16/02/07
It's Friday evening of my first quiet week here! Having worked Monday and Tuesday, I was able to take the last couple of days off, and am almost feeling human again! Just to illustrate how life here in Uganda can be frustrating, although my days off were good, I wasn’t able to so what I’d wanted… At least the matatus went fine, but my internet connection in my usual café was very slow – I think a couple of other people sharing the connection were updating their entire system. After uploading my last couple of blogs, I tried to download emails, but 180 was too many, and it timed out. My next stop was a different internet café, with a pay-as-you-go connection on a different network, which at least let me download my mail. Many thanks to all who’ve been in touch! Uploading all the email I’ve written over the last few weeks was not so successful.
Then the place I was hoping to stay didn’t have any spare rooms (it should have been a reasonable room in a hotel with swimming pool, etc), so I ended up in a dorm at one of the backpackers hostels. Actually it was OK, but no facilities to speak of, and it was so hot that night that I got hardly any sleep and was able to just lie under my mosquito net perspiring… And then trying to send emails again on Thursday morning – the wireless network was down. Such is life. I ended up coming back fairly early in the day, and at least managed a couple of hours sleep in the late afternoon, and then a good night in my own bed.
Today has been reasonable – with two surgeons, the workload wasn’t particularly heavy. My housekeeper got all the laundry and ironing done, so I have clean clothes for the weekend. I haven’t yet got her cooking for me – I need to get a bit more food, and then write down some recipes for her. She’s very keen to learn how to bake too. I just need some time to teach her (assuming I can remember myself!). I’m going to try and get her a cookbook – there’s one around called “My East African Cookbook” which was written by a Muzungu out here for a while and basically is lots of western food recipes that can be made with food that can be got here in Uganda! Having said that, tonight I had Sausage & Mashed potatoes for dinner, and you can’t get much more British than that!
And now I’m off for the weekend. Just as well – as there are only two of us here just now, I’m on-call for surgery again on Monday for the week! I’m heading into Kampala again with a couple of the other Muzungu doctors. We’ve managed to book rooms at the place I was hoping to stay at earlier this week, so the plan is to try once more with the internet, and then head across for some pool and poolside relaxation for the afternoon. Then on Sunday we’ll meet up with Dr Rory who is in Kampala with a vehicle, so we can get a lift back, and get a big supermarket shop on the way. Small things like this have become very important!
I think I promised some amusing tales in my last blog… One of the funniest (at least to the locals who were watching) was on one of the recent cycling trips I took with Dr Rory. The trails around the area are perfect for mountain biking, and everywhere we go we’re greeted with the sound of children (and adults) calling “Hey Muzungu, how are you?” – Sometimes the littlest children get so excited by this activity that they burst into tears! Considering we cycle lots of the trails frequently, you’d think they’d be used to us by now, but Muzungu-calling is obviously a sport that they don’t get tired of! Two things spring to mind about our latest trip.
First was Dr Rory stopping under a fairly uninteresting tree which happened to have a vine growing up it with an unusual gourd-shaped fruit. We had to stop while he found a huge stick to try and collect it… part dismantling a hedge in the process! The locals (and probably me as well, if I’m honest) all thought he was a bit daft!
The second, and certainly funnier, incident involved some of the older kids. A few of them decided to play chicken with us as we cycled along (actually not the best of expressions, as we’ve almost killed a few chickens, not to mention piglets, goats and dogs, which have nearly failed to get out of our way as we’ve been cycling!). These kids wanted to stand in the road, and get out of the way at the last minute, and we actually had quite a laugh with them! At about the same time one of the kids on a bike of his own decided to race us, and managed to overtake Dr Rory. He just about passed me too, but I wasn’t having any of it, and due to my lighter bike and many gears I was able to leave him standing. I know, you’re going to tell me I’m not at all competitive really! All good sport, and having overtaken at least one Muzungu, he was very happy!
