back to work...

After yesterday’s frivolity, back to ward work today – the babies generally doing well in maternity including a couple born at 28 weeks gestation each weighing about 1 kg both progressing well.

Children’s ward not too full which is encouraging but found a new admission – a girl of 12 who back in February had developed some pain and swelling above her right knee.  This progressed and later some pus was discharged.  She received “treatment” in the village which included cutting the skin around her right knee.  She was at some stage taken to another hospital but it doesn’t seem much was done.

The following month she had a pathological fracture through the infected lower right femur.  No effective treatment was received.  This may be partly due to poverty and the family being unable to afford either the cost of treatment or transport to a hospital.

She presents with a small sinus discharging on her right thigh, which is markedly swollen and angulated.  The result of her untreated fracture healing incorrectly aligned is that she has shortening of the right leg [a 6.5cm difference].

She is not in a lot of pain as the fracture has healed and is stable but she has marked deformity and would limp if she tried to walk.  She is now on intravenous antibiotics and will need these for some time to try and clear the infection which is deep seated. 

All this would have been avoided if she had been treated correctly in the first instance and it’s really sad to see such cases.  Once again there is a challenge of health education…

On a happier note, the photo of the two boys shows them enjoying lunch – a mixture of pototoes, avocado and beans!  They both have fractured femurs from falls and are being treated with skin traction using stones in an old paint tin as the weight and other paint tins utilised to tip up the foot of the bed.

===========

Hanna has unfortunately picked up some sort of cold and, very unusually for her, has spent the day in bed…   hopefully she’ll feel better tomorrow.

Draft Manuscript for a comedy drama

Location:  a remote part of a small central African country

Background:  tired group returning home late in the evening after a long trip to the capital, have sat down for a cup of tea at about 11pm and chatted for a few minutes…

Dramatis personae:  [names have been slightly changed to protect the innocent, any connection with persons living is purely coincidental…]

*   Kluless                         a housegirl

*   Eenkredulus                a matron who could not believe what she was hearing

*   Sheik Inwiv Lafter       a beautiful Dutch lady

*   Twitov Thed-Ecade     husband of the above

                                            ==================

ACT 1                          at the home of Sister Eenkredulus

Twitov Thed-Ecade:                Where is the key to our house?

Sheik Inwiv Lafter:                  I gave it to Kluless when we were leaving and she was to leave it here…

Eenkredulus:                           Well, it doesn’t seem to be here

[summons Kluless who is in a backroom sleeping]

                                                Do you know where the house key is?

Kluless [softly]:                        I lost it…

Eenkredulus [loudly]:              lost it!  What happened?

Kluless [very softly]:                it fell down the long-drop*...                 [* = pit latrine]

Eenkredulus [steam coming from ears]:       Lost down the long-drop!!!  what did you do about it?

[meanwhile Sheik Inwiv Lafter is living up to her name]

Kluless [very, very softly]:       I told my mum…

[loud explosions from Sister Eenkredulus mix with the whole room swaying caused by Sheikh Inwiv Lafter…]

ACT 2              Outside the home of Sheikh Inwiv Lafter and Twitov Thed-Ecade, about midnight, very dark all around

Twitov has managed to just slightly open a window.  By a combination of very sophisticated keyhole surgical technique principles and a metal coat-hanger obtained from Sister Eenkredulus, the latch is lifted and he is seen to clamber into the house then opening the back door and saving the day. 

The sight of this manoeuvre has set off Sheikh Inwiv Lafter, joined by Sister Eenkredulus who can now see the funny side of the whole story and with great hilarity they say goodnight, leaving the rest of the community wondering what on earth was going on.

====================

Of course, such a ridiculous story could never happen in real life…

 

could it?

====================

Safely home

Father & daughter on top of the world

We were delighted to hear that Ruth and Beth enjoyed a very good journey home and are safely back.  The house seems very quiet without them and suddenly we can find things again!  We had a great time with them and a lot of happy memories including the climb up a local hill as in the photo.

the great Kisiizi Hospital Bakery project...

The vision:
Some while before we came out on this trip to Kisiizi, we had reflected on how the spare electricity now being generated at night might be used to the benefit of the community and the hospital and we came up with the idea of setting up a bakery.  We wrote up an outline project proposal and sent it to the Management Committee here who approved a scoping exercise to see if the idea is viable.  Thanks to all the individuals who encouraged us to look into it, including members of Standon Parish Church who expressed support.

The aims include
*   providing good quality bread etc
*   helping reduce the cost of living by being competitive in price - this will secondarily help our staff and also mean our patients will not have to spend so much on food so will have more spare to pay hospital bills
*   generate a regular income to the hospital
*   provide employment for a couple of people

Finding local income-generating schemes is important to help Kisiizi be as self-sufficient as possible.  Clearly for the mid-term at least Kisiizi needs to have partnership with supporters outside the country to thrive, but the more local sustainability the better.

Contacts:
On the flight in from UK, our plane from Amsterdam stopped off at Kigali in Rwanda for about an hour before coming on to Entebbe. Ian greeted a Ugandan lady and got talking and found out that her sister is a manager of a big bakery in Kampala.  So we have been in phone contact and hope to meet with her soon.

In the meantime, he visited a new Dutch bakery in Kampala where the co-ordinator was really interested in the idea of a hospital bakery and mentioned a Dutch charity that has set up bakeries in other parts of the country with an emphasis on employing people with physical handicaps who might otherwise find it hard to gain employment.

Then on Saturday morning, after a few false starts going to places only to be told "oh yes, there was a bakery here in the past but it has moved...." we ended up talking with the manager of a very big bakery in Kampala.  This gave us some useful information and an initial financial assessment is suggesting that the project would be viable.  Still a lot to check out but a good start...

The picture shows the old grinding-mill building that we have identified as the likely location for the bakery if it goes ahead. 

Kampala

After the holiday on Wednesday at Jinja we spent Thursday experiencing the challenges of travelling in Kampala as we visited Sanyu Baby Home, an orphanage near Namirembe.  We had visited 3 years ago and Ruth was keen to go again and show Beth.

