Window on Kisiizi

Window on Kisiizi

Sunday, 14 April 2013

What's on at the Theatre?

Our new operating theatres were opened in 2012 and a wide range of surgery takes place.  This includes periodic camps with visiting specialists.  We recently hosted Dr. Keith Waddell with a team from Ruharo Eye Centre in Mbarara who worked with our Ophthalmology Assistant Benon and operated on around 35 patients in 3 days, many having their sight restored after cataracts.  We had Keith for a meal and it brought back many memories as we found his name in our visitors book from 25 years earlier when he had come on a similar "Eye Safari".
Dr. Deo


Dr. Deo from Mbarara came with a team linked to North Kigezi Diocese to run an Orthopaedic Camp. 


Many children benefited from surgery and our Paediatric Ward was even fuller than usual with the post-operative cases.  As they improved they moved up to the Rehabilitation Unit where many are still staying in the dormitories as they are supported to mobilise with physiotherapy. 


Our Orthopaedic Officer Bedard, Phyiotherapist Night and Occupational Therapist Alozius have had a busy Easter!

post-op child with small bottles covering the ends of pins


Other specialists include colleagues from Royal Berkshire Hospital working with Dr. Gabriel on Urological cases.  These visits are a great help to Kisiizi and are allowing us to develop our in-house expertise to the extent that Dr. Gabriel received a referral from Mulago Hospital, the main government teaching hospital in Kampala about 7-8 hours drive away!



Of course one key aspect of successful surgery is good Anaesthesia.  We are grateful to Gershom, Medius and Andrew, our Anaesthetic clinical officers who have provided our 24 hour service.  We have just said goodbye to a recently retired Consultant Anaesthetist, Dr. Angela Cooper, who came as a volunteer with Church Mission Society for six months to help us.  She has provided valuable input into various areas including Pain Relief and given us helpful advice on High Dependency Care as well as her support in the Anaesthetics team.  She has kindly agreed to help us acquire some much-needed equipment for general anaesthesia as our current equipment is decades old and, though it has served us remarkably well, is showing its age!  We do not have, nor do we intend to acquire, piped gases as would be used in western hospitals so traditional Boyles' Anaesthetics Machines are not practical here and we use more basic but effective draw-over equipment.
Dr. Anglea cutting her Goodbye and Thank-you cake
Dr. Angela is hoping we can obtain two portable Glostavent DPAO1machines which cost 2,750 pounds sterling each.  If anyone is able to help towards this cost we would be most  grateful - please contact Ian on khmedsup@gmail.com.

Dr. Robert
Looking ahead we will welcome Dr. Robert back in a couple of months when he will have completed his 3 year training as a specialist General Surgeon.  He has been generously sponsored by our friends at St. Paul's Church in Dublin who also provided the funds for the new operating theatres and previously for the two storey ward block housing Maternity and Paediatrics so we are extremely grateful for their invaluable support.

Michael & Melissa Webb kindly hosted us during our visit to St. Paul's Church in Dublin in January 2013 and have worked tirelessly to support Kisiizi

We are in the process of renovating our very old building that houses our Surgery Ward.  It was actually the centre of the original flax factory which was taken over as Kisiizi Hospital in 1958.  We are grateful for supporters in St. Mark's Church and Putnoe Heights Methodist Church in Bedford who have contributed towards this cost.  We are hopeful that this will allow us to renovate the first ward area [what used to be the old maternity ward in the past] with proper terrazo floors that we will be able to clean properly rather than the current very poor cracked concrete floors that are impossible to clean adequately.  Any support towards the much-needed renovation of the second ward area will be very gratefully received.  Thank you.

So all these strands are coming together as we aim to further improve the quality of our surgical services.  Following the successful seminars we ran recently for World Health Organisation, Kisiizi has been asked to participate in a further 4 year WHO programme on Safe Surgery.  We are waiting to hear if we have been formally approved for this by Uganda Ministry of Health but hope that Dr. Gabriel may be able to attend a meeting in Geneva next month to launch the programme which is being run by WHO in co-operation with John Hopkins university in USA.

