Wednesday 7^th December

This will be the last blog entry for this trip. It has been an amazing 12 weeks. I have spent much of today saying goodbyes as well as showing a nurse from New Zealand around She arrived last night to stay for 3 months and will be living in the house we have been using once I leave.

I particularly wanted to say goodbye to Julius who is in charge at the farm. He had been very kind to us with our milk supplies and had been particularly grateful when I went for milk 2 days after the shootings when few people had wanted milk. I had looked after his sister on our Intensive Care Unit about 10 days ago but she had died very swiftly from cancer at the early age of 29.

They had just killed a pig and there was along queue to buy pork which is a local favourite!

I am returning back to Kampala tomorrow and hopefully will have an opportunity to stop at the café and also a craft shop in Fort Portal on the way back.

My grateful thanks to all of you who have been reading this over the weeks, for your support love and prayers for us both.

Sunday 4^th December

A week has now passed since the events of last weekend. The story of what happened is well documented on the Africa page of the BBC although there was little mention of the events here at Kagando which left 10 people dead. All now seems peaceful and people seem much more relaxed again. The evidence of what happened is fast disappearing as bullet holes are filled in and repairs undertaken.

Bullet damage to the gates of the compound

A window in the chapel damaged by a stray bullet

The honey store peppered with small bullet marks

A larger clibre shell penetrated the guards hut

The last few days has definitely seen an increase in activity in the hospital with all the wards seeing activity at a level comparable to 2 weeks ago. One lady was admitted vomiting blood with a haemaglobin of only 2.9. Shen needed blood but was group O rhesus negative but no compatible blood was available. The decision had to be made to give her O Rhesus positive blood as a life saving measure and worry about the consequences for any future pregnancies she may have for the time when she has recovered. A man was admitted on Friday who had not been able to walk for 2 months because of weakness in the legs. It strongly looks as if he has syphilis affecting his nervous system so hopefully some prolonged treatment with penicillin may restore his ability to walk. The medical work here is full of challenges, not least making the best of the limited resources available.

This afternoon a number of us had a trip out to somewhere about 30kms away for lunch. It was a very relaxing time and a great antidote to everything that we have experienced in the last 8 days.

The current expatriate staff together with Gloria (physiotherapist) and Mary (Paediatrician and Medical Director)

The obligatory stop at the Equator

I am due to leave Kagando on Thursday morning and I am getting a lift from Jonny Rowland who is running the local coffee project. This is a day earlier than I had planned but the opportunity to travel down with Jonny was too good to miss. It is hard to believe that the 12 weeks in Uganda are drawing to a close. So much has happened during the time and I am so grateful to have had the opportunity to be here to share in all the experiences both good and difficult and to have remained well and safe throughout. Coming home again to all the pre-Christmas build up may be rather hard not to mention the freezing temperatures after getting used to an ambient temperature of 25 to 30 degrees and night time temperatures always over 20.

Thursday 1^st December

After the events of the weekend a slightly uneasy peace has again descended onto Kagando with the shops all now open again and people going about their daily lives with a semblance of normality. The events made it to the Africa page of the BBC website but were eclipsed by the death of Castro and an article about Donald Trump!

On Sunday and Monday many patients wanted understandably to be discharged and particularly the medical and surgical wards were quiet for a couple of days. However admissions seem to be picking up again. But throughout the paediatric ward has remained busy with some quite complex situations to be dealing with. A ward round yesterday included a 10 year old with HIV and an extremely low white cell count (CD4 level was only 3), a girl with sickle cell disease with an apparently very high white cell count (which on review of a blood film proved to be a false count contributed too by many red cells emerging from the bone marrow rapidly in response to her sickle cell crisis) and a 4 month old baby with severe fluid accumulation in the abdomen the cause of which we have yet to establish. Today in outpatients I admitted a very ill woman who has HIV and malnourished twins aged 8 months. So there is much to do in the midst of an uncertain situation for many.

It is hard to believe in a week I will be leaving here for the relative security of the UK. To be honest it will be hard leaving behind many to whom I have become close in the last few weeks.

I am so grateful to the many people who have been praying for Kagando and for me in particular over the last few days.

Sunday 27^th November

It has been a dramatic 24 hours. Yesterday there was a serious outbreak of fighting between supporters of the local king and government forces. It started with the Royal Guard as they are called attacking a number of police posts initially in Kasese 40 Kms away. It was clearly a coordinated exercise with several centres being targeted.

