Window on Kisiizi

Window on Kisiizi

Sunday, 17 January 2016

New Year Rollercoaster...

The murram road throught the Kisiizi compound area
As usual living in Kisiizi brings a mix of frustrations, disappointments and challenges plus encouragements, blessings and exhilaration!

Some of the challenges...

On the staffing side we are sad that Dr Dwight and Sandy McLeod had to unexpectedly and suddenly return to UK to care for elderly parents with health problems.  We do hope they will be back with us before too long. Dwight is a specialist Physician and Sandy has valuable nursing experience and has been helping run the Guest House.

Sister Esther, previous Principal Nursing Officer and a very good friend, lost her mum after a long illness so Hanna went to be with the family and to attend the funeral.  Hanna also had to go up to Kampala for dental treatment so has become very familiar with the coach / minibus journey (its about 7 hours to drive in a private car travelling from Kisiizi to Kampala and of course with public transport there can be significant extra delays).

The scandal of a terribly wasted child's ribcage
We still have great sorrow when we see patients arriving too late for us to help.  A mother came recently having had a Caesarian section at a government clinic two days earlier.  She arrived in Kisiizi with gross anaemia, her haemoglobin test being only 2.7 (should be above 10) and in spite of full supportive treatment and transfusion she died the following day.  We still see children coming in grossly wasted and malnourished and can only press on with our Nutrition, Family Planning and Community programmes to try and prevent these tragedies.
Another child with a swollen body for 2 weeks...


Getting better!




     








Financially we are aware of a fall-off in the regular support from Kisiizi Partners but we are very grateful that some of the shortfall has now been made up and we thank those who have made donations, especially the regular standing orders, to help us continue the work here.  We greatly appreciate all the efforts made by the trustees of Kisiizi Partners and for all those who pray for Kisiizi and give in different ways - thank you.

... and some of the encouragements!

The old floor...



We were very grateful to hear from All Souls church in London that they are giving a further gift towards the cost of the renovation of the (embarassingly bad!) old out-patient clinic area to make a fit-for-purpose Maternal & Child Health Clinic.  People are now getting excited as the work proceeds and the new unit takes shape.  It is a busy department with ante-natal and post-natal mothers plus immunisation, child welfare and family planning plus the HIV mother-baby point work.
Transformation underway with skylights and terrazo floors...

We are also excited that after a long period of planning we are due to commence the foundations for our new Mental Health Unit supported by Jamie's Fund.  We recently enjoyed a visit from Linda Shuttleworth and colleagues from the Cheshire & Wirral Mental Health Trust in Chester to support Sister Nancy and our mental health team.  We are due to have a meeting in a few days time with Basic Needs charity representatives and colleagues from Bwindi Hospital, Nyakibale and Kabale as
we seek to plan joined up community mental health services to reach the huge need.  Kisiizi currently sends out two mental health clinics a month and will have between 80 and 120 patients turning up each time.

New Staff accommodation, greatly needed, is under construction with support from our friends in Kisiizi Partners.  Management have decided to renovate another old building for more staff accommodation and to allow us to rationalise the location of hostels for our male student nurses.



The meadow on the way to Kisiizi Falls.
Note the trees felled as we harvest timber.
After a long period with little happening, the interest in developing Kisiizi Falls as a tourist destination has picked up again.  The Ugandan Ministry of Tourism has put Kisiizi forward for a grant from the STEP programme of the United Nations (Sustainable Tourism, Eliminating Poverty) which we understand is sponsored by South Korea.  We should be receiving some financial support to improve the infrastructure such as paths and steps for access to the waterfall and surrounding area plus some added attractions such as a hanging bridge to view the falls.  We are pleased that as a Management Team we have been able to constructively guide the plans to make sure nothing is done to detract from the natural beauty or the work of the hospital or the lives of its staff.  So for example instead of a monument and a hanging bridge in front of the Falls we have proposed the bridge is located in a gorge off to one side so it will not detract from the traditional view of the waterfall.  Similarly the monument, to commemorate the girls who died in the past when thrown over the falls if they became pregnant before marriage, will be sited behind the path to avoid any interruption of the view.