On a slightly more serious note, if you were looking for anything to pray about for us out here, I’m sure Dr Peter would appreciate some prayer as he recovers from his illness. Christiana, wife of our German surgeon, managed to turn their vehicle over on the road from Luwero to the hospital yesterday – she was shaken but not hurt, fortunately, but she would benefit from getting through the next few days without delayed reaction. And as ever, the main work of the hospital in treating patients is only possible with God’s help – definitely please pray for the ones who are needing treatment from me!!!
And may God bless your own work, in whatever form it make take, whichever country you are in just now.
Steve
Saturday 17 February 2007
Wednesday 14 February 2007
Scary Responsibility
I’m writing this on Thursday 8th February – and still haven’t managed to get away from the hospital to post even the last blog! Dr Peter is still ill (apparently bad enough to be in hospital earlier this week – no wonder he didn’t come back last weekend!), so I am still the only surgeon here. Three weeks without a break is becoming quite tiring, more so as the last couple of days I’ve still been operating into the night, having been up working since 7.30am.
I think once Dr Raul is back next Tuesday, I’ll be able to take a couple of days off and get away for a rest. That’s a positive thought to look forward to. I told Dr Rory (in charge) that either I’d get a couple of days off soon, or I’d resign – either way, I’d get a break! I think he realised that I was joking.
I had the strange experience of having my birthday in Uganda on Tuesday of this week. In many ways, it wasn’t too different from back home – often I’ve ended up working on my birthday before. This time I was at least able to control my workload, and finish the day by about 4.30pm. I think most of the other non-surgical docs here are often free by then, but to me it felt very odd! I got a couple of cards from folks here, some food courtesy of someone who was able to get into Kampala that day, and a couple of cards & texts from home.
I had a few folks over for a film in the evening. Not entirely successful…. Thanks to my brother giving me a couple of computer bits to allow me to watch some DVDs he’s put onto a hard drive for me, my main DVD software is not working properly. The options were therefore to use windows media player – but it currently gives full surround sound but no voices at all??? Very strange and not helpful – or playing stuff through winDVD by selecting 30min segments from the file names. That was working well, except that within the same film, the four different segments were in different languages! After the first 20mins I got called to the wards anyway, so it was a bit of a washout. But… once I got back I managed to uninstall and reinstall various drivers, and got the whole thing working again properly. That’s what I call good use of a birthday evening!
The scary responsibility of the title refers to last night’s surgical escapades. Having been operating all day since 10am, at 6.30pm I came out of theatre to review a new paediatric admission who had an obvious bowel obstruction, after a week of bloody diarrhoea. Lots of kids here get their bowel drawn inside itself (an intussusception for the medically minded reader!), and after a while everything turns swollen and necrotic! This was most likely what had happened to this child, although some of the clinical features were not present. In any case this was one sick boy, who was not going to survive without an operation. Unfortunately he was only six months old. I am not, and have never been, a paediatric surgeon, so taking the decision to operate was difficult. Ultimately, the child would have died if I hadn’t operated, so I felt justified taking the risk, even though there was a good chance of it dying in the middle of my operation.
One of the great things about working in theatre’s here is the hospital’s motto – “We treat, Jesus heals”. We usually pray with patients just before they are anaesthetised, and it was great to entrust this little one into God’s hands. During the operation, it rapidly became apparent that most of the large bowel was dead already, and even the small bowel that was left was fairly dodgy. In order to give the best chance I could, I ended up resecting everything, and bringing the bowel to the abdominal surface, emptying it into a bag. If it survived, and recovered, things could then be rejoined to its rectum! After a couple of hours in theatre, the baby was still alive, and I reviewed it on the ward before going to bed. At that point I became a little overwhelmed at the enormity of the responsibility I’m taking on here in Kiwoko for things that I’m not exactly experienced in.