There was soon trouble here at Kagando mid-afternoon after the police post was attacked and a police vehicle burnt out with 3 police officers being killed. The army were here in force quite swiftly coming from their base at Bwera and a fierce fire fight broke out for a couple of hours along the road which divides the compound where the staff stay and the hospital. By about 7pm things had settled down.  Only one casualty was admitted, a 12 year old with  a gunshot wound to the abdomen. He was stable overnight and transferred to Mbarara this morning transported by an American couple who happened to end up stranded here overnight because of the fighting.

This morning at 8am it was safe to go down to the hospital where Rob Morris was already sorting out the transfer of the 12 year old. Police reinforcements arrived about an hour later and the streets were cleared of civilians to allow them to clear the burnt out vehicle and remove the casualties. The day has remained peaceful for which everyone is very grateful.

At times like this I just thank God for His love whatever may happen and the ability to keep calm and know his peace within.

Saturday 26^th November

The blog has been idle over the last week as we have been away ahead of Ann’s return to the UK with rather poor internet access for much of the time.

We were able to spend a very pleasant couple of nights away at Lake Mburo National Park. 

Sunset at Rwakobo Rock Lake Mburo

It is one of the few areas where you can walk safely as there are no Lions in the park (although there are supposed to be seventy Leopards!!) When you are able to walk like that you can get quite close to the animals especially the many Zebra and Impala and can much more easily see some of the amazing birds in the area. Even with the 6.30 am start it all adds up to a very memorable experience.

Zebra on our early morning walk

Red faced Barbet. A Lake Mburo special

Crowned Hornbill keeping his eye on us

Diederick Cuckoo. I had heard this in the past but never seen one

A Lizard Buzzard Another first

Black-Headed Weaver by Lake Mburo

One of the numerous Hippos at Lake Mburo

Ann left on Wednesday afternoon and arrived safely home the following morning after a fairly long Emirates flight. I finally made it back to Kagando on Thursday evening. We are both very grateful for safe travel over last couple of days or Journeying Mercies as they like to term it here!

Yesterday morning was spent on the wards catching up with what had been happening while we had been away.

A local prison inmate who successfully recovered from Cerebral Malaria with Samuel one of the most experienced nurses

In the afternoon I was able to number crunch some of the antibiotic resistance data from the lab at Bwera which I had been able to obtain a couple of weeks ago. It certainly confirms the data I collated a year ago but with over 480 specimen results now available, more than twice  the number I had last year, it helps to make the data rather more reliable. There does seem a gradual creep of increasing resistance to a number of the most commonly used antibiotics here which is somewhat worrying. The data also included some fresh information which will help guide the treatment of Typhoid, Dysentery and Cholera in the days ahead.

Thursday 17^th November

We have tried to break up the week by doing something out of Kagando on Wednesdays. Yesterday was no exception. We went to Bwera again to a school for a repeat performance of Daniel and the Lions. The children at the school we went to (a different one to the ne we have previously visited) thoroughly enjoyed the story with again some very enthusiastic lions! 

The school at Bwera

Enthusiastically doing action songs!

King Darius, Daniel and some Askaris (soldiers)

Practicing our roaring to embarrass our children and amuse our grandchildren!

Make a circle to pray for the school

On the way back we picked up a girl aged nearly 3 years who was unwell and had been having convulsions. She was being treated in one of the many unlicensed drug shops which are prepared to provide treatments for people with even quite serious conditions. We took her to Kagando and hopefully she should do well.

I’m not sure if you believe in miracles but my belief in these has taken a step forward in the last few days. A 12 year old girl was admitted on Wednesday 9^th November with Sickle Cell Disease and remained unconscious for 5 days. Her lumbar puncture was normal ruling out meningitis and her tests for Malaria were negative and it seems most likely that she has had a vaso occlusive episode-a type of stroke occurring in sickle cell sufferers. Ann and I prayed for her on Monday which left us both in tears and seeing little hope of her pulling through.  Many other people were praying for her as well. Yesterday afternoon to my amazement she was awake and looking around although still unable to speak. It was a truly miraculous recovery and although she still has a long way to go, the unshakable faith of her parents that she would recover seems to have been well founded.

Our puppet shows on children’s ward still seem to be going down well. Either side of the shows there is much singing and toys are available for the children. Included is a very realistic baby which had three of the mothers looking carefully and poking it to see if it was real!

The children with the real baby!

We have some occasional visitors who come to pinch the berries from a mulberry bush which is growing behind the house. We managed to get the smallest one to say “I am a parrot”!

Our small visitors

Sunday November 13^th

The last 3 days have been busy. On Friday Ann spent the morning standing in for a sick teacher while I was busy in the hospital. The ward round on proved particularly poignant as I went round with Neil, a newly arrived Doctor from Scotland and Vera, one of the German medical students and we reflected on the fact it was Armistice Day It seemed a fitting way to mark the occasion.

