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…!

Our own personal golf course...

Whilst Alison beavered away with the other VSO health workers at a conference in Seeta, Alan took his caddies along to a golf course in Lugazi sugar plantation. There was not another soul in sight and looking at the visitors' book, the course doesn't get played much. Due to this and the surplus of local labour, the course was in great nick and we made it around 8 very hilly holes in the midday heat, before the 3 caddies pictured wanted to retire to the 19th hole.

Splash it all over!

We spent most of the weekend helping paint the children's malnutrition ward at Kampala's main hospital, Mulago, with the other VSO volunteers. Girls took ownership of some chairs and duly made them their own with some alternative designs.

Worryingly, baby wipes beat white spirit hands down in removing the gloss paint from the participants. Dread to think what the magic ingredients are!

Sunday Treat!

After 4 days without water, bucket washes lost their novelty and so we escaped to the American Club for a long hot shower. The brief swim pictured here, although pleasant on a hot day, simply provided the excuse to use their washing facilities. We have become members of the club for the year, which will provide a welcome haven and no shortage of extra-curricular activities.

Lucky escape!

On our way back from town today, we had our first brush with the Ugandan police force. One of the big hazards of driving in Uganda is being stopped by the police and being fined for various 'offences'. Alan allegedly took an illegal U-turn and this stern copper told him to pull over so he could write out a ticket for the offence. Conveniently thinking he was being waved on by another policeman, Alan saw the opportunity to drive on and leave the policeman on foot in his wake. Further down the road, celebrating our narrow escape, we were surprised to see the policeman pulling up alongside on the back of a taxi motorbike, much to the girls' horror, waving angrily to pull over again.
After a discussion over the finer points of Ugandan road law, with some vociferous contributions from Alison in the backseat, it was decided to revisit the scene of the crime to prove that there were no road signs about illegal U-turns and to show how we were not the only law-breakers there. We gave the policeman a lift back in our car, offering some cold pizza on the way complemented by Zoe turning on the waterworks in sympathy for daddy going to jail! This may have softened him a little, but he was still adamant that we pay the fine or go to court.
Alison got out and took some photos of the crime scene and Alan politely enquired if the policeman was going to arrest all the cars breaking this law, whilst all 3 girls continued to sob in the back! Sensing that we were not going down without a fight, the policeman finally backed down and asked us not to do it again, to which we gratefully agreed. We wheelspun away, enormously relieved not to be spending the night behind bars!

Clarks with a difference!

We went into Kampala to East Africa’s biggest market to get the girls’ school shoes and it was quite an experience. We disappeared into a rabbit warren of covered stalls with row after row of everything you could imagine. In the shoe section, we were collared by a bunch of very eager chaps who had a selection that ranged from second –hand Clarks with the original owners’ names still inscribed (although the shoes had been very well polished!) to the latest fashion, completely impractical high heels in shiny patent leather. Guess which the girls went for?! Schools starts 26th August and they can't wait (neither can Alan!)

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!!

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?

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!

UPCOUNTRY AND BEYOND

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.

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!

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!!

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.

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.