Sitting on our patio drinking freshly brewed Ugandan coffee and looking over the Masindi hills shrouded in a dust haze leads you to reflect on the past year. We have had our downs, breaking my arm was not a good way to start 2008 but there have been lots of ups.
Uganda is a beautiful country with lots to see and experience. It has been good to be able to share some of this with students, friends and family. There are not many places in the world where you can see chimpanzees in the wild raiding the sugar cane! The wildlife in Murchison Park must be some of the best in the world and it has been a real thrill to get so close to crocodiles and hippos. They are big!! The rhinos at Ziwa are fantastic. Walking towards wild rhinos and being able to get within 30 yards of them is an experience to be remembered. They are prehistoric looking animals and you realise how lucky we have been to be able to see them in their natural habitat. The bird life here has been a revelation and most weeks we see something new. Today we are trying to identify a horn bill we saw at Kinyara sugar works. Our walk with John and Rena on the Royal Mile in the Budongo forest must rate as one of our best birding experiences. Raymond the guide knew all the birds and was able to entice several out of the undergrowth by mimicking their calls. Wild life is everywhere in Uganda; we will not dwell on the bats, ants and snakes in the house!
During the year we have met many different people. Sitting in Court View Hotel there is a steady stream of interesting visitors. Some are tourists but many are working for governments or NGOs. You get to hear about various schemes and projects throughout Uganda. Some of the schemes fill you with hope but others are badly thought through and designed to appeal to donors but achieve little for the population.
Living in Masindi makes you realise the incredible difficulties facing the ordinary people. Development and aid seem to be a two edged sword. It is difficult to know the best way forward. There are thousands of NGOs in Uganda and billions of dollars of aid flow in every year. In spite of this there is no functionning health service, the schools are struggling to provide for their pupils and the universities have stopped giving an education to their students. Aid is almost seen as a right here and Uganda has developed a dependance culture. The answer to almost every problem is seen as 'find a donor'. This is true of government, both local and national, as well as individuals. As a mzungu people often approach you to ask for money for every thing from school fees to finance for weddings or funerals.
In the villages children still suffer from malnutrition and women and children are dying every day from malaria and diarrhoeal diseases. HIV and TB continue to devastate the community. Unfortunately many NGOs are seen as serving their employees and not the community. If you want to make money in Uganda you work for an NGO. If you want to make alot of money you go in to politics or the church.
Our project providing mosquito nets operates at the village level and there's little scope for any one to cream off money. It has been one of my high spots getting in to the villages and seeing the volunteers selling nets to ordinary people for use in their homes. I really feel this will make a difference to many families and reduce the dreadful toll of malaria.
Thanks to every one for reading the blog. Special thanks to people who have bothered to leave comments.

Medical Matters

This week I thought I would write about medicine here in Uganda. The week has been interesting but frustrating
On Monday I did a ward round with the clinical officer. One of the HIV patients on the ward was still complaining of a severe headache and we were concerned she may have cryptococcal meningitis. We decided she needed a lumbar puncture. This means an relative had to go in to town to buy a cannula and some gloves before we could proceed. Reluctantly the nurse found a tray to put some swabs and hibitaine on to clean the patient. We managed to get her in a reasonable position on her bed and I proceeded to do the lumbar puncture, with no anaesthetic. Luckily I got some fluid without too much difficulty and we sent it off to the lab. This was my third LP since I have been in Masindi. It is 30 years since I did them in the UK.
Unfortunately the lab technician had decided to go off to his village but promised he would look at the specimen in the afternoon. We only have fluconazole as treatment and I decided to start her on it straight away. He did not arrive back until the next morning when he looked at the fluid and confirmed she had cryptococcal meningitis. When I went to check on the patient the next morning I found she had not been given fluconazole as no one had bothered to collect the drug! This time I insisted the nurse collect the drug and start the patient on it. On Wednesday she was definitely getting the drug but on Fridays ward round no one could find her. The nurses did not know if she had run away or just gone for a walk. Nurses unfortunately seem to have little sense of what is happening on their ward. There is no hand over and no sense of any one being in charge.
The nurse who had been on night duty Thursday night told me she had been ill with fever so she had rested and persuaded a fellow nurse to give her a drip, IV quinine plus an injection of chloramphenicol. She was walking round the ward with a cannula in her arm.
On the Friday ward round there were two patients who needed blood transfusions. One was a 12 year old girl with chronic anaemia and a huge spleen. Her haemoglobin was 6 after a transfusion. She needed more blood and referral for investigation. She probably has hyper-reactive malarial splenomegaly but she definitely needs blood. I was asked to see the other patient when she had collapsed out side the out patients. The story was of weakness and decline over the last few months. She was very pale and in heart failure.We admitted her to the ward and found she had an Hb of 4 and was HIV positive. Both these patients urgently need blood. There is no blood in Masindi or any hospital in the region. At this time of year the blood banks often run out of blood. I do not know if these patients will survive over the weekend
A patient I first saw in September returned this week. He is 14 years old and has a huge tumour in his abdomen. Last time I saw him he looked ok but he had not had the money to return to see me. This time he looked unwell and was obviously in some discomfort. The tumour had grown. I was able to contact another VSO doctor in Kampala who agreed to take him in to the charity ward at the international hospital. Luckily Sallie was going down the next day and she agreed to take Yoweri. The scan he had in Kampala looks like a lymphoma so he is going to have a biopsy next week.
On Wednesday I managed to persuade the leprosy nurse to follow up some patients we had seen a week previously. It was good to see some of them making good progress on treatment but one man has reacted badly and we had to bring him in to hospital for steroid treatment. We found another new case much to the nurses dismay. He thinks we are finding too many cases as it is making his work difficult! I had seen another case in a village but we could not reach him as the vehicle could not make it through the flooded road. Hopefully we can get him on treatment soon but we have run out of treatment at the moment.
We were asked to look at the children in a family were both the wife and husband have leprosy. I was surprised to be faced with 12 children from 2 to 15. The husband had 3 wives. Unfortunately he could not remember the name of the wife with leprosy! Luckily all the children were clear.
So apart from having few drugs, no blood and uninterested nurses things are fine here. Luckily we did get a supply of ARVs last week so we can continue treating the HIV patients.

