24. The Journey Home – Our Final Day

Saturday 24th November 2012

 

Kisiizi Hospital Chapel

It’s yet another early start to the day. I am in the shower for 5.45am and it is still pitch black outside. I have two blogs ready to send but despite my best efforts last night I have no luck with attaching the word documents. I look in the ‘mirror’ again on the way out to check it I look as tired as I feel – I can’t believe I am still getting caught out by that after two weeks! I decide to walk to the IT Department after breakfast and although they are not open, I imagine that anywhere just outside the office is likely to offer me the best chance of a decent internet connection.

 

I have a quick breakfast, dry my hair and put the last few things in my case before walking down to the hospital carrying my laptop and am relieved to find I can quite easily connect to the internet and my documents are sent relatively painlessly. It’s back to Rose Cottage and I have a few presents to leave for the staff there from all the team. I am giving my grey hooded sweatshirt to Amozaic, some money for Philip to buy a present for Treasure, his new baby, two T shirts for Doreen (not Goat Project Doreen, but young Doreen who is a student and helps out in the kitchen to earn some money to buy books for her studies), and half a bottle of Body Shop Papaya Shower Gel and almost a full tub of Cocoa Body Butter for Eugulas. I give everything to Philip and ask him to pass the gifts on with our thanks for looking after us all so well. It’s time to get the cases over to Ian and Hannah’s house which is the location we are meeting at. Tom gets bonus point this morning from the girls in the Round Houses for helping to bring their cases. We agree later in the car that Tom has now earned enough points over the fortnight to graduate today as a man and will no longer be referred to as ‘young boy’. I forgot to mention yesterday that he saved Carolyn from falling into ditch in the road by grabbing her as she lost her footing near to Rose Cottage. She’s now got a bruised arm as he grabbed her pretty fiercely, but she agreed that this was preferable to having been run over by a Boda Boda.

 

There are the seven of us travelling plus Angela, who we are giving a lift to Kampala as she is attending a week’s anaesthetic conference and Fiona, Dr Rachel’s Mum, who is also visiting Kampala. Sampson from the Pharmacy Department is expected but he doesn’t show by 8am and there is no answer from his house so we assume he has changed his mind. We have quite a bit less luggage going back as much of the equipment we brought has obviously been left at the hospital, so with two vehicles ordered for the journey home and just nine passengers, two drivers plus luggage we have much more room than we had on the journey here. It is certainly going to be a more comfortable ride back. Ian and Hannah, Moses, David, Dr Josephine and several other members of staff come to wave us off. Some of the cases were loaded into the backs of the vehicles but the majority were covered with tarpaulin and tied on the roof of our vehicle. Our driver is Bosco, who is sporting a Liverpool shirt with his name printed on the back and the other vehicle with Sam, Sarah, Fiona and Angela is being driven by Augustine who has a reputation for being a very fast driver so we expect them to arrive at our destination well ahead of us.

 

We’ve not travelled far down the road when Augustine stops outside Stella’s guest house and Sam pops in to say goodbye. Ten minutes later they catch us up and draw alongside and a black carrier bag is offered to us through the open window. Stella has done us proud! It’s a bag of warm cheese and tomato toasties for the journey and they are delicious. It is interesting experiencing the first two hours of our journey in daylight – it is just as bumpy as it was on the journey here, but somehow more acceptable because we are not completely in the dark. We see two young boys carrying yellow water carriers and Carolyn asks me if I have seen what they use as stoppers. I hadn’t and found it amusing to learn that a banana was the most common ‘stopper’ used by most Ugandans! We see a crested crane (the National bird of Uganda and very beautiful) in a field but were moving too fast for me to get a photo. But at least I had seen one now. It was only about 9am but already the sun was fierce and I could feel the heat on my right arm through the window. Soon after, we pass a convoy of seven Red Cross Land Rover Discoverys on their way to the Congo, followed five minutes later by a UN vehicle. We stop at the Agip Hotel in Mbarara for a toilet break, a coffee would be good but apparently we are pressing on and the next stop is for lunch. We have made good time so far and are hopeful that we might reach The Boma in Entebbe (the guest house we stayed at the first night) in time to have a shower and a meal before heading off to the airport. Not long after coffee break we are pulled over by Traffic police, but they are pretty friendly, unlike those we met on the journey here and after checking Bosco’s licence they wave us on. I suddenly have a bit of a panic as I realise I have no idea where my e-flight ticket is but everybody assures me there is no need to worry as long as I have my passport which thankfully I have in my handbag. (I will be reminding them of that later when we are at the airport). We pass a grasshopper trap – a large light with sheets of aluminium and a drum underneath. This we learn from Bosco is the most effective way to catch grasshoppers. Incidentally last Thursday when I was ill with my bad throat and there was a tray of roasted grasshoppers for dinner that I missed out on, I forgot to mention that they weren’t served for dinner as had been expected. When Philip was asked why not, he explained that they had been cooked to feed to the chickens. Seems pretty strange that you would cook something to feed to a chicken, so not sure what all that was about, anyway, talking about grasshoppers, Bosco tells us they are delicious. You apparently pull off the wings and legs and fry them in some oil. Think I will give them a miss if they are on the lunch menu. About half an hour later the car slows down a bit and Bosco announces we are in the area where we may see zebras. He spots a couple in the distance and with my zoom on the camera I manage to see them too. The other car pulls up behind us and Sarah decides she needs a closer look. She crosses the road, a very busy road, and must have misjudged the speed of an oncoming car as it misses her by a whisker! How ironic would that have been if we’d had to return to Kisiizi with Sarah as a patient! Further on we see a field with dozens of trees full of white flowers, except on closer inspection they are not flowers, they are birds, hundreds of them – a type of crane and because the field is flooded they all perch in the trees to keep their feet dry!

 

We stop for lunch about 1.30pm at the Highway Motel – the name is a bit deceptive – it’s an outdoor courtyard area with plastic tables and chairs and a few parasols - the same place we stopped at on the way here. Let’s just hope that because we are a little earlier today, they will have more items available on the menu than they had last time. No, it seems not. There is no fish which is what most people fancied, so a couple of people choose chicken and chips the rest decide on omelette and chip, some cheese and some Spanish. Augustine opts for the buffet menu so there are 10 of us ordering off the snack menu. Three meals arrive, followed about 10 minutes later by another three, and 10 minutes later another three and the final omelette arrives about 45 minutes after we ordered. There appears to be no difference between the Spanish and the cheese omelettes. The chicken portion looks like a large wing, very little meat on it so it’s really just deep fried skin and bone. I have ordered a beer after first checking it is cold. Carolyn fancies one too so our waiter brings two bottles but explains there is only one cold one, the other is lukewarm. What sort of restaurant has only one chilled beer available? I tell him we will share the one cold bottle. Just before we are ready to leave a guy comes round the tables selling plastic chickens. They are just plastic junk really and I am about to say no thanks when he pulls a string from the chickens bottom and it runs across the table flapping its wings and ringing a bell. They are quite amusing and very cheap so I buy two as I am sure they will provide some entertainment for Erin and Naomi – my two youngest grandaughters. They certainly give everyone round the table a good laugh!

 

We get back in the vehicles for the remainder of our journey and are soon driving on another very uneven and dusty track, so have to shut the windows for a while, even though it is baking hot. Before too long we are at the Equator again and agree on a 15 minute stop to have a look at some of the shops and for a toilet break. I get drawn in by a few of the traders wanting to show me what they have for sale and lose track of time a bit. I bump into Carolyn and she tells me about another shop she has seen selling soapstone bowls so I have a look, make some purchases and suddenly realise I have been 25 not 15 minutes. I am full of apologies to the rest of the group and we set off again. Ten minutes up the road we hit a major traffic jam. There are serious road works with no traffic light system just a manual and extremely ineffective traffic control system involving a young guy holding red and green flags which he waves in sequence at both queues of traffic, but nobody is taking any notice of him ... it is just like Wacky Races!

