Nick and Tessa in Kisiizi

The Interrogation: Tel Aviv Airport

After bumbling suspiciously at passport control in our sleepy stupor, Nick was taken into the interrogation room for further questioning…

Security: ‘Where will you be staying?”

Nick: “With someone we met online, its “couch surfing”,  an online international organization…

Security (quickly): An online international organization? (Terrorists???)

Security: How much money do you have.

Nick: None.

Security: How do you plan to get into the city with no money?

After Nick displayed his credit card, they rolled their eyes and let us through. Through the door, a big cuddly bear offering Valentine flowers didn’t really compensate. Nice try Israel. The real contrast was being welcomed into Ori’s apartment, our awesome couch surfing host. He makes his own bread, museli, beer and chai tea, studies Chinese and loves discussing food!

The Wall

Of which we now have several chunks.

The illegal wall that snakes through “Israel” dividing the Palestinians is high, imposing and well guarded.  There is no way you could jump this thing. We went there on a bus full of Palestinians returning to Bethlehem from work in Jerusalem. Despite crowding on ‘the other side,’ the Israeli side is barren and stark. Even Israel’s own high court has condemned the wall.

“The people are divided, but connected by their roof tops”

The three Abrahamic religions collide in the old city of Jerusalem. In the bustling markets that fill the streets, you can buy Jewish skull caps, Catholic prayer beads, and colorful head scarfs. In Athens, the ruins are the past. Here, all the important sites are still used for worship and bitterly fought over. Jews wail at the wall longing for the return of their temple, on the rock where Muslims pray in a massive golden dome “of the rock”.  The key Christian site where Jesus (supposedly)  was crucified and buried is now contained within one church. Demoninations are still squabbling over it. Just before we came there was a punch up between Greek Orthodox and Armenian monks! Amazingly though, everyone seems to get on with life together in the old city. While the city is religiously segregated into quarters, Muslims still buy their oranges from Jews. Conflict is the exception rather than the rule. 

Religion is visible. Most men have crocheted skull caps- these are the ‘conservative jews’.

‘Orthodox’ Jews wear ridiculous huge black hats and funny curling dangly side burns which look incredibly tempting to tug, While muslim women wear Hajib, the Jewish women all look like me, which Nick finds disturbing. I had several people each day come up to me and ask me something in Hebrew.

Where Jesus Walked…

We walked on the Mount of Olives where Jesus preached, through the stations of the cross, and on the site of the old Jewish temple, where the High Priests made sacrifices. We saw two places which groups claimed to be where Jesus and his disciples had the last supper, and the stone where it is said Jesus’s body was lade when he was taken down from the cross.

The site of Jesus’s crucifixion was unrecognizable to my imagination, a clutter of golden glitzy icons, images, and elaborate swinging lamps that look like straight out of Aladin (clearly the protestant coming out in me..). The Mount of Olives gave me tingles though- olives still grow abundantly, I could picture Jesus sitting to teach, in site of the Temple.

More than anything, I got ‘Jerusalem orientated’. Nick and I were reading a verse in Acts the other day, where Luke describes how the ‘whole of Jerusalem’ quickly flocks to crowd angrily around Paul. Suddenly we had a vivid picture of the city in our minds. We could quite easily imagine the population of Jerusalem congregating rapidly as word spread. We walked from one end to the other in 20 minutes- the place just isn’t that big! 

Loving you - peace out. At the moment we are celebrating good News from a number of sources from home

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NEW PHOTOS YAY from Jerusalem…
Ahoy beloved friends from home, those harking from the “Island nation” as foreigners like to call it. We have now left Uganda and are dropping in on a few places on the way (loosely on the way) home.

 We are pleased to inform you that all the money donated to Kisiizi hospital through us ($1200 NZ) has been passed on. Half of it has been given to general hospital funds, most of which goes toward paying the beautiful people we befriended (a monthly financial struggle). The other half was given to the Good Samaritan Fund, which pays the bills for those who have no money at all.

Its not bittersweet to be leaving, its just sad. I know Tessa is with me when I say we would have stayed longer. (We do love you guys, really :p). We did not feel we gave anything up, or sacrificed anything living here in Kisiizi. Of course there were new challenges and hard times, but the real challenges here are for the locals, not us. One Ugandan woman who had been to New Zealand remarked bluntly, “In New Zealand, people might jump of a bridge if their boyfriend dumped them, here people are more resilient to problems, they get on with it”

*Irrelevant rant begins*. Apparently we have a shortage of doctors in New Zealand. Before I came here I believed it. What we mean is we have a shortage of doctors to keep up our incredible first world health standards. What we should be complaining about in New Zealand (at least a little) is the shortage of doctors in Uganda. Is our country more important? I am left wondering why we complain so much about a 1 year waiting list for some life changing operation, e.g. a hip replacement, that is not even available in Uganda. What we done about this I’m not sure, but its not right.  *Irrelevant rant ends*

Leaving is an experience in itself, as it is an important part of the culture to make sure you say goodbye to everyone.