The net distribution is going well. We have a net sale on Monday which is the first one without Pam’s support. Thanks to every one who has given through the Just Giving Site.

Merry Christmas

Chris and Maggie


PS Unfortunately Monday morning ward round found that the young girl had died on Saturday. Blood had finally arrived on Sunday too late for her but the other patients were improved.

Living in a cash only society

One of the many ‘challenges’ (not problems) of living in Uganda is non-acceptance of credit/debit cards or cheques. I don’t think we have made a single transaction which has not been cash. It’s not uncommon for our local ATM to be out of order or to have run out of money. When the army/police/teachers, etc. have been paid it’s impossible to get near the ATM for the whole week. I’ve known people to queue for hours. Therefore, we set off to Kampala last weekend for a Christmas shopping trip with very little cash. Unfortunately, non of the banks in Kampala would allow us to use our cards in their ATMs but God moves in mysterious ways! Just as I was on the phone to the Help Desk I looked up and standing next to me was our friend James, a Californian priest living in Masindi. I explained our predicament and he produced a stash of cash from his bag. It was as though he’d fallen from the sky! Without his help we would have been stranded. I must try the Help Desk more often!
Cash also came in handy at the weekend when the hotel had run out of gas, there’s none to be found in Masindi or district at the moment, so an envelope full of money was sent down to Kampala on the local bus and the cylinders returned on a later bus. How’s that for service?
Yesterday we came home to find that Umeme (the electric co.) had delivered our monthly bill with one hand and cut the wires with the other, despite the fact that the date for payment was not due. When they cut you off here they literally cut you off! I marched straight off to the office and demanded to be reconnected. The Manager understood that I needed the cook the ‘big man’ his meal! Once again, it was cash that saved the day.

Highlights of the week:
The VSO Masindi cluster held a Christmas party for 90 kids from the Family Spirit School, mostly orphans due to HIV/AIDS. It was great. See photos.
We found a turkey to go with the frozen sprouts. See next week’s photos!
Setting up the Just Giving website and selling mosquito nets.
Meeting lots of other VSOers at a party in Kampala.

Lowlights:
Starting four babies on ARVs with the expectation that none of them will survive more than a few months.
Realising that Uganda has run out of TB drugs
Buying a bottle of gin and finding we had no tonic.
Me having an argument with the chef who has already resigned but is saying there will be blood before he leaves Masindi. Hopefully not mine!

Maggie

Malaria and Miirya

THE FIRST NET TO BE SOLD

THE NETS ARRIVED FROM RWANDA

TRAINING OF VILLAGE VOLUNTEERS
Today has been a good day (apart from the 45 minutes at the police station but thats another story)
We received 1000 mosquito nets on friday. They arrived at 6.30 at night on the bus from Kamapala. They were unceremoniously dumped at the local filling station and so we had to borrow a pick up to get them up to the house.1000 nets take up a fair amount of space and weigh a lot. How Sam managed to get them here all the way from Rwanda I do not know but he did and this is our first consignment. Hopefully if the fund raising goes well we shall order more soon.
Today was a good day because we went to Rwemagali village and sold nets. Last week the village volunteer Harriet had been sensitising and mobilising in the village. She had put up posters and talked to people about nets and why they are necessary. Today when we arrived there were over 100 people sitting around waiting for nets.Rwemagali is a small village with 269 households containing 1900 people.So we had about a third of the households represented. Our three malarial focal people,Sally,Anna and Donetta gave their talk using posters that Pam had prepared. This goes through what causes malaria, how it affects you and how you can prevent it. Every one sat quietly and listened but when they asked for questions they were politely told to get on with selling the nets.
We sold 130 nets for 3000 ush each.So tonight hopefully those nets will be in use and people will be protected.Without the project there would be no nets for Miirya.Tomorrow two more villagers will be visited.Pam goes home on Sunday to raise funds for the project.We have to keep motivating the volunteers and make sure we get more nets to sell. It is a challenge but probably the most useful thing I can do in Uganda.
Thanks to every one who has so generously donated through just giving.

