Mangoes, monkeys and Maggie

Muzungu, byeee!

2009-10-04T21:29:00.007+01:00

In the four days that we have been home no-one has stopped us in the street to shake our hands, to ask how was our night, how is our morning, how is home, etc. Not a single child has called out ‘Muzungu byeee’ and we haven’t had any requests for school fees!
The grey, damp days are not so difficult; after all, we have had to deal with them for the last 50 odd years. Occasionally the sun comes out and the ever changing light over the river and sea is wonderful, reminding us of why we love this place. Communication is proving more frustrating than Masindi. We miss our little dongle! We do not have a landline, the mobile only works if we literally hang out of the window in the flat (or stand outside in the cold) and the only access to the internet is at the library. Why didn’t somebody remind us it closes all day on a Thursday?! So, just now we are on the train and not only can we sit back and enjoy the beautiful English countryside but we can take advantage of wireless internet. A great opportunity to write our last blog (and 100th posting!). Foremost in my memory right now are the characters who made our time in Masindi such a memorable one so I think it appropriate that my photo entries this time are of these people.

The three youngest children of Rose: Aisha, Udetha and Akim

Udetha and Akim returning from the mosque:

Tracy and Aisha returning from the mosque:

Solomon, one of our two guards at the house:

Rasul, complete with bow and arrow, who is also a guard at the house:

Some of the kids from Family Spirit Orphanage together with our niece Beatrice and friends Rick and Ed:

Susan, teacher and matron at Family Spirit Orphanage:

Maggie with Millie, an employee at New Court View Hotel:

A few of our Masindi friends at Chris' birthday party:

These are a few of my favourite shopkeepers in Masindi:

Looking Back

2009-09-15T13:31:00.014+01:00

Pictures of the hospital showing out patients and the wards.

Children outside their home and a mother showing how she is using her mosquito net to protect herself and her children.

Last week I had my exit interview with Sarah Kyobe from VSO. This gave me a chance to look back and reflect on the last two years in Masindi. It is hard to remember the frustration and depression that I went through in the first six months. When I arrived at Masindi Hospital in October 2007 I was excited and looking forward to working with Ugandan colleagues and learning about health in Masindi. Within a couple of weeks it became obvious that it was going to be a huge challenge. I should have anticipated problems when at the end of the VSO in-country training the representative from Masindi who was supposed to take us there had no transport and seemed to know nothing about what I was supposed to be doing. On the first day at the hospital the medical superintendent who had requested a volunteer announced he was leaving at the end of the week and there was no replacement for him. I had known that resources would be in short supply but I had not reckoned on the lack of motivation and commitment of most of the staff.
There is a major crisis in the Public Sector in Uganda. The population have no respect for public servants and the workers seem to do little to earn their respect. Of course I have met some dedicated staff but the majority are disinterested and often absent from their posts. It is not unusual to visit a school or health centre and find only half the staff present. On the wards nurses come late, they often do not bother with their uniforms and they regularly leave early with out handing over to the next shift. Thgis means that treatment is often forgotten and nurses do not know what is happening to patients. There is poor leadership throughout the service and staff behave as they see their supervisors behaving. Staff are paid poorly and often not on time. This is bound to affect motivation. There is no reward for hard work and people who do little or are absent will receive the same pay. There are no sanctions. Once you are on the government pay roll it is almost impossible for you to be removed. As the pay is so poor most health workers supplement their income by working in private clinics or running drug shops. It is not unusual for drugs destined for the hospital to end up in private clinics. Nurses and doctors seem to accept this as inevitable and there is none of the out rage that would be felt in the UK. When I call these people thieves my Ugandan colleagues think I am too harsh.
Reflecting on how I have changed I realise that I have become more tolerant of failure. I am not sure if this is a good or bad thing. It has probably been necessary in order to stay sane but I am no longer surprised when a patient dies unnecessarily. I can not change the system I can just try and move a few people forward. Things will change when enough Ugandans realise that things could be different. That is why advocacy and working with patient groups is such an important part of VSO’s role.
Although there have been a great deal of disappointments here there have also been some real successes. Treating infections is always rewarding as if you get the diagnosis right there is a good chance the patient will recover completely. In the West doctors spend most of their time dealing with the incurable degenerative diseases. A patient with malaria or TB can be at death’s door but with correct treatment they can be completely cured. I have saved more lives in the last two years than in the thirty years I spent in the NHS. Even patients with HIV are greatly improved by treatment. It has been wonderful seeing how people who are bed ridden and dying can be returned to health with ART. They can return to work and caring for their families and will remain well as long as they have access to the drugs they need.
The Miirya Project has been the most satisfying part of my work and I do believe it has made a difference to the villages where we have worked. The volunteers have shown a commitment and a willingness to learn that is rare in professionals. They seem to have a real desire to help their communities and given a little bit of help they can achieve good things. Pam and I have raised enough money to keep the project going for at least another year after we have left. I intend to continue to raise money and will come out next year to continue supporting the team, We have plans to continue selling mosquito nets but also we shall be developing the other work on immunizations, sanitation and reproductive health. Next month Pam is leading some men’s health days and I shall be interested to see how they are received. Trying to encourage young men to take responsibility for their own and their families health is difficult in any culture. VSO likes the project and is considering how it can be rolled out in other communities.
Looking back it has been a good two years. We have met some wonderful people and made new friends. We have had a chance to see a beautiful country and learn about a very different culture. There are lots of questions about development and how it can be achieved. We have no answers but we do understand the question a bit better. I am sure we have made a small contribution and been able to improve a few people’s lives. That’s not bad for two old buggers from Hull.

Hadija and Rita two children who have benefitted from the links to Hope ward at IHK Kampala. Hadija had her bowel obstruction from TB released and Rita had her congenital heart condition confirmed. Rita is awaiting heart surgery.

This lady was severely ill with TB and HIV six months ago. She was bed ridden and very weak. She is now back at work. A success for the Ugandan HIV/TB programme.

This is Chris the clinical officer who has taught me so much. He is hard working and motivated. He hopes he can go to medical school next year if he can raise the funds to finance his studies

Last weekend there were riots in Kampala because of a dispute between the Kabaka (King) of Buganda and the central government. At least 15 people were killed, 3 of them from Masindi. There was damage to property and cars. Kampala was cut off from the rest of Uganda and the army was patrolling the streets. Radio stations were closed and the main mobile phone company was down. We were fine but you realise how fragile the situation is here. There are elections next year and people are concerned that there may be a Kenyan type situation. We thought family would be concerned but it appears that no one in the UK was aware of the situation. A riot and a few deaths in a capital city in Africa is obviously not news worthy.

The last month!

2009-09-01T13:46:00.003+01:00

It’s hard to believe we are entering our last month here. Obviously there are mixed feelings about leaving as we have made a nice home and think we have made a good attempt at being part of the community. On the other hand, true home will always be the UK and we are really looking forward to being there. Many muzungu tourists pass through Masindi so it takes a while for the local people to know that we are here to stay. I really enjoy walking (or ‘footing it’ as they say here) through town and being stopped by people for a friendly Ugandan greeting and a chat. The conversation usually goes something like this:

“How are you?” ‘I’m fine, how are you?’
“How’s the day?” ‘It’s okay thank you’
“How was the night?” ‘It was good thank you’
“How’s home” ‘Home is fine’
“How’s him?” ‘Chris is fine too’
The three stage handshake can take just as long and starts off as a regular shake, then you rotate the hands to link thumbs and then end with a regular shake. This is sometimes repeated several times. Only after all this can you discuss any business.

A few people have asked what I am going to miss about Uganda. I think I will need to be home for a while to really know the full answer but the obvious things are the friends we have made here, our house and beautiful garden, the delicious fruit and vegetables, the stunning scenery and the wildlife. I can safely say that I will not miss mosquitos and all the other creepy crawlies, frequent power cuts, permanently dirty feet, the heat (can’t believe I’m saying that!), the all year round dark evenings, sleeping under a mosquito net, bat droppings in the bedroom, etc. etc. Utilities can be a problem here but I haven’t been away that long as to forget the battles we also had in the UK. At least when the electricity is cut off here I can go and see the manager and say “How can I possibly give the big man his dinner with no power?” This is something with which he has empathy and promptly arranges for reconnection!

Things I am looking forward to include: family and friends (obviously!), our own home, being in a bit more control of situations, a greater chance of people doing things when they say they will, 5 minutes meaning 5 minutes, constant electricity, the seaside, walking safely in the countryside, driving a car, good restaurants and more choice in the supermarkets (as daunting as that might be at first, I’m sure I’ll soon get used to it). I know Chris’ answer would be a lot simpler: being cold again and almond croissants (ideally from Nightingale Patisserie in Balham)!!

One of our biggest concerns about leaving here has been the fact that Rose and family would also have to leave the compound as VSO were not intending to continue with the rental of this house. She has been struggling to find somewhere suitable to live. Then on Friday we had the great news that VSO are keeping on the house afterall and Rose can stay. We’re delighted with this and so is Rose judging by the number of hugs I got when I told her the news!

One of the things we’ve enjoyed most about living in this house is being able to share it with our many visitors. It was lovely to see Becky here again last week and for her to be able to see how we’ve progressed in the year since her last visit! She was very encouraging and reassuring. This week we have our niece and five friends staying which is great fun and reminds me of home and the days of having a full house. Here is a photo of our team effort at cooking a Ugandan meal. We gave Solomon and Rose some to try. They very kindly said they liked it but our matooke didn’t score very well! I think Chris is pleased that I won’t be able to buy it back in Berwick.
Maggie

Our Ugandan meal:

Enjoying the evening sun in the garden:

Becky buying a bag on Gulu market:

THE MAN WITH THE KEY

2009-08-22T11:03:00.008+01:00

THE VIEW FROM DIRK'S VERANDAH

VSO held two workshops last week one for “leavers” and one for the health volunteers. This was a great opportunity to meet up and discuss the highs and lows of volunteering in Uganda. Pam and I gave a presentation about the Miirya project helped by Stephen and John from the community department. This was well received and the project is seen as an example of how VSO can contribute to grass roots development. It was good to have positive feedback from people you respect who understand the challenges of working here.
Looking back at the project I find it is the work that I am most proud of. I can think of several patients who have benefitted from my interventions but the lasting effect of the Miirya project is much more important. Even today I was approached by one of the staff at Court View who told me his uncle in the village had learnt about Tippy Taps and now he wants to be shown how to make one. That is really the point of working with volunteers in the villages they are so enthusiastic and their enthusiasm infects other people. We have now distributed nearly 5000 nets and for those families we have definitely reduced the incidence of malaria. There is still a demand for nets and with the funding we have attracted we can keep the project going for at least another 12 months. The next stage will be consolidation and more work on hygiene, immunization and nutrition.
After the conference we went to Jinja to stay with Dirk. He is a volunteer with another NGO Softpower. He has been here five years and has built a superb house overlooking the Nile at Jinja. Sitting on his verandah you can watch the brave souls being put through their paces in preparation for the white water rafting. Maggie was very envious of the plot, it would be hard to find a better view. We had a good time in Jinja watching the rafters and eating good food. On Saturday morning we went to have a look round Softpower. They have an education centre and a health clinic. The clinic lab is better resourced and organised than the lab at Masindi hospital. The education block has a library, computer rooms and a theatre and pottery. There is also a craft shop where they sell crafts made by volunteers and local people. Of course we bought some items from the shop. That is were the saga of the key began.
After lunch when Maggie came to pay she realised she had lost her purse with our money and credit cards. A short moment of panic later she remembered putting it on the shelf at the craft shop when she was paying. So all we had to do was track down the man with the key to get back in to the shop. Unfortunately he is the only one without a mobile. Luckily another staff member knew where he lived so we set off to his village. He was not there but someone thought he had stopped off to watch the Premier League. We did find someone with the key for the office so returned to Softpower to find that the key for the shop was not in the key box. So we had to find Safir. Two hours later after visiting every place with satellite TV, and hauling a colleague off the pitch in the middle of a game we gave up and returned to Dirk’s house. After twenty minutes Dirk had a phone call - Safir had been found. He had been at Softpower all afternoon, sitting making jewellery just behind the craft shop. Maggie never loses any thing, she is always organised and in control but Becky and I have enjoyed reminding her not to forget her purse.

GOING

GOING

GONE

Change of scenery

2009-08-10T05:34:00.005+01:00

Today we are going to Kampala for a week. We have to go to Interpol to get proof that we have not been engaged in criminal activity or more particularly child abuse. This is to allow us to get a CRB check when we come home. There are also two VSO workshops, one a leavers workshop and the other a health conference. It is becoming more real that we only have seven more weeks here. Our flights are booked for September 28th which is world rabies day in case any one had forgotten!
The conference is a time for the health volunteers to get together and share experiences. My concern is that my experience may sound negative compared to some of the other projects. Masindi is the only project where volunteers are working directly with the government and this does raise different issues. I have been discussing with the medical superintendent the lack of resources and it is correct when he says that the government can only pay for about 25% of what is needed. One of the problems is that politicians will not admit this to the public and claim that all is well. The hospital has had the same budget of 280 million shillings for the last 10 years. That is in spite of the increase in population and the huge increase in costs of drugs. Most of the time the drugs and equipment needed to provide the care are not available. On Friday Ritah, the librarian who Maggie works with, was admitted to the female ward where I work. She collapsed and needed urgent surgery. Luckily the theatre was available and the surgeon was around so she could be operated on within the half hour. The delay was caused by the need for her family to go in to town and buy gloves, sutures and IV fluid. Happily they were in a position to afford them and she had a successful outcome. That same night a patient needed a caesarian section but had to wait until the morning for the local pharmacy to open so they could purchase what was needed for the section.
There are successes in the hospital and it is important to remember them. Last week we successfully treated a diabetic coma, a woman with cryptococcal meningitis, a child with nephrotic syndrome as well as starting several people on anti TB treatment. We have had reports from the health centres in Miirya that malaria is now less prevalent and that is seen as an effect of our mosquito net distribution. We are on target to finish the distribution of 5000 nets at the end of the month.
This weekend we have had Gemma and Fynn, two children of friends in Budongo, to stay. It was great to see how well they played with Akim, Adeitha and Aiesha the children who live in the compound. The five of them had a great time even though they had little common language. It is sobering to think about their futures. They all have great potential but Ugandan children’s chances of fulfilling theirs is far less. When we leave in September it looks like Rose and her family will have to leave as well. Hopefully they can find some suitable accommodation but it is unlikely to be as good as they have had for the last 2 years. One of the real draw backs of living here for a short time is the problem of leaving people behind. We are going to miss a lot of people.

Enjoying a DVD together:

Bonding without words:

Introducing cricket to Uganda:

What, more wildlife?!!

2009-07-31T16:01:00.005+01:00

Our weekend visit to Murchison National Park was as wonderful as ever. The safari ended up as an elephant chase. We’d seen a few in the first few minutes but they were too far away and we wanted to get closer. Sulieman took us to the north of the park where we had not visited before. There was a lot of evidence of elephants being nearby (fresh dung, footprints and broken branches) but not surprisingly they can easily hide in the trees. Eventually we were rewarded by coming across a large herd including some babies. Two of the males were fighting which was an amazing sight. There was a lot of damage to trees and bushes and you can see why villagers are not keen to have elephants around.
As well as elephants we saw more giraffe than we have ever seen before. They look such ungainly animals but when they move they are incredibly elegant. A herd of forty crossed the road just ahead of us. Tom learnt how quickly baboon can move when he put his packed lunch on the roof of the car for thirty seconds. The baboon grabbed it, opened the box and relieved Tom of his apple and crackers.
Two events at the weekend reminded us how fragile life is here. On the boat trip we passed a group of rangers searching the river for the body of a colleague. He had jumped in to swim to his boat that was drifting away. It sounds like he was taken by a crocodile. There was also a near fatal crash involving a bus full of children. The brakes failed and the bus rolled back down the hill in to another mini bus nearly knocking it in to a ravine. Thankfully there were no serious injuries.
This week I did manage to get out in to the villages to follow up leprosy patients. It is always an adventure going out. This time we got lost miles from any where and ended up driving down single file paths through gardens and fields until we found a road that we recognised. Eventually we found our patient who unfortunately was quite ill. We arranged for his treatment and he was so grateful he gave us money to buy a soda. Ugandans can be generous but rarely do the villagers have cash to give away. This man owns a grinding machine and was obviously making good money grinding maize and cassava.

A few more wildlife photos:

A hippo keeping an eye on the crocodile in the grass in front of him:

Just playing:

Elephant feeding each other:

Cheeky baboon taking a drink from the pool:

Now posing for the photo:

MASINDI UPDATE

2009-07-21T19:40:00.004+01:00

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RHINO SANCTUARY

It seems like no time since the last entry but it is already two hectic weeks. The first week end we travelled to Kampala to meet other volunteers and renew old acquaintances. This was my first time to travel by bus to the city. We left at 2.00 and were at the hotel by 6.30. The bus journey was fine and it was great to find so many of my patients traveling on the same bus. Lots of people greeting “the doctor” made me realise how many people I must have seen in the last 21 months. It is one of the things I will miss the greetings, hand shakes and warm wishes from every one. People regularly greet you by saying “well done” even before you have done any thing. It is particularly welcome as most of the time you are unable to do any thing useful but people are just grateful for attention.
Kampala is a different experience from living in Masindi. Parts of the city are full of muzungos, mainly working for NGOs or out here to save Uganda. There are so many missionaries mainly from the USA that you wonder what they are achieving. They are all building churches or orphanages but many seem very naive about the real problems here.. You would think with all the good will that things would change but it is hard to see progress. Sitting in restaurants or coffee shops you hear people discussing HIV, empowerment, sustainability, income generation etc. It is almost as though we volunteers are the new colonialists and instead of slaves, ivory or diamonds it is orphans, poverty and HIV that we trade in. There are so many people making a career out of all this may hem that you sometimes wonder if we are perpetuating the situation for our own ends.
But at least you can get a nice meal and a good capuccino in Kampala.
One of the things I was able to do was visit Hadija a little girl we had sent to the Hope ward at IHK. It was so nice to go on a clean ward and find caring nurses who knew the patients. She had been properly clerked and was being investigated. We still do not know what is wrong with here but at least she has a chance of being sorted out.
The trip back by bus was more of a problem. When we arrived at the bus park one of the touts from another bus company recognised me, an old patient and tried to get us on his bus. We made the Link bus and joined it. We had been told to be there by 1.00 but the bus finally left at 3.30. We had two and a half hours of entertainment watching all the people arriving and departing and all the vendors trying to sell a huge variety of goods on the buses. It certainly is an experience but some experiences you do not need to repeat!

Last week I had an opportunity to visit Kigumba a small town north of Masindi. Hugh who works for the Salvation Army runs a project in the town. The project supports vulnerable children some of whom sleep rough others who head up households. The project provides meals three times a week and Hugh wanted the kids checked over to make sure they were ok. Pam, Maggie and I went and examined 42 kids. It was a good day and good to find they were all quite healthy in spite of there problems.

New visitors gives us an excuse to do tourist things again. Reg and family have arrived so the rhino sanctuary was first trip. One of the rhinos has had a calf but unfortunately it was not on view. Next week end we are returning to Nile Safari our favourite chill out hotel.

KIGUMBA SOME OF THE CHILDREN OF THE KIGUMBA PROJECT.

ADMISSION
Fraud and corruption are common place in Uganda and it is important that we report on dishonesty and fraud. Finally under intense pressure Maggie has admitted that the picture of us on the blog has been artificially enhanced! She can not resist using her skill on photoshop so she covered my embarassing bald patch and touched up her roots. I find it hard to hold up my head in company but that is not the reason that the GMC have deregistered me that is another story.

SODIS and Tippy Taps

2009-07-08T15:17:00.007+01:00

SODIS BOTTLES AND A TIPPY TAP IN OUR GARDEN

After last weeks excitement chasing chimps we have had a much quieter week. I have had chance to discuss the chronic care clinic with both local management and last night with officials from the ministry. We are still struggling to get a secure drug supply but at least for now have some ART. There seems to be little chance of the district finding a doctor to replace me but at least they seem to have found a clinical officer. He arrived to start work on July 1st but as there was no accommodation he went home. He has been back 3 times to try and move in but the hospital have not fund any where for him.At least he appears keen.
The Miirya project is still progressing thanks to the support of people in the UK. Pamela has been very active moving out to the villages and encouraging volunteers. We held a meeting in each of the three parishes for volunteers and were pleasantly surprised by their continued enthusiasm. It is very humbling seeing people prepared to walk several kilometres in the sun just to hear us talk and give encouragement. It is difficult to pass people by on the road but we have a maximum of seven in a small toyota saloon. Moses our taxi driver is very accommodating but even he needs to change gear sometimes so only 3 in the front! The volunteers do get an allowance for travel to the meeting but most prefer to walk and keep the 2000 ush ( about 60p).
Each meeting is different. Bigando is always our favourite because Miriam in charge of the health centre is so enthusiastic. She produced figures from the health centre showing that there had been a drop in malaria since we started distributing nets.That was great for us to see and great for the volunteers to understand that their work is yielding results.At Kigulya the volunteers are quieter and the support from the health centre is less but it was still a good meeting. At Isimba the health centre failed to send an observer but we did have a resident drunk who kept up a lively contribution until he realised that there was no free food.
Although the main focus of the project has been on malaria prevention by using long term treated nets we have recently held workshops on sanitation and safe water. It was good to see volunteers enthusiastic about SODIS (solar disinfection of water). The idea had really impressed them in its simplicity and relevance. Most of the volunteers had stopped boiling their water and were using SODIS themselves and had taught people in the villages. The limiting factor seems to be availability of plastic bottles. In town you see bottles all over but in the villages they are in short supply. We are now organising collection of the bottles to recycle them in the villages. SODIS does seem an obvious intervention for Uganda with its abundant sunshine. Any reduction of fuel needed will be helpful as well. One of the best things at the Kigulya meeting was hearing Aida a 70 year old traditional birth attendant and volunteer explaining to the group about SODIS. Aida speaks only Runyoro but had grasped all the features of SODIS from the workshop and had been telling people in her village.
We had also shown the volunteers how to make Tippy Taps to wash their hands. Many of them had constructed them at home and already held meetings to show villagers how to make them. Being a good role model is one of the important parts of being a Miirya volunteer.
Of course not every thing is working perfectly in Miirya. We had a report that one of the volunteers who is also a TBA has been dissuading patients from attending the health centre for delivery. This is against government and the project policy. It was helpful to discuss this at a meeting and hear the volunteers condemn this action. They are supportive of the health centres but we need to make sure the health centres are supported to provide safe deliveries.

Chimps

2009-06-30T07:34:00.006+01:00

Getting up at 5.30 a.m. on Saturday was definitely worth the effort. By 7 a.m. we were deep in the forest witnessing a community of chimps waking up. This was a once in a lifetime experience for us; a special treat from our chimp researching friends, Cathy and Roman, who invited us to spend the day with them at their place of work. We kept up with one family group of chimps for the whole day and observed their daily routine. It was fascinating watching the inter-action between the family and their friends and learning about the different relationships. We had it all - the love story, the jealousy, the frustration, the rejection, the sibling rivalry, the parental angst! It would make a great soap! One of the tasks of the research assistants was to collect a urine sample from a particular female. I was intrigued by how this could be possible and expected to see a technical piece of equipment. It turned out to be a long branch with a plastic bag on the end which was strategically placed under the chimp whenever she was up a tree! They weren’t successful on this occasion but I’m told it’s not always so difficult. It was an amazing experience to be with these wild animals at such close quarters. Sometimes they walked right past us, just a few feet away. A couple of times we had a display of anger from one of the males who came charging past us at speed; it was pretty scary! A lot of the day is spent eating and grooming but when the chimps decided to move on we just had to keep up with them. We stomped through the forest and jungle, fighting with the undergrowth, for eight hours. It was totally exhausting but so exhilarating and worth every ache and pain the next day.

Maggie.

It would be impossible to up-load all 380 photos so here’s a very small sample:

Setting out with the sophisticated 'wee catcher':

Back at base, exhausted:

Highs and lows

2009-06-25T07:51:00.009+01:00

By Tuesday it is difficult to remember what happened in the last week. Time is going quickly now as October approaches. We keep thinking of the things we are looking forward to and also thinking about the people and things we will miss about Masindi.
Work has been the usual mix of highs and lows. The grandmother of Vincent the little boy with dislocated knees came to see me this week to show me a picture of him walking normally. She also brought some prize mangoes which were delicious. I also saw Joel a boy with Burkitts lymphoma who has done really well thanks to the Hope Ward, the charity ward at IHK Kampala. He had the biggest tumour I have ever felt but it has disappeared with chemotherapy. Not so lucky are the two patients on the ward with advanced cancer. Their cancers are inoperable and we have not even got simple drugs to relieve their distress. I have failed to get the medical superintendent to order any morphine. There is a great fear of opiates here and little understanding of their role. It has been one of the frustrations working here that I have failed to develop a palliative care service. There is one in Hoima but that is too far away for most patients. Another patient that did not do well is a young women admitted unconscious with gas gangrene of the leg. It was a horrible site and one I will never forget. She would have needed a major amputation to save her life and it was not an option here.
On each ward round there are new things to see and new things to learn. Unfortunately it is rarely that you can do the investigations you would like or give the treatment that is needed. One of the things I have learnt is to be flexible and often the next best thing does still work. The human body has amazing recuperative powers.
Chris
On a more cheerful note I had a great day on Saturday at the Family Spirit School and Orphanage helping some of the older girls with sewing. Naturally there are some children who are coming to the end of their education and the staff are trying to find ways to give them some vocational training in the hope that they can make a living and a new life for themselves. Tailoring is a very popular occupation here. Many people have their clothes and their children’s school uniforms made locally. Just about every street in Masindi has its share of tailors and tailoresses sitting outside with their Singer treadle machines - I think they’re made in either India or China for the african market. I’m always amazed at the beautiful clothes produced given the facilities; there is no workshop space, just the surface around the machine, and there’s always lots of toddlers and customers milling around. Customers just stand in the street to be measured!
There’s little diversity when it comes to training; basically it’s tailoring or carpentry, possibly brick-making. The most popular employment for boys and young men seems to be running a boda-boda bicycle or motorbike. There’s always large groups of them standing on street corners. I’m not sure there is the demand for so many!

A couple of photos of our sewing class:

Another event this week was the African Day of the Child.
This was essentially an event where hundreds of selected school children (possibly the ones with a decent uniform!) marched around the common all morning in the scorching heat in front of dignitaries (sitting in the shade) and then in the afternoon the said dignitaries gave lots of speeches.
At least it was all very colourful - see photos!