Today was another day. The child is still alive, and doing OK. Praise God! I’ve been operating all day again though – today was another complicated abdomen, and then I took a woman back to theatre who I’d operated on originally at the weekend. A fifty year old lady had been attacked (apparently by her grandson) with a panga – basically a two foot long knife/axe used for chopping through the jungle! She had open fractures of both forearms, and half her face had been chopped off. On Saturday I had cleaned and splinted one arm, amputated the other as the hand had been completely destroyed, and tried to put her face back together – fortunately all soft-tissue problems. She has done remarkably, and the face has healed well.
Today I took her back to finish repairing her forearms which I’d left alone in case of infection. I managed to plate both broken bones – orthopaedics is quite fun really – and although I didn’t manage to get all of the damaged muscles and tendons together again, I think she’ll be left with a useable limb. I also closed the amputation and a couple of other wounds I’d left open. So far so good – but I have no idea what her long-term prognosis will be. Will her family help look after her when she has only one partially useable arm, and significant facial scarring? My heart really went out to her when they brought her in half dead, and I am so glad that we have been able to save her life so far. The theatre and ward staff have been very kind in their appreciation of what I’ve been able to do.
Perhaps my next blog entry will be a little more light-hearted. There’s lots of crazy things go on here, which I’m sure would be amusing to relate!
Steve
I think once Dr Raul is back next Tuesday, I’ll be able to take a couple of days off and get away for a rest. That’s a positive thought to look forward to. I told Dr Rory (in charge) that either I’d get a couple of days off soon, or I’d resign – either way, I’d get a break! I think he realised that I was joking.
I had the strange experience of having my birthday in Uganda on Tuesday of this week. In many ways, it wasn’t too different from back home – often I’ve ended up working on my birthday before. This time I was at least able to control my workload, and finish the day by about 4.30pm. I think most of the other non-surgical docs here are often free by then, but to me it felt very odd! I got a couple of cards from folks here, some food courtesy of someone who was able to get into Kampala that day, and a couple of cards & texts from home.
I had a few folks over for a film in the evening. Not entirely successful…. Thanks to my brother giving me a couple of computer bits to allow me to watch some DVDs he’s put onto a hard drive for me, my main DVD software is not working properly. The options were therefore to use windows media player – but it currently gives full surround sound but no voices at all??? Very strange and not helpful – or playing stuff through winDVD by selecting 30min segments from the file names. That was working well, except that within the same film, the four different segments were in different languages! After the first 20mins I got called to the wards anyway, so it was a bit of a washout. But… once I got back I managed to uninstall and reinstall various drivers, and got the whole thing working again properly. That’s what I call good use of a birthday evening!
The scary responsibility of the title refers to last night’s surgical escapades. Having been operating all day since 10am, at 6.30pm I came out of theatre to review a new paediatric admission who had an obvious bowel obstruction, after a week of bloody diarrhoea. Lots of kids here get their bowel drawn inside itself (an intussusception for the medically minded reader!), and after a while everything turns swollen and necrotic! This was most likely what had happened to this child, although some of the clinical features were not present. In any case this was one sick boy, who was not going to survive without an operation. Unfortunately he was only six months old. I am not, and have never been, a paediatric surgeon, so taking the decision to operate was difficult. Ultimately, the child would have died if I hadn’t operated, so I felt justified taking the risk, even though there was a good chance of it dying in the middle of my operation.
One of the great things about working in theatre’s here is the hospital’s motto – “We treat, Jesus heals”. We usually pray with patients just before they are anaesthetised, and it was great to entrust this little one into God’s hands. During the operation, it rapidly became apparent that most of the large bowel was dead already, and even the small bowel that was left was fairly dodgy. In order to give the best chance I could, I ended up resecting everything, and bringing the bowel to the abdominal surface, emptying it into a bag. If it survived, and recovered, things could then be rejoined to its rectum! After a couple of hours in theatre, the baby was still alive, and I reviewed it on the ward before going to bed. At that point I became a little overwhelmed at the enormity of the responsibility I’m taking on here in Kiwoko for things that I’m not exactly experienced in.
