So what does it for you?

I know many people turn to alcohol or drugs, or adventure sports, to get that elusive feel-good factor in their lives, but I’m fortunate enough to be able to get it from my job. Working as a surgeon here at Kiwoko Hospital, Uganda, provides many opportunities for frustration and tiredness, but at the same time, there are often priceless moments when you know you’ve done a good job, and someone’s life has been changed as a result! What a privilege.

Two patients over the last couple of days have delighted me in this way. The first was on Friday afternoon - a Musee (Elderly Gentleman) was admitted with a story of two weeks of a tender swelling in his abdomen next to his liver. He had been seen the previous weekend and ultrasound by one of my colleagues had suggested a liver abscess, for which he had had some pus removed with a syringe, and had been placed on antibiotics. He had not improved, and had come back. I decided to operate so that I could drain the abscess and place a drain for irrigation, but when I opened his abdomen I found that the problem was actually a very inflamed gallbladder, with an adjacent abscess. It was a simple matter to remove the problem gallbladder and wash everything out, and I expect that he will be on his way home in a couple of days. It was great to do an old-fashioned general surgical operation, and the procedure was quick and straightforward. I removed over 130 gallbladders last year, but this was my first in Africa, and the theatre staff had not seen such an operation before.

The second patient was this lunchtime. A Ssebo (man) was admitted with half of his lower lip missing – his “friend” had bitten it off while both were drunk last night! I wasn’t sure how to replace the missing tissue, but hoped to be able to make a skin flap of some description. I was pleased to discover that he had such large lips (common in Ugandans!), that I was able to trim the edges of the defect and close the gap without difficulty. The end result was a neat line of sutures below the lower lip, and he was able to go home later this afternoon.

I’m sure that the feeling of taking a patient with an illness or injury, being able to do something to help in a practical way, and ending with a successful, aesthetic result, is one of the main reasons that I’m a surgeon. If you could bottle the sense of achievement gained, I’m sure I’d be a millionaire by now. Its funny – I’ve often said, ever since I started working as a doctor, that I enjoyed what I do day to day so much that getting paid for doing it was a bonus! Well, I’m putting it to the test this year – I don’t get paid a salary for working here in Uganda!

Having said that, I had a nice weekend away from Kiwoko last weekend. I ended up in Jinja at the Source of the Nile on Lake Victoria for the night on Saturday before dropping a visitor back to the airport on Sunday night. It was relaxing to go to a really decent, and cheap, restaurant, have a couple of nights sleep away from the possibility of being called to operate, and enjoy both the company of friends and some peace and quiet! Its important to remember to take time out to rest, and that can be forgotten easily when you live and work in the same place. I’m looking forward now to the beginning of July – I’m taking a couple of weeks holiday to go on safari, see various parts of the Ugandan countryside, and catch some adrenaline going white water rafting on the Nile. I think I’m about due a break!

No gross medical pictures this week. The child above is one of our adoptive Ugandan family who came to lunch with Rory and myself last Saturday. I don’t know what he was meaning by this pose, but it’s a cute photo!

Steve

What an exciting week...

Several fantastic things have happened this week. It’s often the small things in life that can make the biggest difference, and that sense is sometimes magnified a little here at Kiwoko Hospital, as surgery and life in rural Uganda is a long way from my previous life in Scotland!

The first bit of great news was at the end of last week. I have a young patient who was admitted with a fractured femur (thigh bone) and which the x-ray suggested had an underlying disease that we thought was probably a bone cancer. The combined experience of my cousin and brother (two orthopaedic doctors in Scotland) who gave me some great advice based on an emailed photo of the x-ray, was very helpful in deciding that it was probably an underlying infection rather than cancer, and this probability was confirmed by our visiting specialist from Kampala. Instead of an amputation, the girl faces several weeks of traction and antibiotics, and hopefully the bone will heal given time. She is a really friendly nine-year-old, who is stuck in a bed in female ward, so I took my laptop to the ward on Saturday evening and watched “Finding Nemo” with her – one of the few child-suitable DVDs I have with me in Uganda! She was so excited and enthusiastic about it (even though she speaks very little English) that every time I’m on the ward she asks when I’m bringing my computer again! I may have to do the same for a younger child on Paeds ward who is lying with her feet in the air for the next few weeks in order to get her femur fracture to heal (Picture above).