Proposed developments


Another completely different but strategic development is the Stre@mline IT programme we are developing.  Encouragingly we have been approved for a grant by the Uganda National Council for Science & Technology.  This was a bid against a range of other projects so we are delighted to be awarded the grant which will help us to develop the system.  Increasingly we realise how much impact it may have as we improve our data collection, finances and stock control as well as all the patient safety benefits.




When Ian gave a presentation a month or two ago in Kampala at the Uganda Protestant Medical Bureau annual conference a lot of other units expressed great interest.  We will pilot here first then Stre@mline will be trialed at Rugarama Hospital in Kabale.  Others including Bwindi and Kagando are also keen to be involved.







JOY to the world!

 After a very busy year for all four of us, it was a great JOY to be reunited as a family to spend Christmas together...

Having successfully graduated as PhD, Mark teaches undergraduates at Reading University in the chemistry department.  He has just been offered the chance to lecture in China for a week in March which should be very interesting...

The 8-legged 2-necked Siamese giraffe... or was it my glasses??


Ruth obtained her Masters Education degree from Hommerton College, Cambridge and continues to teach a primary school class in Islington, north London.

The last time we were all four together in Kisiizi was way back in 2005 so it was very special to meet up again in Kigali airport, Rwanda.  We took an extra day to visit the Akagera game park in eastern Rwanda and were thrilled to see not only the wonderful giraffes and elephants but even a beautiful leopard in a bush by the track.  It is rare to see leopards in daylight, and it stared at us for a moment before turning and strolling off into the bush... just a brief encounter but one of those magical moments we will all remember.
On to Kisiizi (had a puncture that could have been serious if it had happened a few minutes earlier, and within 2 minutes of stopping by the side of the road a colleague from Kisiizi drove up behind us!) and a few busy days... Hanna helping out on Maternity and organising Christmas lunch, and Ian was on call from Christmas Eve through to Boxing Day for paediatrics  while Mark and Ruth were roped in to help with judging the annual Ward Competition and presenting the results at the Staff Christmas Party, an extraordinary event where over 700 had a good hot meal and Ian gave a "state of Kisiizi" presentation.  All went well and after Ian preached at the Christmas Day service we enjoyed having our Medical Officers and Interns for Christmas lunch...
Mark viewing the volcanoes


Then we took some days off to enjoy some of the beauty of the region on our way to return Mark and Ruth to Kigali airport.  We were blessed to see some amazing animals and breath-taking scenery and by the time we said our goodbyes had filled the memory-banks for some time to come and thank God for such a special time together with safe travel and good weather.



not just any chameleon... a Rwenzori three-horned male chameleon!

We managed to get back to Kisiizi 15 minutes before the New Year began so were with the excited crowd on the Primary School playground for the traditional countdown...


Reflecting on the beauty all around!



  
Ruth and Hanna

Together again!




Sunday, 15 November 2015

Meetings...

Stre@mline IT programme under development in Kisiizi
It's been a busy diary time... Ian went up to Kampala on 9th November after the Management meeting we hold every Monday in Kisiizi to discuss and pray over the agenda for the weeks ahead. All went well until entering Kampala and getting stuck in traffic so that last part of the journey was painfully slow.  But we had met up with Samuel Mugisha who is working with Ian on the Stre@mline IT programme so plenty to discuss.  Samuel heads up Rimpscom, a software development company in Mbarara. 
We ended up working late on our presentation for the next day when we had a viva / interview at the Uganda National Council for Science & Technology relating to our application for a National Science, Technology and Innovation Project grant. This was the third stage in the selection process and there had been a lot of competition so we were very happy that the panel were very positive about the programme and are offering us support.  Details of the finances to be finalised and they will help us with Intellectual Property rights.  We want to get these to stop some other body pinching the ideas and patenting them as they may then offer the programme to potential users at high price whereas our goal is to make it available at a low price affordable by places like Kisiizi so that as many patients as possible benefit.

