Muzungu, byeee!

In the four days that we have been home no-one has stopped us in the street to shake our hands, to ask how was our night, how is our morning, how is home, etc. Not a single child has called out ‘Muzungu byeee’ and we haven’t had any requests for school fees!
The grey, damp days are not so difficult; after all, we have had to deal with them for the last 50 odd years. Occasionally the sun comes out and the ever changing light over the river and sea is wonderful, reminding us of why we love this place. Communication is proving more frustrating than Masindi. We miss our little dongle! We do not have a landline, the mobile only works if we literally hang out of the window in the flat (or stand outside in the cold) and the only access to the internet is at the library. Why didn’t somebody remind us it closes all day on a Thursday?! So, just now we are on the train and not only can we sit back and enjoy the beautiful English countryside but we can take advantage of wireless internet. A great opportunity to write our last blog (and 100th posting!). Foremost in my memory right now are the characters who made our time in Masindi such a memorable one so I think it appropriate that my photo entries this time are of these people.

The three youngest children of Rose: Aisha, Udetha and Akim


Udetha and Akim returning from the mosque:


Tracy and Aisha returning from the mosque:


Solomon, one of our two guards at the house:


Rasul, complete with bow and arrow, who is also a guard at the house:


Some of the kids from Family Spirit Orphanage together with our niece Beatrice and friends Rick and Ed:


Susan, teacher and matron at Family Spirit Orphanage:


Maggie with Millie, an employee at New Court View Hotel:


A few of our Masindi friends at Chris' birthday party:


These are a few of my favourite shopkeepers in Masindi:

Looking Back

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.

The last month!

It’s hard to believe we are entering our last month here. Obviously there are mixed feelings about leaving as we have made a nice home and think we have made a good attempt at being part of the community. On the other hand, true home will always be the UK and we are really looking forward to being there. Many muzungu tourists pass through Masindi so it takes a while for the local people to know that we are here to stay. I really enjoy walking (or ‘footing it’ as they say here) through town and being stopped by people for a friendly Ugandan greeting and a chat. The conversation usually goes something like this:

“How are you?” ‘I’m fine, how are you?’
“How’s the day?” ‘It’s okay thank you’
“How was the night?” ‘It was good thank you’
“How’s home” ‘Home is fine’
“How’s him?” ‘Chris is fine too’
The three stage handshake can take just as long and starts off as a regular shake, then you rotate the hands to link thumbs and then end with a regular shake. This is sometimes repeated several times. Only after all this can you discuss any business.

A few people have asked what I am going to miss about Uganda. I think I will need to be home for a while to really know the full answer but the obvious things are the friends we have made here, our house and beautiful garden, the delicious fruit and vegetables, the stunning scenery and the wildlife. I can safely say that I will not miss mosquitos and all the other creepy crawlies, frequent power cuts, permanently dirty feet, the heat (can’t believe I’m saying that!), the all year round dark evenings, sleeping under a mosquito net, bat droppings in the bedroom, etc. etc. Utilities can be a problem here but I haven’t been away that long as to forget the battles we also had in the UK. At least when the electricity is cut off here I can go and see the manager and say “How can I possibly give the big man his dinner with no power?” This is something with which he has empathy and promptly arranges for reconnection!

Things I am looking forward to include: family and friends (obviously!), our own home, being in a bit more control of situations, a greater chance of people doing things when they say they will, 5 minutes meaning 5 minutes, constant electricity, the seaside, walking safely in the countryside, driving a car, good restaurants and more choice in the supermarkets (as daunting as that might be at first, I’m sure I’ll soon get used to it). I know Chris’ answer would be a lot simpler: being cold again and almond croissants (ideally from Nightingale Patisserie in Balham)!!

One of our biggest concerns about leaving here has been the fact that Rose and family would also have to leave the compound as VSO were not intending to continue with the rental of this house. She has been struggling to find somewhere suitable to live. Then on Friday we had the great news that VSO are keeping on the house afterall and Rose can stay. We’re delighted with this and so is Rose judging by the number of hugs I got when I told her the news!

One of the things we’ve enjoyed most about living in this house is being able to share it with our many visitors. It was lovely to see Becky here again last week and for her to be able to see how we’ve progressed in the year since her last visit! She was very encouraging and reassuring. This week we have our niece and five friends staying which is great fun and reminds me of home and the days of having a full house. Here is a photo of our team effort at cooking a Ugandan meal. We gave Solomon and Rose some to try. They very kindly said they liked it but our matooke didn’t score very well! I think Chris is pleased that I won’t be able to buy it back in Berwick.
Maggie

Our Ugandan meal:



Enjoying the evening sun in the garden:



Becky buying a bag on Gulu market:

