Snakes...

SNAKES...

This poor lad was very unfortunate – he managed to be bitten by a snake – on his head!

He was sleeping and must have rolled over at the wrong moment and the snake bit his scalp.  He woke up and cried in the dark.  His parents came to see what was wrong and he told them he had been stung by an insect. So they left him and it wasn’t until the morning that the true culprit was seen and dealt with… by which time the boy was swelling up rapidly.

He came to Kisiizi and thankfully we had supplies of the anti-snake venom antidote. 

 He received three ampoules as well as steroids, anti-histamines, tetanus toxoid and antibiotics as he kept on swelling up.

 Happily he did not develop any major complications and stabilised and then slowly recovered.

The next problem was his parents when they heard the cost of the antidote – it is 400,000 Uganda Shillings an ampoule [about £100] (you will understand the cost if you read up how the antidote is obtained – someone has to “milk” the venom from a snake who presumably may not be too pleased about the experience!)

So having been faced with the prospect of their six year old son dying, the parents now faced the potential of having to sell vital land on which their future depended.

 .... AND LADDERS!

But, wonderfully, some members of a UK church who happened to be visiting Kisiizi that day, heard their story and very generously paid the costs of his bill, much to the relief and excitement of the family.

 Here he is with the swelling reducing but still somewhat bemused by the whole affair!

The story is a good illustration of God’s love reaching out to a vulnerable family in Kisiizi.  We really appreciate the prayers and support of many friends, those visiting and those far away.

THANK YOU.

Face creams and Facebook...

The youngsters in this photo were sitting outside as I walked towards Children's Ward... they had chickenpox and generous amounts of calamine lotion had been liberally applied!  We sent them home as they were doing well and we wanted to avoid the disease spreading to other vulnerable patients.

Amongst all the challenges we face day by day, one out of the blue issue is that someone has put up a counterfeit Facebook account in Ian's name - they have used photos from our blog and the hospital website to make it look authentic but then sadly have apparently asked some people for money... this is all a scam so please ignore it and if you have accepted Ian as a friend on Facebook please cancel this as he does not have an account.  If you do wish to support Kisiizi then please look on the hospital website www.kisiizihospital.org.ug and you will find information to help you.  We do apologise for any inconvenience caused.

Do use the box on the right margin to enter your email if you wish to be alerted when we update the blog - the pressure of life here means we often have to wait for a day off to catch up with posting so it may be a bit erratic and the email notification can help you read any new posts.

Smile!

We were pleased to have a visit from a special patient recently.. a little boy with oculo-cutaneous albinism, a condition where the pigment cells of the skin and iris are not working well and the skin and hair are therefore very pale. This can cause a risk of sunburn and potentially malignant melanoma, and the children with this condition may have visual problems.  Happily this youngster is doing quite well and his parents are grateful to Kisiizi where medical students have helped by bringing out high factor suncreams for him. 

The condition may be socially very challenging for the family and child as there are various traditional superstitious beliefs surrounding this condition but we were pleased to see them coping better now after a lot of counselling support initially.

so much more than just a midwife!

It's certainly true that Hanna spends a huge amount of time on the Maternity ward, mostly in the Labour Ward, but she also manages to do all sorts of other things so here are a few photos...


The first shows her improvising in a power cut with a torch under the chin to keep hands free...
 thankfully I don't think she's had to use this technique for delivering babies...




 then there is the vegetable production, with an element of artistic sculpture work thrown in!



 There are times to sit down, so why not make the most of the beautiful view to the waterfall even if it is pouring with rain?!

In addition Hanna organises the Guest House bookings and looks after many visitors and provides a lot of hospitality.

Then she sometimes drives one of the hospital landcruisers through mud and dust... now happy to park back in Kisiizi and head for a cup of tea!

Weekend celebrations...

Drs Bryony, Henry, Paul and Bruce

On 18th January we had a party in our living room to say goodbye to Drs. Paul and Bryony who had worked with us for almost six months.  Paul had mainly worked on Medical and Isolation wards and Bryony on Paediatrics and they fitted in to Kisiizi very well.  We are grateful for all they have done, not only the valuable clinical work and teaching but also entering into the life of the community and sharing in the fellowship.

