Zanzibar

Think coconut palms, delicious seafood, a laid-back way of life and miles and miles of white sands lapped by warm translucent turquoise waters and you have Zanzibar. Of course there is much more to it than that - Zanzibar has a fascinating and turbulent history. Denise, Sallie and I began our trip in Stone Town, on the west coast, which is a labyrinth of Arabian-style alleyways packed with nineteenth century mansions, palaces and bazaars. We were lucky to have Farid (a friend of a friend) to show his us round his home town which he was so obviously passionate about. He introduced us to people and places which I’m sure we would never have found on our own. For instance, the tiny electrical shop whose owner gave us Zanzibar coffee served from deep down behind the counter, the little cafe serving a bowl of bhajia in a coconut and chilli sauce (that’s the only dish the owner has been selling for the last 20 years), to the very busy dhow port where we mingled with the fishermen and watched them at work. To the other extreme he took us to the roof top terrace of a house belonging to a very wealthy hotelier to watch the sun go down. We visited and supported (i.e. bought lots of nice goodies) the Arts and Cultural Centre which Farid owns. The centre provides training and employment for women. Stone Town is famous for it’s doors which were an important way to show the wealth and status of the person who lived there. They are elaborately carved and studded, each one telling a different story. It’s almost unthinkable to go to Zanzibar without going on one of the many Spice Tours on offer. This was a half day trip out to the farms, followed by lunch prepared using the local spices, of course, which we ate sitting on the floor of a traditional village house.
After a few days in Stone Town we moved across to the east coast to a hotel where our rooms were literally a few feet from the beach. Its remoteness meant we couldn’t help but relax. The nearby fishing village looks as though it has never changed. Men, women and children were fishing or collecting seaweed, the latter mostly for export to places like Japan and China for culinary purposes. We watched lobsters, prawns, crabs and fish being caught using traditional methods. We did our bit to support the local economy and ate very well that week! Despite tourism, Zanzibar is still a very poor place. When walking through the fishing village there wasn't a child who didn't hold out their hands and say 'pay school'. I'm sure most of them didn't even know the meaning of the words, in fact many weren't old enough for school, but they knew they were asking for money.
Other news: it was back to reality on Tuesday. Back in at the deep end at work with lots of issues to sort out. A couple of medical students, Susie and Steph, arrived from the UK whilst I was away. They are in Masindi for four weeks and stayed with us for the first few days. It seems that theft is on the increase in Masindi so we have now employed another member of staff - a daytime askari to guard the place. We are trying to see how many local people we can employ! We now have Rose, the housegirl, who lives in a separate house in our garden with her five children and husband Abdul (who is the askari at the hotel), Sam the gardner, Solomon the night-time askari and now Rasul the day-time askari. At least he can help keep the monkeys off my vegetables - there’s not much else for him to do!
Coming up ……...another trip to Fort Portal!

Where has all the blood gone

A day late for all those fans waiting anxiuosly around the world to see if I have survived a week of my own cooking.Surprisingly I have with a little help from some friends.
It has been a strange week not just because Maggie is in Zanzibar. Our first UK students arrived and it has been a good distraction showing them around the delights of Masindi and the hospital. They are here to do research which is difficult in the best of places but a real challenge here. Hopefully they will get something useful out of the experience.
Medicine has been a bit bleak here. The child with a cleft palate seems to have disappeared. no one onn the ward remembers him going but he isnt there now. It looks like the parents decided against intervention and took him back to the village to die.the fact that they already had six children probably influenced the decision. the logistics of surviving in Kampala must have appeared unsurmountable.
We have 4 patients on the ward awaiting blood transfusion.They all have haemoglobins below 5 .One is said to be at 3g.l. There has been no blood at the hospital for 10 days. More worrying is that there is no blood at any other hospital. We phoned the national blood bank today and they had none but hoped to get some tomorrow.It is likely that our patients will have to hang on for another week. Evidently this is a regular occurence when the kids are on school holidays as much of the blood is taken from students.We are not allowed to collect blood locally as we do not have facilities to test for hepatitis and HIV.
The drug supply is still precarious but we have been given permission to order some relevant drugs. let us hope they are in stock. we have the wrong testing strips for the glucometers that the ministry gave out. No one is sure whether the right ones are available in Uganda.
Time is really passing quickly. This week we shall have been here 8 months which is a third of our time.I am still not sure what we are achieving in the long term but every one still seems happy we are here. Ugandans are forever saying thank you and well done and I am not sure why.
I am sure Maggie will want to post her news from Zanzibar when she gets back. She is due home tomorow.


