Mangoes, monkeys and Maggie

Chris and Maggie
in Masindi

Wednesday 27 August 2008

Late again




We seem to have been very busy this week. Being busy does not mean you actually achieve anything. Simple things can take a long time here even paying the electricity bill!. Pam our fellow VSO volunteer offered to pay our bill with hers this week. Monday afternoon she was all set when there was a major rainstorm so all travel was abandonned. Tuesday morning she was there at 9.00 am along with several other people. The office staff aplogised but said they did not have the key to open the office. They sent for the key and every one was allowed into the office. Then they realised they did not have the key to open the safe to get to the books.Another boda was sent to fetch another key.After an hour and a half the bill was paid. You have to pay bills on time here or the electric company just come and cut you off. Sometimes literally they just cut the wires.Power has been really bad recently with long power cuts over the last few days. I think this has been due to the bad weather as well as load shifting to spread the demand.
At the week end we had a trip round the local sugar factory. Kinyara is a huge sugar cane plantation and factory, one of three in Uganda. It produces thousands of tons of sugar for the Ugandan market.It is a fascinating process turning sugar cane in to crystal sugar.The factory is basicaly a huge crusher and pressure cooker.The power and you need a lot of power to make sugar comes from burning the residue of the cane.
On Monday we went out to a village to see Sarah a paraplegic patient from the ward.It was great to see someone who had looked so lost on the ward surrounded by her family and obviously the centre of things. She has a struggle ahead of her but is determined to survive.It was a difficult journey for us to get to see her down lanes and mud tracks right in the bush.We were amazed when we realised she had travelled to hospital, paralysed from the waist down, on the back of a motor bike!
It is wednesday morning and Pam and I are due to start some training of village volunteers. Hopefullly transport will arrive on time and we can get out to Bigando Primary school to start three days of training on preventative health. This will be an experience for us and all the volunteers and none of us know what to expect.

Tuesday 19 August 2008

T.B. or not T.B.



Thirty years working in the UK and I had never diagnosed a case of TB. In Masindi I seem to see several new cases a week. TB is often a co-infection with HIV so most clinics we see patients who may have TB. Some of these patients are very sick and many will die in spite of treatment. Diagnosis is not easy, our lab is under staffed and has only one poor microscope. Over the past few years several microscopes have been stolen. We are promised a new one once we have somewhere secure to keep it.The best way to diagnose TB is by microscopy of sputum samples.The logistics of getting 3 samples on seperate days to the lab is far from simple when patients live miles away from the hospital and have no transport.Some of the lab staff are not interested and do not accept samples or leave them too long to process them. The other way of diagnosing is by xray.Getting an xray is not always easy. This week the hospital has no films.The xray machine needs electricity so you can not take an xray if there is a power cut which happens for some part of most days.Once you have an xray it has to be interprated and here it is me who has to do that!.It is along time since i looked at xrays, you do not see them in general practice. Luckily another VSO volunteer Grania is working in Kampala and is a chest specialist. I regularly send xrays down to her either by taxi or even on the bus. Grania reports them and I can have a report back in a couple of days. A faster service than the NHS could manage in Hull. Grania is fascinated by our xrays because the changes are often so extreme. Patients here present late so the xrays can look unbelievable. Unfortunately Grania returns to London in September which will be a real blow.I will miss her support.
Last week I saw a little boy who Pam had seen on out reach. He had a swelling and deformity of his spine and was generally miserable.At the clinic I found out his father had TB. I arranged an xray which he was delayed because of no electricity but the next day he had one which confirmed my suspicion of TB spine.At 18 months this is a tragedy but he should do well with treatment.I referred him for treatment last week but he still has not started because the childrens doses are not in Masindi. I am still trying to get hold of the right treatment but if there is any more delay he will have to start on a fraction of adult tablets.
This week I also received confirmation that one of my patients has multi drug resistant TB. Raymond has been a volunteer at the hospital for many years and has had 5 courses of treatment for TB. I shared an office with him for the first few months of my stay here.When I realised he was still coughing up TB bacilli we agreed he would stop work at the clinic.I arranged for him to be seen in Kampala and after 3 months his TB culture has confirmed his TB is resistant to 4 of the standard drugs. It is remarkable that Raymond is still alive and active.Unfortunately there is no treatment available for him in Uganda. The drugs for MDRTB are very expensive and not available in Uganda. Raymond is one of many patients who waits for funding for exceptional treatment
In spite of the difficulties TB is a satisfying disease to treat. If you get the diagnosis right patients respond well and rapidly start to feel better, gain weight and get back to working.One of the challenges is that many patients do not finish the 8 months course of treatment. Follow up is poor and patients are lost to the service. This creates a real risk of developing resistant TB.

