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| hailstones! |
Recently we actually had hail stones which is not too common, and you will see on the picture the change in the amount of flow over our waterfall after the rains....
Window on Kisiizi
Friday, 31 August 2012
Climate change...
Recently we actually had hail stones which is not too common, and you will see on the picture the change in the amount of flow over our waterfall after the rains....
Saturday, 25 August 2012
Saturday morning ward round...
Dr. Josephine is having a well-earned rest so Ian is covering paediatrics and neonates. Happily we now have an intern so that is a great help.
I started in our special care baby unit where most babies were improving. One infant had come to Kisiizi a few days old with a major problem called a sacro-coccygeal teratoma. This is a form of tumour that causes a large mass over the lower spine. Dr. Gabriel, our surgeon, had operated to remove the lesion, no mean feat as quite large and even involved the caecum and appendix anteriorly! Happily the baby now looks really well and is thriving.
Then we have the usual mix of premature babies including one born weighing around 900 grams who has now doubled in weight and will be heading for home in the not too distant future.
One baby had been born on the way to hospital and had arrived very cold but is now improving. Another was born here by a difficult breech delivery and needed resuscitation at birth.
The saddest case is a baby who was born some distance from us in the community, apparently in a house belonging to a nurse who is not a midwife. The baby had problems and was seen in a village clinic who only referred her on after a couple of days. She arrived in poor condition and needed urgent blood transfusion and had some initial fits which we were able to control. Today she is much improved but we are guarded about her longer term neurological outcome.
I have just removed an umbilical vein catheter and put in a peripheral cannula on a baby who had a degree of birth asphyxia and still has abnormal tone. It's sad to see such cases born in other places. However, on a positive note, our own maternity and obstetric service is developing. In addition to Dr. Helen Smith, Consultant Obstetrician, visiting again recently to support Dr. Francis Banya, our own Consultant Obstetrician and Gynaecologist, we now have Dr. Rachel with us for a few months as the first "Maternity Hub" registrar. She will help Dr. Francis and the midwifery team in various ways as we seek to improve further the quality of care.
After the babies down to Children's ward. One lad is recovering from a laparotomy [surgical exploration of the abdomen] yesterday. He had had features suggesting peritonitis after a preceding history of fever and abdominal pain and we suspected typhoid and a perforation of the gut which is a well recognised complication. However it turned out that he had a ruptured gall bladder! This is an unusual event in a child of 10 and there were no stones present. It must have been linked to the direct effect of infection causing inflammation of the gall bladder plus or minus an effect of pressure on the drainage duct due to enlarged lymph nodes which we had noted on ultrasound and confirmed at surgery. He seems to be reasonably well this morning considering how sick he was.
Another child aged 20 months came in with a long history of cough and a recent swelling over his thoracic spine. I think he probably has TB and has some damage to one of the vertebral bodies causing some collapse and angulation. Happily he doesn't appear to have any damage to his spinal cord.
So that's just a taster of some of our patients, and of course the usual mix of children with pneumonia, gastroenteritis etc as well.
Then a quick diversion to the hospital "canteen" shop to get some milk as my dear wife is back in UK and the girl who helps run our household is off this weekend. Back home for a coffee and to boil up the milk [it comes direct to the canteen in a metal container and isn't pasteurised] and time to update this blog and to thank you all for the messages of support and encouragement and your prayers that sustain us in this work.
Here is a photo of a child we admitted about 3 weeks ago - the child had a form of neonatal hepatitis that had caused her to remain jaundiced but the prognosis was good. However, the family, advised by the mother-in-law, had taken her to a local traditional healer who had performed "ebiino". This practice involves digging around in the infant's gum and pulling out an un-errupted milk tooth. The practice is usually used in infants with diarrhoea and, as this is usually self-limiting, it perpetuates the myth. However the practice may result in severe infection including septicaemia or, as in this case, bleeding, probably exacerbated by the underlying liver problem affecting clotting.
We had to resuscitate the child, give oxygen and fluids iv and vitamin K and then Hanna, my faithful wife and O Negative universal blood donor, gave some fresh blood to help control the problem with good results.
This case highlights the need for health education and promotion to try and avoid such cases in the future and we hope to develop our community programmes in the coming months to pursue this goal.
I started in our special care baby unit where most babies were improving. One infant had come to Kisiizi a few days old with a major problem called a sacro-coccygeal teratoma. This is a form of tumour that causes a large mass over the lower spine. Dr. Gabriel, our surgeon, had operated to remove the lesion, no mean feat as quite large and even involved the caecum and appendix anteriorly! Happily the baby now looks really well and is thriving.
 |
| Dr Johnson, intern, and Sister Jane on Children's Ward |
Then we have the usual mix of premature babies including one born weighing around 900 grams who has now doubled in weight and will be heading for home in the not too distant future.
One baby had been born on the way to hospital and had arrived very cold but is now improving. Another was born here by a difficult breech delivery and needed resuscitation at birth.