So we set off, waving down a “matatu” taxi – these are almost as numerous as the sand on the seashore it seems – they are all Toyota minibus design and seem to cope with a lot of punishment.  Ended up in the Taxi park and then found another matatu for the second leg to Namirembe.  Cost us 1000 shillings each per leg, that’s about 22pence equivalent each.  So a cheap form of transport but we had to wait a long time to get out of the taxi park for the second leg.  The traffic in Kampala is both dense and risky with hundreds of “boda-boda’s” [= motorcycle taxis where you sit on the back and pray!] cutting in and out of the traffic constantly.

We were made very welcome at the home which deals with children aged 0 – 4 years, many just abandoned.  They have 49 in the home at present and we arrived just as they were having lunch – some just milk, the older ones lined up in home made wooden highchairs in a long row, absolutely gorgeous kids, eyes as big as saucers, and a very happy atmosphere. 

Beth and Ruth helped feed some children and played with them a bit.  Ian was asked when he was going to start doing regular medical ward rounds of the children [we saw at least one child with hydrocephalus who will be getting treatment]!

Moved on to “Matoke Inn”, [matoke is the word for cooked green bananas, a staple food here which we enjoy] a guest house run by AIM [Africa Inland Mission] – it’s a peaceful place with pleasant gardens used by people going in and out of Uganda and in transit to Congo, Sudan etc so we always meet very interesting characters.  There is an American young man who has been working in a secondary school about 80 miles from Kisiizi for the past 8 months [where one of the other teachers there is a good friend of ours from our original Kisiizi days]; a Chinese couple and a Sudanese girl.  After a good meal, we set off for the airport and saw Ruth and Beth safely off.  Back through driving rain on roads without cats’ eyes and with on-coming traffic often using full-beam headlights made it a difficult and potentially hazardous trip with occasional dramatic lightning to light up everything. 

Friday spent initially looking for a PA system for the hospital – walked a lot of miles in central Kampala looking at equipment, sadly finding a lot of it was fake branded goods.  Finally purchased a set which we hope will do the job, then Ian visited a couple of places and talked to people about the idea of setting up a bakery at Kisiizi and the feasibility of such a scheme.  Generally very positive feedback, we hope to visit a bakery tomorrow.

This evening we had the joy of a reunion with special friends Edward and Enid Turitwenka with whom we worked at Kisiizi in the past.  Ian had been deputy to Edward when Edward was the Medical Superintendent.  Edward has just been appointed as lead of the ENT Department at Mulago, the Kampala teaching hospital, meaning he is effectively in charge of national ENT, a challenge and an opportunity.

So a lovely evening catching up with them.

not quite a cruise on the Nile...

For their last full day in Uganda, and to advance celebrate Ruth's 21st birthday, we took a day to go to Jinja and try out white-water rafting.

Whole range of experiences:
early start... efficient safety briefing... meeting others going rafting including Italians and Americans... training session in a calm area learning to paddle [looks easy but as you have to sit at an angle can be quite tiring]...initially totally un-co-ordinated team then gradually into some sort of rhythm ... then reached the first set of rapids - the word "awesome" is often misused but in this case fitted perfectly.  We had to walk around the first half as too risky for anyone to do.  Then back into the raft to carry on, great fun as we had a very good experienced guide and felt confident she knew what she was doing as she gave instructions.
Discovered a lot of muscles that hadn't been used for a long time!  Hard work but exhilarating.

Also some more leisurely sections to enjoy a swim, watch the local birdlife including a fish eagle lifting a fish, various cormorants, darters and later a pin-tailed whydah for those interested!

After about 25 km of river, we ended about 6 hours of enjoyable experience:  " I never in my life thought that I would do white-water rafting" said one particular Dutch member of the crew...

Then a barbeque buffet and on the shuttle back to the guest house - a day to remember.

Zebra, chilli and the Tardis...

Early start with final packing and working out how the four of us plus Anthony and all our bags could fit into Esther's little Toyota Starlet.  Then having used various principles from Houdini's reference on Contortionist tricks we succeeded - it was a bit like the Tardis seeing so much fit into so small a car.  We then set off wondering if we would negotiate the rugged road but blessed by a parting prayer from Esther we found it did very well.  It took 1 hour 20 minutes to reach Rubaale on the murram road, a distance of 18 miles, but then much better on the tarmac, albeit broken in places.

We were blessed to see three zebra close to the road as we skirted the Lake Mburo National Park between Mbarara and Masaka, they looked healthy and the markings were beautiful.

Stopped for a break in Masaka and smiled as the TV in the background was showing Man U vs Spurs!  Premier league football seems very popular in Uganda and in Kisiizi too.  We had laughed before leaving UK at the response to our question "is there anything the hospital needs us to bring" when the first response [yes, from Dr Francis!] was "footballs please!".

Over the equator back into the northern hemisphere, on past people holding up fresh tilapia caught in nearby Lake Victoria, on where the road is being worked on, then finally into the outskirts of Kampala.  Journey time around 9 hours including breaks to that point.

Round the northern bypass then on very broken road into east Kampala to the Red Chilli guest house where we had booked a small "cottage".  It's a place mainly used by tourists so a very odd feeling after living in Kisiizi.  Also odd that many people here don't understand Rukiga if we try and speak it.

So here we are, power is on at present [it gets rationed on a rota basis in Kampala] and linked to the internet via an Orange dongle.
Tomorrow we hope to go to Jinja and see the Nile with the girls. 

SHOCKED!

Shocked on admission, having iv fluids infused

*          Shocked due to severe gastro-enteritis, present for 48 hours, this little boy was on the verge of death.  His pulse was fast and thready, his skin elasticity had gone, and his eyes were sunken.  He was labouring to breath and semi-conscious.

improving after a couple of hours

He was treated with intravenous saline and then maintenance fluids.  Initially he continued to vomit but then started to settle.

*          Shocked that a child came in with a very swollen  right side of face  all due to a neglected dental abscess.  Shocked that in a world where we can unravel the human genome, perform extraordinary keyhole surgery, successfully transplant major body organs we can’t ensure the children of the world get basic dental care [photo not suitable for a non-medical audience]

*          Shocked that children still arrive having been to traditional healers and being subjected to cuts / scarification of the skin as in the photo.  This “treatment” is called “oburu” which means millet and the parents are told the cause of the child’s cough or difficulty in breathing is millet and they offer “millet extraction” to cure it.  In the photo the yellow arrows point to the areas of cuts done in the village in this child who actually has pneumonia and heart failure.