Overview



For those of you in the UK or Ireland, do try and come to

FRIENDS OF KISIIZI DAY

SATURDAY 5TH OCTOBER 2013

 10am - 5pm

at Greyfriars Church, Reading [very close to Reading Station].

Booking not required. Bring a packed lunch.

We hope that it will be possible for Dr. Gabriel Okumu, Consultant Surgeon and Deputy Medical Superintendent, to attend

Challenging IT!

 When we first worked in Kisiizi in 1987 there was absolutely no communication available with the outside world other than walking or, if the mud roads allowed it, driving some hours, then queuing in a post office to try and make a phone call... now we have IT... and it can be amazing, for example I can sit here in my office in Kisiizi, download this article and people all over the globe can be reading it in the next hour... [welcome by the way to those in Russia, Romania, Ukraine and China who are reading the blog apparently according to the statistics...] 

but we do face challenges, not least the erratic internet connection.  The most common excuse from the company providing our connection is that the cable carrying the link has been cut by roadworks on the main road to Kampala...  This can be a real problem as increasingly important messages come via email such as information about meetings that we should send representatives to, so may cause issues if we fail to receive them.

Then sometimes the hardware can have its limitations - we thought you might enjoy the following email we sent to friends last year from a challenging laptop:

========

greetings.... not easy to compose message as laptop missing 3 letters!
you can guess by a process o  elimination t e problem ones!

Still, really grate ul 4 t e recovery disc you sent, muc
appreciated!  Glad to recover some documents so merci beaucoup 4
sorting it!

Dis is one ov de most ridiculous emails I ave ever sent!  but ope you
can decip er it!!!

love +++

Ian and you kno....!

=========
Students in Kisiizi Hospital School of Nursing using IT

Thursday, 28 March 2013

Tragedy strikes...

We are very sad to report the unexpected sudden illness and death of our Nurse Tutor Goretti this week who suffered a catastrophic blood clot to her lungs.  She was a gentle and much-loved member of the Kisiizi community and leaves a huge gap.  She will be greatly missed by Staff and Students.

We are comforted to know that she herself knew the reality of the hope of the Easter message.

Child Health Newsletter article

for those interested, I have written an article for the International Child Health Group newsletter which is available to view by clicking on the link:

International Child Health Group Winter 2013 Newsletter

Sunday, 17 March 2013

Re-creation

Amidst periods of intense activity where the on-call rota seems interminable and the list of "urgent to-do"  items expands rather than contracts and yet another email arrives asking why we haven't replied to their previous one, we have occasional oases of re-creation.

And Kisiizi and the region is a wonderful place to enjoy when we open our eyes and just pause to take it all in... from the astronomical, with the amazing stars at night, to the minute with insects on the dusty path in front of us.
 






Then, of course, there are the birds, amazing in their variety and beauty both at rest and in their aerobatic contortions that leave us breathless....

Ross' turaco in our garden

One of our favourite species is Ross' turaco - we have a pair that are often heard and seen in our garden.  They eat guavas and sit in the jacaranda tree and are stunning  when they fly and reveal the colour of their wings...















We had a wonderful break away at Lake Bunyonyi with visitors Dwight and Sandy Mcleod who were with us for three weeks.  Dwight is a physician and Sandy a health visitor and they are praying about their future and whether they are to serve in Africa longer term...
whilst on Bushara Island we were thrilled to unexpectedly bump into Chris and Polly Barton who have had an amazing ministry setting up dental services in our area and in Rwanda and Burundi.  We hadn't seen them in years so enjoyed a meal together and a chat around a blazing fire catching up...
 
Polly & Chris, Dwight & Sandy, Hanna & Ian
As well as the usual amazing mix of birds, butterflies and otters, we were amazed to see a "linear sunset" where the colour of the sky was divided as if a shadow was present in front of a projector... 
... and then we realised that it  must have been the setting sun's rays blocked by the massive volcano Muhavura not too far away on the border between Uganda and Rwanda...



so we thank God for the beauty of the world around us... and the people He sends our way... including those who inspire us:

The remarkable Joan Hall with Alice from Rukungiri
one such is Joan Hall, a remarkable lady who has given her life in missionary service to Uganda and is much loved by many.  We visited her in her new home in Kabale and then she came to visit Kisiizi a few days later so it was good to catch up with her and friends....
Another inspiration has been this young boy on our ward who has been in traction for a few weeks but remains full of fun exhibiting great patience.  He had fractured his right femur but here demonstrates that he has no problem at all  with  mobility of his left leg!  He doesn't need much to make him laugh and when he does it is infectious!  Good to have at least one positive transmission on the ward....