 

Tom has bought an elephant at the Equator and it is in the same type of small black plastic bag that Stella gave us the toasties in. Beccy and Haley decided to get rid of the rubbish whilst waiting for me to get back stop, and almost throw his elephant away in error. This gives them an idea. They swop bags and replace his elephant bag with rubbish bag and later when they ask him to show them the elephant, he opens the black bag only to find the few remaining uneaten toasties and other rubbish, but no elephant. He is convinced for about half an hour, until they put him out of his misery, that they have thrown it away. We are almost at Entebbe when we see the most ingenious mode of transport you could ever imagine. A guy on roller skates has grabbed hold of the back of a mini bus taxi and is getting a free ride. Looks pretty scary to me and we follow him for a couple of miles before we turn off so don’t know how he manages to get off when he reaches his destination. Presumably he has to wait until the minibus stops nearest to where he wants to be!

 

We are at the Boma and it is almost 7pm so the journey back has taken 11 hours as opposed to 12 hours on the day there – a bit of an improvement but definitely a better journey as we have had so much more space inside the car. We say goodbye to Bosco and Augustine before sitting down to order a meal – most of us choosing salad. We are just getting to the end of the meal when somebody spots three geckos on the roof above the table. Just as Sarah gets out her camera to take a photo, one hops on top of the other and starts thrusting. This has to be a first ... there can’t be many people who have seen two geckos mating? It’s all over fairly quickly and we have a good laugh at what will probably remain one of our final memories of this Ugandan trip.

 

We set off for the airport in two taxis provided by The Boma. As we are nearing the airport, there is a (fairly large) Go Slow sign in the middle of the road and our driver is heading straight for it at speed. He has clearly not seen it and swerves at the very last minute narrowly missing knocking it over. A few minutes later we are pulled over by a Security Guard who tells us he is looking for terrorists and asks us if we are carrying any guns or other weapons. If we had been, were we likely to admit it? It was a very strange security check.

 

We get to check in and the first thing I am asked for is my e-ticket which as you know, I don’t have. There are a few raised eyebrows by the airport staff but I am eventually waved through. At this point Sarah suddenly realises she is one case missing – it has been left behind at the security scanner – not sure how long it would have been before it was taken away and destroyed as those security announcement you regularly hear at airports are always threatening.

 

The flight from Entebbe to Amsterdam is fairly straight forward although I can’t get comfortable and only get about one and a half hours sleep. We arrive at Schiphol airport at about 6am EU time. Our flight departs at 8.20am so after checking out the location of the departure gate, we separate to look around the shops and arrange to meet up at 7.30pm. I get a couple of items from duty free then go in search of somewhere I can plug my computer in as I have very little battery power left. I purchase an EU adaptor and head up to the Business Centre where I get about 50 minutes to write a bit more of my blog. Haley has a mild panic at the final security gate before we board as she has four loose paracetamol and ibuprofen tablets in her money belt. How suspicious is that going to look – a Pharmacist carrying drugs for personal use. But there is no problem and we all board the plane. We will be back in Manchester in just over an hour ... in total we will have spent 28.5 hours travelling since leaving Kisiizi Hospital yesterday. As I contemplate all the entries I have made over the past two weeks and before I finish this final blog, there are several people I want to express my appreciation to. Firstly for Sarah for giving me the opportunity to join the group and have what has been most amazing and incredible experience for me. Also to the others - Haley, Beccy, Sam, Tom and Carolyn for making me feel welcome, and including me as part of the team. I send a ‘Big Hug’ to Peter for encouraging me to make the trip. Even though we have already been away twice this year (we’ve had a family holiday in Spain and an Anniversary trip to New York), so the cost of a trip to Africa had certainly not been budgeted for, but he never complained about the extra expense. I also want to say a big Thank You to Andy, one of our longstanding Countess volunteers who set up this blog for me. Despite uploading my first messages at Schiphol on our outward journey, once I got to Kisiizi, I was unable to upload any further messages – something to do with the slow internet speed I think. So I have written all the messages and sent them as word documents to Andy with my photos and he has spent time designing the layout and style of the blog and has uploaded everything for me. I was only able to connect to the blog page last Wednesday for the first time to see what a great job he has made of it – much appreciated Andy.

 

And finally to you, thanks for making the time to read about my ‘African Adventure’. I hope I have provided you with some insight into Kisiizi Hospital and the achievements that have been made by working in partnership with the hospital. I hope that you have enjoyed the snapshot of Ugandan life and the amazing people who live here that I have tried to provide. As I have said before, I did not really know what to expect but I suppose at the back of my mind I had images of a dusty, barren region and not the beautiful rolling hills, the expanse of green fields with lush vegetation and the fantastic range of exotic plants and flowers that are so typical of this area. The only other images I had in my mind of Uganda were of the TV footage I saw in my late teens and early twenties of the brutal killings under the regime of Dictator Idi Amin, and then more recently when I watched the film ‘The Last King of Scotland’. This is not the Uganda of today. It is extremely unlikely I will visit Kisiizi again, but I know that this experience will stay with me forever. Kisiizi Hospital and all the people I have met here will always have a special place in my heart.

If you want to know anything else about Kisiizi Hospital you can email me at: janet.ratcliffe1@nhs.net

If you want to view the photographs I have taken over the trip you can see them on a Flickr Slideshow

 

23. An Emotional Day

Friday 23rd November 2012

 

The drum that calls people to prayer

Up early again today – the pressure is now on to try and catch up a bit with my blog otherwise I will be writing it when I get home. I’ve also got several things that I want to fit in to my last day here. I am meeting Doreen at 9.30am to see the Goat Project that she runs and definitely have to find a way to get my money exchanged. My skirt and dresses need collecting from the Sewing Room, a visit to IT is necessary to sort out sending my outstanding blogs and photos, plus I have to find time to call at the local shops to get some G nuts for Philip to roast for me to bring home. I have some clothes and cards that I want to drop into Night to give to the families I met last week and Tom has some other clothes for her to distribute generally to needy families in the local community. There is also a Management meeting I have been invited to at 4pm and I have to pack as well. It’s starting to feel like a busy day at The Countess!

 

I can hear the sound of the drum beating to call everyone to Chapel so I make haste. I don’t think I have mentioned the drum yet? It is tied to a tree opposite the Outpatients Dept and is used throughout the day as a method of signalling that things are about to start or finish. The banging of the drum announces the daily Chapel service, Banana break, start and finish, lunch break start and finish and at 5pm to let everybody know it is the official end to the working day for many workers, although not the nurses who work on shifts obviously. In Chapel after the initial hymn, names are called out as usual for the daily rota of staff members who have been nominated to lead prayers in each of the wards. Those named take their leave and the service continues with a bible reading followed by interpretation and translation of the passage, then prayers. During announcements Ian Spillman stands up and thanks the Countess team for all their hard work over the past 2 weeks and for the continuing partnership between the 2 hospitals which is helping to continue improving standards of care for patients. We each then have the opportunity to stand up and say a few words about what we have been doing during our time at Kisiizi, and everybody seems pleased to hear that today we will be ordering more than 100 replacement mattresses. Prayers are offered for our safe trip back to the UK the next day and then a hymn along the lines of “May God keep you safe until we meet again”, is sung with everybody waving farewell to us at each chorus. It is really quite moving.

 



Janet with Peter's goat (he's the one on the left!)

Angela arrives at Rose Cottage with Doreen at 9.30am as she is interested in learning more about the Goat project. We walk down the road, past the school and several little huts referred to as the local shops and on the right hand side of the road is a sign and an opening in a metal fence mesh fence through which we enter. The project was started in 2008 and Doreen liaises with the Children’s ward to identify families where children have been admitted suffering from malnutrition. The families are offered a goat which will provide milk as additional nutrition for the child or children. To ensure the project continues to develop and expand, some families are given both a male and female goat in the hope that they will ‘get together’ and produce one or more offspring. There are several mothers and kids in the pens tucking into some tasty looking greens that they have fill their feeding troughs. They all have really cute faces. I did indicate on a previous blog that I would probably be sponsoring a goat as part of Peter’s Christmas present. Well Peter I hope you didn’t think I was joking. I asked Doreen to take of photo of me with the goat that will soon be heading off to a local family to provide them with a constant supply of milk for their children, and I can’t think of a better pressie that I could have given you. I might also get you a little surprise to open on Christmas Day as well!