We also said goodbye to the visiting urologist, Steve Foley and his registrar Paul plus a visiting student Phoebe all from Reading.  They had been with us for a week and the Urology camp had gone very well.

Jemma and Bryony

We were also delighted to welcome Dr. Jemma Say on the Royal College of Paediatrics & Child Health Global Links scheme to Kisiizi, she will be with us for about seven months taking over the work done by Bryony.





 

 The following day we travelled to Kabale with our friends Moses and Josephine to take part in the service of consecration for the new Bishop of Kigezi, Bishop George who Moses has known for some years. 

There was, of course, a huge crowd and the Prime Minister attended so it was the second time we met him in three weeks!




We drove back over Shoko Hill and enjoyed the beauty of the Kigezi landscape...

Whirlwind!

Apologies to our regular blog visitors for the delay in posting but the last few weeks have been a whirlwind... Ian went to World Health Organization in Geneva for a workshop on Universal Health Coverage [ensuring all people have access to healthcare] and Patient Safety & Quality.  It was a privilege to be one of only five worldwide locations selected for this "learning laboratory" workshop and we had a very good meeting and hope much of value will result.

On the way he was able to snatch a day in Holland to see Hanna's father and other members of the family and then hop to Manchester to see Mark and visit our church TFW in Macclesfield.  Also a very brief visit to former colleagues at the hospital and a lot of phone calls to relatives and friends.  So hectic but very worthwhile...

It worked out really well that his flight back to Kigali, Rwanda, arrived only a few hours before Ruth was due to come for a Christmas visit... only problem was that Turkish Airlines proved unreliable and rude and unhelpful when she missed her connecting flight in Istanbul so ended up arriving a day later than planned.

This meant Ian and Ruth met up with Hanna on 23rd December and got to Kisiizi just in time for the staff christmas party that evening [see www.kisiizihospital.org.ug for blog post and pictures of the party].

Then we had a lovely "bring and share" meal on Christmas day after the service in a very full chapel.  On boxing day there was a more traditional meal with the European contingent so we did very well and put on a fair bit of weight...




...which we immediately lost again getting ready for the meeting yesterday, 28th, when the Prime Minister flew in by helicopter to launch a new tourism initiative... see www.kisiizihospital.org.ug for a blog post and photos of this visit.  The photo here shows the Prime Minister unveiling an artist's impression of a monument to be set up near the falls.

Now we are off for a day's break with Ruth and on to Rwanda tomorrow to take her for her return flight.
When we return on 31st, we will prepare for a Management Committee time away 2-3rd January for Strategic Planning for the year ahead...

Countdown...

Maternity on a quiet day

Lots of plates spinning at present as we prepare not only for Christmas and Ruth's visit but also for Hanna organising a maternity tea party next weekend, sorting out 50 people arriving from Mbarara on a mission here for a week and coming on the same day there is a wedding party in the Kisiizi primary school hall not to mention the continued heavy workload on maternity.
I was thinking the other day as I was cutting Hanna's hair that life can be quite busy.  And, this very morning, as I prepared Hanna's breakfast, I was mentally ticking off the things I need to do before leaving on Thursday to travel down to Kigali to catch a night flight to Nairobi to connect to a day flight to Amsterdam... then on to see relatives including Hanna's dad, then back to Schipol to fly to Manchester. Then on the following Wednesday to World Health Organization for interesting meetings in Geneva.
So at the weekend, while I was polishing Hanna's shoes, I was contemplating that my retirement is quite varied and I can't complain of boredom!
Right, having teased my dear wife I have to be honest and say she does far more for me than I ever do for her and I am so grateful!  It can be high pressure here and having such faithful and loving support is a great blessing.

Of course we have learnt over the years that we can never guess what may happen... for example about 3 weeks ago we heard that the Banyakigezi, a group of influential successful citizens from this region living in Uganda or overseas want to encourage more tourism in Kisiizi, partly relating to the history that in the past tragically many unmarried girls who became pregnant were pushed over the waterfall.  Thankfully what was a place of despair, killing and death has now become a place of hope, healing and life and we want to portray that transformation in some sort of monument.  They may be bringing around a hundred people on 28th December to visit!  There is actually a lot of interesting history here with the original flax factory building having been built by prisoners of war, and the whole story of the hydro-electricity plus a beautiful location with amazing birds...