African Partnerships

We were delighted to welcome four colleagues from Zambia to join us for our African Partnerships for Patient Safety conference we ran here last week on behalf of World Health Organisation.

They arrived in Kisiizi on Sunday having flown to Entebbe via Nairobi.  Ndola is a large teritary hospital with a medical school in a large town so it was quite a contrast coming to Kisiizi but they fitted in extremely well and enjoyed their time with us.

They all made valuable contributions to the conference and we learnt much from one another.

They returned ready to implement some changes and progressions especially relating to the use of the Safe Surgery Checklist.


We do hope to meet up again at some time in the future...

================




The Conference included  presentations, role-plays and the use of videos we had made in Kisiizi that were well received.
role play by Kisiiz theatre staff of use of surgical checklist

Practical demonstrations of the manufacture of alcohol based hand rub and assessment of the effectiveness of handwashing technique using ultra-violet light techniques were appreciated by the 30 or so delegates who came from the hospitals and larger health centres in our neighbouring region.


A range of presentations were shared on topics including Healthcare Associated Infection reduction, Safe Prescribing, Waste Management, Surgical Checklist, How to Teach etc.
Alia and Sr. Moreen


Alia Fry, our US Peace Corps volunteer; Sister Moreen Ahimbisiibwe, our Infection Control Sister; Dr. Gabriel Okumu, our Consultant Surgeon, and Ian gave the main presentations supported by Sr Jovita and our trainee pharmacy technician, Sandra who demonstrated the  production of hand rub.




We broke the group into three parties to tour the relevant parts of Kisiizi which they appreciated.


 The evaluations have all been encouraging, now we all need a rest, then work on putting into practice all that was shared.  We pray it will make a real difference to the safety and quality of care patients receive across the area... and even in Zambia!









Sunday, 10 March 2013

look on the bright side...

we are sometimes inspired by our patients who show extraordinary fortitude...

this little boy has epilepsy and it had not been well controlled in the community.  He had a fit and fell into a fire and was badly burnt on his face.

He ended up in Kisiizi and was stabilised on anti-convulsant treatment and had dressings to his burns followed by skin grafts....







Through it all he kept his sense of humour, laughing very loudly if Ian played peep-bo around one of the pillars on the ward and always maintaining his sense of humour.




Training

We hold weekly audits reviewing the work of our Surgery, Obstetrics & Gynaecology,  General Medicine and Paediatrics Departments.

Maternity Department Audit Presentation
We are pleased that recently the National Intern Committee approved us moving up to two interns in each specialty in which we have Specialists: Surgery, Obstetrics & Gynaecology and Paediatrics.

We are also pleased to have Drs Simon and Samantha Hardman with us for a few months, Simon working in Paediatrics and Sam in Medicine.

As part of the induction process for our new interns they have helped us run some training scenarios:
Intern Doctors Patrick, Gotharido, Francis and Bruce as practical scenario



Intern doctor Henry with registrars Dr. Simon and Sam Hardman, visiting medical student Simon and Medical Officer Dr. Albert

Sunday, 3 March 2013

World Health Organisation links


Kisiizi Hospital is one of 3 English-speaking hospitals linked to the WHO African Partnerships for Patient Safety programme  [APPS].

 The Kisiizi link was recently highlighted on the WHO main international website including a photo of our previous Principal Nursing Officer Sister Esther Kobusingye:http://www.who.int/features/2013/uganda_patient_safety/en/index.html
Dr. Gabriel Okumu lecturing
Dr. Gabriel Okumu, Consultant Surgeon, lecturing
We ran a APPS Sensitisation Day here on 12th February attended by Medical Superintendents and Principal Nursing Officers from hospitals in our two local districts and the in-charges of the major health centres. It proved very successful and will be followed up by a two-day training seminar on 12th and 13th March which we hope will be attended by a small group from Zambia sponsored by WHO to come to Kisiizi.

