I’m not long back from a few days in Kenya, having had a superb break and rest! Four nights at Kilifi Bay Beach Resort – about an hour up the coast from Mombasa, and a long way away from any other sort of African life that I’ve experienced in the last couple of months. If you can imagine an oasis of a swimming pool surrounded by palm trees, several thatched roofs covering a poolside bar and air conditioned en-suite rooms, a second bar built on a terrace over the private white sandy beach with the rolling waves and surf of a very warm Indian Ocean… you may be getting somewhere close!
This was a retreat for development workers belonging to Skillshare International, the charity that is kindly helping to fund my year in Africa. The East African Skillshare team and all the workers they support try to get together once a year with the aim of supporting each other in the places they are working, and building better relationships between development workers and the organisation out here.
There were several short meetings, time spent debating several issues that people were having, and a day spent in team-building exercises. There was also plenty of time for eating, relaxing and swimming. I found it very interesting to meet the different people involved with Skillshare – some in various health projects, some in other different settings on a local or regional basis. On the basis that I haven’t had to seek help from the Skillshare Office since I’ve been here, Kiwoko Hospital was held up as a superb example of a “Partner Organisation” – Skillshare funds and supports people who are employed by other partners in the area.
Kilifi was very hot, so it was a relief in many ways to get back to Uganda on Saturday afternoon. For being a neighbouring country, its very different from Kenya in many ways, and I think I’m very glad to be living and working here. I think the pace of life is a little slower, the people a little more welcoming, and the countryside a little greener…. It’s difficult to explain, but in many ways it felt like coming home!
And so back to work today… many of my patients from the last few weeks have now left having recovered well. My six-month old baby recovered extremely well from its second operation to rejoin its bowel, and went home barely a week after surgery. I ended up paying for its treatment, and even giving some money to help feed the mother while they stayed. I found out today that the mother had been so distressed at the time of the original life saving surgery, and so appreciative of the care given from Kiwoko that she had come to know Jesus through it all and had become a Christian as a result. Personally, I’m delighted to have seen the baby healing well, and getting home – it gives a real sense of what I’m trying to accomplish by being here.
I’ve now been here long enough to want to start putting some stuff together to help improve the services that Kiwoko offers its patients. Over the next couple of weeks I’ll hopefully have time to put together some detailed plans, and start implementing some more formal training. On a more personal level, I’m starting to put together some changes in my accommodation – I’ve wired my fridge into a better location in the kitchen, installed a new oven/cooker, and will soon have electricity for lighting/computer when there’s no mains power, courtesy of a car battery and voltage inverter that arrived as a birthday present from my Dad. In some ways, life is getting a bit comfortable – I’ll not want to leave at the end of the year!
If anyone is interested in personally supporting the work of the Hospital here, and would like to make a financial contribution to the general running costs, or to our “Good Samaritan Fund”, the people of this area of Uganda would be very grateful! Have a look at the “Friends Of Kiwoko Hospital” website - www.fokh.org.uk - for information on how to give, or alternatively get in touch with me directly.
Alternatively, if anyone has access to unwanted medical equipment, that would also be extremely beneficial. One major piece of equipment that would be fantastic to source would be a fibreoptic endoscope and light source… perhaps a hospital somewhere has converted to video endoscopes and has an old fibreoptic scope lying spare?
Anyway, if nothing else, please keep supporting the hospital, its staff and its patients by praying regularly. Your thoughts and prayers are much appreciated.
Steve
Tuesday, 27 March 2007
Monday, 19 March 2007
A good week of General Surgery
I had one especially good day this week. I think this is partly because of who I was operating on, and partly due to the operations I was performing. I am delighted to report that the six-month old baby who I operated on back at the beginning of February, and who I was disappointed that he hadn’t returned last week, arrived back at Kiwoko with his mother on Wednesday. He had even managed to put on a couple of kilograms in the last two weeks since he went home. You may recall my sense of being completely out of my depth when I had to operate on him, and my joy when he survived.
The family had no spare money, so the delay in returning by a week was apparently while they tried to get enough together to afford the cost of travel (probably only about a pound!). This is precisely the type of patient who is in most need of healthcare, and who this hospital tries to help. Our “Good Samaritan Fund” will cover the cost of this admission, hopefully allowing this baby to be restored to health. So many thanks to those generous people who contribute financially to enable this to happen.
So Thursday was a day of general surgery – what I am actually trained to so. I operated on this baby in the morning. It was again a bit of a shock to find out just how small he was, but the procedure went well. For the medical minded amongst you, there were very few adhesions, I was able to mobilise the rectal stump easily, and then joined it to the end of his small bowel which had until then been protruding through his abdominal wall for the previous six weeks. Dr Peter was kind enough to assist me, but I think he was interested in the technique I was using – the type of anastomosis I have been taught is different from his own way of joining bowel. So far the baby has recovered well. He is moving his bowels, and is feeding well. I have high hopes that he will continue to get better and may get home again later this week.
The other good general surgical case was later on Thursday afternoon. A new admission with acute abdominal pain, a gas-filled mass in the centre of her stomach and vomiting suggested obstruction. I decided that an operation was required as her symptoms had been ongoing for 24 hours, and found that she had twisted part of her bowel on itself – a caecal volvulus. Although not gangrenous, the bowel was starting to split open, so resection and re-joining was required. Again, an operation I have actually been trained to do. One right hemicolectomy later, and the patient is already much better. Again Dr Peter was observing my technique – whether he adopts it, I am not sure, but he seemed to like it. It is good that now I have been here a couple of months, we are working together as a team – some things he is more experienced at, some things I am. I hope we will continue to learn from each other.