Then into the new year we hope to have  Management Away Days to plan strategically for the coming year.

Travel log...

We have done a fair bit of travelling recently and more to come...

We went up to Kampala together for a meeting at Makerere University Guest House for members of the Uganda Maternity & Newborn Hub partnerships and for the Royal College of Paediatrics & Child Health Global Links Scheme.  Dr. Josephine Nantongo, our Consultant Paediatrician, came with us and did a joint presentation with Ian on Patient Safety programmes in Kisiizi.  We met up with Maryanna, our registered nurse on the Hub programme, and with Mandy, our new Hub midwife who will be with us in Kisiizi for six months.

Then last week Ian drove to Mbarara 80 miles away and then went the next day on a coach to Kampala, left his bag at a motel, and braved public transport through busy Kampala to the CORSU hospital near Entebbe.  This is a specialist facility providing expert care for orthopaedic and plastic surgery problems, especially for children.  We hope to have a Memorandum of Understanding to facilitate trips by teams from Corsu to help us with paediatric orthopaedic camps in Kisiizi.

Then Ian attended the Uganda Protestant Medical Bureau [UPMB] Council meetings the next day and in the afternoon went up to the top floor of a very posh building in central Kampala to meet with National Social Savings Fund officials.  Contributions to this scheme are similar to National Insurance in the UK.  Having understood that we were very compliant with the scheme an audit has suggested some payments for some staff had been omitted so Ian went to discuss the issues and to see how we can move it forward.

The following day was the UPMB Symposium with one or two hundred people present.  Their annual report and new strategic plan were presented and Ian gave a presentation on aspects of patient safety work in Kisiizi.  Then a group photo, then on a motorbike boda boda through the rush hour traffic to the bus park to get a coach back to Mbarara... meant I got there about midnight. Drove back to Kisiizi the next day after an informal interview with a potential senior member of Staff and then back into on-call mode as some children needed review.

Now having to think about the next trips:  Ian has been invited to Geneva for a World Health Organization meeting on 19th and 20th December and is aiming to go a couple of days earlier to fit in a short visit to family in Holland and then a quick trip to Macclesfield to see Mark.  After the Geneva conference he will fly back to Kigali and, very conveniently, will arrive there just a few hours before Ruth so they will then travel on together the next day to Kisiizi.

Snapshots...

Life in Kisiizi is very varied with so much going on all around....
each patient admitted to a ward will have an attendant to help with feeding, washing etc. so there can be large numbers of people around at times. 

Then some will just sit on the grass and have a rest if the chance arises.

Construction work continues in different areas of the hospital estate.

Here are trees felled to prepare the site for our new Mental Health Unit being sawn into planks.

We are hoping to build a further dormitory for our School of Nursing in the next year or two, and meanwhile work continues on the Mothers' Waiting Home...

 

Meanwhile the multiple types of birds are all around... such as these hammerkops:

 

The clinical work goes on 24 hours a day.  Here is our Maternity Ward, which can be frenetic.  The other day Hanna had 3 ladies all with problems needing to deliver at the same time so it can be challenging.

Attendants will arrive with food for patients, often carried in baskets on their heads in time-honoured fashion. Of course the mothers with young infants will carry them on their backs at the same time.

Numbers...

40...  the number of pineapples I bought from a road-side stall on the way back from Mbarara... most of them for our School of Nursing students who don't always get a very varied diet... in fact often they have posho and beans twice a day [posho is a maize flour porridge rather like "Ready Brek" in the UK but without the milk!]

Also bought one or two onions....

4...  the number of cardiac arrests this 6 week old girl had today...
she arrived in our out-patient/Accident & Emergency area labouring to breath and had her first arrest... then 3 more on the ward. 
I think clinically she has Down Syndrome [not diagnosed previously] and had severe pneumonia and wheeze.  She may have an underlying heart problem though we cannon hear a murmur at present.  I have just done the night round to review serious cases and happily she is much more stable now...

 5... Essentials for any good office secretary!