The next bit of amazing news came later in the week. Two endoscopes arrived at Kiwoko, having been donated as surplus to modern requirements by a hospital in Basingstoke. The possibility of starting to provide a diagnostic and therapeutic endoscopy service was one of my wish-list aims of the year here - one which I never suspected might be possible. We have been given two fibre optic scopes which will allow visualisation of the bowel from within – these are used with an eyepiece, which is perfect for Uganda, whereas the remote TV picture scopes used in most UK hospitals now rely too heavily on electricity for us here! I do still have to source a suitable light/air source in order to start using the equipment, but if none of my contacts in the UK are able to help, there is always eBay! I’m just really excited at the prospect of training the Ugandan doctors over the next six months, and leaving behind a new service that will really make a difference.

I got a call later that evening to let me know that Ethicon (Johnson & Johnson) have donated several boxes of sutures, which have finally arrived in Kampala. They very kindly offered to give me some sutures with blunt needles for use here in Uganda – this will help protect me against needlestick injuries, which is especially important given the HIV rate of about 9% in our local population. The sutures the hospital buys are sourced from India, China and Hong Kong, and are much cheaper than would be bought in the UK, but are not so good. Getting some sutures that I am used to will be great, and much safer for me to use.

The best news of all came with a phone call from my brother this evening! The government has been messing around with medical employment in the UK, and the end result has been that 30,000 junior doctors have been applying for 20,000 jobs to start in August. The whole thing has been a real mess, and many thousand of trained young doctors in the first few years of their careers are finding themselves unemployed. It’s a complete waste, and a political mess that I won’t bore you with – suffice to say that I’m very pleased that I have a job to go back to in Edinburgh at the end of the year, and have been able to watch the disaster unfold from a difference.

Unfortunately my brother has been caught in the middle of the scramble for jobs, and had three interviews recently, finally finding out at the weekend that he had been unsuccessful in getting a job for August. The whole saga has been very drawn out and confusing, and actually he was very positive about the possibilities of a year of locum work interspersed with other non-medical activities such as building a house. However, he heard this evening that there is a job for him for the next six years after all, and not only that, but he’s able to stay in Glasgow where he’s currently settled. What an answer to prayer! As he’ll continue to live fairly near to our parents, it means that there’s less family pressure on me to return to Scotland, as at least one of us will be within an hour’s distance from the parental home… Only joking Mum, I’ll be coming home at the end of the year as planned!

So plenty to be upbeat about this week – both within Uganda, and from back home in the UK. I’m on-call again for the hospital tonight (its been a busy couple of weeks), but its relatively quiet so far. I had an unusual experience earlier though. We had a mother who had been in labour for 24 hours, and was not progressing despite medicinal help with her contractions. There had been no change in the lie of the baby for four hours, and the cervix was no more dilated, so I decided that the baby was stuck above the pelvis and prepared theatre for a Caesarean Section. We had five 1st year nursing students in maternity all of which wanted to see their first operation, so theatre was full of excitement with many people around when the mother arrived in reception. I was just discussing with the anaesthetic nurse what anaesthetic technique we would use when I was called urgently. I arrived in the reception to find three theatre staff and five nursing students standing around a woman on a trolley who had decided that she didn’t need an operation after all, and was delivering her baby there and then! I was handed a pair of gloves, and then performed my first normal delivery in twelve years! I’ve delivered several dozen by C-section and one by vacuum since I’ve been here, but this was the first normal delivery since I was a medical student. The midwife arrived a few minutes later and was surprised to be faced with a healthy baby boy! I guess the bumping around getting the mother onto first one trolley to get from Maternity to Theatre, and then another in theatre itself must have jolted the baby from its position. However it happened, we were delighted with the outcome, and the students were able to witness only their second delivery.