I have been on-call this weekend too – yesterday was busy with a couple of caesarian sections and an acute obstructed hernia. I was in theatre most of the day, which meant I missed most of the excitement of the nursing school sports day. This all-day competition was taken very seriously, and with great enthusiasm. It involved various sports such as volleyball, football, athletics, an eating competition, and even a traditional dance competition – apparently one team performed a traditional circumcision ritual complete with mock-blood! I did witness the most exciting part – the prize-giving, with individual winners getting household implements such as basins and plates!!! However, the prize for the overall winning team was a bull – I think there will be another party in a week or two where this animal will be slaughtered and eaten…
I myself am going on retreat this week. Skillshare International, who are kindly supporting me financially while I am here, are having a get together for all their East Africa development workers. We are meeting in Kilifi, north of Mombasa on the coast of Kenya. I suspect it will be hot, but I’m looking forward to a short break. I leave tomorrow, and get back on Saturday. Must remember the swimming shorts, and the suncream!
So as you can see, the hard work is balance by hard play – precisely the way life should be. I hope this blog finds you in a similar condition!
Steve
The family had no spare money, so the delay in returning by a week was apparently while they tried to get enough together to afford the cost of travel (probably only about a pound!). This is precisely the type of patient who is in most need of healthcare, and who this hospital tries to help. Our “Good Samaritan Fund” will cover the cost of this admission, hopefully allowing this baby to be restored to health. So many thanks to those generous people who contribute financially to enable this to happen.
So Thursday was a day of general surgery – what I am actually trained to so. I operated on this baby in the morning. It was again a bit of a shock to find out just how small he was, but the procedure went well. For the medical minded amongst you, there were very few adhesions, I was able to mobilise the rectal stump easily, and then joined it to the end of his small bowel which had until then been protruding through his abdominal wall for the previous six weeks. Dr Peter was kind enough to assist me, but I think he was interested in the technique I was using – the type of anastomosis I have been taught is different from his own way of joining bowel. So far the baby has recovered well. He is moving his bowels, and is feeding well. I have high hopes that he will continue to get better and may get home again later this week.
The other good general surgical case was later on Thursday afternoon. A new admission with acute abdominal pain, a gas-filled mass in the centre of her stomach and vomiting suggested obstruction. I decided that an operation was required as her symptoms had been ongoing for 24 hours, and found that she had twisted part of her bowel on itself – a caecal volvulus. Although not gangrenous, the bowel was starting to split open, so resection and re-joining was required. Again, an operation I have actually been trained to do. One right hemicolectomy later, and the patient is already much better. Again Dr Peter was observing my technique – whether he adopts it, I am not sure, but he seemed to like it. It is good that now I have been here a couple of months, we are working together as a team – some things he is more experienced at, some things I am. I hope we will continue to learn from each other.
I have been on-call this weekend too – yesterday was busy with a couple of caesarian sections and an acute obstructed hernia. I was in theatre most of the day, which meant I missed most of the excitement of the nursing school sports day. This all-day competition was taken very seriously, and with great enthusiasm. It involved various sports such as volleyball, football, athletics, an eating competition, and even a traditional dance competition – apparently one team performed a traditional circumcision ritual complete with mock-blood! I did witness the most exciting part – the prize-giving, with individual winners getting household implements such as basins and plates!!! However, the prize for the overall winning team was a bull – I think there will be another party in a week or two where this animal will be slaughtered and eaten…
I myself am going on retreat this week. Skillshare International, who are kindly supporting me financially while I am here, are having a get together for all their East Africa development workers. We are meeting in Kilifi, north of Mombasa on the coast of Kenya. I suspect it will be hot, but I’m looking forward to a short break. I leave tomorrow, and get back on Saturday. Must remember the swimming shorts, and the suncream!
So as you can see, the hard work is balance by hard play – precisely the way life should be. I hope this blog finds you in a similar condition!
Steve
Saturday, 10 March 2007
Tropical illnesses!
09/03/07
This week has been a good reminder of how the spectrum of disease here in Equatorial Africa differs from familiar UK practice. The hospital has a monthly “Grand Round” to which all hospital staff and students are invited, which is basically a 90 minute presentation on a clinical topic. Last month it was on “Tetanus” – a disease which is unfortunately not as rare here as it should be (the hospital had more than a dozen cases last year), and which often affects newborn babies due to the local tradition of putting dung onto the umbilical cord stump soon after birth. Not many people are vaccinated here either – the disease is very rare in the UK, in large part due to our vaccination programme.
However, this month’s Grand Round was on two diseases that have been hot topics here in Uganda over the last couple of weeks – Meningococcal Meningitis and Bubonic Plague! Apparently meningococcal meningitis is relatively common across a band of Africa from West to East taking in northern Uganda/Kenya and southern Sudan/Ethiopia. In the last few years in Uganda there have been sporadic outbreaks affecting 50-300 people each year, and there has been one such outbreak in the North recently which was thought to have reached as far South as Masindi – only about 3hrs drive from Kiwoko! If that wasn’t scary enough, it was then reported that 19 people in Masindi didn’t have meningitis but in fact had Bubonic Plague. You may recall this as Europe’s “Black Death” from the 14th century – from where we get the nursery rhyme “Ring a ring of roses”, and recorded in Samuel Pepys diaries along with the Great Fire of London….
