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...