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!