My day at the library was quite challenging as Ritah couldn’t be there. The younger ones are not so proficient in English (or perhaps it’s my accent they can’t understand!) so I read stories with a book in one hand and the swahili dictionary in the other! It was encouraging that a few of the older ones came in during their free time to look at reference books. Thankfully the teacher accompanied the class of 140 children who came in the afternoon!
Maggie

mangoes, monkeys and Meryl!

2009-06-15T05:50:00.004+01:00

We were wondering what had happened to the troupe of monkeys we’d previously enjoyed seeing in the garden. Well, now it’s the mango season again and they’re back! That is, if Akim and Udetha will allow them anywhere near the mango trees. I occasionally hear the boys charging across the compound and wonder what on earth is going on, only to see them chasing the monkeys away. It’s been a good harvest this year with literally hundreds of mangoes between the six trees. We and our neighbours can’t eat them fast enough and we’re really enjoying the smoothies, the cakes, the desserts, etc. Of course, they’re delicious on their own too!
The monkeys are not our only visitors. Last week we said goodbye to Kate, a medical student from the UK, who was staying with us for a month and then two days ago we welcomed Hayley, also a medical student from the UK, who will spend the next month with us.
Yesterday a film crew from VSO UK arrived to make a promotional video to show potential volunteers. They are focusing (no pun intended!) on volunteers in health placements so came to Masindi to meet Chris and Pam the community nurse working here. They are also keen to portray daily life in Uganda so Chris and I were followed around the town and the market buying our provisions. Chris kept calling me Meryl Streep (of Out of Africa fame) but I don’t think she need worry about the competition! I must admit I couldn’t quite see the likeness in Chris to Robert Redford either!! It was good fun but, of course, it was only afterwards that I thought of all the things I really should have said.
We managed to spread Chris’ birthday celebrations over two days last week. One night was spent with our VSO friends and another night some other friends arranged a small party for him. Of course he had a birthday cake and the flavour was …………..mango!
The library sessions went well this week. It was really encouraging to get kids coming in to look at books in their spare time and not just when they were told to. During a session with a P2 group of about 60 children I asked how many of them have a book at home and no-one has! This library is going to be such as important resource to the community.
Maggie

As well as getting older and being a film star I have also been obsessed with diarrhoea this week, at least it makes a change from malaria. As part of the Miirya Project Pam and I have been running workshops for the volunteers on prevention of diarrhoea. Obviously sanitation and hygiene is the basis of this work. It is only when you are out in the villages that you realise how difficult many peoples lives are here. We take latrines for granted but households without latrines are common here, many people just defecate in the bush. There are strong taboos especially regarding pregnant women and the use of latrines.Hand washing is not regularly practised and few latrines even in the hospital or health centres have hand washing facilities. We showed some practical ways of arranging hand washing using “ Tippy Taps” and hope we have convinced the volunteers to use them.
They were impressed with SODIS or solar disinfection of water. This is a system using plastic bottles and sun light to make safe water. One thing Uganda is not short of is sun light and using this system should save people time and resources as it means they do not have to boil water. We have stopped buying bottled water for drinking I just put bottles out in the morning and can use them the next day.
After lots of e mails we have managed to get ARVs. I am not sure if it is coincidence or whether my contacting USAID and the ministry did the trick but I am pleased that we did not have to discontinue anybody’s treatment. We still need other drugs but it is a start.
Chris

Above, Akim playing with one of his favourite toys in our garden.

Also of Akim when he cheekily put on my pair of glasses. I took one photo of him and then without saying a word to each other he just started posing to have more taken - about 20 in all!

polio outbreak

2009-06-07T11:23:00.009+01:00

/
THIS IS A PICTURE OF A TRAINING SESSION FOR STAFF INVOLVED IN DELIVERING THE POLIO CAMPAIGN

THIS PICTURE SHOWS THE MARKET WERE WE FOUND THE PATIENT BELOW. HE WAS THE POLIO SUSPECT.

THE BOY AND HIS MOTHER AT THE MARKET

THE PATIENT NOT VERY IMPRESSED WITH THE MUZUNGOS HOME MADE BALLOON

This week has been full of interesting medicine. On Monday I sent two patients to Kampala for opinions. One little baby was confirmed to have a hole in the heart and will need corrective surgery and the other young boy was for follow up of his Burkitts lymphoma.I also sent some x rays for an opinion from Richard my VSO colleague in Kampala. One of the xrays was of a young man with HIV who I thought also had a lymphoma. Richard suggested he may have TB a much commoner diagnosis and this was confirmed when I aspirated some pus from his lymph node. It is a much better diagnosis and with the right treatment he should do well. I also saw two patients with extensive Kaposi sarcomas. This is a horrible tumour that occurs in advanced HIV and is almost impossible to treat here so they will do badly.There was of course the general run of malaria including a young baby who was desperately anaemic. Again we had no blood available and I expect the parents took her home to die. Malaria still regularly kills children usually because of severe anaemia and our inability to provide transfusions. That is why prevention is so important.
Wednesday was Martyrs day a public holiday held to commemorate some christian martyrs. It was my intention to stay at home and catch up with some work but at 9.30 I had a call from the district health officer saying that there had been a suspected case of polio reported and would I go as part of the team to check it out.
Uganda has had 7 cases of polio in the last few weeks after being declared polio free a few years ago. This has prompted a huge immunisation campaign to try and prevent an outbreak. This week end is the last of the emergency sessions and there has been a great effort to mobilise people to take their children under 5 for immunisation.MTN the mobile phone company has been sending text messages to every one telling them to take their children. The government has threatened imprisonment for parents who do not take their chidren for the immunisation. It is a huge under taking staff have to be trained vaccines obtained and delivered to numerous out posts. the vaccines need to be kept cool. Unfortunately it is difficult to evaluate the success of the campaign as there has never been a register of all children. This time they are trying to register each child so the per centage up take can be calculated. Last time some of the clinics recorded uptakes of 120% which is a worry!
The case we needed to check on was a 2 year old who had stopped walking a month ago. In the same area there had been another child with paralysis of one leg. This child had been admitted for assessment but from the history it looked like this was nerve damage after a poorly given injection a not uncommon problem here. Mutondo is at the far end of Masindi district and it took two hours to get there. When we arrived at the village the child was not there but had been taken to the market. With the help of one of the health workers we were able to track the child down and take him back to the health centre for an examination. This examination took place under a mango tree. He was not happy to be examined by a strange muzungo doctor but it was soon pretty obvious he did not have polio. He appeared to have a painful swollen knee and a heart murmur so I wondered if he had rheumatic fever. I gave some treatment and arranged to see him in a weeks time. Because he had been listed as a suspect we had to arrange for stool samples to be taken to Entebbe for checking. The surveillance here is good but does depend on people getting to health centres and health workers reporting their concerns.
This trip did take me to a part of Uganda I have never seen. While we were there we visited the site of an orphanage being set up by a US medical missionary. This doctor had found a site of 500 acres next to the Nile. He has funded the purchase through churches in the US and is setting about building a school, orphanage and hospital in the middle of nowhere. You do meet some inspiring people here.
Library up-date:
The day that I had planned to go turned out to be Martyr's Day and therefore a national holiday. At the last minute I re-arranged everything to go on Friday instead. It turned out to be an interesting day and not at all as I had expected. Our first group to visit the library that day was one of the P1 classes. One of the two P1 class teachers hadn't turned up for work and the other one really wanted to go to town, leaving about 60 children without supervision. After a lot of chasing we managed to get a group of them in the library - together with a stray chicken! I decided to do a 'warm up' action rhyme with them but this took the whole session. At least they seemed to enjoy it. The following two sessions were with P5 and P7 classes and these turned out to be discussions on topics such as emotions and various sex education issues. As a teaching aid I was using a newspapers produced for primary school children. It has an Agony Aunt page and, because of cultural differences, the letters were nothing like what you would find in the UK! They were difficult topics to cover because the classes have pupils of all ages. Children progress to the next school year based on their ability rather than age so it is not unusual to have older teenagers in a P1 class.
Ritah, the librarian, invited me back to her house in the village at lunchtime. The house is actually a one-room brick building with a metal door, no bigger than most garden sheds, but typical of the way most people live here. There is just enough room for a single bed and a wooden chair with pots, pans and jerry cans piled up in the corner. Her latrine is shared with several families so she prefers to go down the road and use the one belonging to a colleague. Cooking and bathing are all done outside. As she prepared her lunch of fried cabbage and smoked fish we exchanged lots of culinary titbits - I picked up lots of tips! Ugandan cooking is not as easy as it looks. I find it quite tricky wrapping the matooke (a special variety of bananas) in banana leaves in such a way that it makes a tight parcel to steam over the charcoal. Then keeping the charcoal at the right temperature is also a skill. Chris is quite happy for me to not perfect the technique as he hates matooke anyway and thinks I should stick to pasta!
Maggie

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Time flies

2009-06-02T06:16:00.003+01:00

THE PICTURES ABOVE ARE OF TWO BROTHERS WITH EARLY LEPROSY BEFORE NERVE INVOLVEMENT. THE PHOTOS SHOW EARLY SKIN LESIONS.

THE PICTURES BELOW ARE FRANCES THE OLDER BROTHER WHO HAS HAD LEPROSY FOR SEVERAL YEARS AND HAS ADVANCED DISEASE WITH SEVERE NERVE INVOLVEMENT. HE HAS ANAESTHETIC HANDS AND FEET WITH LOTS OF DAMAGE.

EARLY TREATMENT WOULD HAVE PREVENTED THIS DAMAGE.

Some how we missed out on last weeks blog. As we enter our last four months time seems to be going quickly and a week can pass by with out you noticing it. It is also hard to find something new to write about. Things that seemed really novel and interesting this time last year are now not even noticed.
Money has always been a big issue here in all sorts of ways. Even as a volunteer you are seen as much better off than every one else which is true. This does not appear to provoke jealousy but does mean that people regularly ask for money. This week the children have returned to school so school fees are due. Although primary education is free many families opt to send their children to private schools as they hope that the education will be better. Many schools are boarding schools so for much of this week people have been away from their jobs delivering children. It seems to be accepted that a few days off work to take your children to school is reasonable. Families make real sacrifices to send their children to school. Any member of a family who has a job will be expected to support not only his own children but other children as well. Unfortunately the local government has not paid salaries for the last two months so all health workers, school teachers and police are struggling to meet their school fees. It is hard to believe that salaries can just not be paid but it is not uncommon here. When I ask colleagues about it they just shrug their shoulders and say “this is Uganda”.
Most patients are from the villages and are basically subsistence farmers. They have little spare cash but health care here costs money. The health service is supposed to be free but only if the drugs and resources are available. We have not had any X-ray films for over six months and there is no ultrasound. If a patient needs the investigation they have to go in to town and pay 15000 ush for an x ray or scan. I frequently see patients in need of x-rays especially to rule out TB. If they have not got the funds I am able to use some of the money that was donated before I left Hull. This month I have been dipping in to that fund quite a lot. There was the case of the women who had been bitten by a dog that was ill and acting strangely. There is rabies about in Uganda even though cases are rare. The government should supply rabies vaccine but there is none available in the hospital so it has to be bought from a private clinic. There is no chance that this woman could afford 120000 ush for a course so the fund stepped in. It would have been difficult to send her away. Tomorrow I will use some of the money to pay for a special hire taxi to take a baby with a heart defect and a young boy with Burkitts lymphoma to Kampala for assessment. Unfortunately I think the baby has a serious problem requiring surgery which is unlikely to be available here.
By chance this week there has been a team of American medical missionaries visiting. One of them was a nurse who works for a charity in the states that takes babies to the US for corrective surgery.It is just possible that Rita the infant may get her surgery there.
I managed to get out on Wednesday to follow up some of the leprosy patients. One of them asked to see other members of his family. It was an isolated homestead but it was worth the effort as two of his brothers had definite leprosy. Luckily they were early cases and did not have the severe nerve damage that Frances has. It is satisfying to find new cases, I am afraid without my encouragement the leprosy nurse would not have bothered to chase them up. There is a major problem with searching out new cases and getting them on treatment early. One of my aims before I leave is to get the district to recognise that they have a problem with leprosy and must be more active.

LIBRARY UPDATE
On my first day we got off to a slow start. First of all, I should have been going on Wednesday but as Ritah had to go to a burial we postponed until Friday. It was a common 'man with the key' problem. Once we'd gone round the houses, literally, to find the key it was almost lunchtime. As it was the first week of the new term the children were occupied with cleaning classrooms and digging the compound. This meant that the library was not open for business as usual but it did give us an opportunity to start sorting the long awaited shipment of books.It seems that this shipment from the UK has been stuck at customs in Entebbe for quite some time. Also, Ritah did not want the children in the library until some of the girls had taken the mats down to the well to be washed.
My second day, today, turns out to be Martyrs Day and therefore a national holiday so the school is closed. I will hopefully get to work on Friday. Flexibility is the name of the game!
Maggie

Nyabyeya and school library

2009-05-18T08:16:00.004+01:00

Here are a few photos of my first trip to the library:

The library is the room in the centre with the new shutters and roof, next to the condemned classroom which is still in use.

My first meeting with Ritah.

During our meeting some boys came in and made themselves at home! Also in the picture is Cathy.

The 'Interesting Corner' which at the moment mainly focuses on football!

About 30k outside Masindi, on the outskirts of Budongo Forest, is a small village called Nyabyeya. Most of the inhabitants are subsistence farmers, though there is also a small gravel pit where women with babies on their backs work all day digging and grading the gravel. In the village there are a few small shops selling the bare necessities such as kerosene, oil, soap, home-made rope, etc. and a few roadside stalls selling fruit and vegetables. It’s a typical village with groups of men sitting around enjoying the local brew and playing cards.
The journey from Masindi to Nyabyeya is along a marram road which, when dry, makes driving difficult with the clouds of dust but, when wet, is probably worse as the surface becomes like a skating rink. I’m always amazed at how many people walk this road, day and night, often with young children and babies. Some are carrying jerry cans of water, firewood or baskets of produce from the land balanced on their heads. On a good day the journey is quite pleasurable and if you’re lucky you can see colobus and vervet monkeys, baboons and the occasional chimpanzee.
Just outside the village is the Nyabyeya Forestry College and in Budongo Forest itself is an important Field Station carrying out work on chimpanzees.
Nyabyeya also has its own primary school. It is here that the Budongo Forest Conservation Trust have opened a small library to try and raise the academic and language skills of the children. It will also be an important meeting place for the children where they can be taught extra-curricular topics such as conservation and skills which will help them become useful citizens to the Budongo community. The library is funded by the Trust which has paid for the renovation of one of the condemned school buildings and also pays for a full-time librarian called Ritah. So far all the books have come from donors in the UK. The library has a long way to go. It needs many more books, particularly text books, and resources such as charts, posters and other teaching aids.
It is through a friend of ours, one the chimp researchers from the UK who lives at Nyabyeya, that I have been asked to help for one day a week. Cathy and her mother have been involved in raising the money and setting up the library. I have never thought of myself as a librarian but have decided to give it a go! My new jobs begins next week with the start of the new term.
Here are some photos of the library. As you can see, it looks quite sparse at the moment and we only have mats to sit on, but a lot of work has been done to create a safe environment. The roof has been replaced and there are new shutters and doors. The adjoining school rooms remain condemned, with roofs that leak, no windows or doors, but they still have to be used as there is no alternative. The school has a few newer rooms but they are not enough for the number of pupils.
Maggie

A better week

2009-05-12T19:30:00.003+01:00

Uganda does have a lot of compensations. Two week ends ago we went to Lake Albert to stay in a safari lodge overlooking the lake. The lodge is on a cliff and you can look down on the Lake and see the mountains of the Democratic Republic of the Congo on the other side. The setting is superb and the sun setting over the lake was a wonderful sight. There were lots of new birds for Maggie to tick off on her list as well as some beautiful butterflies.

This last week end we stayed at home and entertained friends. Maggie produced wonderful meals including ice cream. She managed to make it out of tinned cream and dried coconut milk. The time it took in preparation was more than it would have taken to drive to Kampala and back but it was really good and every one thought it was worth her effort. On the Sunday morning we had brunch complete with kedgeree. Smoked tilapia off the market made a good substitute for haddock.
After all Maggie’s hard work I had to wash up but its not a bad job here when you can watch Paradise and African blue fly catchers outside your kitchen window. The bird life in our garden has increased with the rains, they are all displaying and building nests. It is easy to spend an hour just sitting and watching. The monkeys have not been around for several weeks. I hope the building work has not frightened them off. Hopefully the mangoes that are just ripening will attract them back.
We are due the first of our visitors from England this week. We should have a string of people coming until September. It is good to have them as they make you look again at Uganda and is an excuse to visit more places.
At work we are celebrating because we finally have a supply of TB drugs. Unfortunately it looks like we may run out of ARVs for HIV next week. Nationally Uganda appears to have no ARVs in the national stores. By using the muzungos network and making lots of phone calls and e mails we have a promise that drugs will be supplied next week. I hope that happens as the consequences of stopping drugs can be serious.

Not a good week

2009-05-06T15:27:00.002+01:00

Unfortunately last weeks smiles were a bit premature. On Tuesday morning I received a phone call from Chris the clinical officer saying that he had been asked to see Slyvia the little girl with diabetes who had been readmitted. She was dead. The story was that she had been admitted through a private clinic in coma. They had given her a shot of insulin and sent her to the hospital. The doctor on call saw her later and ordered a blood test for later in the morning. She did not survive the wait. She had obviously been given too much insulin and should have been treated urgently with dextrose. A simple injection would have saved her but no one thought of the right diagnosis. It is such a pity as she was doing well when I saw her in the clinic last week. Diabetes is not well understood here. It is only just being recognised as a problem in Uganda. Most of the emphasis has always been on infectious diseases which still represents the major risk here. There needs to be a big education programme and I am scheduled to start it next week. You realise how basic the training has to be when you realise some of the nurses do not know how to read urine dip stix.
If I can teach people that unconscious diabetics should be given dextrose then may be Slyvia will not have died in vain.
Th other big problem this week is lack of drugs. I have become used to shortages of antibiotics and anti malarials but we are about to run out of ARVs the essential drugs for treating HIV. These drugs have revolutionised the management of HIV and allowed people with HIV to return to normal life. The drugs need to be taken every day without missing any doses. Even missing a single dose allows the virus to mutate and can produce resistance. Now it looks like patients will be forced to have breaks in treatment and the consequences will be extreme for some.
Lets hope next week is a better one.
May be I should have gone to church!

Smile for the camera

2009-04-26T16:29:00.007+01:00

This Sunday we were invited to another thanks giving at the cathedral. Twice in one month seemed to be excessive and in view of all the thunder and lightening this week we made our excuses. So today we have had a quiet day at home catching up on mail and avoiding filling in a tax return. How come Alastair Darling has time to worry about me this week of all weeks.

PICTURES OF THE PYLON BEING ERECTED.ON THE LARGER PICTURE YOU CAN SEE THE FOREMAN TAKING A REST ON THE TOP GIRDER (IF YOU HAVE GOOD EYES)

This week there has been major excitement at the bottom of our garden. For several weeks there has been building work going on late in to the night and we thought someone was having a house built. As the structure developed it was obvious it was offices and we now find that MTN the mobile phone company has had the offices built. They began erecting a mobile phone mast at the end of last week. It has gone up very quickly built by six men with the aid of a tree trunk with a pulley on the end as their only crane. The men seem to have no fear of heights and walk about the structure with out holding on. Some of them seem to have harnesses but they do not appear to use them. One of the men stands on the top girder and waves when ever Maggie goes out to look. It is an amazing example of building and has absolutely no regard for health and safety. Ugandans are very fatalistic most of the men do not expect to live a long time so they do not consider risks. But considering the statistics those men standing on those girders probably have less chance of dying on this job than a women in the village every time she gets pregnant. Maternal mortality is high in Uganda and even higher in Masindi (over 500 maternal deaths per 100,000 live births). I presume the men get well paid for the job.

SLYVIA AS SHE WAS GETTING BETTER AND JOSEPHINE SITTING OUTSIDE THE MATERNITY UNIT

SMILES
There have been things to smile about this week. The little girl with diabetes survived and went home on twice daily insulin. We were able to give her a supply of insulin and teach her mother how to give it. Of course she is still at risk, she lives in a village away from town and will have difficulty getting supplies but at least she has a chance. Most children with diabetes in Uganda die on presentation often without any one recognising they have diabetes. We received some fresh supplies of insulin this week and an Irish visitor left her glucometer and 100 testing strips so we are able to check blood sugars again. Slyvia (not Sylvia) the little girl had a lovely smile once she was getting better and it made me realise that most of the Ugandans are quick to smile and seem happy to greet you.
This week’s photos are mainly of smiles. Josephine the lady nursing the new born baby is a nurse in antenatal clinic. In spite of her own health problems she is always there to help her family or friends. The picture shows her nursing her latest grand child born eight hours earlier in the hospital. Monica the mother is one of the HIV counsellors and was at work on Wednesday, went in to labour Thursday night and delivered a 3.5 kilo healthy babe a few hours earlier. The maternity unit delivers between 5 and eight babies each day. Babies and children are every where in Uganda. The population growth is one of the highest in the world with the average woman having 7 pregnancies. It is not unusual to have 10 children

SMILEY FACES

Church and home

2009-04-21T19:01:00.004+01:00

THIS IS A PICTURE OF RASOUL OUR WATCHMAN PLAYING LUDO WITH ROSE, AKIM AND ADETHA

This Sunday we were invited to a thanksgiving of one of my colleagues in the community department. Ronald was 58 and wanted to give thanks for his life and his marriage. He had helped as a translator during the workshops for the Miirya project but had become ill during the last workshop. He developed severe heart failure due to hypertension and was off work for several weeks. I visited him at home several times and managed to get his failure and blood pressure under control so he was keen that I attended the thanks giving service.
The thanks giving was part of the weekly English service at the cathedral which is the church that Ronald attends. The first service of the day is at 7.00am in Runyoro. We attended the 8.00 am English language service with about 600 other people. There were 5 muzungos in the congregation. You can not imagine 300 people waiting outside an English church for an 8.00 o clock service but that was what we found when we arrived. The other 300 seemed to be staying on after the Runyoro service. Ronald was there with several members of his family dressed in their finery. They invited us to sit with them in the choir stalls but we opted to sit in the ordinary pews. In spite of this we were spotted and had to stand up and be welcomed by the congregation. The service turned out to be dominated by an election of church wardens. This produced a dispute between members of the congregation and the vicar leading the service. The diocese has a constitution and the election of 12 wardens is not part of that constitution. After a heated discussion the election was abandoned but only after some youth volunteers had been elected. One of the youth did not want to be elected as she did not live in Masindi but her protestations were discarded and she was duly elected to serve the youth of the congregation. It was a shame that in spite of the enthusiasm of the congregation the service appeared to be dominated by politics and collecting money. Ugandans love religion but if this is an example of how the church works they are being let down. I am told that it is very different in the villages and much more joyous.
Maggie’s blog last week mentioned the wild life. She now claims that there is a mouse in the house. Every now and again she shouts out and says she has seen something run across the floor. She is the only one to see it and I am beginning to think she has had too much sun or too much waragi. People say it is a good sign if you have a mouse because it means there are no snakes in the house. The rains are continuing and every thing is growing rapidly. It is a great time of the year here and as long as the roads stay clear you are ok.
This week we have been holding meetings with the volunteers from the Miirya project. Happily most of the volunteers attended the meetings and seem to still be motivated to keep involved. We have nearly finished our first round of net sales and most of the volunteers reported that people had been pleased with the nets. A first look at what had happened to the nets revealed that some people were keeping them and not using them. There is still a lot of education needed so the project needs to develop. One volunteer reported a tragedy where a child had been put to bed in a net and had taken a candle in the bed. She was left alone and the net and bed set alight burning down the house and killing the child. Fires are not uncommon here as people have to use candles or paraffin lamps as electricity is not around in the villages. The villagers did not blame the nets for this tragedy but blamed the mother for leaving the child alone.The nets are flammable but very slowly and appear to be safe. I saw another burn this week of a 3 yr old child whose mother had let fry some eggs over the stove. She was an intelligent mother, a primary school teacher but she did not think that 3 years old was too young to cook. Childhood is very short here for many children. It is not unusual for children especially girls of six years to be caring for their siblings.Most children have jobs to do before and after school such as fetching water or fuel.There is little time to play and most children do not have toys.
Akim and Adetha who live in our compound are luckier than most. Rose is a great mum who spends a lot of time with the children in spite of having 4 jobs. Some one brought out a giant ludo and they love to play. Adetha is the champion at the moment. They also love to play chasing games. Every time we arrive home the boys run out to greet us.They then tig us and shout "Kabali" and race off,I usually manage to catch Akim but Adetha is really fast or may be I am just getting old.

Late news
Maggie is not hallucinating. The mouse is real!

Wildlife

2009-04-14T15:40:00.005+01:00

Above: a weaver bird collecting grass
Below: nest building

The finished result:

When we think of wildlife in Africa we automatically think of the big game and going on safari in a large Landcruiser or similar. But wildlife is also on our doorstep in the form of tiny insects, butterflies and birds. It’s around us all the time but is even more evident after a good rain storm. The seasons are not well defined though there are periods when it’s even hotter than normal. At these times there is a lot of dust but still everything looks quite green. However, when the rains truly begin we really know about it in more ways than one.

Almost every day for the last two weeks we’ve had a good rain storm at some time during the day which has helped to bring the temperature down. The storms don’t necessarily last long but we have torrential downpours and sometimes we are treated to fantastic light shows from the lightening over the hills. The roads can become quite treacherous and most people prefer to just put everything on hold and stay put until it’s cleared. That includes not going to work, appointments, etc!

Anyway, back to wildlife…….. there are some amazing sights after a good rain storm. We have flying ants with huge white wings which, as they hatch, rise up from the ground in great swarms. They shed their wings which cover the ground like petals and the remaining bodies are hurriedly collected to be eaten. People compete with the birds and frantically gather them up in whatever vessel they can find, even in a scrap of cloth or old piece of paper and then take them home to cook. They can be fried or boiled and are apparently highly nutritious. I’m reliably informed that they’re also really tasty which I confidently believe as I’ve no intention of trying them!

