Sunday 11^th February.

We have had a relaxed weekend which is good as I think we were both rather weary after all the travelling.

We walked yesterday morning into Kasinga to find the Coffee factory which has developed hugely since our last visit. The capacity to process the raw beans for transport has increased tenfold in the last year with the introduction of large machines to sort the beans and dry them to achieve the optimal moisture content for the very best quality, and hence the best price. This process alone probably doubles to price the coffee achieved. It is a remarkable project with much further development still to come. We were accompanied by Sara a Spanish nurse who has come here for 3 months to look to see if improvements can be made in the uptake of cervical screening.

 

Johnny showing us the machine for sifting the beans

 

Large driers for redcuing moisture content of beans

In the afternoon we went to see the wife of one of the nurses who has had their first baby by caesarean section but with a very complicated post-operative course requiring 5 trips to the operating theatre and with a wound still partially open. She was very courageous inn spite of all the difficulties. We also visited John who is one of the local church leaders whose main work is with Muslims in the area and we are due to go for dinner at his home this evening.

Chapel at 8am this morning included an acted out sermon which was very well received and an auction of items to support the local youth choir who want to do a recording of some of their songs. There are now 3 sizeable television screens for the words of songs to be shown and the overhead projector has been abandoned-one of many visible changes from when we were here in 2016. Afterwards we were able to take Sarah and two Doctors from the UK who have just arrived, Peter and Susanne to show them some of the local sights!

 

Out for a walk with Peter Susanne and Sara

The entrance our lodger has probably been taking has been located. I am hopeful the new signage will be sufficient to deter him from entering!

It remains hot. The temperature in our bedroom the last couple of nights has been 29 degrees as we have tried to get off to sleep. Hopefully it will rain before too long…

Planes, pests and plumbing!!

Friday 9^th February

We arrived back at Kagando yesterday evening, 48 hours after leaving home.

The flight out took us on a little mini tour of East Africa. The flight we were supposed to be on from Kigali was cancelled and we were put on a flight flying to Entebbe via Nairobi. All went smoothly however and we were relieved to reach Entebbe to find our cases arriving as well!

We spent the first night at Whitecrest guesthouse. On arrival we found a group of vervet monkeys outside the window of our room and one on the balcony looking in at the window hoping to get in! After hanging around for 15 minutes or so they all decided to head off as clearly they weren’t going to be allowed into our room!

We travelled by car yesterday which was fine except for a section of the road before Fort Portal that the Chinese Road engineers (who seem to be everywhere in Uganda these days) were trying to improve resulting in long sections driven on a murram surface which slowed us down somewhat.

On arrival at Karibu house where we will be staying (as we did on the last occasion we were here), we were met by our lodger, a rather fat mouse who scuttled behind the wardrobe! Ann is keen to institute chemical warfare whereas I am more inclined to take a more lenient approach!

One near disaster was the ball cock and valve on the toilet were malfunctioning causing a continual overflow. On inspection it became clear that the arm of the ball cock had been mounted the wrong way us but during the inspection process the ball dropped off the ballcock arm! Eventually it proved possible to fix the problem but not before some very stressful moments trying to effect the repair.

In the hospital today there were many familiar faces who were very genuinely happy to see us again. There is the ongoing issues of lack of drugs and materials, including the main treatment for malaria, the rapid diagnostic tests for malaria and also the main antibiotic in use for most infections but hopefully these can be reobtained before too long but it was a reminder if indeed one was needed of just how precarious the situation with regard to medical care can be here at times.

Nearly succesful repairing the cistern!!

Wednesday 7^th December

This will be the last blog entry for this trip. It has been an amazing 12 weeks. I have spent much of today saying goodbyes as well as showing a nurse from New Zealand around She arrived last night to stay for 3 months and will be living in the house we have been using once I leave.

I particularly wanted to say goodbye to Julius who is in charge at the farm. He had been very kind to us with our milk supplies and had been particularly grateful when I went for milk 2 days after the shootings when few people had wanted milk. I had looked after his sister on our Intensive Care Unit about 10 days ago but she had died very swiftly from cancer at the early age of 29.

They had just killed a pig and there was along queue to buy pork which is a local favourite!

I am returning back to Kampala tomorrow and hopefully will have an opportunity to stop at the café and also a craft shop in Fort Portal on the way back.

My grateful thanks to all of you who have been reading this over the weeks, for your support love and prayers for us both.

Sunday 4^th December

A week has now passed since the events of last weekend. The story of what happened is well documented on the Africa page of the BBC although there was little mention of the events here at Kagando which left 10 people dead. All now seems peaceful and people seem much more relaxed again. The evidence of what happened is fast disappearing as bullet holes are filled in and repairs undertaken.

Bullet damage to the gates of the compound

A window in the chapel damaged by a stray bullet

The honey store peppered with small bullet marks

A larger clibre shell penetrated the guards hut

The last few days has definitely seen an increase in activity in the hospital with all the wards seeing activity at a level comparable to 2 weeks ago. One lady was admitted vomiting blood with a haemaglobin of only 2.9. Shen needed blood but was group O rhesus negative but no compatible blood was available. The decision had to be made to give her O Rhesus positive blood as a life saving measure and worry about the consequences for any future pregnancies she may have for the time when she has recovered. A man was admitted on Friday who had not been able to walk for 2 months because of weakness in the legs. It strongly looks as if he has syphilis affecting his nervous system so hopefully some prolonged treatment with penicillin may restore his ability to walk. The medical work here is full of challenges, not least making the best of the limited resources available.

