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.

Sleep well...

As we upgrade our Surgical services with the new operating theatres opened some months ago thanks to support from St. Paul's Church in Dublin, we have recognised the importance of the Anaesthetics service. 

We are grateful to Dr. Neil Fergusson, Consultant from Chester who joined us for a fortnight, and to Dr. Angela Cooper, Consultant from Peterborough who worked with us for six months via Church Mission Society. 

We currently have an anaesthetic registrar from New Zealand, Mark Fisher, with us for 2 months.  All have helped our own team develop skills.

We are delighted to have installed two new anaesthetic vapourisers, one donated by Dr. Angela Cooper and the other by the Kessel family who visited Kisiizi recently.  This equipment replaces some very old kit that has served very well over decades but has really reached the point of unreliability.  It is used for halothane administration for general anaesthetics.

These improvements are timely as we welcome our new Consultant Surgeon Dr. Robert Mugarura to Kisiizi following his three year specialist training.  He joins Dr. Gabriel Okumu, our lead Surgeon who will be travelling to UK at the end of September for four weeks.  He will represent Kisiizi at the Friends of Kisiizi Day on Saturday 5th October at Greyfriars Church in Reading.  He will spend 2 weeks at the Royal Berkshire Hospital in Reading and then two weeks at Countess of Chester Hospital.  During this time he will refine his urological skills and learn new Endoscopy skills.  We are grateful that he has been granted a Commonwealth Fellowship to support his trip.

our daughter's first day at school!

what do you mean you didn't think we were that young!

Actually, Ruth has just started as a primary school teacher in Islington, north London, so Tuesday was her "first day at school" teaching class 3S.  It all seems to have gone well ... would love to be a fly on the wall!

Jubilee House opening...

After many years of planning and work, the Jubilee house was finally opened by Alan & Helen Smith of Kisiizi Partners with a prayer of dedication by our Chaplain, Patrick Bagorogo and  Archdeacon David Kahindi, a member of our Board of Governors.

The project had faced many challenges, not least problems with the contractor repeatedly demanding more money yet not completing the work.  In the end, following the advice of our hospital lawyer, we had to break into the building and finish the work ourselves.  Unfortunately we found some of the contractor’s work was of poor quality and we had to relay some floors and redo some work which was frustrating and, of course, costly.  However, we did avoid the potentially crippling costs of arbitration which had previously seemed the only way forward.

So there was celebration in the air as Staff gathered, listened to a few short speeches and then the ribbon was cut and the plaque unveiled and people were free to enter the building and look inside.  The eight flats are large and spacious and bright and will be lovely accommodation for some of our more senior staff.

We are so grateful to all who contributed to the cost of the project through Kisiizi Partners and to their trustees who have been generous in further helping us with the unplanned extra costs incurred.  

We thank God for the answered prayers that this building is no longer standing unused but is at last housing staff and helping reduce the pressure on accommodation.

it's here!

The nurse seemed breathless as she came to tell us... "it's here!"

"It" is our new second-hand Mental Health Service vehicle kindly donated by Jamie's Fund who are now raising funds for a new mental health centre here.  This will include in-patient and day unit facilities. 

Jamie's Fund is officially launching as a registered charity in UK on 28th September.

The photo shows our dedicated Psychiatric Clinical Officer, Nancy Mwebesa, trying out the passenger seat and clearly delighted.....


mind you, we were not so sure about the numberplates!

Quiz time... paediatric x-ray

 

Here is the chest x-ray of a seven year old boy admitted to our ward last week. He had a three and a half year history of persistent cough.  When he tried to play football he became breathless more quickly than his friends.

He had received a number of medicines from various clinics including courses of antibiotics and anti-heart failure medication but nothing had made much difference.

What do you think is the underlying problem?

What would you do about it?

Singing in the rain!

We arrived back to find that Kisiizi had had a very long dry spell and fires had broken out on the hillside where the hospital has some eucalyptus plantations which we hope to harvest in the near future.  We looked out of our window just after 6am to see 4 different fires on the hill opposite.  

 In addition there were power cuts to the residences every evening as there just was not enough water to generate the hydro power needed [though thankfully the hospital supply was fine].

So we sent out emails to many supporters asking for prayers for rain.  Thank you to all who joined us in this….. we were blessed with a good downpour which put out all the fires and topped up the river so the power was more reliable.

One issue is the increased use of land in the valley above Kisiizi which means less water flows down the river to us.  The historic papyrus swamps which have acted as natural reservoirs have been gradually eroded by more land being claimed for crops along many miles of the valley.   

