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...

Countdown...

Maternity on a quiet day

Lots of plates spinning at present as we prepare not only for Christmas and Ruth's visit but also for Hanna organising a maternity tea party next weekend, sorting out 50 people arriving from Mbarara on a mission here for a week and coming on the same day there is a wedding party in the Kisiizi primary school hall not to mention the continued heavy workload on maternity.
I was thinking the other day as I was cutting Hanna's hair that life can be quite busy.  And, this very morning, as I prepared Hanna's breakfast, I was mentally ticking off the things I need to do before leaving on Thursday to travel down to Kigali to catch a night flight to Nairobi to connect to a day flight to Amsterdam... then on to see relatives including Hanna's dad, then back to Schipol to fly to Manchester. Then on the following Wednesday to World Health Organization for interesting meetings in Geneva.
So at the weekend, while I was polishing Hanna's shoes, I was contemplating that my retirement is quite varied and I can't complain of boredom!
Right, having teased my dear wife I have to be honest and say she does far more for me than I ever do for her and I am so grateful!  It can be high pressure here and having such faithful and loving support is a great blessing.

Of course we have learnt over the years that we can never guess what may happen... for example about 3 weeks ago we heard that the Banyakigezi, a group of influential successful citizens from this region living in Uganda or overseas want to encourage more tourism in Kisiizi, partly relating to the history that in the past tragically many unmarried girls who became pregnant were pushed over the waterfall.  Thankfully what was a place of despair, killing and death has now become a place of hope, healing and life and we want to portray that transformation in some sort of monument.  They may be bringing around a hundred people on 28th December to visit!  There is actually a lot of interesting history here with the original flax factory building having been built by prisoners of war, and the whole story of the hydro-electricity plus a beautiful location with amazing birds...

Then into the new year we hope to have  Management Away Days to plan strategically for the coming year.

Travel log...

We have done a fair bit of travelling recently and more to come...

We went up to Kampala together for a meeting at Makerere University Guest House for members of the Uganda Maternity & Newborn Hub partnerships and for the Royal College of Paediatrics & Child Health Global Links Scheme.  Dr. Josephine Nantongo, our Consultant Paediatrician, came with us and did a joint presentation with Ian on Patient Safety programmes in Kisiizi.  We met up with Maryanna, our registered nurse on the Hub programme, and with Mandy, our new Hub midwife who will be with us in Kisiizi for six months.

Then last week Ian drove to Mbarara 80 miles away and then went the next day on a coach to Kampala, left his bag at a motel, and braved public transport through busy Kampala to the CORSU hospital near Entebbe.  This is a specialist facility providing expert care for orthopaedic and plastic surgery problems, especially for children.  We hope to have a Memorandum of Understanding to facilitate trips by teams from Corsu to help us with paediatric orthopaedic camps in Kisiizi.

Then Ian attended the Uganda Protestant Medical Bureau [UPMB] Council meetings the next day and in the afternoon went up to the top floor of a very posh building in central Kampala to meet with National Social Savings Fund officials.  Contributions to this scheme are similar to National Insurance in the UK.  Having understood that we were very compliant with the scheme an audit has suggested some payments for some staff had been omitted so Ian went to discuss the issues and to see how we can move it forward.

The following day was the UPMB Symposium with one or two hundred people present.  Their annual report and new strategic plan were presented and Ian gave a presentation on aspects of patient safety work in Kisiizi.  Then a group photo, then on a motorbike boda boda through the rush hour traffic to the bus park to get a coach back to Mbarara... meant I got there about midnight. Drove back to Kisiizi the next day after an informal interview with a potential senior member of Staff and then back into on-call mode as some children needed review.

Now having to think about the next trips:  Ian has been invited to Geneva for a World Health Organization meeting on 19th and 20th December and is aiming to go a couple of days earlier to fit in a short visit to family in Holland and then a quick trip to Macclesfield to see Mark.  After the Geneva conference he will fly back to Kigali and, very conveniently, will arrive there just a few hours before Ruth so they will then travel on together the next day to Kisiizi.

Snapshots...

Life in Kisiizi is very varied with so much going on all around....
each patient admitted to a ward will have an attendant to help with feeding, washing etc. so there can be large numbers of people around at times. 

Then some will just sit on the grass and have a rest if the chance arises.

Construction work continues in different areas of the hospital estate.

Here are trees felled to prepare the site for our new Mental Health Unit being sawn into planks.

We are hoping to build a further dormitory for our School of Nursing in the next year or two, and meanwhile work continues on the Mothers' Waiting Home...

 

Meanwhile the multiple types of birds are all around... such as these hammerkops:

 

The clinical work goes on 24 hours a day.  Here is our Maternity Ward, which can be frenetic.  The other day Hanna had 3 ladies all with problems needing to deliver at the same time so it can be challenging.

