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

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!