 I went across the ponds to see the “Ruchiga warriors” I taught the Haka earlier. I looked forward to seeing the nursing students, for the last time, but was also slightly apprehensive, as I was expecting some requests. “Can you sponsor me to come to your country” and “Can you sponsor my studies” are common as well as the heart shattering “I cant afford to send my kids to school, can you help?” As you can imagine these requests are difficult to manage. On arrival to the nursing school though, I was met by my friend Martin, who after talking for a few minutes said: “I’m sorry we couldn’t manage to get something together for you to remember us by”. This lightened my heart in a place where seemingly good relationships are more often than not made awkward by requests for money. Its’ hard to describe how a new relationship instantly changes after someone has asked you for money. Its not nice. I left the nursing school sad to leave but content having left them with my e-mail address, even though they don’t have e-mails yet… I’ll leave you with a couple of Martin’s comments

“Only 4 million in New Zealand. Ha, obviously not having enough kids. You should bring 50 Ugandans over there and in a few generations they will fill the country”

“You are trying to kill all those animals to protect your trees? Why aren’t they all dead yet? See these boys playing football here, just give them all a panga (machete like knives) and take them to your country and I guarantee you there will be no animals left.”

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One way to say “how are you” in ruchiga translates as “Are you here?” reply:“Yes, I am there”

An hour and a half is a moderate sized lunch break.

“Kamasimwe” (praise god) is used as a filler in sermons where we would use “um”.

Everyone here seems to  know that God is Good, even those who do not follow him yet.

The nurse named “Jolly” is the least Jolly nurse in the hospital! She’s still nice though :p

Death is not abhorhent here. This is a double edged sword. People are accepting and content that their relative has gone to heaven. On the other hand if you miss a dose of medication and a patient dies, its not such a big deal is it?

There is no Ruchiga word for “maintainance”, only one for “repairs”. The implications of this are tangible daily…

We passed a newly admitted comatosed man on the way to break and stopped to make sure everything was done. It wasn’t. Unfortunately there was no oxygen measuring machine, no OXYGEN, no glucose strips, and no feeding tube on the ward!!! Nurses and I scattered around the hospital and managed to find everything. I’m not sure what is more amazing, that nothing was there, or that we found it.

In most families, at least one child dies before they reached adulthood. Thank God that New Zealand has clean water, no malaria, and no HIV. And that we have road rules.

A nurse will not run if a patient is dying, the only time anyone runs here is when it rains.

All the milk for the Kids ward is provided by 3 hospital owned cows in the paddock next door. Awesome.

A man from England who visited 8 Ugandan hospitals told me Kisiizi had the best values, highest standards, and hardest work ethic of all the hospitals. I should be happy, but something in me was hoping other hospitals were better…

There is no Ruchiga word for busy, which is frustrating when you are keen for things to get done in a hurry… On the other hand, I don’t think I have seen a stressed person.

There are 3 orphans schemes attached to the hospital sponsoring over 300 orphans from surrounding villages to go to nearby schools. Aid organizations work, and we’ve met the beautiful people who benefit. They praise God for it. 

Tessa was told to “repent” by one of the mothers on the children’s ward because she was painting Noah’s ark on a Sunday

One of the staff on Psychiatric ward was originally a patient who had his village-applied-handcuffs cut off by beautiful medical staff.  

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Hey everybody, thanks for your support once again We have just uploaded our best photos yet onto flickr, so be sure to click the photos link, or go here:    http://www.flickr.com/photos/33079877@N02/

Football

All 23 of us with both of the hospital

“What team do you support” is the first thing a lot of the guys here will ask.  People are fanatical about football here, especially the boys.

The ground here is extremely hilly, and space is scarce so it is difficult to justify soccer pitches. Kisiizi’s pride and joy is a little less than full size, has a couple of rather major slopes, has 2 large trees inside the touchline (great for confusing people), and is only about 80% grass. Despite these minor foibles, the pitch is one of the best in the region, and many teams travel to challenge the locals on it. 

I have played a lot of football on this hallowed turf. We “train” every weekday, which involves 2 teams being picked and playing a game for about an hour! Needless to say coaching and team structure are sorely wanting. The talent of the players however is impressive. There are sublime skills, and flair not practicality is the order of the day with little flicks, bicycle kicks and shots on goal from everywhere!!! People of all ages play, from 13 through 40, if they are good enough to get picked by the captains… After “training” has been a fantastic opportunity for me to get to know the local people, and talk to them about their lives and God. I have bonded better during and after football than at any other time.