The next day Ian went to Mulago National Referral Hospital for the National Intern Committee.  Kisiizi takes 8 interns, 2 in each specialty of Medicine, Surgery, Obstetrics & Gynaecology and Paediatrics.  We have a good reputation with the committee and they want us to expand the number of training posts in future to include nurses and maybe pharmacists.

Then back to Kisiizi arriving about 9pm as the landcruiser developed a mild oil leak from the rear axle near the end of the trip so we had to proceed slowly.

Next day Thursday 12th we had an unexpected group from the Ministry of Health arrive.  They had been scheduled to come two days earlier but did not materialise and we had not been informed of the change so a lot of re-organisation to sort things out.  Their remit was to audit the medicines received from the Global Fund programmes for malaria, TB and HIV treatment.  It went well but meant that Ian had to sit up late in the evening to finalise documents and presentations for the Board of Governors meeting the next day. 
Meanwhile he was also on-call and sadly had an emergency in Accident and Emergency where a 4 month infant was brought in moribund and died shortly afterwards.  The tragedy was the family delayed coming as they had attended traditional healers who had done a procedure called "Ebiino" where an unerrupted tooth is extracted from the gum as there is a myth that this is the cause of gastroenteritis.  The infants haemoglobin anaemia test was only 2.7, normally it should be 10 or above.  The blood count was very abnormal and the child was shocked and did not respond to resuscitation even though we intubated and ventilated with oxygen and gave dextrose, adrenaline etc via an intra-osseus line.  We are reporting the details to the government District Health Officer to follow up and we will try and do more health promotion to stop this happening.

Members of the Board of Governors
The Board meeting went well including the presentation of the external audited accounts. The 5 year strategic plan is underway and Ian gave a progress report called "Pressing on..."
The Constitution and Terms & Conditions of Service have been extensively updated and confirmed.

The next day we held the AGM of the Kisiizi Hospital Health Insurance scheme and this also is going well with a financial break even and growing numbers.

Group leaders of some of the 200 community insurance groups
We also said goodbye to a team from Countess of Chester hospital led by Sarah Hoyle and Sam Walker who came to support the patient safety work following successful application to THET for a further grant to expand the programmes.
Dr Josephine, Paul & Kate, Sarah, Sam Ian & Hanna, Moses Mugume and George Wadsworth










Saturday, 3 October 2015

Spectacular!


A spectacular sight as a Ross' turaco swoops in and the sun shines through its wings...

it's only taken about 3 years to get this photo! 

A World of Difference...

WE LIVE IN A WORLD OF DIFFERENCE...

While many countries struggle with obesity and health problems resulting from being overweight, we tragically are still seeing children arrive with severe malnutrition.  Sometimes this may be secondary to some other disease such as Tuberculosis or HIV or just to recurrent infections such as gastro-enteritis or worms, but the vast majority are due to poverty.  Some of the saddest cases are those whose protein levels have dropped so low that they have developed oedema, swelling of the body due to fluid moving from the circulation into the tissues.  If untreated the skin will start to break down and ulcerate. 
The photograph on the left shows swelling of the feet due to severe malnutrition

 I had another patient last week who came to us with horrific ulcers around the mouth and the skin was peeling off making an already very weak and vulnerable child wide open to infections.  I cannot publish pictures of that child on the blog as they are too gross and upsetting.
 The child died after a couple of days, she had just come far too late for treatment to work.  Heartbreaking in a world where we can unravel the human genome, perform extraordinary transplant surgery and manipulate microscopic cells....

WE CAN MAKE A WORLD OF DIFFERENCE...

 The weight chart is for the child in the sequence above and shows how much weight the child lost as she improved and the excessive fluid in her tissues was lost.  Of course she then started to put on weight as her proper growth started to recover.

 We are so grateful to many members of our Staff and to our visiting paediatric registrar Dr. Sunil who have helped to recently upgrade and develop our malnutrition programme.  This includes the production in Kisiizi of "KisiiziNut" based on peanut to a World Health Organization recipe.  This is a "Ready to Use Therapeutic Feed" which has the great advantage over milk-based approaches that it can be stored in the village setting without needing a fridge.
 
