Sunday January 29th
In Chapel this morning the preacher was a student from a nearby theological training college and I’m afraid he committed the cardinal sin of being too brief! He was bailed out by the chaplain who added his own mini sermon! We spent the rest of the morning vegetating here at the guest house.
This afternoon we went for a wander on some of the paths behind the hospital. We were invited at one stage by Moses to go to view his tree nursery which he was very proud of and he also took us through some dense vegetation to see some cocoa growing. We had neither of us seen cocoa growing before so that was another first.

                                                     Moses with his Cocoa pods

A day of firsts

Saturday January 28^th

Today started with American Pancakes for breakfast. Heidi one of the students from the States kindly cooked them. Eating them out on the veranda here with the backdrop of the Rwenzoris was a real treat.

                                Breakfast with Heidi form USA and Ruth from Germany

The main business of our day off was a trip to the bank in Kasese around 50Km away. Shared taxis is the main transport here There are no shared minibuses that come this way so that it is a matter of cramming into a car. On the way there were 14 people plus a baby and a chicken in a car with 7 seats. I think they felt sorry for us as were in the back row of seats with just one other adult with a child on his lap. The driving standard was actually very good for a change.

                                                           Only a little bit crowded!

I have an intrinsic distrust of ATM machines. Are they going to malfunction? Will they eat your card? Will the money actually appear? Today however all was well. There aren’t many countries where you can withdraw money and become an instant millionaire! We also had time to have a soda at the Virina Garden Hotel which is probably the best Kasese has to offer. 

                                   The Virina Garden Hotel gives you a warm welcome

This afternoon we had a walk with Helen and Dave Lyth in the nearby hills which was very enjoyable and in the evening a farewell goat roast for 2 German medical students who have been here for 6 months. During the speeches the chaplain commented that in Africa there is increasing individualism as in the West and the sense of community is being lost. “I am because you are” is a very profound phrase stressing that the very best of being here is being part of a community where ones identity is very much tied up with those around us and I think we could learn a lot from that understanding at home.

Nearing the end

Friday January 27^th

One of the particular difficulties about working here is having to rely on translators. I am not alone in this with several of the doctors who are from central Uganda and who are Luganda speakers being in the same boat. However it can lead to some interesting discussions and also some uncertainty on my part at to whether my questions or the patient’s answers have been appropriately understood!

Also the range of symptoms people express are limited. A pretty standard description is that they have “Fever and general body weakness” It can be pretty difficult at times to precisesly nail down what really is the problem. Also people very often done carry their records with them or their previous x-rays which they should have at home have been lost so it can all become pretty challenging!

The end of our time here is fast approaching as we intend to have a short trip to Murchison Falls leaving on Thursday and then travelling onto Gulu on Saturday to look a t a health project there before heading back to Entebbe on Sunday. It should prove to be an interesting trip covering several places we haven’t ventured to before. Ahead of our departure I have been trying to type up a short report to leave with the director here with some reflections on our time here. There have been changes that I do feel we have contributed directly to namely the in-patient protocol for typhoid management, the acquisition of the blood counting machine which has allowed much better assessment of patients and the continuation of the medical education programme here but I hope by sharing the reflections to encourage some further developments over the months ahead particularly I the teaching of the medical students.

Ann concludes the holiday club this evening and is having a meal with those who have been running it so I look forward to hearing all about it later this evening.

 A favourite game at the holiday club has been hurling a flip flop at an empty water bottle. Very        popular!

Ann's been cooking!

Thursday January 26^th

Ann has been busy today trying out various recipes using local ingredients to see if they might be suitable to use in the Esuubi café when it is up and running. Certainly the results were very good when I sampled them at lunchtime.

                    Chocolate Brownie, carrot and pineapple cake and mango rock buns!

This morning was spent in a diabetic clinic. So many people just seem to be brought back every month just to get their tablet which is wasteful of the local doctor’s time but more importantly it costs the patients as they have to pay a consultation fee each time. It’s certainly very tough if you end up developing a chronic condition here as it can get very costly No free prescriptions here!

Once again out patients was very busy this afternoon with an 18year old with rheumatoid arthritis, a boy with a psoas abscess, several children admitted with malaria and pneumonia and several other problems. I was just there alone with a medical student from Mbarara which I hope he found useful. The man from yesterday in fact had a perforated gastric ulcer and seems to be doing OK following his operation.

I hope the blog is of some interest. It certainly helps me think through what has happened during the day and to think of ways to help develop the services here.

                                                           Keep on blogging!

Then a few quiz pictures

                            This 9 year old came to out patients today What is the diagnosis?

                                      Ive never seen anything quite like this Any ideas?

                                                 Finally what does this Xray show?

A challenging day

Wednesday January 25^th

Every morning during the week there is chapel at 8am. This does vary hugely but this week it has been exceptional with Canon Benson talking from Isaiah 49. He has been reminding us of how much God cares for us and is aware of the details of our lives Verse 16 talks about us being engraved on God’s hands reminding us how he is always aware of our lives and his constant compassion for us. I’ve found that a great encouragement and comfort both for myself but also as I consider the plight of the patients I am seeing.

This morning I was helping out with the HIV clinic. HIV patients are a constant challenge both in the complexity and also the potential severity of their illness. Each patient here has about 5 minutes with a doctor while I’m sure at home they would have up to half an hour to be reviewed. Today’s clinic included a 12 year old who had defaulted from treatment for 6 months because the aunt she was living with had moved and not taken her for treatment. Also there was a woman of 53 who had had a cough for 1 week but on listening to her chest almost certainly has TB but can’t afford the UgSh18000 (about £5) for the chest x-ray. This really is a lot of money for these people.

This afternoon I was in out patients with one of the clinical officers and patients ranged from a woman with advanced carcinoma of the cervix, a one year old with pneumonia and a man with abdominal pain who has a gut perforation. My aim in being there has been to encourage where necessary guide decision making and prescribing but my respect for the clinical officers has grown enormously as I watch the range of situations they are having to deal with with very little medical support with their initial assessment of patients.

Unexpected events!

Tuesday January 24^th

The Guest house nearly suffered a catastrophe today. At breakfast one of the American students Heidi decided to make sugar and cinnamon toast by heating the bread resting it on top of the toaster. Result a fairly substantial fire which only died down after about 30 seconds of strong blowing from the 3 of us. Fortunately no damage done we hope but I look forward to doing the toast tomorrow with some trepidation!

A remarkable incident occurred over the last 24 hours. Last night our good friend Bill Cave emailed for up to date news regarding the defunct hydroelectric scheme here as he had a friend staying who had been involved in the refurbishment of the system a few years ago. Amazingly this morning the director here Canon Benson stood up to announce that funds were being made available for a new turbine and cable to connect it to the hospital to restore the system to use. After chapel I talked to Benson and he was desperate to make contact with the very person who is staying with Bill at present. Was this simply a coincidence or Gods way of intervening in the situation? Whatever you may think it was a most remarkable chain of events which has allowed me to email the proposals for the new scheme to Bill within 24 hours of his original email.

Ann happened to be in medical records again trying to establish some degree of order. While she was filing a nurse came in to request a set of notes Obadiah the man in charge of records was delighted and suprised that he could find the notes now in "less than one minute!". So progress is being made.

                The kittens are growing up fast oblivious to their future rat catching career!