Snowmen in Africa!

Christmas is approaching fast and it doesn't have the same commercial profile here as in the UK. However, we've managed to get a nice tacky Christmas tree including flashing lights and have made some of our own decorations. Bella came with Alan to a friend, Naomi's, nursery the other day and we made snowman masks. They had obviously never seen a snowman, but seemed to quickly get the idea and were soon up to their eyes in glue and cotton wool! There was even a panto on at the theatre in town, which we attended along with every other expat in Kampala. Just trying to find a carol service to attend and hope that santa gets his letters from the girls with the Ugandan post!
Girls just broken up for the hols and Granny and Grandpa Cowan arrive tomorrow for 3 weeks- let's see what they make of it here!

The Gruffalo Gets Big in Kampala

Following a very generous donation from the publisher Macmillan via the fantastic efforts of Ed in St Albans, Alan was able to visit the Railway School today with a number of oversize picture books. These books are perfect for the huge classes here as everyone can easily see the pictures and follow the story. The books consisted of the Gruffalo and several others in the same series and they were greeted with great enthusiasm and wonder by all the children - it was like an early Christmas present!Alan then treated' them to a reading of each book before they break up for 2 months holiday this week. The school holidays are not necessarily greeted with the same enthusiasm as they are in the UK, as not all of the children can guarantee a meal at home whereas they are assured of this each day at school. That said, several of them have even had to drop out of school before the end of year exams this term, as they don't have the £10/term to pay for meals and equipment.

they taste just like prawns...

For one month only it's grasshopper season and you can buy them nicely sauteed on nearly every street corner in Uganda. Our Ugandan friend Innocent was kind enough to fry up a tub of the critters and bring them around as an (un)appetiser before dinner. Alan got quite a taste for them, the girls weren't have any of it and Alison and Natalie tried them after some gentle persuasion...

'Fun' Run in the Sun

Putting memories of his Great North Run collapse behind him, Alan joined Alison in Sunday's 10km run through Kampala. Both survived the heat and hills, along with the rest of the VSO team, albeit behind some of the half marathon runners, who set off at the same time! Note Alan's colour change in the before and after shots...
Swanny also managed to join the team. He is based here in Uganda for 3 months doing plastic surgery.

In-ger-land!!!

It was 'International Rainbow Day' at Zoe and Amy's school last week and pupils were asked to come in their national dress. Not sure what this was for England, we managed to track down some England football shirts and the girls went as traditional football hooligans...

Nat and Jack arrive...

Our friend Natalie recently arrived in Kampala laden with fruit, which was dissected in an alien-style autopsy. She is staying in our maid's room when she's in town, but we've let her off the cleaning duties- for now! She's working for the Malaria Consortium and will be based between Malago hospital in Kampala and hospitals around the country.

Move over Williams Sisters...

...here come the Cowan girls!
Coach Godfrey at the ARA is teeing them up for Wimbledon 2018- we may have to work a bit harder on Bella's ballgirl skills though.

a taste of Uganda...

We bid farewell to Uncle Jonathan and Cousin Lucy at the weekend after they spent 10 days experiencing the delights of Uganda. Hopefully they would say these included more than rain and transport issues, but those did figure quite prominently during their stay! We went on the road to visit Lake Mburo National Park again and were diverted off into some fields after a lorry overturned on the road. Then on the way to Jinja, we were navigating a roundabout in Jasper when a wheel fell off- luckily we weren’t going too fast! These incidents aside we packed in a lot of fun, including a rafting trip down the Nile, a visit to the ancient kings’ tombs and some game drives. We also camped in Mabira Forest- our first ‘proper’ camping experience, which was made all the more real by some very raucous monkeys and hyraxes near our tent and a 3 hour downpour at dawn! That was when we realised our tent was not quite as watertight as advertised! Likewise our house, as when we returned home to Kampala, the rain had lashed in horizontally leaving all Jonathan and Lucy's belongings floating in their bedroom.
Lucy kindly brought out a case full of her own story books so we took them to the Railway School, where they were very gratefully received and Lucy read them a couple of her favourite stories. When we walked into the classroom, we were greeted by 100+ excited, cheering kids- it felt a bit like we’d won We Are The Champions. I guess it was quite an eye-opener for Lucy, but it was especially poignant as her school has just been twinned with a school in Northern Uganda so she’ll be able to give the London schoolchildren an idea of what the schools here are like.

The Gruffalo's Child(ren)...