But enough of history. Before you get concerned I am vaccinated against all likely strains of Meningococcus, and Plague is rarely transmitted very far. Plus the hospital groundstaff have been out killing rats this month…. although only this evening I have caught one trying to crawl over the roof of my house! As an aside, the scientific name for the rat is Rattus rattus – which made me laugh! The meeting was very interesting though, and has raised the suspicion level for these two diseases among differential diagnosis lists.
One of our Ugandan doctors, Dr Dan, is very funny whenever we discuss common UK conditions such as heart disease, stroke, lung cancers, etc. Because most of these are rare in Uganda, he describes them as “trendy white-people diseases”! I was able to get him back earlier in the week – one of my patients came back for review and results of a biopsy I had taken a couple of weeks ago, and turned out to have TB which was unexpected, even though that was what I was looking for. I had to go and find out what the local appropriate management was – I’ve never actually treated TB before, so I told Dan that it was a trendy black people’s disease. He and Dr John, our other Ugandan junior doctor both thought this was hilarious.
Actually it brings up an interesting point about Ugandan culture – political correctness simply doesn’t exist here. White skinned people are Muzungus, fat people are called fat, short people short… always to their face, and purely descriptive with no offence intended, or indeed taken. Some might say that I will fit in well, with my own particularly politically incorrect outlook on life!
The latest exotic disease that crossed my path arrived yesterday afternoon. It was a public holiday for National Women’s Day (don’t get me started….) and I was on-call for the hospital. I admitted a man with classical symptoms and signs of Leprosy – another condition I’ve never seen before (perhaps I should get out of the UK more often…). My colleagues today agreed with my diagnosis, and we will await to see the results of investigations. A fascinating week of non-surgical illness!
I’m still keeping busy with many surgical patients to look after. I’m splitting the workload with Dr Peter at the moment which is keeping things controllable. The one disappointing thing this week was that my six-month old baby who I operated on a month ago failed to return for the second part of his operative treatment. I think money may be the issue – even though I had ensured the mother knew that I would take care of the bill if needed. It will be very sad if this child gets neglected and dies, especially after my efforts to save it’s life a few weeks ago…. I’ll keep you updated on any progress – perhaps I’ll try to find the village it lives in on my next cycling excursion, and kidnap the baby back for further treatment… (However, somehow I don’t think that would be culturally acceptable!).
The main exciting news of the week is that our new satellite broadband internet connection is up and running. So far it’s a single socket, but tomorrow I’m heading into Kampala to help buy the components necessary to set up a hospital network, which will include an access point in my house. That will be fantastic (even if it is dependent on power-supply), and will allow me to connect with the outside world when I’m unable to leave the hospital. The monthly cost to us Muzungus will probably be similar to the cost of broadband in the UK, but it’ll certainly be worth it, even if I don’t often have the time to access it.
So, many greetings again from Kiwoko – do keep me up to date with the chat from the UK, and please pray for the patients and staff here at the hospital.
Steve
This week has been a good reminder of how the spectrum of disease here in Equatorial Africa differs from familiar UK practice. The hospital has a monthly “Grand Round” to which all hospital staff and students are invited, which is basically a 90 minute presentation on a clinical topic. Last month it was on “Tetanus” – a disease which is unfortunately not as rare here as it should be (the hospital had more than a dozen cases last year), and which often affects newborn babies due to the local tradition of putting dung onto the umbilical cord stump soon after birth. Not many people are vaccinated here either – the disease is very rare in the UK, in large part due to our vaccination programme.
However, this month’s Grand Round was on two diseases that have been hot topics here in Uganda over the last couple of weeks – Meningococcal Meningitis and Bubonic Plague! Apparently meningococcal meningitis is relatively common across a band of Africa from West to East taking in northern Uganda/Kenya and southern Sudan/Ethiopia. In the last few years in Uganda there have been sporadic outbreaks affecting 50-300 people each year, and there has been one such outbreak in the North recently which was thought to have reached as far South as Masindi – only about 3hrs drive from Kiwoko! If that wasn’t scary enough, it was then reported that 19 people in Masindi didn’t have meningitis but in fact had Bubonic Plague. You may recall this as Europe’s “Black Death” from the 14th century – from where we get the nursery rhyme “Ring a ring of roses”, and recorded in Samuel Pepys diaries along with the Great Fire of London….
But enough of history. Before you get concerned I am vaccinated against all likely strains of Meningococcus, and Plague is rarely transmitted very far. Plus the hospital groundstaff have been out killing rats this month…. although only this evening I have caught one trying to crawl over the roof of my house! As an aside, the scientific name for the rat is Rattus rattus – which made me laugh! The meeting was very interesting though, and has raised the suspicion level for these two diseases among differential diagnosis lists.
