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!

Thursday 27^th October

The first 2 days this week were spent in Fort Portal helping with the PRIME course for 2^nd year Clinical Officers at the government training school. The course seemed to go well and about half of the students got really engaged with what we were teaching which was a mixture of teaching about treating the whole person-body, mind and spirit,  together with some consultation skills and more specific teaching about end of life care and managing Depression. It was good working with Rob Sadler again who ran the course we helped with this time last year. Ann acted as an excellent scribe for the various flip[ charts that were created but also as an excellent depressed woman and someone with terminal cancer in the various role plays which we did. It was the first time she had done this and realised how powerful it can feel when you get into a role like these. I am pleased to say Ann neither has terminal cancer nor depression at the moment!!

Mr TB (me) being told his diagnosis!

The students doing the course

Discussions in pairs.

Wednesday morning we were able to go on a birding walk for a couple of hours from 7am to the botanical gardens in Fort Portal. We saw an amazing range of birds, a number of which we would have easily overlooked without our guide, Andrew, to help us. 

On the birding walk to the birding hot spot!

Ann and Andrew

Dusky-blue flycatcher

Red Backed Shrike

Mackinnon's fiscal

The journey back to Kagando went smoothly and allowed an opportunity to stop at Rubona where there is a cooperative of local woman who make baskets to sell. The amount of work going into the baskets can be huge with one taking the most experienced women two days and then selling for 12,000 Ug Sh, or just under £3.

This afternoon was a further litter picking afternoon. There was a large turnout of local school children who, to the accompaniment of the brass band, did a good job of tidying up Kagando’s main street but until the adults locally see keeping the environment litter free as worthwhile it is hard to see how things will change.

Clean up Kagando

Ann doing some serious litter picking!

Sunday October 23^rd

A day off!

Today we have had our first real day off since we both arrived here which has given us time to reflect on our time here so far.

 Children on a “see-saw” (broken desk) at Ekiwumulo

More children at Ekiwumulo with nursery block in the background

Sanyu Lillian one of Esuubi’s sponsored young people who is about to do A levels at Ebeneezer Secondary School 

Bosco on a road just outside Mityana – we are not entirely sorry not to be transported on the back of his motorbike anymore!

Simon outside “God’s Mercy Electrician” in Mityana town!

There have been good times and more difficult ones and, just as in UK, the more difficult ones occur when people have relationship difficulties that are hard to resolve! 

Today after breakfast we enjoyed a walk to a posh lodge, which is about 8km away. Remarkably we only got lost once and local people were very keen to help us out and point us in the right direction. 

Two boys who were on their way back from digging We met them on the way today.

The views there were stunning overlooking a crater lake and some African tea was very welcome when we arrived.

View from the terrace at Kyanaga Lodge

Rob Sadler has now arrived from Gulu where he has already run several Prime courses and so there will be some planning for tomorrow’s PRIME course with clinical officers in training here in Fort Portal. The course will run over the next 2 days.

Thursday 20^th October

Tuesday evening was spent in a medical meeting at Kagando. There is the ever present problem of increasing resistance to many of the available antibiotics so we were trying to agree some guidelines to most effectively use the antibiotics we had. It proved to be a very useful meeting with a good consensus about what we should be doing and also the universal acknowledgement that we urgently need to be doing more investigation of infections to get up to date information that is needed to make appropriate prescribing decisions

Yesterday was spent transferring to Mityana which took much of the day. It is very good to be back here in Mityana and to see everything that is happening at Ekiwulumo and the Café. Certainly the Café looks very smart at present and seems to be increasingly used by groups visiting. There was a group from Winchester Diocese who went there earlier in the week and there is a group of 14 young people from Wellington school who are going for brownies on Sunday.

There are jobs to be done around Ekiwulmo but this is always the case with such a large ongoing project. The teachers had a blitz on the library today and the children very much enjoyed sorting out some puzzles that had been mixed up.

The libaray looking very tidy after all the teacher's efforts

Many jigsaws needed sorting out

A few were even nearing completion!

This evening we went to “Smart Restaurant” in town where beans matoke and posho can be had for under a pound. One of the waitresses Reema remembered us from a year ago and remembered both our names!!

Sunday October 16th

Ann takes over the blog this time about activities in Mityana Yesterday.

I have had an interesting day today – the morning was spent at the Esuubi Café with Phiona, Nora and Esther discussing encouragements and difficulties.  They gave me a warm welcome and were just unpacking some craft, with which the Café was being restocked. I was quite encouraged to see some customers leaving as I arrived at 10am.

Around midday I was very brave and travelled to Ekiwumulo on the back of John Bosco’s boda (motorbike) - Not my favourite means of transport but the easiest way to get around while I am here! At the school a Primary 7 (last year of primary education equivalent to our year 7 in UK) party was underway. I find this sort of party great fun and a brilliant idea. It takes place about 2 to 3 weeks before the P7 candidates take their end of primary education exams. I was given a huge welcome (and asked where Simon was!) and was asked to help cut a cake made for the occasion and make a speech.

