Nick and Tessa in Kisiizi

Me: “How was your Christmas, did you have meat?”
Boy: (Big smile) “Yes, we had pork, very nice”
Me: “And what’s that you’ve got in the bag”
Boy: “Goat’s lung”
Me: “Goat’s what????????”

Complete with real baby Jesus!

Christmas here is a massive deal. Preparations start days in advance with a Ugandan Christmas carol service, ward decorations, relevant sermons, and a huge party 2 days before Christmas. This is one of the biggest events on the Kisiizi social calendar. Hospital staff are provided with a free dinner of Matoke, Beans, Maize and astoundingly a soda!!! They only start dinner at about 7:00 to try and ensure that all the staff stick around for the show rather than slinking off home.

A couple of weeks earlier I decided to perform the Haka with some local “Ruchiga warriors” at the christmas party. Surprising I had a lot of trouble roping people in. I think the guys here were worried it would be some girly dance that I would force them to do in front of the whole village. In the end some nervous nursing students showed up at the guest house and eagerly learnt the Haka after seeing me perform it. On the first day 10 turned up, then 13 the next, and on the day of the party 7 brave “Ruchiga warriors” were game enough to join me on side of the stage to strip down to our shorts. The cheers we received were enormous and the guys loved it. One came to me with a big smile exclaiming “I have never been on stage before” Tessa also did a poi dance which was awesome and our NZ cultural acts were quite a hit. Funnily enough the speeches went on far longer than the actual performances!!!

Announcing the results of the Ward’s-Christmas-decoration-competition provided the finale of the staff party. The competition was a HUGE deal…after the judges (including Tessa!) declared the winner, Ahumuza (Pysc Ward), the head Clinical Officer of the ward gave a gushing oscar-winning-style speech. When Tessa toured the Wards as a judge, each Ward (patients and staff alike) burst into song, dance, and nativity mimes. Most wards boasted a manager with a dressed up Mary, Joeseph and (real!) baby Jesus, christmas trees, streamers, all made of foliage, flowers and vegetables (see photos!)

Les mentioned that Christmas in New Zealand is plagued with security and consumerism (“boxing day sales”). One Christmas sermon focused on a similar problem, theme: “what do we give Jesus for Christmas”. The sermon focused on Christmas excitement, and how it can be be selfishly based on what we wear and that we get to eat meat on Christmas day (rare for many locals). Some problems are the same worldwide. He preached that we may have already given Jesus our hearts but we need to offer our whole lives as a living sacrifice, especially on x-mas day. It was a good sermon praise God.

The Christmas eve service was stunning, with joyous carol singing in a beautifully decorated chapel. The highlight was splitting up to the different wards and sing and pray with the patients and their carers. One person from each group also gave mini-messages about the shepherds and the good news from the angels. I went to the rehab ward, where we stood outside in the beautiful warm night with crickets chirping and mosquitos buzzing… It was a beautiful experience sharing a small message about God’s peace with a small group of incredibly attentive people. After I had finished my 5 minute mini-message, my translator went on for another couple of minutes!!!! I still have no idea what he said but he was probably adding a simple “gospel presentation” as no sermon here is complete without a warning about being saved…

On Christmas day we experienced an awesome “mzungu feast” where all the mzungus chipped in with impressive food. From glazed carrots to turkey and a Flaming Christmas pudding, it was ironically more sumptuous then a Christmas would be at home. It was great fun, with compulsorary x-mas performances. Tessa and I sang indescribable and amazing love while others played the trick game “black magic” and the Irishman cranked out a very amusing, borderline-appropriate ditty.

And now Christmas is over, back to eating goat lung. Hope your christmas’s were a blessing too ☺

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HI all - Keen to hear bits of news from home in comments, tell us about what’s going on for you too So stoked you got in Ben, congratulations!

We are going to permanently keep our photos on flickr because it is just so awesome. We have added new photos and captions so check it out Make your mark by leaving a comment too, we love comments.

Click on our photos link on the right, or go to       http://www.flickr.com/photos/33079877@N02/

I romantically mopped Nick’s fevered brow, waiting for Dr. Kate to pop round after lunch to inspect the guest-house in patient Later that afternoon, the lab-man came trotting up the path to deliver Nick’s blood slide results in person. 

Yes, despite taking preventative drugs daily and sleeping under mosquito nets, Nick somehow managed to get Malaria. Many people have lived their whole lives here without taking prophyilaxis and never contracted this tropical nasty. Malaria, on second thoughts is not romantic at all, what with the vommitting and flatulence….He has had a horrible couple of days  (you know nick is really sick when he has no desire to play soccer or eat), but has finished his course of drugs and thankfully is now almost completely better. Our friends here were so wonderful, popping in to see him with newspapers, prayers, games, best wishes and medical care!