THE MAN WITH THE KEY

THE VIEW FROM DIRK'S VERANDAH




VSO held two workshops last week one for “leavers” and one for the health volunteers. This was a great opportunity to meet up and discuss the highs and lows of volunteering in Uganda. Pam and I gave a presentation about the Miirya project helped by Stephen and John from the community department. This was well received and the project is seen as an example of how VSO can contribute to grass roots development. It was good to have positive feedback from people you respect who understand the challenges of working here.
Looking back at the project I find it is the work that I am most proud of. I can think of several patients who have benefitted from my interventions but the lasting effect of the Miirya project is much more important. Even today I was approached by one of the staff at Court View who told me his uncle in the village had learnt about Tippy Taps and now he wants to be shown how to make one. That is really the point of working with volunteers in the villages they are so enthusiastic and their enthusiasm infects other people. We have now distributed nearly 5000 nets and for those families we have definitely reduced the incidence of malaria. There is still a demand for nets and with the funding we have attracted we can keep the project going for at least another 12 months. The next stage will be consolidation and more work on hygiene, immunization and nutrition.
After the conference we went to Jinja to stay with Dirk. He is a volunteer with another NGO Softpower. He has been here five years and has built a superb house overlooking the Nile at Jinja. Sitting on his verandah you can watch the brave souls being put through their paces in preparation for the white water rafting. Maggie was very envious of the plot, it would be hard to find a better view. We had a good time in Jinja watching the rafters and eating good food. On Saturday morning we went to have a look round Softpower. They have an education centre and a health clinic. The clinic lab is better resourced and organised than the lab at Masindi hospital. The education block has a library, computer rooms and a theatre and pottery. There is also a craft shop where they sell crafts made by volunteers and local people. Of course we bought some items from the shop. That is were the saga of the key began.
After lunch when Maggie came to pay she realised she had lost her purse with our money and credit cards. A short moment of panic later she remembered putting it on the shelf at the craft shop when she was paying. So all we had to do was track down the man with the key to get back in to the shop. Unfortunately he is the only one without a mobile. Luckily another staff member knew where he lived so we set off to his village. He was not there but someone thought he had stopped off to watch the Premier League. We did find someone with the key for the office so returned to Softpower to find that the key for the shop was not in the key box. So we had to find Safir. Two hours later after visiting every place with satellite TV, and hauling a colleague off the pitch in the middle of a game we gave up and returned to Dirk’s house. After twenty minutes Dirk had a phone call - Safir had been found. He had been at Softpower all afternoon, sitting making jewellery just behind the craft shop. Maggie never loses any thing, she is always organised and in control but Becky and I have enjoyed reminding her not to forget her purse.



GOING





GOING




GONE

Change of scenery

Today we are going to Kampala for a week. We have to go to Interpol to get proof that we have not been engaged in criminal activity or more particularly child abuse. This is to allow us to get a CRB check when we come home. There are also two VSO workshops, one a leavers workshop and the other a health conference. It is becoming more real that we only have seven more weeks here. Our flights are booked for September 28th which is world rabies day in case any one had forgotten!
The conference is a time for the health volunteers to get together and share experiences. My concern is that my experience may sound negative compared to some of the other projects. Masindi is the only project where volunteers are working directly with the government and this does raise different issues. I have been discussing with the medical superintendent the lack of resources and it is correct when he says that the government can only pay for about 25% of what is needed. One of the problems is that politicians will not admit this to the public and claim that all is well. The hospital has had the same budget of 280 million shillings for the last 10 years. That is in spite of the increase in population and the huge increase in costs of drugs. Most of the time the drugs and equipment needed to provide the care are not available. On Friday Ritah, the librarian who Maggie works with, was admitted to the female ward where I work. She collapsed and needed urgent surgery. Luckily the theatre was available and the surgeon was around so she could be operated on within the half hour. The delay was caused by the need for her family to go in to town and buy gloves, sutures and IV fluid. Happily they were in a position to afford them and she had a successful outcome. That same night a patient needed a caesarian section but had to wait until the morning for the local pharmacy to open so they could purchase what was needed for the section.
There are successes in the hospital and it is important to remember them. Last week we successfully treated a diabetic coma, a woman with cryptococcal meningitis, a child with nephrotic syndrome as well as starting several people on anti TB treatment. We have had reports from the health centres in Miirya that malaria is now less prevalent and that is seen as an effect of our mosquito net distribution. We are on target to finish the distribution of 5000 nets at the end of the month.
This weekend we have had Gemma and Fynn, two children of friends in Budongo, to stay. It was great to see how well they played with Akim, Adeitha and Aiesha the children who live in the compound. The five of them had a great time even though they had little common language. It is sobering to think about their futures. They all have great potential but Ugandan children’s chances of fulfilling theirs is far less. When we leave in September it looks like Rose and her family will have to leave as well. Hopefully they can find some suitable accommodation but it is unlikely to be as good as they have had for the last 2 years. One of the real draw backs of living here for a short time is the problem of leaving people behind. We are going to miss a lot of people.

Enjoying a DVD together:



Bonding without words:



Introducing cricket to Uganda:

What, more wildlife?!!