The P7 leavers

The party involved lots of dancing – initially by the P7 candidates and later by everyone. The candidates are all given “Success” cards for their coming exams. I love this idea, as it is an equaliser for all whether the children are academic or not. Following the presentation of cards and speeches a huge lunch is served.

Dancing

Success cards

 The mothers of the houses had been up since 5.30 preparing food and everyone was enjoying themselves.

The Lunch!!

Ann with Mama Joyce and her daughter Nagawa Sarah who is one of the leavers

After lunch I went to thank the housemothers and also Winnie Kisakye who lives at Ekiwumulo and is now teaching the very young children. She has been working with Esuubi since it began. I had learned via face book that she had recently adopted a baby boy following a knock on the door she had had in the middle of the night just over a month ago. She had gone to a house where she found a baby on the floor between the legs of a mother hardly able to move because of HIV – this young mother had been living with her grandmother and had been raped. The man involved had threatened to kill her and her grandmother if she told her grandmother that she was pregnant. The baby had been born prematurely and had been lying on the floor with the mother unwashed for a week and weighed 1.5kg when Winnie was called. Winnie and her daughter Jenny cried when they saw the child. As the family are unable to look after the baby they asked Winnie to take him and she is adopting him. He is still tiny, now weighing 2.5kg, but it is a miracle that he is still alive.

The Baby Winnie has adopted with a friend Brenda

Winnie told me that sometimes she had wondered why she is a Ekiwumulo but she knows that God has used her by being there for this child.  She also said that she at first found it very difficult getting up in the night to feed him!

I shall be travelling on Wednesday to join Ann in Mityana for a few days before going on to Fort Portal next weekend.

Thursday 13^th October

Overnight I had a message from Ann to say she had arrived in Dubai weary but safe and sound. All being well Ann has arrived in Entebbe this afternoon and will be travelling on to Mityana tomorrow after staying overnight at Whitecrest in Lubowa which is a suburb of Kampala. Unfortunately our friend Simonpeter will have left for a trip to Kidepo National Park in the north of Uganda so she will miss him this time. She will be spending a week there and I intend to join her on Wednesday next week when I can share transport to Mityana with someone who is returning to the UK from Kagando. Needless to say I will be extremely pleased to be reunited after spending the last 4 weeks on my own! Our stay in Mityana will give us a good opportunity to see how both Ekiwulomo and the Café are progressing and hopefully sort out any problems that have arisen since the Esuubi trip in April.

In the meantime the hospital remains very busy but the new group of interns have finally arrived. They are equivalent to FY1 doctors in the UK i.e. they have just left medical school so are quite inexperienced. They are working on Maternity and Paediatrics so I probably won’t see so much of them.

We continue to have some challenging cases on the medical wards. Two men ended up sharing a side room over the last 3-4 days. They had very similar stories having had a cough and fever over the last week. However that was where the similarities ended as one man proved to have a straightforward pneumonia while the other appears somehow to have developed a large lung abscess and will take a considerable length of time to improve. 

                                                  Pneumonia in the right lung middle lobe

                                                    Lung abscess in the lower right lung

                                                                                                                                                                  James (who is one of the Ugandan Doctors working on the medical wards) and I also have a” special project”- a man sharing his name and my age (!) so we both feel we have a special interest! He is currently on our Intensive Care unit but making good progress with his pneumonia!

Samuel one of the nurses. James the patient aged 62 and James the Doctor!

James the patient's chest xray

Kagando also never fails to turn up things which I personally haven’t seen since I was working at Kapsowar. A young boy looks as if he has Diphtheria which is now fortunately rare due to children being immunised bit he seems to be making good progress after rather a stormy couple of days.

Boy with probable diphtheria making a good recovery now

This morning I found a patient handcuffed to a bed. He had taken an overdose and had tried to abscond from the hospital so as it is illegal here to commit suicide the police decided to place him temporarily under arrest. Hopefully we were able to sort things out today as he wasn’t intending to kill himself and I think the police were satisfied he wasn’t just about to break the law! Life certainly isn’t dull!

My room mate "George"

Sunday 9^th October

Yesterday I took my first complete day off which is rather overdue I spent the morning going into Kasese around 45 minutes’ drive away. It was interesting to wander around for an hour to reorientate myself to the town after a year’s absence. Peter (who is the project administrator) and Heather his wife kindly took me. No major purchases but we did go to Jambos which is small café in the town which is a popular watering hole for expatriates (of which there aren’t that many, mostly from Kagando).

The end of last week involved becoming involved with treating a Mzungu (white person) who had fallen ill with Malaria. I think there is little doubt that Mzungus if they develop malaria can become quite sick rather rapidly so it was a strong incentive to keep remembering to take my anti malarials! He responded well to treatment and in the end only needed a 24 hour stay in hospital but a slightly anxious first few hours looking after him. Malaria is certainly not a condition to trifle with and can develop in a complicated way very rapidly.