Even more serious is a practice known as “ebiino” where, usually in children with diarrhoea, the “healer” will dig around in the young child’s gums and extract an un-erupted tooth and hold it up saying it is a type of worm.  As most children with diarrhoea recover spontaneously it seems the healer has been successful in many cases so the practice is perpetuated.  Sadly in some children the procedure may lead to haemorrhage, sepsis and sometimes death.

We used to have a fairly comprehensive community health programme at Kisiizi supported by Tear Fund for many years.  We also had “eye safaris” where outreach teams took eye screening and care out to remote areas.  This work was supported by CBM, again for many years.  However these programmes were discontinued when funding ceased.  The main challenge is the cost of transport.

We do still have regular outreach clinics taking immunisation, child welfare basic screening, ante-natal screening and psychiatry and there is support for HIV patients through our Hope Ministries programme which includes the support of many orphans. 

Seeing the above patients makes us very keen to see a lot more health promotion, public health education etc to try and avoid such issues.

We are working on a draft strategy document to submit to Management for discussion to try and produce a 5 year plan with agreed priorities.  We think the community and health education dimensions are every important and will certainly include these in the proposals.

Travelling on...

Tomorrow (Tuesday) we intend to set off early for Kampala.   

Sister Esther has very kindly lent us her little car and we will travel together with her nephew Anthony who needs to go back.   

We hope to spend Wednesday at Jinja on the Nile then on Thursday would like to visit a children’s home / orphanage in Kampala before the girls fly out that evening to Amsterdam then on to Manchester.

Meanwhile we send love and hugs to Ian's mum who celebrates her birthday tomorrow after a most eventful year!  HAPPY BIRTHDAY MUM!

Night round

At around 9pm we reviewed a couple of neonates.  Dr Francis had been called out of the morning service to attend to a lady with a “face presentation” where the baby’s head had not flexed properly for delivery.

Hanna went up to check how things were going and noted another baby having fits.  Sadly this was a case of prolonged labour where the baby had required resuscitation.  Hanna gave the baby intravenous phenobarbitone with some benefit but there was still some abnormal movement so a dose of diazepam was administered.  On review the baby is much more settled, on fluid restriction and covered with antibiotics.

Whilst reviewing this baby we noted a new admission baby having oxygen.  We were able to take the baby out of oxygen having checked the oxygen saturation.  This measurement is a really useful assessment that has become completely routine in UK.

In the photo Ian is using a new portable oxygen saturation monitor purchased with generous donations from colleagues at Macclesfield District General Hospital paediatric and neonatal units.  We are very grateful for this support.  Hanna has arranged for our carpenters to make a small box to house the monitor to provide support for the connection between the sensor wire and the monitor itself.  This junction can be easily damaged with frequent use making the device unusable which would be very frustrating. 

The photo also shows an oxygen concentrator which provides a flow of about 92% oxygen.  This equipment is very appropriate here as it only needs room air and electricity and can run for years.  The alternative of cylinder oxygen is both expensive and impractical.  Cylinders have to be obtained in Kampala which is a long trip, and don’t last long anyway.

You will also notice a couple of incubators in the photo.  Generally its better to keep babies with their mums and to use an approach called "kangaroo care".  However the advantage in this situation with incubators is to have the babies visible so their condition can be monitored easily. These incubators are situated in what is really a corridor so a fairly limited space.  At some time in the future we hope for a proper special care baby unit layout.

However, the challenge of maintenance applies to all these devices and the Hospital Management are looking at how to improve this.

Trouble and Joy...

Sunday 21^st August:  oh dear… the morning after the night before… not a hangover but some of the party who had been to the wedding including Ian experienced hyper-peristalsis!  If you have heard the term “the runs” this was the Ussain Bolt version!  Thankfully now subsiding…

On a brighter note, we had an unexpected visit from our “daughter” Joy who had lived with us all those years ago.  She originally came to us from a village background to help as a house-girl.  This arrangement is part of life here where there are very limited cooking facilities and no washing machines or supermarkets, so the normal household chores take a long time to complete.  The choice is therefore either to work part-time or to employ someone like Joy to help.  We were both working flat out in our hospital jobs so it was ideal to have support from Joy who learnt rapidly how to cope with new experiences like taps for water, door handles, electricity and light switches etc.

When Mark arrived she often looked after him and still has a soft spot for him after all these years.

Later when Ruth came along, we had a second girl, Peace, to help.  Peace has actually been helping us this trip though will now be moving to help a new couple, Kate and Ian who have just arrived.

So we always had joy and peace in our household!

Joy came with her children complete with their school reports to show us their progress.  Hanna realised Joy was having problems reading and went and found her spare pair of reading glasses – suddenly there were whoops of joy as for the first time for ages Joy could again read. 

She is from a very poor background and is faithfully supporting her mother who is quite old and has reduced mobility.  Joy is also caring for her children and has a key role in her local church.  She grows potatoes, millet and sorghum on the small piece of land around their home but hasn’t any other real source of income.  So she had no easy way of getting her eyes tested and paying for glasses.  Little do Tescos realise how much joy a pair of their simple reading glasses can bring!

Knock on the door and two new medical students arrived, bringing 2 models of pelvis / birth canal for the School of Nursing that Hanna had organised for them to bring.

Later another visitor appeared, Ziony, bringing two lovely bags she had made for Ruth and Beth.  She has developed a number of crafts to earn her income and set aside some starting capital for further business ventures.

Now we are planning the week ahead as Ruth and Beth will fly back to UK on Thursday night from Entebbe via Amsterdam so we’ll be travelling up to Kampala this week.