Attendants will arrive with food for patients, often carried in baskets on their heads in time-honoured fashion. Of course the mothers with young infants will carry them on their backs at the same time.

Numbers...

40...  the number of pineapples I bought from a road-side stall on the way back from Mbarara... most of them for our School of Nursing students who don't always get a very varied diet... in fact often they have posho and beans twice a day [posho is a maize flour porridge rather like "Ready Brek" in the UK but without the milk!]

Also bought one or two onions....

4...  the number of cardiac arrests this 6 week old girl had today...
she arrived in our out-patient/Accident & Emergency area labouring to breath and had her first arrest... then 3 more on the ward. 
I think clinically she has Down Syndrome [not diagnosed previously] and had severe pneumonia and wheeze.  She may have an underlying heart problem though we cannon hear a murmur at present.  I have just done the night round to review serious cases and happily she is much more stable now...

 5... Essentials for any good office secretary!

 

    

3... spontaneous triplets born at 4am a couple of weeks ago and all making good progress...

 

Too late...

Increased maternal mortality is multi-factorial

 The photo shows a national newspaper article published earlier this year.  It discussed the many issues that may increase the risk of mothers dying associated with pregnancy and childbirth.

Sadly we experienced a local incident recently. Last Wednesday evening we had a tragedy where a mother in labour was brought to Kisiizi but was dead on arrival at the hospital at around 11pm.

The story behind this sad event is that she had had a previous Caesarean section in one of her nine previous pregnancies.  She went into labour in the village where she lived.  She was taken to a local drug shop / clinic we think at around 3pm and it seems that there was then a long delay before she was put in a vehicle to come here at her own request.


From the description given by the attendants, we suspect she developed a rupture of the uterus through the old scar.

This is the sort of patient who should always deliver in hospital. Most mothers want to deliver at home if possible, partly for cultural reasons, partly economic as it costs a lot in local terms to arrange transport as well as hospital costs, food etc.

One response in Kisiizi is the construction of the Mothers' Waiting Home sponsored by Kisiizi Partners.  This will allow mothers at risk to wait here so when they go into labour they can be moved to the Maternity Ward easily and quickly.
We are following up the case with the District Health Officer and will continue to try and improve health education of both public and community professionals to try and avoid such cases in the future.

Cuisine extraordinaire!

Okay, those of you in Europe will know that the French are encouraging high-end restaurants to include various insects on their menus... but Kisiizi have been doing it for years!  Only problem is they are seasonal...

Here is the extent to which villagers will go to catch grasshoppers at the right time of year - with lights, long pieces of corrugated iron [usually used as roof sheets] and old oil type drums to catch the insects disorientated by a smoky fire.

The result, after removal of heads and wings and frying in oil is as shown below.... brought for us today by a kind neighbour... tastes like shrimps [if you have a good imagination like my wife!]

maybe could do with a few chips?!

"Her tummy's so big, Doctor..."

This little girl presented with a history of significant abdominal distension and discomfort for some time.


Her case illustrates the value of appropriate technology, in this case ultrasound.

The scan demonstrated a cystic lesion thought to be a pancreatic pseudocyst and this proved to be the case at operation when it was removed.

She bounced back really well and her parents were delighted.

 Our only imaging modalities at present are ultrasound and a static x-ray machine.

Our friends in Chester have very kindly donated an image intensifier which will allow real-time imaging and this would be especially useful in procedures in theatre such as orthopaedic manipulations to assure correct re-allignment of fractures etc.  However, our estimate for transporting the equipment here is between five and six thousand pounds sterling.... ummm!

Sun day...

A group of us made a day trip on Sunday to visit Bwindi Community Hospital which is quite remote and very close to the location of some of the groups of gorillas.  It took us about 3 hours with breaks to reach Bwindi but we had a very warm welcome from the staff.

One reason for the trip was to visit a former member of our nurse training school now working in the hospital in Bwindi who unfortunately was burnt by a paraffin stove and is in the ward having treatment.  She was much encouraged by the group.
We enjoyed the tour of the hospital and time to catch up a bit with Kieran & Sarah, two UK doctors we had met before they came out to Uganda when they did the Developing Health course with us.

On the way back we kept watching the sky which was rather cloudy but happily it cleared a bit and we were able to see a partial solar eclipse.  Once more it makes us marvel as we enjoy the heavens...

Safari

After quite a long time working our socks off in Kisiizi we managed to get away after the launch of the Uganda:UK Health Alliance meeting in Kampala and we made our first visit to Murchison Falls National Park.  Having lived in Uganda for so many years it was becoming embarrassing not to have visited this famous place while quite a few of our short-term visitors had been.

