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

Money Makes The World Go Round...

I’ve been struck again this week at just how much poverty affects people in Africa. I know that I live and work in a rural area of Uganda – Kiwoko Hospital is in the Luwero Triangle, the area previously torn apart by the civil war twenty years ago. That’s the reason the hospital is here – An Irish GP came here just after the war finished, when there was no healthcare available for the people living here, and started seeing patients using the shade of a tree as his clinic! Its testament to God’s grace and provision that in merely 20 years the place has progressed to a 250 bed hospital offering some of the best healthcare in the country.

Its very difficult to see patients on the ward who can’t afford the cost of a matatu (public transport, and very cheap really) to get to Kampala, let alone the £15 that a proper Ultrasound scan or Contrast X-ray would cost. We end up providing care based purely on the clinical skills of the doctors with a few limited laboratory tests that may not be particularly reliable. We often even have patients’ attendants asking for money to provide food for themselves and their patient (basic personal care and food is provided by relatives who stay with the patient, often sleeping underneath their bed at night). We are able to help in a number of cases, due to our Good Samaritan Fund, money kindly donated from overseas, which should mean that no-one is turned away from the hospital because of lack of money.

However, Muzungus (white people) are seen as having lots of money… I guess, compared with the local people, we are pretty well off. I’m fortunate enough to be supported while I’m working here by Skillshare International, who give me a small monthly allowance – which in UK terms is next to nothing, but compared with salaries here is possibly four times as much as our nurses get paid each month. The perception is that we have much more, and earlier this week I was asked by one of our students if I could help sponsor her studies. Tuition Fees are about £400 a year, which includes accommodation and food as well as the studies. Often women in this culture take second place to men, and this particular student is facing not being able to complete her course because her brother has now got a place at university, and the family only have money for one child to be able to study. Somehow, the ability to buy CDs and DVDs each month back home seems less important in comparison to helping someone train to get a good job and help to support a family in the future. In one way, its difficult to help one person, rather than all the others who are often in similar circumstances, but at the same time every little helps.

Meanwhile, Surgery here at Kiwoko hasn’t got any quieter. I was on-call this weekend again, and ended up performing 17 operations in addition to reviewing all the medical and surgical patients each day (fortunately someone else saw the paediatric and neonatal patients), and seeing the new admissions. I’d thought that Saturday was busy enough, but Sunday was again the busier day, and I was up from 0345 operating on two emergency Caesarean Sections. Then later in the day, another emergency section – this time the baby unfortunately didn’t survive due to the length of time it had taken for the woman to get to hospital, and in the evening four more operations including two laparotomies for peritonitis and another section. Not such dramatic pathology as the previous weekend, but still quite a variety – draining bones for osteomyelitis, opening abdomens to remove appendices and wash out pelvic abscesses, along with delivering babies with varying degrees of difficulty. I was again completely exhausted on Monday and was fortunately allowed the afternoon off to rest!

Somehow the workload, although tiring, doesn’t seem so much of a trauma as busy weeks back in the UK. Being on your own, making important decisions at all times of the day or night, performing surgery without trained assistants, should make things much harder than back home where there are always other people around to help share the work. However, when you recognise that you are doing what you love doing (Surgery rocks!), for a people who really need your help, and when there’s nobody else to do it, small things like being barely able to stand up due to exhaustion don’t matter so much! It’s going to be difficult to leave at the end of the year!

Hopefully things will be a little easier soon. There’s a doctor from Edinburgh coming out to help for a couple of weeks, who could make my workload easier for the next time I’m on call for the week! Also I have a holiday to look forward to at the beginning of July. The plan is for a bit of a safari in the North west of the country, followed by a bit of white water rafting on the Nile, and a few days of rest and relaxation. It’ll be good to recharge the batteries!

I hope that you are able to see yourself making a difference in the lives of others wherever you are just now too.

Steve

Too Much Talk...

I’ve found myself speaking a lot in public recently. Apparently the locals don’t mind this, as I seem to have a clear British accent which they mostly have no problem in understanding. Some of these occasions have been fairly straight-forward, such as leading the music & singing at our daily morning devotional meeting. As Kiwoko is a Christian Hospital, we have a daily meeting with some sung praise and worship, a short talk, and some prayers, which is a great way of starting the day.