 

I am on my way to the IT Dept when a lady walks up the path towards the front door of Rose Cottage with a basket containing about 10 or 12 tomatoes. Philip is in the garden so I ask him to check if she is ok with me taking her photo. She agrees and I ask (through Philip, obviously as I am not yet fluent in Rukinga) whether she has been to the shops, but Philip explains she has come to the Guest House to try and sell the tomatoes. I ask how much they are and he says 3000 which he indicates is a good price (75p) so I offer to buy them for Phillip. Both he and the seller seem pleased. I probably paid a bit over the odds but does it matter? I don’t think so. I also give Philip 4000shillings (£1) to get a kilo of nuts from the market and he promises to roast them for me after lunch. I get to see Edson a bit later than planned but manage to send off my blog and photos which is a relief. Then it’s off to the Staff Room for Banana Break and Sam arrives a few minutes later armed with a bag full of sweets, including Haribos and chocolate treats that she puts out on all the tables for the staff to enjoy. It’s a lovely gesture and clearly appreciated by everybody there. A bowl is brought in so that some sweets can be given to the team in the Finance Dept, who by the way have sorted out my exchange of money so I can now pay everybody back what I owe them. After a couple of small bananas and a cup of peppermint tea I walk back to Rose Cottage to get the clothes and cards to take to Night’s office. She is most appreciative. I spend about half an hour time taking some last minute photographs around the hospital grounds. As I walk past the Outpatients Dept, there are still several benches full of people sitting there waiting to be seen. People start arriving from around 7.30am each morning without an appointment; it’s a bit like attending our A&E Dept I suppose, and then on the other side is a building where patients with prearranged appointments go.

 

Sarah, Sam, Tom and I have been invited to Ian and Hannah’s house for lunch at 1.30pm. The Pharmacy team were invited yesterday. We have a really delicious lunch of potatoes, chapattis, G nut sauce, cauliflower with tomato and onions, with a mixed salad, then slices of papaya for dessert.

At 3pm I go the Sewing room as arranged to meet Joselyne but she explains she has not quite finished but will have them ready later and will drop them to into me at the Guest House. I suggest I pay her now as I am not sure what time the Management meeting with finish. She has made a skirt for me and three pinafore dresses for my three grandchildren and only charges about £9 but I give her more. I check whether she has been able to make skirts for Shivau and Precious. Because the piece of material I had bought last week was fairly large I suggested to Joselyne that she could make a couple of simple skirts with elasticated waists for them. I don’t have their measurements but show her photos and she estimates the size. She hasn’t been able to finish these in time but promises she will make them next week and drop into Night’s office. I ask her how much I owe for these two but she says she doesn’t want any payment, she knows they are for orphans and she is happy to make them for no payment. She explains that she looks after two orphans as well – I think when her sister died she took her nephew and niece in to live with her. I am really humbled by this gesture. She has very little money herself but she has such a kind heart that she wants to do this. I don’t see her later when she drops the finished dresses off as I am still in the meeting but when I open the parcel she has also made little shoulder bag to match the dress for Heidi – without me asking, and for no extra payment. This is so typical of the generous nature of the Ugandan people.

It’s now 4pm and time for the meeting in the staff room. The seven of us are there and apart from me everybody has prepared reports to be presented to the group. Ian and Hannah are joined by Moses and Father Patrick and we are advised that Sister Anne may join us later but she is currently busy in the Paediatric department. The purpose of the meeting is to feedback what has been achieved during our visit and to report on any challenges that are still being faced. Suggestions will be offered for different ways of working that may improve outcomes based on experience of working practices at The Countess, but our teams never go over to Kisiizi with the intention of forcing or imposing our ideas. This is a partnership and for it to work effectively, each hospital has to be able to see things from the other’s viewpoint and respect the fact that may be genuine reasons why sometimes things can’t be achieved as quickly as anticipated, and that equally there are times when indications are given that things will change but when this doesn’t happen, it can be very frustrating.

 

Haley and Beccy present the pharmacists report and confirm that the audit that have undertaken on the Prescribing Standards show improved results. As discussed at the D&T meeting this morning there are still some improvements that need to be made. The girls have prepared written reports which they will leave with Ian and have put together an audit toolkit so that audits can continue in the department after they have left so that the progress can be monitored on a regular basis. The ARV reporting shows a considerable difference in what is being reported compared to what is moving from the shelves which would explain the variance on stock levels. Carolyn confirms that further improvements will be seen once the new IT system is up and running and the overnight cupboard and emergency boxes on wards will also help. The storages shelves have been re-organised and re-labelled. The Pharmacy Dept is now making strenuous efforts to capture data correctly. It was also acknowledged that there is a need for a second check to be introduced on student nurses when they are dispensing. It was agreed that the new IT system would be set up to be ready for the new calendar year at midnight on 31st December. It was suggested that it would be beneficial for Carolyn to perhaps come back in February/March to see how the system is operating.

 

Sam gave an overview of the APPS Programme confirming that the four key areas were : Hand Hygiene; Waste Management; Safe prescribing; Safe Surgery Checklist (WHO). She had undertaken a review of systems and procedures in all areas and confirmed that policy documents were now available on all wards. There was a bit of an issue regarding Hand Gel in that on the day she and Sarah undertook an audit there was no hand gel in Outpatients. It was agreed that this would be looked into. The need for accurate discharge information to be recorded was discussed and it was agreed that this was a challenge – not just here in Uganda but in the UK as well. Various recommendations were made regarding the Waste Compound but it was agreed that massive improvements had been made in this area since the last visit. Standardising the colours of the waste bins to red and black was agreed in principle but cost implications would need to be looked at.

 

Tom gave the result of his audit on the WHO checklist which indicated that only 18% of the forms had been fully completed. Ian asked that we ensure the stats distinguish between elective and emergency surgery. It was agreed that there is a need to educate and train the staff as to the importance and the benefits of completing the checklist before all operations.

 

Ian thanked everybody for their input and Sarah suggested that although officially the three year partnership would be coming to an end around February 2013, and no further funding had been offered from the British Council to continue the three programmes, she hoped that this would not signal the end of the partnership. She would like to feel that there could be a way we could continue to support Kisiizi Hospital and reiterated what I have heard several times during my visit here; this is a two way partnership where Countess staff members are learning from working with the Kisiizi teams as well as us them learning from us. It was time to say goodbye which was quite emotional, but everybody agreed that we would find ways of making sure the links, professional relationships and friendships that have been made, will continue.

 

It was now after 6pm, very warm and most of the team wanted to get a shower before dinner so we went our separate ways and met up again at 7.30pm for a farewell meal of beef stew, beans and potatoes followed by rhubarb crumble and custard. We said goodbye to Peter and Angus but David said he was coming at 8am in the morning to wave us off. After that we headed back to the Round House to have another round of Bananagrams and to finish the wine off. I don’t stay too late as I still have my packing to do and my Wednesday blog to finish.

 

This will be my last night sleeping in Rose Cottage and as I settle under the duvet I think back to the first night I arrived and how, in my naivety I found the facilities very basic. Having now seen first hand the very sparse conditions that many Ugandans live in, I realise that what I have here is palatial in comparison to what they have. The furnishings may have seen better days and the concrete floor and outdoor shower may have taken some getting used to, but actually how important are these I ask myself? The warm welcome, genuine friendship and hospitality that I have been shown during the past two weeks have made a far greater impact on me that had I been staying in a four star tourist hotel, in relative luxury but where the front of house staff demonstrate little or no interest in you as a person. This has been my first experience of Africa and my first experience of visiting a country in a capacity other than as a tourist, and I can definitely recommend both.

