Meetings...

Stre@mline IT programme under development in Kisiizi

It's been a busy diary time... Ian went up to Kampala on 9th November after the Management meeting we hold every Monday in Kisiizi to discuss and pray over the agenda for the weeks ahead. All went well until entering Kampala and getting stuck in traffic so that last part of the journey was painfully slow.  But we had met up with Samuel Mugisha who is working with Ian on the Stre@mline IT programme so plenty to discuss.  Samuel heads up Rimpscom, a software development company in Mbarara. 
We ended up working late on our presentation for the next day when we had a viva / interview at the Uganda National Council for Science & Technology relating to our application for a National Science, Technology and Innovation Project grant. This was the third stage in the selection process and there had been a lot of competition so we were very happy that the panel were very positive about the programme and are offering us support.  Details of the finances to be finalised and they will help us with Intellectual Property rights.  We want to get these to stop some other body pinching the ideas and patenting them as they may then offer the programme to potential users at high price whereas our goal is to make it available at a low price affordable by places like Kisiizi so that as many patients as possible benefit.

The next day Ian went to Mulago National Referral Hospital for the National Intern Committee.  Kisiizi takes 8 interns, 2 in each specialty of Medicine, Surgery, Obstetrics & Gynaecology and Paediatrics.  We have a good reputation with the committee and they want us to expand the number of training posts in future to include nurses and maybe pharmacists.

Then back to Kisiizi arriving about 9pm as the landcruiser developed a mild oil leak from the rear axle near the end of the trip so we had to proceed slowly.

Next day Thursday 12th we had an unexpected group from the Ministry of Health arrive.  They had been scheduled to come two days earlier but did not materialise and we had not been informed of the change so a lot of re-organisation to sort things out.  Their remit was to audit the medicines received from the Global Fund programmes for malaria, TB and HIV treatment.  It went well but meant that Ian had to sit up late in the evening to finalise documents and presentations for the Board of Governors meeting the next day. 

Meanwhile he was also on-call and sadly had an emergency in Accident and Emergency where a 4 month infant was brought in moribund and died shortly afterwards.  The tragedy was the family delayed coming as they had attended traditional healers who had done a procedure called "Ebiino" where an unerrupted tooth is extracted from the gum as there is a myth that this is the cause of gastroenteritis.  The infants haemoglobin anaemia test was only 2.7, normally it should be 10 or above.  The blood count was very abnormal and the child was shocked and did not respond to resuscitation even though we intubated and ventilated with oxygen and gave dextrose, adrenaline etc via an intra-osseus line.  We are reporting the details to the government District Health Officer to follow up and we will try and do more health promotion to stop this happening.

Members of the Board of Governors

The Board meeting went well including the presentation of the external audited accounts. The 5 year strategic plan is underway and Ian gave a progress report called "Pressing on..."
The Constitution and Terms & Conditions of Service have been extensively updated and confirmed.

The next day we held the AGM of the Kisiizi Hospital Health Insurance scheme and this also is going well with a financial break even and growing numbers.

Group leaders of some of the 200 community insurance groups

We also said goodbye to a team from Countess of Chester hospital led by Sarah Hoyle and Sam Walker who came to support the patient safety work following successful application to THET for a further grant to expand the programmes.

Dr Josephine, Paul & Kate, Sarah, Sam Ian & Hanna, Moses Mugume and George Wadsworth

Spectacular!

A spectacular sight as a Ross' turaco swoops in and the sun shines through its wings...

it's only taken about 3 years to get this photo! 

A World of Difference...

WE LIVE IN A WORLD OF DIFFERENCE...

While many countries struggle with obesity and health problems resulting from being overweight, we tragically are still seeing children arrive with severe malnutrition.  Sometimes this may be secondary to some other disease such as Tuberculosis or HIV or just to recurrent infections such as gastro-enteritis or worms, but the vast majority are due to poverty.  Some of the saddest cases are those whose protein levels have dropped so low that they have developed oedema, swelling of the body due to fluid moving from the circulation into the tissues.  If untreated the skin will start to break down and ulcerate. 

The photograph on the left shows swelling of the feet due to severe malnutrition

  

 I had another patient last week who came to us with horrific ulcers around the mouth and the skin was peeling off making an already very weak and vulnerable child wide open to infections.  I cannot publish pictures of that child on the blog as they are too gross and upsetting.

 The child died after a couple of days, she had just come far too late for treatment to work.  Heartbreaking in a world where we can unravel the human genome, perform extraordinary transplant surgery and manipulate microscopic cells....

WE CAN MAKE A WORLD OF DIFFERENCE...

