...which fortunately coincides with a period of less-intense activity for Kiwoko Hospital. Over the last week or so, the rainy season has begun – meaning that most days there has been a significant downpour. I’m not sure you could really count it as comparable to Scottish rain (although I believe April back home has been hot and dry!) because when it rains it really is a tropical deluge, but it seldom lasts longer than an hour, and the rest of the time its still pretty warm and sunny. The season is really good news for Uganda – it tops up water levels in our rain-water collectors, and allows the crops that have been planted over the last few weeks to start growing with a vengeance. For this Muzungu, it means slightly cooler nights allowing better sleep! All activity seems to stop during the rains, so it also means fewer patients…
Work has settled down into a fairly happy 7.30am-5.00pm routine, with enough time to take a lunch break. I’m still operating almost every day, but that’s shared with Dr Peter, and there aren’t lots of patients to see and sort out every morning. As a result of half-empty wards, we’re currently managing to redecorate each ward in turn by moving patients around. The old dirty walls and peeling paintwork are looking much fresher, cleaner and more hygienic, which has got to be good news for preventing post-op infections. I seem to be doing a steady stream of hernias and hydroceles at present, which is fairly relaxing as it’s within my normal range of operations. I’ve also had several Ugandan staff members approaching me surreptitiously to ask me to circumcise them. I think the main idea is that circumcision has been shown to dramatically reduce the incidence of HIV transmission, and so this has to be a good idea, even if as Christian staff members they are unlikely to be sleeping around anyway!
It has meant that I’ve had time to put together detailed plans for several of the activities that I want to do over the next few months. I’ve got a couple of research/audit studies sorted out, which hopefully I’ll be able to complete fairly easily. I’ve developed plans for introducing reflective learning through looking at our complications and deaths and discussing possible alternative management. I’ve also put together a fairly comprehensive trauma management course loosely based on the ATLS course that many UK doctors complete. The final stage of that may be introducing a “Resus” room for immediate care of critically ill or injured patients, but that will have to wait some further redevelopment of our buildings… although it is a definite possibility.
I’m also starting to get some thoughts together for some travelling – I’ve now been here three and a half months, so its about time I got to see some of the country. My current immediate plan is to get some white-water kayaking on the Nile in the next few weekends, and then I’ve thought about climbing Mount Elgon, abseiling the Sipi Falls, and chilling on the Ssese Islands. I will also hopefully have some visitors before too long, and will plan some safari trips and some white-water rafting with them! So if anyone wants to come and join me for a holiday…
However, the hospital will become busier soon, and unfortunately that’s likely to coincide with a period when we’ll be short of doctors. Our two Ugandan juniors are likely to move on in June – although the basic pay is slightly better here, there’s more opportunity for financial reward in Kampala medical practice. We’ll try to recruit some replacements, but its not easy to attract doctors into a rural area, once they’re used to the facilities available in the big city. I was updating my surgical logbook today, and reflecting on some of the stuff I was doing at the beginning of February when it was busy and I was on my own. I think all of the patients I agonised over and was scared to operate on did very well. There was my six-month old with bowel necrosis from an intussusception, who survived against most odds. There was a man who was very unwell with intestinal fistula who I was forced to operate on twice and who lost most of his weight, but recovered, healed and went home. There was another man with major intra-abdominal sepsis and likely fistula following someone else’s hernia repair who again I had to operate on, and who took some time to recover, but went home smiling!
It’s amazing to be privileged enough to be so involved with these patients lives, and to know that in some way I’ve been part of helping them get from near death to recovered – and humbling to realise that I’m sure I’ve only been a small part of that process. One of my wise friends from home related a story to me recently of how he’d advised a midwife friend at some point in the past that rather than delivering babies herself, she was really a trained assistant to Jesus! Looking back, I can very much empathise with this view of God-given work.
Its been great to get lots of news from home in the UK recently, although given the number of engagements among friends that have suddenly occurred, I think there must be something in the water… I’ll stick to my boiled and filtered bore-hole water here, thanks very much. But all stories of what folk are up to are most appreciated – do consider dropping me a letter or email! Steve Bennett, Kiwoko Hospital, PO Box 149, Luwero, Uganda!