Education, Education,Education

This week I have been visiting primary schools to talk to teachers about HIV. This is part of mainstreaming HIV part of VSO’s programme. It also meant that Sue a volunteer working in education could tap in to HIV funds to pay for her literacy workshops. In all sectors HIV has the biggest budget. I was happy to visit schools and talk to teachers as they have a valuable role to play in HIV awareness.
Primary schools are a growth industry in Uganda with the population growing at such an alarming rate. Universal primary education is supposed to be free but there are so few resources in the government sector that many families opt to send their children privately. In the schools I visited all the classes were large including one of 136 six year olds. How a teacher controls that number of children let alone teaches them. How can you expect children to learn to write when they are crammed in to a classroom with no desks? They have to sit in rows on a concrete floor. The teacher is lucky if he has chalk, lately they have been using sticks of dried cassava as there has been no chalk provided.
In spite of the difficulties many of the teachers are trying hard to provide an education for their pupils. They can be very ingenious in using simple household items to make educational resources. I saw musical instruments made out of bottle tops, counting toys made from empty bottles and lots of posters.
Walking around the schools you see lots of messages designed to keep the children healthy. Many of these are related to HIV. Messages regarding abstinence, keeping your virginity, avoiding bad touches and beware of sugar daddies are all around the schools. In one primary school in big letters on the water tank was the message “Avoid early sex it leads to death”. I am not sure how these messages are received by children in primary schools and whether it changes their behaviour.
On Saturday we went to a fund raising event at the Masindi Centre for the Handicapped. This is a boarding school for children with special needs. The parents pay 60,000 ush less than £20 per term for education and full board. There are over 100 children from 6 -20 years. There are children with Downs’s syndrome, cerebral palsy as well as many deaf children. The classes are small less than 20 per class and the school provides physiotherapy for those who need it. The facilities were far better than I had seen in other schools and the pupil staff ratio was far better. The centre has had a lot of support from international charities and seems to provide a good service for these children. Often the problems begin when the children reach 20 and need to leave the school. There is little provision in the community for them and they have to rely on their families.
To continue with an education theme, I (Maggie) had an invite to attend an end of term Parents' Day at Ayesha's school today.Ayesha is the daughter of Rose who is our house girl. The programme was 5 hours long and I took the advice of a teacher friend to arrive at least an hour late - good advice! Nothing ever begins on time here. I was the only mzungu in an audience of at least 1,500 and the young children found me more entertaining than the performers! It's amazing how you can just look at a toddler and it will burst out crying; possibly something to do with the fact that there is a myth that mzungus eat little children. The programme proceeded as expected but I was fascinated with members of the audience going up to the stage and giving money to certain children while they were still performing, sometimes going on the stage itself. Parents were not particularly giving money to their own children but to anyone they felt deserved it. Those who had solo lines did very well. The headmaster even cashed in on this when, upon finishing to deliver his speech, he began a song and dance routine. By the time he'd finished his pockets were bulging from his admirers! Another thing that really got the audience going was a dressing competition. I was curious when I'd seen it on the programme but it really was just that. Four girls and four boys had to strip down to their underclothes and on the whistle had to see who could dress first. I just couldn't imagine that happening in the UK. Child protection doesn't come into it and of course there were the humiliated children who couldn't even get their garments the right way up never mind put them on. The audience loved it and the winning children loved it even more when they were showered with coins and the doting parents twirled them around the stage. Next came the eating competition which got the audience equally excited. Sadly I had to leave after three hours to check on the christmas cake in the oven!

The pictures are of Rosepreparing Ayesha's hair for her open day and the deaf children performing at the Masindi Centre for the handicapped.

Garibaldis, gingernuts and shortbread

There have been no bats, snakes, monkeys or any other unwelcome visitors this week. We’ve even had power for the last few days. On top of that, I bought a new internet modem for the laptop which will hopefully give us better access and freedom to mail whenever or wherever we want. Things are looking up!
Of course there are the usual frustrations but mostly they have become so predictable and commonplace that they hardly warrant a mention. One of the best ones today was at the Kinyara Sugar Works management club. The club is in the middle of I don’t know how many thousand hectares of sugar but the restaurant couldn’t serve tea because they’d run out of sugar! It also seemed quite alien to them that we could drink tea without sugar but after a bit of persuasion we got it. I didn’t dare complain about the dried milk powder. The only solution was to stick to the beer. At least it was a great day out. The weather was glorious with beautiful blue skies; we enjoyed lots of good company, good food and, of course, a pool to play around in. It didn’t really matter that the bread buns were full of ants and that the person bringing the burgers and salad arrived three hours late.
Someone mentioned the snow in the UK which at the moment feels like a million miles away. The rainy season has just about finished and it’s really hotting up now. December, Jan and Feb will be particularly hot. I returned last night from a couple of days in Kampala; a first attempt at Christmas shopping (and quite unsuccessful at that!). Unless, that is, I purchase some of the second-hand european clothes that line the streets and that we’ve all donated in the first place! There are some real bargains to be had! Things other than clothing are fake and not worth buying; they last no time at all. That’s true of most household items which are also relatively expensive. Fortunately the hotel vehicle uses diesel as there is a major petrol shortage at the moment, not just in Masindi, but nationwide. By the way, if Helene and Kristen are reading this I hope you have managed to get out of Queen Elizabeth National Park and back to Nairobi; it’s a long way on a bike!
Christmas has come early to Masindi. Lots of thanks to our lovely friends who have sent parcels recently. I could hardly contain myself when we received three on the same day and we have been enjoying Garibaldis, Gingernuts and Shortbread. We loved all the other goodies too.
I spoke too soon when I said we haven’t had any unwelcome visitors - I can hear Chris in the other room doing his dressing gown and plastic tub routine with a bat!

Another attempted break in!