 

    

3... spontaneous triplets born at 4am a couple of weeks ago and all making good progress...

 

Too late...

Increased maternal mortality is multi-factorial

 The photo shows a national newspaper article published earlier this year.  It discussed the many issues that may increase the risk of mothers dying associated with pregnancy and childbirth.

Sadly we experienced a local incident recently. Last Wednesday evening we had a tragedy where a mother in labour was brought to Kisiizi but was dead on arrival at the hospital at around 11pm.

The story behind this sad event is that she had had a previous Caesarean section in one of her nine previous pregnancies.  She went into labour in the village where she lived.  She was taken to a local drug shop / clinic we think at around 3pm and it seems that there was then a long delay before she was put in a vehicle to come here at her own request.


From the description given by the attendants, we suspect she developed a rupture of the uterus through the old scar.

This is the sort of patient who should always deliver in hospital. Most mothers want to deliver at home if possible, partly for cultural reasons, partly economic as it costs a lot in local terms to arrange transport as well as hospital costs, food etc.

One response in Kisiizi is the construction of the Mothers' Waiting Home sponsored by Kisiizi Partners.  This will allow mothers at risk to wait here so when they go into labour they can be moved to the Maternity Ward easily and quickly.
We are following up the case with the District Health Officer and will continue to try and improve health education of both public and community professionals to try and avoid such cases in the future.

Cuisine extraordinaire!

Okay, those of you in Europe will know that the French are encouraging high-end restaurants to include various insects on their menus... but Kisiizi have been doing it for years!  Only problem is they are seasonal...

Here is the extent to which villagers will go to catch grasshoppers at the right time of year - with lights, long pieces of corrugated iron [usually used as roof sheets] and old oil type drums to catch the insects disorientated by a smoky fire.

The result, after removal of heads and wings and frying in oil is as shown below.... brought for us today by a kind neighbour... tastes like shrimps [if you have a good imagination like my wife!]

maybe could do with a few chips?!

"Her tummy's so big, Doctor..."

This little girl presented with a history of significant abdominal distension and discomfort for some time.


Her case illustrates the value of appropriate technology, in this case ultrasound.

The scan demonstrated a cystic lesion thought to be a pancreatic pseudocyst and this proved to be the case at operation when it was removed.

She bounced back really well and her parents were delighted.

 Our only imaging modalities at present are ultrasound and a static x-ray machine.

Our friends in Chester have very kindly donated an image intensifier which will allow real-time imaging and this would be especially useful in procedures in theatre such as orthopaedic manipulations to assure correct re-allignment of fractures etc.  However, our estimate for transporting the equipment here is between five and six thousand pounds sterling.... ummm!

Sun day...

A group of us made a day trip on Sunday to visit Bwindi Community Hospital which is quite remote and very close to the location of some of the groups of gorillas.  It took us about 3 hours with breaks to reach Bwindi but we had a very warm welcome from the staff.

One reason for the trip was to visit a former member of our nurse training school now working in the hospital in Bwindi who unfortunately was burnt by a paraffin stove and is in the ward having treatment.  She was much encouraged by the group.
We enjoyed the tour of the hospital and time to catch up a bit with Kieran & Sarah, two UK doctors we had met before they came out to Uganda when they did the Developing Health course with us.

On the way back we kept watching the sky which was rather cloudy but happily it cleared a bit and we were able to see a partial solar eclipse.  Once more it makes us marvel as we enjoy the heavens...

Safari

After quite a long time working our socks off in Kisiizi we managed to get away after the launch of the Uganda:UK Health Alliance meeting in Kampala and we made our first visit to Murchison Falls National Park.  Having lived in Uganda for so many years it was becoming embarrassing not to have visited this famous place while quite a few of our short-term visitors had been.

So off we went with a backpackers tour agency for a couple of nights in safari tents...
after quite a long journey it was all worth it when we were able to walk to the top of the falls and were blessed with beautiful lighting and a rainbow.



The next morning we had a game drive and then in the afternoon a boat trip up the Nile to the foot of the falls.

We loved the giraffes, hadn't seen them in the wild in Uganda before as they are not in Queen Elizabeth park or at Lake Mburo. 