One of our Ugandan doctors, Dr Dan, is very funny whenever we discuss common UK conditions such as heart disease, stroke, lung cancers, etc. Because most of these are rare in Uganda, he describes them as “trendy white-people diseases”! I was able to get him back earlier in the week – one of my patients came back for review and results of a biopsy I had taken a couple of weeks ago, and turned out to have TB which was unexpected, even though that was what I was looking for. I had to go and find out what the local appropriate management was – I’ve never actually treated TB before, so I told Dan that it was a trendy black people’s disease. He and Dr John, our other Ugandan junior doctor both thought this was hilarious.
Actually it brings up an interesting point about Ugandan culture – political correctness simply doesn’t exist here. White skinned people are Muzungus, fat people are called fat, short people short… always to their face, and purely descriptive with no offence intended, or indeed taken. Some might say that I will fit in well, with my own particularly politically incorrect outlook on life!
The latest exotic disease that crossed my path arrived yesterday afternoon. It was a public holiday for National Women’s Day (don’t get me started….) and I was on-call for the hospital. I admitted a man with classical symptoms and signs of Leprosy – another condition I’ve never seen before (perhaps I should get out of the UK more often…). My colleagues today agreed with my diagnosis, and we will await to see the results of investigations. A fascinating week of non-surgical illness!
I’m still keeping busy with many surgical patients to look after. I’m splitting the workload with Dr Peter at the moment which is keeping things controllable. The one disappointing thing this week was that my six-month old baby who I operated on a month ago failed to return for the second part of his operative treatment. I think money may be the issue – even though I had ensured the mother knew that I would take care of the bill if needed. It will be very sad if this child gets neglected and dies, especially after my efforts to save it’s life a few weeks ago…. I’ll keep you updated on any progress – perhaps I’ll try to find the village it lives in on my next cycling excursion, and kidnap the baby back for further treatment… (However, somehow I don’t think that would be culturally acceptable!).
The main exciting news of the week is that our new satellite broadband internet connection is up and running. So far it’s a single socket, but tomorrow I’m heading into Kampala to help buy the components necessary to set up a hospital network, which will include an access point in my house. That will be fantastic (even if it is dependent on power-supply), and will allow me to connect with the outside world when I’m unable to leave the hospital. The monthly cost to us Muzungus will probably be similar to the cost of broadband in the UK, but it’ll certainly be worth it, even if I don’t often have the time to access it.
So, many greetings again from Kiwoko – do keep me up to date with the chat from the UK, and please pray for the patients and staff here at the hospital.
Steve
Saturday, 3 March 2007
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
...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
Saturday, 17 February 2007
Finally, some peace and quiet!
16/02/07
It's Friday evening of my first quiet week here! Having worked Monday and Tuesday, I was able to take the last couple of days off, and am almost feeling human again! Just to illustrate how life here in Uganda can be frustrating, although my days off were good, I wasn’t able to so what I’d wanted… At least the matatus went fine, but my internet connection in my usual café was very slow – I think a couple of other people sharing the connection were updating their entire system. After uploading my last couple of blogs, I tried to download emails, but 180 was too many, and it timed out. My next stop was a different internet café, with a pay-as-you-go connection on a different network, which at least let me download my mail. Many thanks to all who’ve been in touch! Uploading all the email I’ve written over the last few weeks was not so successful.
Then the place I was hoping to stay didn’t have any spare rooms (it should have been a reasonable room in a hotel with swimming pool, etc), so I ended up in a dorm at one of the backpackers hostels. Actually it was OK, but no facilities to speak of, and it was so hot that night that I got hardly any sleep and was able to just lie under my mosquito net perspiring… And then trying to send emails again on Thursday morning – the wireless network was down. Such is life. I ended up coming back fairly early in the day, and at least managed a couple of hours sleep in the late afternoon, and then a good night in my own bed.
Today has been reasonable – with two surgeons, the workload wasn’t particularly heavy. My housekeeper got all the laundry and ironing done, so I have clean clothes for the weekend. I haven’t yet got her cooking for me – I need to get a bit more food, and then write down some recipes for her. She’s very keen to learn how to bake too. I just need some time to teach her (assuming I can remember myself!). I’m going to try and get her a cookbook – there’s one around called “My East African Cookbook” which was written by a Muzungu out here for a while and basically is lots of western food recipes that can be made with food that can be got here in Uganda! Having said that, tonight I had Sausage & Mashed potatoes for dinner, and you can’t get much more British than that!
And now I’m off for the weekend. Just as well – as there are only two of us here just now, I’m on-call for surgery again on Monday for the week! I’m heading into Kampala again with a couple of the other Muzungu doctors. We’ve managed to book rooms at the place I was hoping to stay at earlier this week, so the plan is to try once more with the internet, and then head across for some pool and poolside relaxation for the afternoon. Then on Sunday we’ll meet up with Dr Rory who is in Kampala with a vehicle, so we can get a lift back, and get a big supermarket shop on the way. Small things like this have become very important!
I think I promised some amusing tales in my last blog… One of the funniest (at least to the locals who were watching) was on one of the recent cycling trips I took with Dr Rory. The trails around the area are perfect for mountain biking, and everywhere we go we’re greeted with the sound of children (and adults) calling “Hey Muzungu, how are you?” – Sometimes the littlest children get so excited by this activity that they burst into tears! Considering we cycle lots of the trails frequently, you’d think they’d be used to us by now, but Muzungu-calling is obviously a sport that they don’t get tired of! Two things spring to mind about our latest trip.
