Set on a backdrop of rolling
hills and endless farmlands, I used to always believe that Dorchester was one
of the most beautiful places to work. Of course, that was until I started
working in Kagando. Nestled in the foothills of the Rwenzori Mountains, I can’t
help but stop and feel slightly humbled by the views that are presented to me
each morning. With the peaks often covered in cloud, I am constantly reminded
of how small and insignificant I appear next to them. I do not however have any
inclination to climb the Rwenzori Mountains; I did this last time I was here,
and I am slightly ashamed to say that it was possibly one of the most miserable
experiences of my life (although mainly due to my complete lack of fitness,
rather than anything else).
As I mentioned in my previous
blog, the hospital consists of the staff housing on one side of a road, with the
Chapel and Hospital grounds on the other. After dodging both chickens and
goats, and attempting not to get run over by the multiple motorcycles that
travel up and down the path, it takes me a little over two minutes to walk from
our front door to the hospital gate. This of course depends upon how many
people stop you to ask how your day has been, irrespective of if you know them
or not.
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| Kagando Hospital |
Uganda is a predominantly Christian country, and religion features in a large part of the day to day workings of the hospital. Each working day starts at 8am in the chapel, and although the staff at Kagando appreciate that neither me nor Sophie are particularly religious, we are still expected to attend each morning. The chapel itself is a modest, but welcoming building, with tapestries on the walls and flowers in every corner. The services tends to begin with a couple of upbeat, gospel style hymns, and whilst I would like to say that I join in with as much enthusiasm as everyone else, it really is too early in the morning for me to be singing and dancing (especially when I haven’t had my usual morning cup of coffee!).
Situated next to the chapel is
the Outpatient Department, which also doubles up as Kangando’s A&E. It is
here that all new patients must first be assessed by a clinical officer (i.e.
nurse practitioner) before being admitted onto one of the hospital’s wards.
However, to access these wards, or any other part of the hospital for that
matter, you have to pass through a narrow gate which is manned by a guard at
all times. Kagando itself is much smaller than any hospital I have ever
worked in before. There are only five wards (surgery, male and female medicine,
paediatrics and obstetrics), and whilst there are only thirty or so beds to
each ward, the actual capacity of each ward is much higher; when the beds have
run out mattresses are put on the floor (or anywhere else where there is
space). There are no computers or fancy white boards on the wards, and the
electric is guaranteed to go off at least once a day (normally during a resuscitation
or critical point of a major operation). You are lucky if you can find a fully
functioning observation machine on any of the wards, and the oxygen
concentrators are in such short supply that many patients who are in desperate
need of oxygen have to go without. However, whilst the staff in Kagando have
little to work with, it never fails to amaze me how resourceful they are - whether
it be using a collection of desk lamps to warm the broken incubator on the
neonatal unit, or turning an old rubber glove into a drainage bag for an NG
tube. Either way, they could definitely teach the NHS managers a thing or two!
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| Hospital Entrance |
The operating department at Kagando is rather well equipped, with three operating rooms and a recovery area. They have the capacity to perform most obstetric and general surgical procedures, and can even deliver a general anaesthetic (all be it with a very old fashioned ventilator). It also contains one of the only working computers in the hospital, and whilst I would like to think that it is used to improve patient care, I have only ever seen it being used to play solitaire. Although there are many similarities to the theatres that I have worked in before, there are also many differences. For instance, I have never seen a rat run along the floor or a lizard climb up a wall during the middle of an emergency laparotomy. Also, unlike the UK where most things are disposable, almost everything at Kagando is washed and reused, including surgical masks and sterile drapes. Whilst this is very cost effective and no doubt saves the hospital money, it does mean that I often find myself having to iron my scrub hat each morning in an attempt to dry it out.
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| Operating Department |
Whilst Kagando may not be able to do all the elaborate investigations that we can in the UK, the hospital does have its own radiology department where X-rays and Ultrasounds can be performed. Of course, there is no fancy computer system for viewing the images; instead you have to revert to looking at old fashioned radiographs with a light-box (if you can find one that works). In addition to the radiology department, there is also a small laboratory where basic blood tests can be performed. However, whilst it should in theory be possible carry out renal and liver profiles in Kagando, the reagent needed to perform these investigations has been out of stock for over a month, and there seems to be no sign of it being replaced any time soon.
