Meningococcal meningitis in Masindi

THE PHOTOS SHOW MAUREEN 24 HRS AFTER HER MENINGITIS TREATMENT SITTING OUTSIDE THE CLINIC AND ON THE BED WITH HER FAMILY.THE BUILDING IS PAKANYI HEALTH CENTRE WHERE SHE IS BEING TREATED.

The meningitis out break has continued and I have been able to get out in to the villagers to see what is happening. There have been no deaths in patients who went to health centres but there were 3 more deaths in the villages. Three patients had been seen in one drug shop and treated inappropriately. We visited the shop and found that it was illegally operating as a clinic and giving drips and injections. The nurse in charge could not speak English which means he had not been through secondary school or nursing college in Uganda. The owner of the shop claimed he was trained in the Congo but it seems unlikely. Hopefully the shop has been closed down but I suspect it will reopen some where else. There is money to be made.
Some of the patients had been treated in a Catholic clinic. It was unknown to the district officers but was of a high standard. The nurses knew what they were doing and the place was clean with separate rooms for patients. It had been decided to treat all the patients in clinics rather than bring them to the hospital. It was argued that they would get better care in the clinics.
The politicians have been visiting the area to look at the preparations. They were not impressed that the district had not provided fuel and transport for the health workers. Some sharp words were evidently said and hopefully things will improve now. Today they have sent vaccines so a mass immunisation campaign is starting. All gatherings have been banned and it looks like the schools will remain closed for an extra week. One of the politicians from Kampala was so concerned that he might catch meningitis he demanded the treatment just in case. The image of a politician having 6 mls of oily chloramphenicol jabbed in to his buttocks will be one of my memories of Uganda.
The weather has finally broken and is now much cooler and we have had some rain. This is good for the farmers and should help to stop the meningitis out break. The dust is settling and it is much pleasanter. It could be that this is a temporary respite and we could have dust and heat again but it is nice at the moment.
We had unexpected visitors from Hull this week. Mark and Jonathon had a 3 day job out side Kampala and paid us a visit. It is always good to see people from home and we had a great time catching up on news. Maggie took them on a day trip to Murchison falls and was rewarded by seeing a shoebill, a bird she has been desperate to see since we arrived. She is really enjoying the bird life and is very knowledgeable now.

Hot and dusty in Masindi

It is worrying when the Ugandans are complaining of the heatbut they are now.The last week has been very hot and every one is finding it difficult.By the time I have walked to work, ten minutes down the hill, I am ready for another shower. You sweat and smell all day until you climb the hill for home and another shower.We have it easy with indoor plumbing but most Ugandans have to collect there water from a well, river or borehole. You see children from about the age of four carrying water. It is part of their daily ritual and families will spend several hours a day collecting water.Often the water is not safe to drink so they then need to collect fuel to boil it. Obviously many families do not bother putting themselves at risk of diarrhoeal diseases.The dry season is hotter and earlier this year.People are worried that Uganda could be in for a drought and have to import food.This would have been unthinkable a few years ago but a poor harvest and increasing population could cause problems.It rained last night the first for 4 weeks but it did not last and by morning there was no sign.
With the dry weather comes Masindi's orange dust. This gets in to every thing and it is impossible to keep things clean. As you walk down the road you acquire an orange layer and ginger hair.The lorries are the biggest nuisance they throw up a thick cloud of dust that will envelope you for several minutes. Not only is this bad for your health and clothes but it makes you invisible to the next vehicle and many accidents are caused by dust clouds.
Last week there was an out break of meningitis in the district. There have been 6 deaths so far and several more cases. This generates a response from the district who try and manage the outbreak and limit its spread.Today I went out to the health centre to examine a new suspect. She was related to a previous case and had attended her funeral. The patient was 14 years old and had developed a headache and fever last night. By the time I saw her she was obviously very ill.The cases are looked after in the health centre in a makeshift ward with mattresses on the floor. I managed to do a lumbar puncture on her and prove that she had meningitis and she was started on treatment. Usually one shot of chloramphenicol is enough to treat the patient. There were several patients at the health centre who had been moribund a couple of days earlier who were now ready for discharge. It was impressive to see the nurses and community staff working together and saving lives.But the success is in spite of real difficulties.John who runs the community side has no budget for management of an outbreak. He had to borrow fuel from the Red Cross to get out to the health centre. There is no money for a radio announcement to alert villagers to the problem. There are no vaccinations for health staff and no money to pay their extra allowances. The sample of CSF needs to go to Kamapala for culture and he does not know where he will get the funds for the bus fare.
Money is tight for the routine care but seems available for HIV care. The latest NGO in the patch is just recruiting 48 staff and moving in to a big new office. Its role is to test babies and pregnant women for HIV. Unfortunately they are providing no funds for treatment which they are expecting the hospital to provide. Our clinic is struggling to provide care for are present work load.
On Wednesday I was able to order more mosquito nets thanks to the people who had given through the just giving web site. On Saturday 1000 nets arrived from Rwanda. Sometimes things in Uganda can surprise you with their efficiency. This week 3 more villages will be offered nets.

Happy New Year

New Years resolution was to make sure we did the blog every week end so we’ve failed on that one. At least I have managed to stay off the booze, drugs and single women.
Christmas has come and gone and the New Year has started. Christmas was different. Eating turkey, sprouts and bread sauce at Court View with all our friends was a good way to spend the evening but we missed family and friends back home. African dancers and drumming was a good substitute for Morecombe and Wise.
New Years eve was spend at Nabaye on the edge of the Budongo forest. Cathy and Roman are two research workers working with the chimps in the forest the held a party for all their staff. We had a great time with a big barbecue, dancing and fireworks. The night sky was fantastic with a million stars that you can never see in the UK.
Maggie and I had promised our selves a chill out weekend at Nile safari lodge to start the year. It was a great time and we avoided the game drives and just sat and read and watched the animals from the veranda. It is a special place and we love going there. Even the two punctures, the dust and the tsetse flies could not spoil it. We are going again next month when Hannah comes out.
The New Year has brought fresh challenges at work. We have now completely run out of anti TB drugs. This means we now have to say to patients yes you have TB, that is why you are coughing, sweating and losing weight. There is some really good treatment that would make you feel better within a few weeks. Unfortunately we do not have any, may be try next month. I can not understand how Uganda can run out of such essential drugs.
There was some good news this week. Vincent the baby with dislocated knees came to see me. He is fine very sturdy and taking his weight on good straight legs. His grand mother is very pleased and brought me a live chicken to thank me.