Of course we also have swarms of flies around which attract the flycatcher birds. In our garden we have many different species and just this morning I’ve seen the Northern Black Flycatcher and the African Blue Flycatcher. The garden is a hive of activity with the dozens of different birds and at the moment all I can hear is their birdsong. There are too many to even try and distinguish them. I wish I had a way to record them. On my way into town there is an amazing sight of weaver birds building their nests. One tree is full of them beavering away, as if in frenzied competition with each other. The birds have such skill in home-making. The little nests hang precariously on the tips of branches with the entrance at the bottom. Inside the nests they build small chambers to contain their eggs and offspring, to prevent them from falling out and also to deter predators. Sometimes you can look up and see a cluster of little mouths wide open, eagerly awaiting some food. Also, I noticed the other day that the drain alongside the main road, which is full of very dirty muddy water, is now full of tadpoles. As far as I know, no-one here eats frogs which I find quite surprising as I’ve heard that bats and rats are eaten in some areas. One of the disadvantages of the rain is that there is an increase in mosquitoes. There is a belief that the mangoes bring the mosquitoes; it’s just that the rain brings the mangoes!

Another common sound at the moment is that of women and children hoeing the ground in preparation for planting. Children are expected to help on the land and have to fit it in before and after school. Even the schools recruit children to do the digging. Most people have some land where they grow their own crops for feeding their families and what they don’t eat they sell at the market. At home we are now enjoying our new season of avocados and pawpaw. The mangoes are still a little bit small but the salad and herb crops are all growing well. Soon we will have peppers, aubergine and courgette again.

We enjoyed a relaxing Easter weekend. On Sunday we visited friends who are researching chimps in the nearby forest and live near the village of Nyabyeya, about 30k out of town. We had a barbecue and just to remind us of the UK it rained! Even though Masindi is a small town it’s good to get out into the rural areas. There are always new things to see.

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2009-03-29T15:48:00.003+01:00

THE PICTURES ARE OF CHARLES WHO HAD SEVERE MALARIA WITH ANAEMIA. HIS HAEMOGLOBIN WAS DOWN TO 4.0 BUT WE HAD NO BLOOD TO GIVE HIM. HAPPILY HE RECOVERED AND IS NOW WELL. THE OTHER TWO ARE FRIENDS OF MAGGIE.

It has been strange to be back in Masindi after 3 weeks in the UK. Every one has welcomed us back. People who I do not recognise shout “welcome back doctor” when I walk round town or in the market. The staff at Court View were particularly pleased to see Maggie back after she had been lost for 5 weeks but disappointed when they realised she was not going back to work. They were all keen to hear about the wedding and wanted to see pictures. The informality of Becky and Gordon’s ceremony surprised them and when they heard the reception was on a boat sailing down the Thames they did not believe us.
I was back to work on Tuesday to find no change. Happily we have managed to borrow TB drugs for the moment. It was world TB day on the 24th and the Ugandan celebrations were held in Masindi. There was lots of marching and brass bands with speeches from the politicians. Many people in the town are wearing new T shirts with TB slogans. The man from the ministry admitted that Uganda has run out of drugs but they are expecting a shipment this week. There was also a visit from a team monitoring the TB/CAP programme this is a donor funded programme trying to improve services for patients with TB and HIV. They shared my concern about lack of drugs and were surprised when I reported that we had no x-rays or sputum containers in the hospital. The programme does have a vehicle and I was grateful to be able to use that on Wednesday to go out with the leprosy nurse to review patients. Gradually there seems to be some improvement in the leprosy service and people are getting reviewed and assessed.
Just before I left for the UK Uganda had its first case of polio for 12 years. There have now been 7 cases confirmed in the adjacent district. The out break seems to have moved down from Sudan where immunization programmes have been interrupted by the conflicts. Polio was due to be eradicated from the world but wars in Congo and Sudan and problems in northern Nigeria have delayed the process and there has been a recent upsurge in cases of this dreadful but preventable disease.
President Museveni made a presidential decree that said that all children under 5 years should be immunised in the at risk districts. Somehow with the help of the WHO Uganda mounted an emergency campaign and over 90% of children have received the first of three immunizations. Refusal to present your child is an offence and the police are involved in monitoring the campaign. The UKs efforts to provide immunisation seem feeble compared to such an effort by the community department. John Kirungi who heads up the department is one of the unsung heroes of public health who are scattered through out Uganda and Africa. They keep battling on against all the odds to try and protect their communities.
The Miirya project has continued while we have been away. Fund raising is going well and it looks like we will exceed our target thanks to the generosity of friends and colleagues. It was good to see Comic Relief concentrating on mosquito nets when we were home. Aron the teenage son of Rose our house girl came to see me on Wednesday he was sick with fever and vomiting and looked really ill. He does sleep under a net but still had malaria nets do not give 100% protection. Happily with the right treatment he was better within a couple of days. Teenagers recover well but it is the young children who have the most risk. We have now distributed 2391 nets in 24 villages and have another 15 villages to visit. Pam Llewellyn my nursing colleague who has been fund raising in the UK is coming back out next week to work on the project and hopefully we can further develop the work. There is a lot to do.

Back in Masindi

2009-03-26T16:59:00.005Z

Well, we are now back in Masindi after our trip to the UK. I know the weather was very kind to us in the UK, we missed the snow and rain, but the contrast in temperatures is greater than we’d expected. The heat literally hit us in the face as we descended from the plane at 9.30 on Monday morning and gradually got hotter as we made our way up country. When we left Masindi a few weeks ago we thought the rains were coming, which would cool everything down, but apparently they were short lived. It’s still possible we could get some more rain in the next few weeks to keep us going until the longer rainy season in Sept/Oct. My newly planted vegetable garden is looking very thirsty but the avocados and mangoes seem to be growing nicely. I just have to keep the monkeys off!
It was great to catch up with family and friends on our trip and, of course, the highlight was Becky and Gordon’s wedding. It was exactly as they’d hoped it would be; everyone had a wonderful time and yes I did find 'just the right handbag'! We were lucky enough to also go to the wedding of a friend; another fantastic day and an opportunity to see people.

In many ways it's good to be back. To be greeted by so many people who seem to have genuinely missed us is quite heart-warming. In our absence four new VSOers have arrived which boosts our cluster by 100% and hopefully our social life too! We are looking forward to getting to know them.

Sue, a friend of mine, gave me some shirts for our askaris. Solomon wanted to put his on right away and here is a photo of him modelling it, complete with his bow and arrows!

Maggie

We'll be back

2009-03-07T14:22:00.002Z

We are in the UK at the present catching up with old friends and preparing for Becky's wedding. We do not have e mail access so this is from an internet cafe in Edinburgh. I am taking a breather while Maggie searches for the elusive "just right hand bag" to go with the "have I bought the right one wedding out fit".
We are fine and have had a great time since arriving. Maggie refuses to allow me to post any of the hen night photos.She made an ace roller skater. We had a really good week end with the family. Hull was good. I did a short couple of surgeries to remind myself what it is like to be able to prescribe stuff and know the patient will get it. We also gave a presentation to friends and ex patients about Uganda and the Miirya Project and raised a further £1000.
We are returning to Uganda the end of March.
PS I hear that TB drugs have been found in Masindi so the 5 patients I left desperate for treatment should have started.

Maggie missing from Masindi

2009-02-22T15:19:00.004Z

THE PHOTOS SHOW THE SPECIAL BOARD AT COURT VIEW AND VILLAGERS FROM KIHAMYA WAITING TO BUY NETS

This has been a strange week with Maggie returning to the UK. Every body keeps asking where is Maggie and when is she coming back. The staff at Court View still do not really believe that she has left there and are still hoping she will go back.

Masindi has been full of Muzungos this week with delegations of Bristol teachers and a christian group of over twenty. It is strange to see them all coping with the culture shock that we experienced in 2007. It makes me realise how I have adapted and things that horrified me when I first arrived I now just accept. I am not sure if that is a good thing and whether justified rage would be a better position but you can only stay angry for so long. The people who you really should be angry with are not in Masindi, they are in Kampala in the ministries and their air conditionned offices.

So I did not fly in to a rage when the medical superintendant told me that he could not get morphine for a woman dying from uterine cancer, nor did I get angry when he said there were no sticks for the glucometer so I will have to guess at the values for the diabetic patients. I was pleased that somehow he managed to get hold of some insulin so I did not mind that we do not have any other diabetic drugs. We do not have amoxil, pain killers or hypertension drugs either. The two patients with severe TB I saw on Friday will have to wait for their drugs because we have run out of anti TB drugs again. We do not have leprosy drugs either and there are at least 4 new cases to be assessed this week. We do have ARVs and we were sent some "Plumpy Nut Sachets" to use for malnourished children. Unfortunately they are due to reach their use by date in March so we can not use them properly but at least some of the kids will get a short time benefit.

In spite of the shortages there are successes here and every day you see patients who have benefitted from treatment. Most days the hospital performs caesarian sections for difficult births which undoubtedly saves lives. The maternal and neonatal death rate here is still high but it would be much higher without the skills of the surgeons who operate. Many of the patients with malaria would die without appropriate treatment and it is unusual for an adult to die in the hospital from malaria. Unfortunately often they do not get prompt treatment and the nurses forget to give them their quinine but most survive. Patients with pneumonia usually survive unless they are complicated by HIV. Most of the TB patients do well if they take their treatment and TB is one of the most satisfying things to treat here. Lots of patients have severe TB and look like walking skeletons when you first see them but after a few months treatment they are unrecognisable.

The big problem here is prevention so that is why we are trying to provide mosquito nets and get people immunised. The meningitis has gone but there was a death from neonatal tetanus in one of the villages. All it takes to prevent neonatal tetanus is to give the mother a single shot bf tetanus immunisation in her pregnancy. This mother had attended 3 ante natal sessions but was not given an injection so the baby was not protected.

We have purchased another 1000 mosquito nets for distribution this week. The vehicle is off the road but some how we need to get out to 3 more villages. We may have to take a special hire as the district appear incapable of providing vehicles and do not see the project as a priority. This all costs extra money but it is money well spent.

Obama in Masindi

2009-02-15T06:27:00.003Z

PICTURE OF ISAAC AND STEVEN

PHOTOS ARE OF MURCHISON FALLS TAKEN ON OUR LATEST TRIP.

OBAMA AND MASINDI
Happily the meningitis outbreak appears to have finished as there have been no more cases after the emergency immunization campaign. I have been visiting some of the villages involved and was surprised when John one of my senior colleagues who I travel with told me that the villagers had been asking whether I was Obama come to help them. Obama is a real celebrity in Uganda and every one is expecting great things from him but why villagers should mistake an elderly muzungo for a young Afro-American was beyond me. Thinking about it I realised that if you live in a village you will never see a picture of Obama. TV here is rare and only ever seems to show premier league football, never the news. Newspapers and magazines do not reach the villages and all news comes from the radio which most people listen to. People have heard of Obama but have no image of him. The idea is that if any one from abroad is taking an interest it must be Obama. I hope he has time to sort out Masindi among his other problems, it needs all the help it can get.
We have a great time the last week with Hannah and Sara visiting us from the UK. Our trip to Murchison Park was wonderful as usual and we saw some magnificent elephants and other wild life including a beautiful chameleon on the road. Unpacking the vehicle on Sunday night we realised Maggie’s camera was missing. After intense questioning and threats of torture I confessed that I had hung the camera on a mango tree in the car park at the top of the falls. No one could face a two and a half hour journey back to the tree in the dark over unmade roads. We were advised to report it to the park authorities. I went to the office in Masindi at seven o’clock and was surprised to find a ranger there. Do not worry he said, tell your wife not to beat you these things happen we are all human. He radioed a colleague in the park and they promised to look for the camera the next day.
On Monday morning Maggie went to the office and was told that the camera had been found. They said it would be taken to the foot of the falls and given to the boatman. He would then take it to the office at Paraa. Simon said that when a vehicle came in to Masindi they would bring it with them. In fact the next day we had a call to say that the camera was at the Park Gate 20k out side of Masindi. Simon the ranger said if we paid for his fuel he would go on his motor cycle to fetch it. The camera was returned for the cost of 3 litres of fuel, 10000 ush or £3. A cheap price to save a marriage!
It amazes me that simple things often never happen here but complicated things work out. If I had left a camera hanging on a tree in Pearson Park in Hull there is no chance I would have got it back.

This week I had to ask Isaac who runs the family spirit centre to see a boy in the clinic. This boy has HIV.He is looked after by his grand parents as both of his parents have died from HIV. This is not an unusual situation here. Unfortunately the grand father is disabled after a stroke and the grand mother is an alcoholic who regularly gets drunk and beats the boy. Steven had run away the previous day to his aunt 5 kilometres away. He is malnourished and has Stage 3 HIV. He needs to start ARVs. His grand father accepted he could not care for him and was searching for help. Isaac is a big man but as soon as he walked in to the room you could feel the tension disappear from Steven. Isaac just wrapped him in his arms and gently talked to him.This little boy relaxed and you realised he felt safe at last. It was very moving. It was agreed that he would go to the family spirit centre and live there. He will be looked after and receive an education. Hopefully he will respond to ARVs.

February already

2009-02-01T17:52:00.003Z

PICTURES OF THE STORM AT COURT VIEW AND CHILDREN AT FAMILY SPIRIT WITH ISAAC THE FOUNDER

This has been a quiet week. The weather has broken and there have been some spectacular storms one of which removed the roof from the shop just out side are compound, luckily no one was around. The weather here is amazing it can change from bright sunshine to fierce rain within a few minutes. The rain is usually preceded by a wind which rattles everything in the house. You can often see the rain advancing up the valley. When it comes every one dashes for cover and everything stops. It may pass after a few minutes but sometimes you are stranded for much longer. The rain is just too fierce to walk out in it. I nearly got caught in a storm on Wednesday. The medical superintendent who is in charge of the hospital could not cash his salary cheque and needed some money to travel to Kampala on family business so he asked if he could borrow 200000 ush. I could go to the bank and withdraw it but he has no reserves. Even a man in his position is only just operating above the poverty line and has no spare cash at the end of the month. Most people here seem to live with out cash. Many people do not get a regular salary even when they are working it is not unusual for payment to be delayed. I have not had my salary from the district since July luckily we do not rely on it.
The rain hopefully will have helped bring the meningitis out break to a halt. The ministry sanctioned a mass immunisation campaign so the district rapidly trained staff and deployed them in the villages. I have not seen any one involved this week but I have not heard of a flood of cases and there have certainly not been any admitted to the hospital.It has been remarkable how the service responded to the out break once it was identified. It was not the most efficient response but hopefully it has worked. There has been no mass panic and hopefully no great loss of life.
This week has been busy with net sales. This has been the first time that the team have done it all on their own. I have not been out to supervise and it has been great to see that it all worked and three villages were visited. We are having a meeting tomorrow to plan the next stage. We still need to buy more nets and are now being approached by other villages demanding that they are involved in the project. There are no plans to extend to other villages until all the ones we identified have their nets but it is good that people are asking for nets. The rains will bring an increase in mosquitoes so it is important we get them supplied as soon as possible. A Peace Corps volunteer Chris has offered to arrange some fund raising in the US and we are hoping to raise some money when we return to the UK in March for Becky’s wedding. It looks like we will have to pay more for our next supply of nets but hopefully not too much.
I returned to the Family Spirit Centre this week end. A well wisher from the UK had sent some money for them. They had just been given two exotic goats by rotary international and needed a new goat house so the money came just at the right time. If all goes well they can breed from the goats and generate and income. I am always amazed by the centre. The children have so little but are always cheerful and polite. They are getting an education and somehow Isaac the founder manages to interest local people in the centre and gat them to offer services or food for the children. They are searching for a computer now as Susan the deputy has just done a computer course and wants to use her skills to keep better records. At the moment if they want any letters writing they have to go in to town and pay to use a computer and printer.

Meningococcal meningitis in Masindi

2009-01-26T13:13:00.004Z

THE PHOTOS SHOW MAUREEN 24 HRS AFTER HER MENINGITIS TREATMENT SITTING OUTSIDE THE CLINIC AND ON THE BED WITH HER FAMILY.THE BUILDING IS PAKANYI HEALTH CENTRE WHERE SHE IS BEING TREATED.

The meningitis out break has continued and I have been able to get out in to the villagers to see what is happening. There have been no deaths in patients who went to health centres but there were 3 more deaths in the villages. Three patients had been seen in one drug shop and treated inappropriately. We visited the shop and found that it was illegally operating as a clinic and giving drips and injections. The nurse in charge could not speak English which means he had not been through secondary school or nursing college in Uganda. The owner of the shop claimed he was trained in the Congo but it seems unlikely. Hopefully the shop has been closed down but I suspect it will reopen some where else. There is money to be made.
Some of the patients had been treated in a Catholic clinic. It was unknown to the district officers but was of a high standard. The nurses knew what they were doing and the place was clean with separate rooms for patients. It had been decided to treat all the patients in clinics rather than bring them to the hospital. It was argued that they would get better care in the clinics.
The politicians have been visiting the area to look at the preparations. They were not impressed that the district had not provided fuel and transport for the health workers. Some sharp words were evidently said and hopefully things will improve now. Today they have sent vaccines so a mass immunisation campaign is starting. All gatherings have been banned and it looks like the schools will remain closed for an extra week. One of the politicians from Kampala was so concerned that he might catch meningitis he demanded the treatment just in case. The image of a politician having 6 mls of oily chloramphenicol jabbed in to his buttocks will be one of my memories of Uganda.
The weather has finally broken and is now much cooler and we have had some rain. This is good for the farmers and should help to stop the meningitis out break. The dust is settling and it is much pleasanter. It could be that this is a temporary respite and we could have dust and heat again but it is nice at the moment.
We had unexpected visitors from Hull this week. Mark and Jonathon had a 3 day job out side Kampala and paid us a visit. It is always good to see people from home and we had a great time catching up on news. Maggie took them on a day trip to Murchison falls and was rewarded by seeing a shoebill, a bird she has been desperate to see since we arrived. She is really enjoying the bird life and is very knowledgeable now.

Hot and dusty in Masindi

2009-01-19T17:10:00.003Z

It is worrying when the Ugandans are complaining of the heatbut they are now.The last week has been very hot and every one is finding it difficult.By the time I have walked to work, ten minutes down the hill, I am ready for another shower. You sweat and smell all day until you climb the hill for home and another shower.We have it easy with indoor plumbing but most Ugandans have to collect there water from a well, river or borehole. You see children from about the age of four carrying water. It is part of their daily ritual and families will spend several hours a day collecting water.Often the water is not safe to drink so they then need to collect fuel to boil it. Obviously many families do not bother putting themselves at risk of diarrhoeal diseases.The dry season is hotter and earlier this year.People are worried that Uganda could be in for a drought and have to import food.This would have been unthinkable a few years ago but a poor harvest and increasing population could cause problems.It rained last night the first for 4 weeks but it did not last and by morning there was no sign.
With the dry weather comes Masindi's orange dust. This gets in to every thing and it is impossible to keep things clean. As you walk down the road you acquire an orange layer and ginger hair.The lorries are the biggest nuisance they throw up a thick cloud of dust that will envelope you for several minutes. Not only is this bad for your health and clothes but it makes you invisible to the next vehicle and many accidents are caused by dust clouds.
Last week there was an out break of meningitis in the district. There have been 6 deaths so far and several more cases. This generates a response from the district who try and manage the outbreak and limit its spread.Today I went out to the health centre to examine a new suspect. She was related to a previous case and had attended her funeral. The patient was 14 years old and had developed a headache and fever last night. By the time I saw her she was obviously very ill.The cases are looked after in the health centre in a makeshift ward with mattresses on the floor. I managed to do a lumbar puncture on her and prove that she had meningitis and she was started on treatment. Usually one shot of chloramphenicol is enough to treat the patient. There were several patients at the health centre who had been moribund a couple of days earlier who were now ready for discharge. It was impressive to see the nurses and community staff working together and saving lives.But the success is in spite of real difficulties.John who runs the community side has no budget for management of an outbreak. He had to borrow fuel from the Red Cross to get out to the health centre. There is no money for a radio announcement to alert villagers to the problem. There are no vaccinations for health staff and no money to pay their extra allowances. The sample of CSF needs to go to Kamapala for culture and he does not know where he will get the funds for the bus fare.
Money is tight for the routine care but seems available for HIV care. The latest NGO in the patch is just recruiting 48 staff and moving in to a big new office. Its role is to test babies and pregnant women for HIV. Unfortunately they are providing no funds for treatment which they are expecting the hospital to provide. Our clinic is struggling to provide care for are present work load.
On Wednesday I was able to order more mosquito nets thanks to the people who had given through the just giving web site. On Saturday 1000 nets arrived from Rwanda. Sometimes things in Uganda can surprise you with their efficiency. This week 3 more villages will be offered nets.

Happy New Year

2009-01-08T17:58:00.005Z

New Years resolution was to make sure we did the blog every week end so we’ve failed on that one. At least I have managed to stay off the booze, drugs and single women.
Christmas has come and gone and the New Year has started. Christmas was different. Eating turkey, sprouts and bread sauce at Court View with all our friends was a good way to spend the evening but we missed family and friends back home. African dancers and drumming was a good substitute for Morecombe and Wise.
New Years eve was spend at Nabaye on the edge of the Budongo forest. Cathy and Roman are two research workers working with the chimps in the forest the held a party for all their staff. We had a great time with a big barbecue, dancing and fireworks. The night sky was fantastic with a million stars that you can never see in the UK.
Maggie and I had promised our selves a chill out weekend at Nile safari lodge to start the year. It was a great time and we avoided the game drives and just sat and read and watched the animals from the veranda. It is a special place and we love going there. Even the two punctures, the dust and the tsetse flies could not spoil it. We are going again next month when Hannah comes out.
The New Year has brought fresh challenges at work. We have now completely run out of anti TB drugs. This means we now have to say to patients yes you have TB, that is why you are coughing, sweating and losing weight. There is some really good treatment that would make you feel better within a few weeks. Unfortunately we do not have any, may be try next month. I can not understand how Uganda can run out of such essential drugs.
There was some good news this week. Vincent the baby with dislocated knees came to see me. He is fine very sturdy and taking his weight on good straight legs. His grand mother is very pleased and brought me a live chicken to thank me.

2008-12-28T10:50:00.003Z

Sitting on our patio drinking freshly brewed Ugandan coffee and looking over the Masindi hills shrouded in a dust haze leads you to reflect on the past year. We have had our downs, breaking my arm was not a good way to start 2008 but there have been lots of ups.
Uganda is a beautiful country with lots to see and experience. It has been good to be able to share some of this with students, friends and family. There are not many places in the world where you can see chimpanzees in the wild raiding the sugar cane! The wildlife in Murchison Park must be some of the best in the world and it has been a real thrill to get so close to crocodiles and hippos. They are big!! The rhinos at Ziwa are fantastic. Walking towards wild rhinos and being able to get within 30 yards of them is an experience to be remembered. They are prehistoric looking animals and you realise how lucky we have been to be able to see them in their natural habitat. The bird life here has been a revelation and most weeks we see something new. Today we are trying to identify a horn bill we saw at Kinyara sugar works. Our walk with John and Rena on the Royal Mile in the Budongo forest must rate as one of our best birding experiences. Raymond the guide knew all the birds and was able to entice several out of the undergrowth by mimicking their calls. Wild life is everywhere in Uganda; we will not dwell on the bats, ants and snakes in the house!
During the year we have met many different people. Sitting in Court View Hotel there is a steady stream of interesting visitors. Some are tourists but many are working for governments or NGOs. You get to hear about various schemes and projects throughout Uganda. Some of the schemes fill you with hope but others are badly thought through and designed to appeal to donors but achieve little for the population.
Living in Masindi makes you realise the incredible difficulties facing the ordinary people. Development and aid seem to be a two edged sword. It is difficult to know the best way forward. There are thousands of NGOs in Uganda and billions of dollars of aid flow in every year. In spite of this there is no functionning health service, the schools are struggling to provide for their pupils and the universities have stopped giving an education to their students. Aid is almost seen as a right here and Uganda has developed a dependance culture. The answer to almost every problem is seen as 'find a donor'. This is true of government, both local and national, as well as individuals. As a mzungu people often approach you to ask for money for every thing from school fees to finance for weddings or funerals.
In the villages children still suffer from malnutrition and women and children are dying every day from malaria and diarrhoeal diseases. HIV and TB continue to devastate the community. Unfortunately many NGOs are seen as serving their employees and not the community. If you want to make money in Uganda you work for an NGO. If you want to make alot of money you go in to politics or the church.
Our project providing mosquito nets operates at the village level and there's little scope for any one to cream off money. It has been one of my high spots getting in to the villages and seeing the volunteers selling nets to ordinary people for use in their homes. I really feel this will make a difference to many families and reduce the dreadful toll of malaria.
Thanks to every one for reading the blog. Special thanks to people who have bothered to leave comments.

Medical Matters

2008-12-22T18:12:00.005Z

This week I thought I would write about medicine here in Uganda. The week has been interesting but frustrating
On Monday I did a ward round with the clinical officer. One of the HIV patients on the ward was still complaining of a severe headache and we were concerned she may have cryptococcal meningitis. We decided she needed a lumbar puncture. This means an relative had to go in to town to buy a cannula and some gloves before we could proceed. Reluctantly the nurse found a tray to put some swabs and hibitaine on to clean the patient. We managed to get her in a reasonable position on her bed and I proceeded to do the lumbar puncture, with no anaesthetic. Luckily I got some fluid without too much difficulty and we sent it off to the lab. This was my third LP since I have been in Masindi. It is 30 years since I did them in the UK.
Unfortunately the lab technician had decided to go off to his village but promised he would look at the specimen in the afternoon. We only have fluconazole as treatment and I decided to start her on it straight away. He did not arrive back until the next morning when he looked at the fluid and confirmed she had cryptococcal meningitis. When I went to check on the patient the next morning I found she had not been given fluconazole as no one had bothered to collect the drug! This time I insisted the nurse collect the drug and start the patient on it. On Wednesday she was definitely getting the drug but on Fridays ward round no one could find her. The nurses did not know if she had run away or just gone for a walk. Nurses unfortunately seem to have little sense of what is happening on their ward. There is no hand over and no sense of any one being in charge.
The nurse who had been on night duty Thursday night told me she had been ill with fever so she had rested and persuaded a fellow nurse to give her a drip, IV quinine plus an injection of chloramphenicol. She was walking round the ward with a cannula in her arm.
On the Friday ward round there were two patients who needed blood transfusions. One was a 12 year old girl with chronic anaemia and a huge spleen. Her haemoglobin was 6 after a transfusion. She needed more blood and referral for investigation. She probably has hyper-reactive malarial splenomegaly but she definitely needs blood. I was asked to see the other patient when she had collapsed out side the out patients. The story was of weakness and decline over the last few months. She was very pale and in heart failure.We admitted her to the ward and found she had an Hb of 4 and was HIV positive. Both these patients urgently need blood. There is no blood in Masindi or any hospital in the region. At this time of year the blood banks often run out of blood. I do not know if these patients will survive over the weekend
A patient I first saw in September returned this week. He is 14 years old and has a huge tumour in his abdomen. Last time I saw him he looked ok but he had not had the money to return to see me. This time he looked unwell and was obviously in some discomfort. The tumour had grown. I was able to contact another VSO doctor in Kampala who agreed to take him in to the charity ward at the international hospital. Luckily Sallie was going down the next day and she agreed to take Yoweri. The scan he had in Kampala looks like a lymphoma so he is going to have a biopsy next week.
On Wednesday I managed to persuade the leprosy nurse to follow up some patients we had seen a week previously. It was good to see some of them making good progress on treatment but one man has reacted badly and we had to bring him in to hospital for steroid treatment. We found another new case much to the nurses dismay. He thinks we are finding too many cases as it is making his work difficult! I had seen another case in a village but we could not reach him as the vehicle could not make it through the flooded road. Hopefully we can get him on treatment soon but we have run out of treatment at the moment.
We were asked to look at the children in a family were both the wife and husband have leprosy. I was surprised to be faced with 12 children from 2 to 15. The husband had 3 wives. Unfortunately he could not remember the name of the wife with leprosy! Luckily all the children were clear.
So apart from having few drugs, no blood and uninterested nurses things are fine here. Luckily we did get a supply of ARVs last week so we can continue treating the HIV patients.