Today was another day. The child is still alive, and doing OK. Praise God! I’ve been operating all day again though – today was another complicated abdomen, and then I took a woman back to theatre who I’d operated on originally at the weekend. A fifty year old lady had been attacked (apparently by her grandson) with a panga – basically a two foot long knife/axe used for chopping through the jungle! She had open fractures of both forearms, and half her face had been chopped off. On Saturday I had cleaned and splinted one arm, amputated the other as the hand had been completely destroyed, and tried to put her face back together – fortunately all soft-tissue problems. She has done remarkably, and the face has healed well.
Today I took her back to finish repairing her forearms which I’d left alone in case of infection. I managed to plate both broken bones – orthopaedics is quite fun really – and although I didn’t manage to get all of the damaged muscles and tendons together again, I think she’ll be left with a useable limb. I also closed the amputation and a couple of other wounds I’d left open. So far so good – but I have no idea what her long-term prognosis will be. Will her family help look after her when she has only one partially useable arm, and significant facial scarring? My heart really went out to her when they brought her in half dead, and I am so glad that we have been able to save her life so far. The theatre and ward staff have been very kind in their appreciation of what I’ve been able to do.
Perhaps my next blog entry will be a little more light-hearted. There’s lots of crazy things go on here, which I’m sure would be amusing to relate!
Steve
Tired but still standing!
Written 02/03/07
I haven’t managed to update this for a while – sorry if you’ve been waiting! What started off as a busy surgical workload has turned even busier over the last couple of weeks. I have been on-call for surgical emergencies for the last two weeks 24/7, and have been the only surgeon here for day-to-day work for the same time! Dr Raul is on holiday, and Dr Peter, our Ugandan Surgeon, has been away in Kampala while unwell. That has left me doing everything on my own!
I’ve been able to control the workload somewhat – getting started early in the morning is a good idea, and I’ve been trying to avoid operating too late into the evening. Fortunately the overnights have been alright (except for last Sunday night when I was on for the whole hospital and spent most of the night operating – three caesarean sections and an abdominal operation for obstructed bowel).
Dr Peter was supposed to be back yesterday, and I was expecting him to be able to work today, allowing me to get to Kampala for the day. I need more supplies, and am missing two weeks’ worth of emails! Unfortunately he didn’t make it back yesterday, so here I am, stuck in the hospital. I also didn’t sleep well last night – a combination of heat, thoughts about all the things I’ll not now get done today, the possible beginnings of a cold, and perhaps the Larium, which I’m taking for malaria prophylaxis.
I’ve had Larium twice before over the last ten years and not experienced any problems – there are reports of potential psychotic side effects. However, since being here, various people have said that they’ve had difficulty with insomnia because of Larium. I hope that’s not something that’s going to be a problem for me. Malaria prophylaxis is essential here given the high level of malaria-carrying mosquitoes, and Larium is certainly one of the best in terms of a once-weekly tablet with a good level of protection. If my blogs start showing signs of psychiatric tendencies (at least more than usual), please somebody let me know!
I’ve been managing a vast range of different types of surgery this week. In terms of UK specialities, I’ve been a General Surgeon, an Orthopaedic Surgeon, a Plastic Surgeon, a Urologist, an Ophthalmic Surgeon, a Vascular Surgeon and a Gynaecologist! Operations have ranged from hernias to burns to external fracture fixation, exenteration of an eye, several gynae abscesses and even repair of a major vein! Yesterday was a little disheartening – a 13 yr old with a large muscle tumour of her abdominal wall that was too big to remove and I could only biopsy. She is likely not to survive many months. There was also a man who had refused to seek treatment for an eye infection that had subsequently spread to his sinuses and into his brain. Although I drained the eye, he is unlikely to regain consciousness, and will die soon, I think.
On a lighter note, I now have a housekeeper – a girl who has just finished school and will be starting nursing college in September. My house is now very clean, and I no longer have to worry about hand washing of laundry (except for unmentionables which she won’t have to wash!). I’ll be teaching her how to cook some western-style dishes too, so I should get some decent food when I get back from the wards each evening. Its quite an odd concept, employing someone in this way, but for here its quite normal, doesn’t cost me very much, but gives someone a good paid job with a reasonable wage and is therefore supporting the local economy. I guess for us in the UK such a set-up has concerns about the abuses seen in for example America or South Africa in the past, but here things seem to work very amicably.