One further point for prayer – in addition to losing some of our doctors, several of our nurses have recently departed for government jobs too. Please pray that we would be able to recruit more staff quickly, and also that more donors may be found to help provide finance for the hospital to be able to pay its staff a little more, which may aid in retention of current staff. And of course if you were willing to donate a little yourself, please visit www.fokh.org.uk to see how easiest to give.
God bless,
Steve
Friday, 27 April 2007
Monday, 16 April 2007
Working where the sun don't shine...
I’m on-call tonight for the hospital, and its not been outrageously busy so far – a young child with cerebral malaria causing fits and needing a blood transfusion, a fifteen year old with EMF (EndoMyocardial Fibrosis – an extremely rare condition in which children develop severe heart failure, and are admitted every few weeks to drain fluid which accumulates in their abdomens!), a young woman with pneumonia who is likely to also have HIV, an older child with diarrhoea, vomiting, cough and fever who is likely to also have cerebral malaria… Not too bad so far, but unfortunately I’m likely to be up through the night doing caesarean sections. There are two women in our labour ward who have been in labour for some time, but are not progressing. We’ll reassess both at 1am, but I suspect it may be a busy night in theatre! Well, I did warn you at the end of the last blog that I’d probably be a bit more medical this time!
The title refers to one aspect of my work here that is part of my normal repertoire! Yep, colorectal surgery! Our clinical officers (A&E doc or GP equivalent) don’t seem to be particularly good at diagnosing anal conditions, and I keep getting referred patients “Admit for Haemorrhoidectomy”, who actually have no such thing. In fact in the UK, we rarely operate on piles, as there are other less invasive treatments that usually work. However, I actually have yet to see a patient with decent piles here! The ones who are referred are suffering from a simple bit of excess skin (no treatment required), a small bruise or perianal haematoma (settles by itself), or an anal fissure (incredibly painful and usually treated with a special cream in the UK, but here requires a bit of a stretch!!!).
The difficulty I have is that I want to properly examine the patients, but it is difficult to see the lining of the tail end without the correct equipment. So, I have ordered a special tube and light called a sigmoidoscope, over the Internet that will hopefully be brought out to Uganda from the UK by one of our next visitors. I’m looking forward (perhaps that’s not quite what I mean) to being able to better diagnose and treat patients, and then also to educate the other docs and clinical officers on common colorectal conditions. I have some tutorials that I can use, and it’s good to have identified a simple difficulty/problem that I can easily sort out and train others in. After all, that’s a large part of why I’m here.
Can you tell I’m feeling well rested and cheerful after a good weekend off? Actually Saturday afternoon was quite exciting. I’d been in Kampala in the morning shopping for food, which was a surprisingly successful trip and I had a pretty full rucksack! On the way back in the matatu (share taxi-minibus) the heavens opened and we were completely deluged. Unfortunately I was sitting in the wrong seat and at one point had to get out into the rain to let someone else out, and boy was it wet rain! On this occasion I had to change at Luwero, the town on the main road after which its dirt road for 16km to Kiwoko. The next transport along was actually a car-taxi rather than a minibus matatu, so seven adults and four kids plus my rucksac piled into this rather small saloon car for the journey! I wouldn’t really have believed it possible to get so many people so far in so small a space! The exciting part of the journey was that every so often we would pull into the side of the road – to let a speeding rally car fly past! The “Pearl of Africa” Rally is on at the moment, and the stage for Saturday afternoon included the main road to Kiwoko. Of course, this being Africa, they didn’t close the road to traffic at all – that would spoil the fun of dodging other road users and pedestrians! However, for all those who have commented on my driving in the UK, I have now actually been on a rally drive course during a race…..and lived to tell the tale.
Anyway, I hope life is bright wherever you are reading this, and that you are enjoying what I’m told is unseasonably good weather in the UK. Apologies for any errors here – my mother had the kindness to write this week and tell me off for several spelling and grammatical mistakes in my writings…. And I can’t even use the excuse of typing in the dark any more!
