Doctor, Doctor!

Yes, two doctors in the house now Mark has successfully completed his PhD at University of Reading. 

He had his oral examination on 18th December and passed with flying colours so he can now relax for Christmas.

He is working teaching undergraduate students Chemistry and seems to be enjoying this role greatly.  He has been asked to help write a textbook so that is a new venture for him.

Teacher, Teacher!

We are also very proud of Ruth who has survived another term teaching in a school in Islington while at the same time working for a Masters with Homerton College, Cambridge.  So life is busy for her but she has done very well.

All together now...

We are very happy to have been able to arrange a brief trip back to UK for Christmas so will be with Mark and Ruth and then we all go for a 3-night visit to Holland to see the family there before we return to Kisiizi flying out on 3rd January for a further six months.  After that we are not sure how things will work out.... so watch this space!

Ends of the earth...

It seems that more and more countries are hearing about Kisiizi!  We have just had our first application for an elective attachment from a medical student in Iceland!

Kiwi Invasion:

We have enjoyed a good New Zealand contingent with two trainee midwives, Natasha and Katy, joining us for five weeks and then Nadia, an experienced neonatal nurse, coming up from Kisoro to help us for a month or so.  Then Charlie, a psychiatrist from New Zealand with his wife Cecelia, originally from Chile, have joined us for a couple of months - she is a photo-journalist and psychologist.  We also welcomed Lesley, a manager with CMS New Zealand, for a brief visit.

Beth, a trainee phyiotherapy student, joined us from USA and we had medical students from Germany as well as UK so a really nice international mix.  Add to this Ugandans coming from different parts of the country, some unable to speak the local Rukiga dialect, and you will appreciate the richness of the mix of people working together.

Visitors:

We also enjoyed a visit by our World Health Organization country director and his team plus the District Health Officer from Kabale.  They were impressed by what Kisiizi is  doing and we hope the visit will lead to more interaction in future and the spread of our patient safety programmes.

Importantly we also welcomed members of our Board of Governors and were happy to have the externally audited accounts available up to the 30th June 2014 that were duly approved.  There will be some follow-up meetings to look at our 5-year Strategic Plan and the Terms & Conditions of Service and  Constitution so these are important bits of work to finalise.

One way Kisiizi has received publicity is to be included in a Cultural Museum near to Mbarara

Stre@mline

Ian is working with Rimpscom, an IT company in Mbarara, on the Stre@mline computer software programme that he had developed in Macclesfield.  This is because the existing IT package in Kisiizi has proved frustrating as it does not have the functionality we need and has proved impossible to upgrade or edit.  Stre@mline is an integrated programme that follows the patient journey and incorporates important patient safety principles.  Management have now given approval for Stre@mline to be piloted in out-patients and if this goes well we will extend it systematically to the wards.  If we achieve good functionality we will install it in a sister hospital in Kabale and if both units have a successful outcome then we will aim to write it up and make it more widely available at a low price appropriate for places like Kisiizi.  If it works out well, it could be used "to the ends of the earth"....
The programme will provide much more accurate data as all the information is stored in an underlying SQL database.  The programme uses a browser front-end interface so its easy to learn how to use the system.

Feel like a walk?

Join us for an hour's walk up the path behind Kisiizi up the hills to look at the area and to look back down on Kisiizi nestling at the head of a valley...

"Rent a crowd" is always immediately available!

meet with us some of the lovely children who seem to be able to spot us coming very rapidly.  You will note how we live in a very poor community.

a typical homestead on a hill side with banana plantations around

 

making new friends

Children have to work to help their families, here they are collecting firewood for cooking, this is relatively light work compared to fetching water from springs which can be very hard work.

Here looking back to Kisiizi we see how it lies in the head of a valley in the Kigezi highlands.  The hospital is about 5,500 feet above sea level so although near the equator the climate is generally pleasant and not too humid.

Of course, being in hills means we can get a lot of rain but sometimes the clouds themselves are beautiful to behold...

 

typical homestead with corrugated iron roof and mud walls

spot the boy high in the tree...

There are more plantations of trees as economically timber is valuable

Hello again!