Tuesday, 26 February 2013

Globetrotting



We stayed in Kisiizi for our Staff Christmas Party on 23rd December - a significant event with around 1,500 people getting a hot meal and entertainment!  As we have around 350 Staff and Porters, the numbers are quite high when their families come - and amazingly the food was on-time, hot and very tasty!

The entertainment included not only the expected songs and musical items but also a demonstration by the staff Keep Fit group which made most of us breathless just watching!  

Hanna ran a Dutch game which caused major bouts of hysterical laughter as people tried to jump up and catch little cakes hanging from strings - but not being allowed to use their hands....  We also said goodbye to two members of Staff who were retiring, both after 16 years of service to Kisiizi.  One was a member of the portering team, the other our Primary School Headmaster who stands down but will work one more year as a teacher before fully retiring.  Ian gave a powerpoint presentation with various highlights from 2012.  The MC, one of our teachers, did a good job of continuity even though acts were not always quite ready when their slot on the programme arrived... but a good time was had by all and everyone left in good spirits and reminded about what Christmas is all about...

We then had to finalise packing, last-minute jobs in the office etc ready to leave the next morning at 8am in a hospital vehicle to Mbarara, 80 miles away, which took about 2.5 hours.  We then caught a bus to Kampala which took about 4.5 hours and then a friend collected us to go to Entebbe.  After a nice meal together we went on to the airport to collect the overnight flight to Amsterdam.  Unusually, we both managed to sleep on the plane so must have been pretty tired!

Hanna's dad with Joris
Arrived in around 6am and went to Hanna's sister Leonoor's home, had a nap then to her church for a Christmas service and lunch.  Another nap then the Dutch family gathered for a lovely meal and time together. Short but sweet.  Lovely to see everyone who could make it and to see the children growing up.

Then back to Schipol airport for the short hop to Manchester to enjoy being collected by Mark and Ruth... and so to Macclesfield, and still one day left before Christmas!


Ruth, Ian and Mark
It was lovely to be together with them and to catch up after many months apart.  Also a joy to see other friends and neighbours and to visit our church, TFW, for the Christmas eve and day services.  Amazing how quickly we tuned in to UK again and it all seemed very normal.

In the following month we spent about 75% of our time on  Kisiizi related activities including various talks to different groups and churches in UK and in Dublin where we received a very warm welcome from St. Paul's church who have generously supported the funding of our 2-storey ward block used for maternity and children.  More recently they provided the resources for our new operating theatre suite which is a real step forward, and are also sponsoring the training of our second specialist surgeon, Dr. Robert.

We also included a meeting of some core friends of Kisiizi at the home of Lionel and Mary Mills in Birmingham though not all were able to get there due to the snow and blizzards.  

Time flew by and it was time to head off to Manchester in the early morning [thanks Rhona again!] to fly to Amsterdam, then to Nairobi, then on to Entebbe.  En route met up with friends from University of Chester who have given a lot of support to our School of Nursing so that proved a useful extra meeting.

Arrived safely in Entebbe but our bags didn't!  So ended up with an extra 24 hours there waiting, then the next night picked up 3 out of 4 bags that had come on from Amsterdam where they had sojourned!  The final prodigal was delivered to Kisiizi a few days later!

Managed to get a place on the Postbus at 7am and that took us to Rubaale where Augustine Tusingwire picked us up for the final 18 miles of dirt road to Kisiizi.  And a very warm welcome as we arrived home once again...

Thursday, 13 December 2012

Address...

CONFUSED ADDRESS:

we smiled when we read this address....


STAFF ADDRESS:

Dr. Francis Banya and Dr. Rachel Ion, our maternity hub registrar, together with Dr. Bruce, our obstetric intern, addressed the Staff yesterday for a Maternity teaching session on the management of severe bleeding.  This included a practical demonstration of a balloon device which can be assembled from cheap local materials and may save the lives of mothers with bleeding after delivery.






WHAT A DRESS!

Lovely as ever!






Sunday, 2 December 2012

Work, rest and play...



