Anyhow I have another creature to keep me entertained while I lie here (and a friend to my other dog Quest)… an eight week old puppy called Rafiki. He was found 5 weeks ago crying, obviously abandoned, in a banana plot belonging to some friends. As a then 3 week old, he was blind, deaf and could barely walk. It has been fun (and a little tiring) caring for him up to this point but now he is at least at the age a puppy would normally be allowed away from him mum!
I am so grateful to the Skinners and Hollenbecks who kindly babysat him during the first few weeks while I was at work… couldn’t have done it without you guys!

I could tell you stories about having a small black excitable dog in power cuts and particularly a small excitable black dog, with diarrhoea, in power cuts, but best probably to leave out those graphic details! Here are some photos of my little friend because he is too cute not to share:

“The earth is the Lord’s and everything in it” Psalm 24vs 1

I’ve mentioned before about how “let me come” means I will come in a bit but for the moment I am heading in the other direction. There are lots more and if you are interested then wikipedia has a whole article devoted to Ugandan English here http://en.wikipedia.org/wiki/Ugandan_english.

The one that I am trying hard to get in my head is “May” and “Knew”. Now I am happy for any Ugandans to correct me on this, but from what I have seen so far… If someone says “I may” it means “I am not” (i.e. if someone says “I may not come” that means “I am not going to come”) and if someone says “I knew” it means “I thought” (i.e. if you have a meeting and someone doesn’t come to it, they may say to you “I knew you were not meeting” meaning “I thought you were not meeting”).

Now who is to say one is the right way and one is the wrong way. In fact when I am in Uganda, it surely should be the Ugandan English that is correct. However my head does hurt when I hear someone say something that my brain interprets as an indefinite and try to convince myself it is a definite and vice versa.

The truth is that I feel none of the above. If I was here for the adventure then I would have left by now, yes there are still many new experiences, but there are just as many days when I get up, go to work, cook, clean etc… Rather than seeing it as a project, I am just here living alongside friends, learning from these friends how to function best in this culture, serving the same God. Yes we have projects, but we are doing them together. And as for the having the answers…I think I am still learning what the questions are!

I know my family and friends outside Uganda find this blog helpful for somehow understanding my life is like here and therefore I am going to try and write sometimes. But if I ever mistakenly communicate that I am an expert having an adventure doing a project in Africa… then please tell me and I’ll sort myself out!

A group of healthcare students from Sweden have been visiting and as six of them were physio/OT students, our department has been heavily involved. As a result my colleagues and I had to make several visits to a village area about 2 hours away where the students were doing a field study. This area was in a fantastic location, just on the edge of Queen Elizabeth National Park and we were told that the people we were visiting often had problems with their crops being destroyed by wild animals (this park has plenty of elephants, lions and baboons).

Our pre-visit to meet the patients involved me doing the driving into the areas. I was very grateful for my 4 wheel drive as I was directed up what would barely be called a footpath in the UK. We would drive as far as we could and then get out and walk the rest of the distance. Considering we were visiting people with disabilities who usually would not be able to afford transport, it was a very telling reminder of how isolated these people can be and why they may not be seen at the hospital.

We met 5 people with disabilities, all in different situations. All fantastic people who were dealing with their situation in amazing ways, all causing me (and my colleagues) a sense of frustration when you know how different interventions could help and there being no easy, quick fix, answers about how to make them accessible for them.

These were the people we met (names changed for confidentiality):
David & Andrew (brothers). David is 16 and has a foot deformity. It was caused by a inappropriate injection when he was 5, which lead to paralysis in his lower limb. Without any advice, aids or treatment he just carried on walking on it. It is now fixed so that he almost walks on the top part of his foot, an operation is a very risky option (high chance it may result in an amputation), he can’t get to school or to see his friends because of pain and a wheelchair is not an option in the environment where he lives.
Andrew is 18 and has a mental disorder caused by convulsions when he was an infant. He can’t look after himself, tends to hit the younger children when attempting to play and recently has started having some more convulsions. My colleagues explained that if he was not mobile it would be likely that he would have been kept unseen within the house or not have survived to live this long.

Peter is 5 and had Cerebral Malaria 3 years ago. He developed a left hemiplegia and can no longer use his hand. He can walk with a limp and is determined to join in the everyday tasks of the family. He tries to dig using his good hand and helps with untying the goats. He is going to school although taunted by the other children.

Mary is about 25 and has congenital deformities. She is unable to walk or use her legs. She moves by using two pieces of sacking. She lifts herself onto the front one and then moves the other piece forwards (to protect her clothes from the dirt floor), she has a wheelchair but it wouldn’t work around her home. She makes crafts, helps with the cooking and can use the toilet independantly thanks to the long drop style (floor level) type of latrines they have here. Of all the people we met she was the most content and well integrated, but even she expressed a desire to return to vocational school to learn a craft trade and told us she had not been to the nearby town for a year because of the stigma she got there.

