Window on Kisiizi

Window on Kisiizi

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.


Saturday, 1 February 2014

Face creams and Facebook...

The youngsters in this photo were sitting outside as I walked towards Children's Ward... they had chickenpox and generous amounts of calamine lotion had been liberally applied!  We sent them home as they were doing well and we wanted to avoid the disease spreading to other vulnerable patients.

Amongst all the challenges we face day by day, one out of the blue issue is that someone has put up a counterfeit Facebook account in Ian's name - they have used photos from our blog and the hospital website to make it look authentic but then sadly have apparently asked some people for money... this is all a scam so please ignore it and if you have accepted Ian as a friend on Facebook please cancel this as he does not have an account.  If you do wish to support Kisiizi then please look on the hospital website www.kisiizihospital.org.ug and you will find information to help you.  We do apologise for any inconvenience caused.

Do use the box on the right margin to enter your email if you wish to be alerted when we update the blog - the pressure of life here means we often have to wait for a day off to catch up with posting so it may be a bit erratic and the email notification can help you read any new posts.

Smile!

We were pleased to have a visit from a special patient recently.. a little boy with oculo-cutaneous albinism, a condition where the pigment cells of the skin and iris are not working well and the skin and hair are therefore very pale. This can cause a risk of sunburn and potentially malignant melanoma, and the children with this condition may have visual problems.  Happily this youngster is doing quite well and his parents are grateful to Kisiizi where medical students have helped by bringing out high factor suncreams for him. 

The condition may be socially very challenging for the family and child as there are various traditional superstitious beliefs surrounding this condition but we were pleased to see them coping better now after a lot of counselling support initially.

so much more than just a midwife!

It's certainly true that Hanna spends a huge amount of time on the Maternity ward, mostly in the Labour Ward, but she also manages to do all sorts of other things so here are a few photos...


The first shows her improvising in a power cut with a torch under the chin to keep hands free...
 thankfully I don't think she's had to use this technique for delivering babies...




 then there is the vegetable production, with an element of artistic sculpture work thrown in!



 There are times to sit down, so why not make the most of the beautiful view to the waterfall even if it is pouring with rain?!

In addition Hanna organises the Guest House bookings and looks after many visitors and provides a lot of hospitality.

Then she sometimes drives one of the hospital landcruisers through mud and dust... now happy to park back in Kisiizi and head for a cup of tea!


























Weekend celebrations...

Drs Bryony, Henry, Paul and Bruce
On 18th January we had a party in our living room to say goodbye to Drs. Paul and Bryony who had worked with us for almost six months.  Paul had mainly worked on Medical and Isolation wards and Bryony on Paediatrics and they fitted in to Kisiizi very well.  We are grateful for all they have done, not only the valuable clinical work and teaching but also entering into the life of the community and sharing in the fellowship.

We also said goodbye to the visiting urologist, Steve Foley and his registrar Paul plus a visiting student Phoebe all from Reading.  They had been with us for a week and the Urology camp had gone very well.
Jemma and Bryony




We were also delighted to welcome Dr. Jemma Say on the Royal College of Paediatrics & Child Health Global Links scheme to Kisiizi, she will be with us for about seven months taking over the work done by Bryony.





 

 The following day we travelled to Kabale with our friends Moses and Josephine to take part in the service of consecration for the new Bishop of Kigezi, Bishop George who Moses has known for some years. 

There was, of course, a huge crowd and the Prime Minister attended so it was the second time we met him in three weeks!




We drove back over Shoko Hill and enjoyed the beauty of the Kigezi landscape...


Sunday, 29 December 2013

Whirlwind!

Apologies to our regular blog visitors for the delay in posting but the last few weeks have been a whirlwind... Ian went to World Health Organization in Geneva for a workshop on Universal Health Coverage [ensuring all people have access to healthcare] and Patient Safety & Quality.  It was a privilege to be one of only five worldwide locations selected for this "learning laboratory" workshop and we had a very good meeting and hope much of value will result.

On the way he was able to snatch a day in Holland to see Hanna's father and other members of the family and then hop to Manchester to see Mark and visit our church TFW in Macclesfield.  Also a very brief visit to former colleagues at the hospital and a lot of phone calls to relatives and friends.  So hectic but very worthwhile...

It worked out really well that his flight back to Kigali, Rwanda, arrived only a few hours before Ruth was due to come for a Christmas visit... only problem was that Turkish Airlines proved unreliable and rude and unhelpful when she missed her connecting flight in Istanbul so ended up arriving a day later than planned.

This meant Ian and Ruth met up with Hanna on 23rd December and got to Kisiizi just in time for the staff christmas party that evening [see www.kisiizihospital.org.ug for blog post and pictures of the party].

Then we had a lovely "bring and share" meal on Christmas day after the service in a very full chapel.  On boxing day there was a more traditional meal with the European contingent so we did very well and put on a fair bit of weight...




...which we immediately lost again getting ready for the meeting yesterday, 28th, when the Prime Minister flew in by helicopter to launch a new tourism initiative... see www.kisiizihospital.org.ug for a blog post and photos of this visit.  The photo here shows the Prime Minister unveiling an artist's impression of a monument to be set up near the falls.

Now we are off for a day's break with Ruth and on to Rwanda tomorrow to take her for her return flight.
When we return on 31st, we will prepare for a Management Committee time away 2-3rd January for Strategic Planning for the year ahead...