Home sweet home

After a rather longer journey home than anticipated I have safely landed, showered, eaten, slept and awoken much refreshed. Time for my last update on this blog, ready to close this chapter in the life of Charlotte, once medical student, soon to be doctor (eek).

After leaving Kiwoko (with more than just one tear being shed – Dr Raul kindly asked if I would like an IV line to rehydrate during the doctor's meeting on my last day - above) I headed into Kampala where I met Mark who accompanied me as far as the Airport Guest House in Entebbe, ready for my flight to Nairobi the next morning. I was so glad of his company, not just for the journey but during my whole time at Kiwoko – it was a lovely way to end my happy 2 months by waving goodbye to him in Entebbe.

I spent the weekend in Nairobi with Kieren (ex-youth leader from P’s and G’s, now working in Nairobi at Cheryl’s Children’s Home). I was so pleased to be able to visit Cheryl’s, which has strong links with P’s and G’s church and which there has been so much fundraising for over the years. The children were lovely and there was a real sense of home about Cheryl’s. There is a primary school on weekdays, which serves the residents of the home and local children. Secondary school aged children from Cheryl’s go to boarding schools in Nairobi during the week, although there are plans to build a secondary school to be run by Cheryl’s itself. On Saturday morning I was put in charge of a jewellery making session, with boxes of beads, wire, elastic and thread to use to make bracelets, necklaces and earrings of a sellable quality. The classroom we were in soon descended into chaos, with beads everywhere! The kids seemed to enjoy themselves, and made some nice things, ranging from definitely sellable to possibly sellable, to ‘interesting’.

Other highlights of the weekend included a visit to the infamous Carnivore restaurant where I ate so much that meat I struggled to sleep because of tummy ache! Dinner feast included pork, lamb, beef, sausages, chicken, turkey (see pic for ‘serving suggestion’), ostrich meatballs (v. tasty), roast crocodile (tastes fishy but not in a very good way) and camel (delicious, like roast lamb).

We also paid a visit to the giraffe sanctuary where the giraffes eat from your hand (and mouth if you let them…I opted out of this one after a giraffe sneezed all over me).

I left Kieren’s at 5am on Monday morning (after he stopped me from being ripped off by the taxi driver) and headed for the airport. After a relatively smooth journey from Nairobi (only delayed by an hour because a couple of the flight crew were ‘stuck in traffic’ – easily imaginable given the ‘interesting’ Kenyan driving, in which red lights are more of a guideline than strict rule) my connection to Edinburgh from Amsterdam was cancelled due to some ash spewing from a now rather famous Icelandic volcano. I met a lovely Yorkshire lady on the flight, a grandma of 5, we made friends, exchanged Africa stories and ended up both going to stay with my Dutch friend near Amsterdam for the night. (See pic below of us excited to be on the top floor of a double decker train). She was well cool for a grandma, at one point we were both running along a platform at the train station, her clutching a bottle of wine (as a present for my friend, she’s not an alcoholic grandma!) - I told her she was way too young to be a grandma! She managed to get on an early flight home, leaving me in charge of her luxury lounge pass where I happily installed myself in a very comfy armchair with a never ending supply of tea, juice, beer on tap (which I didn’t sample), cake, biscuits, internet…aaah bliss.

I arrived safely home on Tuesday afternoon, after being upgraded to business class and enjoying complimentary food and drink, giggling like schoolgirls with the two (very) Scottish ladies next to me. By some miracle my rucksack was actually waiting for me in Edinburgh airport, and (by less of a miracle since they’d been waiting for 24 hours already!) so were my parents.

So now it’s time for me to knuckle down to serious revision, first exam is a week on Wednesday. I hope I’ll see lots of you over the summer, thanks for your messages of encouragement over the past couple of months; I look forward to catching up with you in person.

Welaba Kiwoko!

This is the last update I will write from Uganda, as I leave Kiwoko tomorrow, heading to Nairobi for a couple of days to visit Kieren from P’s and G’s, arriving back in the UK on Monday evening all being well. I am a little worried about the ominous ash clouds that still seem to be causing a bit of disruption in air space and would appreciate your prayers for a safe and speedy homeward journey.

I spent last week with Dr Peter on surgery again, although with less theatre time this week – instead I took to covering the ward while he was operating, clerking new patients and reviewing others, and getting some studying done if it was quiet. I really like the continuity of care here – patients being looked after by one doctor for the majority of the time, occasionally being seen by the on-call doctor if new issues arise - by the end of the week I knew all of the patients on the ward, what operation they had already had or were waiting for, what their current issues were and when they were likely to be discharged. When coming to write discharge summaries it is so much easier to actually know the patient, rather than trawling through pages of notes to work out what has happened while they’ve been in hospital. Plus it means that ward rounds are actually interesting because I want to know how the patients are recovering/responding to treatment and it’s so encouraging to see them improve and be discharged back to health.