On Friday afternoon, I was faced with a more involved talk – I discovered that I was on the rota to preach at the local church on Sunday morning. Nobody had bothered to tell me, and the fact that I’ve been going to one of the other local churches, rather than the one attached to the hospital, didn’t seem to matter. At least the service is in English rather than Luganda, and at least I wasn’t planning to be away this weekend, as I had to spend Saturday morning putting together a sermon!

Tomorrow is another talk – medical this time – at another of our Hospital Grand Rounds. This one is on Burns, so I’ve just finished putting together a short talk on “Ongoing management of Burn patients” dealing with things like dressings, skin grafting, surgery, complications, etc. I’ve managed to take a few pictures of various patients we’ve had here over the past weeks, and will hopefully keep it short and simple to cater for the various grades of staff who will attend to be educated. I think its mainly aimed at nurses and nursing students, although the whole hospital is invited.

We’ve actually had quite a number of patients with burns recently. There has been a bit of an epidemic of men getting set alight after being dowsed in petrol (a common form of punishment here!!!), young women getting boiling water thrown over them by neighbours, and children pulling hot food onto themselves or crawling into fires. Sometimes it takes a long time for patients to get here, and we’ve had a couple of kids die shortly after admission as they had lost too much fluid before we could get to treat them. Its tragic, and the majority of childrens burns are due to the cooking method’s in this part of Uganda – most food is cooked on a small charcoal stove sitting on the floor, which is usually fairly unstable and easily pulled/knocked over. The sad fact is that gas and electricity, which would both be safer, are financially out of reach of almost all of the people in this part of the world.

Its also difficult to treat burns here. A number of local remedies applied before attending hospital (including such superb treatments as rolling in ash and animal hair) make infections much more common. Dressings are expensive and we don’t have the number of nurses required to change dressings well regularly. For what we can do - which is usually resuscitation, exposure, keeping flies off, and skin grafting when needed - we actually do pretty well for most of our patients.

The next medical talks I’ll be doing is for our doctors and clinical officers – namely a series of tutorials on surgical topics for those who don’t specialise in surgery. I’ll be doing some stuff on Ano-rectal conditions (not particularly well managed here, yet!) and Trauma Management. I’ve also found a patient with varicose veins (not common here, but one of my specialist operations), and have both of our other surgeons and a number of theatre staff requesting to be present to watch what I do!

And then I’ve also been asked to preach a series of three talks at our morning meetings. We’re doing a series looking at some of the kings of Israel from the Old Testament, looking at what we can learn from their characters, their strengths and weaknesses. We’ve had King Saul and King David already. King Solomon is next week, and then I’ve got three talks on… King Manasseh. Hmm, very well known as the son of Hezekiah. There are 23 verses in the book of 2 Kings about him, rather than the chapters available on the other kings we’ve looked at. Oh well, I guess my evenings will be fairly full for the next couple of weeks as I sort all of these things out.

So as you can see, there’s a lot more to being a Surgeon in Uganda than just operating. You also have to be a Teacher and a Preacher among other things! Still you can’t do Brain Surgery every day…

Thanks for all the comments, and personal emails I’ve been receiving. Support and interest from overseas is incredibly welcome and appreciated. The hospital is also very grateful for some of the equipment that has recently been donated, with some to arrive later in the year. We now have a Sigmoidoscope, and will shortly be receiving a couple of flexible endoscopes. A hospital has also kindly donated their old image intensifier (theatre x-ray machine) which will improve our orthopaedic management considerably, and which should arrive before the end of the year. Thanks also for praying about our staffing situation. Our two local junior doctors have decided to remain with us for the time being rather than moving on elsewhere, which is a considerable blessing.

I hope life is as interesting and varied wherever you may be at the moment.
Steve

The Natives Are Restless...

I made the mistake last weekend of thinking that surgery here at Kiwoko Hospital, Uganda, was becoming somewhat routine. However I’m not sure if it was because of a full moon, but I was on-call all weekend and admitted three different people who had been attacked by their fellow-Ugandans wielding pangas (a large jungle knife). I’m fairly used to seeing the results of human disagreements, with plenty of stab wounds of various degrees occurring most weekends back in Edinburgh, and I’ve even had to take someone to theatre with lead in their abdomen after being shot with a sawn-off shotgun. I’ve even seen the results of panga-injuries before, having put back together half a face that had been taken off.

