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

Thursday September 29^th

I have just been stranded in out-patients for an hour waiting for the rain to stop. When it rains it really rains! 

This blog is a little delayed because I have been laid low with what the locals would call “really serious flu”! In reality a heavy head cold!

The prison visit on Sunday proved extremely interesting. The prison at Naburongo is about 3km from Kagando. It houses 82 prisoners at present, 47 of whom are on remand. That is fairly typical with many spending months before a magistrate hears their case. Most are there because of petty theft. The prison has no perimeter fence and there are in total only ten prison warder so the men are often locked up for up to 16 hours a day. All the men are housed in a single large room with two toilets but sleeping almost touching each other. The women have a small room but there are usually no more than two female prisoners. Each month there is an outreach for some basic medical checks. I had expected to be a spectator on this occasion but eventually asked to see some men including 3 with hernias, one with probable chlamydia and another with nasty infected scabies. As a result of the visit arrangements are being made to screen the rooms with mosquito netting and also provide a 100 litre water tank to allow access to drinking water. Up to now there has been no drinking water available for the men between 6 pm when they are locked up for the night and 6.30 am in the morning. No photos allowed but I am sure you can imagine the conditions but the staff there do their best to provide care to the men in their charge.

Smoking remains a major challenge here with many with lung conditions including a man seen this week with an advanced lung cancer.

70 year old man with an advanced carcinoma of his right lung

Others present with other types of malignancy including a man just yesterday with lymphoma and a teenager with probable Acute Myeloid Leukaemia. Also there have been several cases still with late stage problems from HIV. Unfortunately for many there is little that can be done. It can mean a referral to Kampala for treatment with uncertain prospects of receiving treatment. The only radiotherapy machine in the oncology department in Kampala has currently broken down.

On a more positive note and Intensive Care Unit has been established since I was last here. In reality it is more like a high dependency unit but allows some of the sickest patients to be cared for in one place and provide a high standard of nursing care that can be modeled on the other wards.

Chapel this morning included an interesting and rather telling announcement. Each of the wards had bottles of alcohol liquid for cleaning hands between patients. Apparently some students have been tempted to try drinking it! They were warned today that there are other components including hydrogen peroxide which might leave anyone drinking it rather worse for wear!!

Sunday 25^th September

I feel I am gradually settling in after a few days. I have spent much of the week on the medical wards mainly working with some junior doctors from the UK. Andrew has been here for several weeks and will be here until November. Neil and Jenny were due to go to work at Yeo in South Sudan but have been diverted here because of the fighting in that area. They may be here for up to a year. I hope they have appreciated the opportunity to discuss some of the quite complex medical cases that we have here at present.

I am currently staying in a smallish room in the guesthouse It is rather undecided whether I would be moving to a small house which is currently being refurbished before Ann arrives or whether I might move into one of the other houses when one of the nurses, Rita who frequently comes here, goes back home in mid-October for 3 months. The house being refurbished looks rather like a building site at present and I suspect the completion date of next Wednesday is a little optimistic!

House which may become home in due course

Kitchen diner

The entrance hall!

Yesterday morning was Jha Jha’s day which is a monthly event where local children who are HIV +ve can come to play, do crafts, attend a short service and get a good meal. It is a popular event and supported by some very dedicated mothers who do the cooking and also by the daughter of one of the Clinical Officers who seems to have boundless enthusiasm.

I am going with some of the nurses this afternoon to the local prison where they hold an outreach once a month to check on the health needs of the prisoners. I have never set foot inside a Ugandan Prison so that should prove and interesting and educational expedition.

Lots of young children come to Jha Jha's day

One of the HIV+ve children Some of the local women busy doing the cooking in the background.

 Went to church this morning wearing my Ugandan outfit which was made for us last time we were here. Only problem was I realised half way through the service that I had it on the wrong way round with the pockets at the back!!

Wednesday 21^st September

I am gradually settling back here at Kagando after an eventful flight. I arrived at the check in at Gatwick and was asked to have my hand luggage weighed. This has only happened once but this time I weighed in at 18kg against an allowance of 7kg. The air hostess after reprimanding me was understanding enough to let me through which I was extremely relieved about!

