Do you want to make God laugh?

Tell Him your plans! At least that was what my former minister said (Rev Dennis Lennon, who sadly died recently). I sometimes feel that God’s been able to laugh at me a lot. It’s now over three months since I returned to Scotland from Uganda, and I’m still finding it difficult to settle, workwise. Surgery at the Royal Infirmary Of Edinburgh is a very different work environment from surgery at Kiwoko Hospital in Uganda, but I think it’s more the type of surgery that I’m doing that is causing me difficulties.

I still have two and a half years of specialist surgical training to complete before I become a consultant. My plans had always been to specialise within General Surgery and become a Vascular Surgeon (arteries and veins outside of the heart) – the fine, technical nature of the operations was stimulating; the patients were generally in hospital for slightly longer than a lot of surgical patients, allowing for a better doctor-patient relationship; and the out of hours work is usually limited to exciting emergencies!

However, over the last two months I’ve come to realise that this doesn’t stimulate or interest me any longer. I crave the variety of operations the Generalist Surgeon is able to perform; I enjoy keyhole surgery which isn’t a feature of vascular surgery; I’m already bored of varicose veins; and there is much less of a sense of admitting a patient, diagnosing them, operating on them, getting them better, and discharging them – all too often our vascular patients have multiple medical problems that are difficult if not impossible to sort out, and frequently there is no treatment option other than amputation of a limb, often resulting in a patient who never recovers to get out of hospital.

Fortunately my director of training is very understanding, and has agreed without any problems to enable me to change the direction of my training. I’ll stay where I am for a total of six months, as there’s lots to learn here that will be useful for any type of surgery, but then I’ll continue training in a more General, Gastrointestinal Surgery. The choice then will become where to work as a consultant, and I’ve been finding out a bit about Remote and Rural Surgery in Scotland, which sounds very similar to what I was doing last year in Uganda.

I guess I’m waiting for God to make it clear to me that I’m to go back to Africa, something I’d love to do – but that will have to come from Him, as I’m sure I couldn’t cope if I didn’t have His complete help and support! Still, last year wasn’t my idea at all, and yet I’m sure it’s what He had in mind for me. As Proverbs 3v5 says, “Trust in the Lord with all your heart, and lean not on your own understanding. In all your ways acknowledge Him and He will direct your paths.”

Steve

Life in the UK doesn't completely suck!

I’ve been having a fairly depressing time since returning to Scotland from Uganda – the weather in January was miserable, it’s been a little overwhelming to reacquaint myself with old friends, life is very over-regulated, and returning to work in the NHS hasn’t been easy. However, on Saturday I found myself saying, for the first time in six weeks, “I’m glad to be here today!”

I was standing on top of a mountain at the time, Carn Gorm, north of Loch Tay and Ben Lawyers. The weather was fantastic – sunshine, crisp coldness, no wind – and as a bonus the only clouds were in the surrounding area, with temperature inversion causing only the tops of the other big mountains to show through. It was glorious, the early start totally worthwhile, and the prospect of three more mountains to climb during a circular walk turned the whole thing into a fantastic day out. This is definitely one of my favourite things about living in Scotland. On the right day, being able to get out of the city and up a big mountain within a couple of hours is unbeatable.

Rather than moaning about the last six weeks (which is also one reason why I haven’t posted recently), I’ll try to focus on the positives! I may have been less than enthusiastic about the weather, but the comparison between the constant dry, sunny, 28oC of the Ugandan dry season in December and early January, and the wet, cold, windy, darkness that greeted me for the whole of the rest of the month, was difficult to ignore. Fortunately February has been more than making up for it. It’s been mostly dry, cold but bright, and the days are noticeably getting longer. In fact this week I’ve been cycling to and from work in daylight.

It’s been good to get back together with friends, all of whom have been fabulously interested in what I’ve been doing over the last year. Kiwoko Hospital has been a great place to live and work, and the people there are frequently in my thoughts. It’s been superb to relive many memories of the year as I’ve had various dinner parties, short presentations and catch-up chats, often accompanied by brief photo-sessions. I hope that I’m opening people’s minds to how a good proportion of the world lives, something not often greatly realised by people in the West. I’ve also been very gratified by the number of Ugandans who have been in touch. A number of the nursing staff (male and female!) have been in touch by email and texts, and I’ve spoken with my former housekeepers several times, keeping in touch with what’s happening in their lives. I also have one former hospital staff member (currently studying in Belfast) coming to visit next month, which I’m looking forward to enormously.