The weekend’s collection involved head injuries. The first on Friday evening, someone who had managed to open the front of their skull into the sinuses causing significant bleeding; he had been out drinking the night before, and by the next evening managed to get himself to hospital, unsure of what had happened! Then I was woken at 5.30 am on Sunday morning with a teenager who had been attacked by her husband the previous evening – she had deep injuries to the muscles of her back and forearm, a near-complete amputation of half of her hand, and a slash to her scalp which had managed to slice open the top of her skull like a tin. I was able to close all her wounds, but unfortunately the hand could not be saved, other than her thumb.

In the early afternoon, panga-casualty number three arrived having been attacked by his friend on the way back from the pub the night before. He had attended a local health centre who had noticed a large slab of bone sticking through his scalp and referred him for further management. I ended up doing open brain surgery as I removed blood clot and traumatised grey matter from where the panga had sliced straight into his frontal lobe, before stitching the edges of his dura (the brain’s cover) back together, replacing some bone, and closing his scalp! I’m not sure I recall ever before even seeing the inside of someone’s skull while they were alive, let alone performing brain surgery, but the patient made a great recovery and went home two days later! Whether his personality is changed at all by the loss of some of his frontal lobe will probably never be known by anyone here at the hospital!

These two patients on Sunday proved to be only a part of a full day in theatre which saw me operating on various emergency patients almost constantly between 8am and 2.30 the following morning. There was a baby with a neck abscess, a 3yr old with an open finger tip fracture and nail bed injury, a man with necrotic small bowel and sigmoid colon following an internal hernia who required two resections and bowel anastomoses, a Caesarean section for obstructed labour in a poor teenager who had been raped nine months earlier, an obstructed groin hernia, and a foot which had been injured with an axe. Then I was up again with an ectopic pregnancy early the next morning. All in a day’s work – neurosurgery, orthopaedics, paediatric surgery, plastic surgery, obstetrics, general surgery, colorectal surgery and gynaecology, in most of which I have limited training if any! But then that’s why I’m here – helping those who would otherwise not have any access to healthcare.

On Thursday afternoon, there was another major injury – this time accidental as a woman who had dropped a mirror attended with a laceration to her forearm. On closer examination in theatre it became apparent that she had sliced the entire contents of the palm side of her arm. I ended up rejoining three nerves, two arteries and about eleven tendons in a three and a half hour operation. I had concerns that the blood supply wouldn’t be good enough, but the next morning she had a warm pink hand, so what I repaired had obviously worked. The challenge for this patient is getting the hand moving again over the next few months. I put the arm in a plaster splint to limit finger extension, and made some cunningly-placed rubber bands passively flex her fingers, allowing my repaired tendons to move without tension. She came back for review again today, and I hope will return for regular physiotherapy. Unfortunately the aftercare of patients is very haphazard here, and we regularly see patients returning pieces of metal such as external-fixators which they have removed themselves, and they often ignore advice about the length of time a plaster cast should remain in place. We’ll have to see how this lady allows us to help with her hand.

After all that, I needed to get away for the weekend – so I went to Jinja, the source of the Nile, and spent Saturday white-water kayaking on Grade 2 rapids. As I’ve not canoed for years, that was quite scary enough for me, and great fun. The major coincidence of the day was meeting the person in charge of the kayaking operation, and discovering he was the younger brother of someone I was at medical school with! It’s a small world. I can heartily recommend “Kayak-The-Nile” to anyone interested in a great day out, run by Jamie Simpson, brother of fellow doctor, Gavin!

And so it’s been back to work again today – with some mostly straightforward stuff to counteract the adrenaline-inducing activities of the last two weekends. But still the memory and story to dine-out on for a while yet – I’ve been doing Open Brain Surgery!

Steve

The rains have started...