The saddest case is a baby who was born some distance from us in the community, apparently in a house belonging to a nurse who is not a midwife. The baby had problems and was seen in a village clinic who only referred her on after a couple of days. She arrived in poor condition and needed urgent blood transfusion and had some initial fits which we were able to control. Today she is much improved but we are guarded about her longer term neurological outcome.
I have just removed an umbilical vein catheter and put in a peripheral cannula on a baby who had a degree of birth asphyxia and still has abnormal tone. It's sad to see such cases born in other places. However, on a positive note, our own maternity and obstetric service is developing. In addition to Dr. Helen Smith, Consultant Obstetrician, visiting again recently to support Dr. Francis Banya, our own Consultant Obstetrician and Gynaecologist, we now have Dr. Rachel with us for a few months as the first "Maternity Hub" registrar. She will help Dr. Francis and the midwifery team in various ways as we seek to improve further the quality of care.
 |
| he ain't heavy... he's my brother! |
After the babies down to Children's ward. One lad is recovering from a laparotomy [surgical exploration of the abdomen] yesterday. He had had features suggesting peritonitis after a preceding history of fever and abdominal pain and we suspected typhoid and a perforation of the gut which is a well recognised complication. However it turned out that he had a ruptured gall bladder! This is an unusual event in a child of 10 and there were no stones present. It must have been linked to the direct effect of infection causing inflammation of the gall bladder plus or minus an effect of pressure on the drainage duct due to enlarged lymph nodes which we had noted on ultrasound and confirmed at surgery. He seems to be reasonably well this morning considering how sick he was.
Another child aged 20 months came in with a long history of cough and a recent swelling over his thoracic spine. I think he probably has TB and has some damage to one of the vertebral bodies causing some collapse and angulation. Happily he doesn't appear to have any damage to his spinal cord.
So that's just a taster of some of our patients, and of course the usual mix of children with pneumonia, gastroenteritis etc as well.
Then a quick diversion to the hospital "canteen" shop to get some milk as my dear wife is back in UK and the girl who helps run our household is off this weekend. Back home for a coffee and to boil up the milk [it comes direct to the canteen in a metal container and isn't pasteurised] and time to update this blog and to thank you all for the messages of support and encouragement and your prayers that sustain us in this work.
We had to resuscitate the child, give oxygen and fluids iv and vitamin K and then Hanna, my faithful wife and O Negative universal blood donor, gave some fresh blood to help control the problem with good results.
This case highlights the need for health education and promotion to try and avoid such cases in the future and we hope to develop our community programmes in the coming months to pursue this goal.
Wednesday, 22 August 2012
Beautiful Lake Bunyonyi...
As Hanna is travelling back to UK for 7 weeks today, we "escaped" for a weekend away at Bushara Island, a lovely spot on Lake Bunyonyi [= the lake of little birds]. It was very peaceful and good to have some breathing space after a frenetic few months.
Mark and Ruth had given me a telescope for Christmas and it was put to good use enjoying the magnificent birds and scenery. Unfortunately the sky wasn't clear enough for any good star gazing this time and the backdrop of the volcanoes which are sometimes seen was stubbornly covered in cloud so we'll just have to go back another time.
We travelled on from Kabale up to Mbarara and had a lovely stay with Esther Kobusingye, previously Sister in Charge at Kisiizi. It was good to spend some time with her and catch up with each other. Hanna stayed a further night there and then went on to Kampala and Entebbe yesterday whilst I drove back the 80 miles to Kisiizi, the last 18 miles being on murram gravel road.
We are so grateful for the beauty of this region of Uganda and the chance to enjoy this short break... now back to the mix of admin and clinical work that makes each day different....
Mark and Ruth had given me a telescope for Christmas and it was put to good use enjoying the magnificent birds and scenery. Unfortunately the sky wasn't clear enough for any good star gazing this time and the backdrop of the volcanoes which are sometimes seen was stubbornly covered in cloud so we'll just have to go back another time.
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| no, not an exotic insect! A seed designed to be carried on the wind... |
We travelled on from Kabale up to Mbarara and had a lovely stay with Esther Kobusingye, previously Sister in Charge at Kisiizi. It was good to spend some time with her and catch up with each other. Hanna stayed a further night there and then went on to Kampala and Entebbe yesterday whilst I drove back the 80 miles to Kisiizi, the last 18 miles being on murram gravel road.
We are so grateful for the beauty of this region of Uganda and the chance to enjoy this short break... now back to the mix of admin and clinical work that makes each day different....
Kisiizi tapestry...
Life in Kisiizi is very varied - with the Hospital, School of Nursing, Primary School and Hydro-electric power company there is a wide range of activity both clinical and non-clinical. And then there is always the wild life to enjoy...
Malcolm Crawford, a CMS mission partner in Kisoro, kindly helps us with end of year accounting reviews. Rev Patrick is our hospital Chaplain but has also been serving as acting Finance Manager, whilst Justine is our accountant.
Building and maintenance work is often seen, the photo shows the use of
banana leaves to protect a newly laid concrete slab for a septic tank.
