at the hospital. After a lunch of chapattis and mandazis we set off with Viv Henderson (a Canadian nurse who we knew 25 years ago at Kapsowar) in search of the waterfall which supplies the hospital with power and electricity. After walking for an hour we arrived at a small unfinished refreshment area without refreshments!! We were able to dangle our feet in the refreshing water but we in fact didn’t venture quite far enough to reach the waterfall itself so that remains an expedition for another time. Fortunately the water was working in our room (which it wasn’t earlier in the day) so we were able to have a very welcome shower and cup of tea in front of a fan! Temperatures are at present are unusually high in the low 30s.

Viv and I dangling our toes in the water!

Some boys nearby using the stem of a banana plant to slide on into the water

Friday 25^th February

Ann went off to the nearby orphanage today with Carlie who is one of the people from the UK who has been instrumental in it being set up. They spent a long time holding babies and while Carlie was in a meeting Ann spent a long time on the floor playing with 5 toddlers with at least one of them on her lap at any one time! She also had an opportunity to look at their sand based water filters which we think may be very useful at Ekimumolu. In the afternoon Ann went to the local market and has smuggled in 8 mangoes into the room despite knowing that I’m “lergic” to mangoes!!

Some of Ann's small friends

At the hospital the wards remain busy including a newly diagnosed AIDS patient with definite cryptococcal meningitis. Unfortunately we do not have the necessary drug, amphotericin, to treat her so we are having to make do with a second best treatment. However it is amazing how well people do respond though given the limited range of medications and diagnostic facilities that there are here

One of the sand water filters

Back at Kagando

Thursday 24^th February

Ann’s day started by visiting the primary School here at Kagando and it seems they are very happy for her to teach Bible Explorer all next week and also other things! He has also ventured to the local market and visited the local disabled peoples cooperative so she has been finding her way around

For me it’s been a day back on the wards seeing a number of patients who haven’t been reviewed by a doctor since being admitted at the weekend! Today’s little gem was 2 patients who had taken rat poison (one deliberately after a row with his mother and the other accidentally) which here isn’t warfarin based but is an organophosphate preparation which has the potential for all sorts of nasty consequences but fortunately neither of them suffered any ill effects.

This afternoon Dr Bernard (the Physician from the University) and I spent some time with Benson the Scheme director discussing various equipment and drug needs so hopefully that will yield some helpful results

On the move

Wednesday 23^rd February

We travelled back to Kagando today. The vehicle taking us from Mityana to Fort Portal turned up about a half an hour late loaded with wood because the builder’s vehicle had broken down. Consequently we had to wait until the wood had been delivered to Ekiwolumu which meant a 2 hour delay before setting off but we arrived here before nightfall. These sorts of things happen here however and you just have to accept them!

We have a larger room than at Kolping which is good. We had a small visitor in the shower who at first we thought had died but we were able to liberate him safely to the outside world Also needed to clear out a few mouse droppings but starting to feel like home!

Lionel Lizzard who had taken up residence in our shower tray!

Ebenezer's Success Story

Tuesday 22^nd February

Today has been a day of contrasts. This morning involved some further difficult meetings which we were nevertheless pleased to complete.

This afternoon we visited Ebenezer Secondary School were many of the Namacosi Orphanage children go for secondary school. Academically the Headmaster Richard has achieved some great results with 2 first grades in S4 (equivalent to GCSE level) out of a total of 14 students. The largest secondary school in Mityana only achieved 3 first grades out of several hundred students which gives some measure of the success that the children at Ebenezer have achieved. Almost more importantly the levels of discipline are very high which has been a great help to a number of the children who have come from the very unstructured care they have received at Namacosi .

The children from Namacosi now at Ebenezer School.A great bunch of young people!

While we enjoying tea at Kolping House after the school visit the newly elected MP turned up and we were given a 5 minute resume of his policies to help local farmers rather than further build the paperwork bureaucracy that exists! He is obviously very popular with the local electorate and is not an NRM party member so hopefully will help to bring balance in the new Parliament.