...which fortunately coincides with a period of less-intense activity for Kiwoko Hospital. Over the last week or so, the rainy season has begun – meaning that most days there has been a significant downpour. I’m not sure you could really count it as comparable to Scottish rain (although I believe April back home has been hot and dry!) because when it rains it really is a tropical deluge, but it seldom lasts longer than an hour, and the rest of the time its still pretty warm and sunny. The season is really good news for Uganda – it tops up water levels in our rain-water collectors, and allows the crops that have been planted over the last few weeks to start growing with a vengeance. For this Muzungu, it means slightly cooler nights allowing better sleep! All activity seems to stop during the rains, so it also means fewer patients…

Work has settled down into a fairly happy 7.30am-5.00pm routine, with enough time to take a lunch break. I’m still operating almost every day, but that’s shared with Dr Peter, and there aren’t lots of patients to see and sort out every morning. As a result of half-empty wards, we’re currently managing to redecorate each ward in turn by moving patients around. The old dirty walls and peeling paintwork are looking much fresher, cleaner and more hygienic, which has got to be good news for preventing post-op infections. I seem to be doing a steady stream of hernias and hydroceles at present, which is fairly relaxing as it’s within my normal range of operations. I’ve also had several Ugandan staff members approaching me surreptitiously to ask me to circumcise them. I think the main idea is that circumcision has been shown to dramatically reduce the incidence of HIV transmission, and so this has to be a good idea, even if as Christian staff members they are unlikely to be sleeping around anyway!

It has meant that I’ve had time to put together detailed plans for several of the activities that I want to do over the next few months. I’ve got a couple of research/audit studies sorted out, which hopefully I’ll be able to complete fairly easily. I’ve developed plans for introducing reflective learning through looking at our complications and deaths and discussing possible alternative management. I’ve also put together a fairly comprehensive trauma management course loosely based on the ATLS course that many UK doctors complete. The final stage of that may be introducing a “Resus” room for immediate care of critically ill or injured patients, but that will have to wait some further redevelopment of our buildings… although it is a definite possibility.

I’m also starting to get some thoughts together for some travelling – I’ve now been here three and a half months, so its about time I got to see some of the country. My current immediate plan is to get some white-water kayaking on the Nile in the next few weekends, and then I’ve thought about climbing Mount Elgon, abseiling the Sipi Falls, and chilling on the Ssese Islands. I will also hopefully have some visitors before too long, and will plan some safari trips and some white-water rafting with them! So if anyone wants to come and join me for a holiday…

However, the hospital will become busier soon, and unfortunately that’s likely to coincide with a period when we’ll be short of doctors. Our two Ugandan juniors are likely to move on in June – although the basic pay is slightly better here, there’s more opportunity for financial reward in Kampala medical practice. We’ll try to recruit some replacements, but its not easy to attract doctors into a rural area, once they’re used to the facilities available in the big city. I was updating my surgical logbook today, and reflecting on some of the stuff I was doing at the beginning of February when it was busy and I was on my own. I think all of the patients I agonised over and was scared to operate on did very well. There was my six-month old with bowel necrosis from an intussusception, who survived against most odds. There was a man who was very unwell with intestinal fistula who I was forced to operate on twice and who lost most of his weight, but recovered, healed and went home. There was another man with major intra-abdominal sepsis and likely fistula following someone else’s hernia repair who again I had to operate on, and who took some time to recover, but went home smiling!

It’s amazing to be privileged enough to be so involved with these patients lives, and to know that in some way I’ve been part of helping them get from near death to recovered – and humbling to realise that I’m sure I’ve only been a small part of that process. One of my wise friends from home related a story to me recently of how he’d advised a midwife friend at some point in the past that rather than delivering babies herself, she was really a trained assistant to Jesus! Looking back, I can very much empathise with this view of God-given work.

Its been great to get lots of news from home in the UK recently, although given the number of engagements among friends that have suddenly occurred, I think there must be something in the water… I’ll stick to my boiled and filtered bore-hole water here, thanks very much. But all stories of what folk are up to are most appreciated – do consider dropping me a letter or email! Steve Bennett, Kiwoko Hospital, PO Box 149, Luwero, Uganda!

One further point for prayer – in addition to losing some of our doctors, several of our nurses have recently departed for government jobs too. Please pray that we would be able to recruit more staff quickly, and also that more donors may be found to help provide finance for the hospital to be able to pay its staff a little more, which may aid in retention of current staff. And of course if you were willing to donate a little yourself, please visit www.fokh.org.uk to see how easiest to give.

