Being a Brit here means being in a minority and therefore anything British becomes more close to the heart, however it has been difficult to find a day to celebrate true britishness. What traditions does St Georges day have? When on earth is the Queen’s birthday? and despite renaming July 4th “good riddance day”, it wasn’t really an occasion to put together rival celebrations to my cross-atlantic friends. However then I remembered the day where we burn an effigy on a fire, stand outside in the cold and wet and eat random food – perfect!

So this Saturday Evening we celebrated Guy Fawkes night. No Guy (as decided that might not go down too well without some serious, beyond my capabilities, explaining) and without the atmospheric need to be wrapped up in scarves, hats and glove, but complete with bonfire, fireworks (sort of), baked potatos and toffee apples. There were three other Brits to back up that this was true tradition and then the rest of the party was made up of Ugandans, Americans and Kiwis.

It was interesting to see what seemed perfectly normal to me, seemed unusual to others. Tuna Mayonnaise and carrot soup seemed to confuse the Americans (or maybe just the weird lot we have here) (that’s a joke by the way guys if you are reading this !!), nearly everything was strange to the Ugandans, especially the kids of my friends who had never tasted any British food before. I am hoping the latter weren’t sick afterwards as they got into the toffee apples, baked chocolate bananas and toasted marshmallows.

Anyway, it was great fun and hopefully the start of more parties like this at my place, especially as I now have a permanent bonfire spot. However I did find out from my Ugandan friends that having a fire in front of my house implied that I had died, so people may get confused if I die on a regular basis!

To change the tone a bit, Sunday evening was the Christmas Carol service at my church! Its a university church (hence the early celebration) and was a fantastic, well put together service, but singing “we wish you a Merry Christmas” on November 9th, after a hot sunny day, in a room decorated with pink and white balloons certainly befuddled my brain!

(Oops- it has been a bit long since I wrote anything here. I will work on improving!!)

This weekend I am in the process of buying a car so I thought it was about time I explained how I have been getting around so far.

The main public transport system here in Mbarara is the “Boda boda” . Basically a guy with a motorbike who will take passenger(s). The system is quite organised, there are “stages” where bodas hang out waiting for customers (or you can just hail one down) and the pricing system generally is quite consistant (once you get past the fact that although I am white I am not going to pay 4 times the normal price). However whether these boda drivers have ever had any lessons in driving is questionable considering what I have experienced and more importantly what I see in the hospital!!

So to get to the hospital goes like this…

I walk down the road for about 5 or 10 minutes until I see a boda. There is a stage about 5 minutes away and if there are guys there they will compete to get to me, so I can have 3 or 4 motorbikes speeding directly towards me! I feel it is only fair that I get on the first one to get to me although I think my preference would be for the slowest!! Then comes the price negotiation although now I don’t have to as they know me so well. It costs about 50p to get to the hospital. I then get on the bike side saddle (This is necessary when you are wearing a skirt but I do it even when wearing trousers…I feel it allows a quick exit if needed!) and off we go. Riding can be a bit bumpy and hairy on the busy road bit but generally I enjoy riding them as you get to watch the world go by and it is like a daily cheap Alton Towers ride!! Then there is also the entertainment of the conversation which goes usually something like this… (Mzungu means ‘white person’)

Boda man: Mzungu – how is America?
Me: I don’t know I’ve never been there.
Boda man: (just very confused).

Boda man: Are you married? (yes this is normally in the first 2 minutes of the conversation).
Me: No
Boda man: you find a nice black man.
Me: I’m very happy single.
Boda man: (Just very confused that happy and single could be put in the same sentance).

And on it goes…

Now you don’t get that fun on an Alton Towers ride!!

The use of boda transport is wide and varied. For example a family of 7 can all fit on a Boda and they are also used as the local ice cream van complete with music, sadly the ice cream is not worth risking.

Alternatively they can be used to carry a car door (!?!):

or the method of transport home from hospital for a grandmother with a broken leg!!

In a sort of continuation from my last post. One of the things I want to develop here is making rehabilitation equipment from easily available items – well basically rubbish! As well as providing items to use in the hospital, I also want to make things for home use to inspire patients and their families about what they can do.

I have a few ideas from the book “Disabled Village Children” and things I have seen around (e.g. plastic bag balls) but wonder if anyone is able to help come up with some other ideas.

The sort of items I have easy access to are tin cans, plastic containers, plastic bags, cardboard, paper, metal bottle tops, plastic bottles, sticks, stones, maybe small bits of wood.

I have both children and adult patients with every type of disability imaginable so be creative

Over the last year I have heard many discussions around the topic of foreign aid and the growing concern that it actually does more harm than good. The main arguments being is that it causes dependency, has strings attached that may not focus on the overall picture and does not allow for people to seek to develop in their own creative ways.

Following what I have gained from these discussions, I am starting my work here with a resolution to try and work with the resources that are here rather than be a direct provider of new things – yet I am very conscious of my newness to this situation and the risk of idealism – as with all things round here, it is going to be a steep learning curve.