Every weekday Staff meet in Chapel at 8am and sometimes the Chapel Choir will sing. The "adult mission" has been postponed as, due to the scare about Ebola, it was clear that turnout would be low and the government had recommended the avoidance of large public gatherings.
Happily no new cases of ebola have been confirmed in Uganda for some time. There have recently been cases from neighbouring Congo but interestingly these are apparently a different strain of virus so not part of the outbreak affecting Uganda a month or so ago.
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| Malcolm Crawford, Rev Patrick and Justine auditing accounts |
Building and maintenance work is often seen, the photo shows the use of
banana leaves to protect a newly laid concrete slab for a septic tank.Every weekday Staff meet in Chapel at 8am and sometimes the Chapel Choir will sing. The "adult mission" has been postponed as, due to the scare about Ebola, it was clear that turnout would be low and the government had recommended the avoidance of large public gatherings.
Happily no new cases of ebola have been confirmed in Uganda for some time. There have recently been cases from neighbouring Congo but interestingly these are apparently a different strain of virus so not part of the outbreak affecting Uganda a month or so ago.
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| a small gheko finding a warm place to rest! |
Sunday, 12 August 2012
sport focus...
We have limited internet at times here but have managed to follow the Olympic headlines and to hear reports on the local BBC station based in Mbarara 80 miles away.
People here are generally much more interested in football, especially the Premier League, than in the Olympics though perhaps today's Uganda gold in the marathon may change perceptions!
People will crowd to watch a very small TV screen when the football season is underway, and many will play sports including football, badminton and volley ball when they get the chance.
People here are generally much more interested in football, especially the Premier League, than in the Olympics though perhaps today's Uganda gold in the marathon may change perceptions!
People will crowd to watch a very small TV screen when the football season is underway, and many will play sports including football, badminton and volley ball when they get the chance.
Quote time...
"The most beautiful thing we can experience is the mysterious. It is the source of all true art and science. He to whom this emotion is a stranger, who can no longer pause to wonder and stand rapt in awe, is as good as dead: his eyes are closed."
ALBERT EINSTEIN
===================
"Endless invention, endless experiment,
Brings knowledge of motion, but not of stillness....
Where is the Life we have lost in the living?
Where is the wisdom we have lost in the knowledge?"
T.S.ELIOT
===================
"Every ant knows the formula of its ant-hill,
every bee knows the formula of its beehive.
They know it in their own way, not in our way.
Only humankind does not know its own formula."
FYODOR DOSTOYEVSKY
====================
"We see either the dust on the window
or the view beyond the window,
but never the window itself."
SIMONE WEIL
====================
"So now, from this mad passion
Which made me take art for an idol and a king
I have learnt the burden of error that it bore
And what misfortune springs from man's desire...
The world's frivolities have robbed me of the time
That I was given for reflecting upon God."
MICHAELANGELO
=====================
Accountability...
It was apt that one of our current visitors, a Ugandan medical student who has previously worked with us as a Clinical Officer, spoke on the topic of accountability in Chapel last week. He took the well-known parable of the Talents and the fact that we are all responsible to use our natural gifts and talents, and all that we have and are, to the full.
For, on Thursday, we had a visit from the District Health Officer [DHO] and his team to look at the Hospital and to inspect our record books. It seems Kisiizi has sometimes been slow in sending in data to the district and at times it has been incomplete. Walking around with the team affirmed many areas of practice but also highlighted some improvements needed and was a very helpful exercise that we hope to see repeated regularly.
The DHO visited the new operating theatres, built with support from St Paul's Church in Dublin under the supervision of our builder David Barratt, and was impressed at what he saw. We then toured Maternity, Neonates and Rehabilitation unit having already seen out-patients including the dental, HIV and ophthalmology areas.
We look forward to working more closely with the DHO and his team in the future and share some important goals regarding Community and Public health.
For, on Thursday, we had a visit from the District Health Officer [DHO] and his team to look at the Hospital and to inspect our record books. It seems Kisiizi has sometimes been slow in sending in data to the district and at times it has been incomplete. Walking around with the team affirmed many areas of practice but also highlighted some improvements needed and was a very helpful exercise that we hope to see repeated regularly.
 | |
| DHO and team talk with a patient in Rehabilitation |
The DHO visited the new operating theatres, built with support from St Paul's Church in Dublin under the supervision of our builder David Barratt, and was impressed at what he saw. We then toured Maternity, Neonates and Rehabilitation unit having already seen out-patients including the dental, HIV and ophthalmology areas.
We look forward to working more closely with the DHO and his team in the future and share some important goals regarding Community and Public health.
Friday, 10 August 2012
Ebola update
We are happy to report that Ian phoned the Uganda Viral Institute this morning and they confirm that both our patients in high-level isolation are negative for Ebola.
This is good news and a real answer to prayer. We continue to be vigilant with a triage desk next to our main entrance to screen all patients as soon as they arrive.
The contingency planning has taken quite a lot of time to set up but now seems to be running well. It has been encouraging that a number of Staff have volunteered to help with the high-risk patients which has included night duties. Dr Gabriel Okumu, our Consultant Surgeon, is Infection Control Officer and has led the team well setting a good example in dealing with our first high-risk patient.
