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

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...

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