Buy a man a fish...

…and you feed him for a day, buy him a rod and teach him how to use it, and you feed him for life.

Last week I witnessed Kiwoko Hospital’s own particular way of following this advice! For many years the hospital has had it’s own training school for nurses and laboratory technicians – I think initially set up to help train staff for the hospital, but now recognised as a good institution throughout Uganda. Friday was Graduation Day, and we saw all the trainees from the last two years come together to get their certificates. I guess it was much like a UK graduation ceremony – plenty of speeches, all extolling using God’s gifts wisely in serving others; a couple of songs/poems from some of the students; the handing out of certificates; etc.

Although the training school is separate from the hospital, we work very closely together, and I frequently find myself teaching the students when they are on the wards. This can be from informal anatomy, physiology, and clinical lessons, to describing different parts of a complex operation! The students (or their families) all pay to be here – a year’s tuition including food and accommodation runs to 1.6 million Shillings (about £500) which is a significant outlay – but this shows itself in their keen-ness and interest and desire to learn. I think the students here put UK students to shame – often they will have lectures/tutorials every morning, be on the wards for a full eight hour back-shift five days a week, and have all day teaching on the other two days. They’ll often study on top of this gruelling schedule, and still be keen for more!

It’s also been said that if you educate a woman, the whole community benefits. Certainly more than half of our students are female, and I think it’s very good to be helping women in Uganda find employment. Women are often treated as second class here, and there’s currently a media campaign trying to advise younger women from becoming subservient to older men, “Say No To Sugar Daddies”! This is also an important message in helping stop the spread of HIV/AIDS. If we can get women into employment after training them, they’re unlikely to find themselves in the position of only being able to survive by finding a man to support them.

I think that investing in people and helping them to help themselves has to be the best form of aid that the developed world can offer countries like Uganda. The actual cost of training is very little in UK monetary terms, and the benefits are huge. I’m very excited about starting to do some more training of my own. Our Endoscopy system is now up and running, so we’ll be actively looking for patients so I can teach Dr James & Dr Peter how to use it! Lots to do, but the normal hospital workload is quite intense at the moment with several doctors away, so the next few weeks will be busy. I’m on call tonight, and it’s been pretty non-stop, so I’ll keep this blog short, and hope to get some sleep later.

The only other thing I’ll mention, that will amuse everyone back home, is that I met my housekeeper’s sister this weekend – Helen is leaving me at the end of September to go to college to do a social work diploma, but she’s arranged for her sister who is just finishing school to come and replace her. There’ll be a few weeks gap before she starts, so I’m going to have to cope without a housekeeper during October! It’s going to be tough… although I’d better get used to it for my return to the UK in January!

Steve

Is that poop on my shoes?

I’d like to update this blog every week with more news of what I’ve been doing here at Kiwoko Hospital, Uganda, but the last two weeks hasn’t really produced much that is exciting enough to mention. We have had a number of staff changes – doctors coming and going – and that has meant a period of adjustment. At present we have three surgeons (myself, Dr Peter, and Dr James – a doctor previously at Kiwoko who has just completed three years of surgical training in Kampala), one community doctor (Dr Raul, who also helps with covering surgical on-call as he is a paediatric surgeon from Germany), and three other doctors (Dr Rory, Irish GP and Medical Superintendent; Dr John, Ugandan physician; and Dr Darius, a brand new Ugandan doc who is in between university and internship). As usual, there are other medical folk around: We have one UK elective student, and two Ugandan medical students at present (sometimes there is a short gap between UK elective students – normally we are oversubscribed and have a maximum of five at a time), and we also have another Ugandan doc doing some refresher training after several years away from clinical work.

As there are more surgeons, the workload has been slightly diluted, but we have had to cover more areas of the hospital as a result – I’ve spent slightly more time helping with obstetrics, and Caesarean section is almost certainly the most common operation I’ve done recently. I had a good experience on Sunday afternoon – I was called urgently to the labour ward to see a woman with delayed second stage of labour. The baby had started coming but had then stopped. As I could see the head, I thought of doing a vacuum assisted delivery and got the equipment ready, but the midwives couldn’t find the valve that regulates suction pressure! The baby seemed to be ready to come, so I encouraged the woman some more, and with her very next contraction I was able to deliver a healthy baby girl – my second normal delivery since I’ve been here, and my second since finishing fourth year of university twelve years ago! It was quite nice to feel a little superior to the midwives – normally I recognise my lack of experience and defer to their judgement most of the time… however, you’ll be pleased to hear that I got my just rewards for my pride: I stopped to talk with Dr Rory on the way back from the ward, and he pointed out that I had dirt on my shoes – in the process of pushing the baby out, the woman had pooped on me! Mmm, lovely!

We have a large number of children here with cancers. Lymphoma is relatively common, but we often find other large masses in young children’s abdomens. One such case was this morning. A 2 year old had a four-month story of an abdominal swelling. An ultrasound had suggested a solid mass, and he was admitted with malaria in the meantime. This morning he had fully recovered from his illness, and so we took him to theatre to try to remove the mass, or at least biopsy it. When we got inside his abdomen, he turned out to have a large tumour arising from his liver (not suspected from the scan). While I’m happy to attempt many more operations here that I would be back home (usually there’s no option but to do your best), I decided I had to draw the line at partial liver resections. Livers tend to bleed heavily, and without diathermy (electrical coagulation), I didn’t rate my chances! Unfortunately a biopsy was likely to bleed heavily too! Fortunately I was able to call Dr Raul, who had at least done partial liver resections on children before. It was very interesting to see his technique, which resulted in almost no blood loss – the next time I’m faced with the same situation, I’ll know what to do….

Part of my role here in Uganda is to help train local doctors and improve the facilities of the hospital. This has taken large steps forward in the last few weeks. I’ve started a weekly tutorial for the doctors in the management of trauma. Over the coming weeks I hope to teach many of the different skills required to manage a seriously injured person, with a combination of lectures and practical sessions. Ultimately I’d like this to culminate in the equipping of a “resus” room in our Outpatients Department (A&E/GP equivalent), so that rather than dumping an injured patient straight into a ward, where the nurses then have to find appropriate equipment, the doctor would go to the patient in a room where all the equipment was available – the patient can then be moved once stable.

I’m very excited about getting to do some Endoscopy in the near future too! We have received a donation of a fibre-optic sigmoidoscope, and a light/air source arrived last week. There are a couple of other things to sort out (not least getting the cleaning/disinfection process organised correctly), but hopefully we’ll be up and running in the next couple of weeks. Dr James & Dr Peter especially are looking forward to learning how to use the equipment. At present, Endoscopy (looking at the inside of the bowel with a flexible tube) can only be done in Kampala, and costs more than most people here earn in a month. If the doctors here can be trained successfully, we may get many more patients coming for the test, and it could even turn into a money-earner for the hospital, thus freeing funds for other types of treatment.

I’m also very pleased and encouraged by the amount of support the hospital and I have been receiving from home in the UK. Various people at my parent’s church have kindly given small donations, and they are holding a fund-raising auction soon: hopefully they’ll be able to use the money to sponsor a nurse’s training, as well as some of the other equipment that might be needed. My old hospital in Edinburgh has kindly donated some old Endoscopy accessories, and some drug prescribing manuals that should arrive later this week. And of course the emails and letters that arrive with news from home always encourage me. My Dad comes to visit in a couple of day’s time, the first of my family to do so, and I’m looking forward to a few other visitors later in the year too.

So all continues to go well here. Please remember the hospital, staff and patients in your prayers, as we seek to help those who would otherwise have no access to healthcare.

Steve