Surreal transportation...

I’ve just started back doing surgery at Kiwoko Hospital today, after having a fantastic holiday for the last couple of weeks. It was really great to take some time off and rest, but I also managed an amazing trip around the Ugandan countryside! I could probably write a novel about all the different experiences, but I’ll try and sort out a few thoughts into more manageable chunks of blog! My first thought is to try and explain some of the many ways I’ve found of getting around Uganda!

First off must come what Ugandans call a taxi (Kenyans call it a Matatu – it is probably best described as a share-taxi/minibus). I’ve mentioned a few of my taxi journeys in previous blogs, and after six months in Uganda I’m getting fairly used to the joys of this particular form of public transport. The taxi-parks in Uganda look like complete chaos at first glance, but there’s always a helpful Ugandan to point you in the direction of the minibus going to where you want to go. Then it’s a simple matter of squeezing in with whatever bags you have, and waiting until it’s full. Of course full is a relative term, but in Uganda it’s actually supposed to be illegal to have more than people on board than there are seats! A lot of the time, this is a fairly loose concept, and especially in rural areas where there are no police checks its really a factor of how many can possibly fit. I’ve had 27 people including the driver in one minibus with seats for 14 before!

However, we actually hired a small 4x4 for our week of travelling around the country, and this proved to be a very sensible idea. It meant we could go where we wanted, when we wanted, and therefore enabled quite a creative tour to be created. The 4x4 was very necessary after it had rained almost non-stop for two days, as the dirt road between Murchison Falls National Park resembled a mud-wrestling pit for much of its length. In fact, the most extreme driving conditions were actually found in Kampala at the start and end of our journeys! Driving in Kampala is really just a giant game of chicken… The person with right of way at any junction or roundabout (or even just pulling off from the side of the road) is the person who looks least likely to stop for anything! After carefully negotiating a couple of roundabouts at the start of my driving experience, I must have started getting a slightly crazed look about me – very few other vehicles got in my way, and we were able to get about in a reasonably civilised manner!

I’m sure I’ve mentioned the state of the roads in Uganda before. The main road to the North of the country is supposedly surfaced, but is covered in some of the deepest potholes I’ve seen. I think some of them would swallow a whole lorry if they got the chance. Driving is therefore a case of finding the safest route through/around/over them, usually by weaving all over the road and the verges, while simultaneously watching for on-coming traffic doing the same and keeping out of the way of the taxis or buses coming from behind on either side (I think taxis are much like company cars in the UK – able to drive through potholes/up kerbs without any apparent modification!). The road to Kiwoko Hospital has become very potholed itself, and could do with a re-grading of the murram surface, but is negotiable at a slow speed. The World Bank is financing a resurfacing of the Luwero-Gulu road which made our journey north a little slow as they seem to just plough whole of the previous surface up before attempting any levelling or tarmac, but I was surprised to find the main road to Masindi was mostly newly surfaced.

The most dramatic part of our drive occurred on the very good dirt road into Murchison Falls National park – 20 minutes in and I suddenly lost control of the car, swerving violently into the ditch on the left, then the ditch on the right before managing to come to a stop in the middle of the road. It’s only by the grace of God that the car didn’t overturn, and other than a small bruise on an elbow, nobody was injured! Imagine my surprise when I went to check on the car and found that one of the rear wheels was missing! The nuts securing the brake drum to the axel must have been loose, and had shaken off during the bumpy journey. The wheel was attached to the drum, and was fortunately retrieved from the middle of a field of maize by a couple of helpful locals. I managed to get everything back together as by taking the nuts attaching the spare wheel to the back of the vehicle we had almost enough to secure both brake drum and wheel to the axel! Fortunately the brakes themselves were undamaged.

In the same week we had a superb boat trip up the Nile to view lots of wildlife and the amazing Murchison Falls waterfall, and then at the end of the trip we went white water rafting near the source of the Nile, which turned out to be exhilarating, great fun, and not particularly scary at all! Its just as well that there are no crocs in that part of the Nile, as our guide took great pleasure in allowing us to tip upside down in several of the rapids!

No tour around Uganda would be complete without a game drive – and we managed a sunset trip around the new Kabwoya Wildlife Reserve in the company of the owner of the Lake Albert Safari Lodge who also runs the reserve itself. To complete our set of motorised transport in one week, there was the obligatory Boda-boda ride between the Bujugali Falls on the Nile and The Source of the Nile at Jinja. This is basically a back-seat ride on a 50cc motorbike, often reaching terrifying speeds and winding in and out of traffic and potholes with abandon!