The care of patients in high-isolation is also time consuming and quite uncomfortable as the protective clothing is very hot and it is not too easy to breath. We found also that the protective visors/eye shields tend to fog up making procedures more challenging.
But happily all has gone well. Hanna has done a lot of nursing care for the two patients as has Sister Kate, our Acting Principal Nursing Officer and Ian had to do their blood samples, clearly a high-risk task, but thankfully it went smoothly.
Ian diagnosed another possible case picked up on triage on Wednesday as in fact having pulmonary tuberculosis.
Apparently a case has been confirmed on the Tanzania / Uganda border, again not very near to us but suggesting that there may have been some spread of the condition.
This is good news and a real answer to prayer. We continue to be vigilant with a triage desk next to our main entrance to screen all patients as soon as they arrive.
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| Ian in protective clothing |
The contingency planning has taken quite a lot of time to set up but now seems to be running well. It has been encouraging that a number of Staff have volunteered to help with the high-risk patients which has included night duties. Dr Gabriel Okumu, our Consultant Surgeon, is Infection Control Officer and has led the team well setting a good example in dealing with our first high-risk patient.
The care of patients in high-isolation is also time consuming and quite uncomfortable as the protective clothing is very hot and it is not too easy to breath. We found also that the protective visors/eye shields tend to fog up making procedures more challenging.
But happily all has gone well. Hanna has done a lot of nursing care for the two patients as has Sister Kate, our Acting Principal Nursing Officer and Ian had to do their blood samples, clearly a high-risk task, but thankfully it went smoothly.
Ian diagnosed another possible case picked up on triage on Wednesday as in fact having pulmonary tuberculosis.
Apparently a case has been confirmed on the Tanzania / Uganda border, again not very near to us but suggesting that there may have been some spread of the condition.
Sunday, 5 August 2012
Mental Health service plans...
We greatly appreciated Ann visiting for a week to advise on
our planning for a new Mental Health Unit.
We are the only non-government hospital to run a mental health service,
treating patients who are often marginalized and in desperate need.
Management have identified a site for the new
Unit. Nancy, who heads up the service
here, together with Ann and others in the team spent time hearing the views of
patient groups, relatives and Staff as to what was going to be important in the
new Unit. We have drawn up some initial
provisional plans and Ann will work on these with architect colleagues and fee
back ideas to us. It is special to have
a “blank canvas” rather than having to convert an exisiting building.
Many of you who followed our blog last year will recall the
tragic story of the death of Jamie, the son of Avril and Jim who had come to
Kisiizi to raise support for our psychiatric service. Ann is the sister of Avril so it was really
special to have her here particularly as it coincided with the first
anniversary of Jamie’s death and we were able to go and pray together next to
the site of the new Unit. Avril and Jim
have wonderfully worked to set up a fund in memory of Jamie and will be
establishing a formal charity. They have
already raised support for a mental health vehicle which will allow more trips
into the community to provide support to these patients, and now are focusing
on the funding for the new Unit. You can read more about this by following the link below:
We are excited to see psychiatry, often the "Cinderella" specialty, getting this focus and support and we anticipate that it will lead to something very special indeed.
"Fear not, for I am with you..."
It’s easy to preach such texts in theory but times come when
we are put to the test.
There is
currently an outbreak of Ebola Virus infection in western Uganda. Cases have been mainly in Kibaale forest,
some distance to the north of Kisiizi, but we are taking it seriously as we
know a lot of people from our catchment area travel up to Kibaale to work in
the timber industry. It is likely that
if they become unwell they may return home, and then if they deteriorate they may come to us. We have therefore had to spend a lot of time
putting contingency plans in place including introducing a new patient triage
near our main gate to try and pick out any cases before they mix in the
out-patient queue. We have set up the
old operating theatre as a high-dependency area should it be required with
barrier nursing facilities and we have partitioned our Isolation Ward to give
more control of patient and visitor access.
We hope we don’t get any cases as it is one of the viral haemorrhagic
fever conditions that is extremely infectious.
We have had a number of volunteers from our Staff to help should we have
any cases and will do further training this week.
Some medical students from UK have been advised to cancel or
conclude their electives here because of the outbreak and potential risk.
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| Measles rash |
A lot of our work is to do with infectious diseases, especially pneumonia, malaria, typhoid, TB, HIV and, occasionally, measles. The immunisation rates here are quite good but still we see some cases slip through.
Rotas and Rotors...
We are really pleased that the Ministry of Health has
approved Kisiizi to have a Paediatric Intern to join our surgery and obstetric interns, rotating
with 3 months in each specialty. In
fact, the Ministry would like us to take two interns in each specialty and our
Management team have approved this goal.
Longer term, if we can recruit an
Adult Physician, we will then be able to have a medical intern also and the
rotation would be a full year.
