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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Nick and Tess: Hey everyone,
Hope you are all well!! Thanks heaps for your comments, we feel loved ☺ Internet is proving quite tricky here, but hopefully we will be able to post some news more often soon. We are STILL having trouble sorting out internet lol.

One last pothole, around one last corner… Finally…

We roll into a classically beautiful patchwork-green-hill surrounded red-dust-roaded tiny hospital village. We get out, and of course everyone stares wondering I suppose what we are doing here.

Our “guest house” is a quaint little brick cottage, unmistakable british, with perfectly preened gardens and a mowed lawn. And by mown, we mean painstakingly hacked short with a panga. (machete)

We arrived in the wake of the golden jubilee, and the buzz, excitement, and some leftover VIP mzungus were still floating around. This included Doreen Sharp, wife of the Englishman who founded the hospital 50 years ago, a tiny 75 year old lady with plenty of gumption, who speaks the local Ruchiga fluently. She was with a 101 year old Ugandan lady who was part of her knitting club…

You are probably already feeling the palpable ‘colonial’ vibe around the hospital. It is ever present in the English roses, the Anglican services and the Ugandan housegirls which the ‘mzungu’ (white person!) staff employ. We were expecting rough conditions here but instead we find that our guesthouse is run by 3-4 housegirls, who do most of the work around here (besides washing our undies :p). It may seem strange to employ 4 people to run a house for 3-8 people, but we continue to realise that in Uganda,

“Time is cheap”.

Nick: My first impressions of the hospital however are in stark contrast to our comfortable living conditions. From what I had seen I expected a poor hospital that provided a “nearly western” high standard of care. I have been shocked so far and are finding it hard to the different way things are done here and what seems to me a very low standard of care. I will write far more on this…

The people here are amazing, so lovely, friendly and welcoming it is a pleasure to just be here. On our first day mzungus and Ugandans alike were so keen to talk to us and show us around, to welcome us to their beautiful home.

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If the streets of Bangkok were a sea of people, Kampala was a raging rapid.

While we left ourselves two hours to get from our hostel in Entebbe to the bus station in Kampala, the matatuk (minibus) took 45minutes longer than expected in the mad, mad traffic.

With 3 large, heavy bags, we had too-little time to …
(a) Find a Bank to exchange US dollars for Ugandan shillings (the Master Card failed!!!)
(b) To find the location of the correct bus station (They don’t even have names…)
(c) Get to the aforementioned bus station

Kampala doesn’t seem to have traffic lanes. The streets are a bizarre jumble of pedestrians, trucks and cars. In order to cross, you have to boldly weave your way amongst the chaos, preferably shielded by a local. We arrived, flustered but just on time. The bus left two hours later. Buses don’t leave here until they are totally full. And we mean full, with aisles packed with sacks of produce and three live chickens smooshed into a shopping bag,

During the extremely bumpy 9 hour ride we were blessed to encounter a very friendly, open and thoughtful young Ugandan woman called Jacky, who took a few days off study in Kampala to surprise her family in her remote home village. She was hospitable to the extreme and quite concerned about our ability to reach the hospital safely!

Jacky ended up escorting us all the way to the Hosptial, and sharing a hotel room with us in Kabale on the way. On the bus trip Jacky shared some of her amazing life story with me, and the experiences which have shaped her values and character. I have hardly ever heard someone talk so passionately and openly about God. She also taught me to count to nineteen thousand in Ruchiga (the dialect spoken in Kissizi)! And for Nick: ‘where do you feel the pain?’, phonetically pronounced: oily ku-sha sha.

While I was chatting to Jacky, Nick interacted with a young Ugandan man:

Nick: “I’m here with my girlfriend”
Man: “You have girlfriend?”
Nick: “Yeah, actually she’s sitting over there”
Man “Ah I have no girlfriend…..(looks at Tessa.) You give me girlfriend for 1 cow?”
Nick: “Only 1?”

I think they haggled to four cows before they couldn’t hold back the laughter. A dowry of cows is apparently expected of a man who asks the parents of a girl for her hand in marriage. Proposal-man and Jacky found it hard to believe that New Zealand men don’t ask the parentals permission to marry, or to hand over any lifestock!

I found Jacky so inspiring, not only because she was so warm and welcoming, but also because she such a strong, open-minded and independent woman.

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“Whatever happens, conduct yourself in a manner worthy of the gospel of Christ” (Phillipians 1:27)

Salesman:      “Bargain, Just for you sir 500 Baht”                                          

Nick               “nono 80 Baht only”                                          

Salesman:      “(Laughing) Cannot even make for 80, 350 Baht”  

Nick:             “Another store in the market offered same shorts for 150. Only reason we didn’t buy them is                         because we can’t find the stall again” (true)                                                                

Salesman:     “(Looks berwilded) “Absolute minimum this store 250 sorry” Pause…                                

Tessa:           “200 Baht?”                                                                                                                  

Salesman:     “OK” – Gives big smile and money is friendily exchanged and salesman says thank you with a                         warm smile. We walk away

Were we acting in a way worthy of the gospel of Christ? 

I haven’t bartered before in my life. The experience is extremely foreign, and I really disliked the first couple of times. I felt bad when the seller looks disappointed at my price, I couldn’t stand walking away when I didn’t think the price was good enough… After a while though I began to enjoy the interaction, new experience and even the competition of getting the best price.

Is our retail system more worthy? It seems more straightforward and honest to have the price up there. It also takes a lot of tension out of the shopping experience, but perhaps some of the fun too…

Also, the politeness and friendliness of the salesperson here in Bangkok tops what you normally see in New Zealand. After the vicious bartering process is complete, there is a satisfying sense of connection, a comradery between fellow men who have been through a challenging process.

Perhaps like the Paul said I should look at my conduct, not just the system. Hopefully, we maintained our honesty and integrity while not thowing large amounts of money at mere consumables. Also God sees my heart. He knows whats going on in there. He knows whether I approach a stall with a spirit of malice and deceit, or humility and grace. 

I don’t know whether walking away from a stall to antagonize a lower price is right, but I do know that God is king here, and can use me and salespeople in any trading system, bartering or not, if our heart is in the right place.

I am sure I will be continually challenged with such cultural differences and can think and pray about them.

“And this is my prayer, that your love may abound more and more in knowledge and depth of insight, so that you may be able to discern what is best and may be pure and blameless until the day of Christ”    (”Phillipians 1:9)

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Today we did the tourist thing.

One thing that amazed us about temples was how run down they are. They are far older, have a richer history and are far more impressive than anything we have in New Zealand and yet seem incredibly poorly maintained.

Our pictures will help you visualize this and some of our other “touristy” exploits.

There was even a basketball and a soccer courts inside the main temple grounds. The only public sports ground in the central city? It was bizarre with history at our fingertips. In Nick’s flat, a basketball goes astray and breaks a window. Here a basketball goes astray and breaks the nose off a 500 year old dragon….

The street stores also deserve a mention, where Nike costs 5 dollars

and 500 baht means 50 with good bargaining. The first time we approached a Tuk-Tuk to negotiate a price home, I froze and accepted his first offer. Bargaining is very foreign to us!

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