Today I was involved in a meeting by three visitors from the Western World (who were visiting the hospital for one day) who asked for a shopping list of what equipment would need to be provided for the specific need of wound and lymphodema care. The impression was what was asked for would be provided. My head spun at this point. Where do you start and stop? Yes we could ask for pressure mattresses and walking aids but the real issues are multiple and varied – the lack of space, patients waiting too long for operations because the theatre has run out of oxygen, patients being discharged too early (for many different reasons), staff not having time to teach patients and relatives. I don’t want to knock the work that these visitors are doing, I am fully aware that I new myself both to the hospital and this culture and expect that I am making lots of mistakes and misjudgements, however I can’t see the provision of this equipment making the difference that is hoped for.

I sat in a very different meeting last week, led by the Ugandan head of the physio department, she asked the question “what are the things we need to change?” and then “how do we go about them, starting from here?”, the changes suggested by the team involve upskilling both ourselves and other hospital staff, improving information to patients and seeking to gather evidence to request more staff – if this takes place then the knock on effect will improve, among other things, lymphodema care for patients. Its a long haul but I am grateful that I have colleagues with this mindset and I feel I sit much happier on this side of the fence!

Watch this space… I’m sure my thinking on this issue will develop and change!

One of the things that has been striking for me in the first couple of weeks of being at the hospital is how often the nurses and doctors don’t know the name of the patients they are treating. I suspect there are multiple reasons for this including the fact that there is such a large turnover of patients, higher patient to nurse ratio and often patients on the floor as well as on beds which makes any bed labelling system difficult to manage.

The name issue is not too hard to overcome – fortunately “what is your name?” was one of the first Runyankore phrases to learn or if I just have a set of notes then it is not seen as unusual to go and stand in the middle of the ward and shout out the name until you get a response!

However what I have found hard is how little else I know about the patient. There isn’t a culture of comprehensive history taking here. From the notes I can usually find out the tribe and age of the patient, and also the home village (which may or may not mean anything to me), however occupation, family, type of accommodation, and other social history categories are not included. With my limited Runyankore I have not got to the stage where I can ask these questions myself (well I can ask a few – I just can’t understand the answers!!)

I can see how easy it could be for people to be reduced to just being their condition or bed space and that as your knowledge of the identity of a person becomes so limited how easy it is to just pass by that bed. For me as a Christian, I rely heavily on who I believe people are in God’s eyes as my motivation for providing treatment and time even on a manically tiring and busy day (and also rely heavily on God’s strength to help me try and do that!!).

However knowing more about the patient doesn’t necessarily make the job easier. Yesterday I was in a car with a American and Ugandan friend and they were discussing the fact that the brother of a good friend of theirs had died this week and the impact that was going to have on the family. A little later on we happened to pass the house of this man and saw the huge gathering that had turned out for the funeral. At one point my friends mentioned his name and I realised that it was someone who I had been working with this week. I knew he had died and somewhat accepted the death with resigned inevitability (several of my patients have died in the last two weeks!) but seeing and hearing about the people who had been affected by this death made it all the harder.

It is good to be doing physio work again. I have always enjoyed the privilege of being able to get alongside and help people who are going through tough times and it is nice to get back into that. However there are certainly many differences to physio as I’ve known it.

At the moment it seems as though I am going to be based out on the wards. (The other two physios seem to be mainly based in the outpatient and emergency departments). So I have spent my first few working days making myself known on the Surgical, Medical and Paediatric wards and trying to find some patients. I say trying to find, as it seems that because the physio service has been so limited, the nurses and doctors are not used to being able to having much access to the service and are unsure who will be suitable to refer. However slowly the information seems to be creeping out. So far I have seen patients with Spinal Cord Injury, Head Injuries and strokes, all ones that I am used to treating although the setting and lack of equipment mean that my treatment approach has had to change.
I have also had a number of patients with burns and respiratory problems and children with neuro development problems and amputations. It is a challenge to refresh my memory back to my training as I haven’t worked in these areas for many years.

For those physios (and other healthcare professionals) who are reading this. Here are some of the new questions I am facing:

How do you work with a burns patient who has developed multiple contractures due to not having any physio for a couple of months post injury?

What do you tell the doctor about how long a stroke patient will need to be in the hospital when the norm has been to send them home as soon as they are medically stable and you are the only one able to provide rehab services in the hospital?

Any solutions welcome

The last few weeks have involved a lot of travelling around and getting the house sorted. But as of 10 days ago I was able to eventually start work at the hospital.

Mbarara University Hospital is just on the outskirts of Mbarara Town. It was originally built for 200 patients but today has 600 beds and many more patients than that. Uganda has one of the highest population growths in the world (3.60% compared to 0.28% in the UK) and so hospitals such as this one can only expect to be seeing a constant growth in the number of people demanding their services. To say it is already at capacity is understating the situation.