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Hours of waiting. Even more epic for the patients...

It is only 1:30 in the afternoon and this day has already been moderately epic

Mornings here are gorgeous, the morning chorus here is incredible, matching the forest in New Zealand. Countless birds sing to me and some even flutter in and out of my room. Chapel is a good way to start. We learn Christmas carols in  English and Ruchiga. Extremely dissapointing that their “Hark the herald angels sing” had a completely different tune… All is redeemed though when, with one failed start we manage a lively rendition of  “see him lying in a bed of straw” (trickiest carol known to man).

I turn up to the ward to discover I am doing starting ward rounds on my own. I am relatively confident to do this now and refer the patients I really have no idea about to our uber Dr. Denise, an astoundingly good and extremely nice doctor. Right, time to start on the 35 patients…

1. The first patient I meet deteriorated overnight, he was here after an alcoholic hypoglycaemic coma. This is the most common cause of coma admission here and happens when males (always males…) drink too much of their local brew and get low blood sugar. They quickly come right in hospital and go home. Anyway this guy is a lot worse. He responds with murmurs, and I noticed he is only moving his left arm… turns out he couldn’t’ move his right side and his reflexes were kicking on me just touching them. A stroke . There is no way to look at his brain here to confirm this, but it would not help much anyway. I prescribe aspirin, make sure he has nothing in his lungs and try to explain through a translator to his family what has happened and that recovery will be long and he may not walk again. Note to get Dr. Denise to come back to talk to the family again and make sure there is nothing obvious I have missed…

1. After a couple of malaria patients, another man has “elephantiasis” a common condition here where a limb swells up massively due to little worms in the blood stream…. Incidentally he has had an extremely sore hip for years, and can barely walk. I have a look at the x-ray… not good… his hip joint is literally ground away, the arthritis has destroyed it. We would just get a hip replacement, but here this is reserved for rich tycoons who can afford the expensive operation. We just give pain relief and try to keep him moving as much as he can, even with the pain. Pray for him…

1. Ach, the ultrasound could see everything except the gall bladder and that was the only thing I was looking for! The lovely ultrasound lady recommends I order a chest x- ray in the mean time. Not sure why????

Great, Dr Denise has arrived J

1. Another woman has white under her eyes = > severe anaemia. We look at her old notes and she has a bone marrow disorder (myelodysplasia) causing decreased numbers of all her blood cells. Of course they did not explain this to her at the hospital where she had the test… Explaining to the family is difficult, I don’t’ think there is a word in ruchiga for bone marrow. Earlier Dr. Denise explained gall bladder by referring to a chicken. Everyone here has seen the gall bladder of a chicken. 2 units of blood and move on

1. Great a woman I admitted yesterday! Oh dear she has not improved. The poor woman was given drugs for her fever but vomited them all L The previous tests she had were positive for typhoid, but negative for malaria so I retested her for typhoid while treating it. I pick up her results. WHAT, positive for malaria but negative for typhoid!!!, the opposite??? I start to explain that I am sorry I gave her the wrong treatment and will change to malaria. Dr. Denise stops me. She says patients will never come back if we tell them we have made a mistake. She just tells the woman that she has tested positive for malaria and we will treat it. Wise I am sure, but it feels wrong.

1. Bitten by a spider and swelled up like a balloon! Better today though on steroids and can go home praise the lord 

Its only 1:30 and these are just 6 of the patients we saw this morning. Still a bit weak from my malaria too (oh that’s right haven’t mentioned that yet…) More to do this afternoon. God is good to us, me and the patients. 

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To records keeper:  “Really? I can just take this stack of patient treatment charts home for the weekend to make some stats?”

To secretary: “The Medical Superintendent would have time for a chat? I just go and ask him myself? Right. Good, good….”

To self, shuffling through files in a shelf in pharmacy: ‘I wonder if this cupboard containing the class A drugs should be locked…’

Since arriving, my role here has…evolved. Orginally, I imagined I would be helping a team of people develop excel sheets for the hospital pharmacy.  I soon discovered I was the sole (and extremely inexperienced) undertaker of this task. Within the first week or so I battled with my non-computer inclined brain to develop excel sheets for the HIV drugs, which I have completed. Wise-minded folk around the hospital, however, quickly made me see that excel sheets in pharmacy would be a very short term shallow remedy for a multiplicity of problems concerned with drug management….. the plot thickens…What is needed, it transpires, is an analysis of the current hospital drug system, its problems, and a plan of attack for improvement!

SO. My task here is to research, make a report for the newly formed Drugs Committee, get feedback on recommendations, and play some sort of role in helping things happen.

