*** 22 TODAY ***

CONGRATULATIONS TO OUR VERY SPECIAL DAUGHTER RUTH who celebrates her birthday today... she has just moved down to Cambridge to start her Post-Graduate Certificate of Education and it seems to have started off very well.  She has a room in a nice house very close to college and has good house-mates to share with.





Hanna is currently in the Netherlands visiting her family there, and flies back to UK tomorrow.  Then it will be preparation time to get ready for Friends of Kisiizi day on Sat 6th October at Greyfriars Church in  Reading, before then flying back here overnight 9th arriving in Entebbe on 10th.  Will be lovely to be together again after a long time apart...




But really...

is it really a year since she was 21??


Time flies, seems only yesterday that I posted the collage on our previous blog...

Visitors, partners and friends...

Kisiizi is blessed with a wider network of supporters and friends without whom we could not sustain our work or develop our services.

We have had a large number of visitors in the past month who have enriched different areas.  Neil Fergusson, a consultant anaesthetist from Chester, came for a fortnight with his wife Hilary who is a speech therapist and encouraged our Rehabilitation Unit team.

Neil worked mainly in theatre with Gershom, Medius and Andrew, our anaesthetic officers, and he also ran a seminar on pain relief which ended up being in our lounge as the Staff room had been used as a temporary store for boxes that had come in on a consignment.

Chester team saying goodbye in Chapel with Sister Moreen

We also had nursing friends from the University of Chester and Countess of Chester Hospital who ran training on our wards and in the School of Nursing.

This represents the end of a 3 year programme and the goodbyes in Chapel and at the celebration in the School of Nursing were quite emotional as staff expressed their heartfelt thanks for all the input that had been provided.

A new partnership that has been launched recently is the "Maternity Hub" where UK units are linking to various hospitals or health centres in Uganda.  This compliments our existing links with the Royal Berkshire Hospital in Reading and with Chester.  We currently have our first "Hub Registrar", Dr. Rachel, who is an obstetric registrar and joined us about 6 weeks ago.  She is settling in well and has already helped in a number of ways to examine practice and look at quality improvements.  She also has an interest in family planning and this is an area that Kisiizi, and the wider Diocese, are keen to develop as the population under 15 in Uganda is rising rapidly and many parents are really struggling to feed and educate their children.

Louise Ackers heads up the Hub programme and visited us with a team.  She has visited many different hospitals and health centres in Uganda over the last 4 years so it was encourging to hear how impressed she seemed with what she found here.  She recognised the difference in vision and commitment and was very helpful in offering potential multi-disciplinary support for the future.

it's hard to say goodbye, but maybe the inevitable photos help!

Greg and Wendy Stormont are part of Kisiizi Partners and co-ordinate their Child Sponsorship programme so we were pleased to welcome them back to Kisiizi and to hear their updates at the end of their fortnight which included a number of visits into the community to look at various schools and projects.  Greg did some valuable feedback from looking at pharmacy procurement and stores.

Helen Smith, Consultant Obstetrician from Royal Berkshire Hospital in Reading, returned for another visit bringing a couple of midwifery colleagues.

Helen had been here recently as had her husband Alan who had done a useful initial review of our Health Insurance Scheme.

It was valuable to have some meetings to liaise with Kisiizi Partners, to discuss future plans, and to feed back to Friends of Kisiizi day that will be held at Greyfriars Church, Reading on Saturday 6th October.  All are welcome, just turn up with a packed lunch from about 10am.  The meeting will go on to around 5pm and is being co-ordinated this year by Dr. Philip Haynes.  It will be the first Friends day I have missed having helped with them since 1995 but Hanna will be attending and sharing.

Jubilee House

Dr. Helen Smith, Dr. Rachel and driver Ezra.

One project for which we would very much value your prayers is the Jubilee House.  This is to provide very much needed accommodation for 8 couples / families.  It has been generously sponsored by Kisiizi Partners following the Hospital's Golden Jubilee in 2008.  Unfortunately, the engineer commissioned to organise the project has gone well over budget and is demanding more payment, even though Kisiizi has already paid more than the originally agreed contract.  We had a meeting with him recently with Alan Smith representing the donors in the hope we could come to an agreement but unfortunately the engineer was not prepared to do so.  The result is that we have had to pass it to our hospital lawyers to try and get it sorted out, and I suspect that this will mean arbitration which can potentially drag the whole process out longer. Please pray that God intervenes and the matter is sorted as we really need the accommodation to take on more staff. We need to find more midwives and hope to also expand our number of interns - I will be going to Kampala next month for a meeting about this.

We also welcome significant numbers of trainees and students to Kisiizi and hope that their time here stimulates them.  We are delighted that Dorothy Turitwenka, final year medical student from Kampala, is here.  She is the daughter of Edward and Enid Turitwenka who served in Kisiizi at the time we were first here.  Edward now heads up the national ENT department in Mulago Hospital in Kampala.