Fun and games

Monday February 21^st

Unfortunately the meeting scheduled to take place this morning didnt take place as the Orphanage committee members didn’t attend.

After that rather frustrating start to the day, we had an expedition to Ekiwolumu. The children were very welcoming to “Dare visitoors” There was much singing, dancing and drumming followed by a distribution of clothes and sweets together with Ann leading some parachute games. All great fun. The goat on Sunday actually produced twins who are very cute.

Sweets being distributed

On the way back the pickup had to be used to transport some of the children back to Mityana as the minibus that is usualy used had a flat tyre. We were stopped by the police but fortunately no arrests were made!! We were just admonished that this wasn’t the right vehicle to be transporting the children in!!

Parachute games

Ugandan electrical repairs!

Sunday February 20^th

I was so pleased to see Ann and Kate safely arrive here in Mityana They had a good trip out but both a little weary

We had a meeting this afternoon with the Uganda Esuubi Committee with some difficult decisions to be made. There was complete unanimity between all the members of the group and ourselves which was great.

During the meeting I became a little distracted by some electrical repairs being carried out. They don’t turn the power off just do the repairs with insulated gloves on. All a little hair-raising!!

Ugandan wiring!!

Progress at Ekiwolumu

Saturday 19^th February

Large crowds on their way through Mityana going to the MP's home to celebrate his re-election

The journey from Kagando to Mityana was uneventful There were few people around with many listening out for the election results. After meeting up with Pastor Kisake we started out for Echiwolumu but the road was blocked by huge rejoicing crowds because their local MP was re-elected.  He is not from the ruling NRM party who look certain to win the presidential race for another term in office for President Museveni so I just hope their jubilation won’t turn nasty when the presidential result is announced. The army are  very much in evidence with 2 armoured personnel carriers parked just down the road from where I am staying.

Buiding work has recommenced on the vocational training block in the last 2 weeks

Developments on the Ekiwolumu site have been limited since October as much of the builders attention has been at Namacosi. However the Cows and Goats are doing very well! Water is now being pumped via the borehole  in a temporary fashion into large drums until the proper water take is put in place but it does mean the children aren’t having to cart water backwards and forwards so that is definitely progress.

One of the 2 cows at Ekiwolumu. This one had a calf 2 weeks ago and the other 4 weeks ago

This baby goat was born 2 mintues before this picture was taken



It will be very good to see Ann and Kate tomorrow. They arrive in Entebbe tonight at 10pm local time and are being picked up tomorrow morning so should be here by lunchtime



Election Day

Friday 18^th February

I’m struggling in a major war with mosquitos at present! After 2 very disturbed nights because of mosquitos inside the net I decided last night to try chemical warfare and use the electric device which gives of a toxin to mosquitos. Result absolute failure!! 3 inside the net last night and only managed to get one of them although that was very satisfying!

Election Day is here with something of a carnival atmosphere locally Turnout will be high in what is said to be a tight fight between the NRM (National Resistance Movement) and the PPP which the peoples progressive democratic party (I think!) Everyone is keen and proud to vote some even dressing up for the occasion to receive the mark on their left thumb nail to indicate they have voted.

On the wards its quiet which is just as well as there is only Rachel and I covering medicine and paediatrics and Job and Edward covering maternity and surgery. One boy of 14 turned up with Nephrotic Syndrome which he has had for 4-5 years. This causes swelling of the face and abdomen due the kidneys leaking large quantities of protein into the urine. The underlying cause can’t usually be determined and no one seems to have been able to discover a reason in his case May be tricky to treat with no steroids available.

The shopping list

Thursday 17^th February

Everything seems to be cut off at times at present Yesterday much of the time the water was off The power was off intermittently as well as some repairs were being done The MTN phone and internet was also down much of yesterday but life continues Its surprising how one adjusts to coping without things we regard as basic necessities at home.