Happily Maggies back is much better but she did have to take a day off work last Tuesday.While she was resting at home she heard the sound of breaking glass.She went to the spare bedroom and found a broken window with glass shattered all over the room. Rasoul our ascari had also heard the noise and rushed around to the back of the house. Happily this was not a thief but a monkey that had thrown itself at the window, luckily the monkey was ok. The monkeys are frequent visitors again.They are after the mangoes which are coming in to season.
We have had another visitor this week a bat flying round the living room.I am now getting to be a dab hand at catching bats. The trick is to throw your dressing gown over them as they fly past and then knock them to the floor. Then once Maggie stops screaming you can scoop them up in to a plastic container and put them out the door.
The power situation has improved for us but has been bad for the town. The main transformer has blown so Masindi has had no power for the week and is unlikely to be reconnected for another week. This is causing great problems for the hotels and shops as the freezers are not working. But it is only the muzungos and the wealthy who it affects because the vast majority of Ugandans do not have power at home.It is easy to forget how lucky we are compared to the majority.
This week we have held meetings with the volunters that Pam and I trained.The first meeting was attended by 40 out of 43 volunteers, who had walked up to 5k over bad roads to get to the health centre. They were all pleased to get their t shirts and mosquito nets but we were pleased to see that they were still motivated. They are all keen to use their knowledge and even keener to start distributing mosquito nets. We have 500 to distribute but need 5000. At the moment our best bet is to buy nets through the Red Cross from Rwanda. We are negotiating for a good price but will need to do some serious fund raising. Pam has decided to return to the UK in December and concentrate on raising the money to buy the nets.We have promised the volunteers we will get them and we can not let them down.
The picture at the top is one of my saddest pictures. This is a discarded mosquito net someone has been given and just thrown it away. They do not realise how it could save lives. This is why we are spending time teaching people about the value of nets and why we are selling the nets not just giving them away.

GREAT NEWS

Last week end we had a phone call from Goa. Becky and Gordon have decided to get married in March when we are back in the UK. This is great news and we are really excited at finally being in laws! In Uganda marriage is a huge ceremony and all friends and neighbours are expected to contribute. It is not uncommon for the wedding budget to be displayed on notice boards at work and people come around collecting. Happily this is not what they are doing. They plan a small wedding with just the family but a big celebration.
It has been hard to get back to normal after that news but we have had to concentrate on the here and now. Luckily my computer seems to have recovered. Like most of my patients I have no idea what was wrong with it and no clue as to why it recovered. May be the laptops immune system managed to overcome the virus. Unfortunately for many patients they do not survive but there are always surprises. This week a patient on the ward was semi conscious and we thought she had cryptococcal meningitis. The only drug we have to use is fluconazole. The patients only attendant was her 8 year old daughter but the little girl worked really hard feeding her mum and checking that she took her drugs regularly. The mum responded and is now eating and regaining her strength. It turns out that the 8 year old was also looking after her sister on the maternity ward who had just delivered. This little girl is the best nurse I have seen in Uganda.
Michael the man who went to Kampala was not so lucky. He has a broncho pleural fistula which needs surgery. Surgery is expensive so he is unlikely to have the operation. He is now back in Masindi and at work so he is better than he was.
Unfortunately this week Maggie has had a problem with her back. She shouted for help in the shower as her back had gone in to spasm. She has had minor problems in the past but nothing like this. She has been in agony but luckily there is a therapist who has just come to Masindi and he has given her some treatment. She has had some relief but it is still very painful and very frustrating. Hopefully a few more days and she will be back to normal.
On Saturday Sue one of the volunteers held a coffee morning to raise money for some training she wants to do. This was a new idea for most of the Ugandans who attended but they all seemed to enjoy it and managed to raise 250000 ush. This will go a long way to paying for the training and it was a great way of involving people in fund raising.
This is our eighth night without power. Power seems to have been bad for the last few weeks but this is really bad. It is difficult to keep everything charged and reading by lamplight is a real pain. It is hard to do anything at night. The computer is about to run out of power.

Food glorious food!