This is a
significant development with the prospect of improving patient care and also of
making it much easier in future to recruit Medical Officers. We will have a big change over this week as
the new interns join us and we welcome new Medical Officers. This is all moving towards a departmental
structure and we hope will improve our clinical governance and allow better
medical cover especially supporting out-patients.
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| Centre of attention... |
One major excitement recently was the arrival of a
helicopter from Kampala to transfer a patient who needed further investigations
and support. Many people had never seen
a helicopter before, and as it landed on the primary school playing field a
large crowd gathered including quite a number of patients who left the wards to
witness the event!
Overwhelmed...
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| The Mills family with the Kisiizi waterfall behind |
After the usual long drive from Kampala, stopping en route
to say a quick hello to Esther in Mbarara, we arrived in Kisiizi in the
dark. Accompanying us we had Natalie, a
medical student coming on her elective, and Ann who had come to help advise us about plans for our new Mental
Health Unit.
We drove up to our new
home, the Medical Superintendent house, which was in darkness, but when Hanna
popped her head around the door a great burst of singing erupted and we found a
surprise party in our lounge with perhaps 60 or so people gathered… it was an
opportunity to say goodbye to the Mills family who had been in Kisiizi for 3
weeks as well as to welcome us, and it was such a special time to see the house
full of people from many parts of the hospital community having fun together –
drivers, nurses, teachers, secretaries, chaplains, medics, visitors etc…. so a
real treat and a great encouragement for the future following what has been a difficult
time for the Kisiizi community in the past few months. We felt overwhelmed by the love and warmth of the welcome.
Our new home is lovely with a view from the verandah towards
the waterfall. We have split the house
into two areas as we don’t need such a big place. We have a bedroom, shower, kitchen and the lovely
large lounge. The rear of the house with
a bathroom and bedrooms has been allocated as an extension of the hospital Guest
House as we have been in need of more space and it has already been well used.
Down, down.... up, up and away...
Normal descent into Entebbe, familiar sight of Lake Victoria
out of the window, then all the engines increase power and we are going up
again… fly on for 20 miles, turn and, after an impromptu over-flight of the
Ssese Islands, we head back and land in the opposite direction.
Apparently the reason was that we had a full
aircraft and a significant tail-wind… but we actually wondered if perhaps the
co-pilot was having a go and the Captain took over!
Reminds us of a
number of times taking over medically from junior colleagues also about to hit
a heavy landing!
So we don’t just take travel for granted, we had had a
similar experience years ago coming into Nairobi on a Kenya Airways airbus…
that episode was more dramatic with the plane lurching up having been almost at
touch-down. It turned out that a Air
France plane had pulled onto the runway ahead and we would have collided. So we are grateful to arrive here safely once
again…
Sunday, 3 June 2012
never a dull moment...
Apologies for the long delay in posting new entries but our internet has been off for many days and unreliable when it reappears...
Life remains full with a mix of things filling each day and, sometimes, night.
Hanna has been liaising with the Guest House staff helping organise the new rooms needed for all the visitors which required refurbishment and painting of one end of the house we will move to. Then trying to get to grips with the list of medical students booked for electives which had been rather confusing as it didn't tally with the paper version but hopefully now getting sorted.
The maternity ward has been overcrowded, partly due to some other hospitals in our region not functioning well so patients are choosing to travel here. The result is unsatisfactory as it is not possible to offer good nursing care when so many people are present [each mother will usually have an attendant to support her as the Hospital does not provide meals etc and the relatives have to care for the patients other than the administration of medicines, dressings, observations etc that the nurses do]. The plan is to build a Mothers Hostel for those low-risk ladies waiting to go into labour. The hostel will probably take about 9 - 12 months to build, funding is being provided by Kisiizi Partners. In the meantime we are planning to use the old operating theatres to fulfill this function so Hanna has been busy helping sort out the equipment that had been dumped there - sadly in a real state of chaos which was sad to see. So now, after a lot of hard work, the area is much clearer and the equipment has been moved to areas where hopefully it can be put to good use.
Ian has continued to do ward rounds in general paediatrics and neonates. Back to doing the drips again [back in UK my registrars or specialist nurses do them all!] and having to use a few tricks of the trade when asked to sort out the baby who everyone else has tried to cannulate and has a haemoglobin of only 6 and needs a blood transfusion NOW! Ummm. The usual sad cases as well as happy outcomes. One young infant probably had an underlying congenital abnormality of chest/blood vessels causing respiratory problems but we don't have fancy things like CT scans, angiograms, echocardiograms etc to work out the underlying pathology so have to guess.
Today I preached in the morning service - its Martyrs' day remembering those who were killed at Namugongo for their faith. Afterwards we were relaxing with a coffee when I was asked to go to see a premature baby admitted aged 5 days from a town about 2 hours drive away. The baby was in poor condition, cold and septic and in spite of us providing glucose iv, antibiotics, oxygen etc it was too late and we had to watch the parents come to terms with the loss of their firstborn. Very sad as if they had had the baby here or had at least been able to come earlier we could probably have helped them...
