Window on Kisiizi

Window on Kisiizi

Friday, 23 May 2014

Board of Governors meeting

The Board and Management May 2014
The Board met on May 21st to review a range of topics relating to life in Kisiizi.  Amongst the Board members is our District Health Officer, Dr. Elisa Rutahigwa who spoke very encouragingly of his perspective of Kisiizi's contribution to health care in the region.

Comings and goings...



 VISITORS

The Minister of Health of the Buganda Kingdom cuts the cake
It is enriching for the Kisiizi community to have a mix of visitors arriving for different lengths of time and with different areas of interest.  For example in the last month or two we have had Eric Smith who has faithfully prayed for Kisiizi and its work for over 50 years.  Then one day a knock on the door and out of the blue Graham Piper was there – he had worked as a water engineer in Kabale when we were first in Kisiizi in 1987 onwards with his wife Philippa who is a GP.  In fact Hanna delivered one of their children, Simon, here.  Graham only came to Kisiizi as a bridge was down preventing him travelling his planned route so it was an unexpected blessing for us.

Another unplanned visit was arranged at short notice when Suzy and Suzy, 2 medical students, had commenced their elective in Zimbabwe but after a few days had to leave due to administrative issues outside their control.  They were unable to continue their elective and we heard of their plight through Lionel and Mary Mills who knew one of the Suzi's and her family very well.  It all fell together as we had a vacancy and so the two girls came for about 3 weeks but fitted in a lot during their time here and we suspect that in the fullness of time we will see much fruit from this short but very positive visit to Kisiizi.
 
Dr. Emmanuel
James and Esta came out to work with us for about 3 months, James as a junior doctor and Esta in our primary school where she caused much excitement by introducing very practical sessions on various aspects of science.

Another unexpected visit came following a request that the Minister of Health of the Buganda Kingdom might visit Kisiizi particularly to look at our community health insurance scheme.  He came with a small group and it turned out that the senior doctor accompanying him was none other than Emmanuel who had stayed with us three times long ago when he was a medical student and then a junior doctor so it was lovely to see him again.  He now heads up the African Palliative Care Association.  

Some members of Management with Jamie's Fund team and David, our engineer
Another important visit was by Fiona Clark the new Chief Executive of Jamie's Fund.  She came with our good friends Ewan and Mo Wilkinson from Chester and a colleague Niall Campbell, a GP psychiatrist.  

We were able to agree the go ahead of the architect's plans they had brought out with them so can now work on the costings for the new Ahumuza Mental Health Ward and Day Unit.  One key decision from the visit was that our aim long term should be to have a Consultant Psychiatrist in Kisiizi.  Previously we had expected to continue with a Psychiatric Clinical Officer.  However the new aspiration fits in with our goal to be a centre of excellence clinically and in our training and this will make us a regional centre for Mental Health services which with the very special new ward is entirely appropriate.

Subsequently we were able to once again welcome Dr. Helen, Consultant Obstetrician from Reading who is also the Chair of Kisiizi Partners.  She came with Tess and Charlotte, two midwives from the Royal Berkshire Hospital, who were amazed at how much they saw in a couple of weeks of Kisiizi maternity life.
Noor enjoying the waterfall view
Currently we are delighted to have a special visitor with us - Hanna's sister Leonoor (Noor) from Leiden, Netherlands.  

She had done a sponsored cycle ride in eastern Uganda and we met up in Kampala to bring her the six hour journey to Kisiizi. It is her first time in Uganda.






TRIPS




Dr Jemma & Sr Maryanna presenting

Dr Gabriel, consultant surgeon, has just been to Lachor Hospital in Northern Uganda to look at their endoscopy service and their Intensive Care Unit.  Our second specialist surgeon, Dr. Robert, had previously been away for a couple of weeks at the CoRSU hospital near Entebbe to further develop his orthopaedic skills. We look forward to a further visit from one of our Urology colleagues from Royal Berkshire Hospital, Reading, in June and Dr. Francis is arranging a special Fistula Surgical Camp later in June.  It is good to develop the range of specialty surgery we can offer our patients and we are extremely grateful for all the support towards this goal.
 
