A day to remember

Sunday October 31^st

It was a special Sunday in church for the local people as they were praying for the Primary 7 children and also the final year nursing students. The P7 (end of primary school) have their exams on Tuesday and Wednesday. The whole service was rather like harvest festival with each child or student bringing an offering mainly of fruits but including a chicken and a goat! The goat had to be removed to stop it disturbing proceedings by its bleating! I was summoned out of the service after 2 and quarter hours to attend to some patients on the medical wards. The young man with tetanus unfortunately died this morning leaving his family very distressed. Another lady needed a transfusion organising and another man in his 20s was admitted unconscious so everything carries on and will continue to do so after I have left. This is a busy place serving half a million people, equivalent to the whole of East Sussex or put another way all the services provided by Eastbourne DGH and Hastings Conquest hospitals combined.

This evening a surgeon working with AMREF in Kenya has arrived to help over the next week with fistula surgery. Had a brief chat with him and it seems he was at school in Iten which is about 30 miles from Kapsowar where Ann and I were in the early 1980s. It’s a small world.

Dirty Water !

Saturday October 30^th

Today has been an extremely educational one for me. After spending the morning in the hospital, I went for a walk with a US undergraduate, who has been here for 5 months, and his Professor to a nearby village. He is studying the people who have suffered bowel perforations to look at why these are occurring so frequently here. We visited a man who had survived surgery 3 months ago He looked well but was rather drunk (!) He showed us where he needs to take water from when the standpipe outside his house isn’t working. It isn’t difficult to see why people so easily fall ill when their water supplies are so polluted. Interestingly no one seems to collect the rainwater from their roof which seems crazy in an area having over 500cm rainfall per year. There is a scheme being developed to try to encourage the use of sand filters to purify the water for drinking. Prevention has to better that cure!

This man survived an operation for bowel perforation due to typhoid 3 months ago

This is the small polluted water source the family have to rely on half of the time

Keeping in touch

Friday October 29^th

Today has been dominated by caring for some very sick people A young man of around 20 was admitted early this morning with severe tetanus and Im afraid the outlook for him is not that good. The medical wards do seem to have become much busier over the last few days. I do feel more confident managing the varied problems we are seeing notably typhoid and severe malaria compared to a week ago.

One of the amazing things about being here has been the internet and phone links I hadn’t expected everything to work so well because we are in a very mountainous area and I had expected that to cause more problems.

Despite eating large quantiites of local food such as Matoke(mashed green bananas) Beans Sweet Potatoes Peanut sauce ect I seem to be losing weight which seems hard to believe but Im not exactly wasting away!

Some happy new Mums

Thursday October 28^th

3 of the 4 Ugandan medical officers have gone off to an HIV course in Kampala which has left the hospital a little thin on the ground I spent the first half of the day doing rounds on the medical wards but ventured onto the paediatric wards for the first time today. Some amazing situations there including a 1 year old who presented with an Hb of 1.6 about 15% of what it should have been. Some very tiny babies to see to as well. I have to say there is something very special about looking after small children. I had a chat with Dave Lyth, who is the retired urologist who is working here, this afternoon about various aspects of the hospital which was very helpful. Tomorrow evening there is to be Scottish county dancing in the chapel!  It will be interesting to see how the locals cope with the Gay Gordons!

Smile Please!

What do you think he is writing about?

TV stardom? Unlikely!

Wednesday October 27^th

The nursing school was opened today by a number of dignitaries. I’m afraid I missed it all but there was a cameraman wandering round the wards so who knows I may make it onto Ugandan Television tonight! Ive spent some of the day preparing something to discuss at next Mondays education meeting which I hope will be helpful Ive chosen the topics of “When to do a lumbar puncture” and managing heptosplenomegaly”(patients with large livers and spleens). I am beginning to come to the conclusion that to try to stimulate debate and discussion about how things are currently being managed may be my most helpful input. While some of the skills and practice are amazing given the scarce resources that are present the widespread use of up to 4 antibiotics at a time is one amongst a number of issues that could be improved.

Keeping busy

Tuesday October 26^th

Another full day. There has been much to see and do on the medical wards which are definitely becoming my main area of responsibility. One man admitted this afternoon almost certainly has a brain tumour but there is no CT head scanner (in fact there are still no xrays due to the kamikazee rat who shorted out the transformer for the machine) here so one has to do the best that one can. On a happier note a 14 year old boy who was admitted last week with cerebral malaria and a haemaglobin of only 2.8 (should be 12 or more) at admission went home today and seemed fully recovered.  I was hoping to do a caesarean section myself today but the woman proved to have a ruptured uterus and bladder requiring a complex repair most of which was undertaken but someone at the same level as ST1 (that is just over 2 years since qualifying!) It is certainly amazing the level of skills and competence of the junior doctors here at the moment. Overall there is a very good and supportive relationship between all the doctors which is very encouraging to see and very helpful to me trying to fit in in a useful way for such a relatively short time.

A busy start to the week

Monday October 25^th

The day started with a 2 hour meeting of all the senior staff to discuss issues at the hospital A lot of it is common to the NHS with emphasis on quality and education but just with a lot less resources. I spent the rest of the morning on the medical wards including doing a paracentesis (draining fluid from a woman’s swollen abdomen due to heart failure). The afternoon saw me helping with 2 Caesarean Sections. Its all a  steep learning curve for me. Its amazing what you forget after 25 years! This evening we are having a medical education session (something for my appraisal!!) so all in all a very full day