So off we went with a backpackers tour agency for a couple of nights in safari tents...
after quite a long journey it was all worth it when we were able to walk to the top of the falls and were blessed with beautiful lighting and a rainbow.



The next morning we had a game drive and then in the afternoon a boat trip up the Nile to the foot of the falls.

We loved the giraffes, hadn't seen them in the wild in Uganda before as they are not in Queen Elizabeth park or at Lake Mburo. 

They are magnificent animals and looked very healthy with plenty of space to roam, appearing on the skylines like some sort of alien tripods in a row!














So we enjoyed the wilderness and beauty though the wildlife was a bit too near when a hippo decided to graze right next to our tent so we had to wait half an hour before we could enter!

On returning to Kampala Ian attended the National Intern Committee where it was encouraging to find Kisiizi having a very high profile.

Then on a coach to Mbarara that afternoon and chatting long into the evening with Esther Kobusingye, our former Principal Nursing Officer with whom we stayed.

Raising the profile...

We are grateful for a number of encouragements as we seek to raise the profile of Church of Uganda Kisiizi Hospital.  This is important not because we want to blow our own trumpet but being located in a very rural remote area, there are challenges in recruiting key staff.  So, for example, to ask a radiographer in Kampala to come to Kisiizi might be rather like inviting someone in Manchester to go and work in Iceland - their response would be the same "Why would I?! It's a long way away, it's cold, and they speak a different language"!

Dr Lukwago Asuman, Permanent Secretary, with Ian

The launch of the Uganda : UK Health Alliance in Kampala on 15th October was attended by key leaders from the Ministry of Health including Ministers, Director General and the Permanent Secretary.  The UK delegation was led by Lord Nigel Crisp who had run the NHS for six years.  Also present were key people such as the lead for DfiD in Uganda.

We were greatly encouraged that Kisiizi featured very highly on the evening.  One surprise was to find that the Permanent Secretary had been one of Ian's medical students decades ago! 

Lots of opportunity to network with some key leaders and we have invited a number to come to Kisiizi as we hope this will encourage the Ministry to second key staff to us and increase our budget support.

The following week Ian attended the National Intern Committee and again was encouraged to find Kisiizi receiving much praise and support from the Chairman who is the executive director of the national referral hospital in Mulago.

To add to all the above, a couple of days later Ian had a phone call from the Chairman of the Uganda Medical and Dental Practitioners Council [equivalent to the UK GMC] whom he had met a few weeks ago at a meeting in Kabale. He wanted  information about our Community Health Insurance Scheme to discuss with MP's next week.

We have also had Alia Fry's article about our amplification training for the WHO African Partnerships for Patient Safety heading up the APPS newsletter this quarter, and have contributed a vignette to an article in Archives of Diseases of Childhood in UK and submitted an article for the Contact magazine of the World Council of Churches. 

So we are grateful for these opportunities to raise the profile and pray for good fruit from it all.

What's round the next corner???

A number of unexpected “Goliaths” have crossed our path recently....

Money:                                 

The hospital was audited by a national savings fund [like National Insurance] to which we make mandatory contributions.  We had thought that we were excellent in our compliance but they shocked us by stating that some groups of workers whom we had understood to be exempt from the payments should have contributed.  We have had some good meetings to try and find the way forward and hope the matter will be positively sorted soon.

Danger:                               

 Ian was coming back home on Friday evening 11^th October and thankfully spotted a snake next to our house.  The security guards nearby came and rapidly dispatched the reptile with rapid and heavy blows from sticks so it was dealt with very quickly.  It is actually very rare to see snakes near our houses or in the hospital area but they may have been displaced by the wildfires in our forest areas we described before.  Our main concern is the young children in our community so we will have a thorough session on cutting back long grass to try and avoid the risk.

Health:                 

Having just recovered from a mild viral illness which settled with simple symptomatic treatment,  Ian felt fine again on Monday morning 7^th October but then out of the blue developed pain and swelling in the right wrist and then, overnight, the same symptoms appeared in his left shoulder.  The result was a lot of discomfort but also very limited function.  Fortunately having married the world’s best nurse, it was dealt with very efficiently. [by the way we do recommend you google on “Man flu” on Youtube to enjoy a sketch which will make you sympathise more with Laura, I mean Hanna!]

After a couple of days of high dose ibuprofen and paracetamol and a wrist splint, it was actually getting worse and I had some general fever.  My colleagues commenced me on intravenous antibiotics and “slowly by slowly” as we say here, it is improving. 

Thanks to all of you who have supported us in your prayers that, like David, we might stand in faith and confront the giants that very unexpectedly try to block our path....

Friends Day 2013

We are delighted to hear of great times yesterday at Friends Day in Reading and send special thanks to Dr Philip Haynes and his wife Jocelyn for co-ordinating the programme plus to all the other contributors who made the day a great success.