Dr Bernard and I have been trying to draw up a shopping list of items we need to provide a better service. Simple bits of equipment like a peak flow meter would be so helpful and so often what we can offer is very much limited for want of a few small items Also we are trying to draw up a list of drugs we need to always keep in stock particularly suitable antimalarial medication. Let’s hope we can have some success in tackling what is largely an organisational problem

I’ve rather poured scorn on the idea of an ECG machine being of value here but today it’s proved helpful in confirming an elderly lady’s diagnosis of angina and also in picking up a 35 year old man with a pulse rate of 38 in complete heart block. Any ideas gratefully received!!

Tomorrow is election day and Saturday I travel to Mityana and  have a lift this time rather than having to use the bus so hopefully there wont be any problems

What, no steroids?.

Wednesday 16^Th February

Each day can bring its complications and frustrations. Today its been that there are no steroids that can be taken by mouth in the hospital which complicates managing a number of conditions. This has apparently been the case for the last 3 weeks.  However the hospital here is in a much better state than so many of the smaller surrounding government hospitals who lack a much wider range of basic necessities.

Ronald will be going off to Mulago Hopsital in Kampala. The very enlarged glands he has have been biopsied and it seems most probable that he has a lymphoma, a tumour of the lymph gland system but hopefully this should be responsive to chemotherapy treatment.  The young man with HIV is improving a little. His spinal fluid test was normal which is good but he has a long way to go.

New patients appear daily with HIV. There are currently 7 or 8 in patients with HIV that I am caring for. Yet this is an area with a lower incidence of HIV than many in Uganda and of all the sub-Saharan countries it is only Uganda whose HIV rates are dropping so you can see what a huge problem it is. Each patient is individually both a very complex medical problem but also a very real personal tragedy.

Fly the flag

Tuesday 15^th February

The educational meeting last night was just 5 of us but I think it was a useful start. Next week the paediatric department will be doing the session so hopefully it will be on-going. A group of 5 or 6 Doctors are coming from the UK in March to run some educational sessions so we are trying to gather information on suitable topics for them to teach on.

Today has been dominated by neurological complications in AIDS patients. One had developed a paralysis of her left leg probably due to a spinal cord problem while another young man in his 20s presented very drowsy and may have cryptococcal meningitis. With only limited diagnostic facilities these sorts of patients are a very real diagnostic challenge. Treating them is even more fraught with difficulty.

We were given a reprimand in chapel this morning. The national flag is raised outside the nurses school each morning and a whistle is sounded when the flag starts to go up and a further whistle sounds when the flag is fully raised. Everyone was urged to be truly patriotic and stand still between the 2 whistles! Failure to do so may result in being reported to the police!! I think it was just a timely reminder ahead of Election Day. It will be interesting to see how carefully people heed the warning!

The calm before the storm?

Monday 14^th February

Its been quieter today but from tomorrow I think a number of the doctors are going so they can be at home to vote on polling day on Friday. We may ends up being rather thin on the ground by the end of the week.

There seems to be a fair amount of electioneering going on with some NRM (National Resistance Movement) veterans out yesterday outside the hospital. They are veterans of the war which brought Museveni to power in the 1986. Thankfully everything seems to be going relatively peacefully at present.

I spent the afternoon in Outpatients I think just being available for people to ask questions and seek help is proving to be useful. This evening we are having the first Educational evening meeting since before Christmas so hopefully that will be an encouragement to start having these sort of meetings more regularly

Up to the radio masts

Sunday 13^th February

Definitely in need of a day off today. I came back to my room just before lunch to a flood in my bathroom!! Schoolboy error! I had forgotten to turn the tap off when I tried to use it earlier when the water was off. Fortunately the floor slopes towards the door of my room which meant the water flowed out to flood the room opposite rather than my room! This was the room which I used last October but fortunately isn’t occupied at the moment.