However it does seem that the recent dry spell was extreme and certainly we had had no similar problem in the previous year.

last.second.com !

We are thinking of starting this new website as we found life was so frenetic much of the past months!  Hence the delay in posting on this blog…. So apologies to our readers, wherever you are, but we’ll fill you in on some of the action…

We greatly enjoyed seeing Mark and Ruth again.  We were able to attend Ruth’s Post-Graduate Certificate of Education graduation at Homerton  College, Cambridge and felt very proud of her.   Sadly many in her year had dropped out due to the pressure of the course but Ruth had excellent school placements which she enjoyed [and had the satisfaction of being told she is a “natural”].

She was appointed to a good job as a primary school teacher in Islington, North London, from September.  This was from her first interview, so again very encouraging.  She has a good flat in Crouch End with friends so it has all fallen into place very well.  We smile as we recall her as a young girl lining up her dolls and teddies and taking role-call, now she will fulfil the dream!

Mark has also done extremely well with his PhD in Reading.  He has had an excellent supervisor and has already published some papers.  He is now back in our home in Macclesfield writing up his research on crystal structure of medicines etc etc [far too complicated for us to begin to understand…].  He still enjoys playing drums and keeping fit.

We were able to have 5 days all together on holiday in Barcelona which was lovely.   

Hanna and I also managed to visit Holland and stayed with her father and saw all the Dutch family so it was good to catch up with them including Justin and Amber who were on leave from their work in Turkey.

We were able to visit Ian’s mum and her husband Peter who were well.  Unfortunately time didn’t allow us to see all the rest of the family on this trip.

Ian was able to visit Geneva for a couple of days to present a paper of work we had done in Kisiizi as part of the World Health Organization African Partnerships for Patient Safety programme.  What he didn’t know was that the paper was part of the “Implementation Academy” at the second international conference on prevention and infection control.  Turned out Kisiizi was up against China, Malta, Germany etc…. but, to our surprise and delight, Kisiizi won first prize!  It turned out that a lady from the Ministry of Health in Kampala was attending the conference so she was excited that Uganda won but then a little surprised to see a “muzungu” go up to get the prize!  If you wish to see the abstract of our work click below:

Kisiizi abstract paper

Hanna and I hosted the first week of the Christian Medical Fellowship Developing Health course in north London and, as always, it proved an inspiring time as we met more extraordinary people working in some very challenging resource-poor situations to bring health and wholeness to people often living at the edge of survival. 

We were able to meet up with some Friends of Kisiizi, and spoke at some churches that have prayed for Kisiizi and supported aspects of the work here.  We also had encouraging meetings with the Chief Executives of Royal Berkshire Hospital, Reading and Countess of Chester Hospital.  We met some colleagues due to join us in Kisiizi in the next few months and went up to Yorkshire to help discuss plans for our new Mental Health unit.

But all too quickly it was the pressure of packing for the return trip…. We had booked Qatar airways as it was the cheapest but, for the first time ever, found our hand-luggage being weighed!... NOT a good idea!  It took a lot of arrow prayers and fast talking to persuade them that we needed to take all our luggage which included an anaesthetic machine and surgical instruments… so rather a hassle at Manchester, but then off to Doha.  Arrived about 1am to a temperature of 33 degrees and high humidity – not pleasant at all so hate to think what it would be like in the day time!  Then onto a bus for a good 20 minutes standing to get to a terminal to join a queue to get on another bus back the same 20 minute journey for the second leg flight to Entebbe…. Not our best trip!  But arrived on time and safe with all the luggage so much to be thankful for.

Had a lovely welcome party here in Kisiizi which was very kind of the staff to arrange.  As usual, within 48 hours or so it felt like we hadn’t been away…. 

Paediatric Quiz solution...

Thanks to those of you who posted comments or sent emails suggesting a solution... it seems that my clues were too cryptic!Here is the clue again but with highlights...

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

Some need a clue to the diagnosis in this case for a bolus point:

A scar is the solution, it all comes to the helm in the end!

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

The answer is that the child had sub-acute obstruction caused by a bolus of ascaris roundworms, a type of helminth parasite infection.  Ascaris are quite common but usually only cause mild problems such as malabsorption with the risk of compromise of the child's nutrition.

This unfortunate child had hundreds of worms which were vomited or passed once we gave the child anti-helminth medication [mebendazole].

Re-generation...