Wedding celebrations

Saturday morning:  A group of us from Kisiizi set off to Rukungiri, the nearest significant town, about 75 minutes drive to the north.  The last section of the journey is on tarmac which is bliss after a very rough murram [gravel put onto the underlying earth and occasionally flattened by a “grader” but very quickly rutted when rains come] road.  Only 9 on the way and 11 on the way back.  The group included Edson, who is in charge of IT services at Kisiizi and also teaches IT for the primary school and to hospital staff.  Margaret, a comprehensive nurse whom we know from our original time here also came as did Sister Esther, the Principal Nursing Officer.  When we arrived at Rukungiri we met up with Anthony and Judith, a nephew and niece of Esther.  They had  travelled on the overnight bus from Kampala for the wedding and to meet up with us – Mark and Ruth are very close friends with them from previous visits to Kisiizi.

Arrived at the Cathedral, built with brick and iron sheet roof, to find a previous wedding just finishing and to be greeted by one of the guests attending it, a friend from years ago, Eric Kamuteera.  He worked as a Development Officer in the diocese when we were here decades ago so good to see him again.

Also met up with Dr Shek and Peace Matsiko who had recently arrived from UK for the wedding of Peace’s brother, the son of the late Bishop Ruhindi, who had been the Bishop when we were here.

Then it was our turn,  and we went into the cathedral and a very good minister conducted the service.  He was an excellent speaker, and had a very personal touch for Medius and Aggrey. [pronounced Ag-ray].  

[It was strange to sit in the Cathedral again, we remember being there way back in 1988 when Hanna was expecting Mark.  We had been invited by Bishop Ruhindi to speak at the Diocesan Synod quiet day, turned out to be an audience of about 200 clergy so quite an honour... we had stayed in the Bishop's house and as Hanna was pregnant he insisted on her being driven the 200 meters to the cathedral!]

  Then the inevitable photos outside before we discovered a Ugandan tradition of driving in convoy, peeping horns, throughout the town to celebrate the marriage and to make sure everyone knows about it.  At first I thought there were a lot of potholes but then realised the cars in front were just weaving about the road deliberately in a kind of dance!

At the Groom’s family home we had a buffet meal and sodas [interesting to note that no alcohol seen at any stage of the day] before walking up a small road to an open area where tents had been erected and a large crowd of local people had gathered.  We were treated as celebrities which was very touching.  Esther spoke for the hospital and then called Ian up to “say a few words”.  The winning combination of a big smile while trying with limited success to say a few sentences in Rukiga produced a mix of appreciative cheers and laughs.  The best man speech seemed fairly tame but the highlight was the groom’s response.  He got through the first phrase without too much difficulty and then was overcome with emotion as he started to thank his parents and was so grateful for his new wife.  It was very touching as she put a comforting arm around him.

A lovely celebration, a lot of happiness, a real community. 

We then drove back in the dark, pausing a moment to stop away from any lights to marvel at the heavens – the milky way and constellations clear in the sky above without the background light pollution we find at home.  Puts it all in perspective “when I survey the heavens, the work of your fingers, the moon and stars which you have set in place, what is man that you are mindful of him, the son of man that you care for him?” Psalm 8:3,4

Safely home, tired but content.

HAPPY BIRTHDAY MARK!

Our very special son Mark was unable to join us on this trip though hopes to visit Kisiizi again in the not too distant future.    He seemed somewhat envious of the safari trip...  We celebrate his birthday today, Saturday 20th August.

He is working for a PhD in Reading having completed a Masters in Chemistry at Oxford and seems to be really enjoying the [incomprehensible to most of us] minutiae of crystallography.  As the course has included a jamboree conference in Sicily with all the world experts and he has already got a paper accepted for publication, it seems to be going very well.  His other interests include krav maga and drumming.

Mark, we all send you our love and look forward to seeing you soon... 

Oh, what a giveaway!

After working on the wards after Staff prayers we rushed home to change and get ready to go with a group of staff to attend a “give-away” ceremony for a staff nurse called Medius. 

Ian was asked to drive but didn’t realize quite how remote the location proved to be.  In places there was literally just a path, in others so narrow we could only just get through with the wing mirrors folded, and very rugged.  Happily we had a fairly modern Toyota land-cruiser, (with 12 of us in it!) and it coped well.  Doing the journey back in the dark proved even more interesting.  The girls will find Alton Towers very tame by comparison now.

The “Give-away” is a tradition which takes place at the Bride’s family home.  Her family, relatives and friends gather first and eat and then later the Groom’s family arrive and are welcomed and they eat.  [Very good local food eaten by hand included “oburu” which is millet bread served in special baskets, quite tasty.  Also some fairly lethal white sauce (a local delicacy) that masquerades as mayonnaise but tastes like a very ripe Stilton mixed with beef… gave that a miss! ] Then eventually the Bride appears preceded by her “maids of honour”. The Bride will give presents to certain people in appreciation [we received a lovely woven basket and a cake!] and is introduced to the Groom’s family.  There are a whole range of speeches, fairly informal, but with two MC’s and loud microphones competing with a DJ! 

We have known Medius for many years [she was in the same school class as Mark when we lived here] and were able to help support the cost of her further training as a registered nurse so it was lovely to be able to attend.  Tomorrow we’ll go to the wedding itself in Rukungiri.  She is marrying Aggrey, also a registered nurse.  Ruth and Beth were invited to be “maids of honour” with other Kisiizi staff so were dressed up in traditional style and coped very well with it all in spite of having absolutely no idea whatsoever as to what was being said!

We enjoyed meeting a number of old friends who attended.  We were also warmly greeted by a man who said he wasn’t sure if it was “Dr Iany” until he saw me walk!  Apparently we had looked after his son when aged one with severe measles and coma, presumably encephalitis.  Happily he did well and is now a graduate.

It is, of course, a well known fact that Uganda is in a time warp.  This explains the common phenomenon that any resemblance of actual timings to planned timetables is purely coincidental.  So having originally intended to be back by 6pm in daylight, we didn’t actually set off until 8pm…. But a good time was had by all and hopefully the Bride and Groom will not be too exhausted at the wedding service tomorrow.  There were a good number of Kisiizi staff who made the effort to attend.  Such events help bond the team-spirit as well as representing the hospital to the community.

So safely home, grateful for answered prayers that the threatened rain did not materialise as it would have made it so difficult.

Ian and Hanna

Thursday

Ruth and Beth had a good time going out with the Rehabilitation team on a community visit. There were a range of adults and children including some with cerebral palsy and special needs.

