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!