In addition we have two UK medical students at present.  Sadly a few students cancelled electives here last month due to concerns about ebola, but happily there have not been any more cases.

High pressure medicine!

Perhaps it was a mistake to show a group of visitors around the Hospital as, passing through the adult medicine high dependency unit, we noted a young man of about 30 years clearly in serious trouble with very laboured respiration and looking exhausted.  He was attached to one of our few monitors which was displaying his heart rate as 190 beats per minute.  That would be too fast even for a neonate and was clearly unsustainable.

So later I came back to review him and noted a number of physical signs including a very distended jugular vein in his neck [left hand photo].  As a paediatrician I don't see so many adults usually, but as we don't have a consultant Physician here, I felt obliged to review him and did work out he was in serious heart failure with a gallop rhythm, pulmonary congestion and this very high jugular venous pressure [JVP].

After some mental gymnastics to recall adult doses, we sorted out some treatment and happily this and prayers seemed to make a difference so that by the next morning his pulse was down to a much more acceptable 90 a minute and his JVP much reduced [right hand photo].

Entomology corner...

Some people are not too keen on "creepy crawlies" but on the other hand they can be quite interesting as we have such a variety of crawling and flying insects if you only look...

This beetle seems to be half way through shedding its skin, perhaps to grow even bigger...




This wasp seemed very interested in our rubbish bucket....

We have a range of butterflies and moths, some quite large [those who followed our blog last year will remember we caught some of you out in a quiz where the antennae of a large moth looked remarkably like the horns of a gazelle!]
This butterfly is not as brightly coloured as some but still the pattern is impressive.

Not sure what this one is, but it flies! 

Answers on a postcard please!

Maintenance matters...

VEHICLES:
Keeping a 300 bed hospital,  a hydro-electric power company, a School of Nursing with more than 150 students, and a full Primary School together with a Community Programme on the road is challenging, especially when the roads in question are very unforgiving to vehicles.  The nearest tarmac is 18 miles away, so our local roads are all a type of gravel which is periodically "graded" - this means they are flattened by a heavy machine which scrapes the surface and compresses the gravel.  The good news is that this means that vehicles no longer get bogged down as they did in the past when we just had dirt roads which turned to mud and swamp in the rainy season.  However, the roads do become very rutted and pot-holed which means vehicles are subject to a lot of stress.  Unfortunately one of our vehicles is currently at the Toyota dealer in Kampala and it will cost a lot to put right the faults that have been identified...

BUILDINGS:
Kisiizi Hospital was founded in 1958 and used the buildings from a flax factory as its core.  These are still in use housing surgical ward patients but are in urgent need of renovation.  Here we see the old ceiling tiles have been removed in what was previously the old maternity ward, and we are replacing them and then plan to rewire the building, replaster and repaint the walls, renovate the windows and then, last but not least, put in a new floor.  The terrazo tile floors are best in terms of keeping them clean as a concrete surface gets cracked quite quickly.  Infection control is a priority so we really want to go for an option that allows thorough cleaning though this is much more expensive to put in.  We are grateful to Natalie, one of our recent medical students, who is going to do some fundraising for a new floor.  If any readers of this blog want to help we would be most grateful. Our administrator, Moses Mugume, is getting a number of quotes but we have to be careful to look at quality as well as the financial quote.

BABIES!:

Maintaining a pre-term baby's temperature is also a challenge... I smiled when I saw the clothing for this little girl born about 7 weeks early as she lay in her incubator... certainly plenty of room to grow!  We are very grateful to the individuals and groups who have faithfully sent out knitted bonnets, socks and blankets for our premature babies.  Mothers are given these to take home to keep their little infants warm.

Clinical pot-pourri...

Kisiizi sees the whole spectrum of medical, surgical, obstetric, psychiatric and, of course, paediatric problems....

I concentrate on the babies and children but occasionally end up having to see adults as when involved in screening patients picked up on our triage for ebola [which thankfully seems to have died out now] and when our medical officers need a second opinion.  The key specialist area we are missing here is an adult physician [would suit a GP who wants a change as well as any physicians out there!] and I had to review a man with renal failure and low blood pressure so had to blow away a few cobwebs to remember the right fluid regimes for adults - a bit different from our premature infants!

This child came in to the ward and has obvious Down's syndrome but this had not been identified in the community. 








 Because the child has motor delay and could not sit properly the local traditional healer had cut the child's back in the misguided belief that it would help...

One significant step forward is that Kisiizi now has a CD4 counter in our lab.  This instrument counts CD4 cells that are a key part of the immune system and fall in patients with HIV.  Knowing the count is important in deciding on optimal management and treatment.  Previously we had to send samples to Kabale, a couple of hours drive from here.



Some of you may recall us mentioning a young boy who had been in a serious road accident and came in unconscious.
He required emergency surgery to remove blood clots from around his brain.

Here is an update photo taken in our rehabilitation department as he has physio...