Our list of crazy transport isn’t quite finished, as in the second week of holiday we managed a couple of bike rides in the area around Kiwoko Hospital. A trip to the local town and back was a bit of a warm up for the hot weather and dusty road conditions, and getting three pineapples at the market for the equivalent of 30p was a definite bonus! We also managed a two-hour ride into the unknown to visit some of our students who were on community placement. This involved mostly recently graded dirt roads, but included a couple of sections where the roads were being improved by having mounds of clay dumped on them randomly. I hope they’ll be graded at some point, but it was great fun hurtling downhill at high speed over the bumps!

The most surreal (although seemingly completely safe) journey was also by bike. We visited our friendly Ugandan family at their homestead and after much fun, hot tea and games, ended up cycling back to Kiwoko in the dark. It was interesting to be cycling along pitch-black roads, passing people and other bikes without any lights, and being overtaken by a couple of vehicles and boda-bodas, especially when we had only two lights among three of us! It was completely crazy really, but at the same time actually surprisingly straightforward.

Who would think so much fun could be have just by travelling?!!

Steve

So what does it for you?

I know many people turn to alcohol or drugs, or adventure sports, to get that elusive feel-good factor in their lives, but I’m fortunate enough to be able to get it from my job. Working as a surgeon here at Kiwoko Hospital, Uganda, provides many opportunities for frustration and tiredness, but at the same time, there are often priceless moments when you know you’ve done a good job, and someone’s life has been changed as a result! What a privilege.

Two patients over the last couple of days have delighted me in this way. The first was on Friday afternoon - a Musee (Elderly Gentleman) was admitted with a story of two weeks of a tender swelling in his abdomen next to his liver. He had been seen the previous weekend and ultrasound by one of my colleagues had suggested a liver abscess, for which he had had some pus removed with a syringe, and had been placed on antibiotics. He had not improved, and had come back. I decided to operate so that I could drain the abscess and place a drain for irrigation, but when I opened his abdomen I found that the problem was actually a very inflamed gallbladder, with an adjacent abscess. It was a simple matter to remove the problem gallbladder and wash everything out, and I expect that he will be on his way home in a couple of days. It was great to do an old-fashioned general surgical operation, and the procedure was quick and straightforward. I removed over 130 gallbladders last year, but this was my first in Africa, and the theatre staff had not seen such an operation before.

The second patient was this lunchtime. A Ssebo (man) was admitted with half of his lower lip missing – his “friend” had bitten it off while both were drunk last night! I wasn’t sure how to replace the missing tissue, but hoped to be able to make a skin flap of some description. I was pleased to discover that he had such large lips (common in Ugandans!), that I was able to trim the edges of the defect and close the gap without difficulty. The end result was a neat line of sutures below the lower lip, and he was able to go home later this afternoon.

I’m sure that the feeling of taking a patient with an illness or injury, being able to do something to help in a practical way, and ending with a successful, aesthetic result, is one of the main reasons that I’m a surgeon. If you could bottle the sense of achievement gained, I’m sure I’d be a millionaire by now. Its funny – I’ve often said, ever since I started working as a doctor, that I enjoyed what I do day to day so much that getting paid for doing it was a bonus! Well, I’m putting it to the test this year – I don’t get paid a salary for working here in Uganda!

Having said that, I had a nice weekend away from Kiwoko last weekend. I ended up in Jinja at the Source of the Nile on Lake Victoria for the night on Saturday before dropping a visitor back to the airport on Sunday night. It was relaxing to go to a really decent, and cheap, restaurant, have a couple of nights sleep away from the possibility of being called to operate, and enjoy both the company of friends and some peace and quiet! Its important to remember to take time out to rest, and that can be forgotten easily when you live and work in the same place. I’m looking forward now to the beginning of July – I’m taking a couple of weeks holiday to go on safari, see various parts of the Ugandan countryside, and catch some adrenaline going white water rafting on the Nile. I think I’m about due a break!

No gross medical pictures this week. The child above is one of our adoptive Ugandan family who came to lunch with Rory and myself last Saturday. I don’t know what he was meaning by this pose, but it’s a cute photo!

Steve

What an exciting week...

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.

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