It is a “Regional Referral Hospital” catering for patients from all over South West Uganda and neighbouring Congo, Rwanda and Tanzania and is seeking to become one of three “National Hospitals” in the country.

The hospital does have many of the various specialities that you would expect to see in a hospital of this size: Emergency wing, Burns ward, ITU, Medical ward, Surgical ward (and theatre), Obs & Gynae, Maternity, Paediatrics, Nutrition, Various Outpatient clinics, Physio, OT, Psychiatry, Prosthetics/Orthotics, Radiology. However one of the problems is that the people and equipment resources don’t fit the service requirements. I worked for a while in a similar sized hospital in the UK. There we had over 70 physios, here I make the number up to 3. The ITU has 2 beds with a couple of old ventilators but limited other equipment. The surgical ward has dozens of patients waiting for operations but the theatre staff are regularly unable to operate as there may not be oxygen or anaesthetic drugs or gloves.

There appear to be many issues facing the hospital but there are also lots of things to learn. My colleagues in the physio department and on the wards have much more practice in critical prioritisation of work than I would ever need to do in the UK. Although I want to be a resource and involved in developing the services, I am also keen to learn from them.

After many weeks of searching, deliberating, praying, a contract has now been signed on a house for me to live in. Nicknamed the house on the hill (to differentiate it from all the others we have been looking at) it is not on a very big hill, more accurately it is nearly the highest point on a long ridge just outside Mbarara in a place called Nkokonjeru but it does have a great view and looks East/West which is not bad considering the beauty of African Dawns and Sunsets (I think I may spend more time appreciating the latter than the former!!)

The house currently needs a bit of work doing on it before I can live there. The urgent issues are securing the ceiling that looks like it may fall down at any moment and putting in a new secure gate to replace the sheets of corregated iron that are there at the moment, but we are also hoping to finish the electricity installation and so I can have a few working plugs and lights. I think putting in hot water and a tank is beyond our budget at the moment but having running water in the house is better than what I had when I lived in Kenya so I am not worried about that. I meet with the landlady tomorrow and I am hoping to move in if all goes well within the next two weeks!

This is the same house that I put a photo of here and I do feel very privileged to be getting this house but after all the deliberation it does feel like it is the right place for me to be.

It is also the house that has the small banana plantation, mainly Matoke (savoury bananas) but a few yellows too – very exciting. After only having a few houseplants to look after for the last 15 years, this is going to be a steep learning curve. But this was one of the deciding factors in the house. If I am going to be working with people who spend a lot of their time working on land, it is going to be good for me to have an understanding of where they are coming from. This all being said, I still intend to be spending the majority of my time being a physiotherapist so I will need to be employing workers too… a whole new world!

For those who are interested… here is a google map of some of the key places for me in Mbarara!

View Larger Map

I always knew living here was going to be an education. This weekend I gained a better appreciation of the origins of meat! Some of my colleagues here have been rearing pigs and Saturday was D-day for one of them. I forced myself to go, figuring that if I am happy to eat meat then it would be good for me to accept where that meat came from. It was certainly not a pleasant experience but I was glad I went.

Watching! (adapted for my more sensitive friends!)

The next morning I discovered that Harry the Rooster who I had developed a particular bond with (and roosted in my house on many occasions) had become part of an Easter feast for my landlords family. I hope he tasted good!

Seeing the sacrifice that these animals gave to feed us, was a very small glimpse at a much much bigger sacrifice that we have been remembering this weekend. It was a very timely reminder. Thank you so much Jesus for what you did!

I have just heard that my freight has arrived in Kampala and may even be brought down to Mbarara this weekend. I am very excited.

I am very conscious that material things are something that I have been blessed with compared to many people around me. It is hard to find a moment when you don’t feel extortionately rich (even when I am doing unpaid voluntary work). I am therefore more than aware that I could cope absolutely fine without the items that I have had shipped over. But as I own them anyway, it seems crazy for them to be sat locked away in the UK! Here are a few highlights:

A jar of marmite!
Impossible to get here and my fellow westerners don’t even know about it let alone have a secret stash! YUM!

My physio books!
I am already being asked many questions about physio issues I haven’t worked with for years – it will be good to be able to revise!

My tent & bivvy bag!
There are lots of places to visit in Southern Uganda but beyond my budget – a tent will give me freedom to go and play sometime! In the meantime, camping out in my garden under the stars sounds fun!

Shampoo!
Buying shampoo here is a bit of a treasure hunt as I discovered last week when I ran out, I had to trawl various “supermarkets” and eventually found one bottle which I think is shampoo but my hair is not so sure!

British Chocolate! (If my parents have been nice to me!)
There is Cadbury’s chocolate here but it isn’t quite the same – I suspect that there must be some anti-melt ingredient in it.

The main thing I am excited about is just having reminders of home. With constantly facing new things here, it will be nice to have a few new things that have some old memories attached!