First was Dr Rory stopping under a fairly uninteresting tree which happened to have a vine growing up it with an unusual gourd-shaped fruit. We had to stop while he found a huge stick to try and collect it… part dismantling a hedge in the process! The locals (and probably me as well, if I’m honest) all thought he was a bit daft!
The second, and certainly funnier, incident involved some of the older kids. A few of them decided to play chicken with us as we cycled along (actually not the best of expressions, as we’ve almost killed a few chickens, not to mention piglets, goats and dogs, which have nearly failed to get out of our way as we’ve been cycling!). These kids wanted to stand in the road, and get out of the way at the last minute, and we actually had quite a laugh with them! At about the same time one of the kids on a bike of his own decided to race us, and managed to overtake Dr Rory. He just about passed me too, but I wasn’t having any of it, and due to my lighter bike and many gears I was able to leave him standing. I know, you’re going to tell me I’m not at all competitive really! All good sport, and having overtaken at least one Muzungu, he was very happy!
On a slightly more serious note, if you were looking for anything to pray about for us out here, I’m sure Dr Peter would appreciate some prayer as he recovers from his illness. Christiana, wife of our German surgeon, managed to turn their vehicle over on the road from Luwero to the hospital yesterday – she was shaken but not hurt, fortunately, but she would benefit from getting through the next few days without delayed reaction. And as ever, the main work of the hospital in treating patients is only possible with God’s help – definitely please pray for the ones who are needing treatment from me!!!
And may God bless your own work, in whatever form it make take, whichever country you are in just now.
Steve
It's Friday evening of my first quiet week here! Having worked Monday and Tuesday, I was able to take the last couple of days off, and am almost feeling human again! Just to illustrate how life here in Uganda can be frustrating, although my days off were good, I wasn’t able to so what I’d wanted… At least the matatus went fine, but my internet connection in my usual café was very slow – I think a couple of other people sharing the connection were updating their entire system. After uploading my last couple of blogs, I tried to download emails, but 180 was too many, and it timed out. My next stop was a different internet café, with a pay-as-you-go connection on a different network, which at least let me download my mail. Many thanks to all who’ve been in touch! Uploading all the email I’ve written over the last few weeks was not so successful.
Then the place I was hoping to stay didn’t have any spare rooms (it should have been a reasonable room in a hotel with swimming pool, etc), so I ended up in a dorm at one of the backpackers hostels. Actually it was OK, but no facilities to speak of, and it was so hot that night that I got hardly any sleep and was able to just lie under my mosquito net perspiring… And then trying to send emails again on Thursday morning – the wireless network was down. Such is life. I ended up coming back fairly early in the day, and at least managed a couple of hours sleep in the late afternoon, and then a good night in my own bed.
Today has been reasonable – with two surgeons, the workload wasn’t particularly heavy. My housekeeper got all the laundry and ironing done, so I have clean clothes for the weekend. I haven’t yet got her cooking for me – I need to get a bit more food, and then write down some recipes for her. She’s very keen to learn how to bake too. I just need some time to teach her (assuming I can remember myself!). I’m going to try and get her a cookbook – there’s one around called “My East African Cookbook” which was written by a Muzungu out here for a while and basically is lots of western food recipes that can be made with food that can be got here in Uganda! Having said that, tonight I had Sausage & Mashed potatoes for dinner, and you can’t get much more British than that!
And now I’m off for the weekend. Just as well – as there are only two of us here just now, I’m on-call for surgery again on Monday for the week! I’m heading into Kampala again with a couple of the other Muzungu doctors. We’ve managed to book rooms at the place I was hoping to stay at earlier this week, so the plan is to try once more with the internet, and then head across for some pool and poolside relaxation for the afternoon. Then on Sunday we’ll meet up with Dr Rory who is in Kampala with a vehicle, so we can get a lift back, and get a big supermarket shop on the way. Small things like this have become very important!
I think I promised some amusing tales in my last blog… One of the funniest (at least to the locals who were watching) was on one of the recent cycling trips I took with Dr Rory. The trails around the area are perfect for mountain biking, and everywhere we go we’re greeted with the sound of children (and adults) calling “Hey Muzungu, how are you?” – Sometimes the littlest children get so excited by this activity that they burst into tears! Considering we cycle lots of the trails frequently, you’d think they’d be used to us by now, but Muzungu-calling is obviously a sport that they don’t get tired of! Two things spring to mind about our latest trip.
First was Dr Rory stopping under a fairly uninteresting tree which happened to have a vine growing up it with an unusual gourd-shaped fruit. We had to stop while he found a huge stick to try and collect it… part dismantling a hedge in the process! The locals (and probably me as well, if I’m honest) all thought he was a bit daft!
The second, and certainly funnier, incident involved some of the older kids. A few of them decided to play chicken with us as we cycled along (actually not the best of expressions, as we’ve almost killed a few chickens, not to mention piglets, goats and dogs, which have nearly failed to get out of our way as we’ve been cycling!). These kids wanted to stand in the road, and get out of the way at the last minute, and we actually had quite a laugh with them! At about the same time one of the kids on a bike of his own decided to race us, and managed to overtake Dr Rory. He just about passed me too, but I wasn’t having any of it, and due to my lighter bike and many gears I was able to leave him standing. I know, you’re going to tell me I’m not at all competitive really! All good sport, and having overtaken at least one Muzungu, he was very happy!