Chris

Time flies in Masindi

This week began with a meeting on HIV at a local hotel. It was an important meeting with national facilitation but called at 2 days notice which is often the way in Uganda. I received a phone call from Chris the clinic lead on Saturday afternoon saying that we had been asked to provide a 30 minute power point presentation on HIV treatmen for monday morning. So we spent 3 hours on saturday preparing a presntation.
I arrived for the nine oclock start at 8.45 as the hotel is just down the road from our house.There was no power , no computer and no projector so no hope of power point. The rest of the delegates arrived over the next hour and the meeting began at 10.45. This is a fairly typical Ugandan arrangeent. Time is very flexible here and you have to adjust or you will go mad.Meetings and workshops are very popular here. Attendees receive a lunch and a travel fee. Sometimes there is an actual attendance fee as well. With salaries being so low people rely on these fees to top up their take home pay. Unfortunately it means that people will attend almost anything wheter it is relevant or not.Their is another workshop this week on palliative care in HIV which I want to attend to meet people from the nearest hospice which is in HOima. Palliative care is a neglectd discipline here.
The child with a cleft palate turned up this week looking very frail. The mother who has 5 other children had obviously been unable to feed the child. I admitted him to the paedriatic ward for naso gastric feeding. Unfortunately the ward had nothing to feed the child with so we had to give a little bit of money to buy milk.Hopefully the child will pull through and the father will agree to let it go to Kampala. By coincidence a nurse missionary passed through Masindi this week and stopped at Court VIew for lunch. She offered to come back to Masindi and transport the child to Kampala if they agree. Networks and chance meetings are important here.
Maggie as flown off to Zanzibar with Sallie and Denise two friends from Masindi.When you are this far from home you might as well make the most of it.
We were reminded of home this week when the Hull Journal arrived complete with articles about friends we have left behind.The journal is about as far away from life here as you can imagine but it looks great on the coffee table!