Kisiizi was represented by Dr. Gabriel Okumu, our Consultant Surgeon and Deputy Medical Superintendent.

Philip, Gabriel and Jocelyn

Board of Governors

We were pleased to have a Board meeting on Friday 4th October to discuss progress in the past months and plans and challenges for the future.
The photo shows members of the Board joined by some extra members of Management following lunch together.

Website Update

We have finally gone live with the new Kisiizi Hospital Website.  The main change is that we can now update the site from Kisiizi much more easily so hopefully we can keep it updated and interesting as it had become very out of date...

the site address is unchanged:

www.kisiizihospital.org.ug

We are very grateful for the support from Andy Simpson of Stamford Webdesigns and Dick Elleray of AfriConnect in helping us organise this.

Overview

Stop press

We are delighted to confirm that Dr. Gabriel Okumu has now collected his UK visa and will be travelling to Heathrow for the weekend of 28th September. 

He will be working for two weeks at the Royal Berkshire Hospital in Reading doing urology and endoscopy and will be the guest of honour at the Friends of Kisiizi Day on Saturday 5th October at Greyfriars Church in Reading. 



He will meet the Chief Executive at Royal Berks, Mr Ed Donald [shown in the centre of the photo in July with Ian and with Dr. Helen Allott, Chair of Kisiizi Partners and a Consultant Obstetrician at Royal Berks], who is encouraging closer links between Kisiizi and their hospital. 

 Dr. Gabriel will then move to Chester to do a further fortnight of endoscopy training and will meet up with a range of colleagues who have visited Kisiizi in the past few years as part of the Chester:Kisiizi link.

Paediatric x-ray quiz... great aspirations!

so what did you think was going on?!

Note there is air in the right costo-phrenic angle and maybe in the left so the white-out appearance is not pleural effusion.

Here is the ultrasound examination which confirmed a huge pericardial effusion [collection of fluid in the sac that surrounds the heart].

Dr.Gabriel and the surgical team removed 600mls of fluid and, not surprisingly, he felt much better afterwards! The cough he had had for 3 years diminished and he had more energy to run around.

 It is possible the cause is tuberculosis, an infection that can manifest in a wide variety of presenting symptoms.  It will be interesting to see if it all settles down.  If not, we would aspirate it one more time, and if it then still recurs the next step is a little more invasive with an operation to cut a “window” in the lining of the pericardial sac to prevent re-accumulation.

Day trip...

A group of us went to Kabale last weekend for a meeting of the Uganda Medical Association discussing ethical practice.

Travelling in the early morning over Shoko Hill was beautiful with the mist still lingering in the valleys.

We stopped at the top, not as fatigued as the two men who had reached the summit on their bicycles loaded with sacks of charcoal.

Peter, Paul, Ian, Bryony, James, Onesmus, Hanna

After some business, getting bank statements etc we went to the regional referral hospital for the meeting. Turns out the hospital has the same number of specialists as Kisiizi [5] but should on paper have far more.  We actually have more interns [6] than they do and have much higher activity levels.  This pattern is often seen in sub-Saharan Africa where a lot of the effective care in the rural poor areas is provided by church hospitals and units.

It turned out that the President of the Association is a lady who did the Diploma of Tropical Medicine and Hygiene in London with Ian in 1984!  Also present was the chairman of the Uganda Medical and Dental Practitioners Council who seemed wise and kind and will maybe visit Kisiizi at some stage.

55

This is the 55th year of Kisiizi Hospital and we were thrilled to welcome Doreen Sharp back to Kisiizi.  He husband, the late Dr. John Sharp, was the first doctor in Kisiizi when it opened in 1958.



 Thanksgiving Service

Moses Mugume, Stephen, Doreen & Maggie

Doreen came with her daughter Maggie and Maggie's husband Stephen and stayed with us for a week.  They arrived on a Sunday and we held a Thanksgiving Service in the hall of our Primary School.  It was a wonderful celebration and a great encouragement to our Staff.


 Many people enjoyed meeting with Doreen to chat, she showed immense stamina and proved an inspiration to many.

 

 


One contribution within the service was a song from a Mothers' group, resplendent in their traditional
dresses.
 












On the Tuesday evening we had a special hospital fellowship meeting in the Chapel and showed some photos of Kisiizi over its 55 years and a couple of videos of life in Kisiizi at different stages of its development.  Then Doreen cut a ribbon and opened our newly renovated section of our surgery ward with a prayer of committment, following which Dr. Gabriel Okumu, our lead Consultant Surgeon, cut a cake to celebrate.

We were delighted that Bishop Patrick Tugume travelled specially from Rukungiri to meet Doreen to acknowledge the wonderful input she and John had given in establishing Kisiizi.