 

22. Haley’s Ugandan Birthday

Thursday 22nd November 2012

 

Haley's Birthday

I haven’t slept too well, it was probably the cockerel waking me up earlier than usual with his alarm call, so I am wide awake at 5am, I get up and make a coffee and start trying to get on the internet to send my blog at 5.30am and by 6.30am I give up. It’s Haley’s Birthday today, I sent her a Jacquie Lawson e-card last night, so I just hope there is sufficient internet strength so that she can open it. A new guest joins Tom and I at the breakfast table– we assume he is Michael (who was expected last night to help Carolyn with the new Pharmacy Stock control system but when we introduce ourselves he tells us his name is Emma, (yes I checked I didn’t hear it wrong) and he is a 20 year old student (not medical) that has come to have a look around Kisiizi. We ask him if he wants to walk up to Chapel with us and he does. I see that Father Patrick is in Chapel – that’s good, hopefully he can authorise my exchange of money later. On the way back Emma says he is very interested in finding out more about the hospital so I point a few places out and then suggest that he calls at the Administration office to meet whoever he is supposed to be seeing. He says he will do that later and wants to walk back to Rose Cottage with me. He asks for my email address, my phone number (which I don’t give him) and then asks Philip to take a photo of us together. I’m not sure where this is leading, especially when he asks me what the cost of the air fare is between the UK and Uganda. Peter – I have NOT invited him to stay..... I promise! He wants to walk up to the waterfall but I explain I have a lot of work to do on the computer this morning so he goes off on his own to explore.

 

I go back up to the Finance Office and hand over my English currency and am told to come back in the afternoon as all the paperwork to authorise the exchange needs to be signed by various people. This is clearly not going to be quite as simple a process as I had imagined. Back at Rose Cottage I spend about 45 minutes on my blog and then decide that it might be useful to type up an alphabetical list of all the place names so that whoever is entering patient data in future will have a document to refer to. Sarah arrives about 11am to check off the Excel spreadsheet with me. Two hours later we finally get to the end and it is a huge relief that I won’t have to look at these sheets ever again. This has been my least favourite experience of the trip so far! It has probably taken me a lot longer to complete the task than it would have done for somebody who has medical knowledge, but Sarah assures me it really has been a big help. Normally Sam would be sitting up until 1am one evening processing all this information. It is now lunchtime and I am definitely ready for something to eat. Chips sausage and beans are on offer today which looks very appetising. Unfortunately, although crispy on the outside, the sausages are bright pink inside and even though they actually taste ok, they don’t look very appealing, so Tom and I both leave ours and get some extra chips and beans instead.

 

I decide to try the Finance Office again to get my money so that I can settle my debts and also to make sure I have enough money to pay Joselyne in case she arrives early with the dresses. A guy has set up a stall on the grass verge opposite the Guest House, outside the school gates, and is selling shoes. He has quite a crowd around him but I resist the temptation to have a look. At the Finance office I am told the paperwork still hasn’t been signed and am asked to come back in the morning. This is now cutting things really fine but I am assured I will definitely get my money on Friday. I go down the Round House so that I can finalise the number of mattresses with Sarah as she is going to place the order tomorrow to buy 117 new mattresses in total which will be shared between the Children’s ward, one section of the Surgical ward, the Isolation Unit, Maternity Unit and the Medical Ward. These mattresses have been sponsored at £25 each from donations made to the Kisiizi Fund at the Countess. The order represents just under half the total number that need replacing and we hope that the remaining mattresses can be replaced before too long. Sam downloads the Excel spreadsheet on to her memory stick as she needs to incorporate the data into her report that she is finalising for the Management meeting tomorrow. I ask her how she feels the Programme overall has gone, and what the main achievements of this 2 week visit have been. It is a really useful 20 minute conversation and I learn a lot more about the Infection Control Programme at Kisiizi and the positive outcomes that have been achieved. I hadn’t realised but the partnership between the Countess and Kisiizi Hospital was one of only three African partnerships in the first wave of the African Programme for Patient Safety (APPS) that started in 2009 funded by the World Health Organisation (WHO). One big achievement at Kisiizi has been the increased awareness of the Programme and the improvements that have been made to patient safety as a result of the systems and processes that have been introduced. These have helped to reduce the risks around Healthcare Associated infections. There has also been a process implemented around Medication Safety where Sam has been working in partnership with the Haley and Beccy, our Countess Pharmacists on this trip, and Kisiizi Pharmacy staff, who have together been looking at prescribing standards and use of antibiotics. I know from conversations and various comments made by Haley and Beccy that there have been some challenges surrounding this issue over the past two weeks , in particular with one member of the Kisiizi Pharmacy team. However, more on that subject later, or perhaps tomorrow. Some of the data I had been entering on the spreadsheet was related to the Medical Safety Process, so although it was painful at the time, I can now start to see how everything links up. In fact that has been one of the really good things for me about this trip. Although back in the UK when we have been fundraising for Kisiizi, we tell people the partnership is based on 3 current programmes, Nursing, Pharmacy and Radiology, until I arrived last week I didn’t really have much of an idea what was involved. This trip has given me a much better insight into the work we are doing and why it is so important. Apart from the mattresses, most of the other money raised is to cover the cost of sending out staff out to deliver the Programmes. Sometimes it has been seen that we are fundraising to send our staff out here for a holiday, which as I have mentioned in a previous blog is not the case. If our staff don’t come over here and work in partnership to help improve conditions and suggest new, or different, systems of working, then the partnership would fail. Just for the record, I have self funded my trip and used two weeks of annual leave, it has not been paid for from our fundraising efforts. I am impressed to learn from Sam that Kisiizi Hospital was the first hospital in Uganda to appoint an Infection Control nurse and Sister Moreen is the nurse with this responsibility. Sam has introduced audit and surveillance systems and has seen a steady improvement on outcomes over the past three years. I leave Sam to her report and accompany Sarah on a visit to the Neonatal Unit as I am interested to see this area given the fact that we are soon to launch a major appeal at the Countess to build a new Neonatal Unit. The ‘Unit’ is a room, measuring not more that 10’ x 8’ with 5 incubators. Sarah asked the Sister in charge where the little boy who was in the incubator in the left is. We learn sadly that he died late yesterday evening. There is another little girl, very surprisingly wearing a Pampers nappy – that is rare in Uganda as babies normally don’t wear anything, nappies are too expensive. The mother is happy to have her photo taken but is insistent I send a copy to her. I am just thinking how on earth it will be possible to get a photo to her when she tells me she is a nurse at the hospital. So that is another one to add to my list of photos where I need to get extra copies printed, Max Spielman are going to get a big order from me when I get back!

 

Sarah and I then take a trip to the laundry to check whether the washing machine is in operation again yet. This is a large industrial washing machine that has transformed the laundry services at Kisiizi. Before the machine was installed, all the washing - sheets, blankets, uniforms – was washed by hand in three large stone troughs. A couple of years ago Sarah trekked the Inca Trail and raised £4000 to purchase the washing machine of which she is justifiably proud. She learned on Tuesday that the machine was out of use – not because the machine has broken but there is a faulty part in the electrical box and they have had to order a replacement from the nearest city. Thankfully it is back in working order today and so I take a photo of Sarah and the laundry team and agree to send them a copy to put up on the wall. I have to take the photo three times until they are all happy with the way they look on it. NB Peter.....so it’s not just me that likes to see the photos to check they are ok!

 

A surprise party has been organised for Haley at 6pm so I help to blow up a few balloons before walking back up to Rose Cottage. I’m just about to leave with a bag full of assorted sodas when Joselyne arrives with my skirt for a first fitting. It is not great timing! Unfortunately it is a bit too long and quite tight on the waist but she assures me she is happy to take the waistband off, redo it, and that will correct both issues. She brings one of the girls’ pinafores and it is lovely but just a bit on the large size. However better that, than being too small – the children can always grow into them. I arrange to meet her at 3pm on Friday as she plans to have everything finished by then.

 

I collect a basketful of cold sodas as my contribution to the party and walk down to the Round Houses. Sam has done us proud and the table has bowls of various crisps, chocolates and sweets on offer, and she has decorated inside and outside the building with balloons, banners and tinsel. We have plenty of wine left from our initial visit to the Supermarket in Kampala the day after we arrived, and Beccy has organised and paid for a fabulous iced Birthday Cake proudly baked by Amozaic. The seven of us are ready so before the rest of the guests arrive, Beccy presents Haley with a ‘Birthday Banana’ complete with lighted candles. Why a Birthday Banana you will be thinking? Well this morning Haley opened a card from husband James which said something along the lines of : “As you can’t have a Birthday cake you should put some candles on a banana (particularly appropriate as the staple diet of Uganda is bananas!) So we all sing Happy Birthday to Haley whilst she holds her special banana, making a wish as she blows the candles out. The other guests start arriving. Alia, an American IT specialist, who is at Kisiizi for six months as a VSO volunteer, Peter and Angus our Australian housemates and Sister Moreen with her boys Elijah and Bethan, and three year old Michelle, who is the cutest little thing you can imagine. Her hair is tied up into 2twofluffy bunches with another at the back. She is so lovely and everybody wants a photo. Although I’m sure Haley is disappointed at not being at home with James and her family on her Birthday, we do our best to make this Birthday a memorable one for her and then she can have a second celebration at home on Sunday.