The net distribution is going well. We have a net sale on Monday which is the first one without Pam’s support. Thanks to every one who has given through the Just Giving Site.

Merry Christmas

Chris and Maggie

PS Unfortunately Monday morning ward round found that the young girl had died on Saturday. Blood had finally arrived on Sunday too late for her but the other patients were improved.

Living in a cash only society

2008-12-18T18:34:00.004Z

One of the many ‘challenges’ (not problems) of living in Uganda is non-acceptance of credit/debit cards or cheques. I don’t think we have made a single transaction which has not been cash. It’s not uncommon for our local ATM to be out of order or to have run out of money. When the army/police/teachers, etc. have been paid it’s impossible to get near the ATM for the whole week. I’ve known people to queue for hours. Therefore, we set off to Kampala last weekend for a Christmas shopping trip with very little cash. Unfortunately, non of the banks in Kampala would allow us to use our cards in their ATMs but God moves in mysterious ways! Just as I was on the phone to the Help Desk I looked up and standing next to me was our friend James, a Californian priest living in Masindi. I explained our predicament and he produced a stash of cash from his bag. It was as though he’d fallen from the sky! Without his help we would have been stranded. I must try the Help Desk more often!
Cash also came in handy at the weekend when the hotel had run out of gas, there’s none to be found in Masindi or district at the moment, so an envelope full of money was sent down to Kampala on the local bus and the cylinders returned on a later bus. How’s that for service?
Yesterday we came home to find that Umeme (the electric co.) had delivered our monthly bill with one hand and cut the wires with the other, despite the fact that the date for payment was not due. When they cut you off here they literally cut you off! I marched straight off to the office and demanded to be reconnected. The Manager understood that I needed the cook the ‘big man’ his meal! Once again, it was cash that saved the day.

Highlights of the week:
The VSO Masindi cluster held a Christmas party for 90 kids from the Family Spirit School, mostly orphans due to HIV/AIDS. It was great. See photos.
We found a turkey to go with the frozen sprouts. See next week’s photos!
Setting up the Just Giving website and selling mosquito nets.
Meeting lots of other VSOers at a party in Kampala.

Lowlights:
Starting four babies on ARVs with the expectation that none of them will survive more than a few months.
Realising that Uganda has run out of TB drugs
Buying a bottle of gin and finding we had no tonic.
Me having an argument with the chef who has already resigned but is saying there will be blood before he leaves Masindi. Hopefully not mine!

Maggie

Malaria and Miirya

2008-12-08T19:29:00.004Z

THE FIRST NET TO BE SOLD

THE NETS ARRIVED FROM RWANDA

TRAINING OF VILLAGE VOLUNTEERS
Today has been a good day (apart from the 45 minutes at the police station but thats another story)
We received 1000 mosquito nets on friday. They arrived at 6.30 at night on the bus from Kamapala. They were unceremoniously dumped at the local filling station and so we had to borrow a pick up to get them up to the house.1000 nets take up a fair amount of space and weigh a lot. How Sam managed to get them here all the way from Rwanda I do not know but he did and this is our first consignment. Hopefully if the fund raising goes well we shall order more soon.
Today was a good day because we went to Rwemagali village and sold nets. Last week the village volunteer Harriet had been sensitising and mobilising in the village. She had put up posters and talked to people about nets and why they are necessary. Today when we arrived there were over 100 people sitting around waiting for nets.Rwemagali is a small village with 269 households containing 1900 people.So we had about a third of the households represented. Our three malarial focal people,Sally,Anna and Donetta gave their talk using posters that Pam had prepared. This goes through what causes malaria, how it affects you and how you can prevent it. Every one sat quietly and listened but when they asked for questions they were politely told to get on with selling the nets.
We sold 130 nets for 3000 ush each.So tonight hopefully those nets will be in use and people will be protected.Without the project there would be no nets for Miirya.Tomorrow two more villagers will be visited.Pam goes home on Sunday to raise funds for the project.We have to keep motivating the volunteers and make sure we get more nets to sell. It is a challenge but probably the most useful thing I can do in Uganda.
Thanks to every one who has so generously donated through just giving.

Education, Education,Education

2008-11-30T18:18:00.004Z

This week I have been visiting primary schools to talk to teachers about HIV. This is part of mainstreaming HIV part of VSO’s programme. It also meant that Sue a volunteer working in education could tap in to HIV funds to pay for her literacy workshops. In all sectors HIV has the biggest budget. I was happy to visit schools and talk to teachers as they have a valuable role to play in HIV awareness.
Primary schools are a growth industry in Uganda with the population growing at such an alarming rate. Universal primary education is supposed to be free but there are so few resources in the government sector that many families opt to send their children privately. In the schools I visited all the classes were large including one of 136 six year olds. How a teacher controls that number of children let alone teaches them. How can you expect children to learn to write when they are crammed in to a classroom with no desks? They have to sit in rows on a concrete floor. The teacher is lucky if he has chalk, lately they have been using sticks of dried cassava as there has been no chalk provided.
In spite of the difficulties many of the teachers are trying hard to provide an education for their pupils. They can be very ingenious in using simple household items to make educational resources. I saw musical instruments made out of bottle tops, counting toys made from empty bottles and lots of posters.
Walking around the schools you see lots of messages designed to keep the children healthy. Many of these are related to HIV. Messages regarding abstinence, keeping your virginity, avoiding bad touches and beware of sugar daddies are all around the schools. In one primary school in big letters on the water tank was the message “Avoid early sex it leads to death”. I am not sure how these messages are received by children in primary schools and whether it changes their behaviour.
On Saturday we went to a fund raising event at the Masindi Centre for the Handicapped. This is a boarding school for children with special needs. The parents pay 60,000 ush less than £20 per term for education and full board. There are over 100 children from 6 -20 years. There are children with Downs’s syndrome, cerebral palsy as well as many deaf children. The classes are small less than 20 per class and the school provides physiotherapy for those who need it. The facilities were far better than I had seen in other schools and the pupil staff ratio was far better. The centre has had a lot of support from international charities and seems to provide a good service for these children. Often the problems begin when the children reach 20 and need to leave the school. There is little provision in the community for them and they have to rely on their families.
To continue with an education theme, I (Maggie) had an invite to attend an end of term Parents' Day at Ayesha's school today.Ayesha is the daughter of Rose who is our house girl. The programme was 5 hours long and I took the advice of a teacher friend to arrive at least an hour late - good advice! Nothing ever begins on time here. I was the only mzungu in an audience of at least 1,500 and the young children found me more entertaining than the performers! It's amazing how you can just look at a toddler and it will burst out crying; possibly something to do with the fact that there is a myth that mzungus eat little children. The programme proceeded as expected but I was fascinated with members of the audience going up to the stage and giving money to certain children while they were still performing, sometimes going on the stage itself. Parents were not particularly giving money to their own children but to anyone they felt deserved it. Those who had solo lines did very well. The headmaster even cashed in on this when, upon finishing to deliver his speech, he began a song and dance routine. By the time he'd finished his pockets were bulging from his admirers! Another thing that really got the audience going was a dressing competition. I was curious when I'd seen it on the programme but it really was just that. Four girls and four boys had to strip down to their underclothes and on the whistle had to see who could dress first. I just couldn't imagine that happening in the UK. Child protection doesn't come into it and of course there were the humiliated children who couldn't even get their garments the right way up never mind put them on. The audience loved it and the winning children loved it even more when they were showered with coins and the doting parents twirled them around the stage. Next came the eating competition which got the audience equally excited. Sadly I had to leave after three hours to check on the christmas cake in the oven!

The pictures are of Rosepreparing Ayesha's hair for her open day and the deaf children performing at the Masindi Centre for the handicapped.

Garibaldis, gingernuts and shortbread

2008-11-23T19:32:00.002Z

There have been no bats, snakes, monkeys or any other unwelcome visitors this week. We’ve even had power for the last few days. On top of that, I bought a new internet modem for the laptop which will hopefully give us better access and freedom to mail whenever or wherever we want. Things are looking up!
Of course there are the usual frustrations but mostly they have become so predictable and commonplace that they hardly warrant a mention. One of the best ones today was at the Kinyara Sugar Works management club. The club is in the middle of I don’t know how many thousand hectares of sugar but the restaurant couldn’t serve tea because they’d run out of sugar! It also seemed quite alien to them that we could drink tea without sugar but after a bit of persuasion we got it. I didn’t dare complain about the dried milk powder. The only solution was to stick to the beer. At least it was a great day out. The weather was glorious with beautiful blue skies; we enjoyed lots of good company, good food and, of course, a pool to play around in. It didn’t really matter that the bread buns were full of ants and that the person bringing the burgers and salad arrived three hours late.
Someone mentioned the snow in the UK which at the moment feels like a million miles away. The rainy season has just about finished and it’s really hotting up now. December, Jan and Feb will be particularly hot. I returned last night from a couple of days in Kampala; a first attempt at Christmas shopping (and quite unsuccessful at that!). Unless, that is, I purchase some of the second-hand european clothes that line the streets and that we’ve all donated in the first place! There are some real bargains to be had! Things other than clothing are fake and not worth buying; they last no time at all. That’s true of most household items which are also relatively expensive. Fortunately the hotel vehicle uses diesel as there is a major petrol shortage at the moment, not just in Masindi, but nationwide. By the way, if Helene and Kristen are reading this I hope you have managed to get out of Queen Elizabeth National Park and back to Nairobi; it’s a long way on a bike!
Christmas has come early to Masindi. Lots of thanks to our lovely friends who have sent parcels recently. I could hardly contain myself when we received three on the same day and we have been enjoying Garibaldis, Gingernuts and Shortbread. We loved all the other goodies too.
I spoke too soon when I said we haven’t had any unwelcome visitors - I can hear Chris in the other room doing his dressing gown and plastic tub routine with a bat!

Another attempted break in!

2008-11-18T18:56:00.004Z

Happily Maggies back is much better but she did have to take a day off work last Tuesday.While she was resting at home she heard the sound of breaking glass.She went to the spare bedroom and found a broken window with glass shattered all over the room. Rasoul our ascari had also heard the noise and rushed around to the back of the house. Happily this was not a thief but a monkey that had thrown itself at the window, luckily the monkey was ok. The monkeys are frequent visitors again.They are after the mangoes which are coming in to season.
We have had another visitor this week a bat flying round the living room.I am now getting to be a dab hand at catching bats. The trick is to throw your dressing gown over them as they fly past and then knock them to the floor. Then once Maggie stops screaming you can scoop them up in to a plastic container and put them out the door.
The power situation has improved for us but has been bad for the town. The main transformer has blown so Masindi has had no power for the week and is unlikely to be reconnected for another week. This is causing great problems for the hotels and shops as the freezers are not working. But it is only the muzungos and the wealthy who it affects because the vast majority of Ugandans do not have power at home.It is easy to forget how lucky we are compared to the majority.
This week we have held meetings with the volunters that Pam and I trained.The first meeting was attended by 40 out of 43 volunteers, who had walked up to 5k over bad roads to get to the health centre. They were all pleased to get their t shirts and mosquito nets but we were pleased to see that they were still motivated. They are all keen to use their knowledge and even keener to start distributing mosquito nets. We have 500 to distribute but need 5000. At the moment our best bet is to buy nets through the Red Cross from Rwanda. We are negotiating for a good price but will need to do some serious fund raising. Pam has decided to return to the UK in December and concentrate on raising the money to buy the nets.We have promised the volunteers we will get them and we can not let them down.
The picture at the top is one of my saddest pictures. This is a discarded mosquito net someone has been given and just thrown it away. They do not realise how it could save lives. This is why we are spending time teaching people about the value of nets and why we are selling the nets not just giving them away.

GREAT NEWS

2008-11-10T17:59:00.002Z

Last week end we had a phone call from Goa. Becky and Gordon have decided to get married in March when we are back in the UK. This is great news and we are really excited at finally being in laws! In Uganda marriage is a huge ceremony and all friends and neighbours are expected to contribute. It is not uncommon for the wedding budget to be displayed on notice boards at work and people come around collecting. Happily this is not what they are doing. They plan a small wedding with just the family but a big celebration.
It has been hard to get back to normal after that news but we have had to concentrate on the here and now. Luckily my computer seems to have recovered. Like most of my patients I have no idea what was wrong with it and no clue as to why it recovered. May be the laptops immune system managed to overcome the virus. Unfortunately for many patients they do not survive but there are always surprises. This week a patient on the ward was semi conscious and we thought she had cryptococcal meningitis. The only drug we have to use is fluconazole. The patients only attendant was her 8 year old daughter but the little girl worked really hard feeding her mum and checking that she took her drugs regularly. The mum responded and is now eating and regaining her strength. It turns out that the 8 year old was also looking after her sister on the maternity ward who had just delivered. This little girl is the best nurse I have seen in Uganda.
Michael the man who went to Kampala was not so lucky. He has a broncho pleural fistula which needs surgery. Surgery is expensive so he is unlikely to have the operation. He is now back in Masindi and at work so he is better than he was.
Unfortunately this week Maggie has had a problem with her back. She shouted for help in the shower as her back had gone in to spasm. She has had minor problems in the past but nothing like this. She has been in agony but luckily there is a therapist who has just come to Masindi and he has given her some treatment. She has had some relief but it is still very painful and very frustrating. Hopefully a few more days and she will be back to normal.
On Saturday Sue one of the volunteers held a coffee morning to raise money for some training she wants to do. This was a new idea for most of the Ugandans who attended but they all seemed to enjoy it and managed to raise 250000 ush. This will go a long way to paying for the training and it was a great way of involving people in fund raising.
This is our eighth night without power. Power seems to have been bad for the last few weeks but this is really bad. It is difficult to keep everything charged and reading by lamplight is a real pain. It is hard to do anything at night. The computer is about to run out of power.

Food glorious food!

2008-11-02T11:18:00.001Z

We are casting our minds back over the last two weeks trying to remember what we have been doing (we missed last week’s entry) and it seems that the most memorable occasions have revolved around food and eating! For my friends that will not come as a surprise. We are prone to fantasizing about food back in the UK and can’t wait for an almond croissant, fresh from the oven and ousing marzipan, washed down with a proper cup of Italian coffee, at the Nightingale Patisserie near Kare and Steve’s. Or maybe a nice fat crab sandwich at St. Abbs in Northumberland whilst looking out to sea. Then again, there’s fish and chips at Whitby which can only be eaten straight from the paper whilst sitting on a bench and shivering with the North Sea breeze. Or maybe a succulent pink leg of spring lamb and mint sauce. I could go on and on but must stop! We really don’t do so bad for food here. Last night we hosted a VSO meal for 9 people where we shared the cooking. We ate Italian stuffed aubergines and tomatoes served with olive and rosemary drop scones, followed by freshly caught whole Tilapia fish with a sweet and sour sauce and then sticky toffee pudding and fresh fruit salad to finish. Not bad for up-country Uganda! Thanks to Kare we are also indulging on Garibaldi and ginger biscuits this week!
One of our coping strategies here is to deal with time in bite-sized pieces, whether it’s events that are happening here or visits from other people, as long as we have something to look forward to! One such thing is our visit to the UK. It is necessary for Chris to return within the financial year to have his annual appraisal so we have just sorted out dates and booked our flights. Hannah is coming to visit us here in February so I (Maggie) will return with her on the 15th and Chris will follow a couple of weeks later. We will then have three weeks together in the UK which will hopefully give us time to visit London, Sheffield, Hull and Berwick (and hopefully see as many people as possible in that time).
On a sadder note, Chris’ laptop has well and truly died after contracting a very nasty virus which has wiped out his keyboard. We needed his laptop to access the internet at home as my Apple is not compatible with the system we have. The electricity supply for the last two weeks has been the worst we have ever experienced. Perhaps it’s the storms which have damaged the lines, as we are now in the rainy season, or perhaps it’s because people steal the wire for other uses. We had just got used to the luxury of having the internet at home but will now have to return to trips to the internet cafe and rely on them having fuel for the generator and for the network to be working.
Maggie
Miirya Volunteer Project.
Part of my reason for being here has been to try and develop preventative health in the village. This has been extremely difficult due to lack of resources and in particular transport.
Pam and I have managed to train 91 village volunteers in Miirya sub county. They are remarkable people. Many have been working in various capacities in their villages for many years. Some are traditional birth attendants, some are drug distributors and some health educators. There have been various projects where volunteers have been trained over the years but most of these have fallen by the wayside through lack of funding and organisation.
Our project is linked to community health centres which are key elements of the government health strategy. We hoped that by linking in to the government service this would mean that the project would be sustainable.
The emphasis of the project has been educating villagers about reproductive health, immunisation and malaria prevention. Part of the role of volunteers will be in helping in the distribution of mosquito nets.
Malaria continues to kill children in Masindi district. It accounts for about 80- 90% of the work of health centres. It is preventable. Families that use treated mosquito nets have far fewer attacks of malaria. Our aim is to offer nets at a greatly reduced price. Our problem is finding a reliable supplier and raising the money to buy 5000 nets.
At the moment our best source of nets appears to be to import from Rwanda. One supplier in Kampala raised their price by 100% overnight! The government supply seems to have dried up and they say they are waiting for donors.
It is frustrating to find so many barriers to such a simple intervention.
Chris

Playing god

2008-10-20T18:43:00.002+01:00

This week Michael told me I was his second god. Michael, like many Ugandans, is a Christian - he is “born again” My status was achieved because I arranged for him to go to Kampala for treatment.
Michael is 35 years old and had had treatment for TB in 2006 but he had been troubled with a bad chest since then which was getting worse. He had seen several doctors in Masindi to no avail. When I saw him in the clinic he looked unwell and his chest sounded awful. He needed a chest x ray but as the hospital has no films at the moment he would have to have one privately. In the spirit of free enterprise the private clinic has increased the price from 10000 ush to 15000 ush as they are the only place to get x rays now. Michael had no money so using the donations I was given I paid for his x ray. His x ray was bizarre. He had complete collapse of the right lung with a pneumothorax and a fluid level. I am no radiologist and there is no one in Masindi to interpret x rays so I sent the film on the bus to Kampala. Godfrey the taxi driver picked it up from the bus and took it to the international hospital in Kampala. Grania another VSO doctor is my TB expert and has been a great help. She loves getting x rays from Masindi because they are always bizarre with gross pathology.
Grania felt that Michael needed his chest draining but agreed that it should be done somewhere safe and clean, not the male ward in Masindi. Grania oversees the charity ward at IHK and agreed to admit him there and look after him. This would all be at no cost to Michael as long as he could get there. Michael agreed to go but did not know Kampala. Luckily Sallie was going to Kampala and she agreed to deliver him to the hospital. So I gave Michael 20000 ush for his return fare and he went off to Kampala and he has already had the pus drained from his chest thanks to Grania’s expertise. He is very grateful to the muzungus’ network and to those people in the UK who gave me funds to use. Unfortunately without that help he would have just been left to get on with things.
If god is some one who has money and connections then I have been playing god all week. Because we have had no x rays I paid for another man to have an x ray. This confirmed TB so we could start him on treatment. The woman with a probable liver cancer needed money for transport to go to Gulu for further investigation so she and her daughter had 30000 ush. The 4 year old girl, who last week had been bitten by a dog that subsequently died, needed anti rabies treatment. She had been given one injection but needed four. There is no free treatment available and the family had no money so they came to the muzungu doctor for help. There is not much choice in that situation so she has been given the money for her treatment. It is not sustainable and the government should be providing the vaccine but it is hard to refuse when we have access to money.
But often you can not help. I could not solve the problem of the woman with HIV still breast feeding her 9 month old child because she could not afford any other food. My playing god could not help the 16 month old infant with HIV who weighed less than 5 kilos. His life will be short he is too weak to benefit from treatment and I am afraid he will die soon like his mother and father.

We have had visitors this week 2 very welcome and one not so. Susan and Shaun arrived for the weekend from Kampala and it was great to have them. Our unwelcome guest was a snake. On Friday night we arrived home to be told by the askari that Rose, our cleaner, had seen a snake in our bedroom. Searching for a snake at 10 at night with no power is no fun. We could not find it so went to bed. It was a strange feeling wondering whether there was a snake in our room. It certainly improves bladder control when you dare not get out of bed until it is light. We have not seen the snake , we hope it has gone back to where it came from but we keeping looking!

Twitching

2008-10-12T14:21:00.003+01:00

We neglected the blog last weekend as I (Maggie) was in Kampala for various reasons but most importantly to meet John and Rena (friends from home) who have been staying with us this week. As always, the week has passed very quickly and we said goodbye to them this morning. We had previously visited John and Rena during their four-year stay in Nairobi so it was good to be able to reciprocate and host them here. It helped Chris to have some moral support for the work he is doing and also to be able to talk shop with people who understand what he’s talking about! We did our bit as tour guides and it was great to have John as a fellow ‘twitcher’! We ended the week with a three hour guided bird watching walk through Budongo Forest which has boosted my list of different bird species to over a hundred now. Who needs, TV, cinema or live theatre?!! At Murchison Falls National Park John managed to inadvertently see the highly sought after Shoebill Stork which many people from around the world come here to find (and quite often fail). So I’ve only got 11 months left to see it for myself. It was a real tonic to have John and Rena here. Our chats with them has made us think a bit more about what we would like to do upon our return from Uganda and also about what we can take from our experiences here and use in the next chapter of our lives.
After a steady stream of visitors for the last few months, it’s time to settle down and concentrate on work, though I keep hearing rumours that Christmas is looming - how can that be when it’s hot and sunny and feels like July? I haven’t heard a single carol, seen any Christmas trees, there’s not a bauble to be found in the shops and there aren’t any houses covered in fairy lights! There’s a distinct lack of turkeys here too; I wonder what stuffed Shoebill tastes like? (Chris just said I’ll get lynched for writing that!)
Here are a selection of our photos from the week. The budding twitchers are Rose’s youngest two children, trying to learn how to use binoculars for the first time!

It's great to be a tourist

2008-09-28T08:41:00.004+01:00

For the last 2 weeks we have been tourists. With Becky and Gordon we have travelled around some of Uganda’s beautiful tourist spots. This is the first time Maggie and I have had a chance to see other parts of Uganda. It was great to see it from a tourist point of view, stay in nice places and try and forget about all the difficult issues here.
We picked Gordon up from Entebbe and spent the first night in Kampala. Early the next morning we headed south to Lake Bunyoni. This is about 8 hours from Kampala and the last few hours were on typical Ugandan marram roads, pot holed and very rough. It was a long journey but there was beautiful country side to see, very mountainous and green unlike Masindi. We arrived at the lake and transferred all our luggage on to a boat for the 15 minute trip to Bushara Island. This is a small island run by a community development organization. There are camping facilities, pre erected tents and a couple of cottages. We were in a cottage overlooking the lake surrounded by trees. The whole island is a bird watchers paradise with hundreds of birds all around you. We managed to tick off a number of new species on Maggies now quite impressive list. From our balcony we could watch the traffic on the lake. Every morning the children paddled there dug outs to the local school on the mainland. They start to learn to paddle from the age of 2 years. There was a volunteer on the island from Germany who has been teaching the children to swim. Many local people can not swim inspite of spending much of their time in canoes. Storms can blow up quickly on the lake and drownings are not unusual. The restaurant served a mix of Ugandan and other food but the speciality was crayfish. They are common in the lake and the locals catch them in papyrus traps which are found all over the place. Evidently the crayfish are not native species but were introduced by Idi Amin from Tanzania as he had developed a taste for them.

The weather was mixed but there was a lot to see. One day we had a trip to other islands by dug out canoe. These are the traditional canoes still made from a single tree trunk by local villagers. We travelled to Sharp Island named after a British missionary doctor who had worked in the area for many years. He had set up a leper colony on an adjacent island which at one time attracted patients from all over central Africa. His house on the island has recently been turned in to a guest house by the local diocese but seems to have very few visitors. The next island still had the old leprosy hospital buildings which are now used by a secondary school. It was strange to think how many people had lived their lives on the island slowly dying from leprosy. The last patients finally left the island in the 60’s. Sharp is still held in high regard by local people for what he achieved. The journey we had made to the island had been difficult but so easy compared to those original missionaries who travelled on foot before any of the roads were built.
We left Bushara Island and then travelled to Fort Portal and the crater lakes. This was another long bumpy drive but Sulaiman our driver managed it with no problem. He is a great driver who works for Sallie at Court View and is very experienced and seems to know someone wherever you are in Uganda. He is also able to answer our questions on any thing from politics to local wild life.
Lake Nyianabulitwa is one of three small crater lakes out side Fort Portal. Our accommodation was in two bandas overlooking the lake. The setting was fantastic and it was easy to sit on the balcony and just watch the lake and the wild life. We had been told that there was one hippo left in the lake so we spent 2 days trying to spot it. The first day we took a boat across the lake and then climbed up to the next lake. There were huge hippo foot prints on the track but we did not spot it. The climb to the next lake was strenuous but worth it for the view. Later we called on Mike and Barbara two volunteers who had come out to Uganda at the same time as us. They had been on a one year placement and were returning to the UK the next day. It was good to see them and arrange to meet up in Berwick next year.
The next day we had a longer walk to the "top of the world" a local viewing point which gives you a fantastic panoramic view of lakes and mountains. We walked down to Lake Nkurumba to have lunch at their café. The walk through the forest and round to the lake allowed us to spot lots of new birds and three types of monkey. It was a long walk but the views and the wildlife were spectacular.
Another long drive along some of the worse roads we had used this trip took us back to Masindi. Apart from a puncture the journey was uneventful but we were again thankful Suliaman was our driver.
After a few days in Masindi for laundry and rest we headed off to Murchison falls for our last few days. We had stayed at Nile Safari lodge when Dan had been with us and it is a wonderful relaxing place. The bandas have superb views over the Nile and you are surrounded by wild life. There were even frogs in the bandas!. Frogs and hippos make a great noise at night and you really feel you are in Africa but are protected from the reality of life there by power and room service!
The downside of Nile Safari is getting up at 5.30 am for a game drive. We dragged ourselves up and were at the ferry to cross the Nile by 6.45 only to find that the ferry had broken down. This meant that you could not get across the river to the animals. Suliaman managed to get us seats on the river boat for a cruise down to the Falls which is the other thing every one does at Murchison. We had a good cruise seeing lots of crocodiles, hippos and birds. In the evening we hired a boat from Nile Safari and had a trip in the other direction towards Lake Albert. As this was a smaller boat and we were the only ones on it the boatman Frances could take a more leisurely pace and get close to the animals. Becky thought he got a bit too close to some of the hippos but we managed to get some great pictures. This trip is my favourite at Nile Safari.