Sunday 10 August 2008

Compare and contrast




This week we say farewell to Olav, a VSOer from Holland, who is finishing his two year stint as an IT specialist at Kabalega Secondary School in Masindi. His skills have not been limited to helping the school; he has been in great demand for the whole community, including New Court View Hotel and all the VSOers. We will miss him for his good humour and good company, and not just for his incredible patience when sorting out everyone’s computer problems! Whenever we saw him the conversation always began with “Olav, just one quick question…….”. We had a small party for him and fellow VSOers at our house; the hotel came up trumps again with a Mongolian barbeque and my sticky toffee pudding went down quite well. Needless to say we shared a few beers and glasses of wine!! By contrast, the school had organised an official leaving do for him which we attended last night. Naturally, it was a very typical Ugandan affair. The programme stated a 5 p.m. start and included prayer, six speeches which were each introduced by another speaker (therefore six more speeches!), gift presentations, a typical Ugandan buffet, followed by dancing. In true Ugandan style we did not arrive until 6.30 but the proceedings did not begin for another hour. At least we assume there was dancing; by the time the food arrived it was already way past our Ugandan bedtime so, after a decent interval, we made a polite exit. We were top table guests so had to be on best behaviour! Official functions are very popular here. We are not sure if the format is a corruption of the English way of doing things but everyone loves speeches, so the more the merrier. Whatever the occasion there is always a top table, a photographer and a master of ceremonies. The buffet is always chicken, fish, beef or goat stew, bean stew, matoke (mashed banana), potato (often sweet potato as well as plain boiled which they call ‘Irish’), rice, chapattis and possibly posho which is made from maize. On the same plate you will have slices of fruit, usually water melon. A meal here is not considered ‘food’ unless there are at least four carbohydrates together.

I (Maggie) put on my ‘Tour Guide’ hat again and took a family from Ireland to see the chimps. (Yes Mari, it was me last time too) This time they performed well (the chimps not the family!), though they stayed in the trees because it was raining. They were just waking up from their afternoon snooze and waiting for the rain to stop to go and raid the sugar cane. One toddler was having great fun on a smooth tree trunk by climbing up it and sliding down again! There was a lot of communicating going on which makes you realise that there are many more chimps than you can actually see. These small riverine forests are some of my favourite places here. They are really remote and very few people know that the chimps are there, so it’s a privilege to be able to go. We always see monkeys, baboons and lots of bird life too. I really had to keep a straight face when the mother of my group asked if the chimps would go back to the wild after being here - I’m really not sure how much more wild it can get!

Talking of wildlife, Chris is thinking of introducing a new Olympic sport. It involves a race to go out into the garden to hang out the washing and see who can get back with the least ant bites! At the moment we are plagued by an army of soldier ants which are huge and seem to find their way into your clothing within seconds. They have strong pincers and have to be prised off. I just wish I’d had the video camera ready!