 

Sam has gifts for the children, sticker books, bubbles and toy cars for the boys – as you can imagine they are very well received, as are the balloons that we all start playing with about 10 minutes later. We play ’keeping the balloon from touching the floor’ which really brings the children out of their shells and everybody joins in providing a great source of entertainment and amusement for at least fifteen minutes. Balloons are such a simple thing and yet they brought so much pleasure to the children and to all of us as we watch them having fun. I must remember to include some balloons when I send my next letter to orphans Shivau and Precious. I think Sampson is probably too old for balloons so will have to think of something different for him. The party has to end at 7.30pm as Philip is expecting us at Rose Cottage for supper. Bethan, Elijah and Michelle fill carrier bags with their gifts and some balloons and set off for home.

 

We have vegetable curry and rice followed by crumble – a lovely Birthday meal which was enjoyed by us all. We are sharing memories and photos of the past two weeks and I must be getting brave in my old age as I look at a photo of a huge Wilms tumour that was removed from the stomach of a 3 year boy during an operation the previous week. Tom spent last week in theatre with Dr John Sloan from the Countess who was over for a couple of weeks with Myra, and found the experience invaluable as he was able to take lots of photos during several operations and surgical procedures that he would not have been allowed to do in the UK. As part of his work here Tom has also been doing an audit of the WHO checklist – a procedure that is undertaken with the whole theatre team prior to surgery taking place to ensure that everything is correct – patient details, type of surgery, ensuring patient understand the procedure and consent forms are signed etc. The WHO checklist is acknowledged to have reduced incidences of wrong site surgery – not just in Uganda but throughout the world. As with any change management process it is not always a smooth ride, people need to see the benefits of changing what they currently do. Tom is undertaking an audit to look at levels of compliance in usage of the checklist and will present his findings at the Management meeting tomorrow.

 

We adjourn to Round House afterwards for a glass of wine and play several game of Bananagrams . It’s a game that Haley has brought with her – a bit like Scrabble and good fun, although Tom finds it a bit frustrating when he can’t make some words quickly enough before having to pick up more letters.

 

Later as we all head off to bed, I contemplate the past 14 days. Tomorrow is our final day and it really has been an amazing experience. I have tried to capture as much as I can on the blog but I know there will be lots of things I have forgotten to include. It will probably mean long blogs to read tomorrow and Saturday!

21. A Trip to Rehab

Wednesday 21st November 2012 

Kisiizi School

After a coffee, shower and weetabix I head over to Kisiizi School on the way to Chapel. I feel like a bit of an Indian giver as I have come to ask John to give me back 2 of the pencil sharpeners I gave him yesterday. Reason being is that David, who is the engineer at Kisiizi and responsible for all the building projects, runs an Orphan programme (separate to the one I have already supported) and he has asked me if I will post some of the children’s letter to their sponsors when I get home. I gave him a box of pencils and 4 sharpeners yesterday and asked him to pass them on to the children but he said it would be nicer for me to give them to the children myself so he has arranged for them to come at 4.30pm, There are six children coming and I only have four sharpeners, hence the reason for me asking for two back. I see John and he says it is no problem at all.

 

At the end of the service this morning there is a Paediatric audit which I decide to stay for, Sarah says I will probably find it interesting which I did. I was a bit concerned however when just before the presentation started Ian stood up to check that there were no patients or carers still in the chapel as he didn’t want the photos to distress them. I wasn’t sure whether that should be my cue to leave (you know how squeamish I am) but I stay, and I am glad I did. The audit covers the month of October and in the Special Care Baby Unit there were 39 admissions with four deaths and on the Children’s ward 171 admissions and two deaths. The pathway from the admission to the death of the 18 month old child was shown and it was clear that had the child been brought in earlier she would have had a much better chance of survival. She had pneumonia on admission and despite the very best efforts of the staff over four days she was too ill to survive. The message that was given to all staff was that at every opportunity they need to be educating the local community to bring their children to the hospital sooner. Often the children are taken first to a local healer and valuable time is lost when this happens. The case in the Neonatal Unit that was looked at was a two week old twin that suddenly developed a range of symptoms, swollen joints, peeling skin on fingers, a rash on his face and body and a huge swelling of the clavicle. Nobody had any idea what the problem was and it turned out to be an extremely rare condition – a syndrome known as SHOBA. Quite fortunately one of the radiographers from Chester had seen this before and was able to provide the diagnosis, and the baby is currently undergoing treatment.

 

On the way back from Chapel I call into the Finance Department to see if I can change some English pounds into shillings so that I can pay my debts to Sam and Haley for money I borrowed during our Safari break. I had thought there would be a currency exchange facility at Queen Elizabeth Park but I was wrong. The Finance Manager was in a meeting so I was asked to try again later. Back to Rose Cottage to get stuck into finishing the rest of my Data Entry task. I was really looking forward to that....not! At 11.20am I decide to have my own ‘Banana Break’. I have resisted the two last Snickers in the display cabinet since I arrived but decide it is now time to have one. Horror...they are no longer there but luckily in their place a large box of bars of Cadbury’s Milk chocolate has arrived. I purchase one and have it with my coffee. It made a nice change from bananas.

 

Before lunch I nip up to the IT Dept and send a few blogs and photos to Andy. I am still days behind but trying to catch up as best I can given the fact that you really don’t get a lot of spare time here. I am sure that there are some members of staff at the Countess who feel that the teams coming over here are coming on holiday. I can tell you having seen it firsthand that nothing could be further from the truth. They work really hard, often late into the night getting various reports written and preparing for meetings. Everybody does tend to do something on their weekend off (like five of our group going on Safari whilst the other two went off to see the Gorillas) but the weekend is free time and everybody pays for these trips themselves.

 

After lunch, at which there is a lot of discussion about various operations that have been taking place that morning, I pop into the Sewing Room in search of Joselyne who I am hoping will make my skirts and the girls’ dresses. I am told she is off today but a colleague phones her and she agrees to meet me in an hour. She measures me up and sketches out a pinafore style dress for Erin, Naomi and Heidi and I give her the measurements for these. She promises to do her best to get them ready for Friday. I call into the Finance Department but they are in another meeting.

 

I’ve arranged to go and have a look around the Rehabilitation Unit and Sarah is hoping to join me if her meeting finishes in time. I am waiting on a bench outside the unit for Royce to arrive when a red and yellow Little Tykes car drives past with a small girl sitting inside and a not much bigger boy is pushing her. They are clearly having fun. Royce arrives and shows me around the unit. In the room on the left they have Occupational Therapy for adults and children and on the right had side they have a gym and a physiotherapy treatment room. Royce suggests I have a go on the exercise bike and I oblige ... for all of about five minutes. There is a child OT session this afternoon and the little girl who was in the car earlier is being encouraged to colour in some pictures using crayons in her left hand as she has mild cerebral palsy with a stiffness down her left side. Another little girl who has cerebral palsy and is blind is in a wheelchair and one of the team is helping her to play with musical instruments to stimulate her others senses. There are 2 other children, not happy, one little boy is crying constantly, who are put into standing frames as part of their therapy. I meet Aston a five year old who was in a serious accident in April when he was run over by a Boda Boda (motor bike). He spent 5 months in hospital and has a huge scar on his skull where he clearly had major surgery. There was some brain/nerve damage and he has been learning to walk so all of the staff are delighted to see the progress he has made. He has been visited over the past 4 months by the Community team but this is the first time the hospital team have seen him since August. I also meet a man who is currently weaving a mat as part his programme to improve the use of his hands following an accident and another guy who is paralysed down one side and is learning to touch type. Royce shows me all the cards and beads that the patients make in the weekly craft classes they run and I buy a necklace and some matching earrings.