A couple of patients spring to mind from this week. One guy in his 30s sent to the ward from outpatients with a ‘7 year history of scrotal swelling’. Scrotal swelling was an understatement – he had a hernia the size of a basketball which was now affecting his work as a cattle herder because it was so heavy. The previous evening I’d been practicing my slick finals-style hernia exam on the long suffering Dr Carolyn who had obligingly agreed to perch a banana and two oranges in the correct anatomical position for such an exam. I was pleased to have an opportunity to practice on a real patient (not pleased for him, of course, I pitied his 7 years of giant herniation) and to have my diagnosis of massive right inguinoscrotal hernia confirmed by Dr Peter when he reduced it in theatre the next day. The patient was pleased to be relieved of his swelling and was discharged a couple of days later, fit and well.

On Sunday afternoon Carolyn and I went on a little revision-break visit to the hospital farm which supplies milk to staff and patients. We took a bodaboda from outside the hospital which, after much skirt rearrangement to cover up our exposed ‘genitals’ (knees), was actually reasonably enjoyable compared to bodas in Kampala. After navigating our way around the potholes and even doing a little off-roading to avoid a cow we arrived bang on milking time. We were given our own cow and bucket and proceeded to milk it with surprising success - we reckon we got about 2 1/2 litres out of her (admittedly in the time it took the milkmen to fill several buckets) and were very pleased with ourselves. We had a nice walk back to Kiwoko in the warm afternoon sun and when the milkman arrived this evening we were very pleased to ask for 2 cups please, feeling proud that we'd personally milked this milk with our own bare hands. We set the milk on the stove to boil and settled down to play Settlers of Catan (addictive board game). About half an hour later when an interesting smell started to waft through from the kitchen we suddenly realised we’d completely forgotten about the milk. NOOOOOOOOO! It was absolutely burnt solid, completely dry and blackened in a thick layer onto the bottom of the big pan. The pan was so big it hadn't even boiled over. It then took another half hour of scraping with knives and wire wool to get it clean again. We laughed. A lot. Neither of us have ever worked so hard to not get any milk!

This week I’ve been in outpatients department – the equivalent of a GPs surgery combined with A+E. I was expecting to sit in with one of the clinical officers but when I pitched up on Tuesday morning I was told they were short of staff so I would run my own clinic, and was given a room, a translator and a steady stream of patients with all sorts of weird and wonderful complaints. The Oxford Handbook of Tropical Medicine has come in very handy! There seemed to be a lot of mzungu-fearing children this morning – there’s a familiar look that passes across their faces when they come into the room, see white skin, grab mama’s leg for reassurance and then burst into fervent screams if you dare approach them, no matter how much cooing or distraction is used!

I have thoroughly enjoyed my time here in Uganda; there have been tears, laughter (a lot of that!) and daily challenges. Kiwoko has earned a very special place in my heart – after my gap year in Nepal I thought there couldn’t possibly be a cooler country in the world, but you know what, I think Uganda might just be that place. I have been so lucky with the people I’ve met and the friendships I’ve made. I will be back….! If anyone reading this blog has ever considered taking some time out to go abroad I would highly recommend Uganda as a welcoming, exciting and very beautiful country. I’m looking forward to catching up with you all back in the UK very soon.

God is always in time!

This week has been a very busy one, apologies for not writing an update for a while. I’ve been on female ward which is divided into medical and surgical, although the majority of the patients are on the medical side. I’ve been left in charge of the ward for a good portion of the week, while the doctor overseeing me has either been in theatre, off the ward discussing patients with other doctors or away visiting relatives, occasionally popping in to do a quick ward round or see patients for review. I am rising to the responsibility, something I found terrifying to start with but am now getting used to. I think female ward is my favourite – the nurses are great fun and the ward rounds are usually punctuated with howls of laughter. The ‘in charge’, Sister Grace, is a total legend, a cuddly mother figure who always has a smile on her face and repeatedly tells me ‘EH! Why are you still here? It is past even African lunchtime (2pm – our lunch is ready at 1) – you must be so hungry! This patient can wait, go and eat something!’

There have been some challenging cases on the ward, in particular an elderly woman who came in yesterday morning following a fall at home. She was fairly drowsy, confused and disorientated, and very difficult to take a history from (made even more difficult by me not speaking Luganda), let alone examine. Trying to do a neurological exam through a translator on a drowsy, uncooperative patient is challenging to say the least. We got there in the end – it seems that she has suffered a fairly severe stroke, so we started treatment but I remained guarded about the outcome. Early this morning before chapel (or even breakfast!) I was called by the ward because the patient’s condition had changed. She had slipped into a coma, her BPs had soared and unfortunately despite our attention she died shortly afterwards. Even with fancy tests like CT scans I’m not sure the outcome would be any different. Having said that, in the UK she would have had her blood pressure checked decades ago by a friendly GP and antihypertensives started, potentially preventing the stroke. Only yesterday I was thinking that I hadn’t had a death in a while, and as it happened my morning bible study was about attitudes to death and conquering death, looking at Revelation 20:11-15. In fact I was reading the bible study when Daniel the nursing student came to get me. At least for the patient’s sake she slipped away quickly and painlessly, something that I had prayed would happen if that were to be the outcome.