We are casting our minds back over the last two weeks trying to remember what we have been doing (we missed last week’s entry) and it seems that the most memorable occasions have revolved around food and eating! For my friends that will not come as a surprise. We are prone to fantasizing about food back in the UK and can’t wait for an almond croissant, fresh from the oven and ousing marzipan, washed down with a proper cup of Italian coffee, at the Nightingale Patisserie near Kare and Steve’s. Or maybe a nice fat crab sandwich at St. Abbs in Northumberland whilst looking out to sea. Then again, there’s fish and chips at Whitby which can only be eaten straight from the paper whilst sitting on a bench and shivering with the North Sea breeze. Or maybe a succulent pink leg of spring lamb and mint sauce. I could go on and on but must stop! We really don’t do so bad for food here. Last night we hosted a VSO meal for 9 people where we shared the cooking. We ate Italian stuffed aubergines and tomatoes served with olive and rosemary drop scones, followed by freshly caught whole Tilapia fish with a sweet and sour sauce and then sticky toffee pudding and fresh fruit salad to finish. Not bad for up-country Uganda! Thanks to Kare we are also indulging on Garibaldi and ginger biscuits this week!
One of our coping strategies here is to deal with time in bite-sized pieces, whether it’s events that are happening here or visits from other people, as long as we have something to look forward to! One such thing is our visit to the UK. It is necessary for Chris to return within the financial year to have his annual appraisal so we have just sorted out dates and booked our flights. Hannah is coming to visit us here in February so I (Maggie) will return with her on the 15th and Chris will follow a couple of weeks later. We will then have three weeks together in the UK which will hopefully give us time to visit London, Sheffield, Hull and Berwick (and hopefully see as many people as possible in that time).
On a sadder note, Chris’ laptop has well and truly died after contracting a very nasty virus which has wiped out his keyboard. We needed his laptop to access the internet at home as my Apple is not compatible with the system we have. The electricity supply for the last two weeks has been the worst we have ever experienced. Perhaps it’s the storms which have damaged the lines, as we are now in the rainy season, or perhaps it’s because people steal the wire for other uses. We had just got used to the luxury of having the internet at home but will now have to return to trips to the internet cafe and rely on them having fuel for the generator and for the network to be working.
Maggie
Miirya Volunteer Project.
Part of my reason for being here has been to try and develop preventative health in the village. This has been extremely difficult due to lack of resources and in particular transport.
Pam and I have managed to train 91 village volunteers in Miirya sub county. They are remarkable people. Many have been working in various capacities in their villages for many years. Some are traditional birth attendants, some are drug distributors and some health educators. There have been various projects where volunteers have been trained over the years but most of these have fallen by the wayside through lack of funding and organisation.
Our project is linked to community health centres which are key elements of the government health strategy. We hoped that by linking in to the government service this would mean that the project would be sustainable.
The emphasis of the project has been educating villagers about reproductive health, immunisation and malaria prevention. Part of the role of volunteers will be in helping in the distribution of mosquito nets.
Malaria continues to kill children in Masindi district. It accounts for about 80- 90% of the work of health centres. It is preventable. Families that use treated mosquito nets have far fewer attacks of malaria. Our aim is to offer nets at a greatly reduced price. Our problem is finding a reliable supplier and raising the money to buy 5000 nets.
At the moment our best source of nets appears to be to import from Rwanda. One supplier in Kampala raised their price by 100% overnight! The government supply seems to have dried up and they say they are waiting for donors.
It is frustrating to find so many barriers to such a simple intervention.
Chris

Playing god

This week Michael told me I was his second god. Michael, like many Ugandans, is a Christian - he is “born again” My status was achieved because I arranged for him to go to Kampala for treatment.
Michael is 35 years old and had had treatment for TB in 2006 but he had been troubled with a bad chest since then which was getting worse. He had seen several doctors in Masindi to no avail. When I saw him in the clinic he looked unwell and his chest sounded awful. He needed a chest x ray but as the hospital has no films at the moment he would have to have one privately. In the spirit of free enterprise the private clinic has increased the price from 10000 ush to 15000 ush as they are the only place to get x rays now. Michael had no money so using the donations I was given I paid for his x ray. His x ray was bizarre. He had complete collapse of the right lung with a pneumothorax and a fluid level. I am no radiologist and there is no one in Masindi to interpret x rays so I sent the film on the bus to Kampala. Godfrey the taxi driver picked it up from the bus and took it to the international hospital in Kampala. Grania another VSO doctor is my TB expert and has been a great help. She loves getting x rays from Masindi because they are always bizarre with gross pathology.
Grania felt that Michael needed his chest draining but agreed that it should be done somewhere safe and clean, not the male ward in Masindi. Grania oversees the charity ward at IHK and agreed to admit him there and look after him. This would all be at no cost to Michael as long as he could get there. Michael agreed to go but did not know Kampala. Luckily Sallie was going to Kampala and she agreed to deliver him to the hospital. So I gave Michael 20000 ush for his return fare and he went off to Kampala and he has already had the pus drained from his chest thanks to Grania’s expertise. He is very grateful to the muzungus’ network and to those people in the UK who gave me funds to use. Unfortunately without that help he would have just been left to get on with things.
If god is some one who has money and connections then I have been playing god all week. Because we have had no x rays I paid for another man to have an x ray. This confirmed TB so we could start him on treatment. The woman with a probable liver cancer needed money for transport to go to Gulu for further investigation so she and her daughter had 30000 ush. The 4 year old girl, who last week had been bitten by a dog that subsequently died, needed anti rabies treatment. She had been given one injection but needed four. There is no free treatment available and the family had no money so they came to the muzungu doctor for help. There is not much choice in that situation so she has been given the money for her treatment. It is not sustainable and the government should be providing the vaccine but it is hard to refuse when we have access to money.
But often you can not help. I could not solve the problem of the woman with HIV still breast feeding her 9 month old child because she could not afford any other food. My playing god could not help the 16 month old infant with HIV who weighed less than 5 kilos. His life will be short he is too weak to benefit from treatment and I am afraid he will die soon like his mother and father.

We have had visitors this week 2 very welcome and one not so. Susan and Shaun arrived for the weekend from Kampala and it was great to have them. Our unwelcome guest was a snake. On Friday night we arrived home to be told by the askari that Rose, our cleaner, had seen a snake in our bedroom. Searching for a snake at 10 at night with no power is no fun. We could not find it so went to bed. It was a strange feeling wondering whether there was a snake in our room. It certainly improves bladder control when you dare not get out of bed until it is light. We have not seen the snake , we hope it has gone back to where it came from but we keeping looking!