The girls were on half-term this week so after a trip to the cinema and a couple of trips to the ARA to go swimming, Alan took them along for his weekly session at the Railway School, where they were very keen to do some reading to the pupils themselves. We also made some flapjacks to hand out, which went down very well, although Amy had her hands full trying to ration them to one flapjack each! There was a cultural exchange of playground games and songs and both parties seemed to really enjoy themselves.
Thank you so much to those who have offered to collect books to send out to the school. We already have our first donation of books here, which arrived today with Alison's brother and niece. They will be joining Alan next week to start stocking up the library shelves.

Birthday Beer and Curry

Alan got to choose the destination for his birthday, so beer and curry it was. But he did have to wear a silly hat too.

Beaten at our own game...!

Alan turned out for VSO Uganda FC against the American volunteer version, Peace Corps, and to our shame we lost 5-1 having taken an early lead. Age went against us, but we were holding out until the heavens opened and our lack of appropriate studded footwear created several openings to the yanks who gratefully accepted them. The supporters were in fine fettle and not put off their drinks by the rain...

Charlie Dimmock eat your heart out...

The minature garden is coming along quite well with some help from little green fingers, although our gatekeeper was kind enough to point out that we had been lovingly cultivating a tub full of weeds, believing them to be some exotic chillies- Alan Titchmarsh I am not!
As well as the green fingers, Bella has been busy with her red, blue and green hands and feet...and plenty more of the arts and crafts now we are in half-term week.
Alan has his hands full with keeping the kids entertained. Alison's brother Jonathan and his daughter Lucy come out on Friday and we're off camping again with the hippos and hyenas.

The Gruffalo hits Kampala...

Alan went for his second morning of teaching at the Railway Primary School today. The school largely serves the local slums and street kids and there are a large number of orphans. The children seem genuinely delighted to be at school and appreciate any input. Despite Alan's best efforts with reading them some of his favourites, it was too much for some to stay awake. But with school hours of 7-5 and school lunch probably the only meal of the day, who can blame them?!
Teaching here is still somewhat along Victorian lines with a lot of rote learning, not helped by class sizes of 100+. Last week the classes were significantly smaller as over half of the children had been sent home for not paying overdue school fees (£10 for the term to cover food and other essentials)
The school has a large library consisting mainly of empty shelves and so if you have any old childrens' books you are looking to put out, please keep them back, as we may be looking to have some sent out here. They would be so well received and the kids are really hungry to learn. It is a privilege to facilitate this in some way

Back to Business

My feet barely touched the ground on our return from the clinic visits before the 2 day workshop for the doctors and clinical officers was upon us! Luckily, I had made sure that most of the preparations had been done before leaving on our trip, but the fine-tuning always seems to take longer than imagined, so the lead up to the workshop was fairly frenetic! We had a total of 19 participants and it all seemed to run smoothly with some good feedback at the end. All the delegates participated fully and worked really hard throughout the workshop. They engaged wholeheartedly in role plays, brainstorming sessions, small group work, and contributed actively to all of the sessions. One of the sessions I organised was on rational antibiotic prescribing, as this is highlighted as a general problem in Uganda, and so I had been looking at this a bit more closely as I visited the clinics. I was especially encouraged by the group’s active participation in this activity and the enthusiasm with which they suggested ways of improving their rational antibiotic use. We then broke up into smaller groups, and armed with appropriate evidence-based resources, each group was allocated a small disease category in which to work and come up with suggestions as to which antibiotic to use, at what dose, for how long and in which circumstances. We then discussed these choices as a larger group, and after some fine-tuning, we have collated the material into an IMC adult antibiotic guideline to help standardise antibiotic use across the clinics. As well as appreciating the opportunity to share ideas and best practice, all the participants commented on how much they also enjoyed making new friends, and not least of all, having fun together! The next workshop is scheduled for February although there is a request for them to be quarterly, so we will have to see what time allows. Especially since I am also hoping to get involved in setting up some womens’ health services for the local community where HIV and sexually transmitted diseases are rife and resources minimal, which could be a sizeable time commitment too! In addition to helping develop a robust evidence-based cervical smear programme at the hospital, which is also a worthy cause, given that the rates of cervical carcinoma in Uganda are very high. Oh, and with any remaining time, look into helping set up a Masters’ Degree course in Family Medicine at the university affiliated to the hospital! So in short, plenty to do!!!!
Alan is also busy getting involved in the local school where the ratio of pupils to teacher is 100+ to 1!!! Again, they are so grateful for any interest which makes it a very rewarding experience for all concerned. Reading books are a very scarce resource too so we may be issuing a plea for donations of books with which you have finished, so watch this space…!

Too close for comfort!

Hippos are the main killers here, but luckily we took precautions...

Into the Wild...