 The weight chart is for the child in the sequence above and shows how much weight the child lost as she improved and the excessive fluid in her tissues was lost.  Of course she then started to put on weight as her proper growth started to recover.

 We are so grateful to many members of our Staff and to our visiting paediatric registrar Dr. Sunil who have helped to recently upgrade and develop our malnutrition programme.  This includes the production in Kisiizi of "KisiiziNut" based on peanut to a World Health Organization recipe.  This is a "Ready to Use Therapeutic Feed" which has the great advantage over milk-based approaches that it can be stored in the village setting without needing a fridge.

 

 

 

The programme also includes setting up a demonstration garden to help families see how they can improve the diet of the children when they return home.  There is also a new chicken house to provide eggs for the children on the ward.

Chicken house

enjoying KisiiziNut

We hope to expand the programme and start screening children in the community and provide KisiiziNut to the borderline cases in the hope it will prevent them needing to be admitted.  Clearly prevention is far better than cure so we are trying to increase health promotion including family planning so the number of children to feed is reduced and education about practical and affordable ways of improving childhood nutrition.  In addition we continue to have our Goat Project which supports very poor families by providing them with a pregnant goat.  Once the goat delivers, usually two kids, one is returned to the project and the family keep the other and the second kid.  This gives them a chance for a fresh start and helps break the relentless cycle of poverty that otherwise traps them.

Kisiizi operates as a not-for-profit hospital.  One of our themes is "care for the vulnerable".  If anyone reading this blog would like to make a donation to help Kisiizi make a world of difference to some of these vulnerable patients we would be extremely grateful.  Please see our hospital website page with details of how you may do this.... click on the link below.

Kisiizi Hospital website - support page 

THANKYOU!

 

 

 

During and after treatment...

Crash out time...

Yes, in all the mix of things, we did have time for a break as we went on a last-minute package trip to Crete with Mark and Ruth... we have to confess we didn't see a great deal of the island as we were all just ready to crash out so much time was spent by or in the pool... it was lovely to have a breather and the weather was perfect, food good and we had many laughs as we did rounds of crazy golf, played a Dutch card game the kids enjoyed when much younger, and tried, not very successfully, to get photos of Ruth before she covered her face with her hands!

 

 

side view... well it was crazy golf!

"What do you mean, watch your steeeeeeeeeeeeeepppp??!!"

All Nations

time for a trip down memory lane... having been in Macclesfield for a few days juggling appointments for ourselves at the dentist/optician/GP etc and for the car for MOT etc plus helping sort out final drafts for the application to THET for a grant for Kisiizi, it was time to head to London to help Ruth move from one location to another.  She has a room in a house about 25 minutes walk from the school in Islington where she works as a Primary School Teacher.  In addition to this she has also been working on her Masters' Thesis with Homerton College, Cambridge and we have shared in this joyful process by reading proofs etc rather than wasting our time on secondary activities like sleeping!  But its pretty well ready to hand in as we write this and its looking to be an interesting and engaging thesis.

so, after the move, we headed up the A10 to retrace our historical footsteps as we attended a CMS conference held at All Nations where we had studied decades ago just before we were married.

It was a good few days of interaction with some inspiring people and some good sessions, not least the masterful session led by Martin Goldsmith who remains as stimulating and provactive as ever!

We enjoyed a walk in the countryside and will take back photos of the fields to amaze friends in Kisiizi!

Then on to stay with Jonathan Jones and his family... his daughter Georgie came for a couple of months in her Gap Year and Jonathan, an orthopaedic surgeon, came for the first couple of weeks and left with a desire to help us develop orthopaedic services in Kisiizi... so we really enjoyed meeting the rest of the family and, as a wonderful bonus, Peter and Rebecca Winfrey with daughter Lizzy also came up to see us so a good time of catch up was enjoyed by all.

We do thank God for the amazing family of Kisiizi that extends to many parts of the world and allows Kisiizi to continue its extraordinary ministries...

a trip to the Netherlands...

We spent a week in Holland based at the home of Leonoor, one of Hanna's sisters.  The main reason for our journey was that, following the death of Hanna's dad, the siblings needed to sort through the house ready for it to go on the market. 

We were pleased to meet up with all the family including our nephew Justin and family back from Turkey and, of course, to be impressed at how the children are all growing and developing!

Noor and Hanna in the wind!

We had a trip to the Dutch seaside which was quite windy but pleasant.

We visited a charity that recycles medical equipment run by about 80 keen volunteers and this will be a useful resource for Kisiizi in the future we think...

Fine regalia!

We were delighted to be basking in reflected glory as we attended Mark's PhD graduation ceremony at the University of Reading.  We were blessed with a lovely sunny afternoon and Mark looked very distinguished in his historical garments and seemed a natural in the role! 