Hanna taught in the School of Nursing as well as some midwifery.

Ian reviewed some neonates and then did the Children's ward round, didn't get back for lunch until 3pm due to a case of meningitis being admitted fitting.

We are pleased that quite a number of people are following this blog, varying from Beth's grandmother [Hello!] to some of our colleagues at Macclesfield District Hospital and many members of our church in Macclesfield as well as family.  So I have added a Medical posting below for those interested...

Ian and Hanna

Children's Ward round Thursday

[SKIP THIS POST IF YOU ARE NOT MEDICAL!]

Patients on the round today include
*  a 1 month baby presenting with an extensive florid rash with some open sores, flaking of the soles of the feet, nasal congestion but not bleeding, diarrhoea.  Mother had history of perineal lesions herself and loss of a previous pregnancy.  Ix confirm congenital syphilis.  Improving with benzyl penicillin 10 day course, topical gentian violet to sores.  Mum now improving with treatment herself.

* a 3 month infant with a persistent cough who had received all sorts of treatment in the community.  On examination has clear  paroxysmal cough and fine in-between.  Clinically pertussis. Covering with erythromycin.

*  a very heartbreaking 3 year old who was admitted very dyspnoeic due to gross ascites splinting her diaphragm.  Terribly wasted. Clinically some relief after insertion of drain.  Had been on TB Rx for 2 months but clearly not helping.  Scan seems to show a mass. Probable malignancy but not clear type.  ? retro-peritoneal.  Has had a transfusion as so anaemic and looks a bit better.  May be having exploratory laparotomy.  Parents probably can't afford the cost of that so are meeting with our Principal Nursing Officer Sister Esther to discuss help from the Good Samaritan fund that supports patients who cannot afford their treatment.

*  a 6 year old admitted semi-conscious.  Previously had "meningitis" aged 1 and subsequent right sided weakness esp arm.  Has some spasticity right side and up going plantar.  Now increased neck stiffness and proceded to fit.  Settled with diazepam.  Fundi ok [ophthalmoscope a bit faint but got there with perseverance!]  Wanted to give dexamethasone, found 4mg but that was all so gave that and then on-going hydrocortisone in equivalent potency doses as that's all we have in pharmacy so hope it helps.  We do have some ceftriaxone so using that.  Haven't LP'd yet as too unwell.  Prob meningitis, but is covered with quinine for cerebral malaria just in case while we wait for tests which should have been sent "urgent" but appear not to have been labelled as such so not back until Friday am!

*  a few young children with gastro-enteritis, prob viral

* a few pneumonia cases including a couple of neonates

*  an infant with florid herpetic gingivo-stomatitis in a great deal of discomfort, doing well with good old gentian violet and aciclovir plus analgesia

* a 10 year old girl with severe diarrhoea and abdo pain, stool giarida +++.  On anti-retroviral Rx and prophylactic co-trimoxazole since 2005.

*  an 8 yr old boy one day post-op laparotomy - found 2 perforations due to typhoid.  Disappointing as he had been in for the previous 3 days on typhoid antibiotics but clearly we caught it too late.

* a 6 year old boy one day post-op laparotomy for a traumatic wound when fell off bicycle.  Intestines were exposed through the wound.

*  Malnutrition kwashiorkor child with diarrhoea and possible lactose intolerance, hopefully secondary


*  a lad with burns - we are trying to sort out adequate analgesia for his dressing changes and use ketamine

*  a lad with a fractured femur going home today on crutches made in the workshop

Last week we had a child with probable Down's not previously diagnosed, aged 2.  So a wide range of cases and a fast turn-over.

We have oxygen concentrators but maintenance not very good - we are encouraging this.  I was able to get one working once I found a spare part in the stores that they didn't seem to know was there...

Nurses generally very good and will put in cannuale etc often.

24 hour safari...

After ward rounds yesterday morning, after lunch [matoke (cooked green bananas), dodo (spinach) and G-nut sauce (purple sauce from non-roasted peanuts)] we "escaped" for a 24 hour break leaving about 3.30pm.  We hired a hospital vehicle and headed off, no maps available and, although Kisiizi is now on Google Earth [see link] it has hardly any detail on the map for this region.  So we relied on a mix of a prayer on departure and our Rukiga asking local people from time to time to check we were on the right way "omuhanda gwa Ishasha - ahamaisho?" etc.  We always produce a lot of incredulity and smiles when we speak Rukiga!  And of course, all along the route the children yell out "Abazungu!!!" [Europeans] and get very excited to have spotted these rare specimens...

Some sections of the road initially quite muddy and slippery but then improved.  Over hills to Kihihi and then about 5.30pm we were on the last section to the southern part of the Queen Elizabeth National Park at Ishasha which is right up against the Congo border. Saw a troop of monkeys in a tree, then Uganda kob and topi [varieties of antelope].  We purchased our tickets at the park entrance and had about an hour driving on the local tracks, seeing buffalo and a mix of birds including crested cranes and eagles all with the backdrop of the Rwenzori mountains behind.
On the way out of the park we caught sight of a group of elephants and managed to drive quite close to them - majestic creatures.

As there were no huts available for hire at the park, we went back about 20 min to a hotel for the night and then got up fairly promptly and headed back to the park at about 7.20am.  We were rewarded by a lot of special sightings - a hyena, which we have never seen before, walked across the road in front of us!  Bigger than we realised.
Then in the park itself we saw another hyena with a kill, possibly left over from lions.  The hyena was alone apart from some vultures.  Quite a rare sighting.
Then almost straight away 3 elephants enjoying stripping leaves off a tree that they had pushed over.  [see photos]

We then went on to the Ranger office and got a guide who proved excellent.  We drove down to the river and saw hippos, baboons and some rare birds [black bee eaters if anyone is interested] on the other bank in Congo.
Later we searched for the famous tree-climbing lions, visiting the big old fig trees but to no avail initially.  However, after a while, there they were!  Two fast asleep in a tree, clearly tired after a night of hunting, and looking content and well fed, so a real treat.