Kisiizi Hospital Power Ltd, our hydro-electric power company, plays a vital role in keeping Kisiizi operational.  For many years we ran the Hospital on the 60kW Gilkes generator and then in 2008/9 the new 300kW generator was installed by Charles Swainson and the team.  This has allowed power to be transmitted to our community for domestic use or, in some cases, providing energy for small industrial concerns such as carpentry workshops.

Gideon inspects the alternator bearings

Now the main generator has been running for 4 years and we are grateful that Charles has returned to supervise the essential maintenance required to ensure the on-going smooth running of the turbine, alternator and whole system.

Paediatric Quiz - CLUE TIME

Some need a clue to the diagnosis in this case for a bolus point:

A scar is the solution, it all comes to the helm in the end!

Draining...

Brain drain...

Occasionally we are disappointed when one of our Staff decides to leave for a higher-paid job in a big city rather than staying to help care for our desperately poor community... but on the other hand it makes us really appreciate the Staff who faithfully serve even though they could earn so much more elsewhere for less work.  One such is Dr. Gabriel, our Consultant Surgeon, who has now returned safely from a trip to Geneva to the World Health Organisation and this all went very well.

One other factor in a couple of Staff leaving is that we discovered some were holding full-time government jobs as well as their Kisiizi appointments and were trying to do them in their days off from here... but of course this could mean compromising on both sides.

Chest drain...

this youngster is an example of a child being brought to us late in a disease progression.

He was very breathless and had a large amount of fluid accumulating in his left chest.

The x-rays show the difference before and after a chest drain was inserted to relieve his distress.

The first film shows his heart pushed across to the right by all the fluid [which looks white on the x-ray].  In the second film the right lung looks more normal and the tube of the chest drain can be seen in the lower left chest.

We were able to remove the drain after about 3 days and he went home a few days later.

Tank drain....

Kisiizi has 360 beds and sometimes the number of patients exceeds this.  Then patients all have attendants who help them with washing, food etc [the nurses concentrate on observations, dressings, medication etc] so that adds another group of people.  Add a couple of hundred student nurses/midwives, about 430 pupils in the primary school and a few hundred out-patients every week and you will understand that there is quite a demand for basic water and sanitation.  We are blessed with a capped spring and gravity flow water system that has served Kisiizi for its 55 years.  The pipes will need replacing but happily there still seems to be adequate water for our needs at present. Sanitation is provided by a range of different facilities ranging from extremely basic pit latrines to western-style flush systems and anything inbetween.  Only problem is that a lot of these facilities drain into septic tanks and with time these fill.  So one joy to anticipate is draining some of these tanks in the next week or so.  Moses, our senior hospital administrator, assures us that it will be fine and not an assault on our olfactory senses...

Ambassador

Dr. Gabriel lecturing on the Kisiizi APPS Amplification seminar

Dr. Gabriel Okumu, our Consultant Surgeon, is currently in Geneva at the invitation of the World Health Organisation to represent Church of Uganda Kisiizi Hospital at a strategic planning meeting relating to the Surgical Unit-based Safety Programme.  This is a new initiative from WHO supported by a team from John Hopkins university, USA.  Kisiizi has been asked to participate following the recent successful amplification work as part of our role as the only first-wave hospital in Uganda on the WHO African Partnerships for Patient Safety programme. We will continue to liaise with our partners at Countess of Chester NHS Trust as the programme develops.

Kisiizi has also been asked to act as one of five worldwide WHO "Learning Laboratories" researching the ways to link Patient Safety to the Universal Health Coverage targets.  Other sites are in places like Bangledesh, Gambia and Dominica so hopefully we can all learn from one another.

Our large community Health Insurance Scheme, with over 35,000 members in 177 groups, will help us interact with our communities, sharing health promotion messages and listening to key issues raised.  In addition, as part of the North Kigezi diocese of the Church of Uganda we have another network with around 320,000 members, again in a structure of parishes and archdeaconeries that will facilitate similar interactions.

Special guests...

We were delighted to welcome Sister Esther Kobusingye, our former Principal Nursing Officer, back for a visit to Kisiizi this weekend. 

She retired from Kisiizi about 18 months ago and now works part time in Mbarara, about 80 miles away.  It was a joy to see her again, accompanied by Oriki, seen here with Esther and his sister Gladys and her young baby.

Paediatric Quiz time...

for the medics amongst you, here is a case we admitted recently...  a previously well child of about 8 months presenting with intermittent severe abdominal cramping pain and this appearance...







What do you think is the cause?

We will give the answer in a week or so!