God bless,
Steve

Working where the sun don't shine...

I’m on-call tonight for the hospital, and its not been outrageously busy so far – a young child with cerebral malaria causing fits and needing a blood transfusion, a fifteen year old with EMF (EndoMyocardial Fibrosis – an extremely rare condition in which children develop severe heart failure, and are admitted every few weeks to drain fluid which accumulates in their abdomens!), a young woman with pneumonia who is likely to also have HIV, an older child with diarrhoea, vomiting, cough and fever who is likely to also have cerebral malaria… Not too bad so far, but unfortunately I’m likely to be up through the night doing caesarean sections. There are two women in our labour ward who have been in labour for some time, but are not progressing. We’ll reassess both at 1am, but I suspect it may be a busy night in theatre! Well, I did warn you at the end of the last blog that I’d probably be a bit more medical this time!

The title refers to one aspect of my work here that is part of my normal repertoire! Yep, colorectal surgery! Our clinical officers (A&E doc or GP equivalent) don’t seem to be particularly good at diagnosing anal conditions, and I keep getting referred patients “Admit for Haemorrhoidectomy”, who actually have no such thing. In fact in the UK, we rarely operate on piles, as there are other less invasive treatments that usually work. However, I actually have yet to see a patient with decent piles here! The ones who are referred are suffering from a simple bit of excess skin (no treatment required), a small bruise or perianal haematoma (settles by itself), or an anal fissure (incredibly painful and usually treated with a special cream in the UK, but here requires a bit of a stretch!!!).

The difficulty I have is that I want to properly examine the patients, but it is difficult to see the lining of the tail end without the correct equipment. So, I have ordered a special tube and light called a sigmoidoscope, over the Internet that will hopefully be brought out to Uganda from the UK by one of our next visitors. I’m looking forward (perhaps that’s not quite what I mean) to being able to better diagnose and treat patients, and then also to educate the other docs and clinical officers on common colorectal conditions. I have some tutorials that I can use, and it’s good to have identified a simple difficulty/problem that I can easily sort out and train others in. After all, that’s a large part of why I’m here.

Can you tell I’m feeling well rested and cheerful after a good weekend off? Actually Saturday afternoon was quite exciting. I’d been in Kampala in the morning shopping for food, which was a surprisingly successful trip and I had a pretty full rucksack! On the way back in the matatu (share taxi-minibus) the heavens opened and we were completely deluged. Unfortunately I was sitting in the wrong seat and at one point had to get out into the rain to let someone else out, and boy was it wet rain! On this occasion I had to change at Luwero, the town on the main road after which its dirt road for 16km to Kiwoko. The next transport along was actually a car-taxi rather than a minibus matatu, so seven adults and four kids plus my rucksac piled into this rather small saloon car for the journey! I wouldn’t really have believed it possible to get so many people so far in so small a space! The exciting part of the journey was that every so often we would pull into the side of the road – to let a speeding rally car fly past! The “Pearl of Africa” Rally is on at the moment, and the stage for Saturday afternoon included the main road to Kiwoko. Of course, this being Africa, they didn’t close the road to traffic at all – that would spoil the fun of dodging other road users and pedestrians! However, for all those who have commented on my driving in the UK, I have now actually been on a rally drive course during a race…..and lived to tell the tale.

Anyway, I hope life is bright wherever you are reading this, and that you are enjoying what I’m told is unseasonably good weather in the UK. Apologies for any errors here – my mother had the kindness to write this week and tell me off for several spelling and grammatical mistakes in my writings…. And I can’t even use the excuse of typing in the dark any more!

Please keep Kiwoko hospital, its staff and patients in your prayers.

Steve

Frustrated...

It was going to happen sooner or later… At some point I was always going to get a bit frustrated at life in Uganda, compared with back home. This weekend was it, possibly the first time that I’ve felt a bit fed up! Fortunately it didn’t last long, and had an underlying cause. The couple of weeks since I last posted a blog have been very busy – apologies if you’ve been waiting for an update – and this combined with several poor nights of sleep managed to turn me grumpy!

