Sunday 3 March 2013
Link for Zambia blog
Thursday 20 May 2010
Home sweet home
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
I spent the weekend in
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
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
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.
Wednesday 12 May 2010
Welaba Kiwoko!
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
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
Friday 30 April 2010
God is always in time!
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
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
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
An entertaining evening’s activity here in Kiwoko is to go for a bike ride. Last week
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!
Wednesday 21 April 2010
Thank you for the work!
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
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
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
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
Tuesday 13 April 2010
It is what? It is absolutely chucking it down!
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!
Sunday 4 April 2010
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
Days start around
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: ‘
As a medical student at Kiwoko I have far more responsibility than back in
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
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
I'll leave you with this view of the Nile from the hostel at Jinja.