On a slightly more serious note, if you were looking for anything to pray about for us out here, I’m sure Dr Peter would appreciate some prayer as he recovers from his illness. Christiana, wife of our German surgeon, managed to turn their vehicle over on the road from Luwero to the hospital yesterday – she was shaken but not hurt, fortunately, but she would benefit from getting through the next few days without delayed reaction. And as ever, the main work of the hospital in treating patients is only possible with God’s help – definitely please pray for the ones who are needing treatment from me!!!
And may God bless your own work, in whatever form it make take, whichever country you are in just now.
Steve
Wednesday, 14 February 2007
Scary Responsibility
I’m writing this on Thursday 8th February – and still haven’t managed to get away from the hospital to post even the last blog! Dr Peter is still ill (apparently bad enough to be in hospital earlier this week – no wonder he didn’t come back last weekend!), so I am still the only surgeon here. Three weeks without a break is becoming quite tiring, more so as the last couple of days I’ve still been operating into the night, having been up working since 7.30am.
I think once Dr Raul is back next Tuesday, I’ll be able to take a couple of days off and get away for a rest. That’s a positive thought to look forward to. I told Dr Rory (in charge) that either I’d get a couple of days off soon, or I’d resign – either way, I’d get a break! I think he realised that I was joking.
I had the strange experience of having my birthday in Uganda on Tuesday of this week. In many ways, it wasn’t too different from back home – often I’ve ended up working on my birthday before. This time I was at least able to control my workload, and finish the day by about 4.30pm. I think most of the other non-surgical docs here are often free by then, but to me it felt very odd! I got a couple of cards from folks here, some food courtesy of someone who was able to get into Kampala that day, and a couple of cards & texts from home.
I had a few folks over for a film in the evening. Not entirely successful…. Thanks to my brother giving me a couple of computer bits to allow me to watch some DVDs he’s put onto a hard drive for me, my main DVD software is not working properly. The options were therefore to use windows media player – but it currently gives full surround sound but no voices at all??? Very strange and not helpful – or playing stuff through winDVD by selecting 30min segments from the file names. That was working well, except that within the same film, the four different segments were in different languages! After the first 20mins I got called to the wards anyway, so it was a bit of a washout. But… once I got back I managed to uninstall and reinstall various drivers, and got the whole thing working again properly. That’s what I call good use of a birthday evening!
The scary responsibility of the title refers to last night’s surgical escapades. Having been operating all day since 10am, at 6.30pm I came out of theatre to review a new paediatric admission who had an obvious bowel obstruction, after a week of bloody diarrhoea. Lots of kids here get their bowel drawn inside itself (an intussusception for the medically minded reader!), and after a while everything turns swollen and necrotic! This was most likely what had happened to this child, although some of the clinical features were not present. In any case this was one sick boy, who was not going to survive without an operation. Unfortunately he was only six months old. I am not, and have never been, a paediatric surgeon, so taking the decision to operate was difficult. Ultimately, the child would have died if I hadn’t operated, so I felt justified taking the risk, even though there was a good chance of it dying in the middle of my operation.
One of the great things about working in theatre’s here is the hospital’s motto – “We treat, Jesus heals”. We usually pray with patients just before they are anaesthetised, and it was great to entrust this little one into God’s hands. During the operation, it rapidly became apparent that most of the large bowel was dead already, and even the small bowel that was left was fairly dodgy. In order to give the best chance I could, I ended up resecting everything, and bringing the bowel to the abdominal surface, emptying it into a bag. If it survived, and recovered, things could then be rejoined to its rectum! After a couple of hours in theatre, the baby was still alive, and I reviewed it on the ward before going to bed. At that point I became a little overwhelmed at the enormity of the responsibility I’m taking on here in Kiwoko for things that I’m not exactly experienced in.
Today was another day. The child is still alive, and doing OK. Praise God! I’ve been operating all day again though – today was another complicated abdomen, and then I took a woman back to theatre who I’d operated on originally at the weekend. A fifty year old lady had been attacked (apparently by her grandson) with a panga – basically a two foot long knife/axe used for chopping through the jungle! She had open fractures of both forearms, and half her face had been chopped off. On Saturday I had cleaned and splinted one arm, amputated the other as the hand had been completely destroyed, and tried to put her face back together – fortunately all soft-tissue problems. She has done remarkably, and the face has healed well.
Today I took her back to finish repairing her forearms which I’d left alone in case of infection. I managed to plate both broken bones – orthopaedics is quite fun really – and although I didn’t manage to get all of the damaged muscles and tendons together again, I think she’ll be left with a useable limb. I also closed the amputation and a couple of other wounds I’d left open. So far so good – but I have no idea what her long-term prognosis will be. Will her family help look after her when she has only one partially useable arm, and significant facial scarring? My heart really went out to her when they brought her in half dead, and I am so glad that we have been able to save her life so far. The theatre and ward staff have been very kind in their appreciation of what I’ve been able to do.
Perhaps my next blog entry will be a little more light-hearted. There’s lots of crazy things go on here, which I’m sure would be amusing to relate!
Steve
I think once Dr Raul is back next Tuesday, I’ll be able to take a couple of days off and get away for a rest. That’s a positive thought to look forward to. I told Dr Rory (in charge) that either I’d get a couple of days off soon, or I’d resign – either way, I’d get a break! I think he realised that I was joking.