The next day we went for the early morning game drive and this time the ferry was working. Suliaman had arranged for us to have George as our guide one of the most experienced rangers. We had a good drive and managed to see all the animals we wanted apart from the elusive leopard.
All things considered this has been a great break and a good way to finish our first year in Uganda. It reminded us what a beautiful country Uganda is and what a lot it has to offer. It has been great to share it with Becky and Gordon and see the country through tourist’s eyes. We can really recommend Uganda as a tourist destination.

Back in Masindi Becky and Gordon are planning the next part of their journey to India and we are thinking of getting back to work. The last 12 months has gone quickly. We have learnt a lot and are still not sure of what we have achieved. May be in the next 12 months we can consolidate some things we have started and

Inspiration in the sticks

2008-09-14T17:09:00.008+01:00

Becky here. I'm finally getting into the swing of things here in Masindi, i.e. the power cuts, red feet from the dust, navigating the half built roads and pavements, being called muzungu, everything you eat tasting slightly like midget gems (aka washing up liquid) and walking through grass without being petrified of snakes. I'm also getting used to every trip into town taking hours because of all the people who stop to talk to mum and dad. Mum seems to be getting to grips with Runyoro and Swahili, but dad's useless, no one even tries to talk to him in anything but English.

One of the most memorable experiences so far has been a trip to the Boomu Women's Group about 40min outside Masindi in the middle of nowhere. Mum and I decided to stay the night but weren't sure what to expect so we took huge bags packed with something for every eventuality, e.g. string, mosquito nets, candles, a penknife and lots and lots of biscuits and snacks. But we needn't have worried because our little banda was lovely, freshly painted with clean linen, towels, nets and not a snake in sight. We even had a jerry can of hot water to get showered under the stars (and the twittering yellow weaver birds making their nests in the tree above).

Talking to Edna, the lady who set up the group, was fascinating. Her story was really inspiring. She had left her husband with 2 small children in 1990 because, she said, it was impossible to 'develop' with a man around. She's been trying to put her children through school (her daughter is now at university which seems an amazing achievement) and support other women in the village ever since. The sad thing was that Edna couldn't see any future for her daughter, despite her university education, other than marrying a drunken man and returning to village life.

Edna took us on a 'community walk' through the fields to the local village. The proceeds of the walk are donated to a nursery school that the women have set up. Villages here are really spread out and are made up of lots of small clusters of huts which usually belong to one family, so just walking around one village took us 1 1/2 hours. Edna explained what all the different crops were along the way, and talked us through how they use the various leaves and stalks for food, medicine, and dye. She also talked about the many barriers obstructing development for the villagers, especially the women. One such barrier is the ever changing weather and seasons in Uganda at the moment. This means that women now have to plant crops throughout the year in order to safeguard against spoilt harvests because they can't predict when the rains are going to fall. As a result they are spending more and more time in the fields, leaving less time for other income generating activities such as basket weaving.

Back at the camp Edna attempted to teach us how to weave a basket and believe me it is much, much harder than it looks, shockingly so when you think that baskets are selling here for £2-3. Again, it was fascinating to hear how different parts of various plants are used in different ways with virtually nothing going to waste.

To top it all we were served a typical Ugandan feast of beans, veg stew, matoke, casava, sweet potato and rice all cooked on a charcoal stove with the root veg wrapped in a banana leaf.

With all the frustrations and scams that mum and dad have faced in their jobs in Masindi it is easy to think that people here are quite happy to sit and wait for someone else to come along and bail them out, but we both left Boomu feeling that Edna was an inspiring example of someone who was not only trying to lift herself and her children out of poverty, but support and motivate those around her too. We've been talking since about possible ways to support this project and hopefully we'll be able to go back there soon.

In the meantime we're all packed and ready to go for our much more upmarket tour of the mountains and lakes. Hopefully it won't rain too much because the roads are already getting slippy and muddy, but dad assures me that Sulaiman our driver is an old hand, and we're going in a big 4 x 4. Saying goodbye to all the staff at the hotel and here at the house seems to have taken forever and no doubt when we get back they'll all be rushing up to mum saying 'maggie, you are lost' as they did when she got back from Kampala last week. I dread to think what they'll be like when they leave for good!

Greetings and farewells

2008-09-07T19:50:00.003+01:00

This has been a week of arrivals and departures. Denise, a VSOer in Masindi, completed her two year placement last week and departed for the UK on Monday. I (Maggie) accompanied her down to Kampala to say farewell. Denise was half way through her time here when we arrived and I can remember feeling very much the newcomer and she the wise one who had lived here for a whole year and consequently she suffered our constant questions and insecurities. Now we are in the same boat as she was then and it really brings home how quickly the time passes here and how little time there is to achieve anything. On the same day as Denise leaving we welcomed Laura, a medical student from the UK, who is spending her elective period here and staying with us for a week. I packed Laura off to Masindi in a taxi and waited another day in Kampala for the much anticipated arrival of Becky .. The taxi delivering us to Masindi then returned to Entebbe airport with Jarrad, a student from Hull, who has been with us for about 10 days. As Jarrad is considering a career in medicine he wanted to come out and spend some time with Chris – hopefully being thrown into the deep end of the Ugandan health service hasn’t put him off! Our next arrival is Gordon coming to join Becky in a week’s time. In the meantime, it’s been great showing Becky the delights of Masindi district, including chimps and rhinos. Unfortunately we came across an unexpected piece of wildlife yesterday. Becky has a real phobia of snakes and I haven’t seen one the whole time I’ve been here but, right on cue, one squirmed its way across our path! Now Becky’s inspecting under every bit of furniture with a torch! Gordon’s arrival will mark the beginning of our holiday. The four of us are taking off for two weeks to explore other parts of Uganda – can’t wait.

The Ziwa Rhino Sanctuary is only a 40 minute drive from Masindi. It is here on this 7,000 ha piece of savanah that both black and white rhinos have been re-introduced to Uganda. There are only six at present but it is hoped that one day the sanctuary will be home to many more. When we last visited in March the first calf has just been stillborn after a 15 month gestation period. Rhinos only produce every 2 or 3 years so it's going to be a slow process. We picked up our ranger guide at the gate and with the use of walkie-talkies to communicate to the other rangers he led us through the bush to find the rhinos. Fortunately we found the group all grazing altogether and they seemed more interested in that than us. We managed to see them at very close range, but I did stay very close to the ranger with the rifle and always had one eye on the nearest tree in case I had to make a run for it! Becky didn't think I could still climb a tree but I had not doubt of my ability if a rhino was charging me!
On our return to the gate we had an interesting conversation with the ranger. He told us that he only has five children so far and his ambition is to have 20! To reach his goal he is looking for a third wife! He talked of how a man is under pressure from his clan elders to produce many children in order to earn respect. If he fails to do so he is excommunicated from the clan. Our hints at expensive health care and education fell on deaf ears. He agreed that it would take a strong person to challenge his own culture.
Whilst at the sanctuary we paid a visit to Heidi who has been managing the place for the last few years. Sadly she had a very bad accident a week ago when travelling at night. A lorry forced her off the road and left her there in the bush. She couldn't move because of her injuries and whilst lying there a man came and robbed her of all her belongings. It was two hours before she was found by a more considerate person and taken to the hospital on a boda (a motorbike) with someone else on the back to hold her on. Fortunately she is going to be okay and will recover from her injuries but is obviously very badly shaken. She had already taken the decision to leave Uganda in a couple of week's time so it's a pity she will be leaving after such a bad experience. This is just another example of why we don't travel at night!

Where have all the nurses gone

2008-09-01T19:39:00.002+01:00

On Wednesday evening I had a phone call asking me to see a relative of Sullieman one of Sallies drivers. The story was she had had diarrhoea for a couple of days and had become worse that afternoon. Sullieman offered to bring her up to our house. The last time Sullieman had brought someone to see me the patient was dead. This time the patient was unconscious. Limited examination in the back of the Landcruiser confirmed her need for urgent admission so I sent them down to the hospital. Half an hour later Sallie called to say they could not find a nurse. I went down and there were no nurses of any description in the hospital. There were two midwives in maternity but they could not leave their ward. The watchman who was supposed to call in staff in an emergency was drunk!
Eventually after phoning the administrator a nurse was found. I managed to borrow IV fluids from maternity , get some quinine from the male ward and put a drip up on the girl, she had cerebral malaria. The next day she had improved and she was able to go home at the week end. The medical superintendent assured me that this was an isolated incident and has never happened before. I hope he is right but I suspect nursing care at night is even worse than during the day.
We still have no gloves at the hospital. If you need a procedure you have to purchase gloves before any one can do any thing. We are short of cannulae, IV fluids and most drugs. Today I heard that we have no TB drugs to start patients on. As I diagnose TB two to three times each week that is a disaster.
This week Pam and I have started our education sessions for village volunteers. We were in Bigando about 8 km from Masindi. Some how we managed to get a vehicle and driver to take us out there on Wednesday morning. We had three days working with 42 volunteers from villages in Bigando parish. Most of them spoke some English but we needed a translator to help. Luckily Miriam the nurse in charge at the health centre was brilliant. We had three days of active adult learning, challenging for them and us but they all stayed the course This was one of the best things I have done in Uganda. The volunteers were keen and committed so different from most of the staff in the hospital. The project is to train the volunteers about preventative health especially malaria. We are trying to encourage the use of mosquito nets. We are searching for nets at a price we can afford so we can sell them at reduced cost in the villages. You would not think it would be difficult to find a supplier in Uganda but it is proving difficult. One of the main distributors has run out of nets. How come in a world that spends billions on complicated HIV drugs a simple net is so hard to come by.
At the week end we went to see the Family Spirit Centre again. This is an orphanage and school I have been to several times. It is run by a group of HIV positive men and women who recognised the need to support vulnerable children. It is the first time Maggie has been and she was impressed by the efforts of the school and their philosophy. They need money to complete their pit latrine and thanks Steve and Denise we were able to give them some money so they can complete it. Money is obviously tight at the school but they are trying really hard to give these kids a chance in life. It is always up lifting to visit the centre and the best thing about it is that it is a Ugandan response to a Ugandan problem.

Late again

2008-08-27T05:18:00.002+01:00

We seem to have been very busy this week. Being busy does not mean you actually achieve anything. Simple things can take a long time here even paying the electricity bill!. Pam our fellow VSO volunteer offered to pay our bill with hers this week. Monday afternoon she was all set when there was a major rainstorm so all travel was abandonned. Tuesday morning she was there at 9.00 am along with several other people. The office staff aplogised but said they did not have the key to open the office. They sent for the key and every one was allowed into the office. Then they realised they did not have the key to open the safe to get to the books.Another boda was sent to fetch another key.After an hour and a half the bill was paid. You have to pay bills on time here or the electric company just come and cut you off. Sometimes literally they just cut the wires.Power has been really bad recently with long power cuts over the last few days. I think this has been due to the bad weather as well as load shifting to spread the demand.
At the week end we had a trip round the local sugar factory. Kinyara is a huge sugar cane plantation and factory, one of three in Uganda. It produces thousands of tons of sugar for the Ugandan market.It is a fascinating process turning sugar cane in to crystal sugar.The factory is basicaly a huge crusher and pressure cooker.The power and you need a lot of power to make sugar comes from burning the residue of the cane.
On Monday we went out to a village to see Sarah a paraplegic patient from the ward.It was great to see someone who had looked so lost on the ward surrounded by her family and obviously the centre of things. She has a struggle ahead of her but is determined to survive.It was a difficult journey for us to get to see her down lanes and mud tracks right in the bush.We were amazed when we realised she had travelled to hospital, paralysed from the waist down, on the back of a motor bike!
It is wednesday morning and Pam and I are due to start some training of village volunteers. Hopefullly transport will arrive on time and we can get out to Bigando Primary school to start three days of training on preventative health. This will be an experience for us and all the volunteers and none of us know what to expect.

T.B. or not T.B.

2008-08-19T17:09:00.003+01:00

Thirty years working in the UK and I had never diagnosed a case of TB. In Masindi I seem to see several new cases a week. TB is often a co-infection with HIV so most clinics we see patients who may have TB. Some of these patients are very sick and many will die in spite of treatment. Diagnosis is not easy, our lab is under staffed and has only one poor microscope. Over the past few years several microscopes have been stolen. We are promised a new one once we have somewhere secure to keep it.The best way to diagnose TB is by microscopy of sputum samples.The logistics of getting 3 samples on seperate days to the lab is far from simple when patients live miles away from the hospital and have no transport.Some of the lab staff are not interested and do not accept samples or leave them too long to process them. The other way of diagnosing is by xray.Getting an xray is not always easy. This week the hospital has no films.The xray machine needs electricity so you can not take an xray if there is a power cut which happens for some part of most days.Once you have an xray it has to be interprated and here it is me who has to do that!.It is along time since i looked at xrays, you do not see them in general practice. Luckily another VSO volunteer Grania is working in Kampala and is a chest specialist. I regularly send xrays down to her either by taxi or even on the bus. Grania reports them and I can have a report back in a couple of days. A faster service than the NHS could manage in Hull. Grania is fascinated by our xrays because the changes are often so extreme. Patients here present late so the xrays can look unbelievable. Unfortunately Grania returns to London in September which will be a real blow.I will miss her support.
Last week I saw a little boy who Pam had seen on out reach. He had a swelling and deformity of his spine and was generally miserable.At the clinic I found out his father had TB. I arranged an xray which he was delayed because of no electricity but the next day he had one which confirmed my suspicion of TB spine.At 18 months this is a tragedy but he should do well with treatment.I referred him for treatment last week but he still has not started because the childrens doses are not in Masindi. I am still trying to get hold of the right treatment but if there is any more delay he will have to start on a fraction of adult tablets.
This week I also received confirmation that one of my patients has multi drug resistant TB. Raymond has been a volunteer at the hospital for many years and has had 5 courses of treatment for TB. I shared an office with him for the first few months of my stay here.When I realised he was still coughing up TB bacilli we agreed he would stop work at the clinic.I arranged for him to be seen in Kampala and after 3 months his TB culture has confirmed his TB is resistant to 4 of the standard drugs. It is remarkable that Raymond is still alive and active.Unfortunately there is no treatment available for him in Uganda. The drugs for MDRTB are very expensive and not available in Uganda. Raymond is one of many patients who waits for funding for exceptional treatment
In spite of the difficulties TB is a satisfying disease to treat. If you get the diagnosis right patients respond well and rapidly start to feel better, gain weight and get back to working.One of the challenges is that many patients do not finish the 8 months course of treatment. Follow up is poor and patients are lost to the service. This creates a real risk of developing resistant TB.

Compare and contrast

2008-08-10T14:28:00.002+01:00

This week we say farewell to Olav, a VSOer from Holland, who is finishing his two year stint as an IT specialist at Kabalega Secondary School in Masindi. His skills have not been limited to helping the school; he has been in great demand for the whole community, including New Court View Hotel and all the VSOers. We will miss him for his good humour and good company, and not just for his incredible patience when sorting out everyone’s computer problems! Whenever we saw him the conversation always began with “Olav, just one quick question…….”. We had a small party for him and fellow VSOers at our house; the hotel came up trumps again with a Mongolian barbeque and my sticky toffee pudding went down quite well. Needless to say we shared a few beers and glasses of wine!! By contrast, the school had organised an official leaving do for him which we attended last night. Naturally, it was a very typical Ugandan affair. The programme stated a 5 p.m. start and included prayer, six speeches which were each introduced by another speaker (therefore six more speeches!), gift presentations, a typical Ugandan buffet, followed by dancing. In true Ugandan style we did not arrive until 6.30 but the proceedings did not begin for another hour. At least we assume there was dancing; by the time the food arrived it was already way past our Ugandan bedtime so, after a decent interval, we made a polite exit. We were top table guests so had to be on best behaviour! Official functions are very popular here. We are not sure if the format is a corruption of the English way of doing things but everyone loves speeches, so the more the merrier. Whatever the occasion there is always a top table, a photographer and a master of ceremonies. The buffet is always chicken, fish, beef or goat stew, bean stew, matoke (mashed banana), potato (often sweet potato as well as plain boiled which they call ‘Irish’), rice, chapattis and possibly posho which is made from maize. On the same plate you will have slices of fruit, usually water melon. A meal here is not considered ‘food’ unless there are at least four carbohydrates together.

I (Maggie) put on my ‘Tour Guide’ hat again and took a family from Ireland to see the chimps. (Yes Mari, it was me last time too) This time they performed well (the chimps not the family!), though they stayed in the trees because it was raining. They were just waking up from their afternoon snooze and waiting for the rain to stop to go and raid the sugar cane. One toddler was having great fun on a smooth tree trunk by climbing up it and sliding down again! There was a lot of communicating going on which makes you realise that there are many more chimps than you can actually see. These small riverine forests are some of my favourite places here. They are really remote and very few people know that the chimps are there, so it’s a privilege to be able to go. We always see monkeys, baboons and lots of bird life too. I really had to keep a straight face when the mother of my group asked if the chimps would go back to the wild after being here - I’m really not sure how much more wild it can get!

Talking of wildlife, Chris is thinking of introducing a new Olympic sport. It involves a race to go out into the garden to hang out the washing and see who can get back with the least ant bites! At the moment we are plagued by an army of soldier ants which are huge and seem to find their way into your clothing within seconds. They have strong pincers and have to be prised off. I just wish I’d had the video camera ready!

A feel good story

2008-08-03T16:32:00.004+01:00

I thought I would include a happy story this week. Reading back on the blog we seem to be concentrating on the negative bits but it is not all gloom and doom.
I was asked to see Vincent when he was a few days old. As you can see from the pictures he had a problem with his legs. I honestly could not immediately work out what was wrong but knew that his legs should not bend the way they were. I arranged to see him two days later and rushed to the internet. A few minutes later I had found the answer. He has bilateral congenital dislocation of the knees a rare congenital abnormality. Not only did I know what was wrong with him but I knew he could be treated quite easily by splints and physiotherapy. Unfortunately I was not confident that the treatment was available in Masindi.
Sally the local information centre knew a Dutch woman in Kampala who was married to an Italian paedriatric surgeon in Kampala. Networks here are so important. A phone call to Dr Fulvio led to an appointment in Kampala. The problem was how do you persuade an 18 year old girl from the village to go to Kampala with her baby and how does she get there. After some negotiation via a Ugandan teacher who works for the Ugandan Disabled Children’s Society it was agreed that mother grandmother and Vincent would travel to Kampala and stay at Katalemwa Cheshire Home where they would see Dr Fulvio. Luckily Sally and Maggie were going to Kampala so they were able to take the trio. Using funds from the UK we were able to pay the modest amount to allow them to stay for three weeks at Katalemwa. The treatment was free and Vincent returned to Masindi with straight legs. He should be able to walk and play normally. The family are so grateful for the help and support of people in the UK.
Yesterday I was asked to be a god father to Vincent an honour but I turned them down. I think Vincent deserves some body with more faith.

We were neglectful of the blog last week, not because there wasn’t anything happening but because we didn’t have time when we weren’t too tired to sit down and do it! One totally unexpected experience was when I was at the hotel and a local tour operator arrived with an American family of six. It seems Sallie had agreed that she would arrange a guide to take them to see the chimps that we know about which are in a small forest about 30k away from Masindi. These are chimps that are at risk from poachers and Sallie employs rangers to guard them. We are really fortunate because we sometimes get to accompany Sallie to see them. On this day Sallie was out of town and the guide she had arranged hadn’t turned up. I tried to find someone else who could take the group of Americans but failed to find anyone who knew the way. The only option was for me to pretend I was a tour guide and jumped in the vehicle and went! The Americans were really pleased to have a ‘muzungu’ guide - if only they knew! Although I’d visited the small riverine forest on several occasions I’d never really taken much notice of which tracks we’d driven along through the mile upon mile of sugar cane. One field of sugar cane looks pretty much the same as the other. I know someone who once lost his way and was driving around for 1 ½ hours trying to get out! Thankfully we did find the right bit of forest and I don’t think they noticed the look of panic on my face every time we came to another turning and I had to make a decision about which way to go. To cut an even longer story short, we did get sightings of some chimps but nothing like the display we’ve had on some trips. Luckily we saw various other monkeys, baboons, etc. but I had a job to keep the teenagers interested. I bluffed my way through the whole experience with my limited knowledge of the production of sugar cane and my equally limited knowledge of primates and wild birds! Anyway, the family seemed to go away happy - at least they hadn’t had to pay a fortune to enter one of the national parks. (Come to think of it, I didn’t get a tip!).

Masindi Movies: We recently bought half a share of a projector so I decided we should begin movie nights at the hotel, showing our vast and extensive range of DVDs! We held our first one on Saturday with a huge audience of 15 people. I thought it would be quite apt for our first ever showing to be The African Queen as a lot of it was filmed right here at Murchison Falls National Park. All was going well until 10 minutes before the end when the DVD had a blip and we had to abort - very embarassing!! No-one believes us that it ends with Humphrey Bogart being killed and Katherine Hepburn relishing her newborn zest for life and going off with three of the sailors from the Louisa.

News from home (UK!) - Kerry gave birth to Maxx on the 21st. Both are doing well. They are hoping to move to a bigger house in a couple of weeks. Becky completed the sponsored 10k in less than an hour and raised almost £800 for school fees for children in Masindi. Congratulations to both of them! Thanks to everyone who pledged money for the run.
Maggie

HOW TO SPEAK 'MASINDI'

2008-07-20T10:37:00.004+01:00

IDIOMS - HOW TO SPEAK ‘MASINDI’

A few days ago I realised that I’d said to someone “You are lost”. It was only then that it occurred to me how I’ve not only become accustomed to the local idioms but that I’m also using them myself!

Here are a few I regularly hear:

I’m going for a short call - I need a pee
I’m going for a long call - I may be some time, I need to find somewhere to defecate quietly!
It got finished - I forgot to order any more
It got spoilt - I can’t be bothered to fix it
I am through - I have finished eating, you may clear my plate
Now - I’ll do it tomorrow or possibly some time next week
Now now - Today
Yes - I don’t really understand what you’re saying but I’ll agree to it anyway
It’s behind - You’ll find it in the kitchen
Are we together? - Do you have any idea what I’m talking about?
I’m somehow - I could be feeling better
I’m fine - I’m still breathing
I’m a little bit fine - I’m at death’s door
I’ve got Flu - My nose is running
I’ve got Malaria - I think I might have had a temperature
The day is somewhat okay- No problems today
He’s around - He hasn’t come to work yet
Let me struggle - Of course I don’t know how to do it but I’ll work it out somehow
Can you assist me? - I’d like something from you (money)
It is disturbing me - It’s a conundrum
Ugandans are time bad- Expect a meeting to start 2 hrs later than scheduled
Greet me to ………… - Please give my regards to……..
You are lost - I haven’t seen you for a day or two

MAGGIE

The four pictures of hospital vehicles covers the whole fleet of vehicles. Unfortunately only one of these vehicles is driveable, I will not say roadworthy because it would not be in the UK.
The maternity ambulance has had its two front wheels stolen several weeks ago. The British ambulance kindly donated by a rotary club has a flat tyre and leaks oil, the pick up is leaking oil and is jacked up on rocks, the old ambulance does travel but you have to stop now and again to reconnect the battery.
The Pajero which we managed to get back on the road a couple of months ago has two flat tyres and has been parked in a police compound at Kyrandango for the last three weeks. The tyres need replacing and there is no budget.
The hospital is waiting for its allocation from central government which is 2 months late. At present they are 60 million ugandan shillings in debt. This means that vehicle maintenance is low priority.
Travel in Uganda is a challenge and visiting the community health centres and home visiting of patients is difficult. I should have learnt how to ride a motorbike!

CHRIS

Blame the visitors

2008-07-12T15:20:00.002+01:00

We seem to have neglected the blog and all I can do is blame the visitors.Dan flew home yesterday after a short visit. It was great to see him and we enjoyed showing him Masindi and Murchison Falls. Emma a medical student has also been heretaking a look at medicine in Masindi before travelling to Bwindi for the rest of her elective.
Having visitors is great as it makes you look again at things you have begun to take for granted. Showing people around the hospital is always interesting seeing the response of pateints and nurses as well as the visitors. Dan could relate to the hospital after his elective in Malawi but Emma was quite shocked especially by the nursing situation.This week end the female ward where i work has moved to a new ward. This ward was built £ years ago but has never been opened. It is better than the old ward but why would any one design a hospital ward with not a single sink. There are some toilets in another part of the building and some sinks there but they are not functionning! I am becoming obsesswed by hand washing and the lack of facilities. A new Medical Superintendant has arrived this week and he seems to share my concerns. He did however point out that the hospital is 60 million ugandan shillings in debt at the end of the financial year and that they had not received there money from central government for the last 2 months. It is not surprising that the system is in decline.Every one blames the fact that all the money goes to HIV/AIDS and there is none left for the routine work. That is a factor but only part of the picture.
This week I went out ot a village and saw 5 patients with leprosy. This is a disease which should be relatively easily managed in Uganda. There is a programmme, the drugs are cheap and in the country but why was only one of these patients on adequate treatment. Next week I have a meeting with the Leprosy lead for the district and I will try and find out what is happening.
On a happier note the child with dislocated knees is back from Kampala and appears to have been sorted. That is one small achievement but great for him.
We spent the weeekend as tourists at Murchison Falls. As Dan was with us we treated our selves to 2 nights at the Nile Safari LOdge. This was a great place to stay overlooking the Nile. The noise of frogs and hippos at night was unbeleivable and Maggie managed to add another 20+ birds to her list. She is becoming quite a twitcher.