Rachel a GP trainee has come back after a week off together with her friends Ruth and Andrew. Rachel is here for 6 months and has been covering paediatrics. Amazingly discovered she and Ruth trained in Bristol in the year above Toby and know him. It is a very small world. She has let me download the lectures from the Diploma Tropical Medicine which she has just taken in Liverpool so plenty of homework for me to get teeth into!

The view over the local countryside from the radio mast hill

Exercise this afternoon took me on a circuit to the nearby village of Kasinga and then up the hill behind the hospital where the telephone masts are situated. Its 2 years since God gave me a very definite word that I would go to a place dominated by radio masts… I guess this is where He wants me to be just now. Thank you to all of you for your interest and prayers. Looking forward so much to Ann coming out next week They will arrive the day after the National Elections More of that later in the week.

The Radio Masts-MTN's on the left keeps me in touch with the world!

Introducing Ronald

Saturday 12^th February

Working again today as not too many people around. One of the things that struck me was how much of a bill some people accumulate One young man had only been in around 2 days but because of scans and intravenous treatments he has 130,000 UgSh which is around £35 which is a great deal for these people. The other catch phrase seems to be “Out of stock” with many commonly needed items not available. At present the only treatment we have for malaria is Quinine. It really is down to organisation as other malaria treatments are readily available in Uganda

Over the last 3-4 days a quiet revolution has been taking place as many of the staff have been taught how to perform a rapid diagnostic test (RDT) for malaria This is a very sensitive test and could revolutionise the way people are treated with far fewer being blindly treated using quinine as happens at the moment as much more accurate diagnosis would be possible

The new RDT malaria Kits

One 2 year old I have already taken to heart is Ronald. He really looked pitiful when I first saw him yesterday. Unfortunately he is very ill with widespread enlarged glands in his neck and groins and severe pneumonia He almost certainly has TB He did seem a little more cheerful so Ill let you know how he gets on.

Ronald's nasty looking Chest Xray for those who are medically inclined! And Ronald himself!

The childrens ward

Friday 11^th February

It was a very hectic day today. The medical director disappeared for the day at short notice so I spent the afternoon going round the very many paediatric in patients for 4 hours covering his absence. It was my first time doing a ward round on the childrens ward and it was the first time many of them had been reviewed by a doctor for 2-3 days. It is amazing just how tiny some of the babies are around 700grams yet doing OK.

Last night a doctor who is the medical director at Nyankunde Hospital in Congo stayed at the guest house. Dr Philip Wood was a very modest man of around 65 very active and very fulfilled in what he was doing. He was evacuated from Nyankunde in 2002 when it was overrun by rebels and several hundred people killed but he seemed very philosophical about the security situation in that area of the Congo at present. It was very humbling to meet someone so dedicated to what he was doing. I have certainly met an amazing range of people through my weeks here.

A new beginning?

Thursday 10^th February

Dr Bernard the lecturer from the university turned up and it has proved a very useful and fulfilling day. The morning was spent on the wards seeing and discussing the patients in detail which I think we both found mutually beneficial I certainly learnt a lot particularly about AIDS management. We had a number of the clinical officers in training with us so it turned into quite a long teaching opportunity.

Anaemia is very prevalent and often the cause isn’t easily elucidated Hook worm is a particularly common problem which contributes to this. This lady had a haemoglobin of 3.3 which is about a quarter of what it should be and hook worm seems a likely culprit. Note the smooth pale tongue for those in the know!

The afternoon was spent in out patients which actually feels very much like a GP surgery at home with patients with osteoarthritis, diabetes (which I actually think is more common here than at home!) and hypertension

I hope this may prove to be the start of the working relationship with the University that Kagando is seeking.

The patient ran away

Wednesday 9^th February

Its very hot at present with daytime temperatures around 30+ and overnight around 20. Even a number of the local staff are finding it too hot. For me its pleasantly warm during the day but a cold shower right now would be a treat but the water is off!