So we were greatly blessed to see so many lovely animals, in a location with very few tourists.  We have been to the park in the past and not seen the lions.  [I like the story from years ago of the missionaries who went there and failed to find any lions and just had a picnic and came home.  A few weeks later when they had their photos developed {pre-digital era!} there were lions in the tree behind them!]


A safe journey home and now a cup of tea and catching up with messages etc. Ruth and Beth are nursing aching index fingers from pressing their camera buttons so many times in 24 hours!
It has been a wonderful break which we were ready for.

Again thanks to those of you who have been in touch.  Much appreciated.

Ian and Hanna

once more unto the breech dear friends...

The old jokes still work -- Hanna, conveniently O Negative, gave some blood this morning to help a baby with severe anaemia and a mother with clotting problems following post-partum haemorrhage; the midwives were laughing that the recipients' hair was already looking straighter...
Hanna also did a breech delivery with Dr Francis this am and resuscitated the baby all before coffee!

As well as ward rounds we spent some useful time talking with Dr Tonny Tumwesigye, the Medical Superintendent, recently returned from a visit to UK.  We discussed various aspects of Kisiizi life and the liaison with Friends of Kisiizi.

Eric, now a Tutor in the Nurse Training School, who had been here when we lived in Kisiizi, gave us the photo of his son's twins born in Kabale and now in Mulago Hospital, Kampala.  They are conjoined and have been undergoing tests to work out which organs are shared etc and what prospects there are for separation. They seem to be growing and staying quite well so far so please pray for the medical team to have discernment in the right course of action.

Ian and Hanna

Visting time...

After the 9am service where Ian spoke to a full chapel [the moving stories of the lost sheep, lost coin and lost son...Luke 15 interspersed with anecdotes of patients with dislocated jaws etc - I'll explain it when we're home!] it has been a very enjoyable day of visits. 

Jasper, a nurse Hanna helped to train decades ago, came - she is still faithfully serving in Kisiizi.

Then a group of UK medical students here on elective came after the service for coffee and home made cake before they, together with Ruth and Beth, walked up the hills and visited a small local orphans home and played games with the children.

This evening we had a lovely meal at Nancy's home together with her [young adult] children so a lot of memories and laughs and delicious bakiga food.

At the bottom of the blog we have added some photos taken today of some of the plants/trees here - so much beauty to enjoy as well as the challenges.

back to work tomorrow...

Ian and Hanna

Sports & recreation

After fairly steady and welcome rain last night and this morning it cleared and the school playing fields became the arena for football, netball and volleyball matches with crowd volume to match Wembley!  Great enthusiasm and fun had by all.

Later in the evening in the school hall we found another group watching Arsenal on Match of the Day satellite tv on a tiny screen, again with great enthusiasm.

 We enjoyed a lovely meal with Gabriel [the Kisiizi Surgical Consultant] and his wife Maureen who came with their two small boys.  It's good to start to get to know more people here.  Other visitors include Medius, one of our nurses, who is getting married next weekend and has invited Ruth and Beth to be "maids of honour" at the "Give away" ceremony which will be the day before the wedding itself. 

Our water is all running again which we greatly appreciate and so far no power cuts this evening.  The internet link seems fine so we enjoyed a skype chat with my sister Claire in Australia, Hanna's father and sister in Holland and Mark in UK - amazing to have such links when we recall in the past being here with no communication with the outside world at all.

Variety

Ruth and Beth went to a small primary school in the community this am and had a wildly enthusiastic welcome.  European visitors are infrequent there compared to Kisiizi so their time was much appreciated.

Hanna had a trip to Kabale with Esther, our Principal Nursing Officer, and did some shopping for essentials so we are stocked up for a while.  The trip takes around an hour and a half each way.  After return she helped again on Maternity - six caesarian sections this evening!

Ian did the round on Children's ward again with two UK elective students and Ugandan nurse trainees and a clinical officer - the usual mixture of sad cases [e.g. a one month baby coming in with gastro-enteritis, anaemia, wasting having lost her mother straight after delivery in the village with haemorrhage - now being looked after by grandmother who is giving the child normal cow's milk as there is no infant formula easily available and when it is it is orders of magnitude too expensive for such a family to afford] and on the other hand sending home youngsters who are feeling better - if you scroll down to the bottom of this blog you will see photos I took today of the lad with nephrotic syndrome who came in with very swollen eyes and is now improving.  Mind you, we don't yet know if the underlying problem with his kidneys is settling but we will review him as an out-patient next week and meanwhile he is on high dose steroids, diuretics and prophylactic penicillin.

I have included some other snaps of children on the ward to give you some insight into these lovely people who put up with so much.

Hanna has just videoed a teaching session on obstetric emergencies given by Helen Smith so it can be made available for others to benefit from in future.

We met with members of the Management Committee to discuss some issues including medical equipment and maintenance and clinical governance issues.

On the way back later spotted the crested cranes, magnificent birds [as on the national flag of Uganda] plus the less striking but interesting hammerkop.  The most colourful local bird we have spotted is Ross' turaco which has a deep red/maroon flash of wing when it flies.

So life remains varied and interesting.  Thanks for your messages which we appreciate.

warm greetings

Ian and Hanna

Thanksgiving...

We started today with a special service replacing our normal Staff Prayers at 8am.  This was to coincide with the Thanksgiving service for Jamie, the little boy who had become unwell and died after transfer to Nairobi, being held today in UK.  The vicar conducting the Thanksgiving had emailed out a copy of the order of service to Kisiizi so we used some of the same passages and songs.  Nancy spoke a little about the mental health service that the family had come to Uganda to support and of how touched she was that they are setting up a foundation in Jamie's memory to help raise support for the Mental Health Unit.  Various members of Staff read passages and prayed for the family and Ian gave a short talk.  It was a time of mixed emotions, great sadness at the loss and yet hope that comes from an eternal perspective.

We are happy to welcome new Interns to Kisiizi.  This is possible as we now have accredited Consultant level staff:  Francis in Obstetrics & Gynaecology and Gabriel in Surgery.  So we welcome Albert and Onesimus for six months, they will rotate between the two specialties.