Please keep Kiwoko hospital, its staff and patients in your prayers.
Steve
The title refers to one aspect of my work here that is part of my normal repertoire! Yep, colorectal surgery! Our clinical officers (A&E doc or GP equivalent) don’t seem to be particularly good at diagnosing anal conditions, and I keep getting referred patients “Admit for Haemorrhoidectomy”, who actually have no such thing. In fact in the UK, we rarely operate on piles, as there are other less invasive treatments that usually work. However, I actually have yet to see a patient with decent piles here! The ones who are referred are suffering from a simple bit of excess skin (no treatment required), a small bruise or perianal haematoma (settles by itself), or an anal fissure (incredibly painful and usually treated with a special cream in the UK, but here requires a bit of a stretch!!!).
The difficulty I have is that I want to properly examine the patients, but it is difficult to see the lining of the tail end without the correct equipment. So, I have ordered a special tube and light called a sigmoidoscope, over the Internet that will hopefully be brought out to Uganda from the UK by one of our next visitors. I’m looking forward (perhaps that’s not quite what I mean) to being able to better diagnose and treat patients, and then also to educate the other docs and clinical officers on common colorectal conditions. I have some tutorials that I can use, and it’s good to have identified a simple difficulty/problem that I can easily sort out and train others in. After all, that’s a large part of why I’m here.
Can you tell I’m feeling well rested and cheerful after a good weekend off? Actually Saturday afternoon was quite exciting. I’d been in Kampala in the morning shopping for food, which was a surprisingly successful trip and I had a pretty full rucksack! On the way back in the matatu (share taxi-minibus) the heavens opened and we were completely deluged. Unfortunately I was sitting in the wrong seat and at one point had to get out into the rain to let someone else out, and boy was it wet rain! On this occasion I had to change at Luwero, the town on the main road after which its dirt road for 16km to Kiwoko. The next transport along was actually a car-taxi rather than a minibus matatu, so seven adults and four kids plus my rucksac piled into this rather small saloon car for the journey! I wouldn’t really have believed it possible to get so many people so far in so small a space! The exciting part of the journey was that every so often we would pull into the side of the road – to let a speeding rally car fly past! The “Pearl of Africa” Rally is on at the moment, and the stage for Saturday afternoon included the main road to Kiwoko. Of course, this being Africa, they didn’t close the road to traffic at all – that would spoil the fun of dodging other road users and pedestrians! However, for all those who have commented on my driving in the UK, I have now actually been on a rally drive course during a race…..and lived to tell the tale.
Anyway, I hope life is bright wherever you are reading this, and that you are enjoying what I’m told is unseasonably good weather in the UK. Apologies for any errors here – my mother had the kindness to write this week and tell me off for several spelling and grammatical mistakes in my writings…. And I can’t even use the excuse of typing in the dark any more!
Please keep Kiwoko hospital, its staff and patients in your prayers.
Steve
Wednesday, 11 April 2007
Frustrated...
It was going to happen sooner or later… At some point I was always going to get a bit frustrated at life in Uganda, compared with back home. This weekend was it, possibly the first time that I’ve felt a bit fed up! Fortunately it didn’t last long, and had an underlying cause. The couple of weeks since I last posted a blog have been very busy – apologies if you’ve been waiting for an update – and this combined with several poor nights of sleep managed to turn me grumpy!
So yesterday I was feeling a bit fed up. A bit isolated, miles from anywhere, with no personal means of transport; A little annoyed that I’d have to spend most of another Saturday travelling into Kampala to do some food shopping, carrying everything back in a matatu afterwards; Definitely annoyed at the kids who run around noisily outside all the time with no concept of allowing any privacy or any sense of what may be someone else’s garden; Very tired due to two hot nights with restless sleep and one night where the village disco was blaring music until 4am; Frustrated that all the things I’m planning to do and develop here at the hospital are taking a long time to sort out; Arrgghh – as you can probably see, I got a little overtired!