Last week I joined the community team who run the HIV clinics, the Youth Friendly Centre in Kiwoko town and do community visits for immunisation clinics. The YFC is a drop in centre for young people, where health promotion videos aimed at this age group are shown, games are available and there are clinical officers, counsellors and a small laboratory to run HIV, STI and pregnancy tests. I found it encouraging how clued up the young people were about the importance of getting tested and the implications of contracting HIV. There was even a group of them who had written a song in 3 part harmony about how abstinence is best and that they should be protecting their health! Brilliant!

Despite there being lots of positive work in the community there are still areas of frustration. On one day we went out to a village deep in the bush to run an immunisation clinic for local mothers with young babies. All immunisations are free, and the mothers are given plenty of notice in advance before the clinic. However still only 5 mothers turned up in the 4 hours we were there – apparently there is still doubt in the local people about the effectiveness of immunisation, and many prefer to stick with traditional healers instead. Each baby is weighed using a sling with scales hooked onto a tree branch and the immunisations delivered on a bench under the tree. Details are entered into a book and the mother goes on her way, walking barefoot along the dusty dirt track further into the bush with her baby slung on her back.

Last weekend was my first full weekend in Kiwoko, and for the first time there were just two of us in the Guest House, as we said goodbye to Sian, Carolyn and Abi last Friday. But we have certainly not been lonely - on Saturday we opened our doors to a collection of nursing students, doctors, families and other acquaintances for a party to celebrate Rhea’s birthday. Fuelled by fizzy pop and mandazis (like doughnuts but more stodgy!) we had a lot of fun, particularly playing musical chairs and blind man’s bluff – these went down very well with the nursing students in particular! Getting to know some of the students has been a real highlight of my time here, through nurses fellowship (praise and bible study every Wednesday evening until the electricity goes off), working together on the wards and now even playing party games together!

I was pleased to be able to join Mark for the morning service at Voice of Truth church on Sunday morning. There was much clapping, dancing, arm waving, whooping and disco beats from the keyboard. And apparently this was relatively reserved for an African church service! I was made to stand up and introduce myself into the booming microphone, I’m just glad I wasn’t asked to sing (a tradition in some churches to welcome newcomers!). A handwritten poster on the wall read ‘God is always in time’ which made me chuckle – Ugandan timing is very approximate – for example the service started at 8am so Mark picked us up at what time? 8am! When we arrived around 20 past we were the only ones there, by 8.45 the church had begun to fill and the service started properly. At least by Ugandan standards I am usually early!

An entertaining evening’s activity here in Kiwoko is to go for a bike ride. Last week Sian, Mark and I borrowed some fairly ancient bikes to cycle to the nearby orphanage, New Hope. The journey was…interesting! On the first downhill I realised that the luxury of brakes does not extend to Uganda, at least not on the bike I had been given. I gritted my teeth and hoped for the best as I started to pick up speed along the dusty road, trying to avoid potholes, bodabodas, heavy laden trucks, goats, pedestrians and other cyclists. There was only one slightly hairy moment when a charcoal truck piled high with sacks of coal came thundering along the road, with a matatu coming the other way while I was squeezing my non-existent brakes in a vain attempt to stop and get off the road. In the end I stuck both feet down and eventually shuddered to a standstill, dragging my bike out of the oncoming path of the unforgiving truck, much to the amusement of its passengers who were perched high up on top of the sacks. If I borrow a bike again I will definitely make sure it has functioning brakes! Mukama yebazibwe (praise the Lord) we all made it to New Hope and back in one piece!

Mmm...fish heads. The stench of these is overwhelming. I think it is a sack of these delightful subjects that we once shared a hot matatu with for a several hour journey.

With only a week and a half to go here at Kiwoko I’m trying to make the most of my remaining time here, but having to strike a balance with studying for finals. It’s been great to hear from everyone back home – keep the emails/facebook messages coming. Looking forward to seeing you all again in the not so distant future. Email is brown_chicken@hotmail.com if you hadn’t worked that out already!

Thank you for the work!

