Posted by: zdy1 | 19 January, 2010

One year on…

Exactly one year ago I had just landed in Africa, having just said goodbye from everything familiar and unsure what was ahead of me. I knew that I would be moving to Mbarara in Uganda after one month orientation in Kenya but was unsure what that would look like.

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!).

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Posted by: zdy1 | 21 December, 2009

The Big Drive

In my last post I mentioned that I had travelled to Kampala three times in the last couple of months. I thought that the journeys there and back were worth a post of their own.

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!!

Posted by: zdy1 | 21 December, 2009

The Big City

Over the last couple of months I have had to make the journey to Kampala three times. Seeing as I had managed to only make the trip twice in the previous nine months, this has felt pretty excessive. Those who know me well will know that cities are not my favourite destination and seeing as this one is a five hour drive away then that makes this one less appealing. The first time was for a dentist appointment (read “even more depressing!!”) and the second was for a big physio meeting. However this weekend we went up so that a group of us could go to a big Christmas show put on by a Watoto Church.

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.

Posted by: zdy1 | 10 November, 2009

Two seasons in a weekend

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.

BonfireBrits

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.
toffee apples Noel & Pearl

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!

Posted by: zdy1 | 19 September, 2009

Getting around

(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: What is your name?
Me: Whitehouse
Boda man: as in Obama!
Me: yes as in Obama.
Boda man: But you are not American
Me: no I am not American.
Boda man: (just very confused)

Boda man: When you go home you take me with you.
Me: (“Usually some politish response but thinking ‘Why would I want to do that??!’)

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!!

boda1boda2
boda3

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 (!?!):

boda - car door

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

boda - broken leg

Posted by: zdy1 | 26 June, 2009

Rubbish Rehab Equipment!

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 🙂

Posted by: zdy1 | 26 June, 2009

What helps the best?

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!

Posted by: zdy1 | 14 June, 2009

Identity?

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.

Posted by: zdy1 | 9 June, 2009

Back to being a physio

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?

How do you treat the spinal cord injury patient who has not had his neck stabilised as is still on the surgical waiting list (1 month post injury)?

How do you treat the unconscious patient with sputum retention when you have no access to equipment like suction machines or humidifiers?

How do you support the patient who is wanting to discharge themself as they and their family cannot afford to continue buying food and need to return to their subsistence farming, even though it means that he may never be able to walk again?

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 🙂

Posted by: zdy1 | 9 June, 2009

Mbarara Hospital

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.

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