Another cause for thanksgiving for Ian was going on the ward round this am and finding a child he had seen in extremis with severe heart failure looking so much better.  He had arrived exhausted, with a very fast heart rate, congested lungs, grunting respiration and a big liver all related to heart failure and today looks a different child - we had expected that it was very likely the child would die in the night so lovely to see the turn around today.

Our youngster with nephrotic syndrome [see previous blog] is making progress, his weight dropping as the excess fluid starts to reduce, so we pray that the steroids he is having in big doses will stop the protein leaking from his kidneys.

Ruth and Beth spoke at the last day of term in the Primary School assembly and then Ruth did a presentation to the teachers on Autistic Spectrum Disorders, an area they have not really focussed on before.  They received the talk warmly and have started to catch a vision for some sort of focus on special-needs children in future, perhaps eventually setting up some sort of centre here not only to help such children but also to train other teachers from schools in the region to better care for these special pupils.

Challenges continue - today we have no water in the house, due to a broken pipe supply.  3 power cuts yesterday evening, not sure why, all only brief though.  But we still have so much compared to many in our community who often, through it all, continue to be thankful.

Ian's vision seems to have fully recovered so again we are really thankful.

Press on!


Ian and Hanna

Meetings...

Today we had the privilege and joy of meeting up with our newly-appointed Bishop, Patrick, in Rukungiri which is about an hour's drive away, mostly on murram roads.  It proved a really encouraging meeting discussing a number of aspects of life at Kisiizi.  It is a key time in the life of Kisiizi with many significant changes anticipated so we pray that the opportunities will be taken to move things forward positively.  We will be having various meetings about strategic plans for the future.

We enjoyed stopping in a river valley for 15 minutes on the way home to look at the hot springs and watch a few of the local birds.  We could hear but not see monkeys nearby.

This afternoon we met with Dr Denise who is a physician and heads up the HIV work here.  She is also the co-ordinator of the medical student electives together with Grace Iga who is an Orthopaedic Officer.  We discussed how to maximise the benefit of the electives for both Ugandan and ex-patriate students.

Ruth and Beth have developed a reputation for teaching enthusiastic PE classes and Ruth will be giving a presentation on Autistic Spectrum issues tomorrow as this is an area that is not really appreciated here at present.

The man admitted yesterday with shackles has now had them removed and has commenced his medication.

Ian and Hanna

new admissions...

Over the past few years the mental health services at Kisiizi have developed and are led by Nancy Mwebesa.  A new patient arrived today in shackles, put on in the community as he was out of control and they didn't know what else to do.  Hopefully with compassion and good psychiatric care he will improve but will certainly be out of his shackles.

It's heart breaking to see children with malnutrition. A child with bad kwashiorkor protein-energy malnutrition has been admitted with swelling of the legs, changes to the skin and general malaise and misery, together with infection.  Some of these children have TB or HIV infections.  We do now have effective medicines to treat TB and the anti-retroviral drugs are making a big difference to HIV management but it is still a challenging task with the children very vulnerable to infections.

Hanna is teaching in the School of Nursing today whilst Ruth and Beth continue to help in the primary school.

Dr Tonny Tumwesigye, the Medical Superintendent, has arrived back safely after his trip to UK.

We are pleased that two new interns are starting with Kisiizi. This can happen as we have recognised Consultant level specialists - Francis in Obstetrics and Gynaecology and Gabriel in Surgery.

thanks to all who have fed back comments, its good to hear from you.

Ian and Hanna

Gloria!

The highlight of today is that at around 9.45am Confidence Banya delivered a baby girl assisted by Dr Helen Smith and Hanna.  Mother and baby doing well - praise God.  Francis is of course absolutely over the moon.

Alan Smith and Ian had a valuable meeting with Moses Mugume, Hospital Administrator, discussing various plans and liaison matters.

Alan and Helen, together with ourselves, are due to meet the new Bishop in Rukungiri on Wednesday morning at 9am so we look forward to that time.  We had met him [Bishop Patrick] right back in 1988 early in our time here when he was Diocesan Secretary.

Ian attended a "Knowledge Centre" meeting organised by one of the Staff.  This is effectively a forum for discussion on a range of issues.  There were about 40 people there to discuss the topic "dealing with corruption - from grass roots up" and after a slow start it warmed up well.

Thanks to those of you who have sent us email feedback from this blog and for all the prayers and messages of support we are receiving.

Ian and Hanna

breathing space...

In addition to the work side of life we have found some time for other things - one was an impromptu party Dr Francis Banya organised last minute for his wife Confidence for her birthday... he was operating at 6pm and suddenly the thought came to him to organise something so he ran around making arrangements and at about 10pm Confidence returned to what she thought was an empty home to be greeted with cries of "Surprise! Happy Birthday!" and a cake, samosas [the local guy who pushes a trolley around selling them must have thought Christmas had come!] and soda etc and a good time was had by all.  Lovely to see Francis and Confidence so happy and expecting a baby.

Thursday evening had a good "English language Bible study" in the evening, led by the hospital occupational therapist, and then enjoyed a visit from Moses [hospital administrator] and Josephine [paediatrician who has nearly completed her specialist paediatric training in Kampala] on Friday evening, so good to see them and catch up a bit.

Had a relatively relaxing day yesterday [Saturday] though Hanna did go in to help a while on Maternity.

Very pleased to meet up with Alan and Helen Smith with their son Callum and his fiance Emily together with a friend Catherine who have just arrived from UK.  They are here visiting for a week.  Helen set up the Sponsor a Nurse charity, now re-named Kisiizi Partners, that has done so much to raise support for Kisiizi.  Good to see them and to start discussing various aspects of life in Kisiizi.

Today we will be going out to a church in Ndago about 3 or 4 miles from here with the hospital driver, Augustine Tusingwire.  He is also a pastor of the church and has invited Ian to preach.  None of the brief UK type sermons of 15 minutes here, usually more like 40 minutes within the context of quite a long service.  We hope to be an encouragement - most people are subsistence farmers and life is very tough with no safety nets of free NHS or pensions or social security etc to fall back on.  And yet, in the face of much challenge we often find people with a contentment and joy as they face each day with faith.

Tomorrow we will be involved in some Management Committee discussions and hope to be able to help guide some key reviews of strategy and planning for the future.