We headed out of Kampala into the country on a road trip that combined work and pleasure. Along with Alison’s sister, Nicola, and another doctor from IHK, Rob, we took Jasper out West to visit 2 of the regional health clinics and take in a couple of National Parks en route.
We stopped at the equator crossing for the obligatory photo and demonstration of how water flows in opposite directions down a plughole on either side of the equator. We then stayed a night under canvass amongst the wildlife in Lake Mburo NP. There were zebras, hippos and warthogs aplenty, as well as some rarer hyenas and leopards that were slightly harder to spot. The tent was rather remote and the nocturnal walk for Bella’s toilet trip seemed a bit long to Alison who was unsure whether she would find baboons waiting in the loo for her!
We then went to Mbarara where Alison and Rob did a day’s training with the clinic staff. We stayed 2 nights on the Mweya Peninsula in Queen Elizabeth NP in the hostel. On the first evening we took a stroll to a nearby restaurant armed with torches for the walk back in the dark. A few steps into our return, a Land Rover pulled up alongside and told us to jump in immediately as it wasn’t safe. We thought they were being overly cautious until later that night we heard lions roaring a few feet away from our room! The next day we went out in the car on a game drive and saw a number of lions up close, having taken a particularly hairy drive off- road, with which Jasper coped with surprisingly well. We also took in a great boat trip and spent some time relaxing by the pool at the upmarket Mweya Safari Lodge, whilst Alison went to the clinic in Kasese.
The last night of the trip was spent at Fort Portal, which occupies a lovely location in the rolling foothills of the Rwenzori mountains. We went out for dinner to celebrate fellow VSO volunteer Geoff’s birthday, and headed back to Kampala with a Dutch couple who hitched a lift. Jasper made it back without any problems and we are looking forward to the next trip out into the beautiful Ugandan countryside.

On the Road...

I am still really enjoying the work here, and I have managed to visit most of the clinics now, which was my objective before the 2 day workshop we are arranging at the end of this month. I spend my time at the clinics getting to know the team and seeing how the clinic runs, undertaking mini-audits of their antibiotic-prescribing practices (over-use of antibiotics is a widespread problem in Uganda), reviewing the emergency care provision at the clinic and also delivering some training in womens’ health. The other week I spent the day at a flower factory in Mukono, where one of the clinics is based, and found it very rewarding and inspiring. They offer primary care to the employees and also to the surrounding local communities, in which HIV is a big problem. They also have peer educator days during which they deliver health education to the local villages. They have invited me to hop onto the back of their motorbike in a couple of weeks time and join them at one of these community outreach sessions, which should be fun. They also make use of community-based volunteers, who offer their time free of charge to attend to house-bound people suffering with HIV, feeding and bathing them when necessary. The clinic staff do a fantastic job motivating the volunteers and patients alike and manage to maintain an excellent service with very little resource! Again, despite having quite a few patients with womens’ health issues, the clinic team were having to manage without any equipment (speculae) to conduct the relevant examinations! They are hoping to offer coils as part of their service next month, so hopefully the speculae will have arrived by then! We found that their emergency equipment was similarly limited, not even having oxygen on the premises!! So, not surprisingly, we found that despite having about 2 snake bites a month, they also did not stock anti-venom. On questioning how they manage such patients, the response was to monitor them and pray that the snake was not poisonous!!! Again, the benefits of working within the arm of a private, not-for-profit organisation, means that we should be able to stock all the clinics with emergency equipment and medication by the end of this month which will hopefully benefit the local communities enormously!!! We still have to work on the availability of anti-venom, as each vial costs about £130.00 with a limited shelf-life and since only a very small percentage of snakes are poisonous there is the potential for wasting a lot of money! Apparently there is a way of determining if your bite is that of a poisonous snake (other than if you are still standing!) through looking at the pattern of the fangs, so if there are any snake experts out there, we would welcome your input!!
We are heading out West this weekend to visit some clinics in Mbarara and Kasese. Nestled between these small towns happens to be Queen Elizabeth National Park so we are planning to fit in some safaris between the clinic visits. My sister, Nicola, is visiting at the moment, so along with Dr Rob (an American emergency physician who is also volunteering with VSO) Alan and the kids, and the resuscitation dummy, we will have a bus full!!! That is if we manage to leave Kampala! We are waiting to see how the riots settle over the next 2 days but are hopeful they won’t escalate, so fingers crossed we will have some exotic wildlife photos to show you on our next installment!

Like London Buses, It's another Birthday!

Hot on the heels of Alison and Bella, it was Zoe’s birthday last Friday. We celebrated with some of the other VSO volunteers at our local Italian restaurant, complete with a ‘Z’ birthday cake. Zoe’s present of a crying and laughing African dolly was a complete hit and is getting a lot of competition for attention from the other sisters. Thanks to all who sent cards/gifts/emails- most appreciated.