This afternoon involved a return trip to the prison together with Captain Ezra who was able to translate for me as I spoke about the resurrection. I asked tentatively at the end if any of the prisoners wanted to talk to the group about their faith. One man volunteered and told them how his attitude to his Christian faith had changed while he had been in prison. He was extremely courageous to speak out as he did.

The remainder of the day has been spent with Johnny at his house He is recovering from his malaria. His father Martin arrived on Friday which has been a big help I had the opportunity to see the coffee project which in the space of 12 months has grown into a huge enterprise buying coffee from local farmers for drying and then selling on to the open market. It already is benefiting over 100 local farmers ensuring them a fair price for their coffee as well as providing employment to an number of local people who work in the storage area. That visit was followed up by a delicious evening meal including Yorkshire pudding (!) and at Johnny’s request a game of Settlers of Catan! It has been a very enjoyable and relaxing day.

Coffee drying on trays

Coffee in storage rooms

Coffee being turned to help drying to prevent mould forming

Thursday 6^th October

Yesterday I spent the morning in the HIV clinic. Managing HIV patients poses particular problems for Doctors coming here from outside Uganda. 

Board outside the hospital advertising HIV services. Spot the deliberate spelling mistake!

HIV is a complex disease and often one which is relatively unfamiliar to Doctors in the UK. The complications of advanced disease are rare in the UK while the treatment regimens available are designed for conditions locally providing drugs that both affordable and effective. To make matters more complicated the Ugandan medical authorities have a huge liking for abbreviations. For instance TR means Tested and Received by patient negative result while TRR means the patient has a result that is reactive ie they have HIV. There are numerous others relating to testing for HOV and the treatment regimens so it does take time to really assimilate the local systems. However the clinic time yesterday proved very useful and I think for the first time I really have got to grips with the local systems!

There is a huge poster campaign at present encouraging people to take steps to avoid catching HIV. It is hard to know what impact they are having but at least it is a real effort to stem the resurgence of HIV here after a number of years of decline in new HIV cases.

One of many different posters on display at present

For the medically minded some fascinating and relatively unusual things crop up. One girl presented with Nephrotic syndrome, a situation where the kidneys become very leaky to protein but she also had a rash. This has proved to be due to an unusual condition called Henoch Schoenlein Pupura. She is rapidly improving which is an encouragement when there have been a number of patient deaths during the week largely due to their very late presentation at hospital.

Young girl with Nephrotic Syndrome and rash on her legs and arms

The Bishop is here today which mean I get the added bonus of being invited to lunch so I shall be having more than chapattis today. One good thing I have discovered this week is that one of the local shops can do Rolex (Chappati with omelette) which is a real bonus!

While writing this there has been a sound like a heavy lorry passing by and the furniture is shaking- a not inconsiderable earth tremor which has occurred on a couple of occasions since I’ve been here. It lasted around 15 seconds. This is a potential earthquake area although nothing substantial has happened for many years!

Sunday 2^nd October 2016

One of the things which I find most distressing when I am here is how thin the thread between life and death really is. Somehow at home we feel very insulated from this most of the time. For me this was exemplified on Friday when a 15 year old was brought in after taking rat poison. Rat poison is widely available here and is quite often taken by young people as a deliberate overdose. He had had an argument with his mother and locked himself in a room and taken the poison. There are 2 main types of rat poison here. One taken in overdose is relatively harmless but the other made from organophosphorus compounds has serious side effects. Unfortunately for him he took the latter. Although on arrival he didn’t seem too badly affected, he soon deteriorated and, despite the very best efforts of all involved, he died because his heart just went more and more slowly until it stopped all within the space of 2 hours. In an environment where many struggle to survive, it seemed such a tragic waste of a previously fit young man’s life.

Chapel this morning included a performance by the students choir “Echoes of Victory” It was mainly intended as a fund raiser to help replace some of the electrical equipment which the group uses. Part of this involved public pledges where the amount donated is publically announced. I really feel very unhappy about how this makes people feel coerced into giving but it is a relatively common practice here in Uganda along similar lines to the Harambee appeals in Kenya where people are encouraged to publically donate to support an individual or a needy cause.

This afternoon was a return trip to the prison and a few photos were allowed this time. The mosquito mesh on the windows is all in place and the tank for water with its stand is all ready to be used. The kitchen and washroom may be future projects to assist. We were able to hand out a lot of tubes of clotrimazole cream for numerous prisoners with fungal skin infections and also some antibiotics for others with skin infections. Unfortunately the man with suspected chlamydia has already been moved on to another prison so not sure if we will be able to catch up with him. There were a further 10 new inmates with 11 having left some released oin the last week so there is a fairly steady turnover. I think I will probably make that a regular Sunday visit while Im here even though the medical outreach is only once a month normally.

New water tank for use in the prison ward overnight

Mosquito screening in place. Only suggested this last week!

Door to the women;s prison room with mosquito screening in place

Dilapidated wash room Located right next to the kitchen area. In serios need of relocation and repair

Kitchn area with half roof missing also in desperate need of repair