 
 

The programme also includes setting up a demonstration garden to help families see how they can improve the diet of the children when they return home.  There is also a new chicken house to provide eggs for the children on the ward.


Chicken house

enjoying KisiiziNut
We hope to expand the programme and start screening children in the community and provide KisiiziNut to the borderline cases in the hope it will prevent them needing to be admitted.  Clearly prevention is far better than cure so we are trying to increase health promotion including family planning so the number of children to feed is reduced and education about practical and affordable ways of improving childhood nutrition.  In addition we continue to have our Goat Project which supports very poor families by providing them with a pregnant goat.  Once the goat delivers, usually two kids, one is returned to the project and the family keep the other and the second kid.  This gives them a chance for a fresh start and helps break the relentless cycle of poverty that otherwise traps them.

Kisiizi operates as a not-for-profit hospital.  One of our themes is "care for the vulnerable".  If anyone reading this blog would like to make a donation to help Kisiizi make a world of difference to some of these vulnerable patients we would be extremely grateful.  Please see our hospital website page with details of how you may do this.... click on the link below.


THANKYOU!
   
During and after treatment...

Tuesday, 25 August 2015

Crash out time...

Yes, in all the mix of things, we did have time for a break as we went on a last-minute package trip to Crete with Mark and Ruth... we have to confess we didn't see a great deal of the island as we were all just ready to crash out so much time was spent by or in the pool... it was lovely to have a breather and the weather was perfect, food good and we had many laughs as we did rounds of crazy golf, played a Dutch card game the kids enjoyed when much younger, and tried, not very successfully, to get photos of Ruth before she covered her face with her hands!
  
side view... well it was crazy golf!

"What do you mean, watch your steeeeeeeeeeeeeepppp??!!"

All Nations

time for a trip down memory lane... having been in Macclesfield for a few days juggling appointments for ourselves at the dentist/optician/GP etc and for the car for MOT etc plus helping sort out final drafts for the application to THET for a grant for Kisiizi, it was time to head to London to help Ruth move from one location to another.  She has a room in a house about 25 minutes walk from the school in Islington where she works as a Primary School Teacher.  In addition to this she has also been working on her Masters' Thesis with Homerton College, Cambridge and we have shared in this joyful process by reading proofs etc rather than wasting our time on secondary activities like sleeping!  But its pretty well ready to hand in as we write this and its looking to be an interesting and engaging thesis.

so, after the move, we headed up the A10 to retrace our historical footsteps as we attended a CMS conference held at All Nations where we had studied decades ago just before we were married.

It was a good few days of interaction with some inspiring people and some good sessions, not least the masterful session led by Martin Goldsmith who remains as stimulating and provactive as ever!

We enjoyed a walk in the countryside and will take back photos of the fields to amaze friends in Kisiizi!

Then on to stay with Jonathan Jones and his family... his daughter Georgie came for a couple of months in her Gap Year and Jonathan, an orthopaedic surgeon, came for the first couple of weeks and left with a desire to help us develop orthopaedic services in Kisiizi... so we really enjoyed meeting the rest of the family and, as a wonderful bonus, Peter and Rebecca Winfrey with daughter Lizzy also came up to see us so a good time of catch up was enjoyed by all.

We do thank God for the amazing family of Kisiizi that extends to many parts of the world and allows Kisiizi to continue its extraordinary ministries...

a trip to the Netherlands...

We spent a week in Holland based at the home of Leonoor, one of Hanna's sisters.  The main reason for our journey was that, following the death of Hanna's dad, the siblings needed to sort through the house ready for it to go on the market. 

We were pleased to meet up with all the family including our nephew Justin and family back from Turkey and, of course, to be impressed at how the children are all growing and developing!

Noor and Hanna in the wind!


We had a trip to the Dutch seaside which was quite windy but pleasant.