On the admin side lots of meeting trying to sort out a whole range of issues. Yesterday we had a Finance Committee with two members of the Board of Governors coming. It went well, as we had pushed to get our QuickBooks accounting software up to date and to analyse the figures to date so had a detailed print out of the situation. Overall fairly promising but need to see how it plays out to the end of the financial year which here is 30th June.
Sadly we had to dismiss one employee found deliberately falsifying receipts. We are checking a few other areas of concern. It reflects a period of drift in Kisiizi with inadequate accountability and too much laxity in some arrangements. It is good that the new management team is working well together to try and move things forward positively. I will address the staff on Thursday morning as a follow up to the Management team meeting due on Wed afternoon and hopefully we will lay out the plans for the Hospital in the next few months.
Well, our holiday is nearly over and we fly back to UK next Monday ready for work and talks both in Macclesfield and then for the Royal College in London on 14th. Then a week gap before the Christian Medical Fellowship Developing Health Course in London...
thanks for all the messages of support and the prayers, much appreciated.
Life remains full with a mix of things filling each day and, sometimes, night.
Hanna has been liaising with the Guest House staff helping organise the new rooms needed for all the visitors which required refurbishment and painting of one end of the house we will move to. Then trying to get to grips with the list of medical students booked for electives which had been rather confusing as it didn't tally with the paper version but hopefully now getting sorted.
The maternity ward has been overcrowded, partly due to some other hospitals in our region not functioning well so patients are choosing to travel here. The result is unsatisfactory as it is not possible to offer good nursing care when so many people are present [each mother will usually have an attendant to support her as the Hospital does not provide meals etc and the relatives have to care for the patients other than the administration of medicines, dressings, observations etc that the nurses do]. The plan is to build a Mothers Hostel for those low-risk ladies waiting to go into labour. The hostel will probably take about 9 - 12 months to build, funding is being provided by Kisiizi Partners. In the meantime we are planning to use the old operating theatres to fulfill this function so Hanna has been busy helping sort out the equipment that had been dumped there - sadly in a real state of chaos which was sad to see. So now, after a lot of hard work, the area is much clearer and the equipment has been moved to areas where hopefully it can be put to good use.
Ian has continued to do ward rounds in general paediatrics and neonates. Back to doing the drips again [back in UK my registrars or specialist nurses do them all!] and having to use a few tricks of the trade when asked to sort out the baby who everyone else has tried to cannulate and has a haemoglobin of only 6 and needs a blood transfusion NOW! Ummm. The usual sad cases as well as happy outcomes. One young infant probably had an underlying congenital abnormality of chest/blood vessels causing respiratory problems but we don't have fancy things like CT scans, angiograms, echocardiograms etc to work out the underlying pathology so have to guess.
Today I preached in the morning service - its Martyrs' day remembering those who were killed at Namugongo for their faith. Afterwards we were relaxing with a coffee when I was asked to go to see a premature baby admitted aged 5 days from a town about 2 hours drive away. The baby was in poor condition, cold and septic and in spite of us providing glucose iv, antibiotics, oxygen etc it was too late and we had to watch the parents come to terms with the loss of their firstborn. Very sad as if they had had the baby here or had at least been able to come earlier we could probably have helped them...
On the admin side lots of meeting trying to sort out a whole range of issues. Yesterday we had a Finance Committee with two members of the Board of Governors coming. It went well, as we had pushed to get our QuickBooks accounting software up to date and to analyse the figures to date so had a detailed print out of the situation. Overall fairly promising but need to see how it plays out to the end of the financial year which here is 30th June.
Sadly we had to dismiss one employee found deliberately falsifying receipts. We are checking a few other areas of concern. It reflects a period of drift in Kisiizi with inadequate accountability and too much laxity in some arrangements. It is good that the new management team is working well together to try and move things forward positively. I will address the staff on Thursday morning as a follow up to the Management team meeting due on Wed afternoon and hopefully we will lay out the plans for the Hospital in the next few months.
Well, our holiday is nearly over and we fly back to UK next Monday ready for work and talks both in Macclesfield and then for the Royal College in London on 14th. Then a week gap before the Christian Medical Fellowship Developing Health Course in London...
thanks for all the messages of support and the prayers, much appreciated.
Visitors...
Kisiizi is blessed with many visitors and we have had many in the past week or so... Janet an ultrasonographer, with Mark and Darren radiographers made up a team from Countess of Chester hospital helping our imaging services for a fortnight. I certainly have noticed a high standard of chest x-rays on Children's Ward recently.
Then a second team arrived from Royal Berkshire Hospital in Reading, with two more teams due, each here for a fortnight. They are a mix of nurses and medics and have proved enthusiastic and helpful. They have been involved in fund raising support at home so it is good to be able to show them around here.
Occasionally unexpected visitors appear, such as this moth in out-patients!
A big group of 22 from St Andrew's School in Dublin have been with us a few days mainly to visit a local secondary school with whom they have links but also visiting the hospital. Some of them stayed in the large lounge of the house we are due to move to in a few days time. We have effectively partitioned the house into two functional flats as we don't need all the space and because visitor accommodation is at a premium at present and already it has been put to good use.