‘Jebalico!’ is a very common way to be greeted here at Kiwoko, literally meaning ‘thank you for the work’ or ‘well done’. You can be thanked simply for getting up in the morning, for watching while someone else does the hard work or for making it through the day in one piece. Another common Ugandanism is ‘sorry’ – not an apology from the perpetrator of an inconvenience but an expression of empathy for something you’re going through. For example on noticing the multitudes of mosquito bites around my ankles (which often swell together to give me very attractive ‘cankles’) the nurses will say ‘sorry for the mosquito bites’ or ‘sorry for the sunburn’ or sorry for anything at all. I really quite like it, and I’ve found myself saying it too. I can’t say I’ve picked up the habit of adding ‘what?’ into my sentences though – apparently a lot of schools here teach English by rote, in which the teacher will say something like ‘the table has four legs. The table has what? Four legs.’ This then becomes incorporated into day to day language which can be confusing if you’re not used to it – one of the doctors will say ‘the patient has a what?’ leaving me wondering if I’m meant to answer at all, and if I am then what on earth does the patient have – a hernia? A nasty case of scabies? An unpaid bill? But then I am put out of my misery when the doctor says ‘the patient has a cough’.

The prospect of looming finals has started to become a reality, so last week I wasn’t too disappointed if the maternity unit was quiet as it meant I could nip back to the guest house and bury my head in some revision. I enjoyed getting to know a couple of the nursing students on maternity – one in particular called Mary who is just lovely and made me promise to come back and visit her once I’d moved on to other wards the following week. In fact one of the highlights of the week was joining the nursing students for their worship and bible study session last Wednesday evening, held in the nursing school over the other side of the hospital. The session was on relationships, a topic that the students had requested, so this week we looked at ourselves, what we think of as beauty, our relationship with God and what he sees as beauty. We had some interesting discussions about skirt length, with the students in my group being adamant that to honour God our skirts must be longer than the knee. They found it strange when I told them that back in the UK people wear short skirts all the time, but generally women don’t strip their top halves off quite as readily as they do here!

While on maternity I learnt a new and very important Lugandan word. On my first day as soon as I stepped into the labour suite I heard several midwives shouting ‘sindica! Sindica!’. On asking a nursing students what it meant I was told, ‘it’s obvious – push!’. I heard ‘sindica’ a lot more during the course of the week. Two more sad events this week, two deaths that just wouldn’t have happened in the UK. The first was the unborn baby of a lady with a previous caesarean scar. When she had already begun the second stage of labour she decided to travel to Kiwoko, but when she still had a 1 ½ hour bumpy bus ride to go she felt excruciating abdominal pains in the area of her previous scar. By the time she arrived here she had a rigid abdomen and no foetal heart could be heard. Her uterus had ruptured, the baby had been born into her abdomen and died. An emergency section was carried out which saved her life but unfortunately not the life of her child. In the UK she would have either come into hospital far sooner anyway as part of her birth plan, opted for an elective caesarean or been blue lighted for emergency section, not travelled in a cramped matatu with 20 other people and a few chickens.

Even more upsetting was the 28 year old with a 26 week pregnancy with pre-eclampsia – very high blood pressures and protein in her urine, which progressed to eclampsia – seizures. Again, none of the fancy continuous monitoring of mother or baby that would happen in the UK, little choice of antihypertensives and far fewer neonatal intensive care facilities for premature newborns. It was opted to attempt to control maternal blood pressure, allowing an extra 48 hours for the foetus to develop with the aid of some steroids to help its lungs. Unfortunately less than 12 hours later the foetal heart became undetectable, and at some point during the night the mother began fitting again, went into a coma and died. Not one life lost, but two.

It wasn’t all doom and gloom this week, I did see several successful deliveries, including a caesarean section for twins in which the mother had developed pain in her previous section scar. This time the section was done in time and two healthy baby boys were born, mother and babies are all doing fine.

Last weekend we took a ferry from Entebbe to the Sese Islands on Lake Victoria, a collection of beautiful tropical islands with white sandy beaches that just call out to be swum from. After staying the night in a ramshackle wooden hut with thatched roof in a hippy campsite run by a completely bonkers German couple we experienced the loudest thunderstorm that I have ever seen, complete with overhead forked lightening and torrential rainfall. This temporarily scuppered our plans for a day on the beach, but by midday the rain had stopped and we set out on foot to explore the island. On the advice of the mad German lady (who it seems had been drinking and smoking pot with her husband for the majority of the 14 years they’d been running the campsite) we walked in the boiling hot sun for several miles to find a pineapple farm. The owner, a smiley old man, greeted us like long lost friends and invited us to sit and rest under a tree, pulling up benches for us

After saying that the pineapples were not ripe at the moment (to our great disappointment – the last few miles were walked in the hope that a juicy pineapple was awaiting us), but on seeing our crestfallen faces he asked us to wait and disappeared off somewhere, coming back with 3 juicy, ripe looking pineapples in his arms. He prepared one for us there and then, a beautifully sweet, refreshing, ripe pineapple – just what we needed! We managed to hitch a lift on top of some firewood in the back of a pickup for most of the journey back to the campsite – when we arrived we jumped straight in Lake Victoria (worrying about Bilharzia and crocodiles later…!).

