Pictures of the hospital showing out patients and the wards.
Children outside their home and a mother showing how she is using her mosquito net to protect herself and her children.
Last week I had my exit interview with Sarah Kyobe from VSO. This gave me a chance to look back and reflect on the last two years in Masindi. It is hard to remember the frustration and depression that I went through in the first six months. When I arrived at Masindi Hospital in October 2007 I was excited and looking forward to working with Ugandan colleagues and learning about health in Masindi. Within a couple of weeks it became obvious that it was going to be a huge challenge. I should have anticipated problems when at the end of the VSO in-country training the representative from Masindi who was supposed to take us there had no transport and seemed to know nothing about what I was supposed to be doing. On the first day at the hospital the medical superintendent who had requested a volunteer announced he was leaving at the end of the week and there was no replacement for him. I had known that resources would be in short supply but I had not reckoned on the lack of motivation and commitment of most of the staff.
There is a major crisis in the Public Sector in Uganda. The population have no respect for public servants and the workers seem to do little to earn their respect. Of course I have met some dedicated staff but the majority are disinterested and often absent from their posts. It is not unusual to visit a school or health centre and find only half the staff present. On the wards nurses come late, they often do not bother with their uniforms and they regularly leave early with out handing over to the next shift. Thgis means that treatment is often forgotten and nurses do not know what is happening to patients. There is poor leadership throughout the service and staff behave as they see their supervisors behaving. Staff are paid poorly and often not on time. This is bound to affect motivation. There is no reward for hard work and people who do little or are absent will receive the same pay. There are no sanctions. Once you are on the government pay roll it is almost impossible for you to be removed. As the pay is so poor most health workers supplement their income by working in private clinics or running drug shops. It is not unusual for drugs destined for the hospital to end up in private clinics. Nurses and doctors seem to accept this as inevitable and there is none of the out rage that would be felt in the UK. When I call these people thieves my Ugandan colleagues think I am too harsh.
Reflecting on how I have changed I realise that I have become more tolerant of failure. I am not sure if this is a good or bad thing. It has probably been necessary in order to stay sane but I am no longer surprised when a patient dies unnecessarily. I can not change the system I can just try and move a few people forward. Things will change when enough Ugandans realise that things could be different. That is why advocacy and working with patient groups is such an important part of VSO’s role.
Although there have been a great deal of disappointments here there have also been some real successes. Treating infections is always rewarding as if you get the diagnosis right there is a good chance the patient will recover completely. In the West doctors spend most of their time dealing with the incurable degenerative diseases. A patient with malaria or TB can be at death’s door but with correct treatment they can be completely cured. I have saved more lives in the last two years than in the thirty years I spent in the NHS. Even patients with HIV are greatly improved by treatment. It has been wonderful seeing how people who are bed ridden and dying can be returned to health with ART. They can return to work and caring for their families and will remain well as long as they have access to the drugs they need.
The Miirya Project has been the most satisfying part of my work and I do believe it has made a difference to the villages where we have worked. The volunteers have shown a commitment and a willingness to learn that is rare in professionals. They seem to have a real desire to help their communities and given a little bit of help they can achieve good things. Pam and I have raised enough money to keep the project going for at least another year after we have left. I intend to continue to raise money and will come out next year to continue supporting the team, We have plans to continue selling mosquito nets but also we shall be developing the other work on immunizations, sanitation and reproductive health. Next month Pam is leading some men’s health days and I shall be interested to see how they are received. Trying to encourage young men to take responsibility for their own and their families health is difficult in any culture. VSO likes the project and is considering how it can be rolled out in other communities.
Looking back it has been a good two years. We have met some wonderful people and made new friends. We have had a chance to see a beautiful country and learn about a very different culture. There are lots of questions about development and how it can be achieved. We have no answers but we do understand the question a bit better. I am sure we have made a small contribution and been able to improve a few people’s lives. That’s not bad for two old buggers from Hull.
Hadija and Rita two children who have benefitted from the links to Hope ward at IHK Kampala. Hadija had her bowel obstruction from TB released and Rita had her congenital heart condition confirmed. Rita is awaiting heart surgery.
This lady was severely ill with TB and HIV six months ago. She was bed ridden and very weak. She is now back at work. A success for the Ugandan HIV/TB programme.
This is Chris the clinical officer who has taught me so much. He is hard working and motivated. He hopes he can go to medical school next year if he can raise the funds to finance his studies
Last weekend there were riots in Kampala because of a dispute between the Kabaka (King) of Buganda and the central government. At least 15 people were killed, 3 of them from Masindi. There was damage to property and cars. Kampala was cut off from the rest of Uganda and the army was patrolling the streets. Radio stations were closed and the main mobile phone company was down. We were fine but you realise how fragile the situation is here. There are elections next year and people are concerned that there may be a Kenyan type situation. We thought family would be concerned but it appears that no one in the UK was aware of the situation. A riot and a few deaths in a capital city in Africa is obviously not news worthy.