WORK:
Hanna has been busy on Maternity, and delivered one lady who had had 11 previous pregnancies but only 3 surviving.  They had all been girls, but this time she had a boy who was healthy.  The mum went home very happy.

Other details of Hanna's work are not suitable for a general public audience but represent the aftermath of picking up the pieces where women have been inappropriately cared for in the community prior to coming to Kisiizi.

Hanna, conveniently for others being O Negative blood group, gave blood again recently and probably has the record for duration of a bruise which is still prominent over 2 weeks after the event!


We have had some challenging cases in the Children’s ward recently... as well as 3 children needing chest drains we have had a wide range of patients.   
Child with pneumothorax and right chest drain in situ
We have discharged one girl who had bad burns and has done well, but still have a young boy who has developed tetanus secondary to his burns and is quite unwell.  We have tried to access tetanus immunoglobulin [this is a preparation of body defence protein specifically against the toxins produced in tetanus] but it doesn’t appear to be available in Uganda and we are trying to access it from Nairobi...

Then a one month infant came in with a swollen everted lower eyelid related to infection... happily now responding to treatment.
 
We have had a few cases of dysentery all improving but tragically a little boy who had nephrotic syndrome [kidney problem with big loss of protein in the urine causing body swelling] and who had a background poor nutritional state died yesterday.  I had a day off so wasn’t there but he apparently collapsed having been out to a washroom.  It highlights how limited our resources are as we would have had a much greater insight into his diagnosis and guidance in how to manage him optimally if we had been in UK with all the tests available.  Having said that, we are much better off than many other places in Uganda having ultrasound, basic tests and specialists around.

We have a 9 year old admitted unconscious, it seems this is caused by very high blood pressure in turn due to kidney problems.... not very common fortunately.  I was pleased to hear today she has started eating and communicating.


Then we had a baby who had come in to the hospital at the age of two weeks with infection of the tibia [bone in the lower leg] sufficiently serious to expose the bone.  A couple of weeks later he had developed very unusual swellings of the ends of his collar bones [as shown in the photo] where they join the breast bone.  These were quite prominent and symmetrical.  I had never come across this before but one of our visitors from Chester told us she had seen it in older children at Alder Hey hospital in Liverpool.  It is due to an overgrowth  called hyperostosis.  A quick look at the literature has not turned up any cases younger than 3 years with this condition [Sapho syndrome] so we might write up the case...

REST AND PLAY
so at last due for some days off...

but had to go in the first day as the Primary School had arranged an end of year concert and I had to give a speech... 


then it turned out one of our medical officers had also arranged another meeting for in-charges of health centres that we are responsible for in our health sub-district so, yes you guessed, another speech... [fortunately I managed to avoid mixing up the speeches!]...



 ...then in the evening after having a couple of people for a meal we had a surprise birthday party here for Peter, one of our two Australian medical students who have been with us for about six weeks.  

 The guest house had produced a good cake and someone brought roasted g-nuts [ = ground nuts, the local name for peanuts which we more usually eat as g-nut sauce...] and Gloria Banya, aged 1, was of course present to share in the fun...
 




But yesterday was a proper day off, and we needed it.  Good to unwind a bit and Kisiizi is a beautiful place to do this.

  
 The sun was out, the sunbirds were out, the spray from the waterfall picked up by shafts of sunlight through the trees,





the hospital cows chewing the cud contentedly

[they provide milk for malnourished children on the ward and for Staff] 





 
and Hanna enjoying a break on the verandah. 
 










I had a short game of badminton and paid the price in the evening with stiff muscles not used often enough.
Last night we had a very enjoyable meal with Dr. Gabriel and his wife Sister Maureen and their 3 children, followed by a look at the night sky through a telescope... the moons of Jupiter were like tiny pinpricks next to the planet, the Seven Sisters beautifully clustered, and the almost full moon breathtaking.  Today Herbert, one of our electricians, spoke in chapel for advent Sunday and, having been sidetracked to see review the child with tetanus, we had a number of friends for coffee...  and later an enjoyable lunch with another group... so we thank God for the variety that is Kisiizi.

staff walking down towards chapel