We also enjoyed meeting some of his colleagues and supervisors and then we went out with Mark and Ruth and their respective friends Sammie and Jacob for a lovely celebration meal together.

Time travel!

There MUST be a time warp somewhere on the way back from Kisiizi to Europe as time seems to have rushed by in a whirlwind... and so much has happened so apologies to those regular readers of this blog who thought we had hibernated!  Fortunately we didn't forget to remember our 30th Wedding Anniversary!

As soon as we arrived back in UK Ian was off to London to the Royal Society of Medicine / Royal College of Paediatrics & Child Health conference on international child health.  Ian had in the past shared an office with the professor who introduced the conference so it was good to catch up and also to chat with Peter Nash who has co-ordinated the RCPCH Global Links programme that has sent Kisiizi a number of excellent registrars in the past couple of years.  Unfortunately the DfiD grant via THET (Tropical Health & Education Trust) which has allowed RCPCH to run the scheme is being discontinued which is a great shame as the programme has proved very successful with both registrars and Kisiizi.  Peter Nash had visited Kisiizi only a few months ago and remains very positive about our work so will endorse future paediatric trainees who come to Kisiizi even if there is no college funding.
At the end of the conference Ian met with a colleague from the London School of Hygiene &Tropical Medicine as they are proposing to send a group of doctors participating in the Diploma of Tropical Medicine & Hygiene to Kisiizi for a week of practical work.

A couple of days later we were back down to London to attend the Friends of Kagando day as we would like to strengthen Kisiizi's links with other church hospitals, something we had done 25 years or so ago when first in Kisiizi and which proved mutually beneficial.

Then on to the annual Christian Medical Fellowship Developing Health course which runs for two weeks and is a brilliant mix covering all the medical specialties for those wishing to work in resource-poor countries.  We are "hosts" so try to look after the participants (we had about 79 in total of whom 39 were there for the full two weeks).  Ian co-ordinates the Paediatrics Day and is one of the course directors.  As always we met inspiring people both participants and lecturers.  The course included much practical work varying from plaster of paris applications to breech deliveries to spinal anaesthesia to dental extractions from pigs' heads!
(see http://www.cmf.org.uk/international/developinghealth/developing-health/)

During the course Ian went into London to meet Anna Bishop of All Souls Church, Langham Place, who have kindly helped Kisiizi with support towards renovating an old clinic building to be a Maternal & Child Health clinic.  Kisiizi's links with All Souls actually go back to the founding of the hospital as the first doctor, John Sharp, and his wife Doreen had lived in the flat in the All Souls Rectory above John Stott who later visited them in Kisiizi!

Just for added interest this year we also had the spectacle of Venus and Jupiter being close together in the evening sky and could see their relative positions move daily.

Following the Developing Health course we went down to Battle to see the Carers & Sharers group who have faithfully supported Kisiizi for decades.  We enjoyed tea at the garden party and gave a talk about the work in Kisiizi which generated quite a few questions and a good discussion.

One unexpected result was that for the first time we came across a PORTABLE oxygen concentrator.  We do, of course, have quite a few standard concentrators in Kisiizi as our main oxygen sources but didn't realise that they are now available in a portable format which is very attractive for us as it offers the chance to move oxygen-dependent patients to x-ray or to the wards after surgery etc as the devices work on batteries.  They also have a connector to a vehicle socket so offer the potential to transport patients to other units which we rarely have to do but when it does occur it is usually with very sick cases who need oxygen and until now we had to rely on cylinders which all too quickly run out.

Subsequently we visited medical equipment charities in Holland and UK and have been able to access with the help of the Battle group a compact device that will help us achieve the above goals.

FRIENDS OF KISIIZI DAY 2015 CONFIRMED

UK FRIENDS OF KISIIZI DAY 2015
This year's UK Friends Day will be on
Saturday 19th September, 2015
at Brookside Church, Brookside Close, Gipsy Lane, Earley, Reading RG67HG
PLEASE NOTE THE VENUE HAS CHANGED!

Car park available at the venue.  Arrive for coffee from 9.45am, meeting starts at around 10.30am.  Bring a packed lunch, we will provide tea, coffee etc.  The meeting will end at around 4.30-5pm.  Booking is not required.  Unfortunately we cannot provide childcare.



The programme will include feedback from Kisiizi and some special interest groups.  We expect to have some visitors from Kisiizi including Sr. Agness, our Patient Safety Nurse; Joseph, our Biomedical Technician and Francis, the new In-Charge of our Laboratory. Others may also be present and we will post details as they are confirmed.