Finally Mercy was a widow in her 40s with 3 children in their late teens. She developed Rheumatoid Arthritis 11 years ago and after a few month in hospital returned home without knowing hardly any information about her condition. Expecting it to get better she took to her bed and waited. 10 years later she now has many contractures, is unable to sit without assistance, no chance of standing again and only moves out of her bedroom when her children are home during the holidays.

As we worked with the Swedish students, we came up with many intervention ideas for all these patients. However the difficulty is that we have no rehabilitation service provision that can reach these people and them reaching us is practically and financially out of the question for most of them. It was difficult to drive away not being able to guarantee any follow up.

On a positive note travelling to and from these villages gave plenty of opportunities for discussion. As I said before there are no quick fixes however Mbarara University is working hard at looking at how to improve health services at a community level and the momentum is in the right direction. There are already volunteer community health workers in each of the villages we visited and training of these workers certainly seems a first step. In the meantime please pray for these families that we left behind.

One way of managing this is requesting patients to purchase necessary items, however this is not always possible as patients and their families often have very limited funds. This method also requires patients to see the value in the treatment. When that is applied to items needed for Physiotherapy/Occupational Therapy that can mean there is no possible way to provide them. (People here often prefer injections/creams to other methods of treatment). For example a patient with a Severe Head Injury who is at risk of developing hand contractures who would benefit from a hand resting splint.

My friend Grace, who is an occupational therapist, visited for a few weeks recently and this was a great opportunity to discuss (along with our OT/Physio colleagues at the hospital) and trial alternative options.

I was really impressed with her ingenuity and know she’ll hate me for posting pictures of her but here we are any way (until she asks me to remove them!):

First attempt was a splint made out of Banana plant – a piece of stalk for the hand and bark for the arm bit:

This worked great as a temporary splint but it was difficult to maintain a fixed position and obviously concerns about skin care.

The second attempt involved trying to make a salt dough mould to then make a paper mache splint on, unfortunately the dough changed shape in the oven!!

The final attempt involved making a paper mache splint using a human model. A long process but it worked well.

The paper mache was initially made using maize flour – just the slight problem that this is also what is used as dog food here, so there was one episode of needing to extract it from a dog mouth!! In the end Grace discovered that millet/Cassava flour worked the best. (Ivan, the OT at the hospital, suggests that just cassava flour is good, but we didn’t have any of that to try).It took a few days of moulding/remoulding/reinforcing and then varnishing but the end product was great. (Grace will express concerns about some aspects of it but I still thought it was fab!!)
Here it is on the patient:

Sadly the patient was discharged home shortly after this (unexpected discharges is a big thing that the rehab team have to contend with here) and so we don’t know the outcome but the family members seemed really on board with the idea and certainly the time taken over it will hopefully have reinforced to them the importance of hand care.

We went to Fort Portal for a few days which is North West of Mbarara.

Our Campsite was at Amabeere Caves…

Here are the caves.. “Amabeere” means “breasts” in the local language and gets its name from the strange stalactite formations… decided to save you those photos but safe to say it was rather surreal having the guide point them all out!

One day we went on a trip round the foothills of the Rwenzoris… very fun drive!!

We were heading to Semuliki National Park which is on the Congo border and has lots of amazing birds and hot springs…

We then moved South to a “crater lake” area where we went swimming…

and cycling…

and saw lots of monkeys…

Of course no trip here is complete without the sights you see while travelling.

The driving school (having seen some of the driving “in his mercy” sounds about right!!)…

The comfy way to travel (although not sure they were too impressed with having their photo taken!!)

The matoke (green bananas) carrier (very common sight here). The guys who push these must be very fit – they often go miles,up and down hills.

When you don’t get confused even though the person you’re talking to keeps mixing up ‘he’ and ‘she’ in the same sentence.

and adding one of my own:

When you are surprised to see a man walking with a dog on a leash and then realise that it is ok, it is only a goat.

Today I see Mbarara as a home and many things have here have become familiar including the constant feeling of being unsure what is ahead of me!!

The day I have had so far may give some idea of my life here. I woke up at 6.30am to finish marking the last of some assignments for the Rehab Medicine course I helped teach at the local university. This assignment required the students to interview a patient about their life and marking them was not an easy task as some of the true stories were difficult to read – the tailor who loved her job but who had been robbed and lost her eye and hand and was wondering what the future held – the father who described all his hopes for his children but was now unlikely to be able to afford to let them continue in school because of the hospital costs and his newfound disability – the wife whose husband had divorced her because she was ill and he still had three other wives – the mother who had seen 4 of her children die in childhood – the teenage girl who had been raped (and impregnated) twice by the same man, lost one of the babies, became mentally ill as a result and on pursuing justice had seen her family home be demolished and the family evicted from the village because the accused man had a family of influence. I have not been blind to how tough things are here for so many people but reading 70 stories all in one go was a hard challenge.
What was exciting about reading these essays was learning from the amazing courage and faith that so many of these patients described and seeing the obvious desire of the medical students writing about them, wanting to be able to make a difference.