Sunday 3 August 2008

A feel good story








I thought I would include a happy story this week. Reading back on the blog we seem to be concentrating on the negative bits but it is not all gloom and doom.
I was asked to see Vincent when he was a few days old. As you can see from the pictures he had a problem with his legs. I honestly could not immediately work out what was wrong but knew that his legs should not bend the way they were. I arranged to see him two days later and rushed to the internet. A few minutes later I had found the answer. He has bilateral congenital dislocation of the knees a rare congenital abnormality. Not only did I know what was wrong with him but I knew he could be treated quite easily by splints and physiotherapy. Unfortunately I was not confident that the treatment was available in Masindi.
Sally the local information centre knew a Dutch woman in Kampala who was married to an Italian paedriatric surgeon in Kampala. Networks here are so important. A phone call to Dr Fulvio led to an appointment in Kampala. The problem was how do you persuade an 18 year old girl from the village to go to Kampala with her baby and how does she get there. After some negotiation via a Ugandan teacher who works for the Ugandan Disabled Children’s Society it was agreed that mother grandmother and Vincent would travel to Kampala and stay at Katalemwa Cheshire Home where they would see Dr Fulvio. Luckily Sally and Maggie were going to Kampala so they were able to take the trio. Using funds from the UK we were able to pay the modest amount to allow them to stay for three weeks at Katalemwa. The treatment was free and Vincent returned to Masindi with straight legs. He should be able to walk and play normally. The family are so grateful for the help and support of people in the UK.
Yesterday I was asked to be a god father to Vincent an honour but I turned them down. I think Vincent deserves some body with more faith.

We were neglectful of the blog last week, not because there wasn’t anything happening but because we didn’t have time when we weren’t too tired to sit down and do it! One totally unexpected experience was when I was at the hotel and a local tour operator arrived with an American family of six. It seems Sallie had agreed that she would arrange a guide to take them to see the chimps that we know about which are in a small forest about 30k away from Masindi. These are chimps that are at risk from poachers and Sallie employs rangers to guard them. We are really fortunate because we sometimes get to accompany Sallie to see them. On this day Sallie was out of town and the guide she had arranged hadn’t turned up. I tried to find someone else who could take the group of Americans but failed to find anyone who knew the way. The only option was for me to pretend I was a tour guide and jumped in the vehicle and went! The Americans were really pleased to have a ‘muzungu’ guide - if only they knew! Although I’d visited the small riverine forest on several occasions I’d never really taken much notice of which tracks we’d driven along through the mile upon mile of sugar cane. One field of sugar cane looks pretty much the same as the other. I know someone who once lost his way and was driving around for 1 ½ hours trying to get out! Thankfully we did find the right bit of forest and I don’t think they noticed the look of panic on my face every time we came to another turning and I had to make a decision about which way to go. To cut an even longer story short, we did get sightings of some chimps but nothing like the display we’ve had on some trips. Luckily we saw various other monkeys, baboons, etc. but I had a job to keep the teenagers interested. I bluffed my way through the whole experience with my limited knowledge of the production of sugar cane and my equally limited knowledge of primates and wild birds! Anyway, the family seemed to go away happy - at least they hadn’t had to pay a fortune to enter one of the national parks. (Come to think of it, I didn’t get a tip!).

Masindi Movies: We recently bought half a share of a projector so I decided we should begin movie nights at the hotel, showing our vast and extensive range of DVDs! We held our first one on Saturday with a huge audience of 15 people. I thought it would be quite apt for our first ever showing to be The African Queen as a lot of it was filmed right here at Murchison Falls National Park. All was going well until 10 minutes before the end when the DVD had a blip and we had to abort - very embarassing!! No-one believes us that it ends with Humphrey Bogart being killed and Katherine Hepburn relishing her newborn zest for life and going off with three of the sailors from the Louisa.

News from home (UK!) - Kerry gave birth to Maxx on the 21st. Both are doing well. They are hoping to move to a bigger house in a couple of weeks. Becky completed the sponsored 10k in less than an hour and raised almost £800 for school fees for children in Masindi. Congratulations to both of them! Thanks to everyone who pledged money for the run.
Maggie