Tme flies

2008-07-01T05:19:00.002+01:00

Tuesday morning and we have not done the blog again. The plan was to do it on Sunday night but UMEME the local electicity supplier had other ideas.We were subject to electicity switching on and off, lights flickering and power surges. That is not good for computers so we sat in the dark and watched Gavin and Stacey on the laptop.
On Saturday we did the "walk for a cause" a charity walk around Masindi organised by VSO Masindi.Thank you to every one who sponsored us.The walk attracted over 250 people, mainly school children but a number of adults joined us. The walk was to show support for people living with HIV and to raise some money for a local HIV support group.We plannned to start at 8.00. Three weeks before we had checked with the police who said no problem. We called in to remind them on the morning and they said we needed an escort which they would provide at 9.30. At 10.00 after another visit to the police an escort arrived and organised us to walk around Masindi.It was good to get going but by that time it was really hot. We managed the walk and did not lose any one.It was interesting to show some of the local children historical sites around their town which many had not seen. The main monument is to record the meeting between Sir Stanley Baker and the King of Bunyoro. The king refused Bakers terms and preferred to retain sovereignty.I am not sure how much money was raised but even small amounts can make a difference here.
On Sunday we went up to Budongo forest to look for chimps. There is a problem with the chimps raiding farm land and eating crops. A group of chimps can do a lot of damage and it is hard to manage the needs of both. One farmer close to the edge of the forest has real problems. His land is full of fruit trees all providing the chimps favourite foods.We did not see any chimps but there were some nests where they had been sleeping. Sally was involved in a village meeting to discuss the problem. The villagers were not anti chimps but wanted some help to manage the situation.It was a positive good natured meeting so hopefully a way forward can be found.
We did not see chimps but did see collobus and blue monkeys as well as a group of beautiful Turacos.

Late again

2008-06-26T16:04:00.003+01:00

I can not believe it is Thursday already. We seem to have been busier than usual this week and both of us have a cold or flu as it is called in Uganda. All the patients are demanding antibiotics for their coughs and runny noses and I am not popular when they just get paracetomol.
We have had another visitor to stay. Grace has just qualified and has been teaching me modern medicine and I have been teaching her cynicism to prepare her for life as a doctor. It has been really good to have another medic to discuss cases. There have been a lot of sick patients this week including a poor lady who had a fit and fell in a fire. She has 60% burns and has been lucky to survive. We have managed to transfer her to Hope Ward at the International Hospital Kampala Thanks to Grania another VSO doctor who works there. The hospital had no money for the fuel to take her so I used some of the donations from the UK.It is so useful having that money to dip in to but I do not want to give the impression that I am the muzungo with a cash answer to every ones problem.
Next week Dan is coming out which will be great we are really looking forward to him coming.
To the guy who left a comment about groups of teenagers running around Masindi. It was Kabalega Secondary Schools army training group preparing for their passing out parade

Old age beckons

2008-06-16T19:50:00.004+01:00

It’s been another week full of new experiences. For a start, Chris celebrated his 57th birthday. “No, it’s not possible” I hear you cry, but the reality is that it is! To be kind to him on the actual day we cancelled our weekly Swahili lesson, which Chris would do anything to miss at the best of times. We enjoyed a meal with friends and then celebrated in ‘style’ on Saturday with a bar-b-que at our house complete with chefs and waiters. I’m not quite sure which ‘style’ could describe a Mongolian bar-b-que in Uganda! Anyway, we mus-tered up our small but select group of 15 friends here in Masindi. It’s interesting to think that a place such as this can attract people from the Philippines, Canada, Germany, Zan-zibar, Kenya, Holland and of course the UK and Uganda.
Another cause for celebration was on Tuesday when Chris borrowed the hospital phone, which is programmed for the internet, and we actually managed to get on line at home us-ing the laptop!! Unfortunately the joy was short lived as the phone had to go back the fol-lowing morning just in case somebody needed to use the internet but at least we know it’s possible. We think we’ve found a similar phone but it seems to have something missing. It’s only taken 9 months to get this far so we’re not giving up yet.
Through a friend who is doing a research project on chimps in a nearby forest, I heard about a group of women from a small village who make baskets but are struggling to mar-ket their products. I took a taxi to visit them and have a chat about design, quality control, prices, etc. They were swahili speaking but thank goodness there was an interpreter - I really should do my homework! There’s a lot of talent out there, it just takes time to dis-cover it. Another Ugandan friend has brought some of her own label garments to sell; at this rate I’m going to need an extension to the shop!
This week we were also invited to the wedding of the daughter of one of Chris’ work col-leagues. The actual wedding clashed with our party so we went to the Introduction instead which was the previous day. We’re getting used to Ugandan time keeping so when the invitation said to begin at 2.00 we knew not to arrive before 3.00. We thought we’d stay for a couple of hours and make a discreet exit. Proceedings finally began at 5.00 and to our surprise we were treated like guests of honour and were seated on the front row. There was no escaping! Fortunately, because of the late start, they cut the ceremony down to a couple of hours. It’s very interesting to observe. The families of the two parties are seated opposite each other in different marquees with Elders from the villages repre-senting the bride and groom. Using a PA system, there is a lot of amusing banter and bargaining going on until the bride and groom and the two families finally accept each other. Of course, it’s all followed by an enormous feast. A table was laid especially for us inside the house while the rest of the party stayed outside. There was no way we could refuse the hospitality but the problem was that we were meeting friends for dinner that night. Ugandan ceremonies always seem to involve feasting.
One of our askaris, Soloman, had to go to Kampala this week to see his sister. This meant that we would be with out an askari for some of the time. Rasoul refused to allow us to be unprotected and stayed at his post for 36 hours! We feel very grateful for the loyalty of our staff. There have been a number of robberies in the area and every one is very upset about them. Happily we seem to have been spared so far.

HIV and mangoes

2008-06-09T08:36:00.003+01:00

In March while sitting at Travellers Corner a local café there was an accident between a boda and a taxi. I heard a terrible bang and then saw a man catapulted down the road. He was badly injured with major head and facial injuries. There was blood all over him. As people gathered round him and manhandled him on to the back of a pick up I grabbed his head to support him, in the process getting blood all over my hands. The patient died a few hours later. There is no intensive care out side of Kampala and he had very severe injuries. He was one of six people who have died on the main street of Masindi since it has been resurfaced. A few days later I began to realise what a stupid thing I had done. In any country it is not advisable to handle blood but in Uganda the chance of a boda driver having HIV is fairly high. Logically I knew the chance of me catching HIV from this blood was low but during the next few days it became a worry and I realised that to be sure and in fairness to Maggie I would need to take a test after the three months window period.
HIV testing in Uganda is readily available and this week I arranged a test. I did not put my self through routine counselling because I am fully aware of all the issues. I by passed the system and asked Soloman the laboratory technician to do the test. I was confident that the test would be negative. I knew my risk was low but it was still a slight worry as I waited 15 minutes for the test result. How different it must be for most people, many of them know they have significant risk. They may already know that their partner is positive, they may already be suffering from ill health. Many people take the test expecting their result to be positive. I have to admire the way most Ugandans accept their testing and results. It is more difficult to understand why many people continue to put them selves at risk in spite of having the knowledge about risk factors.
It must be particularly difficult to have your child tested. One of the nurses at the clinic has been struggling with this problem. She is HIV positive and has been taking ARVs for three years. She has always been afraid to have her child tested although she suspected he was positive. He has had a number of infections and recently had a particularly bad chest infection. She was persuaded to let us test him and he is positive with a very low CD4 count. This means that the virus has already seriously affected his immune system. He needs to start ARVs him self but she is still reluctant to start him on treatment. She feels guilty because she caused his infection and she is finding it very difficult to discuss it with him. How do you tell a nine year old boy that he has HIV and that he will need to take medication for the rest of his life? How do you answer your son when he asks why he has the infection?
It is a year since we came to Masindi on holiday. Once again it is the mango season and Masindi is full of talking trees. In every mango tree you walk past there are young boys hidden from view searching for the juicy fruit. Each one you pass shouts “muzungo how are you” and if they are cheeky enough they add “give me some money”. The standard answer is to say “I am fine” and I always ask them for money which usually provokes a fit of giggles from the middle of the tree. This time of year the incidence of fractures goes up as the boys regularly fall out of the trees.
Another harvest this week has been the flying ants. The weather has been rainy and this has provoked swarms of flying ants. They discard their wings after mating and are eagerly collected by every one. They are fried and served as a delicacy. It is said that in the schools you can tell when ants are about as the health of the children improves with better nutrition. We have not eaten ants yet but I did have some grass hoppers which were very good.
This week’s challenge at the hospital is lack of drugs. The drugs were supposed to be delivered from the national medical stores 2 weeks ago but have still not arrived. We have run out of many essential drugs and have no x-ray films. The community clinics are in an even worse situation as their drugs are 4 weeks late. Yesterday I was told that one of the delivery trucks had been involved in an accident and thieves had stolen the drugs. We wait to see what arrives in Masindi but it may be we have to wait another 2 months for the next drug supply.
We had a good trip to Fort Portal and it was great to see a different part of the country and meet up with fellow volunteers. Fort Portal is much prettier than Masindi with beautiful hills and crater lakes. We climbed one hill called “the top of the world” from where you can see for miles and view 3 crater lakes. On the walk through the forest we encountered lots of beautiful birds and at 3 types of monkey. The monkeys took no notice of us and seemed happy to be photographed eating, grooming and leaping from tree to tree.
Fort Portal hospital is a regional referral hospital of 350 beds. It was sad to see that it suffered from the same problems as Masindi. There was a shortage of doctors and drugs. There were few places to wash your hands although as it was a newer hospital it was easier to keep clean. The x-ray unit has been closed for refurbishment but this means that they will not be able to do any x-rays for several months.
It was interesting to look around the psychiatric unit as this is the first I have seen in Uganda. There is no psychiatrist but two psychiatric clinical officers run the service. They were obviously trying hard to provide a service but hampered by lack of medication. They knew what they should be prescribing but were limited to what was available. Basically they had some chlorpromazine, some amitriptyline and diazepam injections.
Masindi has been cooler the last week.This means we have no excuse for being lazy.It is Heroes Day today and a national holiday but Maggie and I are both at work although the pace is slow. Hopefully today we can sort out a budget for the community project.

Becky's Sponsored Run

2008-06-02T15:40:00.002+01:00

Sponsor Becky’s 10K to raise money for students’
school fees.

On 20th July our daughter Becky is running the Great
Capital Run (10K) to raise money for a local school
project here in Masindi. Primary education in Uganda
is free but secondary is fee paying. As a result of a
documentary about the difficulties faced by young
people in Uganda shown on BBC2 in 2005 several donors
from the UK offered to pay for a class of students’
school fees. Unfortunately these donations have run
dry and a class of 55 secondary school students risk
being thrown out of school because they cannot afford
the school fees. Sallie, from New Court View Hotel in Masindi, is organizing a fundraising
campaign to try to keep the students in school. If
you would like to sponsor Becky to complete the 10K in
less than an hour then please go to the widget on the right hand side of this page.
Thank you!

Zanzibar

2008-05-25T14:33:00.004+01:00

Think coconut palms, delicious seafood, a laid-back way of life and miles and miles of white sands lapped by warm translucent turquoise waters and you have Zanzibar. Of course there is much more to it than that - Zanzibar has a fascinating and turbulent history. Denise, Sallie and I began our trip in Stone Town, on the west coast, which is a labyrinth of Arabian-style alleyways packed with nineteenth century mansions, palaces and bazaars. We were lucky to have Farid (a friend of a friend) to show his us round his home town which he was so obviously passionate about. He introduced us to people and places which I’m sure we would never have found on our own. For instance, the tiny electrical shop whose owner gave us Zanzibar coffee served from deep down behind the counter, the little cafe serving a bowl of bhajia in a coconut and chilli sauce (that’s the only dish the owner has been selling for the last 20 years), to the very busy dhow port where we mingled with the fishermen and watched them at work. To the other extreme he took us to the roof top terrace of a house belonging to a very wealthy hotelier to watch the sun go down. We visited and supported (i.e. bought lots of nice goodies) the Arts and Cultural Centre which Farid owns. The centre provides training and employment for women. Stone Town is famous for it’s doors which were an important way to show the wealth and status of the person who lived there. They are elaborately carved and studded, each one telling a different story. It’s almost unthinkable to go to Zanzibar without going on one of the many Spice Tours on offer. This was a half day trip out to the farms, followed by lunch prepared using the local spices, of course, which we ate sitting on the floor of a traditional village house.
After a few days in Stone Town we moved across to the east coast to a hotel where our rooms were literally a few feet from the beach. Its remoteness meant we couldn’t help but relax. The nearby fishing village looks as though it has never changed. Men, women and children were fishing or collecting seaweed, the latter mostly for export to places like Japan and China for culinary purposes. We watched lobsters, prawns, crabs and fish being caught using traditional methods. We did our bit to support the local economy and ate very well that week! Despite tourism, Zanzibar is still a very poor place. When walking through the fishing village there wasn't a child who didn't hold out their hands and say 'pay school'. I'm sure most of them didn't even know the meaning of the words, in fact many weren't old enough for school, but they knew they were asking for money.
Other news: it was back to reality on Tuesday. Back in at the deep end at work with lots of issues to sort out. A couple of medical students, Susie and Steph, arrived from the UK whilst I was away. They are in Masindi for four weeks and stayed with us for the first few days. It seems that theft is on the increase in Masindi so we have now employed another member of staff - a daytime askari to guard the place. We are trying to see how many local people we can employ! We now have Rose, the housegirl, who lives in a separate house in our garden with her five children and husband Abdul (who is the askari at the hotel), Sam the gardner, Solomon the night-time askari and now Rasul the day-time askari. At least he can help keep the monkeys off my vegetables - there’s not much else for him to do!
Coming up ……...another trip to Fort Portal!

Where has all the blood gone

2008-05-19T14:16:00.002+01:00

A day late for all those fans waiting anxiuosly around the world to see if I have survived a week of my own cooking.Surprisingly I have with a little help from some friends.
It has been a strange week not just because Maggie is in Zanzibar. Our first UK students arrived and it has been a good distraction showing them around the delights of Masindi and the hospital. They are here to do research which is difficult in the best of places but a real challenge here. Hopefully they will get something useful out of the experience.
Medicine has been a bit bleak here. The child with a cleft palate seems to have disappeared. no one onn the ward remembers him going but he isnt there now. It looks like the parents decided against intervention and took him back to the village to die.the fact that they already had six children probably influenced the decision. the logistics of surviving in Kampala must have appeared unsurmountable.
We have 4 patients on the ward awaiting blood transfusion.They all have haemoglobins below 5 .One is said to be at 3g.l. There has been no blood at the hospital for 10 days. More worrying is that there is no blood at any other hospital. We phoned the national blood bank today and they had none but hoped to get some tomorrow.It is likely that our patients will have to hang on for another week. Evidently this is a regular occurence when the kids are on school holidays as much of the blood is taken from students.We are not allowed to collect blood locally as we do not have facilities to test for hepatitis and HIV.
The drug supply is still precarious but we have been given permission to order some relevant drugs. let us hope they are in stock. we have the wrong testing strips for the glucometers that the ministry gave out. No one is sure whether the right ones are available in Uganda.
Time is really passing quickly. This week we shall have been here 8 months which is a third of our time.I am still not sure what we are achieving in the long term but every one still seems happy we are here. Ugandans are forever saying thank you and well done and I am not sure why.
I am sure Maggie will want to post her news from Zanzibar when she gets back. She is due home tomorow.

Chris

Time flies in Masindi

2008-05-11T16:08:00.002+01:00

This week began with a meeting on HIV at a local hotel. It was an important meeting with national facilitation but called at 2 days notice which is often the way in Uganda. I received a phone call from Chris the clinic lead on Saturday afternoon saying that we had been asked to provide a 30 minute power point presentation on HIV treatmen for monday morning. So we spent 3 hours on saturday preparing a presntation.
I arrived for the nine oclock start at 8.45 as the hotel is just down the road from our house.There was no power , no computer and no projector so no hope of power point. The rest of the delegates arrived over the next hour and the meeting began at 10.45. This is a fairly typical Ugandan arrangeent. Time is very flexible here and you have to adjust or you will go mad.Meetings and workshops are very popular here. Attendees receive a lunch and a travel fee. Sometimes there is an actual attendance fee as well. With salaries being so low people rely on these fees to top up their take home pay. Unfortunately it means that people will attend almost anything wheter it is relevant or not.Their is another workshop this week on palliative care in HIV which I want to attend to meet people from the nearest hospice which is in HOima. Palliative care is a neglectd discipline here.
The child with a cleft palate turned up this week looking very frail. The mother who has 5 other children had obviously been unable to feed the child. I admitted him to the paedriatic ward for naso gastric feeding. Unfortunately the ward had nothing to feed the child with so we had to give a little bit of money to buy milk.Hopefully the child will pull through and the father will agree to let it go to Kampala. By coincidence a nurse missionary passed through Masindi this week and stopped at Court VIew for lunch. She offered to come back to Masindi and transport the child to Kampala if they agree. Networks and chance meetings are important here.
Maggie as flown off to Zanzibar with Sallie and Denise two friends from Masindi.When you are this far from home you might as well make the most of it.
We were reminded of home this week when the Hull Journal arrived complete with articles about friends we have left behind.The journal is about as far away from life here as you can imagine but it looks great on the coffee table!

BWINDI TRIP

2008-05-04T12:19:00.003+01:00

We had been planning a trip to a community project in the far south west for several months. VSO have had a GP and community nurse working there for two years Paul and Vicky. Due to communication problems we had had difficulty arranging a date so when we received an e mail on Saturday suggesting a trip the next week we jumped at the chance. By Saturday afternoon we had hired a driver and 4w drive vehicle, booked accommodation in Kampala, arranged a visit to Reach-out Mbuya a HIV community project and managed to sort out a meal out with Dan and Grania our friends in Kampala. Things can happen quickly in Uganda.
Reach-out is a community based HIV programme which provides excellent home based care for people living with HIV/AIDS. It is recognised through out Uganda as a centre of excellence. Pam and I spent the day there seeing some of the work they do. We were particularly interested in their nutrition programme. They have support from various donors and have been able to provide nutritional support to children and malnourished adults. This is an area we would like to develop in Masindi. At Reach out not only are they able to give out food but they have a training scheme to encourage patients to grow foodstuffs. They have an impressive programme of community support and every week visit patients in their homes. The project was started by a parish priest and still is concentrated on the parish. This means most of the homes are within walking distance.
After two nights in Kampala we set off for Bwindi. This is a ten hour drive the last two hours on marram roads. Luckily Soli are driver was very experienced and we arrived safely on Tuesday evening. Bwindi is on the edge of the impenetrable forest where you can go gorilla trekking if you have the $500 for a pass. It is a stunning location with mountains all around. The first two nights we stayed in a lodge just in the park and hoped we might just bump in to a gorilla but no such luck. One of the advantages of working in this area is that rich tourists can be persuaded to donate money to support the health centre. Paul and Vicky have been able to raise an impressive amount of money and the centre has grown enormously during there time. There are new wards and a maternity block is about to open complete with a waiting mothers hostel.
Our particular interest was to look at some of there preventative work. They had had a major programme of mosquito net distribution which had significantly reduced the impact of malaria. Their nutrition programme was impressive and there was an active educational element. Pius another VSO volunteer from Kenya has started a garden which produces an abundance of vegetables and shows people what is possible.
Vicky and Paul made us very welcome and it was a great opportunity to discuss the challenges of working in Uganda and learn from their experiences.
Every one we met was welcoming and keen to show us their work. Maggie threw herself in to it all and was soon helping out the nurses. On one morning Scott the founder of the project took her on a ward round and she is now an expert at listening to chests and feeling spleens! The children’s ward was a delight so light and airy with children running around and playing so different from Masindi hospital. They even had an outside play area and a mother’s garden.
On one day we went out on a HIV outreach to a district health centre. It was disappointing to see that it was as dysfunctional as those in Masindi. Staff rarely attend and the place was run down and filthy. The most worrying thing was that it was close to the district headquarters and should have been easily supervised.
One of the delights of Bwindi was sitting on Vicky’s veranda watching the red tailed monkeys. The veranda is surrounded by trees and the monkeys are fearless. They often get in to the house to steal food. They are the most beautiful vermin you could imagine. There are also beautiful birds and butterflies around all the time. It really is a beautiful place.
We left Bwindi impressed with their achievements with ideas which we could transfer to Masindi. There are major differences in the set up and working in the public service has challenges especially lack of resources but hopefully we can do something. On the journey back Maggie was able to buy some crafts for the shop. She is becoming very adept at haggling a true African.
It is ironic that after all my efforts to avoid the pharmaceutical industry in the UK this trip was partly paid for by a grant VSO received from Astra Zenica do not tell any one.

Returning to Masindi was a shock. All those plans have to be put on hold because of work load. Monday morning found me doing a ward round alone. There where 6 mattresses on the floor with extra patients. There were the usual mix of patients some who should have not been there and some who were seriously ill. The number of malaria cases seems even higher. This week national TV news showed mosquito nets being delivered to Masindi hospital for use on the wards. There was no evidence of them and the sister had no idea they had arrived. I am becoming more confident in diagnosing TB or may be I realise that no one here is quite and my guess is as good as any ones. We seem to diagnose two or three cases a week usually a co infection with HIV. It is really satisfying to see the improvement on a few weeks treatment. Patients you really thought were at deaths door restored to health. One of the big problems here is following up patients to make sure they complete treatment. Only 38% of TB patients take the full eight months of drugs.
Some time this week I was asked to see a baby born in a village who was not feeding well. She had a cleft palate and will need surgery. By the time I contacted Andrew Hodges a plastic surgeon in Kampala the mother had run away back to the village. Luckily we knew the health centre that she attends and were able to visit there the next day and arrange to see the baby again. There is an opportunity for her to be operated on in Kampala but the question is can we persuade the mother to take her. We shall see.
At the moment JCRC have failed to send the grant to run the HIV clinic. Although we have drugs all the other things needed to run a clinic are in short supply. Worse of all for me is that the internet subscription has not been paid so I am having to rely on the internet café which is slow. We are still trying to get connection at home. The right phone has been located but the connecting cable is in short supply. Evidently they fetch a good price in Congo and the Sudan presumably because of all the NGOs wanting connection. All the cables have been bought up and exported. May be that is what is meant by trade not aid but it is annoying.

Comments
It is great to read peoples comments on the blog. Unfortunately we have been getting loads of computer generated spam so I have had to put an extra manual step in the process. Hopefully it will not deter people from contacting us.

Bwindi trip

2008-04-24T16:03:00.002+01:00

We ended the last entry with the words mpora, mpora (slowly, slowly) but just to prove that some things can happen quickly I thought I would mention our trip to Bwindi. Chris and Pam wanted to visit a health centre in Bwindi where two VSOers are working and apparently having a positive experience and really making a difference. Communication with that part of Uganda is difficult and we made several attempts to contact Paul and Vicky. On Saturday we received an e-mail saying that this week would be good for a visit so within a few hours we had a car and driver booked and set off on the 4 hour drive to Kampala (overnight in Kampala) and then a 10 hour journey down to Bwindi. It's right in the south west about 1 mile from the Congo border (see map on right!). So, we are here for a week, returning to Masindi on Sunday. I'm sure there'll be lots to tell but it will have to wait until the following week! Have just managed to get a slot on the internet (it's apparently no good when the sun shines) but thought we'd let everyone know that all's well and we're having a great trip. Until next week ..............

April Showers

2008-04-14T09:36:00.002+01:00

The last few days have been cooler and the rains have started so it is not dusty just muddy! There is power this morning and the computer is working so only a day late with the blog.
The Gift Shop at the hotel is thriving. Word is getting around and people are coming out of the woodwork (or, more accurately, the bush) to sell me their work. Some of it is really creative and good but some is less so and I don’t like having to turn people away. The aim of the shop is to provide good quality, Ugandan crafts and to provide an outlet for people to market their products.
This week I decided to stock up on certain things but, like everything else here, that is not such a simple task. One of our suppliers is a project for women producing beautiful bas-ketware. Everything is made from natural resources, including the dyes. The women are taught the necessary skills and then they work from home and have a guaranteed income. The only problem is that their village is near Fort Portal which is an 850k round trip from Masindi via Kampala. As Sallie was going to Kampala early on Tuesday morning I ar-ranged a lift down with her. We eventually set off at 4 p.m. and arrived late in the evening and booked into a hotel for the night. Sallie’s driver, Godfrey, was taking me from Kam-pala to Fort Portal the following morning - we finally left at 4.30 and arrived at 8 p.m., far too late to go to the village. The bonus was that I got in touch with our VSO friends based in FP and they were celebrating Barbara’s 70th birthday. I gatecrashed their dinner party and stayed the night with them! It was great to catch up and hear how they are getting on. Unfortunately, Godfrey had to return to Kampala early that morning (we’re now on Thurs-day!) so on Wednesday night another driver, Sulliman, had to come all the way from Masindi to pick me up and do the last leg of the journey. He had a dreadful journey down - the road is made of marum (no tarmac) and treacherous when wet. His brakes failed about 50k out of FP so he had to rely on his handbrake. Consequently, the vehicle spent a couple of hours in the garage in FP on Thursday morning. This was the vehicle I was re-turning in so I didn’t feel too confident about the journey home. The garage, along with it’s mechanics, didn’t exactly fill me with confidence either though it was quite amusing when a lady brought out a stool for me and asked me to sign the visitor’s book! Late Thursday morning, after all the frustrations, we finally set off to the village to buy the bas-kets. After two days of travelling I was relieved to be able to do what I had come for - or so I thought………..we arrived at the shop to find it was closed! So Sulliman and I just did what every Ugandan would do and sat and waited. A lady from a nearby shop produced two chairs and I was harassed the whole time by a gentlemen who had obviously been sampling the local brew and seemed to think I was his Auntie. Quite entertaining actually. Patience paid and the shop did eventually open. I practically cleared the shelves - I had no intention of coming back for a long time! We took the short route home but had a 5½ hr bone-shaking journey along very wet, muddy, hilly roads with the car sliding all over the place, but at least the brakes held out. This road is only really passable with a 4 x 4 but the other option is a two day journey back via Kampala. I can sense all my friends in the UK reading this blog and wondering why I didn’t just order the goods by mail order. Things just don’t work like that here and nothing is ever paid for by credit card, only cash.
The one compensation is that the scenery in that part of Uganda is stunning. FP is in the foothills of the snow-capped Rwenzori mountains, also known as the Mountains of the Moon. The climate is cooler with more rain, but very green. It’s home to Uganda’s tea plantations, established in the 1930s by Europeans and Indians. Mineral water from the mountains, cooking oil and soap are also produced there.
Chris is still pleased with his vehicle, the Pajero, for work. It’s been spotted all over the place delivering goods, etc. but, more importantly, taking staff out into the rural communi-ties. Chris and Pam have been able to get out to the district health centres. It has been used for outreaches and this week in one clinic over 200 people were seen. The Pajero’s had three punctures this week because of shonky tyres but we can’t get hold of any new ones until May due to lack of funds at the district. Hopefully it will keep on the road next week.
Our motto is mpora, mpora (slowly, slowly, in the local Runyoro language) but sometimes you think you are not going slowly but going backwards!