A group of ten medical students from Makerere University in Kampala arrived late last night as the bus had broken down on the way. They are here for 4 weeks involved in a community training programme.
One lovely result of the news going around that we are here has been a number of people dropping in to greet us.
One is Eldad who retired from Kisiizi a few years ago after more than forty years of faithful service as a porter with a particular role in looking after the water system which all comes from our capped spring on a nearby hillside.
A group of four electricians from Bwindi hospital have been here learning from our Power Company team about hydro electricity to better look after their own project which one of our own technicians has been overseeing. Our power has been quite reliable since we came this time which is encouraging, unlike the internet connection which has been hopeless and off for many days hence the very sparse postings on this blog!
Then a second team arrived from Royal Berkshire Hospital in Reading, with two more teams due, each here for a fortnight. They are a mix of nurses and medics and have proved enthusiastic and helpful. They have been involved in fund raising support at home so it is good to be able to show them around here.
Occasionally unexpected visitors appear, such as this moth in out-patients!
A big group of 22 from St Andrew's School in Dublin have been with us a few days mainly to visit a local secondary school with whom they have links but also visiting the hospital. Some of them stayed in the large lounge of the house we are due to move to in a few days time. We have effectively partitioned the house into two functional flats as we don't need all the space and because visitor accommodation is at a premium at present and already it has been put to good use.
A group of ten medical students from Makerere University in Kampala arrived late last night as the bus had broken down on the way. They are here for 4 weeks involved in a community training programme.
One lovely result of the news going around that we are here has been a number of people dropping in to greet us.
One is Eldad who retired from Kisiizi a few years ago after more than forty years of faithful service as a porter with a particular role in looking after the water system which all comes from our capped spring on a nearby hillside.
A group of four electricians from Bwindi hospital have been here learning from our Power Company team about hydro electricity to better look after their own project which one of our own technicians has been overseeing. Our power has been quite reliable since we came this time which is encouraging, unlike the internet connection which has been hopeless and off for many days hence the very sparse postings on this blog!
Wednesday, 23 May 2012
Life in all its fullness...
Days remain full and stimulating with unexpected twists... for example Hanna went to change the filters on the new oxygen concentrators... all fine until she arrived in surgical ward and was told one machine was not needed at the moment so had been stored carefully in a cupboard... there it was with its new dustcover in place but when she removed the cover out jumped a rat that had eaten half the filter to start making a nest!!! not what we had planned for... seems there is a problem in the old buildings with rats and people have got used to it. However, we haven't so the rats are in for some challenges in the not too distant future as we seek to remove them.
Hanna has also been busy helping Moses sort out guest and visitor accommodation and arrangements and this includes sorting out the painting of the rooms in the house to which we will move that are being switched to a guest accommodation role.
Just to vary her day, she was summoned to the lab with a message that "Dr Ian had said she could give blood!" A 7 year old had been admitted to the Children's ward with a haemoglobin of only 3.8 [should be at least 12] due to malaria. Her blood group was A negative and the hospital did not have any in the blood bank. The regional blood centre is in Mbarara about 80 miles away and it would have taken forever to get any so as, conveniently, Hanna is O Neg, she was called to donate. Happily the child is looking much better today.
Ian has been busy with a mix of clinical and management tasks ranging from finance, buildings, interviews and meetings with visitors. Encouraging progress in some areas but humanly the task is daunting, as we knew, and as a team we need wisdom to know the priorities. We have visiting radiographers and ultrasonographer from Chester, doctors from Reading and a retired anaesthetist and electrical engineer from Australia here at the moment for time spans varying from 2 nights to 2 weeks. Then expecting a big group of secondary school pupils from Dublin with four teachers, they are visiting a local school and are here for about 5 nights in a group of 22. They will be pleased to find some others from Ireland here at present helping with physiotherapy.
So we enjoy the mix of visitors who come through Kisiizi - quite amazing really when you see how small it is and how remote [see the link to Google Earth...] - we used to tell people that if you flew over Kisiizi and blinked you would miss it and yet this little place God called into being at the head of a valley has had an impact reaching around the globe...
Hanna has also been busy helping Moses sort out guest and visitor accommodation and arrangements and this includes sorting out the painting of the rooms in the house to which we will move that are being switched to a guest accommodation role.
Just to vary her day, she was summoned to the lab with a message that "Dr Ian had said she could give blood!" A 7 year old had been admitted to the Children's ward with a haemoglobin of only 3.8 [should be at least 12] due to malaria. Her blood group was A negative and the hospital did not have any in the blood bank. The regional blood centre is in Mbarara about 80 miles away and it would have taken forever to get any so as, conveniently, Hanna is O Neg, she was called to donate. Happily the child is looking much better today.