Briefly since I’m aware this is getting a bit lengthy: I’m on community this week, went to the Youth Friendly Centre in Kiwoko this morning for clinic where HIV and syphilis tests are carried out, counselling given and treatment started if necessary (see pic).

I was surprised at the number of younger people coming to get tested – some as young as 12 or 13. I was sat in the hot seat and told to do the consultations, although since I don’t speak Luganda the reality was I asked how the patient was/what they were here for and the translator did the rest of the consultation. On the walk home a girl cycled by and then her chain fell off – I was glad that there was actually something I could do here that wasn’t affected by language barriers! A quick tweak was all that was needed to get her chain back on, she was very grateful – ‘thank you Mzungu!’.

Last piece of news from this week – over the weekend there was a new arrival to Kiwoko Hospital, in the form of Gideon Mugisha Wilson, new born son of Denise and Dr Rory the medical superintendent. The announcement in chapel on Tuesday morning was greeted with lots of whooping!

It is what? It is absolutely chucking it down!

Welcome to a Ugandan winter – 30+ degree heat, mega humidity and almost daily thunderstorms. I have just run around the outside of the guest house shutting the shutters and am now soaked to the skin, time to settle down with a mug of tea and update my blog.

So I’m already into week 4 of elective, time is flying by.

I had a very busy week last week on surgery, and was ready for a rest at the weekend. Surgeons here work hard and patience is a necessity. There is no diathermy here so all bleeding vessels are meticulously tied off one by one – the first operation I scrubbed in for was a total abdominal hysterectomy with many, many bleeding vessels. As you will know I am a bit of a surgery keano and will jump at the chance to scrub in for an op. So the first day I gladly scrubbed up, put on my thick plastic apron, giant welly boots, thick reuseable cotton hat and mask (I approve of the re-use that goes on here!) and visor. About 30 seconds later the sweating started. By the end I had a small pool in each welly and my scrubs needed to be peeled off me! On male surgical ward the vast majority of patients are in with road traffic accident injuries, hernias or assault wounds. For a good few days I wondered why so many patients had sexually transmitted infections, until I finally asked and was told that actually STI stands for soft tissue injury. My mistake!

This week I saw possibly the most gruesome injury I’ve ever seen - a guy who had been assaulted with a banda knife and had his hand pretty much clean cut off. The cut had gone right through the wrist joint, leaving his hand hanging on by a couple of muscles on the thumb side, a bit of gristle and (very luckily for him) his radial artery which was supplying blood to the dangling hand and meant that it didn't have to be amputated. First we stabilised the joint by suturing the torn supporting ligaments back together (when I say ‘we’, I mean Dr Peter the surgeon did all the work, and I held the hand in place! It did get quite tiring on the old arm muscles though, since the hand and forearm had to be held vertically for the best suturing angle), then carefully found every severed tendon on both sides of the wound and paired them up, identifying their function by giving them a tug and watching to see which finger flexed. Apparently we used nearly all the artery forceps in the hospital in the process! After his 7+ hour surgery the outlook is mixed – he is very lucky to still have his hand, but the likelihood of anything near normal functioning is fairly low, and unless there is some serious nerve healing he probably won’t have much feeling in his hand, although hopefully he will have decent motor function, providing he comes back for physio. I was very impressed that Kiwoko was able to offer such intricate and demanding surgery and was again reminded of the demands on surgeons here to adapt to cope with anything that comes through the door. (Following photo the closest I could get to a surgical one...)

Following several late nights in theatre assisting with hernias (including one traumatic hernia – a man who was hit in the stomach by metal poles tied onto the back of a motorbike, who then developed an impressive bulge at the site of injury) and assault injuries I was totally pooped! So when Saturday morning rolled around I was very glad that we were heading off to the Murchison National Park in the north west. 4 of us from Kiwoko spent Saturday travelling up there (~5 hour bus journey, half of which was on bumpy dirt tracks in the bush) and then headed out on safari on Sunday. Got up at 6, ready to set off at half past to start heading around a portion of the 5000square km national park, starting with crossing the Nile on a ferry right at the moment of sunrise.

We were so lucky to see so many animals - the common ones in this park: waterbuck, ugandan cob, oribi - all look a bit like deer, very beautiful and vast numbers of them, then some buffalo and then suddenly we stopped because the guide had seen something....lions! One male and two females not too far from the track, the male and one female wandered away but the other female ambled across the track in front of us. They were so beautiful. We were extra lucky because we then saw lions twice more on the same trip - the third one was a female sitting right next to the track, literally a few metres from us. Also saw elephants, loads of giraffes - I really like them, they're so graceful and elegant and look like they're in slow motion when they run.