 For the last three weeks I have felt like a detective, talking to people at all levels, understanding the systems, drawing flowcharts, and doing some mini audits with records.

While perhaps you are yawning and feeling sorry for me, I feel in my God-given element; very excited and challenged with this work! Of I course a complete newbie, learning how to do this as I go, stretched beyond my current skills. But that makes me just like a lot of people here who learnt on the job…

I am constantly amazed by the complete lack of confidentiality, security and strict systems here…as the snippets above indicate, I am completely at liberty to bowl up to however I need to, access any files I need to. I have found that people at all levels are more than happy to sit down with me for an hour and talk me through their part of the system, their fustrations…sometimes personal fustrations!

Some drug problems at Kissizi:

Doctors often don’t know if a drug is available or not, so they prescribe it, only for the nurse who walks to pharmacy to pick it up to find that it is not there!.That could mean a patient gets no drugs for a day.

They don’t measure the quantities of drugs used, which makes it pretty hard to make good orders! They used to try to keep more of such records in 2006, but had to stop because they didn’t have time for the paper work, the photocopier kept breaking down, oh, and they ran out of paper.

Because we are so extremely rural here, acquiring drugs for the hospital is a big challenge. This challenge is heightened by the fact that our (multiple) suppliers are prone to running out of stock themselves, and also frequently delay our orders. When they finally have our order ready for us, we send a ‘driver’ on a nine hour bus ride to Kampala to pick them up (packing them in the store of the bus!!). Sometimes these drivers forget to check expiry dates, and lab reagents have expired on the bus…

It is truly incredible how people here battle obstacles and keep the whole place running!

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 Clinical officer: “No point in referring him elsewhere, there’s no heart surgery around and the family certainly can’t afford it”

Me: “But this boy has two stuffed heart valves and a massive heart, are you saying he is just going to die in the next few years?”

Working in this beautiful place of healing is emotionally taxing. My expectations were of a slightly underresourced western style hospital. How wrong I was. For two weeks now I have moved around the wards in the morning (Psychiatric, Medical, Surgical, Isolation, kids, and Mothers and babys) and worked in outpatients in the afternoon. From now on I will concentrate on medical ward and outpatients, which is where my interest lies and where I can be useful.

There are 3 types of clinical staff here, Doctors, clinical officers and nurses. Clincal officers are like doctors with less training. They act as junior doctors here, admitting patients, doing clinics and doing ward rounds.

Nurses here have a different role from New Zealand. Every patient must come in with an “attendant”, who feeds, cleans, and even gives out the drugs to the patient!!! On childrens ward every morning there is a bizarre scene where mothers crowd around the nurses to collect their children’s medications… The nurses here put in intravenous lines, put in feeding tubes and do many things that doctors usually do in New Zealand.

Patients often travel hours to get here, if they have any way to get here. One woman gave birth to a child at home who was not breathing, it took her 6 hours to walk here and of course it was too late. This is one of but many heartbreaking stories. In New Zealand if we are too isolated a helicopter will probably come pick us up… Apart from life threatening emergencies, patients join a long queue where they wait for hours before seeing a clinical officer. If they do not come early enough, patients sleep overnight in a hostel before being seen the next day.

Patients have to pay here, which seems strange but it is the only way for things to work. Apparently it is more expensive to make things happen at public hospitals… Although fees are low by our standards (1 NZ dollar to be seen, 5 dollars for a basic drug regime) they are desperately high for the people here. Thankfully there is a fantastic health insurance scheme here which more than half patients here are signed up to. It currently costs about 35 NZ dollars to insure a family of 5 for a year.

 A few times I have been in the strange situation of treating people only to the amount can pay. A guy came in with an incredibly painful 10 cm long, deep dirty burn on his leg. I handed him a treatment sheet which included pain relief, antibiotics and daily dressings which cost 15000 ($15) The man handed it back saying he could only afford 6000. I explained it to the doctor in charge, who cut it down so it cost only 6000!!!!!. Thankfully If patients desperately need treatment they can’t afford, there is a “good samaratin fund” which can help them. It seems like a great system, with the nurse in charge finding out about their living situation and their family, and judging just how extreme their poverty is.

I wish to write much more, and I am sure I will soon so stay posted for astonishing stories of God’s hospital, Kisiizi

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Hi Everyone :) 

We were dying to upload some pictures for you guys and still can’t, so as a stopgap measure we posted some on flickr for your viewing pleasure

Just go to the PHOTOS link on the right hand side of our page, or copy this link into your browser   www.flickr.com/photos/33079877@N02

The best way to view them is probably in their sets on the right of the page labelled  ”kisiizi” etc. as we loaded them in a random order.

God Bless, Nick and Tess

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