We visited a charity that recycles medical equipment run by about 80 keen volunteers and this will be a useful resource for Kisiizi in the future we think...


Fine regalia!

We were delighted to be basking in reflected glory as we attended Mark's PhD graduation ceremony at the University of Reading.  We were blessed with a lovely sunny afternoon and Mark looked very distinguished in his historical garments and seemed a natural in the role! 







We also enjoyed meeting some of his colleagues and supervisors and then we went out with Mark and Ruth and their respective friends Sammie and Jacob for a lovely celebration meal together.

Time travel!

There MUST be a time warp somewhere on the way back from Kisiizi to Europe as time seems to have rushed by in a whirlwind... and so much has happened so apologies to those regular readers of this blog who thought we had hibernated!  Fortunately we didn't forget to remember our 30th Wedding Anniversary!

As soon as we arrived back in UK Ian was off to London to the Royal Society of Medicine / Royal College of Paediatrics & Child Health conference on international child health.  Ian had in the past shared an office with the professor who introduced the conference so it was good to catch up and also to chat with Peter Nash who has co-ordinated the RCPCH Global Links programme that has sent Kisiizi a number of excellent registrars in the past couple of years.  Unfortunately the DfiD grant via THET (Tropical Health & Education Trust) which has allowed RCPCH to run the scheme is being discontinued which is a great shame as the programme has proved very successful with both registrars and Kisiizi.  Peter Nash had visited Kisiizi only a few months ago and remains very positive about our work so will endorse future paediatric trainees who come to Kisiizi even if there is no college funding.
At the end of the conference Ian met with a colleague from the London School of Hygiene &Tropical Medicine as they are proposing to send a group of doctors participating in the Diploma of Tropical Medicine & Hygiene to Kisiizi for a week of practical work.

A couple of days later we were back down to London to attend the Friends of Kagando day as we would like to strengthen Kisiizi's links with other church hospitals, something we had done 25 years or so ago when first in Kisiizi and which proved mutually beneficial.

Then on to the annual Christian Medical Fellowship Developing Health course which runs for two weeks and is a brilliant mix covering all the medical specialties for those wishing to work in resource-poor countries.  We are "hosts" so try to look after the participants (we had about 79 in total of whom 39 were there for the full two weeks).  Ian co-ordinates the Paediatrics Day and is one of the course directors.  As always we met inspiring people both participants and lecturers.  The course included much practical work varying from plaster of paris applications to breech deliveries to spinal anaesthesia to dental extractions from pigs' heads!
(see http://www.cmf.org.uk/international/developinghealth/developing-health/)

During the course Ian went into London to meet Anna Bishop of All Souls Church, Langham Place, who have kindly helped Kisiizi with support towards renovating an old clinic building to be a Maternal & Child Health clinic.  Kisiizi's links with All Souls actually go back to the founding of the hospital as the first doctor, John Sharp, and his wife Doreen had lived in the flat in the All Souls Rectory above John Stott who later visited them in Kisiizi!


Just for added interest this year we also had the spectacle of Venus and Jupiter being close together in the evening sky and could see their relative positions move daily.

Following the Developing Health course we went down to Battle to see the Carers & Sharers group who have faithfully supported Kisiizi for decades.  We enjoyed tea at the garden party and gave a talk about the work in Kisiizi which generated quite a few questions and a good discussion.

One unexpected result was that for the first time we came across a PORTABLE oxygen concentrator.  We do, of course, have quite a few standard concentrators in Kisiizi as our main oxygen sources but didn't realise that they are now available in a portable format which is very attractive for us as it offers the chance to move oxygen-dependent patients to x-ray or to the wards after surgery etc as the devices work on batteries.  They also have a connector to a vehicle socket so offer the potential to transport patients to other units which we rarely have to do but when it does occur it is usually with very sick cases who need oxygen and until now we had to rely on cylinders which all too quickly run out.


Subsequently we visited medical equipment charities in Holland and UK and have been able to access with the help of the Battle group a compact device that will help us achieve the above goals.