Joseph
Ian travelled up to Kampala with Dr. Jemma, Paediatric Registrar, and Sr. Maryanna, Maternity Specialist Nurse, for a meeting of the Uganda Maternal and Newborn Hub where we all gave presentations.  We were struck again how blessed we are compared to some of those working in government hospitals who were expressing frustration at not being able to get things done due to lack of administration support in their institutions.
 There was also a meeting about medical equipment and our new Biomedical Technician, Joseph, attended.

Ian went on to Harare for an important workshop/conference for the partnerships belonging to the World Health Organization African Partnerships for Patient Safety.  Kisiizi is one of only 3 English-speaking hospitals in the first wave, and there are now a further 5 second-wave partnerships.  This was the first time that all eight partnerships had the opportunity to meet up and it was a full and stimulating 3 days together.   


WHO had purchased the air tickets and maybe went for the cheapest option as Ian ended up leaving Entebbe at 1.40am and flying south-west to Kigali, Rwanda.  After an hour on the tarmac there, off again north-east to Addis Ababa.  Another couple of hours then flying south to Harare... a rather roundabout route but at least one leg was in a new Dreamliner plane.





Sarah Hoyle from Countess of Chester Hospital and Ian gave a presentation which was well received.  We are the only one of the partnerships to have in-patient mental health services, a large community health insurance scheme and involvement in the WHO Universal Health Coverage / Patient Safety & Quality learning laboratories as well as running the WHO Surgical Unit-based Safety Programme.  We are hopeful that we will be in a good position to obtain a grant in the next few months to help us further develop our services.


Marriage seminar

We were recently invited to share with the Student Nurses on the topic of relationships and marriage.  It proved a very popular topic with a large number attending. 

We started with a questionnaire and then mixed a talk with role-play and it all seemed to go well.

Saturday, 12 April 2014

3 things you must do!


1]   Visit the Kisiizi website



2]   Look out for the total lunar eclipse this Monday April 14th, it should make the moon appear a reddish colour.  Our son Mark brought this to our attention.  Interestingly the moon will be very near to Mars in the night sky, and Mars itself will be at its nearest point to earth, something that only happens every 2 - 3 years...



3]  Book to come to Friends of Kisiizi Day at Greyfriars Church in Reading on Saturday June 28th

Some of those present at Friends Day 2013



Suits you!

Well, it is indeed an unusual sight, Moses and Ian in suits!  This was due to them going with Bishop Patrick Tugume, Chairman of our Board of Governors, to represent Kisiizi at an important meeting in Kampala. 

Some of you supported us in prayer as we met with the Acting Managing Director of the National Social Security Fund to discuss some unexpected issues that had arisen. It proved a helpful and constructive session...

Photo quiz...

This photo was taken in Kisiizi... what is it?


A night at the theatre...

One of 3 main theatres funded by St. Paul's
Our surgical department does extraordinary work on a wide variety of patients.  We are so grateful to St. Paul's Church in Dublin who have not only funded our new Operating Theatre block but have also very generously contributed to the salary of our second Consultant Surgeon, Dr. Robert.  Prior to all this they had donated the funds for the 2-storey ward block with Maternity and Children's Wards so they have truly gone the second mile in helping Kisiizi.

Removal of an inhaled foreign body in a child


In addition to our general surgical cases we have periodic specialist camps.  We recently had a plastic surgery camp with AMREF doing cleft palate corrective surgery and we also appreciate Dr. Keith Waddell and his team from Ruharo in Mbarara coming regularly to do eye surgery especially catarracts. 

Dr. Robert will be going to Kampala in May for 2 weeks to work with CoRSU Hospital to further develop his orthopaedic skills whilst Dr. Gabriel is now doing some quite sophisticated urology procedures and plans to introduce endoscopy in the next couple of months.

part of the newly refurbished area not yet officially opened
 This all needs the support of the Anaesthetics team, Lab, Pharmacy, Imaging etc etc and we do appreciate the hard work of Staff to help many patients.
 


We now have also been able to renovate one end of the original flax-factory building that was the core of Kisiizi when it opened in 1958.  We again appreciate support from churches, organisations and individuals to enable this to be done. The photo shows the floor being washed and the new curtains made by Doreen Wadsworth in place.