At Dubai security decided my 4 way plug was too dangerous and confiscated it. I think they were worried I might strangle the pilot! Eventually arrived at Entebbe at around 2 pm on Monday Unfortunately everyone was there to meet their relatives returning from celebrating Eade so it took over an hour to clear the airport car p[ark. Fortunately things went rather more easily from then and I had a pleasant stay with our friend Simonpeter in Kampala before travelling on to Kagando with 2 other people who have come out to do work in prisons, work with the physio department and other things.

Today has been spent greeting many people and spending time on the medical wards. The hospital is fairly busy at present and the doctor numbers lower than on some occasions with a number of junior doctors from the UK filling in.

I am currently living in the rather cramped conditions in the guest house but hopefully moving to a small house that is being made ready in a week or so. A welcome find amongst things we left here nearly a year ago was another 4 way plug so I can have the computer, a bedside light and a kettle all going at once! 

Friday 27^th November

On Tuesday we went to the school where Ann has been helping and we were entertained by the P2 class singing for us and then we were given a gift of material to make a shirt for me and a top and skirt for Ann.

Ann with the two P2 class teachers

Serenaded by P2!

A real African woman!

It was with some sadness that we left Kagando on Wednesday morning. We had felt very settled in the house we had been staying in and had had Johnny as company during our time there.

Mixed feelings leaving Kagando

We had to say goodbye to Charles Cockroach who has been living in one of our kitchen cupboards for the past four weeks!

Johnny loading up the pickup.

After a good journey down to Mityana, we had a full day couple of days with meetings and an opportunity to see how things are progressing at Ekiwumulo. We have become aware of more that needs to be done in particular the need for replacement mattresses for the children. These are foam mattresses which have been in use for over 5 years in some cases and are looking a little the worse for wear so we have decided to make this a project for the proceeds of our bring and buy sale in January with the aim of replacing 100 mattresses.

There are now some new banners to be put outside the Café to try to advertise it better and we very much hope it will help to increase the number of visitors to the Café.

One of the new banners to go on the front wall of the Café site.

Being in Mityana allowed us to get Rolex which an omelette combined with a Chapatti-absolutely delicious!

Rolex being made. A local delicacy in Mityana.

Today we have travelled on to Kampala. It seems strange to be back here after seven and half weeks. The Pope arrived in Uganda this afternoon which is provoking a huge amount of interest.

 

The Popes arrival was avidly watched on local Television

 We spent most of the afternoon meeting up with Bob and Eric and Bob’s friend Katz. Bob and Eric have both been sponsored through Esuubi in the past but Bob has now completed his degree in IT and Eric is currently doing a course sponsored by the Bible Society.

Katz, Ann Bob and Eric.

Tomorrow we are heading to Entebbe and will be flying out on Sunday morning for a short holiday so this will be the last blog from this trip. It has certainly proved a rewarding but at times challenging time and one we are grateful to have experienced.

Monday 23^rd November

Our time at Kagando is rapidly drawing to a close. It hardly seems possible that 7 weeks have gone so swiftly and in huge contrast to how we felt when we first arrived we shall be very sad to be leaving

We had. a leisurely Sunday with a 6 mile walk around the back of the hospital We now feel we are becoming very familiar with the local landscape. There are huge numbers of butterflies at present many of which are spectacularly colourful.

One of the butterflies to be seen on the walk

Another butterfly. They don't stay still for too long!

It was rather a muddy walk in places!

In the afternoon we invited a number of the junior doctors for tea but many of them were busy at the hospital so we only had one guest! The cakes were not wasted however and were eagerly devoured by staff at both the Kagando Farm and the local school!

Playtime on the children's ward

Mastering skittles!

We did our last health promotion puppet play this afternoon with Betty again tragically falling victim to typhoid but eventually making a complete recovery. Always drink clean water was Sister Harriet’s strong message!

Betty is just about to drink some water straight from the river!

Sister Harriet working "very hard" to make Betty better

We are travelling on Wednesday to Mityana for a couple of days to have some further Esuubi meetings and a final look at the School and Café before heading off to Kampala on Friday. Our travel that day clashes with The Pope’s arrival in Uganda so it may prove an interesting journey!

Reflecting on our time at Kagando. No pairs of glasses lost and I have only sat on one pair!