They are magnificent animals and looked very healthy with plenty of space to roam, appearing on the skylines like some sort of alien tripods in a row!














So we enjoyed the wilderness and beauty though the wildlife was a bit too near when a hippo decided to graze right next to our tent so we had to wait half an hour before we could enter!

On returning to Kampala Ian attended the National Intern Committee where it was encouraging to find Kisiizi having a very high profile.

Then on a coach to Mbarara that afternoon and chatting long into the evening with Esther Kobusingye, our former Principal Nursing Officer with whom we stayed.

Raising the profile...

We are grateful for a number of encouragements as we seek to raise the profile of Church of Uganda Kisiizi Hospital.  This is important not because we want to blow our own trumpet but being located in a very rural remote area, there are challenges in recruiting key staff.  So, for example, to ask a radiographer in Kampala to come to Kisiizi might be rather like inviting someone in Manchester to go and work in Iceland - their response would be the same "Why would I?! It's a long way away, it's cold, and they speak a different language"!

Dr Lukwago Asuman, Permanent Secretary, with Ian

The launch of the Uganda : UK Health Alliance in Kampala on 15th October was attended by key leaders from the Ministry of Health including Ministers, Director General and the Permanent Secretary.  The UK delegation was led by Lord Nigel Crisp who had run the NHS for six years.  Also present were key people such as the lead for DfiD in Uganda.

We were greatly encouraged that Kisiizi featured very highly on the evening.  One surprise was to find that the Permanent Secretary had been one of Ian's medical students decades ago! 

Lots of opportunity to network with some key leaders and we have invited a number to come to Kisiizi as we hope this will encourage the Ministry to second key staff to us and increase our budget support.

The following week Ian attended the National Intern Committee and again was encouraged to find Kisiizi receiving much praise and support from the Chairman who is the executive director of the national referral hospital in Mulago.

To add to all the above, a couple of days later Ian had a phone call from the Chairman of the Uganda Medical and Dental Practitioners Council [equivalent to the UK GMC] whom he had met a few weeks ago at a meeting in Kabale. He wanted  information about our Community Health Insurance Scheme to discuss with MP's next week.

We have also had Alia Fry's article about our amplification training for the WHO African Partnerships for Patient Safety heading up the APPS newsletter this quarter, and have contributed a vignette to an article in Archives of Diseases of Childhood in UK and submitted an article for the Contact magazine of the World Council of Churches. 

So we are grateful for these opportunities to raise the profile and pray for good fruit from it all.

What's round the next corner???

A number of unexpected “Goliaths” have crossed our path recently....

Money:                                 

The hospital was audited by a national savings fund [like National Insurance] to which we make mandatory contributions.  We had thought that we were excellent in our compliance but they shocked us by stating that some groups of workers whom we had understood to be exempt from the payments should have contributed.  We have had some good meetings to try and find the way forward and hope the matter will be positively sorted soon.

Danger:                               

 Ian was coming back home on Friday evening 11^th October and thankfully spotted a snake next to our house.  The security guards nearby came and rapidly dispatched the reptile with rapid and heavy blows from sticks so it was dealt with very quickly.  It is actually very rare to see snakes near our houses or in the hospital area but they may have been displaced by the wildfires in our forest areas we described before.  Our main concern is the young children in our community so we will have a thorough session on cutting back long grass to try and avoid the risk.

Health:                 

Having just recovered from a mild viral illness which settled with simple symptomatic treatment,  Ian felt fine again on Monday morning 7^th October but then out of the blue developed pain and swelling in the right wrist and then, overnight, the same symptoms appeared in his left shoulder.  The result was a lot of discomfort but also very limited function.  Fortunately having married the world’s best nurse, it was dealt with very efficiently. [by the way we do recommend you google on “Man flu” on Youtube to enjoy a sketch which will make you sympathise more with Laura, I mean Hanna!]

After a couple of days of high dose ibuprofen and paracetamol and a wrist splint, it was actually getting worse and I had some general fever.  My colleagues commenced me on intravenous antibiotics and “slowly by slowly” as we say here, it is improving. 

Thanks to all of you who have supported us in your prayers that, like David, we might stand in faith and confront the giants that very unexpectedly try to block our path....