Sam, Infection Control Nurse; Dr Alex (WHO visitor) and Dr Robert

Following the success of our work with World Health Organization last year we have now launched the Surgical Unit-based Safety Programme (only Kisiizi and the national referral hospital in Mulago are running the programme in Uganda and only 3 other hospitals in Africa).

We recently had 2 visitors on a WHO assessment of the programme and they joined us for a small celebration of the successful launch together with our visitors from Chester to set up the microbiology lab.


Yet at the end of the day it is all about the patients...



 This lovely child needed surgery for a neglected left leg where infection had destroyed a significant part of her tibia and a bone graft was required.



And this young boy had arrived unconscious with a fractured skull after being hit by a speeding motorcycle.  He needed surgical elevation of a section of skull bone.  As you can see, he bounced back!











Sunday, 23 March 2014

Culture and Sensitivity...

no..... not a previously undiscovered novel by Jane Austen but a big development in Kisiizi...
the old room before renovation...

We are very grateful for our colleagues from Chester who are here for 2 weeks helping us set up a microbiology laboratory able to culture bacteria from various samples and then to assess their sensitivity to antibiotics.

Ian had been involved in a study published back in 1995 looking at cultures done over a month or so but we have not had any further work on this until now.

Changing the roof sheets...
We have been able to move the Electricians' workshop to a new location in one of the old theatres and so could relocate the surgical clinic and release the room for use as a microbiology lab.  It connects to the main lab and by re-organising we have been able to open up the intervening office area to house the small autoclave etc needed.

Our aim was to have a room with good natural light levels so we had to replace some of the normal iron roof sheets with clear plastic to put in skylights.

We now have 3 clear panels and it has certainly helped improve the lighting in the lab areas.



Then we needed surfaces that are easy to clean so put in a new floor and tiles plus workbenches with
formica tops.


We moved an incubator to keep the cultures warm and a microscope in to the room and replaced the old sink that was too small for its new use.

The next challenge was an email from Chester asking if we had a "Class 1 Safety Cabinet"?  Having found out what this is, we realised that we did not possess this item that is to help our staff remain free from infection when handling samples.  We therefore decided to modify an old baby incubator that was no longer functional, and install a fan in the base to extract air from the chamber which would be accessed through the original perspex hand ports.  The extracted air passes through a filter which can be changed regularly.
the old incubator...





The extracted air passes to the bucket and is filtered





















 ... and finally...

the Kisiizi Class 1 Safety Chamber mark 1!


 but, you are asking yourselves, does it work?












We set up a very high tech test to check it out... would the smoke from a candle be drawn in through the hand port-holes indicating a negative pressure chamber effect?

While we had been busy setting up the above, repairing autoclaves and fridges etc, our colleagues in Chester had worked very hard to assemble a wide range of equipment to help set up the lab.

Happily they sailed through customs and immigration without any problems and arrived safely in Kisiizi.


so all the pieces of the jigsaw were taking shape...
















the first control culture showing the media is fine...
 The first patient sample that was processed gave the staff a surprise when they looked at it down the microscope - they found what is probably tetanus organisms in a sample from the wounds of a man involved in a bad road traffic accident who had spent quite a while in a government regional referral hospital before being transferred to us with severe infected wounds.  Unfortunately we are now growing some very unpleasant multi-resistant organisms from this sample... and in fact have had to order a new antibiotic, amikacin, not previously used in Kisiizi as its the only thing the pathogen is sensitive to.

We are hoping our home-grown bugs are more friendly when we get results next week..




So a huge thanks to our own lab staff and our enthusiastic visitors
Dr Ildiko, Consultant Microbiologist' Sam, Infection Control Lead  & Sharon, Senior Lab Scientist

Dr Ildiko's birthday party










Sunday, 16 March 2014

Escape...

This vehicle fell off a bridge over the river just below the hospital area but thankfully ended up the right way up and nobody was seriously injured.  It reminded us of an incident 20 or so years ago when we first lived in Kisiizi and a lorry fell off the same bridge at night.  Sadly on that occasion there were people sitting on top of sacks in the back of the lorry and they fell into the river followed by the heavy sacks.  We went into the river in the dark and pulled some people out but one lady was drowned.