So yesterday I was feeling a bit fed up. A bit isolated, miles from anywhere, with no personal means of transport; A little annoyed that I’d have to spend most of another Saturday travelling into Kampala to do some food shopping, carrying everything back in a matatu afterwards; Definitely annoyed at the kids who run around noisily outside all the time with no concept of allowing any privacy or any sense of what may be someone else’s garden; Very tired due to two hot nights with restless sleep and one night where the village disco was blaring music until 4am; Frustrated that all the things I’m planning to do and develop here at the hospital are taking a long time to sort out; Arrgghh – as you can probably see, I got a little overtired!

Fortuntately I was able to finish work on time yesterday, and got out on my bike for a ride around the local area. I can really recommend exercise as a good way of letting off steam, but riding around the local dirt roads and tracks, seeing the houses and the way people live, and being greeted by the children and adults alike, all brought home to me in so many ways just how much I have here compared with the rural population, and also reminding me why it is that I’m here, and who I’m here to help. The alteration in perspective was very welcome, and I arrived back after an hour very hot, tired and dusty, but also happier and more fulfilled. I just need to try and prevent it happening again now, or at least recognise it sooner.

There have been many good times here that I now remember fondly! The weekend before Easter was especially busy. I got to Kampala on Saturday morning to get a large car battery for emergency power, and had a particularly successful shopping trip – just because something is there one week is no guarantee that you’ll see it again for months! Then Saturday evening was party time at the Nurse training school. You may remember that the prize for the winning “house” at the sports day was a bull – well Saturday was the bull-party (nothing to do with a stag party in case you’re confused!). Being a Muzungu, I was of course one of the guests of honour (they are really into respect here – it goes both ways) and the party was fairly long and involved. We had games, dances, speeches, more dances, amazing barbequed bits of bull with roast potatoes, and a great time! I think the cultural thing here is to perform by putting on a tape/CD of some music you like, while singing/dancing along to it (a bit like Karaoke). For encouragement, other people then dance up to you from the audience, join you for a couple of minutes and then press a gift into your hand – a sweet, a coin or even a flower. One apparently popular girl had about ten different people giving her gifts all at the same time, or perhaps she was just so bad they wanted to make her feel better by encouraging her! After several hours of this I was ready to leave, but then they got on with the less formal part of the evening, and I was dragged up to dance for a while… I really wish I had more natural dance rhythm! The students all thought it was great of course (or perhaps they too were being polite!).

Then Palm Sunday was spent in one of the local churches, which was fairly lively and good fun, and humorous at the end when they had an auction of local market produce to raise funds – quite a surreal way of ending a church service! Then the afternoon and early evening was spent at the Training School “Easter Carol Service”. This turned out not to be half a dozen Easter songs, but in fact was a three hour Passion play put on by the students, interspersed by a dozen different Easter hymns. After the initial shock when (as of course a guest of honour) I was given the programme, it actually turned out to be a really good spectacle, with only a couple of dodgy theological moments! One memorable bit was after the crucifixion scene – cue darkness, thunder and lightning, with the devil running around going mad and celebrating. Of course we call it Good Friday because through that crucifixion, the devil didn’t gain a great victory but was in fact defeated….

I’ve then been on-call for surgery all week and weekend, hence the slightly run-down state by Easter Monday. I have at least found time to connect up my new emergency power supply to the house lighting system, so I now have electric light whenever the mains is off. I’ve also been getting a bit more involved with the musical side of our morning hospital meetings. Every morning we have fifteen minutes of sung praise and worship before a talk and prayers, which is a fantastic way of starting each day, recognising who ultimately is responsible for the work that will be done that day, and entrusting it all into God’s hands. I’ve been helping lead some of the singing, and have been slowly introducing a couple of newer songs. Everyone seems very enthusiastic, and this morning’s praise was especially good.

Next week I’m doing the talk on Friday morning. I’ve not been given a topic, so I’ll have to put something together myself. I’m actually a little apprehensive, as although I’m sure I’ll be able to stand up and say something, I think that the Ugandans working here perhaps have as much knowledge of God as I do, and put their faith into action much more readily, so I feel a little under-qualified to preach to them! I think some prayer of my own is required!

So no medical stuff to describe this week! Those of a squeamish nature will be grateful – those who love the gory detail will have to be patient until next time. Happy Easter, and God bless you.

Steve