I think I’ll leave this blog entry here (and post it on the net when I can – hopefully I’ll get a day off during the week once Dr Peter’s back). I hope my frustration about being so busy the last couple of weeks doesn’t show too much! All-in-all, I’m really enjoying what I’m up to, and after all, the work is the reason I’m here! Many greetings to all back home… I hope February isn’t too cold!!!
Steve
I haven’t managed to update this for a while – sorry if you’ve been waiting! What started off as a busy surgical workload has turned even busier over the last couple of weeks. I have been on-call for surgical emergencies for the last two weeks 24/7, and have been the only surgeon here for day-to-day work for the same time! Dr Raul is on holiday, and Dr Peter, our Ugandan Surgeon, has been away in Kampala while unwell. That has left me doing everything on my own!
I’ve been able to control the workload somewhat – getting started early in the morning is a good idea, and I’ve been trying to avoid operating too late into the evening. Fortunately the overnights have been alright (except for last Sunday night when I was on for the whole hospital and spent most of the night operating – three caesarean sections and an abdominal operation for obstructed bowel).
Dr Peter was supposed to be back yesterday, and I was expecting him to be able to work today, allowing me to get to Kampala for the day. I need more supplies, and am missing two weeks’ worth of emails! Unfortunately he didn’t make it back yesterday, so here I am, stuck in the hospital. I also didn’t sleep well last night – a combination of heat, thoughts about all the things I’ll not now get done today, the possible beginnings of a cold, and perhaps the Larium, which I’m taking for malaria prophylaxis.
I’ve had Larium twice before over the last ten years and not experienced any problems – there are reports of potential psychotic side effects. However, since being here, various people have said that they’ve had difficulty with insomnia because of Larium. I hope that’s not something that’s going to be a problem for me. Malaria prophylaxis is essential here given the high level of malaria-carrying mosquitoes, and Larium is certainly one of the best in terms of a once-weekly tablet with a good level of protection. If my blogs start showing signs of psychiatric tendencies (at least more than usual), please somebody let me know!
I’ve been managing a vast range of different types of surgery this week. In terms of UK specialities, I’ve been a General Surgeon, an Orthopaedic Surgeon, a Plastic Surgeon, a Urologist, an Ophthalmic Surgeon, a Vascular Surgeon and a Gynaecologist! Operations have ranged from hernias to burns to external fracture fixation, exenteration of an eye, several gynae abscesses and even repair of a major vein! Yesterday was a little disheartening – a 13 yr old with a large muscle tumour of her abdominal wall that was too big to remove and I could only biopsy. She is likely not to survive many months. There was also a man who had refused to seek treatment for an eye infection that had subsequently spread to his sinuses and into his brain. Although I drained the eye, he is unlikely to regain consciousness, and will die soon, I think.
On a lighter note, I now have a housekeeper – a girl who has just finished school and will be starting nursing college in September. My house is now very clean, and I no longer have to worry about hand washing of laundry (except for unmentionables which she won’t have to wash!). I’ll be teaching her how to cook some western-style dishes too, so I should get some decent food when I get back from the wards each evening. Its quite an odd concept, employing someone in this way, but for here its quite normal, doesn’t cost me very much, but gives someone a good paid job with a reasonable wage and is therefore supporting the local economy. I guess for us in the UK such a set-up has concerns about the abuses seen in for example America or South Africa in the past, but here things seem to work very amicably.
I think I’ll leave this blog entry here (and post it on the net when I can – hopefully I’ll get a day off during the week once Dr Peter’s back). I hope my frustration about being so busy the last couple of weeks doesn’t show too much! All-in-all, I’m really enjoying what I’m up to, and after all, the work is the reason I’m here! Many greetings to all back home… I hope February isn’t too cold!!!
Steve
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