In the afternoon we went back to the village where we had been to on Thursday evening. The event ended with an amazing time of singing and dancing. The Ugandans certainly know how to celebrate and blow away our English Reserve.

On Saturday after a walk in the morning we set of for a village called Kitabu to another “Crusade”. This involved a journey along the worst road we have ever experienced in all our years of travelling in East Africa. We arrived safely and remarkably the saloon car we were travelling inn survived the journey relatively intact! 

The road to Kitabu

On arrival we were given a second lunch at 4.30pm. Ann then taught the children using the story of Daniel and the lions which they acted out. The main problem seemed to be the enthusiasm of the lions to eat Daniel! I spoke on John 15 where Jesus describes himself as the true vine and us as the branches. 10 to 15 years ago speaking to a group of 200 people would have caused huge anxiety but I have to say I was just able to enjoy the huge privilege of sharing the passage with the people who were there. I am pleased to say we arrived home safely after coming back by a different rather smoother route.

Waiting for second lunch with John Murabyo A chicken was sitting on her eggs in the corner

Chapel this morning featured “O Come all Ye Faithful” and “Joy to the World” so they are really warming up for Christmas already. One important notice was about security. We were advised not to be going out to clubs to dance until 1am. Why not enjoy dancing instead in your living room listening to the radio! Also we were warned not to catch and eat our neighbour’s grasshoppers!

After chapel at Jonny's choosing a new coffee for the Esuubi Cafe

We went to the prison again this afternoon. We have slightly modified the way the medical outreach is being done no longer measuring blood pressures and checking blood sugar levels but trying to concentrate on identifying those with skin problems including a number with scabies, and checking for any sexual health problems. It seemed to go relatively well although many of the prisoners wanted to use the opportunity to discuss their multiple medical problems!

The medical outreach at the prison

One of a number of prisoners with infected scabies

We invited many of the younger doctors here to a cream tea this afternoon as a prelude to a game of Settlers of Catan this evening. It has definitely been a busy few days.

Cream tea with Neil, Neil, Jenni,Vera and Andrew

Thursday 10^th November

The last couple of days we have spent much of the time out with John Murabyo who is one of the diocesan evangelists

Yesterday we visited the school at Bwera where we have been before and the children acted out Daniel in the Lion’s den. We were certainly made very welcome. 

Eagerly awaiting Daniel in the lions den!

One of the schools makeshift classrooms

We also visited a woman whose husband had died just a month ago He was a Muslim but his wife had become a Christian just over a year ago when she was an inpatient at the hospital after delivery of her youngest child. It could have proved a very sombre occasion but together with Jane and Richard Gill who knew her well we were able to have a good time sharing together.

On the way there were many grasshopper traps in place. These are a local delicacy!

On the way from there we were able to call in at Bwera Hospital.

Outside Bwera hopspital with the "canteen" in the background!

I had visited the Microbiology lab there a year ago to collect their data on antibiotic resistance. On the previous occasion it had been a rather laborious job photographing their work books and later manually entering everything on an excel spreadsheet but this time I was able to download their database onto a memory stick. With nearly 450 specimen results this would have been an enormous task to do manually so I was enormously grateful to be able to down load the information in a matter of seconds! The data will prove extremely useful if guiding antibiotic prescribing at Kagando in the years ahead. Bwera Hospital is built on a hill with the most amazing views of Lake Edward and also into the Congo.

On the last 2 evenings we have found ourselves roped into a local Crusade organised by one of the churches in a nearby village. Ann has done an excellent job teaching the children while I have rather unexpectedly found myself as a visiting speaker on the makeshift podium. It certainly moves a great deal when the choir is performing so I’m grateful it hasn’t collapsed during proceedings.

Waiting for the Crusade to start

The choir warming up

The rather unstable looking podium with John speaking

Ann doing the story of Jesus calming the storm

The children thoroughly enjoying themselves

Sunday November 6^th

There have overall been more doctors here during the weeks I have been here than on previous occasions although a mass exodus meant I was first on call for the first time in many years on Friday night! With more staff the opportunity to audit some of the hospitals activities has been possible and I have been spending some time looking at how effectively the patients on the wards are being screened for HIV. Inevitably there is always room for improvement but it was encouraging to find that overall HIV rates on the Medical wards is only 5.8% which I’m sure is considerably lower than it was 5-6 years ago. I have also spent some time looking at Serum Sodium levels which overall are very low in the hospital population. This may be due in part to low salt intake but also due to the severity of the conditions leading to people being admitted. It almost certainly increases mortality for the patients having a low sodium so is an issue we need to try to address.