Economic pressures:
One of the key issues at the moment is the inflation which is currently running at 18% in Uganda.  In the past few days the cost of basics has shot up, e.g. a kilo of sugar was 5,000 USh last week, now 7,000USh, rapidly becoming an unaffordable luxury for most.
Not only is this a serious concern to our patients, but also to the staff and to the hospital  - somehow the books need to balance... and the pressure to increase salaries to cope with the raising costs of living will become more acute as the prices shoot up higher and higher..
The majority of our patients are subsistence farmers who can ill afford any unexpected expense, leave alone drastic increases in school fees or hospital bills.


Ruth and Beth are aching this morning having gone with some of the medical students here on their electives on a long walk over the hills to a little lake.  [mad dogs and Englishmen out in the mid-day sun!]

Do have a look at the link we have added on the right to the updated Google Earth satellite view of Kisiizi - the previous one had been disappointing as just showed cloud but now they seem to have done a high-definition sequence which includes Kisiizi so you can see the hospital buildings and layout - amazing!

Ian and Hanna

Activities...

Clinical work:
Medically Hanna has been very busy on Maternity which is overcrowded.  It is hoped to move some lower risk patients to another area to relieve the pressure which is partly due to Kisiizi having a good reputation and people choosing K rather than other hospitals. Current delivery rate about 2500 a year but a higher rate of abnormal pregnancies as a lot of mothers will still try and deliver at home.

Hanna is also teaching in the Nurse Training School.

Ian has been doing ward rounds on children's ward and seeing neonates.  A wide range of pathology as well as the common cases of pneumonia and some malaria.  One lad came in with grossly swollen eyes so he could not see plus fluid in his lungs and abdomen due to nephrotic syndrome.  Another child has a fever and arthritis due to brucellosis.  Sadly still seeing malnutrition, TB and HIV.

He has also done some medical teaching using some of the material from the Developing Health course.  There are a lot of UK medical students visiting on their electives.


Ian spoke in Staff prayers yesterday and is preaching at one of the local churches tomorrow so it is good to have these opportunities and also to be involved in some of the Management discussions re planning for the future of Kisiizi.


Ian developed a problem with vision in his right eye with a central scotoma and some blurring.  Having stopped his doxycycline malaria prophylaxis it seems to be improving for which we are very grateful.

We have had a very warm welcome from the Kisiizi community and we are now settling in to a more normal programme after what has indeed been a very stormy start to this visit.  Thanks to all of you who have sent messages of encouragement and prayers for our time here, much appreciated.

Ruth and Beth have been enjoying teaching in the primary school and have also been out on trips with some of the medical students and have come on ward rounds to see something of the clinical side of the hospital's work too.

They will travel back to UK in about 3 weeks so we will go up to Kampala to take them.  We hope to get a bit of time to go to a game park and maybe visit the Nile and perhaps do some whitewater rafting....

Stormy start...

Having had a very good time helping at the Developing Health course in north London for almost a fortnight, we traveled up to Derbyshire for the start of our church weekend and enjoyed the sessions that evening and the next morning on the topic "facing our giants".

Wedding of the year:
  Then on the Sunday down to the south coast ready for Ian's mother's wedding to Peter the following day.  Quite an occasion with a gathering of the clans including Ian's brother and family from France and his youngest sister who had flown across from Australia.  Ruth joined us to travel down from Macclesfield and Mark managed to get to the wedding so it was lovely to all be together again.  Ian had the unusual task of giving away his mum and then speaking in the service as well as doing a modified "father of the bride" speech at the reception.

The expedition begins:
We then traveled back late and due to the joys of the M6 were not back until 4am on the Tuesday morning.
Managed to get all the packing done, Hanna having a huge amount of last minute liaison regarding equipment for the hospital, and finally off to Manchester airport with Ruth and her friend Beth plus a huge amount of luggage.... Manchester airport was in beautiful sunshine, said goodbye and thanks to the lady who had kindly given us a lift in her large people carrier only to discover the flight to Amsterdam had been cancelled due to terrible thunderstorms in Holland!
So then had to organise trips to go home again, then up at 2.30am to do two trips back to the airport to catch the first flight out to Amsterdam.  We successfully boarded our main flight to Entebbe via Kigali.  Arrived safely but slightly late to find our lift had not materialised so had to get a local taxi to the guest house we had booked.
Up early the next day [Saturday] to set off on the 7 hour journey to Kisiizi.  Main road now has some quite good stretches which is good and work going on in other sections.
Past the equator into the southern hemisphere, down to Masaka, on to Mbarara and then onward on the road towards Kabale, turning off at Rubaale onto the rough "murram" dirt road to Kisiizi for the final 18 miles.

Arrived in daylight and started unloading our things.  Staying in a lovely little house set up by George and Doreen Wadsworth in a peaceful far corner of the hospital land.


Not long after we arrived Ian was asked to see a little 4 year old boy of a visiting family from UK who were helping raise support for the Kisiizi mental health programme.  Sadly he had been unwell since arriving in K a couple of days earlier and had a very serious infection.  In spite of intra-venous fluids and antibiotics he was deteriorating the following day and we had to give him a blood transfusion and then transported him all the way up to a Kampala hospital on the Sunday night, a 7-8 hour journey. Thankfully he tolerated the journey surprisingly well.  The team there ran further tests and he was then airlifted to Nairobi the same morning and treated in intensive care but tragically a week or so later died.  All the team here had been brilliant in the support and care given and it highlighted to us the difference in available resources for treating such a condition here compared to UK.

More storms:
The following week included other challenges including power cuts and then a very unusual severe thunderstorm which led to one person being killed by lightning on the hills in the area and others injured and some cattle dying.  The main new hydro-electric generator here was damaged by lightning which burnt out a circuit board and a transformer was also affected.  Thankfully with help from Charles Swainson who was in Uganda on a break from his current project in Rwanda, the power is now fully operational again.  Whilst it was off the hospital itself continued with the old hydro-electric generator but the residences and the community power was lost.

Internet has also been erratic, hence the delay in being able to put together this blog, but there is hope some changes in the next week will help improve its reliability.

We are so grateful for all the prayers and support we have received

Ian and Hanna