This afternoon a number of us had a trip out to somewhere about 30kms away for lunch. It was a very relaxing time and a great antidote to everything that we have experienced in the last 8 days.

The current expatriate staff together with Gloria (physiotherapist) and Mary (Paediatrician and Medical Director)

The obligatory stop at the Equator

I am due to leave Kagando on Thursday morning and I am getting a lift from Jonny Rowland who is running the local coffee project. This is a day earlier than I had planned but the opportunity to travel down with Jonny was too good to miss. It is hard to believe that the 12 weeks in Uganda are drawing to a close. So much has happened during the time and I am so grateful to have had the opportunity to be here to share in all the experiences both good and difficult and to have remained well and safe throughout. Coming home again to all the pre-Christmas build up may be rather hard not to mention the freezing temperatures after getting used to an ambient temperature of 25 to 30 degrees and night time temperatures always over 20.

Thursday 1^st December

After the events of the weekend a slightly uneasy peace has again descended onto Kagando with the shops all now open again and people going about their daily lives with a semblance of normality. The events made it to the Africa page of the BBC website but were eclipsed by the death of Castro and an article about Donald Trump!

On Sunday and Monday many patients wanted understandably to be discharged and particularly the medical and surgical wards were quiet for a couple of days. However admissions seem to be picking up again. But throughout the paediatric ward has remained busy with some quite complex situations to be dealing with. A ward round yesterday included a 10 year old with HIV and an extremely low white cell count (CD4 level was only 3), a girl with sickle cell disease with an apparently very high white cell count (which on review of a blood film proved to be a false count contributed too by many red cells emerging from the bone marrow rapidly in response to her sickle cell crisis) and a 4 month old baby with severe fluid accumulation in the abdomen the cause of which we have yet to establish. Today in outpatients I admitted a very ill woman who has HIV and malnourished twins aged 8 months. So there is much to do in the midst of an uncertain situation for many.

It is hard to believe in a week I will be leaving here for the relative security of the UK. To be honest it will be hard leaving behind many to whom I have become close in the last few weeks.

I am so grateful to the many people who have been praying for Kagando and for me in particular over the last few days.

Sunday 27^th November

It has been a dramatic 24 hours. Yesterday there was a serious outbreak of fighting between supporters of the local king and government forces. It started with the Royal Guard as they are called attacking a number of police posts initially in Kasese 40 Kms away. It was clearly a coordinated exercise with several centres being targeted.

There was soon trouble here at Kagando mid-afternoon after the police post was attacked and a police vehicle burnt out with 3 police officers being killed. The army were here in force quite swiftly coming from their base at Bwera and a fierce fire fight broke out for a couple of hours along the road which divides the compound where the staff stay and the hospital. By about 7pm things had settled down.  Only one casualty was admitted, a 12 year old with  a gunshot wound to the abdomen. He was stable overnight and transferred to Mbarara this morning transported by an American couple who happened to end up stranded here overnight because of the fighting.

This morning at 8am it was safe to go down to the hospital where Rob Morris was already sorting out the transfer of the 12 year old. Police reinforcements arrived about an hour later and the streets were cleared of civilians to allow them to clear the burnt out vehicle and remove the casualties. The day has remained peaceful for which everyone is very grateful.

At times like this I just thank God for His love whatever may happen and the ability to keep calm and know his peace within.

Saturday 26^th November

The blog has been idle over the last week as we have been away ahead of Ann’s return to the UK with rather poor internet access for much of the time.

We were able to spend a very pleasant couple of nights away at Lake Mburo National Park. 

Sunset at Rwakobo Rock Lake Mburo

It is one of the few areas where you can walk safely as there are no Lions in the park (although there are supposed to be seventy Leopards!!) When you are able to walk like that you can get quite close to the animals especially the many Zebra and Impala and can much more easily see some of the amazing birds in the area. Even with the 6.30 am start it all adds up to a very memorable experience.

Zebra on our early morning walk

Red faced Barbet. A Lake Mburo special

Crowned Hornbill keeping his eye on us

Diederick Cuckoo. I had heard this in the past but never seen one

A Lizard Buzzard Another first

Black-Headed Weaver by Lake Mburo

One of the numerous Hippos at Lake Mburo

Ann left on Wednesday afternoon and arrived safely home the following morning after a fairly long Emirates flight. I finally made it back to Kagando on Thursday evening. We are both very grateful for safe travel over last couple of days or Journeying Mercies as they like to term it here!

Yesterday morning was spent on the wards catching up with what had been happening while we had been away.

A local prison inmate who successfully recovered from Cerebral Malaria with Samuel one of the most experienced nurses

In the afternoon I was able to number crunch some of the antibiotic resistance data from the lab at Bwera which I had been able to obtain a couple of weeks ago. It certainly confirms the data I collated a year ago but with over 480 specimen results now available, more than twice  the number I had last year, it helps to make the data rather more reliable. There does seem a gradual creep of increasing resistance to a number of the most commonly used antibiotics here which is somewhat worrying. The data also included some fresh information which will help guide the treatment of Typhoid, Dysentery and Cholera in the days ahead.