While I was finishing the marking, Ruth arrived who comes to my house once a week to do my washing and help me with some of the cleaning, this is certainly one of the parts of life here that I don’t complain about!!

I then took my marks into the hospital to hand in. While I was there I discovered that the news had just been announced that the building of a new hospital was to begin – this has been talked about ever since I got here and the latest I had heard was that it had been postponed indefinitely due to lack of funds. Anyhow it is apparently going to start….tomorrow!! The building is supposed to be started in the part of the hospital that currently holds the emergency ward, ICU, orthopaedic ward, orthopaedic workshop and physiotherapy. The patients are all going to be squeezed into other wards but there have been no solutions found for where the workshop (which has large equipment to make prosthetics/orthotics) and physiotherapy (which has a busy outpatient department) can go. Seeing as the buildings are likely to be demolished within a week or so – it seems life is about to get interesting (once again!).

To be honest there aren’t really words that do the ride justice, but it fits somewhere between an extreme game of dodgems and an alternative to the car wreckers yard, with the occasional safari experience thrown in. It isn’t complicated, from the outskirts of Mbarara to the outskirts of Kampala it is one straight road with no traffic lights and only a couple of junctions. However it still takes between 4 and 5 hours. There are just three major hazards… the road, the other road users and the police and I’ve had fun encounters with all three.

The road is currently being resurfaced and widened and to be honest is improving each time I have travelled it, but the bits being worked on still cause fun. There is not necessarily an understandable system to where the work is being done so you can be travelling fine along a nice bit of new tarmac and then without warning (or slope) it just comes to an end (and that direction is better than when you hit it the other way). Alternatively where there is no surface they helpfully encourage you to go slowly by erecting speed bumps – these certainly do the job… there is no warning that they are there, there is no marking to make them clear to see, and it feels like you are climbing up and down a steep mountain when you go over them. In fact speed bumps are favoured as a speed control measure everywhere in Uganda, one day I will have to make a point of counting how many I go over on the way to Kampala but I wouldn’t be surprised if it is in the hundreds!! Oh and I haven’t even mentioned the pot holes…

I won’t talk too much about the other road users, but somehow despite the multitude of potholes, buses seem to still manage to gain a bit of speed on the road and the rule here seems to be “If I’m bigger than you then you get out of the way even if I’m on your side of the road”. Once you get that rule, it has actually been ok to win the game of dodgems. Once you get into Kampala it is another story.. lets just say I am learning the knack of driving with as few millimetres between me and another vehicle as possible.

The final fun is provided by the traffic police who are regularly seen by the side of the road. I am learning that single white female is a signpost for them to stop the vehicle and see if they can get a salary boost. The first time I was stopped for going 156km/h in a 50km/h zone. This was confirmed to me by a speed camera display. I’m still intrigued about how when going at this speed I managed not to take off into space over the speed bump I had just passed over and how I managed to stop immediately by being waved down.

It isn’t all bad though. On the way you pass over the equator and there is a great tourist cafe there where I can sit and relax and enjoy an expensive fruit smoothie. You also pass near to a national park. I have passed zebras by the side of the road and even spotted a couple of hippos. There are the entertaining fish sellers who wiggle the fish by the side of the road to make it look fresh and then you pass cars with the purchased fish tied onto their front bumper as this is apparently the best way to carry it! My most fun drive was when I travelled back with my work colleague who kept deciding to take me to visit his relatives or pick up random friends. The journey subsequently took eight hours but it was nicely broken up and I got to see some bits of Uganda I wouldn’t have done otherwise!!

Some of you may have hear of Watoto Childrens Choir (a group of orphaned children who often travel to the UK to put on shows), so naturally I expected that this was going to be a childrens choir concert. In fact I got roped into doing a filmed interview before the show (it was amazing how quickly the rest of the group I was with slunk into the background!) and raved about how I was looking forward to seeing these children. However… the show was being done by an adult choir (some may have been grown up Watoto children), bit of a suprise (and felt slightly stupid about my interview!!) but was still fantastic. I particularly enjoyed the first half which fitted the description I had heard that alikened the show to a Broadway production. A 200+ strong African Choir which made a fantastic sound and at one point there was an entrance of a larger than life giraffe and zebra which reminded me of the start of the West End “The Lion King” production (fully recommended if you have never been to see it!).

One thing that really struck me was the nativity scene. Ok we don’t really know what sort of place Jesus was born in (we just know that there was a manger there and it wasn’t an inn!), but there was something very special about it being portrayed as a basic grassroofed place similar to many places I have seen here. It was a helpful reminder of God’s willingness to have his son born in such a basic place and what that can mean to people who contend with such basic surroundings on a day to day basis. This Christmas is certainly going to be different and very hard to be away from family but I am also looking forward to the new insights that celebrating Christmas so differently will give.