Lots of birds too, including the national bird of Uganda, the Crested Crane - a pretty cool bird with blue eyes and spikey neck feathers. But the best of the morning trip was a leopard - these are v. rare to see since they are elusive and hide in trees. I happened to spot a tail dangling out of a big tree high not too far from the track. I yelled 'stop!' as we were driving along, and then thought 'oh no, I bet it's just a twig that I saw' but then was so glad to have yelled out because when we reversed back to the tree right enough there was a beautiful leopard sitting up there. After looking at us for a while he came down and slunk off, although our guide reckoned he was stalking an innocent deer that was nearby. We were all v. pleased to have seen him.

It was SO hot up in Merchison - apparently it's at a lower altitude than Kiwoko, and way more humid. It was 37 degrees on Sunday, so hot that as soon as you step out of the shower you immediately start sweating again. We were not a pretty sight! I'm actually looking forward to the coooool summer of the UK - but at least Kiwoko is definitely not as hot. In the afternoon on Sunday we took a boat trip along the Nile to the falls themselves, where the entire Nile squeezes through a 5m gap in the rocks creating HUGE waterfalls which can be heard rumbling from miles away. We saw looooadddds of hippos (i've just been through my photos doing a massive hippo cull) and crocodiles too. They are uber scary, so evil looking. Near the falls there is a tree with swarms of crocs underneath, and as the boat approached they all started running out and slithering down into the water, where only their eyes and the tips of their noses can be seen. I stayed away from the edge of the boat!

I’m on maternity this week. This morning I saw an evacuation of products of conception on a girl who had tried to give herself an abortion. Abortions are illegal in Uganda so sometimes women resort to desperate measures. I have mixed feelings about abortions in general, but if the alternative is a risky self-induced termination which is likely to result in sepsis maybe legal, safe termination isn’t such a bad thing. At least this girl can now be offered family planning advice and hopefully there won’t be a repeat event. I then saw a successful delivery, complete with un-anaesthetised episiotomy. Yowch!

Anyone for a grasshopper?

First full week of hospital life at Kiwoko complete! (Guest house pictured above). Time is going by very quickly here, it’s been a busy week with high points and very low points (more on those later). I’m absolutely loving life here in Uganda, the work, although stressful and very frustrating at times, is interesting and challenging.

Days start around 7.30am with a ward round – this week I’ve been doing medicine, based on the male and female medical wards. Once the ward round is finished we head to chapel, sometimes catching most of the sermon, sometimes just slipping in at the back in time for Dr Rory (medical superintendent from N. Ireland) to give the closing notices. Yesterday Dr Rory was away and one of the administration staff stood up to give the worrying news that Rory had been driving to Kampala and had accidentally scraped the President’s car, but worse he didn’t have his driving license with him so was in a bit of trouble. This was followed by a pause and some nervous chattering, and then an announcement from Ken for us all to go out and enjoy the day (‘the service is over, let the worship begin’), and not to forget that the day was in fact the first of April. April fool’s day is universal it seems!

During the day I am responsible for clerking new patients, coming up with a reasonable set of differentials and management plan and discussing them with the doctor in charge of the ward. Very few of the patients speak English so most history taking and examination is done with the aid of an interpreter, usually one of the nurses or nursing students. They are very helpful and mostly very good at translating, but there can be some frustrations. One such frustration runs a little like this: Me: ‘do you have a cough’, Interpreter: ‘(translates into Luganda)’, the patient and interpreter then have a long, drawn out conversation involving many gesticulations and further questions. After several minutes of unintelligible dialogue the interpreter turns back to me and says ‘no’. I wish I knew more than 'how are you, cough, vomit and diarrhoea' in Luganda!

As a medical student at Kiwoko I have far more responsibility than back in Scotland, for example conducting ward rounds when the doctor I’m with is away. This was a little daunting to start with – at home being asked to write in the notes for the ward round is a rare responsibility, let alone making decisions about patient management. Having said that I’ve never felt unsupported, and it is easy enough to pin down a doctor to get a second opinion. The most difficult moment I have experienced so far, and probably in the whole of medical school, was on Wednesday afternoon. In the morning a patient had come in, a 9 year old girl unconscious in respiratory distress and a history of cough and fever. A diagnosis of pneumonia was made and appropriate treatment started, but the outlook from the beginning was fairly poor. In the afternoon I was clerking a new patient in the bed opposite her when Minsa, one of the nurses, came over and said she thought the girl was ‘slipping away’. I dropped what I was doing and raced over to the other bed where the girl was lying completely still, with mum sobbing in the chair next to it. She had no pulse and no respiratory effort so Minsa called the ward doctor as I started CPR. After attempting CPR for what felt like an eternity the doctor calmly strode in, pausing in the doorway to chat to someone. I felt like screaming HELP ME NOW! at the top of my voice, but when he finally came over he said ‘stop CPR, there’s no point – she was beyond saving when she came in’. The heartbreaking thing was that she had actually been seen at a peripheral clinic five days earlier and her parents told that she should come to Kiwoko for treatment. It took them 5 days to scrape enough money together to come here, by which time it was really too late.