Fortuntately I was able to finish work on time yesterday, and got out on my bike for a ride around the local area. I can really recommend exercise as a good way of letting off steam, but riding around the local dirt roads and tracks, seeing the houses and the way people live, and being greeted by the children and adults alike, all brought home to me in so many ways just how much I have here compared with the rural population, and also reminding me why it is that I’m here, and who I’m here to help. The alteration in perspective was very welcome, and I arrived back after an hour very hot, tired and dusty, but also happier and more fulfilled. I just need to try and prevent it happening again now, or at least recognise it sooner.
There have been many good times here that I now remember fondly! The weekend before Easter was especially busy. I got to Kampala on Saturday morning to get a large car battery for emergency power, and had a particularly successful shopping trip – just because something is there one week is no guarantee that you’ll see it again for months! Then Saturday evening was party time at the Nurse training school. You may remember that the prize for the winning “house” at the sports day was a bull – well Saturday was the bull-party (nothing to do with a stag party in case you’re confused!). Being a Muzungu, I was of course one of the guests of honour (they are really into respect here – it goes both ways) and the party was fairly long and involved. We had games, dances, speeches, more dances, amazing barbequed bits of bull with roast potatoes, and a great time! I think the cultural thing here is to perform by putting on a tape/CD of some music you like, while singing/dancing along to it (a bit like Karaoke). For encouragement, other people then dance up to you from the audience, join you for a couple of minutes and then press a gift into your hand – a sweet, a coin or even a flower. One apparently popular girl had about ten different people giving her gifts all at the same time, or perhaps she was just so bad they wanted to make her feel better by encouraging her! After several hours of this I was ready to leave, but then they got on with the less formal part of the evening, and I was dragged up to dance for a while… I really wish I had more natural dance rhythm! The students all thought it was great of course (or perhaps they too were being polite!).
Then Palm Sunday was spent in one of the local churches, which was fairly lively and good fun, and humorous at the end when they had an auction of local market produce to raise funds – quite a surreal way of ending a church service! Then the afternoon and early evening was spent at the Training School “Easter Carol Service”. This turned out not to be half a dozen Easter songs, but in fact was a three hour Passion play put on by the students, interspersed by a dozen different Easter hymns. After the initial shock when (as of course a guest of honour) I was given the programme, it actually turned out to be a really good spectacle, with only a couple of dodgy theological moments! One memorable bit was after the crucifixion scene – cue darkness, thunder and lightning, with the devil running around going mad and celebrating. Of course we call it Good Friday because through that crucifixion, the devil didn’t gain a great victory but was in fact defeated….
I’ve then been on-call for surgery all week and weekend, hence the slightly run-down state by Easter Monday. I have at least found time to connect up my new emergency power supply to the house lighting system, so I now have electric light whenever the mains is off. I’ve also been getting a bit more involved with the musical side of our morning hospital meetings. Every morning we have fifteen minutes of sung praise and worship before a talk and prayers, which is a fantastic way of starting each day, recognising who ultimately is responsible for the work that will be done that day, and entrusting it all into God’s hands. I’ve been helping lead some of the singing, and have been slowly introducing a couple of newer songs. Everyone seems very enthusiastic, and this morning’s praise was especially good.
Next week I’m doing the talk on Friday morning. I’ve not been given a topic, so I’ll have to put something together myself. I’m actually a little apprehensive, as although I’m sure I’ll be able to stand up and say something, I think that the Ugandans working here perhaps have as much knowledge of God as I do, and put their faith into action much more readily, so I feel a little under-qualified to preach to them! I think some prayer of my own is required!
So no medical stuff to describe this week! Those of a squeamish nature will be grateful – those who love the gory detail will have to be patient until next time. Happy Easter, and God bless you.
Steve
So yesterday I was feeling a bit fed up. A bit isolated, miles from anywhere, with no personal means of transport; A little annoyed that I’d have to spend most of another Saturday travelling into Kampala to do some food shopping, carrying everything back in a matatu afterwards; Definitely annoyed at the kids who run around noisily outside all the time with no concept of allowing any privacy or any sense of what may be someone else’s garden; Very tired due to two hot nights with restless sleep and one night where the village disco was blaring music until 4am; Frustrated that all the things I’m planning to do and develop here at the hospital are taking a long time to sort out; Arrgghh – as you can probably see, I got a little overtired!