The excitement of today was a diabetic patient who became very agitated and aggressive and who after having 100mg of chlorpromazine to settle him decided to jump over the hospital perimeter fence and abscond so I just hope he will be OK. Otherwise it remains surprisingly quiet. I did have a long discussion with the overall director of the hospital to try to sort out how best to use my time here. I am hoping to discuss with the Medical director about getting some case based and regular topic education sessions going as there haven’t been any educational meetings for the doctors in the last 2 months. Tomorrow also the physician from the university is coming so hopefully I can discuss with him how the educational side of things could be built up. It is a process one has to be very patient with building relationships and trust being paramount.

I did discuss with one of the junior doctors about my plans to pay a visit to Mityana government hospital while I’m in Mityana. He informed me that it had featured on the Ugandan news a while back as the local residents were protesting outside the hospital because the doctors were never there! Also it seems there have been allegations made that one of the reasons drugs are in short supply is that they are being stolen by doctors! Its unclear if there is any truth in that!

A quick dash to Kasese

Tuesday 8^th February

Internet is sorted! It involved a rapid return trip to Kasese around 45km away. As always the car was a little cramped with up to 10 people. It needed some cooperative driving with me releasing the handbrake at one point. But mission accomplished and also the opportunity to do a little shopping. When I returned from Kasese I spent a couple of hours helping in the operating theatre but to be honest I’m still pretty weary after all the travelling. The joint ward round earlier this morning was encouraging with Marvin one of the Ugandan junior doctors which genuinely felt like a joint learning experience. There seemed to be several young women all with symptoms suggestive of first presentation of Schizophrenia which was both unusual and challenging! Even Marvin who isn’t from this area was struggling to understand their stories. With so many different tribal languages and only really English as a universally used but not widely spoken language even the Ugandan Doctors need quite a bit of translation help which isn’t something Id anticipated.

First day back

Monday 7^th February

Several of the local staff seemed very pleased to see me back which was encouraging. I am the only mzungu Doctor at present and the medical director seemed happy enough for me to be involved on the medical wards again. A new development is that there is now a visiting Doctor from the University of Kampala Medical Department nearby at Ishaka who is coming next at the end of this week so that is progress I hope. The wards are not so busy at present. I think a number of factors are contributing Costs are rising for patients as there is some inflation here in Uganda In October a pound was 3500 UgSh whereas now it is nearer 3700 UgSh. Also it’s hotter and drier so there isn’t so much malaria. The elections are also coming up in just over one weeks time.  I’ve spent a little time taking some short film clips around the hospital so hopefully we can put something together to go on the practice website. I was quite pleased to have a quiet day after the last 2 days travelling.

On the buses!

Sunday 6^th February

The flight out was a very smooth one and the overnight accommodation very comfortable apart from the creaking security gate being opened every 1-2 hours overnight. Ask for a rear facing room when you stay Ann and Kate! But at least I didn’t have to contend with any exploding taps this time!

Travelling by bus has to be one of the best ways to get in touch with the local culture but 9 hours was a little long!! I didn’t see a single Mzungu (white person) the whole day until I arrived here at Kagando. Various culinary delights are on offer en route; roast meat, roast liver, roast maize or cassava none of which really appealed. The chap sitting next to me seemed quite an expert and rejected several offerings as they were undercooked “They can induce vomiting” he confidently told me! However I was brave enough to try the roast bananas which I have to say were delicious. I was very relieved to arrive before dark somewhat exhausted! I was greeted by a very friendly couple who made me a very welcome cup of tea. They are leaving tomorrow. The wife is a retired GP who set up the palliative care provision a few years ago which seems to offer a very effective service. I also met a Canadian nurse, Viv Henderson, who amazingly was one of the nurses at Kapsowar when we were there. I don’t think she recognised me after 26 years!