Unfortunately this story is all too common around here. Parents hang on at home, hoping the child will perk up and therefore avoid expensive hospital fees, but by the time they realise just how ill they are it's too late to do anything about it. Anyone coming into hospital in the UK in such a sick state would be immediately taken to the resus room where they would be attended to by at least three consultants, have intravenous lines, monitors, hefty infusions of drugs and fluid yet she was merely lying in a bed on the ward with one drip and occasionally me or the other medical student checking her pulse and respiratory rate. I couldn't hold back the tears once the urgency of CPR was stopped. The doctors and nurses working here are so used to seeing death that they take it in their stride, but it’s something I’m just not used to, and the frustration of knowing that a child with what was essentially a chest infection should never die was just overwhelming.

On a lighter note there's a delightful old lady on female ward who has had a pleural effusion with a chest drain for about a week, who sits on her bed grinning her gappy smile as you go past, and laughing at my attempts to speak Luganda while doing her breathing exercises which involves blowing up a latex glove. Very funny to watch! She is so sweet!

After a busy or stressful day on the wards a great way to unwind is to go running in the evenings. There is a group of us that have started going for runs three times a week through the nearby countryside, past mud huts and banana plantations. The children certainly find the sight of six red faced mzungu women jogging past absolutely hilarious and take great pleasure in yelling ‘how are you? Fine! How are you?’ at us.

I’m just back at Kiwoko after a weekend in Jinja, white water rafting capital of Uganda. Had a great day on the Nile yesterday going down grade 5 rapids, absolutely terrifying but brilliant fun too. Our boat flipped a couple of times, one of which I got stuck underneath it which was slightly scary, but the guides are v. experienced and can always get you out of a pickle. Lunch consisted of fresh pineapple eaten on the rafts as we floated along a calm section, followed by a dip to rinse off the sticky juice. The day was rounded off with a monster of a rapid called ‘the bad place’, in which 7 out of 8 rafts flipped, and one boat even started falling apart!

On our way back to Kiwoko while waiting in Kampala for the bus to leave (they won't leave until it is full....which can take several hours) we were offered many things to eat and drink. Despite much persuasion this guy wasn't able to convince us to buy any of his curried grasshoppers. The smell alone was enough to put anyone off!

Back to work tomorrow, surgery this week and a trip to Murchison Falls planned for the weekend. I love Uganda! Thank you all for your comments and emails, I enjoy hearing from everyone back home.

I'll leave you with this view of the Nile from the hostel at Jinja.

Extend! Extend!

The story of a journey from Kampala to Kiwoko, Ugandan style.

The main public transport here are little 9 seater minibuses called matatus, painted white with a blue pattern and adorned with varying encouraging messages on the front such as 'Jesus Saves' and 'John 3:16'. After spending the weekend in Kampala the other students and I headed to the main bus park in Kampala to catch the bus back to Kiwoko. It was absolute mayhem, similar to the bus park in Kathmandu - buses everywhere in a muddy, dusty, potholey park, with no indication either on the ground or on the buses which ones are going where. We asked someone for help, and he waved vaguely to the other side of the park; we then weaved in and out of these buses until we found someone who said 'follow me' and took us to a bus. We piled in, already pretty sweaty because of the humid African heat, and waited for the bus to fill up. Meanwhile sellers came to the windows offering all sorts from cold drinks, sunglasses, fake watches and food to posters of the recent riots in Kampala.

After lots of horn tooting, manouvering and loud shouts to the other buses from our driver we set off towards Kiwoko. The first part of the journey was pretty uneventful and an hour and a bit later we rolled into Luweero bus station, 14km from Kiwoko. We were turfed off this bus and onto another, very old and battered looking one, whose windscreen had an ominous looking crack down the middle, that looked like it would struggle to make it out of the bus park, let alone along the potholed dirt track to the hospital. With about 11 people in we pulled off, but it seemed we were just going to the garage to inflate the tyres and fill up with petrol, then drive back to the bus park and wait for more passengers. A lady with 4 children piled in. Great, we thought, bus definitely full now - lets go. Not so fast! Another lap of the bus park to pick up some potatoes to put in the boot, and tie some luggage onto the roof and then off goes the engine again. Cries of 'extend! extend!', which interprets as 'budge up, this bus can take plenty more passengers yet' and we all squished up to allow another passenger to join the overloaded bus, and then another 3 children.

