Time flies...

26/02/07

...when you’re having fun! In some way it seems like only yesterday that I was in Kampala updating my blog, but over a week has gone by, with it’s usual busy-ness! By the way, a couple of my more intelligent readers failed to realise for ages that if you click on the “read more” link at the bottom of the screen these blogs stretch to a couple of pages long! Well done, guys!

I’m writing this on Monday evening – my first night not on-call since my time off last weekend. It’s actually been a very pleasant evening – I got three letters from the UK today (mail usually arrives on a Monday), and it was great to read lots of news, even if one of the letters stretched to eleven pages! I decided it was about time to do some home-baking, as my housekeeper has been asking me to teach her for several weeks. Cue Delia Smith and a chocolate sponge cake… which has actually turned out alright, even if I nearly killed myself with a dodgy gas oven which managed to blow itself out and then produce a reasonable explosion! All body parts are intact and no hair was singed – a better result than the last time I tried to use a gas oven when I took most of the hair off my arms! In fact that was ten years ago, and also here in Kiwoko… perhaps I should stick to electric ovens in future!

There’s a funny story there about arm hair too. When I was last here, one lunchtime, after a meal with a couple of Ugandan medical students, I was surprised by the strange sensation of having my forearm stroked! Diana spent a couple of minutes being fascinated by my mildly hairy arms – black skin doesn’t produce much hair, and I was therefore very unusual! This story came to mind because earlier this evening I was sitting on my verandah reading my mail when a few of the local kids came over and also started rubbing my arms. They then managed to point out my longish head hair – and the fact that it is receding in places – thanks, kids!

Last week was fairly busy, but not as bad as a few weeks ago. Operations this week included a hysterectomy (I’d at least assisted at doing one before in the UK and this one went very well) among others. We’ve had an anaesthetist from the UK here this week, helping train our anaesthetic technicians, and introducing halothane anaesthesia. I had a bilateral hernia repair to do, and she expressed doubt that a spinal anaesthetic (to freeze everything below the waist without putting the patient to sleep) would last long enough – the particular anaesthetic we have here only lasts about an hour. It was good to do some operating that I’m used to doing regularly in the UK for once, and I was pleased to surprise the anaesthetist by completing both sides within 40 minutes…

Dr Peter came back on Wednesday. Thanks for your prayers as he recovered from Malaria. He has been gradually getting involved over the last few days, and it has been very reassuring to get another opinion on some of the patients I’ve been concerned about. I must have been doing alright, as he’s been nothing but complimentary about all my efforts. It’s great to share a little of the workload, even if I have just worked my fourth weekend out of five! Dr Raul is on-call for nights this week, and with Dr Peter helping with the day-to-day work, I’m hoping this week will stay manageable.

Some updates on some of my patients for you… My little baby who I had to remove its large bowel on has recovered well. The only problem at present is that due to the shortage of proper bags to collect his bowel contents, his skin is getting irritated around his stoma. The difficult thing is deciding at what stage to re-operate and join him back together – ideally I’d like to wait three months, but he’ll never cope with a stoma for that long. Perhaps next week… My panga attack lady also did well. Her wounds are healing nicely and she has a reasonable amount of movement in her hand. She has now left to get further rehab in her local government hospital, so I’ll probably not get to see how she progresses from here.

That’s also one of the slightly crazy things about practicing medicine here. Often patients will request discharge before you’ve managed to get them better. Sometimes that can be understandable – why pay to be in hospital while you recover from a stroke, when you can be at home, even if you’ll not get the physio and care that you need. Sometimes it’s a case of wanting to recover at a hospital nearer home – Kiwoko is one of the best hospitals outside of Kampala, so people travel a long way to get here. Sometimes, however, it’s the person with the purse-strings who makes the decisions. Women and children are sometimes ordered home by the man of the house even when advised that if not treated they could die! At other times, people needing an operation will sometimes return when they’ve had a chance to save some money. This may involve selling the family pig or goat… On the other hand, patients often stay around the hospital after we’ve discharged them, waiting for someone to come from home to pay the bills, often for several days.

It’s really good to be living and working here in rural Uganda, compared with Kampala. Last weekend I stayed in a superb hotel with leisure facilities frequented by ex-pats. It was very comfortable, but I soon realised that lots of the ex-pats went there all the time – For me, part of being here is living a little of the African lifestyle, and it was great to recognise that I actually wouldn’t want to be part of an ex-pat enclave living western-style in the capital.

One bit of progress I will look forward to, hopefully, is a reliable internet connection for the hospital, which may finally be becoming a reality. They were even chopping down a couple of trees today to make way for the antenna. A few home-comforts must be acceptable here in the country!

Thanks to all who have written or emailed me. All news is much appreciated, and I’ll try to reply in due course, one way or another. I hope the UK winter has been bearable. February’s the hottest month here, and it’s been a very pleasant 30 degrees C this week!

Steve