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.
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