Internet problems

Thursday 30^th June

Apologies for all those eager to look at xrays! The internet is so slow at times it’s difficult at present to download pictures. Whenever the mains power goes off which is several times a day at present then the internet seizes up. Also when the power is down the xray machine can’t function. There is one you man who has been waiting for 3 days to get an xray done because of this.

The typhoid protocol has been looked at by everyone and suitably tweaked so hopefully we are nearing the finished article.

Ann did a revision class for P7 who she taught back in February. The school was shut today because of a teacher’s conference but the P7 form are boarders so were free all day. They were very pleased to see her and the lesson was much appreciated by those who stayed awake!

David and Goliath

Wednesday 29^th June

Today has been a busy one at the hospital with many sick patients on male ward. In particular there are a number of patients with cardiac failure and a boy in his teen who is failing to respond to his TB treatment and on whom we haven’t been able to get a CXR done because of difficulties over the power supply which has been very erratic. I’ll post some xrays I’ve copied for the interest of the medically inclined!

Ive had an opportunity to discuss the guideline for abdominal pain with fever which needs tweaking but everyone seems very enthusiastic.

Ann taught about David and Goliath. She used a long stick with a balloon on to represent Goliath and the children were highly amused when he fell down and the balloon burst! This afternoon she went to another nearby school where she heard a recorder recital including Joy to the World and the local Bokonzo anthem.

Another wet day

Tuesday 28^th June

When Ann arrived at school this morning there weren’t many children around She wasn’t sure if it was because they hadn’t paid their school fees or just because it was too wet! Its certainly been very wet here today so quite envious of the UK heat wave. It was difficult at times teaching over the heat of the roof.

The medical students seem to be gradually finding their feet but we now have 3 from Makere University who have just appeared in addition to the Ugandan students from Mbarara university and the UK students.

We have been writing and typing up a guideline for treating abdominal pain with fever which I am going to get the other doctors to sruitanise to try to make sure that any early typhoid cases presenting to the hospital are promptly treated.

Marching round the walls of Jericho

Some of the children in Ann's class trying to keep warm

Shades of The Constant Gardener

Monday 27^th June

At school Ann lost her red pen. Absolutely essential for marking as no other colour will do! After looking for it for some minutes one of the children offered to lend her her pen which Ann found very touching. The children thoroughly enjoyed acting out the story of the Israelites leaving Egypt particularly the ten plagues of Egypt.

One of the issues regarding the Typhoid epidemic here is whether the ciprofloxacin we have is of adequate quality. So one of today’s missions was to the pharmacy to get samples of the ciprofloxacin (the main antibiotic being used to treat typhoid) being dispensed. One of the brands is rather discouragingly named Ificipro which doesn’t fill you with confidence!! Reminds one a little of The Constant Gardener for those who have seen the film.

On the ward round this morning I had no less than 6 medical students in tow which I think I would find very frustrating but Im doing my best to stimulate their interest and get them motivated to do some learning Today I also did a session for them on typhoid and dysentery.

Getting wet!!

Sunday 26^th June

The sermon in church today was about having a good marriage using the text of Samson and Delilah! Also apparently marriage is like an orange! I’ll leave you to work that one out!

I did say to Ann thus morning that I wasn’t going to the hospital today but a couple of phone calls later and I was needed by some of the medical students!

This afternoon involved much wetness. We set out for the waterfall and after walking for 15 minutes we were stranded in a downpour fortunately sheltering under a tin roof of a nearby shop. The walk to the waterfall proved challenging for the 7 of us (including Rachel and 4 of her friends from UK). We walked through the river for around 20 minutes lead by Rachel with the river  in full flow because of all the recent rain and some strong currents needing to be negotiated. Once at the waterfall we had a very welcome swim in some freezing water. We are still trying to warm up 2 hours later.

With another snake seen today the snake score so far stands at 4! Fortunately only one alive-a green tree snake seen yesterday!

Had to shelter from this downpour!

Swimming under the waterfall

Our first sunny day

Saturday 25^th June

The morning started with a further discussion about tackling Typhoid here. I may be able to help by constructing an acute management pathway for the staff in out patients to use. Also it can come down to money. There is a hope to obtain 30000 water filters at a cost of £500000 so its an ambitious target. I then went to the hospital for “5 minutes” and ended up tied up for 2 hours!

This afternoon has been hot and sunny for the first time since we have been here and we enjoyed an outing to the nearby orphanage to see further developments there and on to Queen Elizabeth pavilion near the entrance to the park for a soda. We had hoped to see some of the nearby craters but they were inside the park and didn’t really justify the $30 each entrance fee to the park.

The boy with the psoas abscess is making good progress but he has to have the gentamicin (an antibiotic) he needs purchased from the nearby shops as the hospital is out of stock!

Im sure theres a lion out there somewhere.....

Ann keeping in touch with the world on facebook!!

Typhoid is a big problem

Friday 24^th June

Today has been focused on typhoid. Dave Lyth one of the surgeons here is starting a coordinated campaign to tackle the typhoid epidemic there is here. Last month there were 32 patients requiring surgery for gut perforation which is a staggeringly large number.  There needs to be a coordinated and multifaceted campaign to tackle the problem involving clean water supply better education alleviating poverty as well as striving to achieve the best possible management when patients arrive at hospital.

The hospital has a substantial number of medical students who seem to have been very much left to get on with things. I took pity on them today and ran a session on malaria for them which seemed to go down OK and I’ve promised to do something around lunchtime each day next week so hopefully by the end of it all they may have some grasp of what is going on in the medical and paediatric wards

Ann managed to teach the remainder of lesson 1 this morning and this afternoon had a very successful trip to Kazinga market. There is certainly a lot more fruit available at present. Pity I don’t like mangoes!

A big avocado pear 4p!

large finger bananas cost about 15p - delicious!