Now it's getting really very full, we're squished into the back seats all v. sweaty and dusty by this point. But then shock horror...another passenger turned up, but not just anyone - one of the Sisters from the hospital. She is some lady. A formidable size, with what can only be described as a 'shelf bottom', something so big it almost eclipses the sun. There was no way she was going to fit in this tiny minbus - there were already 18 people in a bus designed for 9, but this didn't to pose any problem to the driver. He turfed a couple of passengers out of the front seat, who joined the sweaty mob in the back (more cries of 'extend!') and Sister squeezed into the front. Finally it appeared we were going to leave, about an hour after changing buses. We pulled off and drove a little further along the road through Luweero, only to stop AGAIN and pick up not one but TWO more passengers. There wasn't a whole lot of extending we could do - the middle of the minibus was full to bursting, so as a solution a couple of children were passed backwards to join the sweaty, cramped muzungus on the back row, making use of the vertical space by sitting on our knees so the extra passengers could fit in; they didn't bat an eyelid, despite the common rumour here that white people eat children. Final tally: 22 passengers in a 9 seater bus. Oh yes.

Made it back to Kiwoko in one piece, very dusty, VERY sweaty and very glad to get home for a much needed shower.

Starting hospital placement proper tomorrow - medical stories to follow!

Oli otya from Uganda

Technically the title of this post is grammatically incorrect, since 'oli otya' means 'how are you', but as it is the standard greeting it seems a shame not to share it.

I arrived here at Kiwoko Hospital yesterday lunchtime, after a night in Utrecht, near Amsterdam with my good friend Aukje, and a night in Entebbe and have been made to feel thoroughly welcome by everyone I've met - Ugandans are very friendly. I already feel very at home in the small house I'm sharing with three others - a paediactric reg (also from Edinburgh), a nursing student and another medical student. My bed is comfy, the company is good and the food is excellent! The amazing quantity of fresh fruit and veg is a particular bonus - pineapples like I've never tasted, bananas, passionfruit, avocados grown just down the road...unfortunately it isn't mango season at the moment but with the variety of the available selection I think I'll cope.

I was shown around the hospital yesterday afternoon (in the baking Ugandan sun, such a nice change!) and was quite surprised at how big it is - there's been a fair bit of development since Dr Ian Clarke who started the hospital wrote the book 'The Man With The Key Has Gone', which is pretty much what my mental pictures were based on. I am still slightly disorientated when walking around the hospital, but its main components are: outpatients department where new arrivals are seen, male and female wards which each have a medical and surgical area, children's ward (for children under the age of 5 - any bigger and they won't fit in the cots!), recently completed maternity unit with neonatal ICU, theatres, TB ward, nutrition ward, administration block and multipurpose hall used for morning chapel/staff meals/lectures.

I spent the morning on the paeds ward with Carolyn the paeds reg and saw my first cases of malaria (lots of them), sickle cell crisis, osteomyelitis...oh and a case of bronchiolitis that made me feel at home. There are a lot of differences between the practice of medicine here and in the UK, the most striking being the limitations to investigation and treatment due to financial shortages of the patient and their family. Blood tests are carefully justified, not fired off as fast as the admitting doctor can think of them, and if the treatment needed is too expensive it simply cannot be carried out. There are also far more deaths here than I have ever seen in the UK, already four patients, two of which were children, since I arrived. I wasn't involved with their care on the wards but two of my housemates were and understandably found it quite difficult emotionally. I am not looking forward to the time when I will experience it for myself.

On a lighter note I met my first cockroach yesterday on the way to the outdoor long drop toilet. Wasn't as unpleasant as I'd expected! (The cockroach, not the toilet - although actually the same could be said for that).

The electricity has just gone off again and my battery is running low so I'll sign off.

Sending lots of happy thoughts from Uganda

Charlotte

10 days to go...

In just over a week I'll be flying from Manchester to Entebbe airport, Uganda, with a quick stop in Amsterdam to visit a gap year friend. I am due to arrive on 23rd March, and will head out of Kampala to Kiwoko Hospital the next day.

My room here in Edinburgh is currently strewn with clothes, textbooks and medical equipment (including 50 catheters, 100 infant nasogastric feeding tubes, several boxes of sterile gloves, scalpel blades and sutures and one lonely chest drain). My task now is to somehow squeeze all this stuff into my rucksack...easier said than done.

I will hopefully be able to update this blog every once in a while, and will try and put some photos up once I've worked out how to use my fancy new camera. I am very excited about this trip - it will be so good to experience everything of Kiwoko and Uganda as a country that I've heard so many good things about.

That's my side of the bargain - yours is to keep in touch with me by email/facebook/Ugandan mobile - I have been given a sim card but not sure of the number yet, I should find out once I get there.

Looking forward to updating you once I get to Uganda!

Charlotte