Twitching

We neglected the blog last weekend as I (Maggie) was in Kampala for various reasons but most importantly to meet John and Rena (friends from home) who have been staying with us this week. As always, the week has passed very quickly and we said goodbye to them this morning. We had previously visited John and Rena during their four-year stay in Nairobi so it was good to be able to reciprocate and host them here. It helped Chris to have some moral support for the work he is doing and also to be able to talk shop with people who understand what he’s talking about! We did our bit as tour guides and it was great to have John as a fellow ‘twitcher’! We ended the week with a three hour guided bird watching walk through Budongo Forest which has boosted my list of different bird species to over a hundred now. Who needs, TV, cinema or live theatre?!! At Murchison Falls National Park John managed to inadvertently see the highly sought after Shoebill Stork which many people from around the world come here to find (and quite often fail). So I’ve only got 11 months left to see it for myself. It was a real tonic to have John and Rena here. Our chats with them has made us think a bit more about what we would like to do upon our return from Uganda and also about what we can take from our experiences here and use in the next chapter of our lives.
After a steady stream of visitors for the last few months, it’s time to settle down and concentrate on work, though I keep hearing rumours that Christmas is looming - how can that be when it’s hot and sunny and feels like July? I haven’t heard a single carol, seen any Christmas trees, there’s not a bauble to be found in the shops and there aren’t any houses covered in fairy lights! There’s a distinct lack of turkeys here too; I wonder what stuffed Shoebill tastes like? (Chris just said I’ll get lynched for writing that!)
Here are a selection of our photos from the week. The budding twitchers are Rose’s youngest two children, trying to learn how to use binoculars for the first time!

It's great to be a tourist

For the last 2 weeks we have been tourists. With Becky and Gordon we have travelled around some of Uganda’s beautiful tourist spots. This is the first time Maggie and I have had a chance to see other parts of Uganda. It was great to see it from a tourist point of view, stay in nice places and try and forget about all the difficult issues here.
We picked Gordon up from Entebbe and spent the first night in Kampala. Early the next morning we headed south to Lake Bunyoni. This is about 8 hours from Kampala and the last few hours were on typical Ugandan marram roads, pot holed and very rough. It was a long journey but there was beautiful country side to see, very mountainous and green unlike Masindi. We arrived at the lake and transferred all our luggage on to a boat for the 15 minute trip to Bushara Island. This is a small island run by a community development organization. There are camping facilities, pre erected tents and a couple of cottages. We were in a cottage overlooking the lake surrounded by trees. The whole island is a bird watchers paradise with hundreds of birds all around you. We managed to tick off a number of new species on Maggies now quite impressive list. From our balcony we could watch the traffic on the lake. Every morning the children paddled there dug outs to the local school on the mainland. They start to learn to paddle from the age of 2 years. There was a volunteer on the island from Germany who has been teaching the children to swim. Many local people can not swim inspite of spending much of their time in canoes. Storms can blow up quickly on the lake and drownings are not unusual. The restaurant served a mix of Ugandan and other food but the speciality was crayfish. They are common in the lake and the locals catch them in papyrus traps which are found all over the place. Evidently the crayfish are not native species but were introduced by Idi Amin from Tanzania as he had developed a taste for them.

The weather was mixed but there was a lot to see. One day we had a trip to other islands by dug out canoe. These are the traditional canoes still made from a single tree trunk by local villagers. We travelled to Sharp Island named after a British missionary doctor who had worked in the area for many years. He had set up a leper colony on an adjacent island which at one time attracted patients from all over central Africa. His house on the island has recently been turned in to a guest house by the local diocese but seems to have very few visitors. The next island still had the old leprosy hospital buildings which are now used by a secondary school. It was strange to think how many people had lived their lives on the island slowly dying from leprosy. The last patients finally left the island in the 60’s. Sharp is still held in high regard by local people for what he achieved. The journey we had made to the island had been difficult but so easy compared to those original missionaries who travelled on foot before any of the roads were built.
We left Bushara Island and then travelled to Fort Portal and the crater lakes. This was another long bumpy drive but Sulaiman our driver managed it with no problem. He is a great driver who works for Sallie at Court View and is very experienced and seems to know someone wherever you are in Uganda. He is also able to answer our questions on any thing from politics to local wild life.
Lake Nyianabulitwa is one of three small crater lakes out side Fort Portal. Our accommodation was in two bandas overlooking the lake. The setting was fantastic and it was easy to sit on the balcony and just watch the lake and the wild life. We had been told that there was one hippo left in the lake so we spent 2 days trying to spot it. The first day we took a boat across the lake and then climbed up to the next lake. There were huge hippo foot prints on the track but we did not spot it. The climb to the next lake was strenuous but worth it for the view. Later we called on Mike and Barbara two volunteers who had come out to Uganda at the same time as us. They had been on a one year placement and were returning to the UK the next day. It was good to see them and arrange to meet up in Berwick next year.
The next day we had a longer walk to the "top of the world" a local viewing point which gives you a fantastic panoramic view of lakes and mountains. We walked down to Lake Nkurumba to have lunch at their café. The walk through the forest and round to the lake allowed us to spot lots of new birds and three types of monkey. It was a long walk but the views and the wildlife were spectacular.
Another long drive along some of the worse roads we had used this trip took us back to Masindi. Apart from a puncture the journey was uneventful but we were again thankful Suliaman was our driver.
After a few days in Masindi for laundry and rest we headed off to Murchison falls for our last few days. We had stayed at Nile Safari lodge when Dan had been with us and it is a wonderful relaxing place. The bandas have superb views over the Nile and you are surrounded by wild life. There were even frogs in the bandas!. Frogs and hippos make a great noise at night and you really feel you are in Africa but are protected from the reality of life there by power and room service!
The downside of Nile Safari is getting up at 5.30 am for a game drive. We dragged ourselves up and were at the ferry to cross the Nile by 6.45 only to find that the ferry had broken down. This meant that you could not get across the river to the animals. Suliaman managed to get us seats on the river boat for a cruise down to the Falls which is the other thing every one does at Murchison. We had a good cruise seeing lots of crocodiles, hippos and birds. In the evening we hired a boat from Nile Safari and had a trip in the other direction towards Lake Albert. As this was a smaller boat and we were the only ones on it the boatman Frances could take a more leisurely pace and get close to the animals. Becky thought he got a bit too close to some of the hippos but we managed to get some great pictures. This trip is my favourite at Nile Safari.