We too need to escape sometimes - life in Kisiizi is very full as we live, work, worship and play with the same group of people.  Living on-site means we are available, which is good but can be demanding  and there is a lot of on-call and work committment.  Hanna has spent many hours on labour-ward, sometimes going back to check up on patients as some of the other staff are very junior and inexperienced.  Overall Ian is on-call 1 in 2 nights which usually involves a night ward round at about 9.30-10pm and then it depends on how the patients progress.  In the past 2 months we have had a run of very sick babies and children.  Sometimes it is heartbreaking when patients come too late for us to help, maybe due to financial pressures or the inability to get transport to come.
For example a mother was referred late by a health centre and died shortly after arrival here as she had lost so much blood.  This morning on the ward round I saw a 2 year old child who had been in the national referral hospital in Kampala for weeks and has now come to us with what is probably a liver tumour....


So we are grateful for a garden to enjoy with a view to the waterfall and for the opportunity to escape sometimes to some of the beautiful places in this region.
Volcanoes at Lake Mutanda


Pied kingfisher on mirror-surface lake
In the past months we have managed a few short breaks and appreciated the beauty of rural south-west Uganda...


Sunday, 2 March 2014

Night life...

The last week or two have been very busy medically with some extremely sick patients coming and a lot of broken nights being called in to help.

Often patients present very late and on the edge of death.  Some tip over the edge, others are resuscitated.

Here is an example of a technique called intra-osseus infusion that we use in shocked children if it is hard to find a suitable vein for a drip.  The needle goes in to the marrow cavity of the tibia and works very well allowing both fluids and medicines and even blood transfusions to be administered.

 The commonest reason for needing such interventions are patients with gastroenteritis who have lost a lot of fluid or those who are shocked due to anaemia such as that caused by malaria.

Other cases include serious infections such as septicaemia or meningitis.


 Later as this patient improved we were able to site an intra-venous line in the external jugular vein and remove the intra-osseus line.

You may smile at the artwork with the strapping adhesive tape - this is due to the tape not always being very good quality hence a large amount has been applied in the hope the line will remain secure and functional.

wood fires in children's ward kitchen area





In Kisiizi patients have attendants to care for their domestic needs such as food, washing etc.  Even at night, the mums are still cooking on wood fires to prepare food.

It is not always with the greatest of joy that we answer the phone for calls to the ward at night but  one of the rewards can be coming back and enjoying the stars and planets and sometimes the dawn...

Kisiizi dawn with the moon and planet Venus the morning star

Sunday, 23 February 2014

Snakes...



SNAKES...

This poor lad was very unfortunate – he managed to be bitten by a snake – on his head!
He was sleeping and must have rolled over at the wrong moment and the snake bit his scalp.  He woke up and cried in the dark.  His parents came to see what was wrong and he told them he had been stung by an insect. So they left him and it wasn’t until the morning that the true culprit was seen and dealt with… by which time the boy was swelling up rapidly.

He came to Kisiizi and thankfully we had supplies of the anti-snake venom antidote. 
 He received three ampoules as well as steroids, anti-histamines, tetanus toxoid and antibiotics as he kept on swelling up.

 Happily he did not develop any major complications and stabilised and then slowly recovered.


The next problem was his parents when they heard the cost of the antidote – it is 400,000 Uganda Shillings an ampoule [about £100] (you will understand the cost if you read up how the antidote is obtained – someone has to “milk” the venom from a snake who presumably may not be too pleased about the experience!)


So having been faced with the prospect of their six year old son dying, the parents now faced the potential of having to sell vital land on which their future depended.


 .... AND LADDERS!

But, wonderfully, some members of a UK church who happened to be visiting Kisiizi that day, heard their story and very generously paid the costs of his bill, much to the relief and excitement of the family.

 Here he is with the swelling reducing but still somewhat bemused by the whole affair!

The story is a good illustration of God’s love reaching out to a vulnerable family in Kisiizi.  We really appreciate the prayers and support of many friends, those visiting and those far away.

THANK YOU.