 

I have to be back for 4.30pm as “David’s orphans” are coming to visit. I call into the Finance Dept again but am told now I need to get permission from Father Patrick and he has gone home sick. I am to try again tomorrow. I’m sitting in the lounge when I suddenly see red and white check dresses at the door. They have arrived. There are five girls and one boy so I invite them in and they are all sitting around the dining table when David arrives. He suggests they may like a soda. Coke, Sprite are all referred to as sodas here. So I ask them which they would prefer and I buy two Sprites, three bitter lemons and a Fanta. David tells me later that for them this is the equivalent of us having champagne, and suggests that they perhaps get a soda maybe just two or three times a year and they would certainly not have the option of choosing, they would just get whatever flavour was available. They are all very shy and it is not easy to make conversation but they are from Kisiizi school so have seen me in assembly the previous day which helps a bit. I share out the rubber topped pencils, asking Rita to work out how many they will each have if there are 24 pencils and six of them. They each get four pencils and a sharpener and seem very pleased. We talk about school, their favourite subjects and what foods they like. I tell them that Philip makes us a lovely crumble and custard to have as a dessert some evenings. David tells me they won’t know what custard is and it is unlikely they would ever have tasted crumble as the houses where they live don’t have ovens, but cook instead on open fires. Again, this is such a simple thing that we take for granted. It is Haley’s Birthday tomorrow so I ask the girls sitting next to Rita whose name I have forgotten, to translate HAPPY BIRTHDAY into Rukinga, the local dialect here, so that we can include in on her card.

 

I wave them goodbye as they go back over to the school playground and decide to walk down to the Rounds Houses as there was some talk of a walk this evening to the waterfall. This is visible from the back of the Round Houses and is apparently quite an easy walk and is certainly something I should do whilst here. Myself, Tom, Haley and Beccy set off. Haley is somewhat anxious about the cows in the field that we have to walk through but Tom earns some ‘man point’ by distracting them and putting himself between the cows and Haley to shield her. It is a lovely short walk and the waterfall is beautiful, very powerful and quite therapeutic to just stand and watch it. Beccy gets some photos, (I have stupidly forgotten my camera) and we walk back to the Round Houses where I stay briefly before heading back to Rose Cottage to write up a bit more of my blog before dinner.

20. We have an earthquake!

Tuesday 20th November 2012

 

Kisiizi School

Today we have been invited to attend the assembly at Kisiizi School just over the road so we meet outside Headmaster John’s office at 7.55am. It is noticeably colder this morning and I walk over with Tom who has brought two footballs for the school. When the children see him, he is almost mobbed!

 

I have some less interesting but nevertheless hopefully useful, pencils, rubbers and sharpeners which I give to John. Whilst chatting to him we learn that he retires on 21st December but will stay on for 12 months as an English teacher whilst Spencer, a teacher who has been there for 16 years takes over as the Head. John explains there is no pension system here so I suppose although everybody complains about the level of pensions in the UK, at least we have one. All the children line up in classes – there are nine of them, and a total of 342 children in the school. Spencer gets all the children running on the spot to keep warm, followed by about 5 minutes of physical exercise with star jumps seeming to be what they enjoy the most. The Ugandan flag is raised by one of the pupils as everybody sings the National Anthem and then the Kisiizi School song. All the children then file class by class, into the main hall. They are all sitting on rows of benches when we enter and sit at the back on the plastic patio chairs provided for the benefit of visitors. After some singing, clapping and prayers we are all invited by John to come to the front. He tells the children where we are from and then asks us to each introduce ourselves and say a few words. There is a further song and the children are then set a test. Can they remember our names? I thought it was highly unlikely, however I was proved wrong. Not everybody put their hand up as John went along the line but there was always somebody that could remember. Quite a few hands went up when it was my turn and John explained my name was quite an easy one for them to remember as it is a girl’s name in Uganda. Looking at things in the country generally, not just from a medial point of view, they are about 50 years behind the UK. I wonder ... if the name Janet is as popular here now as it was in the UK in the 1950’s, do you suppose that in another 50 years there will be many Ugandans running around with the names Kai, Tyler, Kylie or Brooklyn?

 

We are invited to join a couple of the nursery classes and hear the children singing and look at some of their work which is a delight. In one class there is clearly a ‘naughty chair’ a narrow desk and chair behind the door and we didn’t notice at first there is a little boy sitting there out of sight behind the open door. The teacher says something and he comes out to sit at his own desk and join the class.

 

It’s back to Rose Cottage to start the Excel spreadsheet. I am entering information on the prescribing of antibiotics and patient information about age, date of admission, bed number, area they live and what procedures they have had as an inpatient. Well let me tell you this was no easy task. Firstly just trying to decipher the handwriting was difficult enough and then with no medical knowledge at all attempting to work out the names of the antibiotics, and the dosage and the number of times a day it had been administered, nearly had me beaten. But I wasn’t going to give up easily, so did my best knowing that I could check with Sam and correct whatever strange named drugs I had inadvertently created. However when it came to the place names, well that really was a test of my patience. I had a map and was looking from the map to the drug sheet back to the map usually by which time I had lost my place. Can you imagine trying to distinguishing between Bwambara, Bwizibwera and Bushenyi (with bad handwriting) or between Kabwoya, Kagamba, Kaswengo and Kahung, and these are just seven out of about 70 different areas. I was losing the will to live by about 4.30pm so knocked off early and had a coffee with my last two Aldi Florentines – I was impressed with the self discipline I had demonstrated, making them last this long - but today I had earned them both. I consoled myself with the fact that Sam had said me doing this job for her was really helpful and gave her time to get on with something else. I wasn’t even half way through it so knew I still had a lot to do before the task would be completed......but I’ll worry about that tomorrow.

 

We have been invited out tonight to Stella’s. She used to manage Rose Cottage but now runs another guest house down the road. We are all going along with sister Moreen so set off at 7pm just as it is getting dark. I have remembered my torch but soon it is pitch black and I wonder how all the locals manage to see as they walk along the bumpy road riddled with stones, lumps, bumps and potholes. It’s been raining and some areas are bit slippery so I need to watch my footing. I don’t want to fall over, sprain my ankle and be carried back to the hospital. As we walk down the road we hear some children calling out “Hello Tom”, it is obviously children from the school who recognised him for this morning’s assembly. Then I hear “Hello Janet” and some giggling as we walk past.

 

We arrive at The Goodfellas guest house about 10 minutes later and get a really warm welcome form Stella. Obviously most of the group know Stella from previous visits and they are happy to see each other again. We all sit down at the table and Stella asks us what we would like to drink. As a cold beer is on offer it would be rude to refuse. I sit next to Kenneth who I learn is sister Moreen’s husband. He is good company and we are soon joined by Dr Denise who was previously a physician at Kisiizi but left earlier this year when her husband Dr Tonni, who was the Medical Superintendant at Kisiizi for several years, moved to a new job. We had been sat down for probably only about five minutes when suddenly the whole house started shaking and there was a thunderous sound as if there were a high speed train speeding past in the back garden. We all look at each other wondering what has happened. “It’s just an earthquake” Stella says very matter-of-factly. It would appear that this is not that uncommon an experience. We have a delicious meal of pork, potatoes, matoke (but served in their skins), vegetables and chapattis, followed by pineapple crumble and custard – she knows it is a favourite of the Chester team! We have a really interesting evening and at about 9pm Richard arrives to have a meal; he doesn’t join us but eats with other guests staying at the guest house. At 10pm as we are getting ready to leave, he offers to drive us back to the hospital. It is a welcome offer as it is a reasonably long walk back so we all pile into his vehicle – not the luxurious nine seater that we had for the trip to Queen Elizabeth Park at the weekend - but the seven seater with the sunroof that he originally suggested for the trip. Thank goodness we paid the extra 600,000 shillings for the larger vehicle. The suspension seems to have gone as we are almost touching the floor and can feel every bump in the road as he drives over them. You would have to have been there to see the funny side of that trip home, and I won’t attempt to describe it on paper as it will be lost on you, but we were all literally crying with laughter as we got out and each made our way back to our individual houses. It had been a great night.