I had the strange experience of having my birthday in Uganda on Tuesday of this week. In many ways, it wasn’t too different from back home – often I’ve ended up working on my birthday before. This time I was at least able to control my workload, and finish the day by about 4.30pm. I think most of the other non-surgical docs here are often free by then, but to me it felt very odd! I got a couple of cards from folks here, some food courtesy of someone who was able to get into Kampala that day, and a couple of cards & texts from home.
I had a few folks over for a film in the evening. Not entirely successful…. Thanks to my brother giving me a couple of computer bits to allow me to watch some DVDs he’s put onto a hard drive for me, my main DVD software is not working properly. The options were therefore to use windows media player – but it currently gives full surround sound but no voices at all??? Very strange and not helpful – or playing stuff through winDVD by selecting 30min segments from the file names. That was working well, except that within the same film, the four different segments were in different languages! After the first 20mins I got called to the wards anyway, so it was a bit of a washout. But… once I got back I managed to uninstall and reinstall various drivers, and got the whole thing working again properly. That’s what I call good use of a birthday evening!
The scary responsibility of the title refers to last night’s surgical escapades. Having been operating all day since 10am, at 6.30pm I came out of theatre to review a new paediatric admission who had an obvious bowel obstruction, after a week of bloody diarrhoea. Lots of kids here get their bowel drawn inside itself (an intussusception for the medically minded reader!), and after a while everything turns swollen and necrotic! This was most likely what had happened to this child, although some of the clinical features were not present. In any case this was one sick boy, who was not going to survive without an operation. Unfortunately he was only six months old. I am not, and have never been, a paediatric surgeon, so taking the decision to operate was difficult. Ultimately, the child would have died if I hadn’t operated, so I felt justified taking the risk, even though there was a good chance of it dying in the middle of my operation.
One of the great things about working in theatre’s here is the hospital’s motto – “We treat, Jesus heals”. We usually pray with patients just before they are anaesthetised, and it was great to entrust this little one into God’s hands. During the operation, it rapidly became apparent that most of the large bowel was dead already, and even the small bowel that was left was fairly dodgy. In order to give the best chance I could, I ended up resecting everything, and bringing the bowel to the abdominal surface, emptying it into a bag. If it survived, and recovered, things could then be rejoined to its rectum! After a couple of hours in theatre, the baby was still alive, and I reviewed it on the ward before going to bed. At that point I became a little overwhelmed at the enormity of the responsibility I’m taking on here in Kiwoko for things that I’m not exactly experienced in.
Today was another day. The child is still alive, and doing OK. Praise God! I’ve been operating all day again though – today was another complicated abdomen, and then I took a woman back to theatre who I’d operated on originally at the weekend. A fifty year old lady had been attacked (apparently by her grandson) with a panga – basically a two foot long knife/axe used for chopping through the jungle! She had open fractures of both forearms, and half her face had been chopped off. On Saturday I had cleaned and splinted one arm, amputated the other as the hand had been completely destroyed, and tried to put her face back together – fortunately all soft-tissue problems. She has done remarkably, and the face has healed well.
Today I took her back to finish repairing her forearms which I’d left alone in case of infection. I managed to plate both broken bones – orthopaedics is quite fun really – and although I didn’t manage to get all of the damaged muscles and tendons together again, I think she’ll be left with a useable limb. I also closed the amputation and a couple of other wounds I’d left open. So far so good – but I have no idea what her long-term prognosis will be. Will her family help look after her when she has only one partially useable arm, and significant facial scarring? My heart really went out to her when they brought her in half dead, and I am so glad that we have been able to save her life so far. The theatre and ward staff have been very kind in their appreciation of what I’ve been able to do.
Perhaps my next blog entry will be a little more light-hearted. There’s lots of crazy things go on here, which I’m sure would be amusing to relate!
Steve
Tired but still standing!
Written 02/03/07
I haven’t managed to update this for a while – sorry if you’ve been waiting! What started off as a busy surgical workload has turned even busier over the last couple of weeks. I have been on-call for surgical emergencies for the last two weeks 24/7, and have been the only surgeon here for day-to-day work for the same time! Dr Raul is on holiday, and Dr Peter, our Ugandan Surgeon, has been away in Kampala while unwell. That has left me doing everything on my own!
I’ve been able to control the workload somewhat – getting started early in the morning is a good idea, and I’ve been trying to avoid operating too late into the evening. Fortunately the overnights have been alright (except for last Sunday night when I was on for the whole hospital and spent most of the night operating – three caesarean sections and an abdominal operation for obstructed bowel).
Dr Peter was supposed to be back yesterday, and I was expecting him to be able to work today, allowing me to get to Kampala for the day. I need more supplies, and am missing two weeks’ worth of emails! Unfortunately he didn’t make it back yesterday, so here I am, stuck in the hospital. I also didn’t sleep well last night – a combination of heat, thoughts about all the things I’ll not now get done today, the possible beginnings of a cold, and perhaps the Larium, which I’m taking for malaria prophylaxis.
I’ve had Larium twice before over the last ten years and not experienced any problems – there are reports of potential psychotic side effects. However, since being here, various people have said that they’ve had difficulty with insomnia because of Larium. I hope that’s not something that’s going to be a problem for me. Malaria prophylaxis is essential here given the high level of malaria-carrying mosquitoes, and Larium is certainly one of the best in terms of a once-weekly tablet with a good level of protection. If my blogs start showing signs of psychiatric tendencies (at least more than usual), please somebody let me know!
