Chocolate heaven

The most important news this week is that a lone bar of Galaxy chocolate arrived at our Post Box much to Maggies delight. We have had a post box for the last 4 weeks but this is our first delivery. It arrived safely if a little misshapen after only 1 week. Thanks to Kare for her trust in Ugandan Post. We have a post box but so far do not have a key for it. Maggie goes every week to ask for the key to be told 'the man' has not made it yet so come back next week

Last weekend we had a visitor, Dada from the Philipines one of the VSO volunteers working in Kampala came to Masindi as part of her work on environmental issues. She and Daryll, another volunteer, cooked a wonderful Filipino chicken dish and we all watched Motor Cycle Diaries round the laptop. Who says you cant have fun in Masindi? This was the first time we had bought chicken here. You have two choices: buy a live chicken from the market or off the back of a bicycle, kill it, pluck it and then cook it, or go to the Shell garage and see if there is any frozen chicken in their freezer. At least Shell have a generator so you hope the freezer has not defrosted too many times. We opted for frozen.

Maggie has been busy at Court View Hotel. Sallie, who owns the hotel, has been in the UK and she asked Maggie to keep an eye on the place especially the kitchens. The first food hygiene courses were held this week and well received. One of the biggest challenges is to get the rats out of the kitchens. Another challenge this week was that Masindi had run out of gas for a few days so everything had to be cooked on charcoal. (notice we have adopted VSO's way of saying 'challenges' rather than 'problems'!) We are thinking of asking Gordon Ramsay to visit and advise. It would make a good TV programme. Court View is probably one of the best kitchens in Masindi but it is not quite to UK standards! Maggie is quite enjoying working with the staff who seem pleased that someone is taking an interest in their work. It is off putting eating there after Maggies description of what happens behind the doors but the food tastes good and we haven’t caught anything yet.

The HIV clinic is the main focus of my work. We see about 50 patients on Tuesdays and Thursdays. This week we have had 3 visits from the ministry of health . They are continually checking on what we are doing and looking at the documentation. Unfortunately this usually means stopping the clinic and keeping patients waiting for a couple of hours. Ugandan patients seem willing to accept long waits. We have supplies of ARVs but most other drugs are not available so it can be very frustrating trying to deal with patients' problems. This week I have needed to admit 2 patients from the clinic; one was dehydrated with dysentery and another had pneumonia and oesophageal candidiasis. Luckily we were able to access drugs to treat them. There are lots of patients with dual infection with TB and HIV. One of my tasks is to better coordinate their treatment as they can easily default from treatment which is a risk for the patient and the community. Another young patient at the clinic has cervical cancer as well as HIV. She was referred several months ago to the cancer specialist but as it is in Hoima 2 hours away she has not gone. She has no money for the fare and no prospect of being able to afford to stay in the hospital for treatment. Treatment is free in Uganda but you need to supply your own food and have an attendant to cook it and look after you. This young womans family can not support her so she will almost certainly die from her cancer if she does not succumb to the HIV. Another young woman with HIV on the ward has developed a stroke probably due to infection with toxoplasmosis. The treatment for that is not available so she has been taken home by her family to die.
The reality in Uganda is that many people are dying and it appears to be accepted. Patients are not demanding better treatment. There is a fatalism and people just say “this is Africa”. There is a lot of faith and that gives people the courage to carry on but sometimes it appears that it also prevents them from looking for solutions.

These are pictures I took in the HIV clinic - you can see how cramped it is. This was a quiet time. The guy in the fetching yellow outfit is a prisoner; we see lots of prisoners each clinic. The prevalence of HIV must be very high there. The man squatting has Stage 3 HIV and had dysentery. He looked alot better 2 days later after some antibiotics and fluid. His long term survival is unlikely I am afraid.

I also managed a trip in to the field to see some health centres. These clinics should provide most of the primary care but are sadly neglected. Staff are poorly motivated and often absent themselves from the job. The worst clinic we came across was anHC III which provided obstetric care. the delivery room had a foul smell which we traced to a dead bat in the corner. So much for infection control!

These pictures show patients at a health clinic plus the pile of used drugs and needles left on the windowsill.

Pictures of the market the clinic and health centres seem to go where they want and the captions go somewhere else. It is hard work being a blog virgin this posting has taken over an hour so hope you enjoy it.

It is Sunday morning and we have just had a walk round town but it is very hot. Morning coffee beckons and we have just had an invite for afternoon tea. It is tough in Masindi!