19. Starting my second week

Monday 19th November 2012

 

The Round Houses

I am awake early so get up at 6am. I go to make a coffee and realise I have left it at the Round House as we went there after dinner last night so have to settle for a lemon and ginger tea instead. I’m going to use the time before breakfast to write up a bit more of my blog as I still have to finish my diary entry for Thursday – the day of my visit to the Community – which is turning out to be quite a long one as some of you will have read by now. I nip to the loo with my torch as it is still dark outside and the ground is pretty uneven outside the back door. The one time I have not got any tissues in my dressing gown pockets turns out to be the time the loo paper has run out. Luckily I am only going for a ‘short call’.

 

Walking to Chapel this morning I can see that there is already a really big crowd on benches outside the Outpatients Department. As part of the service we have a really long bible reading and I am wishing that I had arrived early enough to get a wall seat. We have a song and Hannah offers to share her hymn book – I do my best but it is difficult to know how to pronounce the words never mind trying to fit them to a tune I don’t know! We then listen to a beautiful song harmonised by 3 student nurses. There are various announcements welcoming the new student nurses to the School of Nursing which is now becoming very well known not only throughout Uganda, but internationally as well. Doctor Rachel is welcomed back as she has been away for about 8 weeks. A wedding announcement is made for a couple who are getting married on 8th December and it appears that everybody in the hospital is receiving an invite. WE also get the welcome announcement that the patient who died last week did not have the Marburg virus so that is a relief to everybody. The nursing team who looked after him are thanked for their care and professionalism and everybody is reminded to be vigilant and to continue operating the triage system, isolating patients as necessary.

 

I get back to Rose Cottage and Philip is washing the floor by hand with a bowl and a cloth – they really do work hard in the guest house to make sure everybody is looked after. It might be basic but it is cosy and you are made to feel very welcome. I ask how his new baby daughter is doing and he says...fine, crying in the night but ok otherwise. I meet Tom who has not been to Chapel this morning and he tells me he has a bit of an upset stomach.....so that’s where all the loo paper went!

 

Edson in the IT Department

I call up to see Edson in the IT Dept to ask if he can sort my computer out, it is driving me mad! Whilst I am in the office, Night arrives and reiterates her thanks for my buying the dress for her. It appears she has already made that treacherous journey back to the village where we had lunch in the ‘hotel’ just so that she can buy the dress she tried on. I assumed she would wait until she was next in the area, but apparently not. She tells me she saw her husband this weekend and he very much admired the dress and she told him her friend from England had bought it for her. I was thinking again about my day out in the community last week and something I didn’t put in my blog that day was coming home and feeling a little bit (on a much smaller scale obviously) how I Imagine the people featured on ‘Secret Millionaire’ must feel.

 

I pop back to the children’s ward as there are a couple of beds still to measure. I meet a lovely little girl aged two and a half called Deeana who was brought in the previous day very distressed but happily she is a lot more lively today and happy to pose for photos. I also see a boy with burns to the lower part of his body; obviously in pain but again, happy to smile for the camera. I come out of that building and see all the freshly washed blue hand towels being put out to dry. This is a new initiative introduced as part of the Infection Control programme that Sam has been helping to implement since first coming to Kisiizi. Her visits are funded by the World Health Organisation (WHO) and another of her achievements has been to get all the staff to use hand gel. Initially this was brought over from the UK on visits but the Kisiizi Pharmacy team have now learned how to make their own and are able to refill the bottles that are on the wards as well as the small ones carried around by nurses. Tomorrow Sam will be undertaking an audit to ensure the practices are still being adhered to.

 

During banana break I meet Angela in the staff room and she tells me she has just received her first letter – posted from the UK on 14th October! Sarah returns from her duties for the morning – checking through the Maternity notes to ensure all the Caesarean Sections have been recorded as she is doing an audit later in the week and this information will form part of it. Tom doesn’t come for break as he is busy in Theatre and Haley, Carolyn and Beccy are all in a Pharmacy meeting. Carolyn has been expecting a visit since she arrived from Michael, the Chief Executive of the company that installed the Pharmacy IT programme some time ago. Michael is coming from Kampala (a 10 hour journey) and Carolyn in concerned that if he doesn’t arrive soon she is not going to be able to achieve what she had hoped during her two week visit. There appears to be some resistance from the Kisiizi Pharmacy staff to use this new stock control system and Carolyn is unsure whether it is a case of lack of understanding, ability or just resistance to change.

 

After break Sarah and I go to Rehab, not to check in, but to meet the staff and for me to get more of an understanding what goes on there. However there is a mix up with the meeting time and Royce who we are hoping to meet, is not there. We cross over to the single storey building opposite and go inside to measure the beds in the bedrooms. This is where parents stay over when the children are having a course of physiotherapy, or adult patients can stay if they are receiving occupational therapy. Many people don’t get the therapy they need because it all has to be paid for and for some it is a choice between having treatment and feeding the family, so food comes first. Many patients travel up to 10 kms to get to the hospital, usually on foot – even pregnant women. Occasionally you see a patient arriving on a home-made stretcher being carried in by his or her relatives.

As I walk back up the road for lunch I see a boy of about 8 or 9 wearing a faded yellow sweatshirt with BROWNIES printed across his chest. He is wearing it with red shorts, a blue knitted hat and flip flops. It is definitely a case of anything goes here in terms of fashion, and I remember last week when I walked to Upper Kisiizi, I saw a child wearing a ski jacket (with the hood up) playing next to a child in T shirts and shorts. For the ladies it is often a case of the brighter the better. Often they have several pieces of different coloured patterned material draped around them as tops or skirts and although nothing matches or co-ordinates, it somehow doesn’t look odd. However I’m not sure it is a look I could successfully pull off.

 

It’s fish pie again for lunch which I just don’t fancy, so I have a piece of toast an peanut butter instead ( I only found out during a chance conversation they have peanut butter so have missed out on that for the last week!) . Afterwards, I walk back to the staff room and on the way see the field on the left being cut. No lawnmower here though – it is all done by hand with a machete and long stick. The stick is used at an angle by the guy cutting the grass to steady himself whilst he bends over to cut the grass in a sweeping motion. It looks like back breaking work. I see Tom walking back to Rose Cottage for a late lunch and this reminds me I have not told you much about him yet. Tom, 21, is currently a support worker in Theatres at the Countess but wants to be a Doctor and has recently applied to Medical School. He is in the only male amongst our group of 7 and to fair he has coped well with us all. At the airport we had all been through security once and then Tom was pulled again to have his bags checked, so Beccy said it was probably because he was a young boy. He wasn’t keen on that tag so we teased him and said he would have to earn some ‘Man Points’ during the trip and we would consider reclassifying him. He’s earned several during the first week but then lost 2 earlier today when he mentioned that he had brought his pencil case with him. He also lost a point for ordering a Pina Colada and not a beer at the bar at Mweya, although he did earn several points for spotting the first elephant. He will certainly earn some more today if he manages to eat a plate of the fish pie!

 

I meet up with Sam in the afternoon so that she can show me what she wants me to do on the anti-biotic audit. Entering data on an Excel spreadsheet is not my favourite job but obviously I have offered to help out wherever I am needed so can’t be too fussy. It’s 4.30pm by now and so I tell her I will start in the morning as I want to walk back to the village to see if I can get more material for the dressmaker Jocelyn who I am meeting tomorrow.

18. A Hairy ride back to Kisiizi

Sunday 18th November

View from the Veranda

Sarah and Angela are going for a walk this morning at 7am with a local guide and the rest of us have decided to have a lazy Sunday morning. I don’t think I’ve mentioned that Angela has joined the group from the weekend. She’s is an anaesthetist from Peterborough who has been at Kisiizi for five weeks as part of a six month volunteer programme. She’s not yet had the chance to get away anywhere for the weekend so we were more than happy for her to join us when she asked earlier in the week.

 

I drew back the curtains to enjoy the most amazing view from our veranda. It’s just a pity we don’t have coffee making facilities in the room as I would have enjoyed sitting out with a cup, drinking in the view. However, no slacking allowed. I have work to do. I am days behind with my blog as there just hasn’t been any time since Wednesday night to put pen to paper so now is my chance. I decided not to bring my laptop with me for the weekend as there wasn’t a lot of space in the vehicle and I already looked like the bag lady with my haversack, bum bag, handbag and a small folding shopping bag, plus my waterproof and fleece carried separately as they wouldn’t fit in the (very small) haversack. So I am writing my blog longhand to type up when I get back.

