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.