 As we return towards Kisiizi we see the hospital laid out before us.  The roundabout is in front of the Chapel which is at the centre of the original building that previously housed a flax factory.  The two storey building seen to the right is the Maternity ward upstairs and Children's ward below.  Behind the old flax building the blue/green roof is the new hydro-electricity generator house.  In the foreground on the right is the isolation and medical ward block  with the new mothers waiting home to the right and the rehabilitation hostel nearest the camera.

Just to the left of the middle of the foreground is a greenish roof - this building used to be a bank but is now housing the Staff Room and the Records and Data department.

As always we are amazed that, as we have often said, if you flew over Kisiizi and blinked you would miss it as geographically its quite small.  But now with the mothers waiting home taking us up to 284 beds and more activity and training going on, Kisiizi is having an ever growing influence near and far.

Catch up...

 Squashing a lot in...

How to fit a large immunisation cool-box in a small hospital Suzuki...

Time to catch up as Ian has been away in Kampala for a week speaking on Ebola/Marburg at the Uganda Maternal & Newborn Hub meeting in Mulago on the Monday; visiting WHO Country Office on Tuesday and then attending the Uganda Medical Association conference in Jinja at the end of the week when he gave a talk on Integrating Patient Safety which was well received.

Back to a busy clinical schedule as Dr. Josephine, our other Paediatric Consultant, is on leave/days off.  Thankfully we have an excellent visiting registrar from N Ireland, Lynne Speirs, who is a great help.  We have just had the national intern change over so now orientating the junior doctors in their new specialties.  Unfortunately due to national financial constraints, we have no new doctors posted here so will be running with six instead of eight interns.  However we are happy to have some visiting doctors from UK, Michaela who is here until December, and Richard & Katie with us until July.  We also have welcomed Nadia, a neonatal nurse from CMS New Zealand for 3 months.

Prior to the Kampala trip Ian had represented the hospital at the regional Independence Day celebrations, the only muzungu (European) in a large crowd, a somewhat amusing scenario as some of the songs were celebrating the departure of the Brits!

Mental Health team from Cheshire & Wirral partnership trust

Hanna remains very busy with her more-than-full-time role in Maternity and also running the Guest House plus providing a lot of hospitality to many visitors.  We enjoy the comings and goings of people from all over Uganda and overseas that enrich our community here.

We had a good AGM of our Kisiizi Health Insurance scheme with about 150 group leaders representing over 36,000 members.

Dr Josephine, Dr Gabriel, Justine, Dr Bruce and Bowers planning HIV programmes

There have been many late into the night meetings to try and organise a budget for our HIV services as these have been re-organised due to the political fall out in Uganda where USAID suddenly dropped its links to our previous funding channel.  In fact it has been a good thing to review the programme and draw up new targets.

Now we have a plastic surgery camp this week working on infants with cleft lips and palates. We have a visiting team of two radiographers from Chester for a fortnight and we have a biomedical engineering technician conference here on Saturday. The following week we will have our Board of Governors meeting and then a paediatric team from Bwindi Hospital will visit at the beginning of December.
The list goes on... a bit like homework!

Special deliveries...

Well, we have certainly noticed the 9-months post-Christmas holidays impact on birth rate with a big surge in deliveries meaning Hanna has been working really hard.  By 27^th September there had already been 220 births in the month!  As we are still short of senior experienced midwives, and as our percentage of abnormal deliveries is  high because many normal deliveries still take place at home, it is quite demanding.   

In addition the intern doctors rotate every 3 months and need induction and support to settle in.  We are grateful to Dr. Helen Allott from Royal Berkshire Hospital who has made many visits to Kisiizi and has just been here for 6 weeks.  She ran a series of training sessions for the intern doctors on emergency obstetrics.

Special Care Baby Unit continues to care for a range of neonatal problems including small preterm babies.  The photo above shows one of our nurses inserting a cannula to give intravenous fluids for a small premature baby in an incubator. What makes the photo even more special is that the nurse was delivered by Ian when we were first in Kisiizi in the late 80's!

We never know what we will see next.  The photos show a baby born with hyper-extended legs due to mother having oligohydramnios (reduced water around the baby) in pregnancy.   