So, there has been much joy and excitement here this week. I hope life is just as interesting wherever you live and work. God bless,

Steve.

They didn't put this in the job description...

Aside from some very busy weekends and nights of operating, the last few weeks have been relatively quiet at Kiwoko Hospital, Uganda. There hasn’t been a large amount of day-to-day surgery (possibly because I’ve done it all at the weekends!), and it’s been good to relax a little, catch up on sleep and enjoy being in the middle of rural Africa.

This weekend I was hugely reminded that our nice rural setting is actually the middle of wild Africa – courtesy of a gigantic 4 metre long snake! I was out with Dr Rory on one of our cycling expeditions into the local countryside, and about 40 minutes out, we stopped to visit a small homestead where Rory had met several football-mad boys on a previous occasion. They were very excited to show us their evening’s entertainment from a couple of nights earlier – a huge snake had made its way into their front yard, and was recognised as one who had eaten a whole calf earlier in the month! Around nine small boys had attacked it with sticks and panga knives, and had succeeded in killing it without getting injured themselves in the process! The boys proudly took us to where they had buried their snake, and dug it up for us to see! The monster pictured above was the result!

Its very easy to assume that things are very safe here at Kiwoko – the main annoyance is the insects and mosquitoes, with the occasional small rat or grass snake seen escaping into the bushes, and the only really scary animal being one of the many long-horned cattle that graze freely in the area. However, there is a lot of African wildlife around, as demonstrated by the size of that snake… And I’m aware of people being brought to the hospital with injuries sustained from crocodile bites, and even a leopard mauling, sustained only 15 miles away! However, we have good security guards on the hospital site, even if it is slightly scary seeing them patrolling at night with a homemade bow and arrow!

Sunday afternoon’s cycle ride was great for more than just the snake. The family we visited were rural subsistence farmers, with ten girls, nine boys, three mothers and a father all living in five mud huts surrounded by a boundary hedge – a really beautiful little compound. The boys would go out and look after the cattle, the girls would help with digging the ground for their crops, and they seemed to survive very well, if very basically. Being out in the middle of nowhere, two Muzungus on bicycles were the centre of attention for a couple of hours! The bicycles were rapidly borrowed (along with the excitement of a pair of Oakley sunglasses), and great fun was had! We were welcomed to Chai (hot milky tea), pineapples, bananas, and an impromptu Ugandan music and dancing display, followed by a photo-opportunity for their milk-jug collection (!!). Rory was lucky to escape getting married off to one of the twenty-something daughters, and two of the nine-year old girls seemed to be getting promised to me, so we stopped the chat and played football with the boys for a while!

Ugandan people are so welcoming and hospitable; it is sometimes difficult to know how to respond to their generosity, especially when it is obvious how poor they are. There is a danger in insulting them by refusing what they offer, and you want to respond in kind without being seen as a rich condescending westerner. In the end, we escaped without any extra gifts, and left behind a small plastic football, with promises to return again soon.

The social side of life here at the hospital has picked up a little recently as well. I’ve been getting involved with playing some volleyball with the some of the students, and have enjoyed various times of music with others. I have a number of budding guitarists who are very keen for me to improve their knowledge of different chords and rhythms, which is also great fun. I have another visitor from Scotland arriving on Sunday, so it may well be time to arrange another ceilidh (Scottish country dancing) in the next couple of weeks.

Thanks again for all the emails, letters and comments I’ve received over the last few weeks. Its quite exciting to get random messages from people I’ve never met who have been reading this blog – isn’t the internet an amazing thing! Everyone’s prayers, support and encouragement are most appreciated. God bless, whatever part of the world (safe or unsafe) you may be in at the moment!

Steve