Mangoes, monkeys and Maggie

Chris and Maggie
in Masindi

Sunday 28 December 2008







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.

Monday 22 December 2008

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.

Thursday 18 December 2008

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

Monday 8 December 2008

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.