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.

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