I recently had the pleasure of playing a Kisiizi vs Rukungiri match. Ne’er have I played in front of such a large crowd, with over 300 people watching. The whole occasion was modeled on professional play, with everyone shaking hands before the game, and the referee playing strictly by international rules. We were down 1-0 with 5 minutes to go when we scored. It was a privilege to be around as the crowd erupted onto the field, doing somersaults and yelling like crazy. This has to be one of the best experiences in my life, and although I didn’t score I made 4 or 5 shots that were very well saved (if I may say so myself), and provided some excitement for the crowd. After the game for a couple of days loads of people came up to me and said “thank you for the game, thank you for the game” which was very strange. I replied with “thank you for watching” as only my faithful family comes to watch in New Zealand

But in the weekend, the soccer pitch is empty. Instead over 100 people pack in the local hall and sit on wooden benches to watch professional soccer on a couple of small televisions (see photo). People travel from local villages and try to sneak in without paying. If they get kicked out they watch through the windows from outside!!! The chaplain takes pride of place with his personal chair in the middle J The English premiership is part of the local culture. Everyone picks a team to support, and this is their team for life. Predictably only the top 4 teams have supporters!!! People are remarkably quiet during the games, until a goal is scored and such a yell goes up we can hear it from our rooms 200 meters away.

2 Weeks ago I co-coached an under 16 team (with one 25 year old???) to a match in Kabale. Most of them had never been to the local centre before, despite it being just over 1 hours drive away. The trip was anticipated for days, and the boys were up at 9:00am on game day running around the field before we left at 12:30pm. I’m not quite sure why, I didn’t have the heart to tell them it was best to conserve energy.

                      21 in the back

We picked 14 boys to go, but somehow 21 boys packed into the back of the Kisiizi ambulance (see picture). And don’t ask why one of 2 hospital ambulances is taken for soccer trips. After spending 2 anxious hours finding the people we were supposed to play, the match began. The Kisiizi boys have never lost a game vs. the local villages, (I have seen them slaughter 3) but the city boys were too good going down 2-0. The boys will blame it on the pitch… The match was played in great spirits and I was happy to be part of Kisiizi. On the way back the ambulance was still buzzing with excitement, despite the driver having to stop twice as fights broke out for the millimeters of spare space. There is still post-match analysis at training (although I can’t understand most of it).

Perhaps I have convinced Tessa the merit of sport. Kama Simwe

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I run up the red path, banana plantations to my left, a pineapple garden to my right. How do pineapples grow? On the ground in little clumps, apparently. Two seconds later a stream of  little children trot along behind me, giggling and yelling:

“Mzungu Mzungu!! (white person white person!)”

“I’m fine I’m fine, how are you?” (chirped at high pitch)

“You give me my money!”

“You give me sweeties!”

On one occasion a little boy even said “give me balloon!” (Balloon??!?) Charming aren’t they… for a long time I wondered where these kids got the idea that all mzungus constantly carry with them small change, sweets and balloons. Apparently a ‘children’s mission’ visited a couple of years ago and well meaning Brittish folk distributed many boxes of sweets and balloons. And have thus plagued western visitors in the area for evermore…..

I run to the ‘the mast’ (radio tower high up in the hills) most days, and unfortunately create quite a spectacle, firstly because I am white, and secondly because nobody seems to run here, especially not up hills. Some people laugh and smile and wave “agande!”, some joke and follow me for a while and some stare blankly.

After a few weeks I met Shellinah. A tiny girl came running from her home towards me chirping ‘I want to talk to you I want to talk’. And she did, bright eyed, in perfect English, not asking for anything. Shellinah is a pretty bright cookie, and wants to be a doctor. Her father died five years ago, which has made things pretty hard for the big family, although her mum has kept the family plot of land flourishing well, complete with several goats and pigs. Shellinah is blessed to have sponsorship that pays for her schooling at the very good (private) Kissizi primary. Her brother (one year older, 11) is not so lucky and is now herding goats. School fees are fairly ridiculous, NZ$150 per year, while a hospital laborer like Shellinah’s late father earnt $400 per year. Government schools are much cheaper but by all accounts rubbish.

That made me sad, because he too is a keen spark…he didn’t ask for sweeties. Infact, when we were discussing children begging mzungus for sugar he declared:

“Sweets give you tooth decay, a disease called tooth decay!”

He also noted seriously, ‘Smoking and Alcohol is bad, they can give you lung cancer and asthma.’ Alcohol gives you asthma? Education is a beautiful thing.

Visiting Shellinah is an interesting experience. They live high on the hill in a mud-brick house with separate kitchen/cooking-fire overlooking their ‘garden’ (patchwork crops). Shellinah showed me her room and prized English bible, then her family showed me their photo album, a common occurrence when you visit someone. Photo albums are full of serious portrait shots of  family members and friends at important events (baptisms, deaths, weddings, school ceremonies). Notable in their album was:

1)    The ‘men’ with a disembowled ?goat?!? A triumphant kill for a special occasion

2)    A photo of a man who none of the family knew

3)    Scantily clad western models cut out of a magazine…..don’t ask. I have NO idea why.