 

Around 8.15am I get a shower, a lovely long warm, power shower with my Body Shop Papaya shower gel – it feels like a real luxury when compared to the shower back at Rose Cottage. I join Haley, Sam and Tom for breakfast and today choose the pancakes, crispy bacon and maple syrup option, plus juice fresh fruit and coffee. It is cloudy today so it’s not really ideal for sitting by the pool and we have to check out by 11am anyway. I decide to go and pack and then have a wander around the grounds. Haley and Tom have booked a massage in the Spa for 10am. There are so many opportunities for good photos – I am surprised my memory card is still holding out – I must remember to download the card when we get back to Kisiizi as I’m sure there can’t be much space left on it. I have a look in the gift shop, there’s not a lot to tempt me (I can hear Peter thinking...thank goodness!) but manage to purchase a couple of items – some wooden salad servers (which is something we do actually need) to serve as a souvenir of the trip - and a jar of locally made pineapple jam which I am hoping if well packed might survive the trip home in one piece.

 

We are staying for lunch before we leave at 2pm and I choose to have two starters and a banana split (I had looked enviously at Angela’s yesterday). Richard arrives on time and we pack up the vehicle, settle the drinks bill – ridiculously cheap – and hit the road. Tom doesn’t seem as keen to travel in the front as he had on the journey here, so I offer to take his place. Not quite sure if this is a good move or not. We hadn’t been going long when Angela’s phone rang. Apparently they had forgotten to add her boat trip to the bill, so could we either come back or pay the security guard at the exit gate. We choose the latter option. Five minutes later another phone call and this time they are trying to say Tom has not paid either. This is incorrect but because we had split the cost of two doubles and a single and shared it between the five of us, it had obviously confused the reception staff, so Sarah got on the phone and put them right politely, but firmly, as is her way, dear. We saw more animals on the way out and stopped at a craft shop outside the Park that Richard assured us was ‘very cheeeep’. We have a look around but the quality of the stuff is not great so nobody buys anything which seems to surprise him. Just as we get back in the rain starts so we have to close the roof. We drive over the bridge linking Lake Albert and Lake Edward and the photo we had hoped to get of both lakes was now not possible with the roof down. Never mind, we still have the picture of this spectacular sight in our minds. Once Richard puts his foot down we are moving pretty fast – I check the speedo at 80kms per hr – not sure what the speed limit is (or if there is one?) but on these roads that seems pretty fast. It’s not long before he is back on his horn, pretty much in the same way he was on the journey to Mweya. He’s using the horn to warn pedestrians, cars and bikes ahead to pull over as we are coming through and he is actually using it in a safe fashion, it just seems to us to be pretty excessive use - but perhaps this is the norm here? To be fair he is also on another mission – trying to get us to the place where we can see monkeys and chimps. However when we reach the spot there are none to be seen – I suspect they are all sheltering from the rain, which by now is fairly heavy.

 

Richard makes a few calls on the mobile, I obviously don’t understand what he is saying but from the tone of the conversation it would appear that there is some sort of problem he is trying to sort out.

 

We stop at a little village and immediately the van is surrounded by hoards of children holding up plates of all sorts of things for us to buy. We politely decline, apart from the char grilled corn on the con which looks and smells pretty delicious there is nothing else that looks remotely appealing. Richard purchases 2 cobs of corn and 2 kebabs of some sort of meat – it’s not obvious what it is. I ask him later and he says it is goat. I don’t know whether the white chunks in between the meat are bits of fat or onion, but he’s tucking in and clearly enjoying his lunch. I’m just a bit worried that if he brakes sharply again like he did earlier, then he is going to spear the roof of his mouth with the kebab stick, and you know how I am not good with blood. The mobile goes again and this time he has the steering wheel in his left hand and a large piece of corn and the mobile in his right. It’s quite an art that he manages to talk, eat corn and drive at the same time. The exchange between Richard and the caller is now getting more heated and at one point his hand comes of the steering wheel and he punches his fist into mid air, presumably in frustration at whatever he is hearing on the other end of the phone. The next thing I hear is “Hallo.... hallo...” the phone has obviously been put down on him. The phone calls continue on and off for about 30 minutes with him getting more and more irate. At one point he clicks off and says in English pointing at the phone, presumably for our benefit ... ”He is an Idiot”.

 

A bit later I try and make conversation with Richard which isn’t the easiest thing to do as his understanding of English isn’t great. He is a lovely guy, and is really funny without realising it – his mannerisms and his ‘not quite understanding our question’ expression on his face always makes us smile. He reminds me of Eddie Murphy. I ask him where he lives. He tells me the time. I ask again where he lives and eventually he understands and I learn he lives in Upper Kisiizi with his wife and three children. It takes almost 10 minutes to extract this little bit of information, so I decide to give the conversation a miss for now and start jotting a few thoughts about the weekend in my notebook for my next blog. Clearly Richard is curious about what I am doing. I realise after a while that he thinks I am making a report about his driving, especially when he apologises to me about having to use the phone so much. From then every time I see something out of the window that I note down, he thinks I am writing something about him. We stop to get petrol and on the waste ground to the side there are a group of boys aged about seven or eight having great fun playing with a football made out of rags.

 

Richard then starts chatting to me perhaps looking to get me on side, so that I give a good “report” about his driving ability. However the difficulty is every time he turns to me to ask something he is not looking at the road ahead. It’s a bit hairy and I am starting to see why Tom was keen to sit in the back

 

Driving along we see loads of people walking along the side of the road. Ladies carrying their baskets on their heads, men with huge piles of wood balanced precariously also on their heads, and a small boy with a stick keeping his herd of about 20 goats in check to stop them running out into the road. We pass all the banana and tea plantations again that we saw on Friday and before long we are driving off the tarmac road and on to an incredibly bumpy track. We will be on this for probably about an hour. Sam passes her bags of sweets around – what a lifesaver! I choose a drumstick which, instead of chomping in 30 seconds, as usual I manage to make last for about 10 minutes – Peter would be impressed! The track we are driving on has now become bright orange with the rain water mixing into the dust, and the streams of water flowing down through all the crevices in the track look the colour of rust. We see a group of young girls to our right at the side of the road washing their clothes in the rainwater.

 

Haley announces that she needs Richard to stop for the toilet. He enquires as to whether it is a ‘short call’ or a ‘long call’ she needs. Establishing it is the former, he starts to look for a suitable place to stop at the side of the road with some bush cover. There is nothing suitable and after about 10 minutes of keeping an eye out without success he tells Haley that there is a petrol station in about 20 minutes. Haley agrees she can hang on.

 

Another phone call comes through and this time Richard’s response is in English for some reason. “Not now, I am busy” he says and clicks the phone off. I remind Richard that Sam has mentioned earlier that she would like to try a Jack fruit which is a huge strangely shaped fruit that each time she has visited Kisiizi, she has forgotten to try. We ask Richard to stop on the way to get us one and he is pleased because his children like them too so he will get some for them. We stop 30 minutes later at another village and again all the plates of fruit and vegetables appear for sale and this time there is a small child carrying a sugar cane about twice his height which is also for sale. Angela gets two avocados for 100 shillings each (about 3p if I have not miscalculated) and Richard chooses us a Jack Fruit to take back to Rose Cottage for Phillip to prepare for us. Apparently there is a bit of a knack to getting them ready for eating.

We pass through several more villages on the way back to Kisiizi and they all have the same unlikely looking hotels and beauty salons amongst lots of other shops selling mobile phone tops ups, fruit vegetables and mattresses. People seem to just stand or sit outside the shops and their homes; they don’t appear to be engaged in conversation with each other, they just sit and watch the passing traffic and animals and keep an eye on their children playing close by. We pass a large football field and the scene is just like home with all the parents standing on the sidelines shouting words of encourage to the, would be, footballing stars of the future.

 

We get back at 7pm just in time for a quick wash and change before dinner. It’s been an amazing weekend, but it’s back to work tomorrow – I’m down to help out with some data entry relating to antibiotics – that should be interesting!