The day will be a great opportunity to update about the varied ministries of Kisiizi, to pray for the on-going work and to network with other Friends of Kisiizi many of whom have worked in Kisiizi or visited in the past.
If you need collecting from the station we may be able to help. Contact Jocelyn or Philip Haynes on 07503029820 or 07947053111
 

Time flies!

Our son Mark has just been out to visit us, his first trip to Kisiizi for 10 years!  Yet so many people remembered him (though wouldn’t necessarily have recognized him!) and it brought back a lot of memories.It was a real treat to have him with us in Kisiizi...

Mark completed his PhD just before Christmas and is now teaching undergraduates chemistry in the University of Reading.  He could only come for a short time but we were able to pack a great deal in and really enjoyed having time with him.   

Straight after Ian had spoken at the Good Friday service and we had had lunch we set off for a 24 hour visit to Ishasha, the closest section of the Queen Elizabeth National Park, and were blessed to see herds of elephants, buffalo and many antelope types as well as a hyena, warthog, baboons etc plus hippos in the river that is the border between Uganda and Democratic Republic of Congo.  

But the highlight was the animals in the trees.  Ishasha is famous for its tree-climbing lions, the only place this occurs other than a location in Tanzania.  We found 3 lions up in a fig tree, mostly quite sleepy but one lioness then woke up and sat up looking fairly fierce!  

 

 Then, as we started driving back towards the park information centre, our ranger spotted a leopard in a tree… this was a real thrill as we have never previously seen a leopard in the wild as they are often nocturnal and quite shy so difficult to find.

No TV for us in Kisiizi but we enjoyed one night of the power cut to look at the stars and planets with a small telescope and followed in Galileo’s footsteps as we gazed at the moons of Jupiter, and then looked at the nebula in Orion… another breath-taking experience.

Finally we went with Mark to Lake Bunyonyi, the lake of the little birds, for 24 hours, and had a swim, watched some of the birds and relaxed together before taking him down to Kigali for his plane home.

Clinical developments and visitors

A&E

Our new Accident and Emergency area is proving valuable as it gives us much better space and facilities for stabilizing very sick patients arriving day and night in Kisiizi.   It did require a bit of structural change to make doorways wide enough for trolleys to use.

 For example Ian was called to an unconscious 4 year old who had been hit by a boda-boda (motor-bike) and knocked down.  She needed a collar to stabilize her neck and medication to reduce brain swelling.  She had a fit needing anti-convulsants.  Her mother arrived and promptly collapsed on the floor due to her distress as she thought her daughter would never recover.   

However, thankfully, the child was transferred safely to children’s ward on a trolley, using the new paths that connect the A&E/Out-Patient building to the wards.  The next day she was sitting up and eating and has now been discharged well much to the delight of staff and family.

 

Laboratory

The laboratory is also upgrading.  We have been able to create a new phlebotomy room so patients no longer need to come into the lab itself for blood tests.  We have put in new hatches for samples and new benches and we are re-configuring the layout of test equipment to make space for the new analysers that have been installed.  Our new In-Charge, Francis Orishaba, is settling in very well and demonstrating much initiative and enthusiasm so our lab services are definitely going up a gear (or two!)

new CD4 machine to monitor HIV patients

Clinical Staff training session with visiting colleagues

With this support plus input from Dr. Charlie Martin-Bates, a recently retired GP from Reading, we have been updating our Diabetic Clinic arrangements and hope to run a much more comprehensive service.  This is appropriate as the incidence of diabetes continues to rise and has hitherto been poorly provided for so many patients have developed complications that might have been avoided.

Dr. Ian Kemp also came and has worked with our surgeons Dr. Gabriel and Dr. Robert to develop our upper-gastro-intestinal endoscopy service.  This is also very opportune as we have a high incidence of stomach cancer in our community and diagnosing it earlier may avoid much suffering.

We also enjoyed a fortnight’s visit from Jonathan Jones an Orthopaedic Surgeon from Stamford who kindly brought out some very useful equipment and hopes to support the development of orthopaedic services here.  This tied in very well with a further team from Dublin.  As well as physiotherapists we were pleased to have an Occupational Therapist and, for the first time in Kisiizi, three dietitians who looked at our malnutrition programme for children and the work on improving diabetic control.

Dublin team running an Audit session

Currently we have a 6 day visit from Dr. Jim Hansen, with his wife Suzanne from USA.  They visit Kiwoko Hospital once or twice a year and kindly agreed to come down to Kisiizi to help as Jim is an Adult Cardiologist.  So we have run a Cardiac Clinic and been able to get an opinion and echocardiogram on many patients which has been valuable. 

So we are really grateful for all the support and encouragement and practical help our visitors bring with them