Wednesday, 29 July 2009

Making banana bread

The treat of the week has been the purchase of a small electric oven! We found the solar oven worked well for keeping food warm but when we tried to tackle anything more it went a bit pear-shaped! Much to our disappointment, after 2 days of cooking in bright sunlight, our banana bread was the same consistency as when we started out!! With the arrival of the oven Bella's birthday cake is back on the agenda, although maybe not the train cake that she is requesting!!!

Meeting Brian

We had the privilege of meeting this wee 1 year old chap, Brian, on the malnutrition unit at Mulago hospital. The Kampala VSO crowd had arranged to paint the unit over a couple of weekends, and whilst there, noticed that Brian, who was recently orphaned and has TB and HIV, was not being fed/cleaned. It seems that everyone had given up on him. As sometimes happens, the basic care of those who have no advocate in hospital falls by the wayside with the pressure of work, and those most vulnerable end up losing out. An impromptu rota of volunteers was arranged to pop in for feeding, cuddling and cleaning, and now a local orphanage is involved so he has really rallied. The girls, and especially Amy, loved the cuddles, as did Brian it seemed, so we hope to pop back soon. The next weekend of painting is planned for 2 weeks time so we may be able to leave Amy to do some babysitting while we paint. We will have to see how the other 2 get on wielding their brushes!!

Tuesday, 21 July 2009

The Walk Home

There is never a shortage of willing volunteers to accompany Alison on her walk home from the hospital. The pushchair is a bit of a novelty and always attracts a fair bit of attention. We've befriended a few local schoolchildren who are always keen to ask 'how are you?' and exchange gifts and letters.

Fish Supper!

Freshly caught Nile Perch- now where's that recipe for fish fingers?

Sunday, 19 July 2009

Silky Skills

Alan comes out of retirement to sign for the Dutch in an exhibition match against the mighty Irish. Bit of a challenge for the rusty skills on a slightly uneven surface.

New Wheels

‘Jasper’, our 4x4 with space for a couple of extra passengers. Well used to the erratic Ugandan roads!

Home Sweet Home

Our solar cooker- great if you’re not in a rush to eat (and the sun is shining!)

Home Sweet Home

Weekend chores- the new ‘housegirls’ getting stuck into the washing!


I have just returned after a 3 day trip to the upcountry clinics in Gulu and Lira, in the North of Uganda. It was a fantastic experience and I really enjoyed it! The 5 hour road trip up north was quite a challenge as the roads are pretty poor, although much better than they used to be apparently. It takes their toll on the vehicles so every few hundred yards there are cars pulled up having broken down. We passed a lorry whose engine had literally just dropped through the chassis onto the road!! Despite the quality of road and vehicle, people still go as fast as possible so the accidents are all too frequent as well. It was quite horrifying to be overtaken by a bus packed full of people travelling sideways at speed because the chassis was off centre!! Our pickup made it, although it did need new bearings to come back…apparently. It is quite common for requests for new parts to be made, requiring cash that then never materialises into the new part!! However, once we had acclimatised to the travelling, it was possible to enjoy the scenery which was spectacular and involved lots of greenery, colourful birds, baboons, and brightly coloured market stalls lining the roads. We also drove over the Nile which was superb.

We were really warmly welcomed on arrival at each of the clinics and treated to a delicious lunch of local cuisine which usually involved rice and a meat stew! After that, it was straight to work as time was very limited across both clinics. Stephen, the clinic pharmacist was not able to accompany us on this trip, so I did some of the pharmacy auditing at the clinics which was especially important as some of the drugs were going missing. It was an interesting exercise and I was in admiration of the clinical officers and nurses, who are also responsible for costing, dispensing and keeping track of the drugs in addition to treating the patients. Having completed a few checks I then ran a couple of training sessions over the 3 days and was encouraged by how actively and enthusiastically each team member participated. They all seemed to really appreciate the time spent with them. Some of the training was on women’s health, and the management of vaginal discharge and sexually transmitted infections. I had accounted for the fact that the investigations that could be done locally were very limited as there is no facility to culture the swabs, and so concentrated on what was available to process the swabs, such as microscopy and introduced the concept of testing the ph to distinguish the aetiology of the discharge. However, I had not fully appreciated that one of the clinics did not even have any equipment (speculae) to carry out the basic vaginal examinations and had never had access to this, despite also running an HIV clinic!! The beauty of working for a private organisation meant that we could arrange for speculae to be delivered to the clinic on the next trip, and this would benefit all the patients attending, whether they could afford the full price or not. It was an epiphany moment for me, as before coming out here I had reservations about working for a profit/not-for-profit organisation. However, especially in the upcountry clinics, it is clear that money made from those able to pay for their treatment, is fed back to subsidise those that cannot afford to access medical care. It seems the government-run organisations charge a nominal fee so all can be treated but if any investigations or treatment are needed, that requires an additional payment which most people can’t afford, and so their medical care often stops there. Within IMG, for whom I work, all aspects of the care of charity patients, from consultation through laboratory costs to drug costs are paid for through the not-for-profit arm, IMF. Obviously the number of charity patients that can be treated has to be capped but ways of increasing those numbers and extending into the communities to meet those that most need it are continually being looked at and it was great to be a part of that. I visited a school, Lira primary school, which refers a large number of charitable patients to the clinic with malaria, to see if there were ways of reducing those numbers through preventative means. Before visiting we had thought about possibly being able to get hold of some subsidised mosquito nets to distribute amongst the boarding pupils but as you can see from the photos above, even where there were mosquito nets, with the mattresses squeezed in on the floor in that way, they couldn’t be hung properly anyway. We were able to make a few suggestions t o rectify this and also other measures to help, such as reducing the mosquito breeding grounds around the school, and bringing the prep time forward so they were not up so late and exposed to the mosquitoes (all pupils did prep from 8-10pm every night!??) The clinic nurse was going to look at it more closely too. The headteacher said that about 6 pupils a day presented with suspected malaria so hopefully we may be able to impact on those numbers a little.