Fortuntately I was able to finish work on time yesterday, and got out on my bike for a ride around the local area. I can really recommend exercise as a good way of letting off steam, but riding around the local dirt roads and tracks, seeing the houses and the way people live, and being greeted by the children and adults alike, all brought home to me in so many ways just how much I have here compared with the rural population, and also reminding me why it is that I’m here, and who I’m here to help. The alteration in perspective was very welcome, and I arrived back after an hour very hot, tired and dusty, but also happier and more fulfilled. I just need to try and prevent it happening again now, or at least recognise it sooner.
There have been many good times here that I now remember fondly! The weekend before Easter was especially busy. I got to Kampala on Saturday morning to get a large car battery for emergency power, and had a particularly successful shopping trip – just because something is there one week is no guarantee that you’ll see it again for months! Then Saturday evening was party time at the Nurse training school. You may remember that the prize for the winning “house” at the sports day was a bull – well Saturday was the bull-party (nothing to do with a stag party in case you’re confused!). Being a Muzungu, I was of course one of the guests of honour (they are really into respect here – it goes both ways) and the party was fairly long and involved. We had games, dances, speeches, more dances, amazing barbequed bits of bull with roast potatoes, and a great time! I think the cultural thing here is to perform by putting on a tape/CD of some music you like, while singing/dancing along to it (a bit like Karaoke). For encouragement, other people then dance up to you from the audience, join you for a couple of minutes and then press a gift into your hand – a sweet, a coin or even a flower. One apparently popular girl had about ten different people giving her gifts all at the same time, or perhaps she was just so bad they wanted to make her feel better by encouraging her! After several hours of this I was ready to leave, but then they got on with the less formal part of the evening, and I was dragged up to dance for a while… I really wish I had more natural dance rhythm! The students all thought it was great of course (or perhaps they too were being polite!).
Then Palm Sunday was spent in one of the local churches, which was fairly lively and good fun, and humorous at the end when they had an auction of local market produce to raise funds – quite a surreal way of ending a church service! Then the afternoon and early evening was spent at the Training School “Easter Carol Service”. This turned out not to be half a dozen Easter songs, but in fact was a three hour Passion play put on by the students, interspersed by a dozen different Easter hymns. After the initial shock when (as of course a guest of honour) I was given the programme, it actually turned out to be a really good spectacle, with only a couple of dodgy theological moments! One memorable bit was after the crucifixion scene – cue darkness, thunder and lightning, with the devil running around going mad and celebrating. Of course we call it Good Friday because through that crucifixion, the devil didn’t gain a great victory but was in fact defeated….
I’ve then been on-call for surgery all week and weekend, hence the slightly run-down state by Easter Monday. I have at least found time to connect up my new emergency power supply to the house lighting system, so I now have electric light whenever the mains is off. I’ve also been getting a bit more involved with the musical side of our morning hospital meetings. Every morning we have fifteen minutes of sung praise and worship before a talk and prayers, which is a fantastic way of starting each day, recognising who ultimately is responsible for the work that will be done that day, and entrusting it all into God’s hands. I’ve been helping lead some of the singing, and have been slowly introducing a couple of newer songs. Everyone seems very enthusiastic, and this morning’s praise was especially good.
Next week I’m doing the talk on Friday morning. I’ve not been given a topic, so I’ll have to put something together myself. I’m actually a little apprehensive, as although I’m sure I’ll be able to stand up and say something, I think that the Ugandans working here perhaps have as much knowledge of God as I do, and put their faith into action much more readily, so I feel a little under-qualified to preach to them! I think some prayer of my own is required!
So no medical stuff to describe this week! Those of a squeamish nature will be grateful – those who love the gory detail will have to be patient until next time. Happy Easter, and God bless you.
Steve
Tuesday, 27 March 2007
Aren't holidays great!
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
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
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
Subscribe to:
Posts (Atom)