I’ve been managing a vast range of different types of surgery this week. In terms of UK specialities, I’ve been a General Surgeon, an Orthopaedic Surgeon, a Plastic Surgeon, a Urologist, an Ophthalmic Surgeon, a Vascular Surgeon and a Gynaecologist! Operations have ranged from hernias to burns to external fracture fixation, exenteration of an eye, several gynae abscesses and even repair of a major vein! Yesterday was a little disheartening – a 13 yr old with a large muscle tumour of her abdominal wall that was too big to remove and I could only biopsy. She is likely not to survive many months. There was also a man who had refused to seek treatment for an eye infection that had subsequently spread to his sinuses and into his brain. Although I drained the eye, he is unlikely to regain consciousness, and will die soon, I think.
On a lighter note, I now have a housekeeper – a girl who has just finished school and will be starting nursing college in September. My house is now very clean, and I no longer have to worry about hand washing of laundry (except for unmentionables which she won’t have to wash!). I’ll be teaching her how to cook some western-style dishes too, so I should get some decent food when I get back from the wards each evening. Its quite an odd concept, employing someone in this way, but for here its quite normal, doesn’t cost me very much, but gives someone a good paid job with a reasonable wage and is therefore supporting the local economy. I guess for us in the UK such a set-up has concerns about the abuses seen in for example America or South Africa in the past, but here things seem to work very amicably.
I think I’ll leave this blog entry here (and post it on the net when I can – hopefully I’ll get a day off during the week once Dr Peter’s back). I hope my frustration about being so busy the last couple of weeks doesn’t show too much! All-in-all, I’m really enjoying what I’m up to, and after all, the work is the reason I’m here! Many greetings to all back home… I hope February isn’t too cold!!!
Steve
I haven’t managed to update this for a while – sorry if you’ve been waiting! What started off as a busy surgical workload has turned even busier over the last couple of weeks. I have been on-call for surgical emergencies for the last two weeks 24/7, and have been the only surgeon here for day-to-day work for the same time! Dr Raul is on holiday, and Dr Peter, our Ugandan Surgeon, has been away in Kampala while unwell. That has left me doing everything on my own!
I’ve been able to control the workload somewhat – getting started early in the morning is a good idea, and I’ve been trying to avoid operating too late into the evening. Fortunately the overnights have been alright (except for last Sunday night when I was on for the whole hospital and spent most of the night operating – three caesarean sections and an abdominal operation for obstructed bowel).
Dr Peter was supposed to be back yesterday, and I was expecting him to be able to work today, allowing me to get to Kampala for the day. I need more supplies, and am missing two weeks’ worth of emails! Unfortunately he didn’t make it back yesterday, so here I am, stuck in the hospital. I also didn’t sleep well last night – a combination of heat, thoughts about all the things I’ll not now get done today, the possible beginnings of a cold, and perhaps the Larium, which I’m taking for malaria prophylaxis.
I’ve had Larium twice before over the last ten years and not experienced any problems – there are reports of potential psychotic side effects. However, since being here, various people have said that they’ve had difficulty with insomnia because of Larium. I hope that’s not something that’s going to be a problem for me. Malaria prophylaxis is essential here given the high level of malaria-carrying mosquitoes, and Larium is certainly one of the best in terms of a once-weekly tablet with a good level of protection. If my blogs start showing signs of psychiatric tendencies (at least more than usual), please somebody let me know!
I’ve been managing a vast range of different types of surgery this week. In terms of UK specialities, I’ve been a General Surgeon, an Orthopaedic Surgeon, a Plastic Surgeon, a Urologist, an Ophthalmic Surgeon, a Vascular Surgeon and a Gynaecologist! Operations have ranged from hernias to burns to external fracture fixation, exenteration of an eye, several gynae abscesses and even repair of a major vein! Yesterday was a little disheartening – a 13 yr old with a large muscle tumour of her abdominal wall that was too big to remove and I could only biopsy. She is likely not to survive many months. There was also a man who had refused to seek treatment for an eye infection that had subsequently spread to his sinuses and into his brain. Although I drained the eye, he is unlikely to regain consciousness, and will die soon, I think.
On a lighter note, I now have a housekeeper – a girl who has just finished school and will be starting nursing college in September. My house is now very clean, and I no longer have to worry about hand washing of laundry (except for unmentionables which she won’t have to wash!). I’ll be teaching her how to cook some western-style dishes too, so I should get some decent food when I get back from the wards each evening. Its quite an odd concept, employing someone in this way, but for here its quite normal, doesn’t cost me very much, but gives someone a good paid job with a reasonable wage and is therefore supporting the local economy. I guess for us in the UK such a set-up has concerns about the abuses seen in for example America or South Africa in the past, but here things seem to work very amicably.
I think I’ll leave this blog entry here (and post it on the net when I can – hopefully I’ll get a day off during the week once Dr Peter’s back). I hope my frustration about being so busy the last couple of weeks doesn’t show too much! All-in-all, I’m really enjoying what I’m up to, and after all, the work is the reason I’m here! Many greetings to all back home… I hope February isn’t too cold!!!
Steve
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