Mixed week in Masindi

2008-04-07T11:57:00.004+01:00

This week has been dominated for me by the arrival in town of the Elton John Pajero. This is the vehicle that was given 4 yrs ago for work in the community. It had been off the road for over a year but I gave some money from the donations I brought out to have it repaired. It has been a complicated process but it is back on the road. The first I knew of it was when I saw it delivering children at one of the local schools but after a few days chasing it was delivered to the hospital and handed over.
After the trouble we previously had getting out to the health centres it was great this week to travel in relative comfort and safety out to Kyateri health centre. I spent the day observing and working with the clinical officer, a young women of about 23 years. There were the usual cases of malaria and diarrhoea. One child had a pneumonia and probable malaria In the UK she would have been admitted to paediatric intensive care but here she was sent home with amoxicillin and Co Artem. The area has a high maternal mortality rate even by Ugandan standards. Although most women attend ante natal very few of them deliver at the unit, most choosing to stay at home and be delivered by relatives or friends. If there is a problem, then transfer to Masindi hospital 20 km away is the only option and that is if you can find transport. Theoretically there is an ambulance at the hospital to collect patients but this rarely seems to happen.
The health centre seemed to function quite well and was providing a good service to the community.
On Friday we used the vehicle again to visit a patient who had not attended clinic to pick up his drugs. He has TB and HIV and was ill the month before with a haemoglobin of 5.9.When he sent a supporter to pick up his drugs we were concerned that he might need admission so we arranged to go out to see him. This is just the reason why we wanted to get the vehicle back on the road.
He lives near Biso about 24 km from Masindi. The homestead was several km out of Biso down several cycle paths only just passable in the 4x4. Eventually we came to a group of mud huts where we were greeted by Godfrey the patient and forty of his relatives, several of whom spoke perfect English. Luckily he was improving and the last few days he had started to eat again and was feeling stronger. His family are originally from the Democratic Republic of Congo just the other side of Lake Albert. They fled in 1983 to avoid the war and had to flee again from Buliisa to avoid famine. They now live together in this homestead of 42 people. It was remarkable how well they all seemed to get on. Godfrey’s father had had 40 children but Godfrey only had 6. When the children arrived home from school they all knelt down before the old women as a sign of respect. At 6.00 pm Godfrey called one of his sons to get the radio and he tuned in to BBC world service. He said he always listened to World Service as he liked to know what was happening in the world.
We were introduced to a little girl of 8 years. She was severely stunted and Cushingoid. She had been put on steroids at a year old for arthritis and the family had been buying them ever since. The drugs had severely affected her growth and now it is doubtful she will ever be able to come off them safely. Godfrey’s brother was very concerned about epilepsy as one of his sons had developed fits. It appears that this is a common situation in the locality and no one is sure why there is such a high incidence. Hopefully we can go back there and collect some information to clarify the situation. Unfortunately anti convulsants are not readily available here.
On Saturday we were invited to our askari’s home. He was keen to show us what he had spent the 300,000ush loan on. Soloman has been our night watchman since we moved into the house. He comes every night at 7.00 and leaves at about 6.30a.m. His job is to protect us and the property. He is a likeable chap who does not seem to mind working 7 nights a week. This seems to be the normal situation here and he is glad of a job. He lives with his 10 children and other family members on a large plot of land which he farms. His father obtained the plot many years ago when he came to Masindi with the British from the Sudan. Soloman considers himself Ugandan but his roots are in the north. He has been building his new house for 9 years; whenever he gets any money he does a little more. The money we loaned him in January he used to buy iron sheets for the roof. He now has half the roof covered and he has moved into half of the building. He proudly showed off his land and his crops. He obviously grows enough to feed every one but there is no spare cash and I expect part of his reason for showing us his home was to ask for a raise or another loan. As we left he scooped up a duck, placed it in a carrier bag and gave it to Maggie for our meal. It is hard to refuse a live duck! We took it to Court View and persuaded the chef to kill and pluck it. We muzungos prefer our meat on Perspex trays wrapped in clingfilm.
Today we have walked the Masindi trail. This is a 3 hour walk around Masindi which was originally worked out by previous VSO volunteers. It incorporates some of the historical features of the town and was good fun but very hot in the sun. The Masindi volunteers are planning to organise a sponsored walk using the trail in June to raise money for a local HIV/AIDS charity and to raise awareness locally of the issues.
There are some photos attached.If you look carefully at the one of the pick ups you can see the second driver. Soloman our askari is the one with a big grin and his long suffering wife is beside him.The others are from the trail.

2008-04-04T10:44:00.000+01:00

Photo success

2008-04-04T09:16:00.008+01:00

Have taken advantage of good network and uploaded a selection of photos! The 'fishy 'ones were taken on a recent trip to a remote fishing community on the shore of Lake Albert. There is one of Chris' car being towed away by the ambulance to be repaired (see earlier blog!), one of my craft shop and one of our camping friends.

Six months!

2008-04-02T15:30:00.000+01:00

It has just dawned on us that we have now been here six months. When thinking about what to write about on the blog, it seems that incidents that happened five or six months ago deemed worthy of comment but those same situations now seem less out of the ordinary and not worth mentioning. So, although it’s difficult to think what to write about, a lot has actually happened and the days have passed really quickly.
A parcel of somewhat squashed mini chocolate eggs from Becky and a box of ‘bits and bobs’ from Kare were most welcome. The eggs were fine after a few hours in the fridge! We’ve had various visitors this week - some more welcome than others! Somehow a couple of baby bats escaped from the roof into our bedroom (one lodged in the mosquito net and scared me to death), followed by a mouse and then a frog - geckos don’t count anymore! Our invited guests were Grania and Dan from Kampala who came to stay with some of their friends from the UK and camped in the garden. We had a good night with them all and the monkeys behaved themselves and left them alone. Work has been busy for both of us this week. Every day brings new challenges and frustrations. The notion that life would be simpler here was way off the mark. Nothing ever goes according to plan and just the simplest things become so complicated. Fortunately there aren’t any complicated things to sort out. Adapting to not being able to achieve as much as you would like is one of the hardest lessons. It’s not all doom and gloom though! It’s good to be able to walk down the street or around the market and be recognised by people who want to greet you and wish you well. There’s never any hostility but plenty of curiosity!
Being English I feel it’s my duty to mention the weather! The temperature has dropped a few degrees this week and the rains have started in ernest. It’s interesting to see the local people in their thick padded jackets and woolly hats and babies in several layers of knitted garments and quilted blankets. We are still walking around in t-shirts which prompts a few comments.
Now that the ground is wet Sam, the gardner, has been really busy planting my vegetable and salad seeds which arrived from the UK (thanks Steve and Denise). The only problem is keeping the monkeys and the mongoose off them. It will be such luxury to have lettuce again. I’m easily pleased these days - who needs radicchio, lollo rosso, curly endive, little gem and rocket when a good old iceberg will do?
This is going to be a brief blog as I want to try and upload some photos that we’ve been unable to do the last few weeks due to poor network. We’ll see what happens!

One of our rhinos is missing

2008-03-23T10:15:00.001Z

Maggie and I decided to have a weekend away from Masindi at Ziwa Rhino Sanctuary. The original plan was a romantic weekend for two, but it is too hot for that sort of thing so all the Masindi volunteers decided to come out for the Saturday night which worked really well.
We arrived on Friday after work to find that one of the female rhinos had given birth to a still born calf that week. There are only six rhinos in the sanctuary and the hope is to breed them to restock parts of Uganda that previously had wild rhinos. Every one was sad to lose the first calf a month premature after a 15 month gestation. To add to the concern three of the rhinos had escaped from the ranch when the villagers cut the fence to gain access to the grazing. The rangers had to track down the lost trio and found them several miles from the ranch. Finding them is difficult but more of a problem is to persuade them to turn round and return. You can not just say shoo to a rhino they are big and definitely have minds of there own. At one point they charged the rangers who had to climb a tree to keep safe. Some how they managed to return them to the ranch and repair the fence.
We spent Saturday sitting on the verandah , reading and watching the birds and butterflies around the house. It was idyllic. We did manage a short walk but realised that we were not sure of the correct procedure if we met a rhino. The rhinos roam wild and there was plenty of evidence of their presence with great piles of rhino dung around the place. They certainly do not suffer from constipation. At one point on our walk there was a crashing in the bushes so we decided to retreat to the verandah for another cup of tea.
Sunday it was decided we would all go off and see the rhinos with a ranger. The 2 groups of three rhinos are all supposed to be watched by the rangers all the time so there whereabouts are known. After about 20 minutes off road driving we parked and the rangers pointed out the beasts in the bushes trying to find shade. We were able to walk to within about 30 yards of the group. Luckily rhinos have poor eyesight and locate you by smell. We can’t have smelt too bad that day as they took no notice of us.It was a great weekend after a pretty awful week at work and we returned to Masindi refreshed.
This week has been better. The mouse and stray bat that invaded us last week seem to have taken the hint and left. Maggie seems to take all our little visitors in her stride but was very annoyed that the mouse had dared to chew a corner of her Green and Black chocolate. She managed to overcome her disgust and eat it, needs must I suppose.
Last week most of the staff I work with had been on a diabetes course leaving me to run the clinic and the ward. It is much easier when the whole team is available. Unfortunately Monday was another difficult day. During the ward round we found the 10 yr old severely disabled child of one of the patients fitting. She had stopped taking her phenytoin as they had run out. It took 3 doses of diazepam and over an hour for her to stop fitting. There were no other drugs available either in the hospital or in the pharmacies in town. It was awful to see this child fitting with nothing available to help. She may have had malaria so she was given quinine. It took 2 days for her to really come round but by Friday she was back to her normal self. She has no sitting balance and a left hemiplegia but she has a lovely laugh when she is tickled. What sort of future she has is debatable especially as her mother has terminal liver disease. There are so many tragic stories here.
Monday also was the day that we asked Raymond to stay away from the clinic. Raymond has been the mainstay of the clinic for several years. He is an expert patient and chair of the local group for people living with HIV/AIDS. Unfortunately he also has open TB. He has had 5 treatments for it but is still positive which almost certainly means he has drug resistant TB. There is no treatment for MDRTB in Uganda. The best we have been able to do for him is to register him at Mulago hospital so if a donor starts a programme with the necessary drugs he will be able to access them. It was sad to see Raymond go he will be sadly missed but the risk to other patients and staff is too great .
The Tuesday clinic was quiet without him and not as efficiently run as there was no one to do his job but the patients were all seen.
On Wednesday I managed a trip out to the community. This was in a UK ambulance donated by the rotary club of Hereford and Wye. The siren was useful at scaring children and cows!. We travelled to a village where 2 children had died from diarrhoea and vomiting in 3 days. The concern was that it may be the start of a cholera outbreak. From the story it is possible that it was cholera but could have been any diarrhoeal disease. Unfortunately the parents had not taken the children to the health centre and they had died from dehydration. The village is several kilometres from the health centre. It has very poor sanitation and poor water supply. Many of the houses have no latrines and the water comes from the local river. There is a market in the village which attracts many people. There is no latrine or washing place for the market. It is not surprising that diarrhoea is common. Death of children is common here and is an accepted part of life.
Everyone is aware of the need for improved sanitation, in fact this week is national sanitation week, but the resources are not available to deal with the problem in the villages.
On Saturday I visited the Family Spirit Centre with Pam our latest VSO volunteer. The centre has 57 pupils , 35 of them are orphans or abandoned children who live at the school. They range from 18m to about 13 years. The centre was started by a small group of concerned parents to try and provide education and shelter for vulnerable children. In spite of no official funding they manage to feed and clothe the children. The children all seemed happy and well cared for. The centre is always short of money but never short of children. They desperately need more accommodation and a fence around the compound. They have just dug a new pit latrine as the old one is nearly full. They needed money to complete the programme and I thought that it would be a good use of some of the donated money I brought out to Uganda. For 800,000 ush the building could be complete, that is about £240. They were very grateful so we had kids singing and speeches in the African style. It is an inspiring place. One of the best things about it is that it is a purely Ugandan response to a Ugandan problem. Yes they would like help from any one who can give but the inspiration and drive is coming from ordinary Ugandans who recognise that there is a big problem..

No pictures the system has crashed 3 times!

The Lost Forest

2008-03-09T17:11:00.002Z

Normally we set aside some time at the weekend to put something on the blog. As we have now learnt through experience, and become to accept, there is no point in making definite plans. Last Saturday I was unexpectedly invited to a wedding ‘introduction’ to accompany Sallie. In Uganda this ceremony is as important, if not more so, than the wedding itself. The mother of the bride, daughter-in-law to the king of one of Uganda’s kingdoms, is someone I have met before. On our visit here last June we went with her to her ranch set on a very remote five square mile plot of land in the middle of the bush. So remote, she couldn’t find it herself as she hadn’t visited for some time. We had to stop often to ask the villagers, who inhabit her land, where it was. She has lived in Barnet for the last thirty odd years since she went there with her lawyer husband and young family. Her husband was murdered during the Amin regime. The Introduction was at the same venue but we managed to find it a bit more easily this time and only had to stop once for directions. It was a very grand affair with marquees outside. We were the honoured guests from the UK and were seated with the princes and princesses. It was quite an experience and I’m pleased I had the opportunity to attend. These occasions can be very lengthy and often boring but this one,although lengthy, was well organised and entertaining. Many potential brides are paraded before the groom before he declares which one he will accept. Gifts are proffered, numerous speeches delivered, the ceremonious cutting of the cake (the bride-to-be with her brother as the groom has to wait until the actual wedding), certificates to be signed, local entertainment, etc., etc.
Sunday turned out to be quite an interesting day too. We set out to go for a swim at the Kinyara Sugar Co. Management Club, as we have done many times before. It is quite a trek to get there, along narrow, dusty roads and we have to rely on being able to find a driver and car to take us. On the way, Sallie announced that she’d like to just pop and check up on the chimps which are under threat from poachers and live in a nearby forest. I’m not sure how many miles we drove around the sugar plantation; it was like being in a maize of 6ft high sugar cane. We drove from forest to forest, sometimes off road (in a saloon car!) until we eventually found the right forest. Of course, by this time it was bedtime for the chimps and we didn’t find any. We did see lots of collobus monkeys and african grey parrots. The moonlit swim was quite nice really!
So, despite being away from Masindi for five weeks, we soon felt like we hadn’t been away at all. Chris managed to go straight back to work although his arm is very weak. I’m sure everyone who has seen him recently will be pleased to know that he’s gaining weight - we managed to eat very well back in the UK and we don’t exactly go hungry here either. Trouble is, I am also gaining weight and I’d rather not. When we returned I was paid a great compliment, allegedly in Ugandan culture, by a couple of people who told me I was fat! This means I must be very healthy and strong. Mmm….!!
Chris was very excited to finally see the vehicle which he is hoping to use for work being towed away by an ambulance (though we haven’t found out where to yet). When we arrived in Masindi last September, Chris found it abandoned in the hospital grounds and discovered it hadn’t been anywhere for six months. No-one seemed to know why not and there were no plans to get it back on the road. It was originally donated by the Elton John Foundation and intended to be used for District work. As this is what Chris is supposed to be developing and can’t because of lack of transport, he thought he would some of the funds he has raised to get the vehicle back in action. So, after several trips to the ATM to withdraw the necessary 4.3 million shillings (and a suitcase to carry it in!) it has been towed away - I wonder when we will see it again. Another great excitement last week was the arrival of Pamela, a VSO district nurse from the UK, who will be working with Chris. Pamela is staying with us until her house is ready and we are doing our best to gently introduce her to Uganda without scaring her away and heading for the next flight home. She bought a washing up bowl and a spoon yesterday so it’s looking hopeful that she will stay! I am full of admiration for anyone coming here on their own and tackling this.
Before we left for the UK I had been setting up a craft shop at Sallie’s hotel. It has always been on my list of ‘things I’d like to do’ but never yet got around to doing. I was really pleased when Sallie took up my suggestion and was just about ready for opening when I was whisked away. Thankfully they managed to finish getting it ready for the half-term rush and it’s doing very well. If you look hard enough there are quite a lot of crafts being made by various projects in Uganda, some of them struggling to market their goods, so hopefully this will be another useful outlet for them. Consequently, I am spending more time at the hotel but really enjoying it and there’s never a dull moment!
Yesterday I celebrated my birthday as well as International Women’s Day. I cooked for a group of friends and had a lovely day. I’ll try not to let muttering of ‘best food in Masindi’ followed by ‘best food in Uganda’ go to my head!! I received some very nice cards and gifts, thank you all!
It is Sunday again and we are about to set off for a swim at Kinyara - watch this space……………….

P.S. photos to follow, network is too slow tonight!

Back on Berwick Bridge

2008-02-19T17:03:00.002Z

It is freezing on the bridge but the light is fantastic and Sammy the seal is just in front of me. This posting is a bit late for various reasons normal service should be resumed back in Uganda.
Yes, we are still in the UK but the end of our nomadic lifestyle is in sight. We reluctantly tore ourselves away from our one and only settee, which is carefully positioned parallel to the window to take advantage of the wonderful view of the walled town of Berwick and from there the mouth of the river and out to sea, to travel to London for Chris’ out patient’s appointment. Once again we have Kare and Steve to thank for their generous hospitality. After a brief chat with the doctor Chris was given the all clear to leave. Understandably, VSO require a letter of confirmation and we were a bit disconcerted to learn that at St George’s they send their dictation to India to be transcribed and it returns three weeks later. Fortunately Chris managed to persuade the doctor to hand write a letter there and then. Our priority was then to contact VSO and see when the next available flight would be. We were prepared for anything - my experience in Kampala a month ago has taught me to always travel with a toothbrush, change of underwear and passport as you never know which continent you are going to be whisked off to at a moment’s notice. It seems that the next batch of VSOers will be travelling out to Uganda on the 22nd February and seats are available for us on the same flight. One of the new recruits is a district nurse who will be working along side Chris in Masindi. We have had telephone and e-mail contact with Pam and we’re looking forward to meeting her. Waiting until next Friday to fly out has meant we’ve been able to spend a bit more time with family and friends, although they’re getting tired of saying ‘goodbye’! We really hope that this time we’ll stay put for some time. We haven’t spent more than four consecutive weeks in our house in Masindi. The other advantage of being in the UK is being able to satisfy our desire for comfort food and try and replace some of the two stone lost by Chris. Whilst at Hannah’s house in Sheffield we thought we’d help Chris with his newly acquired phobia of step ladders. For some reason, he can’t even walk within ten feet of a ladder without nervously flinching. Neither Hannah nor I could stop the smoke alarm so Chris had to find considerable nerve and pluck up courage to climb those steps with the two of us tightly clutching the base. Just to complete the therapy session for the day we made him change the light bulbs while he was at it!
We’ve mastered the art of travelling by public transport in the UK; approximately ten train journeys up and down the country and numerous tube and bus rides. I wonder if the concept of buses leaving on time will catch on in Uganda. There the bus will only leave when full of passengers and that can take up to three hours, sometimes never, and then you have to disembark and look for another one! Masindi here we come!!

Back in Berwick

2008-02-04T16:09:00.000Z

Thanks to the wonderful NHS my R arm is now plated and almost working. After arriving at Heathrow we were taken to St Georges,Tooting Casualty department. Two trips to fracture clinic and then it was decided that the fracture needed plating and I was booked on the next available trauma list. Unfortunately this was not until Sunday but at least I was not admitted until the Saturday. Thankfully Kare and Steve live only 10 minutes away from the hosptital and we were very grateful to stay there and be looked after.I admit I am not the most patient patient and it was annoying not to be able to do anything. It is remakable how a broken bone can affect all of you,I certainly felt I was paying for my moment of madness.
Surgery went fine and I was out the next day the arm is painful and stiff but it is improving every day. We have returned to Berwick for rest and recuperation. I have an out patients appointment on 14th Feb and hope to fly back to Uganda soon after.
It is sobering to think what would have happened without VSO and insurance.For most Ugandans the treatment would have been painkillers and wait and see. The best result would have been a stiff useless right arm. This would mean no chance of earning a living with no safety net of sick pay.We heard the other day of a bad bus crash in Masindi and 15 people were admitted to hospital. One needed transfer to Kampala in a coma, others had fractures.Hopefully they will recover. It makes you think about the differences between the two countries so we made a list of good things in Berwick and Masindi.

BERWICK

NHS
Family & friends
Transport
Haddock, chips & mushy peas
Comfort food
Sea
Changing weather
Broadband
Radio 4
No leaking gutters!

MASINDI

Sunshine
Friends & colleagues
Work
Birdlife
Slower pace of life
Swahili lessons
Shopping on the market
Smiley kids

Perils of a left-handed pee!

2008-01-23T18:06:00.000Z

VSO promises you a new experience. One I had not planned for is a left-handed pee. We’d had a pretty straightforward week and were wondering what to put on the blog. Maggie went off with Sallie to Kampala to shop for the hotel and I was planning a quiet weekend at home. I’d finished off a report on the chronic care clinic whilst sitting on the patio watching the birds. I then made a stupid error. I decided to try and fix the gutter which had been leaking. It’s fairly easy climbing up a ladder but it’s so much quicker falling down! I landed on my back on the concrete with my right arm underneath me. Luckily I did not hit my head. Once I had collected my thoughts I realised my shoulder was ‘spoilt’. I thought I’d dislocated it and tried to remember how to relocate it. Unfortunately this was extremely painful and I started to feel 'a little unwell'. As I was on my own, I was concerned I was going to pass out but managed to phone Olav, a fellow volunteer, to get him to come round. By the time Olav arrived I realised that I needed an x-ray. This isn’t a simple procedure in Masindi. I knew that the hospital didn’t have any x-ray films so we phoned the Supreme Clinic. Their x-ray machine was ‘spoilt’ but Daniel, the Clinical Officer, said to go down and he would look. Luckily Wilson, the radiographer from Masindi Hospital, was at the clinic. He said he would take a film from the Supreme to the hospital and x-ray me there. Wilson had had a stroke several months ago and had a left-hand hemiplegia. While I struggled to get into the front of Olav’s car with a very painful right arm, Wilson struggled to get into the back of the car with a hemiplegia. The x-ray was duly taken and showed a very nice fracture of the surgical neck of the humerus. By the time I arrived at the hospital, Rose the cleaner, Solomon the askari, plus Daryl, had all arrived to see how I was doing. I don’t know much about bones but I realised this fracture would need surgery and I would have to go to Kampala. I plucked up courage to phone Maggie and admit my stupidity and a taxi was arranged to take me to meet her in Kampala. The four hour trip with an unstable fracture is another experience that I hope never to repeat. Thanks to the VSO medical insurance I went straight to A & E at the International Hospital. After a quick assessment, Doctor Victor decided to put a back-slab on to stabilise the fracture and to admit me. He also gave me a shot of pethidine for which I was most grateful. Sunday morning I was seen by the orthopaedic consultant who said that the fracture needed to be plated. Unfortunately the special plate is not available in Uganda so he recommended re-patriation to the UK. Somehow the insurance company managed to get us a flight to Heathrow at 9.45 the following morning (flashing lights and sirens in the ambulance to Entebbe and then Business Class no less!). From Heathrow we were transferred to St George’s Hospital and now it is a matter of waiting until they can perform the operation. We don’t know when we will be able to return to Uganda.
Meanwhile, Chris is learning to do things left-handed; peeing is possible but cleaning teeth is a real challenge!

All quiet in Masindi

2008-01-13T10:11:00.000Z

This has been a quiet week in Masindi, no floods or burglaries so what is there to write about apart from the tragic loss of a family heirloom. Unfortunately the kids will not have the pleasure of fighting over Maggies favourite cooking knife she has treasured for 30 years after our demise. The sturdy knife was no match for a green coconut and Daryl. Daryl a volunteer from the Philipines offered to show Maggie how to open a coconut. She not only failed to open the nut but snapped the blade.
Coconuts do not grow in Uganda for some reason but Maggie had asked some one selling vegetables for a coconut 6 weeks ago. He arrived this week with a lovely bunch of coconuts he had brought from Tanzania. He was a bit disappointed when Maggie only wanted one but the others all turned up on the market so he had good business. You have to be careful what you say here as people are so keen for sales they will sometimes go to extraordinary lengths to get you something. Strangely, on the market, stall holders often refuse to sell you poor quality items but take you to a competitors stall that has better ones. Presumably they feel that in the long term you are likely to go back if they show concern.
This week we had the monthly meeting of the Chronic Care team. This is supposed to happen every month but is often cancelled and poorly attended. I suggested we put review of allowances as an agenda item to encourage attendance. This worked but a meeting scheduled for 10.00 did not start until 11.00.All meetings start with a prayer then there has to be laborious reading of the last minutes which have been written in great detail. The real business does not start for a good half hour. We did have some useful discussion. I had persuaded Maggie to make a banana cake as people here had never heard of one in spite of the fact they are surrounded by bananas and eat matoke most days. The cake was cut with due ceremony complete with photos! Every one seemed to like the cake and a short speech of gratitude was made. Cake has been ordered for the next meeting.
On Friday we made a rare trip out to see a patient with HIV who had not been seen for 9 months. He had had a stroke and could not get in to the clinic. His treatment supporter regularly collects his medication. He lives about 12 km from Masindi right in the bush. We travelled by special hire taxi. As we did not know exactly where he lived we had to ask a couple of people, the last of whom turned out to be his sister. We arrived at this hut and were invited in to meet the patient. He was lying in a small room on a single bed. He could not see out of the window and obviously very rarely leaves the bed. I was greatly surprised when he greeted me in perfect English. He evidently used to be a lecturer in agriculture at the local college. He had had a devastating stoke and was obviously trapped in the hut. He was remarkably cheerful but I could not imagine how he passed the time. He had no books, no radio and seemed only to have his aged sister for company. Unfortunately his blood pressure was very high and he is a candidate for another stroke. We started him on treatment but he will obviously need monitoring .On the way back to Masindi we called at the local health centre and asked that they check his blood pressure and keep us informed. I will be pleasantly surprised if that happens but it is what should happen and one of the reasons I am here to improve primary care.