Since arriving in Kagando, Sophie
has started working on the paediatrics ward, and I have ended up on surgery. When
I first began on the surgical ward, there was a Consultant surgeon, a ‘middle
grade’ and three interns (who were all in their first year of working since
graduating). However, over the last month both the Consultant and all the
interns have left (without any immediate replacement being found), and it is
now just me and Naomi, the middle grade surgeon, left to look after the ward. Needless
to say I have been a lot busier over the last couple of weeks compared to when
I started, and whilst I have had both my good and bad days, I have, for the
most part, enjoyed it.
My day typically starts at 8.30am
with a ward round of all the surgical inpatients; usually I have Naomi with me,
but there have been several occasions where I have been on my own. On the occasions
that I have had to carry out the ward round by myself, I am not only faced with
the problem that I have a rather limited knowledge of many surgical conditions
– especially tropical ones (although I am slowly learning), but also by the
fact that not many of the patients speak English. I therefore have to conduct
the entire consultation though an interpreter (usually a nurse); I cannot begin
to describe how frustrating it is when the patient and interpreter have a five
minute conversation, but all that is reported back to you is a one word answer.
After the ward round we head to
the operating department, where, after a cup of Ugandan tea (warm milk, lots of
sugar and the possible suggestion that it was shown a tea bag for all of five
seconds), we are ready to start surgery. Of course, nothing ever starts on
time, as the first problem to overcome is that there is only one anaesthetist to
be shared between both the general surgical and obstetric teams (and C-sections
almost always take priority). Even if you manage to secure yourself an anaesthetist,
this doesn’t remove the fact that this is Africa, and even in emergencies
everything happens at a relaxed pace; I am not known for being the most patient
person at the best of times, and I have soon learnt that if you want anything
in Africa doing remotely quickly, it is often best if you do it yourself
(including wheeling the patient from the ward, to X-ray and then to theatre).
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| Scrub Hats |
Apart from basic suturing, which I am usually happy to do by myself, my role in theatre is to assist Naomi. Now, it has been a long time since I assisted in an operation, and even then it was a very infrequent occurrence during my foundation training. Fortunately for me Naomi is very patient when I repeatedly hand her the wrong instrument, let go of the retractor when I’m not meant to, or generally get in the way and make her job twice as hard. Nevertheless, I think I am slowly learning, and can now recognise and name about five of the surgical instruments (which is five more than I could name before coming to Kagando). However, I think I may decline the option of learning how to do a C-section by myself – despite the Ugandans’ best efforts to try and persuade me otherwise.
Whilst we are in theatre, me and
Naomi are often called to review outpatients, who come in with anything from
life threatening conditions that need operating on there and then, to patients
who really shouldn’t have bothered paying for the journey (not too dissimilar
to A&E departments in England when I
think about it). By the time all the new admissions have been reviewed, I
usually finished between 4-5pm. They have asked me if I want to be included in the
on-call rota for surgery. However, I have declined this offer for the present
moment, as although I have done my fair share of on-calls it the past, I really
don’t think I would be the best person to be called for a multi-vehicle RTA, or
a Hippopotamus bite (yes, that did happen, and no, the person unsurprisingly
didn’t survive).
During my time in Kagando, I have
tried to keep a logbook of my daily activities and any interesting cases that I
have seen. My initial plan was to include a couple of these cases in this blog.
However, after looking through my notes, I have decided that there is simply too
much that I want to talk about, and that it is best to leave it all for a
separate blog entry. Instead, I am going to finish off this current entry by
talking about a couple of things that I have been up to in Kagando, outside of
work.
A Ugandan Easter (17th- 21st April)
For Ugandans, whose life is
influenced largely by religion, Easter is one of the most celebrated events of
the year, and when we arrived in Kagando on the Monday before Easter it was
clear that the staff and students here weren't about to miss out on of all these
festivities. The celebrations started on Thursday in the chapel, with Easters
Carols and the nursing school’s yearly performance of the ‘Crucifixion of Christ’,
a two hour play detailing the days leading up to Christ’s execution, the crucifixion
itself, and then the resurrection. Bearing in mind that this was only rehearsed
in the evenings, and in between their studies, I think they did do a pretty
good job; no one forgot their lines, the costumes were brilliant, and they had
even constructed a full sized cross that ‘Jesus’ had to stand upon (although there
were times that I did worry that he was about to fall off!). Apparently the
same set of students had also performed the Nativity scene at Christmas.