The next day we went for the early morning game drive and this time the ferry was working. Suliaman had arranged for us to have George as our guide one of the most experienced rangers. We had a good drive and managed to see all the animals we wanted apart from the elusive leopard.
All things considered this has been a great break and a good way to finish our first year in Uganda. It reminded us what a beautiful country Uganda is and what a lot it has to offer. It has been great to share it with Becky and Gordon and see the country through tourist’s eyes. We can really recommend Uganda as a tourist destination.

Back in Masindi Becky and Gordon are planning the next part of their journey to India and we are thinking of getting back to work. The last 12 months has gone quickly. We have learnt a lot and are still not sure of what we have achieved. May be in the next 12 months we can consolidate some things we have started and

Inspiration in the sticks

Becky here. I'm finally getting into the swing of things here in Masindi, i.e. the power cuts, red feet from the dust, navigating the half built roads and pavements, being called muzungu, everything you eat tasting slightly like midget gems (aka washing up liquid) and walking through grass without being petrified of snakes. I'm also getting used to every trip into town taking hours because of all the people who stop to talk to mum and dad. Mum seems to be getting to grips with Runyoro and Swahili, but dad's useless, no one even tries to talk to him in anything but English.

One of the most memorable experiences so far has been a trip to the Boomu Women's Group about 40min outside Masindi in the middle of nowhere. Mum and I decided to stay the night but weren't sure what to expect so we took huge bags packed with something for every eventuality, e.g. string, mosquito nets, candles, a penknife and lots and lots of biscuits and snacks. But we needn't have worried because our little banda was lovely, freshly painted with clean linen, towels, nets and not a snake in sight. We even had a jerry can of hot water to get showered under the stars (and the twittering yellow weaver birds making their nests in the tree above).

Talking to Edna, the lady who set up the group, was fascinating. Her story was really inspiring. She had left her husband with 2 small children in 1990 because, she said, it was impossible to 'develop' with a man around. She's been trying to put her children through school (her daughter is now at university which seems an amazing achievement) and support other women in the village ever since. The sad thing was that Edna couldn't see any future for her daughter, despite her university education, other than marrying a drunken man and returning to village life.

Edna took us on a 'community walk' through the fields to the local village. The proceeds of the walk are donated to a nursery school that the women have set up. Villages here are really spread out and are made up of lots of small clusters of huts which usually belong to one family, so just walking around one village took us 1 1/2 hours. Edna explained what all the different crops were along the way, and talked us through how they use the various leaves and stalks for food, medicine, and dye. She also talked about the many barriers obstructing development for the villagers, especially the women. One such barrier is the ever changing weather and seasons in Uganda at the moment. This means that women now have to plant crops throughout the year in order to safeguard against spoilt harvests because they can't predict when the rains are going to fall. As a result they are spending more and more time in the fields, leaving less time for other income generating activities such as basket weaving.

Back at the camp Edna attempted to teach us how to weave a basket and believe me it is much, much harder than it looks, shockingly so when you think that baskets are selling here for £2-3. Again, it was fascinating to hear how different parts of various plants are used in different ways with virtually nothing going to waste.

To top it all we were served a typical Ugandan feast of beans, veg stew, matoke, casava, sweet potato and rice all cooked on a charcoal stove with the root veg wrapped in a banana leaf.

With all the frustrations and scams that mum and dad have faced in their jobs in Masindi it is easy to think that people here are quite happy to sit and wait for someone else to come along and bail them out, but we both left Boomu feeling that Edna was an inspiring example of someone who was not only trying to lift herself and her children out of poverty, but support and motivate those around her too. We've been talking since about possible ways to support this project and hopefully we'll be able to go back there soon.

In the meantime we're all packed and ready to go for our much more upmarket tour of the mountains and lakes. Hopefully it won't rain too much because the roads are already getting slippy and muddy, but dad assures me that Sulaiman our driver is an old hand, and we're going in a big 4 x 4. Saying goodbye to all the staff at the hotel and here at the house seems to have taken forever and no doubt when we get back they'll all be rushing up to mum saying 'maggie, you are lost' as they did when she got back from Kampala last week. I dread to think what they'll be like when they leave for good!