Mince pies in Masindi

2008-01-06T09:42:00.000Z

HAPPY NEW YEAR!
New Year’s Eve, like Christmas, was very low key. We managed to watch a few episodes of Green Wing on DVD before falling asleep! We were determined to make the most of Chris’ day off on New Year’s Day and hired a car plus driver. On a previous trip we’d spotted a church on a very remote hillside about 10 miles from Masindi. This turned out to be a catholic church built by Polish refugees in 1945. By coincidence, as a result of VSO using Chris’ profile for fund raising purposes in the UK, we received a very moving letter from an elderly lady who had been one of those refugees. She had been one of many Polish families sent to the Russian Syberia in 1940 soon after Stalin’s Army crossed the Polish border. She spent 20 months there in a labour camp surviving starvation and very cold weather, though many did not. Eventually Stalin agreed to release prisoners from camps and jails to form the Polish Army. Her father and husband were fighting with the British Army; their families were sent to safe camps in various parts of the British colonies, one of them being Masindi. Her letter describes the five years of life in the camp at Masindi as being very simple but happy times.
As well as the church, they had built their own houses of quite a unique style amongst the trees and also a school and hospital. On her request we took lots of photos to send to her.

On our visit we were fortunate to arrive when there was a service in full swing. We were made very welcome. It is one of the few churches around which still uses the traditional instruments for music for the services unlike Masindi where they use electronic equipment and microphones at 5 a.m.!
The afternoon was spent having a lazy swim and food at the Kinyara Sugar Factory social club.

As we are feeling more settled I am beginning to enjoy the surroundings and have even surprised myself at becoming a bit of a twitcher! We have a beautiful view from the house across to the hills. We now have some wicker to sit on the terrace and watch the subtle changes of the countryside. Very early in the morning (yes, even I have been known to witness it on the odd occasion!) there is a beautiful sunrise with mist down in the bottom of the valley. It is always sunny though sometimes hazy. At times it is very clear but, whenever I look, I see something new. The bird life just in the garden is amazing. It’s quite hard trying to do the washing up with binoculars and bird book in one hand! I get quite excited when I see a bird for the first time and even more excited when I can actually identify it. Just the other morning I spotted a Northern Black Flycatcher, an African Blue Flycatcher, a Village Indigobird, several Speckled Mousebirds, a ‘Greenish’ Yellow White-eye, a Pin-tailed Whydah, several Red-cheeked Cordon Bleu and a Fork Tailed Drongo! I am not disheartened by the fact that, according to the book, they are all very common here!

The highlight of the week was a parcel arriving from Sheila in Duns containing delicious homemade mince pies. They were slightly battered but that didn’t detract from their deliciousness! So, thank you again. The internet has been abysmal for three weeks over the Christmas/New Year period. We are just beginning to catch up on e-mails but want to wish you all a very happy and healthy 2008. Don’t forget, the spare room is now up and running! We thought we’d got rid of the bats with the flood. They’re back, but don’t let that put you off!

Maggie

Happy New Year

2008-01-01T16:09:00.000Z

It has been 4 weeks since we managed to post a blog. Today the internet is working but not reliably so a short piece to say we are well and looking forward to 2008. Today is a public holiday so we hired a taxi and went off in search of the Polish Church. This is a Catholic Church built in 1945 by women and children from Poland who had been released from Stalins camps by the British and sent to safety in Uganda. It is a remarkable story and a really beautiful church in the bush. It is well used and there was a service there today complete with a choir and traditional instruments.

MERRY CHRISTMAS ( BETTER LATE THAN NEVER)
We have just returned from a two week break in the UK. It was great to see family and catch up with all the news. England was cold and Christmas was on everyone’s mind. It had been hard to think of Christmas in Masindi where it is so hot and dusty. I am afraid that we have sent few cards and bought fewer presents this year but we will be thinking of everyone on Christmas day. It looks like we will be having turkey courtesy of Sallie at the hotel. Maggie managed to bring some Brussel sprouts and a Christmas pudding back. I am not sure what they will taste like in the heat but we will enjoy and remember everyone back in the UK, especially our children and grandchildren who seem to be well organised for the festivities. Maggie did have to make Daniels favourite parsnip roulade for his Christmas dinner to leave in Hannah’s freezer but everything else they seem to have sorted.
The blog has been neglected for the last few weeks but lots of people in the UK said they
enjoyed our ramblings so we will try and keep it up to date.
We were in Kampala the last week of November for more VSO training. It was good to meet up with our fellow volunteers and share experiences. We felt lucky to have found such good accommodation and friends in Masindi. Most people were finding work challenging but were keen to continue. Half way through the training we heard that our house in Masindi was flooded. As Soloman, our night askari, put it “there is too much water in your house”. We had made sure the house was secure before we left and foolishly had not left a key. Luckily Masindi connections worked again and we were able to send a key back so someone could gain access. We thought that was sorted but the next day we still had ‘too much water’. Our efforts to make the place secure meant that we had locked all the internal doors and the key for the inner door was not where I thought I had put it. No worries, someone decided to switch off the supply from the water tank outside as that should stop the flow. Next day there was still ‘too much water’ so the water board was contacted but unfortunately no stop cock had been fitted when the water meter was fitted.
We arrived late Sunday night to find water flowing out of the door. I managed to gain access and climbed in to the loft to find the cold tank had fallen and the mains pipe was happily pouring water in to the loft. This was flowing out of a hole in the ceiling and we had our very own waterfall into the hall by our bedroom. There was six inches of water in the bedrooms so we had to abandon the place and stay at Court View. The next day a water board plumber managed to stop the leak and by pass the pipe. Once the leak was fixed all we had to do was brush the water out of the door and throw the mats out to dry. The advantage of concrete floors and no carpets is everything dries quickly. Luckily the ceiling did not crash down so we were able to move back in after 3 days. We then had to pack for our return to England for mum’s funeral and Ben and Faye’s wedding.
We are now back in the house after having spent only 3 nights here in the last month and are looking forward to welcoming our first guests next week. The spare bed will arrive once we have found a pick-up to deliver it. We have the slight panic ‘will it fit up the stairs?’ but there is no point in worrying; some how things always seem to sort themselves out in Uganda.

The internet has been impossible over Christmas but we hope to post this today Sunday. Christmas has passed with Maggie finally cooking the turkey on Boxing Day. We had four guests and all enjoyed a traditional English Christmas meal complete with bread sauce and sprouts. Simba, our guest from Zanzibar, managed to eat the regulation one sprout but it is an acquired taste so he did not ask for more! As usual we were left with large amounts of turkey but managed to have more guests last night for a turkey curry followed by Papaya Sherbet. Maggie is getting a well earned reputation as a cook in Masindi and as she has one of the few ovens every one is expecting great things for 2008. She has managed to make bread and this is the first decent bread we have had in Uganda as Ugandans like sweet bread.
We have also hosted our first guests this week. Dan and Grania came from Kampala and stayed the night. Luckily we had managed to track down a pick up and transport the bed from the carpenters. It took 4 men to lift it off the pick up and it then had to be taken to pieces to fit in to the room. But all was well in time for the arrival. Maggie finished the curtains and they were fitted just in time. The spare room is now complete for any one who wants to visit. .

We will atempt a better blog next week when hopefully we can send some pictures

Sad Week

2007-12-01T17:53:00.000Z

Unfortunately this week Chris's mum became ill and died in St Georges Hospital London. This was difficult and made us realise how far we are from family and friends. We have arranged to return to the UK for the funeral and to be with the family.
Mum was a wonderful person and an inspiration .She never really understood why we came to Uganda but always supported us. She valued life and was always conscious of the good life she had with dad. At 86 she was an age that very few Ugandans will ever reach. Death at a young age is a common occurrence. Eighty percent of the deaths are from preventable diseases and that is why we are here. Somehow we have to make a difference so that Ugandans can look forward to old age as we do in the developed world.
We have been in Kampala this week as part of VSO training. It has been a great opportunity to meet up with fellow volunteers and share stories and frustrations. We are all finding difficulties in our placements but we have learned from others that there are ways forward and hopefully we can use these ideas in Masindi.

Safari salaama

2007-11-18T14:19:00.000Z

While Maggie was in Kampala I took the opportunity to visit the Family Spirit Centre. I had met the founder Isaac at the clinic and he had told me of the work he had been doing. He looks after over 20 orphans and vulnerable children from the age of 3 to 15. He has been doing this for several years and seems to have financed this on his own. As the venture grew he decided to open a school to give the children an education. He now has a school for 50 children and attracts some from the local village. These children pay a small fee which he uses to subsidize the orphans. He has some paid and some volunteer teachers.
I was impressed by the centre. The children all seemed well nourished and lively. I was given an impromptu concert of songs and nursery rhymes after a prayer led by a 4 year old! The children all seemed to have a good relationship with Isaac and many called him daddy. For a lot of the children he was the only father they could remember. There were 4 children who had arrived this week. The oldest girl was about eight and she was looking after the 3 younger children. They had been abandoned by their family and were sad and lonely among the other children. This process of vulnerable children being left is happening all over Uganda. The childrens’ families are destroyed by war, poverty or illness. It is left to people like Isaac and the staff of the centre to pick up the pieces and help these children.

As Chris says, I had yet another trip to Kampala. So far I’ve always managed to get a lift with Sallie; we stay over for two nights as she has business to attend to. This gives me a great opportunity to shop and stock up on supplies but, believe me, it is far from pleasurable! I’ve been persuaded to buy an oven and as I’ll be the only volunteer here with one I can see I’m going to have lots of orders for cakes and puddings (they’re non-existent in Masindi unless you count drinking yogurt in a bag). We return from Kampala feeling incredibly hot, sticky, dirty and tired. On a good day the trip only takes three and a half hours. Unfortunately yesterday was not a good day! We were already running late and didn’t leave until 4.30. As we pulled out of the car park onto the road, I looked out of the window and noticed that the front passenger side wheel was suspended in mid-air over a ditch. Sallie couldn’t move in either direction. Luckily help came and a few men ‘lifted’ the Land Cruiser back away from the ditch. On the way home we got a puncture. We were in the middle of nowhere, and the only traffic was the occasional lorry or bus pelting past at full speed. It was dark, very dark, as only Africa can be but a lady appeared from out of the bush with a lantern. We tried to find appropriate tools which meant emptying the boot - I wasn’t very popular with all my shopping! We failed miserably to change the tyre. The phone signal was intermittent but luckily we eventually managed to get hold of someone to send a mechanic. We then got a call to say that someone had seen the Masindi bus leaving Kampala after us and they would phone the conductor and tell him to look for us and help. So much for travelling safely in day time! The crowded Masindi bus arrived and came to the rescue. The car we were driving happened to belong to the owner of the bus. Networking here is great. In fact, everything relies on it.
Kampala is crazy at the moment. CHOGM (Commonwealth Heads of Government Meeting) is being hosted there this week and for months it is all everyone has talked about. An obscene amount of money has been spent to ‘beautify’ the City. The infrastructure is nowhere near ready and everywhere you go there are construction workers working around the clock. Some of the repairs on roads that will take our Queen from the airport have already been washed away with the heavy rains. It is easy to see which route the VIPs will take. A huge amount of money has been diverted from other essential areas just for these three days. A school and teacher training college in the centre of the City was bought (allegedly for 10 dollars!) by a Saudi prince so that he could demolish them and build a hotel for CHOGM. After demolition he changed his mind. Many hotels have sprung up (with worrying speed) specifically for this occasion but apparently some countries are not happy with standards and are even planning for their VIPs to stay in Nairobi and fly them into Entebbe everyday.
It is an everyday occurrence to hear of many injustices and nothing seems to shock anymore. It’s also easy to become cynical living here.
Perhaps I should go for my Sunday swim and relax a bit!

Chocolate heaven

2007-11-11T07:47:00.000Z

The most important news this week is that a lone bar of Galaxy chocolate arrived at our Post Box much to Maggies delight. We have had a post box for the last 4 weeks but this is our first delivery. It arrived safely if a little misshapen after only 1 week. Thanks to Kare for her trust in Ugandan Post. We have a post box but so far do not have a key for it. Maggie goes every week to ask for the key to be told 'the man' has not made it yet so come back next week

Last weekend we had a visitor, Dada from the Philipines one of the VSO volunteers working in Kampala came to Masindi as part of her work on environmental issues. She and Daryll, another volunteer, cooked a wonderful Filipino chicken dish and we all watched Motor Cycle Diaries round the laptop. Who says you cant have fun in Masindi? This was the first time we had bought chicken here. You have two choices: buy a live chicken from the market or off the back of a bicycle, kill it, pluck it and then cook it, or go to the Shell garage and see if there is any frozen chicken in their freezer. At least Shell have a generator so you hope the freezer has not defrosted too many times. We opted for frozen.

Maggie has been busy at Court View Hotel. Sallie, who owns the hotel, has been in the UK and she asked Maggie to keep an eye on the place especially the kitchens. The first food hygiene courses were held this week and well received. One of the biggest challenges is to get the rats out of the kitchens. Another challenge this week was that Masindi had run out of gas for a few days so everything had to be cooked on charcoal. (notice we have adopted VSO's way of saying 'challenges' rather than 'problems'!) We are thinking of asking Gordon Ramsay to visit and advise. It would make a good TV programme. Court View is probably one of the best kitchens in Masindi but it is not quite to UK standards! Maggie is quite enjoying working with the staff who seem pleased that someone is taking an interest in their work. It is off putting eating there after Maggies description of what happens behind the doors but the food tastes good and we haven’t caught anything yet.

The HIV clinic is the main focus of my work. We see about 50 patients on Tuesdays and Thursdays. This week we have had 3 visits from the ministry of health . They are continually checking on what we are doing and looking at the documentation. Unfortunately this usually means stopping the clinic and keeping patients waiting for a couple of hours. Ugandan patients seem willing to accept long waits. We have supplies of ARVs but most other drugs are not available so it can be very frustrating trying to deal with patients' problems. This week I have needed to admit 2 patients from the clinic; one was dehydrated with dysentery and another had pneumonia and oesophageal candidiasis. Luckily we were able to access drugs to treat them. There are lots of patients with dual infection with TB and HIV. One of my tasks is to better coordinate their treatment as they can easily default from treatment which is a risk for the patient and the community. Another young patient at the clinic has cervical cancer as well as HIV. She was referred several months ago to the cancer specialist but as it is in Hoima 2 hours away she has not gone. She has no money for the fare and no prospect of being able to afford to stay in the hospital for treatment. Treatment is free in Uganda but you need to supply your own food and have an attendant to cook it and look after you. This young womans family can not support her so she will almost certainly die from her cancer if she does not succumb to the HIV. Another young woman with HIV on the ward has developed a stroke probably due to infection with toxoplasmosis. The treatment for that is not available so she has been taken home by her family to die.
The reality in Uganda is that many people are dying and it appears to be accepted. Patients are not demanding better treatment. There is a fatalism and people just say “this is Africa”. There is a lot of faith and that gives people the courage to carry on but sometimes it appears that it also prevents them from looking for solutions.

These are pictures I took in the HIV clinic - you can see how cramped it is. This was a quiet time. The guy in the fetching yellow outfit is a prisoner; we see lots of prisoners each clinic. The prevalence of HIV must be very high there. The man squatting has Stage 3 HIV and had dysentery. He looked alot better 2 days later after some antibiotics and fluid. His long term survival is unlikely I am afraid.

I also managed a trip in to the field to see some health centres. These clinics should provide most of the primary care but are sadly neglected. Staff are poorly motivated and often absent themselves from the job. The worst clinic we came across was anHC III which provided obstetric care. the delivery room had a foul smell which we traced to a dead bat in the corner. So much for infection control!

These pictures show patients at a health clinic plus the pile of used drugs and needles left on the windowsill.

Pictures of the market the clinic and health centres seem to go where they want and the captions go somewhere else. It is hard work being a blog virgin this posting has taken over an hour so hope you enjoy it.

It is Sunday morning and we have just had a walk round town but it is very hot. Morning coffee beckons and we have just had an invite for afternoon tea. It is tough in Masindi!

Better late than never!

2007-11-02T12:52:00.000Z

It’s taken Maggie a month to brave a ride on a boda boda. These come in two varieties: a motorbike and a pushbike. As the road from town to our house is up hill, she decided not to inflict herself on the cyclist and opted for the motorbike. VSO actually advises against using these but when it’s scorching hot and you’re carrying big bunches of bananas, pineapples, bottles of water, etc. etc. it’s easy to give in. (She hasn’t yet mastered the technique of carrying everything on her head!). The other problem is returning after dark (7pm). It’s unwise to walk but, if you want any sort of a social life, a boda boda is the answer. Bear in mind these roads are just dirt tracks, full of craters and potholes and treacherous when wet, but exhilarating all the same on the back of a boda boda!
It’s worrying how excited we get when the power comes back on. There’s a mad scramble to rush round the house charging phones, laptops, cameras, putting the water heater on and even washing and blow-drying hair (Maggie that is, Chris doesn’t bother!). The latter is a bit risky as sometimes it’s off again before finishing.
The other highlight of the week has been the arrival of a Rocco Set (3 piece suite), dining chairs and shelves. (We have such an exciting time!) We actually managed our first bit of entertaining of the other VSOers though catering was a bit limited with a two ring burner. We’re finally getting our house staff together. We’ve already got Solomon who patrols the grounds at night looking very fearsome with his bow and arrow. He doesn’t like using his torch as he doesn’t want anyone to know he’s there and decrease his chances of using his weapons! Some other volunteers are leaving Masindi this week so we’ve taken on Rose, their house girl (not exactly a girl as she has five children), and Sam their gardener. Rose and children will live in the quarters in the garden but Sam will live out and come three times a week. Last night we went to the departing volunteer’s leaving party which was quite an experience. It was modeled on an English wedding with a top table. The outgoing volunteer and incoming volunteer cut the cake together whilst being sprayed with some sort of sparkly dust and the speeches were interspersed with outbreaks of Celine Dion.
In desperation of not wanting to just eat tomatoes, onions and aubergines forever more, Maggie plucked up courage to buy fresh Talapia from the market (caught in nearby Lake Albert). It’s a bit off-putting when it’s exposed to the sun and swarming in flies but it’s very fresh and not a problem if cooked straight away. The meat will have to wait a bit! This is a picture of Christine’s shop which is literally at the end of our garden(oh no it isnt we can not upload it for some reason). It doesn’t have the choice of Sainsbury’s but we can buy fresh eggs from the chickens which have had free range of our garden!
For anyone who thinks we’re getting on a bit to learn a new language, they’re absolutely right! It’s fair to say we never have been natural linguists. We’re struggling with our weekly Swahili lessons but struggling even more with the fact that only some of the population speak it and the rest speak the local tribal language of Runyoro. By the time you’ve established who speaks what, a conversation has already been struck up in English!
Chris finally managed a trip into the district. It’s supposed to be a weekly event but has only been achieved once. Even then, it was touch and go whether he would make it but a vehicle finally turned up two hours late to take him. The HIV clinic is extremely busy and will take some time to organize. The first priority is to sort out management of pregnant patients. It appears they they are not getting preventative treatment which is a tragedy when you can prevent children being born with HIV.
Maggie is still spending a bit of time each day trying to improve the catering and service at the hotel. She’s running food hygiene sessions but has had to go right back to basics. It’s certainly a challenge but hopefully only a short term one. We’re slowly finding out about projects in the area where there might be a possibility of helping.
Generally, life is okay here. The weather is very hot (due to get hotter!) and there are storms most days, though these are short lived. The scenery is beautiful and it’s very easy to ignore it when all around you is such poverty. We haven’t encountered any nasty creepy crawlies yet! The house is starting to look more like a home and we met our immediate neighbours recently. One is the gentleman who lives in the hut at the water tower with I don’t know how many children and he tends the compound. Next door is a carpenter, so we know where our next order of furniture is coming from! The locals are all very friendly; the small children address us very politely in English and then fall about in fits of giggles when we reply.

We are having difficulty loading our pictures but we will keep trying

The first 4 weeks

2007-10-21T08:12:00.000+01:00

We have now been in Uganda for 4 weeks and are beginning to realise we are not on holiday. It has been a major culture shock adapting to the Ugandan way. The heat and the incredible rain showers no longer phase us.We justsweat and paddle about in the mud like every one else. Travel is a major issue in masindi. Our house is 15 minutes walk from the centre of town which is ok during the day but a challenge we have been advised not to take at night. So far we have been lucky and been able to beg lifts if we are iut at night.

Maggie has been to Kampala twice this month for shopping trips. No surprise there but in reality if you need anything other than basics you have to go to Kampala. This is a day each way. As the house is completely unfurnished she has needed to buy a fridge and washing machine as well as material and "luxuries". The process of purchasing is relatively simple but how do you then get the goods back to Kampala. Those in the know arrange a pick up or if necessary arrange to put it on a lorry or bus bound for Masindi. It some how arrives intact a few days later. We have been greatly helped in all this by Sally and her staff who seem used to helping out naive muzungus.
We have finally moved in to our house this week.We do not have a postal addresswe just tell everyone we live on Kuzungu hill, (the white mans hill) opposite the resevoir.We are having furniture made locally a 3 piece suite for 200,000 ush about £60. Reasonable for solid oak furniture.
Being house owners we have had to employ an Ascari or night watchman. Soloman comes at 7.00 pm and stays patrolling our compound throughout the night to disuade intruders.We have had to supply him with a torch, flask,coat and gum boots. these had to be brought from Kampala but the boots arrived as a pair of left boots!.It is just one of those frustrations you can not nip back to change them.Various people keep arriving to offer their services as domestic staff. Unemployment is high and people are desperate for work.There is no real system and it is difficult to recruit staff who will be happy to work and reliable.There is a big element of hope it all works out.
The house already has some uninvited lodgers. There are lots of geckoes which are fun to watch but maggie refuses to share the shower with. There are bats and unfortunately some lve above the bedroom and leave there deposits on our bedroom floor!We have lots of birds in the garden and inthe early mornings you can hear the monkeys on the roof and in the trees.Early mornings are a reality here.People start moving around about 5.00 am. We are regularly woken by the mosque and singing and chanting from the local church.
Our social life revolves around other volunteers at the moment. Sunday has been a swimming trip, Monday is Swahili lessons,Friday is food and a drink at Murchisons bar in Masindi.
Maggie has been advising in the kitchens at Court View hotel, she is realising that food preparaqtion in Uganda is a little different from the UK. She has also visited a local seamstress training school run by Felicitas the wife of a local American missionary.Gradually Maggie is finding a role but sensibly not rushing in to anything yet.
I have managed one trip with the community team to visit a local school.Masindi public school is one of the primary schools in Masindi. Over 1000 pupils, classes oversubscribed with one class of 117.The head struggles to provide a service to the pupils with very little resource. The main issue he identified was no water on site,the tap has been vandalised and the kids are all hungry. Many of the children arrive not haviing eaten and will have nothing for lunch. It is a surprise if the manage to learn at all.

mutterings from Masindi

2007-10-07T12:08:00.000+01:00

Things never go quite as planned in Uganda! Our lift could not take all our luggage so we had to leave several bags behind in Kampala. We were supposed to leave early afternoon but did not get out of Kampala until after 6. This meant we broke rule no. 27 in the VSO handbook which says you should not travel after dark. Luckily Suliman the was an experienced driver and got us to Masindi safely at 10.30 despite the state of the roads and the lorries with no lights. Apparently many Ugandan lorries travel with no battery. Once they have been started the driver takes the battery out in case it is stolen! There is a belief that driving with lights slows the vehicle down. The Ugandan highway code seems to be 'size matters' - the biggest vehicle has right of way. As our house isn't yet ready we had arranged to stay at Court View Hotel. Unfortunately, as we arrived late they had let the room but luckily the wonderful Sallie found us another hotel (we were serenaded all night by a frog under the bed - not the the wide-mouthed one!). We returned to Court View the next day and still remain. (Maggie is enjoying the hospitality, especially the red wine!). We have had several dates for moving into the house. Today we have been told it will be ready by Wednesday. Good news is that Maggie returned to Kampala and has bought a fridge. As we speak, our bed and table are being made locally (though with all the power cuts, who knows when they'll be ready). Power seems to be off more than it is on so we've stocked up with candles.
We're slowly adapting to the pace of life and keep being told to stop trying to get to the end of the race before it's started. Why is it that driving is the only thing that happens quickly in Uganda.
The hospital is incredibly short of resources but very busy. Malaria is the commonest problem. If a patient has had a fever in the last 3 days you presume malaria and treat, if the fever has been for longer you do a blood smear, if it is positive you treat for malaria. If it is negative you do not believe it and you treat for malaria. Unfortunately the hospital pharmacy has run out of adult dose Co-artem the recommended treatment. HIV and TB are common and there is a real shortage of drugs for opportunistic infections. There are no xrays and few reagents for blood tests. This makes diagnosis a real clinical challenge and Chris has a lot to learn from the clinicians here. The remarkable thing is that people seem to survive and it is a sobering thought to learn how resilient the human body is and how great the will to survive.
The social high spot of our week is a trip to Kinyara sugar plantation's swimming pool. A trip denied to most of Masindi but gratefully accepted by the VSOers.
Please keep us abreast of your news. The outside world seems a long way away.

Kampala at last

2007-09-28T13:07:00.000+01:00

We have been in Uganda for 6 days and are just beginning to adjust to the heat and the pace of life. Today was the last day of our course the day we met the employers.Unfortunately the hospital transport was not operational so Richard one of the clinical officers was sent on the bus to meet us.He was able to give me a quick run down on the hospital which sounds a challenging environment. He says they have run out of most drugs which is not unusual and there is no paper for clinical notes. With my hand writing that is probably a blessing. The work sounds really interesting and it looks like I will be working in medical out patients and in the community. It looks like the information about my surgical skills has got out and no one is going to let me near a scalpel.
We are in the VSO offices now waiting for a lift to Masindi for us 6 cases a mattress pots pans and Maggies box of wine.

Chris and Maggie

The final countdown Sept 18th

2007-09-18T11:42:00.000+01:00

We are in our last few days in Berwick!!! Panic is beginning to set in now. What have we let ourselves in for? What should we pack? How shall we manage all these bags?
We have had a good few weeks here and really enjoyed walking around Berwick and the coast. There is so much to see and the weather has been really kind to us. We are going to miss the coast and the for ever changing sea but I am sure there wil be compensations.
We are expecting to arrive in Masindi on Sept 30th. We havent heard about the house but I keep reassuring Maggie that it will all be alright and the accomodation will be all sorted. If the worst happens we can always stay at Court View Hotel for a few days. There have been bad floods on Eastern Uganda but as far as we can tell this has not affected Masindi although the experts say there will be bad rains this year. As the road from Kampala was bad in the summer it could be a real challenge in the rains.
We are really going to miss every one in England but at least the internet will allow us to keep in touch. We hope lots of people find an excuse to come out to see us. Africa is a fascinating continent and Uganda needs tourism. There is a lot to do and see.

Chris and Maggie