However, instead of ending with the happy event of Jesus’s birth, they decided
to add drama to their performance by finishing with the slaying of the babes (although
they could not understand why everyone left the chapel in a state of shock and
tears).
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| The Easter Play |
Over the Easter weekend itself many people went home, and for those who didn’t there were extended services in the chapel each day (although me and Sophie failed to make it to any of them, having decided in advance that a lie-in was much more appealing). On Easter Sunday one of the German radiographers, Ulga, had decided to hold an Easter party at her house, where there were plenty of pancakes to eat (all of which had been cooked by Ugandan men who had never cooked anything before, but took great pride in showing off their pancake making skills). As our gift we brought our last supply of English chocolate, Sophie’s mini-easter eggs. Needless to say these got eaten very quickly, and we now how to wait a full three months to have chocolate again (unless we want to eat Ugandan chocolate, which tastes awful and really did ruin chocolate for me last time I was here).
‘Ja Ja Home’ Day (24th
April)
If anyone knows anything about
heath in Africa, they will know that one of the most prevalent diseases, apart
from malaria, is HIV. However, HIV not only affects the person who has the disease,
but the whole family as well. In addition to the
risk of the mother passing the disease onto her unborn baby, there is the sad reality that when the parents ultimately
die from AIDs, their children will be left to fend for themselves, or, if they
are lucky, be looked after their grandparents (called ‘Ja Ja’ in Uganda). Several years ago a British
couple set up ‘Ja Ja Home’ day, a charity which aims to help and support these children,
as well as their carers. The main role of the project is to get all the HIV
orphans together once a month in Kagando community hall, where they can have a
full health check, and ensure that they are receiving the right treatment.
After this is done, they are then allowed to play and have fun with a variety
of games that are set up for them, all before receiving a hot meal and heading
home. It also gives their carers the chance to get together, share stories, and
have a well-deserved break.
Now, anyone who knows me will surely know that
me and children generally don’t get on very well, and that I tend to avoid them
whenever I can. However, the second weekend that we were here coincided with ‘Ja
Ja Home’ day, and it is such a good cause that even I couldn’t say no to going
along and helping out. Forty or so children turned up, with ages ranging from
as little as six months to sixteen years. We started off by helping the children
to decorate and write their names on the badges that we had made the night
before. These were brilliant, and it never fails to amaze me how just a bit of
card and ribbon can make one child so happy. Wanting to take a photo of my handy
work, I pulled my camera out and photographed a child wearing a badge that I
had helped them to make. Needless to say I soon had ten or so children flocking
around me, all wanting to have their picture taken.
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| Making The Badges |
After every child had received a name badge, and had subsequently had at least twenty photos taken of themselves, it was time move outside for the fun and games. As I watched a small boy get hours of fun out a toy car that was missing two wheels, and another small girl playing with a cuddly dog with no tail, I realised more than ever how lucky children in the UK are. My brother and sister have more toys at home than they know what to do with, and often won’t even realised if you throw a bag or two of them away. Yet they will cry and beg, and state how unfair life is if they haven’t been brought the latest computer game, or most expensive Lego set. As I watched these children play with broken toys, I appreciated more than everwhy this charity is so important – it allows children to be children again. As they played football, danced to music, or chased a balloon around the field, they were no longer children who had been orphaned by HIV, but instead were just children playing and having fun, something every child is entitled to. Sadly, many of these children live in such poverty that they can’t afford toys, and instead spend their days fetching water, looking for food, or caring for their younger siblings who were also orphaned by this devastating disease. But at ‘Ja Ja Home’ day, they can at last have their childhood back, even if it is just for one morning a month.
However, the sad reality is that, not matter how important ‘Ja Ja Day’ is, they simply can’t afford to run it all of the time. Despite costing as little as £100 a month, there have been times when they have had to miss a month or two, simply because the funds have run out. Whilst I’m not going to sit here and beg, if there is anyone reading this who has the odd spare change that they are wishing to donate to charity, but aren’t entirely sure which one, then please at least consider this worthwhile cause.
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| Playing 'Catapillar' |
Whilst I have endless tales of our Safari with crocodiles, or our trip to Lake Bunyonyi, I realise that this entry is already long enough, and my concentration has all but run out. I will therefore leave you with this for the time being, and promise to write again soon.