Friday, 10 July 2009

First week at work - International Hospital Kampala

I have just drawn to the end of my first proper week of work, and yet it feels like I have been here for ages! I am beginning to get a feel for what my role entails, thanks to the fantastic handover my predecessors arranged and the high standard of work they managed to achieve in their year here. I hope the bar hasn’t been set too high!!! The objective is to develop an ongoing training programme for all the staff, clinical and non-clinical, manning the rural clinics affiliated to the hospital (IHK) where I am based. This will be rolled out on an ongoing basis by a Ugandan training team who will maintain the continuity and standard of care in the group, as there is such a high attrition rate amongst the clinical staff. So, I am having to do a crash refresher course on adult learning concepts, consultation skills, reflective learning, significant event analysis, audit etc. I am also very grateful for the VSO pre-departure course which taught me a lot of the facilitation skills and teambuilding games that will be necessary to use in the clinics too, as encouraging a good team spirit is very important alongside the medical provision, in such remote settings. We are also looking at possibly getting involved with an NGO which provides a telephone advice service via mobiles to very remote villages in the North of Uganda that have limited access to healthcare. Not sure how feasible that will be though but it will be an interesting exercise and excellent if it works!! Anyway, there is certainly plenty to be getting on with! The level of need is overwhelming but around every corner you hear about such levels of compassion, it really is quite humbling. We are due to meet a 28y girl from UK next week who visited Kampala 8 years ago for a holiday and has ended up staying and taking in 16 orphans from the slum on our doorstep, and raising them on her own, supported by various small business she has set up around Kampala. One of her businesses is a small pre-school so Bella may pop along there for a few mornings a week.
Alan is kept very busy at home too, shopping, cooking and entertaining the girls! He is exceptionally good at it too and produces some amazingly tasty dishes on our 3-ring stove from all the fresh produce he barters for at the local market! When they are not playing with the local kids and neighbours outside, the girls occupy their time making crafts from packaging so our wee house looks fantastic with colourful paintings/banners/paper models etc. They haven’t once missed the TV! In fact, I suggested a DVD on our laptop at the weekend (I have to use it at work in the week) and it was shouted down in preference to emailing!! Amy is also busy writing a story about her African adventure and is on chapter 6 which we had to have as a bedtime story tonight!

Sunday, 5 July 2009

Play time!

We have just spent a lovely afternoon at Centenary Park in central Kampala with a crowd of the other VSO volunteers based in and around Kampala. All very relaxing until we realised the level of supervision required on the play equipment, in particular the trampoline!?!! You may be concerned about the lack of safety net,but we were more anxious about the huge tear in the centre of it!! Bella did land safely by the way!!

Saturday, 4 July 2009

Getting around

We have spent the first couple of weeks braving the roads on foot, apart from the occasional boda-boda (motorbike taxi!)ride as pictured here. However, dodging the vehicles, cows and mudslides has taken its toll and we are now looking at buying an old, but hopefully reliable, 4-wheel drive people carrier, which seats 8 people! This will also allow us to go on some road trips with a couple of spaces for any visitors too.

Less friendly locals!

Some slightly less friendly locals pictured here are ones to avoid on the roads! They have absolutely no lane discipline and have a tendency to use their horns to their advantage!

Friendly Locals

We get a lot of attention from the neighbourhood children who want to hold our hands and stroke Alan's hairy legs! Alison gets walked home from the hospital by a gang of schoolgirls on a daily basis keen to try out their English.

Wednesday, 1 July 2009

The Eagle Has Landed!

Apologies for the delay in starting this blog. The internet connection we were expecting in our Kampala home isn’t in evidence and we were thrown straight into VSO training the moment we got off the plane. Therefore, we’ve had to wait until Alison starts her job at the hospital before getting internet access. We should be able to update the site at least on a weekly basis, but things aren’t as technologically advanced here as we imagined!
First thing is that everyone is fit and well, bar the odd mild tummy upset (only really Alan from his more adventurous/cavalier approach to trying the local cuisine!) and only the one mossie bite, which Bella took on the cheek and then got infected. We’ve only really managed to pause for breath today after a week of ‘in country’ training and setting up our Ugandan home. We were very lucky to be taking over both a job and house from Pete and Fiona, who have been fabulous in helping us settle in and introduce us to essential local amenities and ‘dos and don’ts’. Without a car, it can prove quite tricky getting yourself established, but Alison’s packing was first class and the house even has some nice homely touches including plenty of pictures of friends and family- thanks for all your contributions.
Amy, Zoe and Bella have settled in incredibly well, from the moment we left the airport. They have embraced the whole African adventure and kept us laughing when things have got a little hairy, such as lack of beds and mosquito nets on our first night in our home! The heat and new cuisine don’t seem to have phased them either, although they did pass on the grasshoppers that we were offered as we dined in the street on our first night in Kampala. Having said that, they have been quite happy to try the odd fish head or two! Amy was the star pupil in language training and has been trying it out at every available opportunity, which are numerous given the amount of attention Muzungus (white people) attract on the streets. We’ve only walked a few paces from the front door, when we have numerous little hands from the neighbouring slum slipped into ours. After Alison’s first day at the hospital she was walked the 20 minutes home by a group of young schoolkids eager to exchange names. We already feel very welcome in the local community and feel very safe, even at night, although the mossies do tend to keep us indoors.We’ll fill you in further on our new lifestyle in due course. Thank you for all your emails; we do appreciate your support and updates, even if we can’t respond as yet.