As we are living in our own small house we have the opportunity to invite people to supper.  Last week we had 3 lots of people round and played the inevitable Settlers of Catan board game afterwards which everyone seemed to enjoy. No television here!!

This weekend has again allowed us some time to wander on our favourite walk behind the hospital Everything is very green at present as the rain intensifies. The rain also has led to some relatively low overnight temperatures and I woke feeling cold last night for the first time!

Setting off on our circular walk. It takes around 2 hours.

A local brick Kiln we passed on the way.

The goats are happily eating the elephant grass which is sprouting with all the recent rain

Thursday 3^rd November

On Monday Ann visited the coffee storage facility which is proving so successful in providing the local coffee growers with a good price for their coffee. Last month over 200 tons of coffee was sent to Kampala and the process seems to be growing daily. Unfortunately one of the unforeseen consequences of schemes like this is that the additional income to the family isn’t necessarily channeled into essential items such as food or school fees but ends up being spent on alcohol.

Coffe drying outside on tarpaulins and racks

Inside packing the coffee.

Some avocados purchased on the way back from the coffee store. The avocados cost 3p each.

Electricity supplies are a constant source of problems here at Kagando. Often the local main electricity supplier shuts off power for several hours and then the hospital is dependent on a generator to maintain supplies. On Tuesday unfortunately the generator failed when it was needed causing everything to shut down in the hospital. This included vital equipment such as the incubators for premature babies and oxygen concentrators. This could have been fairly catastrophic but with much boiling of water on gas rings and using the hot water in water bottles the incubator problem was overcome but it took well over an hour before a solar electricity source could be tapped into to get the oxygen concentrators going. All potentially very stressful but is amazing how everyone pulls together in circumstances like that. Hopefully the generator is now fixed but it an ageing piece of kit and probably events like those of Tuesday are more likely to occur in the months and years ahead.

Having a cup of tea on the veranda at the end of a busy day with the rain pouring down.

The rain is getting pretty heavy these days!

Ann went to see a local nursery school on Tuesday. There are around 100 children who attend each morning in 3 tiny rooms in a single building which is rented. The premises are very cramped and Robert who runs the school is seeking finance to build premises and expand the very limited facilities there are. He provides the education for very low fees but the school relies on external funding to survive.

Robert's School.

The single building currently housing the school.

Some of the nursery school children.

This afternoon Ann and I spent an hour and a half in the stores looking through want remained of the contents of a container which had been sent from Australia. Unfortunately some of the items are out of date and also not necessarily appropriate for use here and in many ways if the money spent sending a container and clearing its contents through customs were directly donated instead probably better use could be made of the money.

Grovelling in the stores!

Sunday 31^st October

On Friday while I was tied up in the hospital,  Ann spent the afternoon at the local market with Yana. Ann managed to buy some beef by pointing at the bit of the hind leg that she wanted. It has made a very good casserole in our pressure cooker which we will be having for dinner this evening.  The market has grown enormously since we were first here in 2010 which probably reflects the population growth since then.  

We are settling into the house we are using for the next few weeks. For me it is a huge contrast to the small guest house room I was previously using, allowing us some space to spread out. We possibly have one or two small furry visitors from time to time but we are endeavouring to ensure we block all the routes they might be potentially entering through!

Yesterday we had a very enjoyable rest day visiting Queen Elizabeth National Park. We hadn’t been anticipating being able to make a visit but we were very kindly asked by Rob and Jen Morris (Rob is the Deputy Medical Superintendent here) to join then together with Charles Swainson (who is currently looking at the feasibility of the hydroelectric project for Kagando) and Yana his wife. We had an amazing time seeing many animals including a pair of male lions and a leopard.  Even on our way home as it was getting dark there were elephants wandering very close to the road.

A female lion teasing some Uganda Kob which rather stupidly weren't getting out of the way!

A newly born Ugandan Kob with its mother.

Two young male lion brothers We were able to get very close to them.

An African Spoonbill seen on the Kazinga channel between lake George and Lake Edward

Two baby crocodiles with their mum.

A monitor lizard looking for Weaver Bird eggs.

An albino Malachite Kingfisher. It is probably unique.

A leopard waiting for tea..!

Two dung Beetles busy at work.

We went to the hospital chapel this morning when a representative of the Mothers Union was preaching about Elisha and the Widows oil nut running out emphasising the trust we can put in God when we face life’s difficulties. We have also had the opportunity to go on a walk looping behind the hospital narrowly avoiding two thunderstorms which threatened to drown us!