Working in the NHS again hasn’t been the most pleasurable experience, although things are getting better as I settle in. From being my own boss, solely responsible for my own patients, I now have to work for five different consultant surgeons, sharing responsibility with four other middle grade doctors, and supervising a number of more junior doctors. It isn’t helped by the type of surgery I’m doing just now – there was hardly any need for vascular surgery (arteries & veins) in Uganda, and I haven’t worked in the specialty for several years. It’s an odd experience from being the most experienced General Surgeon in a hospital to being unsure of how to manage most things because my knowledge is a few years out of date and from a different hospital setting. Add to that the fact that most of my patients are old with multiple other illnesses to manage (almost none of them encountered in the last year!), and I’ve been feeling a bit like a fish out of water. Still, a fortnight in, I’m starting to understand the system, and am trying hard not to harbour thoughts of putting most of my patients out to pasture!

One thing that has been good is the amount of surplus equipment and consumables that I’ve been able to collect – things that can’t be used in the NHS for whatever reason, but that can be used time and time again in a Developing World hospital – and which I’m hoping to take out to Kiwoko when I next visit, possibly at some point in the next few months.

Anyway, if I haven’t managed to catch up with you personally yet, get in touch – what are you waiting for? If you think you might be able to help Kiwoko Hospital in any way, get in touch! If I can offer any assistance to anyone thinking of going to Uganda, get in touch! I’m told that the real depression is going to hit about three months after getting back here... that means I’ve about six weeks to go!

God bless,
Steve

Out of Africa...

...and back home in Edinburgh! My year’s adventure in Uganda has come to an end, and I have safely returned, although I’m aware that a large part of me has been left behind and is still in Kiwoko Hospital. In many ways it’s a miracle to have made it home (there seemed to be a conspiracy to keep me at the hospital!). First off was the planned UK airports strikes, cunningly designed to impact my planned date of flying! These were fortunately called off well in advance.

Then came the situation in Kenya. Although obviously devastating for that country, the violence that has erupted there in the wake of the disputed elections has a much wider impact on the whole region. Most of Uganda’s imports come through the port of Mombasa, passing through Nairobi on the way to the border. This trade route was effectively closed, with the result that Uganda rapidly ran out of fuel. Unlike a western country where there would be reserves and a control on prices, in Uganda the few stations still able to sell fuel were able to inflate the price enormously. I’ve heard complaints from the UK about petrol reaching £1/litre, but in the space of a couple of days after New Year, people were paying £5/litre. In a country where a large part of the population earn less than £1 a day, this is obviously unaffordable, and resulted in most transport ceasing. My planned route to the airport – a public share-taxi, usually costing a couple of pounds at most – would have had to charge four or five times as much to cover its costs, which no locals could afford, and so wasn’t running. Fortunately I was able to get a lift with Dr Rory, who was heading to Kampala for the weekend, but meaning I left a day early and spent time in hotels in the capital and Entebbe instead.

The send-off I got from the people in Kiwoko was a bit overwhelming. We held a ceilidh (Scottish dancing) on my last night, following which several people were in tears as they said goodbye. The Ugandan locals had obviously welcomed me completely into their community over the last year, and were very sad I was leaving. For my part, I have made many good friends who I will miss terribly, both among hospital staff and locals, and will definitely return to visit soon.

And so I’m now back in a very cold, wet, windy, dark and miserable Scotland - just my luck to return in the middle of a few days of appalling weather. It’s been good to spend time with my family, and good to start catching up with friends again. In many ways it feels like I haven’t been away, with so much just the same as before I left, but I’m also aware that a year has gone by in everyone’s life here, just as it has for me. It’s going to take a while to settle back into life.

I have managed to get things fairly well sorted out in my flat; I have so much stuff here compared with in Africa. Now I’m here, there are various talks I’ll have to prepare for various groups that have supported me this year, and then various admin jobs to complete, such as my tax return, and sorting out a parking fine dispute from November which actually concerns a white van which has cloned my car’s numberplate while I’ve been away! Unbelievable! Then comes the challenge of reintegrating myself into the UK health system, when I start work again at the beginning of February. I'm still not sure what job I’ll be doing…

Anyway, to all those who have been following my adventures this year, I hope that this blog has given a good idea of what life is like in one part of the Developing World. It’s been a fantastic experience for me, and one that will stay with me for the rest of my life. Please do continue praying for the work of Kiwoko Hospital, and the staff and patients there, as they show a practical expression of God’s love for all people, in an area of great need. Check out www.fokh.org.uk for more information about the hospital and how to support it.

God bless,
Steve