Ian has been busy with a mix of clinical and management tasks ranging from finance, buildings, interviews and meetings with visitors. Encouraging progress in some areas but humanly the task is daunting, as we knew, and as a team we need wisdom to know the priorities. We have visiting radiographers and ultrasonographer from Chester, doctors from Reading and a retired anaesthetist and electrical engineer from Australia here at the moment for time spans varying from 2 nights to 2 weeks. Then expecting a big group of secondary school pupils from Dublin with four teachers, they are visiting a local school and are here for about 5 nights in a group of 22. They will be pleased to find some others from Ireland here at present helping with physiotherapy.
So we enjoy the mix of visitors who come through Kisiizi - quite amazing really when you see how small it is and how remote [see the link to Google Earth...] - we used to tell people that if you flew over Kisiizi and blinked you would miss it and yet this little place God called into being at the head of a valley has had an impact reaching around the globe...
Saturday, 19 May 2012
Kisiizi Health Insurance Scheme
One thing that has surprised us this visit is the number of patients registered with the Kisiizi Health Insurance scheme - a staggering figure of more than 37,000! This makes us the largest scheme in the country by a big margin and either the largest or second largest in East Africa apparently...
Patients join in various sized groups, paying a premium that is remarkably low by western standards - equivalent to only about £4 a year! The advantage is not only financial to the patient if they become ill but also means people are much more likely to present promptly with symptoms rather than procrastinating or buying a few tablets from a market or going to a traditional healer where interventions may be damaging in some cases...
From the hospital point of view it is a benefit that these patients are sure to pay their bills as the Scheme reimburses Kisiizi for its treatment.
So now we hope to utilise the scheme more for health prevention teaching and we are awaiting the outcome of a new bid for support for a 30 month community programme to improve mother and child health particularly.
Patients join in various sized groups, paying a premium that is remarkably low by western standards - equivalent to only about £4 a year! The advantage is not only financial to the patient if they become ill but also means people are much more likely to present promptly with symptoms rather than procrastinating or buying a few tablets from a market or going to a traditional healer where interventions may be damaging in some cases...
From the hospital point of view it is a benefit that these patients are sure to pay their bills as the Scheme reimburses Kisiizi for its treatment.
So now we hope to utilise the scheme more for health prevention teaching and we are awaiting the outcome of a new bid for support for a 30 month community programme to improve mother and child health particularly.
Saturday, 12 May 2012
We arrived in Kisiizi 2 weeks ago today after a smooth trip via terminal 5 Heathrow courtesy of BA [chosen as we had 3 bags of luggage each]. Spent a night in Matoke Inn, the AIM guesthouse, and had the happy opportunity to meet up with old friends Irene Kambonesa and later Edward & Enid Turitwenka.
On the journey down to Kisiizi we stopped off in Mbarara to visit Sister Esther Kobusingye who recently retired and lives very conveniently close to the main road.
We had a warm welcome on arrival here and have spent these first two weeks working through administration issues with Dr Tonny Tumwesigye, outgoing Medical Superintendent, who left this morning.
Hanna has been organising arrangements for a new batch of much-needed oxygen concentrators donated by Kisiizi Partners. Ian has done some paediatrics, mainly neonatal rounds. Transfused a very preterm baby last night, only weighs 780 grams, she looks much better this morning...
Thanks for all the messages of support and the prayers which are much appreciated. The internet was off almost the whole of the first week or so but now it is improving so we hope to be in touch more often.
On the journey down to Kisiizi we stopped off in Mbarara to visit Sister Esther Kobusingye who recently retired and lives very conveniently close to the main road.
We had a warm welcome on arrival here and have spent these first two weeks working through administration issues with Dr Tonny Tumwesigye, outgoing Medical Superintendent, who left this morning.
Hanna has been organising arrangements for a new batch of much-needed oxygen concentrators donated by Kisiizi Partners. Ian has done some paediatrics, mainly neonatal rounds. Transfused a very preterm baby last night, only weighs 780 grams, she looks much better this morning...
Thanks for all the messages of support and the prayers which are much appreciated. The internet was off almost the whole of the first week or so but now it is improving so we hope to be in touch more often.
Wednesday, 29 February 2012
Countdown starts...
We have very recently been asked to go back to help at Kisiizi Hospital - we had anticipated we might go out in a year or so but were not expecting anything so soon. However it seems that there have been some major issues and we need to go so the countdown has commenced and we have a lot to do.
Ian has resigned his NHS job from the end of June and we will go out in mid-July for an as yet unclear duration. We will take annual leave to go out on a preliminary trip to be in Kisiizi in May. In June we will take part in the CMF Developing Health course in London.
Hanna will come back in August and stay for Friends of Kisiizi Day which is Sat Oct 6th at Greyfriars Church in Reading. Not sure yet if Ian will be able to come back then.
We are grateful for all the prayers and expressions of support we have already received.
Ian has resigned his NHS job from the end of June and we will go out in mid-July for an as yet unclear duration. We will take annual leave to go out on a preliminary trip to be in Kisiizi in May. In June we will take part in the CMF Developing Health course in London.
Hanna will come back in August and stay for Friends of Kisiizi Day which is Sat Oct 6th at Greyfriars Church in Reading. Not sure yet if Ian will be able to come back then.
We are grateful for all the prayers and expressions of support we have already received.
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