On Saturday we then went to Didi’s World- Uganda’s answer to Disney, but more like a static gypsy fun fair! It was so quiet that they opened up rides as and when you wanted them and you took your chances on the dodgy dodgems, rickety roller coaster, etc.

Treasure Hunt

Alison joined forces with 3 other brave lasses to form the Nile Special Team entering the Irish Society’s Kampala treasure hunt in the middle of the midday heat. There were about a dozen teams in fancy dress (including the pictured Jackson 5!) running around town following cryptic clues, which proved rather tricky as Alison’s team were all pretty new to town. However, against all odds they managed to pick up 3rd place. A welcome cold beer and barbecue followed.

Students + After Eights = Trouble...

We invited over 4 Leeds medical students for dinner this week who are doing some of their elective at International Hospital Kampala. They introduced us to a new way of eating After Eight mints that involved migrating them from forehead to mouth without the use of hands- well, witout a TV we have to take any entertainment as it comes!

First Day at School

Here are the girls boarding the 'school bus' for their first day at Rainbow School complete with tie-dye uniform. The day seemed to go well for both of them and they made some new friends. The cucumber sandwiches for lunch was the only let-down! The school follows the UK curriculum and has a really friendly feel to it. Bella starts at nursery next week for 3 days per week, which will give Alan a little breather.

Can I blame the altitude?

I dusted down my running gear and braved the Kampala hills this morning….and almost ground to a halt!!! I kept going, although barely(!) and managed to run for 40 minutes! I felt incredibly unfit though so I am now determined to get into a routine of regularly running and I have a few willing companions to accompany me/carry me! I think the Kampala marathon in November is looking unlikely though…!

The training team is launched!

The final ‘training the trainers’ workshop went off without a hitch on Friday. Members of the training team had volunteered to prepare some teaching on subjects such as audit, change management, chairing meetings, and so with some coordination and a few planning meetings the day ran very smoothly amongst flipcharts/role playing/group work/ and homemade flapjacks to incentivise the team! The idea is that members of the training team can now travel around the clinics throughout Uganda supporting the local teams on the ground, teaching and conducting audits and appraisals. The first audit on our list is to check hand washing facilities at every clinic, something that my predecessors had worked very hard at ensuring was in place, so fingers crossed! I have also been conducting mini-audits at the clinics on rational antibiotic prescribing, something that is notoriously problematic in Uganda, with a view to improving and standardising management across the clinics and hopefully coming up with an IMC antibiotic guideline which we will tackle at the doctors’ workshop at the end of September. So we have a busy few months ahead, but all very exciting!

The rainy season has arrived with a vengeance!

It started on the 15th August, as every Ugandan seemed to predictmuch to our amazement, and involves daily downpours like that pictured here. The storms are amazing and really dramatic… almost enjoyable, as long as you are not caught in it on foot, or in a car, attempting to drive!! Both of which we managed today. Alan and the girls chose the wrong moment to walk out for an ice-cream and half way there, the heavens opened. I jumped in the car to rescue them and almost ended up getting stuck on a road that had swiftly become a raging river, complete with rapids!! Thank God for the 4-wheel drive mode! Every day, you see cars that lack the necessary amphibious qualities, abandoned in ditches by the side of the road! The storms don’t last long and then the sun burns through very quickly. For those planning to visit, don’t be put off as apparently the wildlife is amazing in the rainy season and in fact some hippos have been sighted nearby on the shores of Lake Victoria!! We have not seen them yet though, but we can confirm that the birdlife has increased in magnitude! Unfortunately so too have the mosquitoes, much to Zoe’s misfortune as they LOVE her.

Bella's Birthday Bash!

The girls have just collapsed into bed after a day of balloons, face painting, dancing queen, party games and far too much cake and drink!!! Nothing new there then! The build up to Bella’s birthday was onerously big, especially when I cracked the first egg yesterday morning to start baking for today and almost in synchrony, the electricity and consequently the oven, went off!!! We had already tricked the girls into thinking Bella’s birthday was today to allow time to bake, after returning home from a 3 day conference late on Friday and the expectation for birthday cake had to be met. By midday the electricity still had not returned so we headed for the beach to join the rest of the VSO crowd for ultimate frisbee and a barbecue instead and then paid the price later as we were up until 1am this morning baking! Some things never change!! Thankfully it all came together and Bella seemed to have a fantastic time!!! The Snazzaroo face paints were a big hit, especially for the Ugandan kids, so we may have to set up a road-side stall! The rains held off too (the rainy season began yesterday with a vengeance!) so we could be outdoors for most of the day, which was great as our little house struggles to hold too many and we ended up being a fair few! Bella beamed from the beginning to the end of the day…!