The baby was treated with plaster of paris casts and physio and made excellent progress.

Renovation

It’s good to see things improved around the compound whether it be fences and paths or vehicles and buildings. It had been embarrassing to see some patients in pain being transported to the wards on trolleys which were shaking due to the rough gravel driveway causing more discomfort so it is encouraging to see the new path from Out-Patients to the ward area now available.  We plan to further extend it to the surgical ward to enable transfer of theatre patients to be smooth and comfortable as well.  We are grateful to friends at Mortimer Church in Reading for sponsoring the path.

 Some of our vehicles are quite old now and the roads here do shake them up a lot so it has been good to see the mechanics working on renovation of the old landrover.  They were so enthusiastic with the spray painting that they have now gone on to also paint hospital lockers!

On the building renovation side we are really grateful to the churches and individuals who supported the work on the old flax factory that houses our surgical wards.   

The first half is open with female patients, mostly those needing gynaecology operations.   

We hope to raise support to continue this work to the other side of the building which houses the male surgical ward and the extension with the female general-surgery patients.

 

Rev. Patrick sorting out the new Chaplain's office

The Chaplains have just moved to a new office that is much nearer to the Chapel and the wards so will be more convenient for the services – especially in the rainy season!  The room is more spacious and a good place for counseling and praying with patients and relatives.  It will be well used in the next few weeks as we prepare for the Hospital Mission on the weekend of 17-19^th October which has the theme “Free Indeed” (which also happens to have been the title used for the magazine produced by the Christian Union at Ian’s medical school, the Royal Free Hospital in London).

Locally grown papyrus reeds are used to make fences.  Papyrus swamps are a common feature in the region though as the population grows very fast more and more swamps are being drained and used for agriculture.  The valley above Kisiizi is being increasingly cultivated with the result that the flow of water along the river and over our waterfall is significantly less than in the past which poses challenges to our hydro-electricity generation in the dry season.

Thes is it!

We are very proud of our son Mark who kept up the momentum with his PhD thesis and was able to hand it in recently... it represents a huge amount of work and is way beyond our understanding! 

He will now complete his post-doc research post at the end of September and start a new job teaching undergraduate chemistry students.

Visit to Mbarara...

Children at a road-side stall

We escaped for a weekend to Mbarara, a city 80 miles away.  We drove a hospital land-cruiser and it proved to be the best journey ever to Mbarara – the murram road (gravel that has been graded) to Rubaale was quite reasonable without significant potholes and took only about 50 minutes.  We then joined the main Kabale – Mbarara tarmac road which is now being upgraded properly and is completed past Ntungamo as far as Itojo government hospital.  It is being actively worked on from there to Mbarara which has always been the worst section of road … someone had even attempted to partly fill the very big potholes.  The road is still challenging as it has eroded and crumbled away on either side but is much better now the holes are easier to negotiate.  

 

 Ian then had a meeting with the team from Rimpscom, an IT company with whom he is working on Stre@mline, a database programme he had developed in Macclesfield (which is still used every day in the paediatric department there).  The hope is to adapt it to work in Kisiizi and to start with a pilot in Out-Patients.

 

Esther demonstrating grinding technique

We then enjoyed meeting up with Esther Kobusingye, our friend who had previously served many years in Kisiizi as Principal Nursing Officer.  On Saturday we went out with her to a new Culture Museum and Centre which was interesting and Esther was pleased to find details of her own family and tribal group ancestry.

 

We then went and visited Reverend and Mrs Katombozi who had also served in Kisiizi in the past.  It was good to be together again.

Rev. Zabuloni Katombozi, Ian, Mrs. Katombozi, Sister Esther Kobusingye

On Sunday we attended the morning service at St. Luke’s Chapel in Mbarara University with a large number of enthusiastic medical students and healthcare workers before going on to meet up with Amos and Mabel Twinamasiko who had also served in Kisiizi when we were first there – in fact Amos was Medical Superintendent when we first arrived in 1987.  We then went on for a short visit to Esther's home out in the rural area south-east from Mbarara and we drove on down to the border with Tanzania then turned westwards for home.

As we look back all those years we are grateful for the friends we made along the way and for blessing us with the chance to meet up again now.