Greetings and farewells

This has been a week of arrivals and departures. Denise, a VSOer in Masindi, completed her two year placement last week and departed for the UK on Monday. I (Maggie) accompanied her down to Kampala to say farewell. Denise was half way through her time here when we arrived and I can remember feeling very much the newcomer and she the wise one who had lived here for a whole year and consequently she suffered our constant questions and insecurities. Now we are in the same boat as she was then and it really brings home how quickly the time passes here and how little time there is to achieve anything. On the same day as Denise leaving we welcomed Laura, a medical student from the UK, who is spending her elective period here and staying with us for a week. I packed Laura off to Masindi in a taxi and waited another day in Kampala for the much anticipated arrival of Becky .. The taxi delivering us to Masindi then returned to Entebbe airport with Jarrad, a student from Hull, who has been with us for about 10 days. As Jarrad is considering a career in medicine he wanted to come out and spend some time with Chris – hopefully being thrown into the deep end of the Ugandan health service hasn’t put him off! Our next arrival is Gordon coming to join Becky in a week’s time. In the meantime, it’s been great showing Becky the delights of Masindi district, including chimps and rhinos. Unfortunately we came across an unexpected piece of wildlife yesterday. Becky has a real phobia of snakes and I haven’t seen one the whole time I’ve been here but, right on cue, one squirmed its way across our path! Now Becky’s inspecting under every bit of furniture with a torch! Gordon’s arrival will mark the beginning of our holiday. The four of us are taking off for two weeks to explore other parts of Uganda – can’t wait.

The Ziwa Rhino Sanctuary is only a 40 minute drive from Masindi. It is here on this 7,000 ha piece of savanah that both black and white rhinos have been re-introduced to Uganda. There are only six at present but it is hoped that one day the sanctuary will be home to many more. When we last visited in March the first calf has just been stillborn after a 15 month gestation period. Rhinos only produce every 2 or 3 years so it's going to be a slow process. We picked up our ranger guide at the gate and with the use of walkie-talkies to communicate to the other rangers he led us through the bush to find the rhinos. Fortunately we found the group all grazing altogether and they seemed more interested in that than us. We managed to see them at very close range, but I did stay very close to the ranger with the rifle and always had one eye on the nearest tree in case I had to make a run for it! Becky didn't think I could still climb a tree but I had not doubt of my ability if a rhino was charging me!
On our return to the gate we had an interesting conversation with the ranger. He told us that he only has five children so far and his ambition is to have 20! To reach his goal he is looking for a third wife! He talked of how a man is under pressure from his clan elders to produce many children in order to earn respect. If he fails to do so he is excommunicated from the clan. Our hints at expensive health care and education fell on deaf ears. He agreed that it would take a strong person to challenge his own culture.
Whilst at the sanctuary we paid a visit to Heidi who has been managing the place for the last few years. Sadly she had a very bad accident a week ago when travelling at night. A lorry forced her off the road and left her there in the bush. She couldn't move because of her injuries and whilst lying there a man came and robbed her of all her belongings. It was two hours before she was found by a more considerate person and taken to the hospital on a boda (a motorbike) with someone else on the back to hold her on. Fortunately she is going to be okay and will recover from her injuries but is obviously very badly shaken. She had already taken the decision to leave Uganda in a couple of week's time so it's a pity she will be leaving after such a bad experience. This is just another example of why we don't travel at night!

Where have all the nurses gone

On Wednesday evening I had a phone call asking me to see a relative of Sullieman one of Sallies drivers. The story was she had had diarrhoea for a couple of days and had become worse that afternoon. Sullieman offered to bring her up to our house. The last time Sullieman had brought someone to see me the patient was dead. This time the patient was unconscious. Limited examination in the back of the Landcruiser confirmed her need for urgent admission so I sent them down to the hospital. Half an hour later Sallie called to say they could not find a nurse. I went down and there were no nurses of any description in the hospital. There were two midwives in maternity but they could not leave their ward. The watchman who was supposed to call in staff in an emergency was drunk!
Eventually after phoning the administrator a nurse was found. I managed to borrow IV fluids from maternity , get some quinine from the male ward and put a drip up on the girl, she had cerebral malaria. The next day she had improved and she was able to go home at the week end. The medical superintendent assured me that this was an isolated incident and has never happened before. I hope he is right but I suspect nursing care at night is even worse than during the day.
We still have no gloves at the hospital. If you need a procedure you have to purchase gloves before any one can do any thing. We are short of cannulae, IV fluids and most drugs. Today I heard that we have no TB drugs to start patients on. As I diagnose TB two to three times each week that is a disaster.
This week Pam and I have started our education sessions for village volunteers. We were in Bigando about 8 km from Masindi. Some how we managed to get a vehicle and driver to take us out there on Wednesday morning. We had three days working with 42 volunteers from villages in Bigando parish. Most of them spoke some English but we needed a translator to help. Luckily Miriam the nurse in charge at the health centre was brilliant. We had three days of active adult learning, challenging for them and us but they all stayed the course This was one of the best things I have done in Uganda. The volunteers were keen and committed so different from most of the staff in the hospital. The project is to train the volunteers about preventative health especially malaria. We are trying to encourage the use of mosquito nets. We are searching for nets at a price we can afford so we can sell them at reduced cost in the villages. You would not think it would be difficult to find a supplier in Uganda but it is proving difficult. One of the main distributors has run out of nets. How come in a world that spends billions on complicated HIV drugs a simple net is so hard to come by.
At the week end we went to see the Family Spirit Centre again. This is an orphanage and school I have been to several times. It is run by a group of HIV positive men and women who recognised the need to support vulnerable children. It is the first time Maggie has been and she was impressed by the efforts of the school and their philosophy. They need money to complete their pit latrine and thanks Steve and Denise we were able to give them some money so they can complete it. Money is obviously tight at the school but they are trying really hard to give these kids a chance in life. It is always up lifting to visit the centre and the best thing about it is that it is a Ugandan response to a Ugandan problem.