BWINDI TRIP

We had been planning a trip to a community project in the far south west for several months. VSO have had a GP and community nurse working there for two years Paul and Vicky. Due to communication problems we had had difficulty arranging a date so when we received an e mail on Saturday suggesting a trip the next week we jumped at the chance. By Saturday afternoon we had hired a driver and 4w drive vehicle, booked accommodation in Kampala, arranged a visit to Reach-out Mbuya a HIV community project and managed to sort out a meal out with Dan and Grania our friends in Kampala. Things can happen quickly in Uganda.
Reach-out is a community based HIV programme which provides excellent home based care for people living with HIV/AIDS. It is recognised through out Uganda as a centre of excellence. Pam and I spent the day there seeing some of the work they do. We were particularly interested in their nutrition programme. They have support from various donors and have been able to provide nutritional support to children and malnourished adults. This is an area we would like to develop in Masindi. At Reach out not only are they able to give out food but they have a training scheme to encourage patients to grow foodstuffs. They have an impressive programme of community support and every week visit patients in their homes. The project was started by a parish priest and still is concentrated on the parish. This means most of the homes are within walking distance.
After two nights in Kampala we set off for Bwindi. This is a ten hour drive the last two hours on marram roads. Luckily Soli are driver was very experienced and we arrived safely on Tuesday evening. Bwindi is on the edge of the impenetrable forest where you can go gorilla trekking if you have the $500 for a pass. It is a stunning location with mountains all around. The first two nights we stayed in a lodge just in the park and hoped we might just bump in to a gorilla but no such luck. One of the advantages of working in this area is that rich tourists can be persuaded to donate money to support the health centre. Paul and Vicky have been able to raise an impressive amount of money and the centre has grown enormously during there time. There are new wards and a maternity block is about to open complete with a waiting mothers hostel.
Our particular interest was to look at some of there preventative work. They had had a major programme of mosquito net distribution which had significantly reduced the impact of malaria. Their nutrition programme was impressive and there was an active educational element. Pius another VSO volunteer from Kenya has started a garden which produces an abundance of vegetables and shows people what is possible.
Vicky and Paul made us very welcome and it was a great opportunity to discuss the challenges of working in Uganda and learn from their experiences.
Every one we met was welcoming and keen to show us their work. Maggie threw herself in to it all and was soon helping out the nurses. On one morning Scott the founder of the project took her on a ward round and she is now an expert at listening to chests and feeling spleens! The children’s ward was a delight so light and airy with children running around and playing so different from Masindi hospital. They even had an outside play area and a mother’s garden.
On one day we went out on a HIV outreach to a district health centre. It was disappointing to see that it was as dysfunctional as those in Masindi. Staff rarely attend and the place was run down and filthy. The most worrying thing was that it was close to the district headquarters and should have been easily supervised.
One of the delights of Bwindi was sitting on Vicky’s veranda watching the red tailed monkeys. The veranda is surrounded by trees and the monkeys are fearless. They often get in to the house to steal food. They are the most beautiful vermin you could imagine. There are also beautiful birds and butterflies around all the time. It really is a beautiful place.
We left Bwindi impressed with their achievements with ideas which we could transfer to Masindi. There are major differences in the set up and working in the public service has challenges especially lack of resources but hopefully we can do something. On the journey back Maggie was able to buy some crafts for the shop. She is becoming very adept at haggling a true African.
It is ironic that after all my efforts to avoid the pharmaceutical industry in the UK this trip was partly paid for by a grant VSO received from Astra Zenica do not tell any one.

Returning to Masindi was a shock. All those plans have to be put on hold because of work load. Monday morning found me doing a ward round alone. There where 6 mattresses on the floor with extra patients. There were the usual mix of patients some who should have not been there and some who were seriously ill. The number of malaria cases seems even higher. This week national TV news showed mosquito nets being delivered to Masindi hospital for use on the wards. There was no evidence of them and the sister had no idea they had arrived. I am becoming more confident in diagnosing TB or may be I realise that no one here is quite and my guess is as good as any ones. We seem to diagnose two or three cases a week usually a co infection with HIV. It is really satisfying to see the improvement on a few weeks treatment. Patients you really thought were at deaths door restored to health. One of the big problems here is following up patients to make sure they complete treatment. Only 38% of TB patients take the full eight months of drugs.
Some time this week I was asked to see a baby born in a village who was not feeding well. She had a cleft palate and will need surgery. By the time I contacted Andrew Hodges a plastic surgeon in Kampala the mother had run away back to the village. Luckily we knew the health centre that she attends and were able to visit there the next day and arrange to see the baby again. There is an opportunity for her to be operated on in Kampala but the question is can we persuade the mother to take her. We shall see.
At the moment JCRC have failed to send the grant to run the HIV clinic. Although we have drugs all the other things needed to run a clinic are in short supply. Worse of all for me is that the internet subscription has not been paid so I am having to rely on the internet café which is slow. We are still trying to get connection at home. The right phone has been located but the connecting cable is in short supply. Evidently they fetch a good price in Congo and the Sudan presumably because of all the NGOs wanting connection. All the cables have been bought up and exported. May be that is what is meant by trade not aid but it is annoying.

Comments
It is great to read peoples comments on the blog. Unfortunately we have been getting loads of computer generated spam so I have had to put an extra manual step in the process. Hopefully it will not deter people from contacting us.