You may well ask, where are these photos printed? How are they taken? Well. There is no electricity in this village and no running water in houses but there is still more than one photo studio  in these remote remote hill villages of Uganda. Photographs are important here…and exchanging photographs is very meaningful!

I wave goodbye to Shellinah, her brother Josiah and the rest of the family and run down towards the hospital…what are they thinking?

My impression is that Shellinah and her brother like hearing about strange places and telling me about their lives, and listening to my MP3 player. Shellina listened to the Beatles: “a yellow WHAT?” ….try explaining submarines to a land-locked 10yr old who has never traveled beyond her village. I think her big sister wants me as some sort of permanent donor to the family…while Shellinah’s mum seems quite chuffed to be visited by a mzungu (arghhh so wrong!). 

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With our powers combined, we are… Captain medicine! (yeah right)

There are 2 new medical students here, Shi and Alice from Malaysia. Over the New Year with doctors on leave, we are doing ward rounds with little supervision. Together we nearly make up one “real” doctor, and are certainly not up to the super-sub-specialty medicine we are attempting at the moment. God is with us and the patients though, and is a continual comfort. (Oh dear that sounds bad, “attempting” medicine. The sad thing is the element of truth….)

P.S if you like House you will like this…

“Heart”

“bzzzzzzzz, bzzzzzzz” Oh dear, his chest is buzzing due to a damaged valve, not a good start to our exam. He’s only 60 and usually well, but his heart is failing ‘cause a valve is stuffed. His family says they can afford an operation in Kampala, but the noble patient refuses, saying it would leave his children broke and would force them to sell their small farm. What an awful situation! We do all we can to get rid of the fluid in his lungs so he can at least sleep again. Who knows what will end up happening here?

Water

I put my hand on her tummy and leave a deep handprint as I displace the water under her skin. I have never seen a patient this swollen before. She is swimming in her own fluids.

She came in nearly dead after not peeing for 3 days. Her kidneys had packed up and unless they started again soon, her time was short…

Incredibly she was quickly by the best doctor here, and by the grace of God improved drastically. Her complaint today is that she is still puffed up like a balloon and she wonders why we have not cured her yet? We lovingly explain that she has to gradually pee out the litres and litres of excess water and that this will take a long, long time…

Fire

Thankfully the nurses have managed to take temperatures every 6 hours. Yes, she is on fire. 40 degrees again last night? Dark brown urine? Lost nearly all her red blood cells??? After 20+ minutes of searching I find a doctor who confirms one of our thoughts. She has malaria with the dreaded “blackwater fever”. So many red blood cells get destroyed and excreted, the urine bizarrely turns nearly black. Dr. Patrick shakes his head and labels her a “time bomb”. “The only thing which will help her now is blood”

“What…. No blood at the lab….???”

Mortified, I charge around like a headless chicken. Thankfully she is O+ (extremely common). I track down the lab technician, who helps Shi and some nursing students give blood and become instant life saving angels. She get blood, and is now at home just a few days after nearly dying. Kama Simwe (praise God)

Wind

This man was direct from the village through the hospital doors, not on our “captain medicine” ward round. He was a 20 year old happy guy whose only complaint was a cough for a month. I would have sent him back to his village had he not taken off his shirt. He was wasted and sickly looking and was only 38 kgs!!! I admitted him for tuberculosis testing and it turns out his lungs are infested with the dreaded consumption. Chances are he has HIV this young with tuberculosis. I feel for him but it is awesome that people from all around the world fund hospitals like this so that poor young men like him can get free treatment (HIV and TB treatment is free).

Earth?

“Just a sore leg and a headache?”

“Yes but the leg is so sore I can’t even walk on it, and the headache and leg pain have been getting worse for about 3 months now. The pain is almost unbearable”

“???????”

Bewildered, we tap his knee with a tendon hammer. I have never seen such a big kick. We pull his foot up and are mesmerized we watch it bounce up and down until we release the pressure (clonus). The cogs in our young medical brains tick away slowly. Brain tumor? We decide to wait till Dr. Denise comes before telling the patient and the family to make “absolutely sure”. Bad call. That night after 3 months of gradual deterioration the tumor must have bled and he dies and is taken home before we even see him in the morning. His family will never know what killed their father, their husband. I pray they do not blame the hospital for killing him. I feel pretty awful

His body is in the earth, but I believe and pray for much better for him.

And with their powers combined, they are… captain medicine. Not. And believe me when I say this is just a selection… Pray for me, Shi, Alice, Tessa, the doctors nurses and the patients as we work together in this awesome place of healing. 

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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!

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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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