Our weekend visit to Murchison National Park was as wonderful as ever. The safari ended up as an elephant chase. We’d seen a few in the first few minutes but they were too far away and we wanted to get closer. Sulieman took us to the north of the park where we had not visited before. There was a lot of evidence of elephants being nearby (fresh dung, footprints and broken branches) but not surprisingly they can easily hide in the trees. Eventually we were rewarded by coming across a large herd including some babies. Two of the males were fighting which was an amazing sight. There was a lot of damage to trees and bushes and you can see why villagers are not keen to have elephants around.
As well as elephants we saw more giraffe than we have ever seen before. They look such ungainly animals but when they move they are incredibly elegant. A herd of forty crossed the road just ahead of us. Tom learnt how quickly baboon can move when he put his packed lunch on the roof of the car for thirty seconds. The baboon grabbed it, opened the box and relieved Tom of his apple and crackers.
Two events at the weekend reminded us how fragile life is here. On the boat trip we passed a group of rangers searching the river for the body of a colleague. He had jumped in to swim to his boat that was drifting away. It sounds like he was taken by a crocodile. There was also a near fatal crash involving a bus full of children. The brakes failed and the bus rolled back down the hill in to another mini bus nearly knocking it in to a ravine. Thankfully there were no serious injuries.
This week I did manage to get out in to the villages to follow up leprosy patients. It is always an adventure going out. This time we got lost miles from any where and ended up driving down single file paths through gardens and fields until we found a road that we recognised. Eventually we found our patient who unfortunately was quite ill. We arranged for his treatment and he was so grateful he gave us money to buy a soda. Ugandans can be generous but rarely do the villagers have cash to give away. This man owns a grinding machine and was obviously making good money grinding maize and cassava.

A few more wildlife photos:

A hippo keeping an eye on the crocodile in the grass in front of him:



Just playing:


Elephant feeding each other:



Cheeky baboon taking a drink from the pool:



Now posing for the photo:

MASINDI UPDATE

RHINO SANCTUARY

It seems like no time since the last entry but it is already two hectic weeks. The first week end we travelled to Kampala to meet other volunteers and renew old acquaintances. This was my first time to travel by bus to the city. We left at 2.00 and were at the hotel by 6.30. The bus journey was fine and it was great to find so many of my patients traveling on the same bus. Lots of people greeting “the doctor” made me realise how many people I must have seen in the last 21 months. It is one of the things I will miss the greetings, hand shakes and warm wishes from every one. People regularly greet you by saying “well done” even before you have done any thing. It is particularly welcome as most of the time you are unable to do any thing useful but people are just grateful for attention.
Kampala is a different experience from living in Masindi. Parts of the city are full of muzungos, mainly working for NGOs or out here to save Uganda. There are so many missionaries mainly from the USA that you wonder what they are achieving. They are all building churches or orphanages but many seem very naive about the real problems here.. You would think with all the good will that things would change but it is hard to see progress. Sitting in restaurants or coffee shops you hear people discussing HIV, empowerment, sustainability, income generation etc. It is almost as though we volunteers are the new colonialists and instead of slaves, ivory or diamonds it is orphans, poverty and HIV that we trade in. There are so many people making a career out of all this may hem that you sometimes wonder if we are perpetuating the situation for our own ends.
But at least you can get a nice meal and a good capuccino in Kampala.
One of the things I was able to do was visit Hadija a little girl we had sent to the Hope ward at IHK. It was so nice to go on a clean ward and find caring nurses who knew the patients. She had been properly clerked and was being investigated. We still do not know what is wrong with here but at least she has a chance of being sorted out.
The trip back by bus was more of a problem. When we arrived at the bus park one of the touts from another bus company recognised me, an old patient and tried to get us on his bus. We made the Link bus and joined it. We had been told to be there by 1.00 but the bus finally left at 3.30. We had two and a half hours of entertainment watching all the people arriving and departing and all the vendors trying to sell a huge variety of goods on the buses. It certainly is an experience but some experiences you do not need to repeat!

Last week I had an opportunity to visit Kigumba a small town north of Masindi. Hugh who works for the Salvation Army runs a project in the town. The project supports vulnerable children some of whom sleep rough others who head up households. The project provides meals three times a week and Hugh wanted the kids checked over to make sure they were ok. Pam, Maggie and I went and examined 42 kids. It was a good day and good to find they were all quite healthy in spite of there problems.

New visitors gives us an excuse to do tourist things again. Reg and family have arrived so the rhino sanctuary was first trip. One of the rhinos has had a calf but unfortunately it was not on view. Next week end we are returning to Nile Safari our favourite chill out hotel.



KIGUMBA SOME OF THE CHILDREN OF THE KIGUMBA PROJECT.


ADMISSION
Fraud and corruption are common place in Uganda and it is important that we report on dishonesty and fraud. Finally under intense pressure Maggie has admitted that the picture of us on the blog has been artificially enhanced! She can not resist using her skill on photoshop so she covered my embarassing bald patch and touched up her roots. I find it hard to hold up my head in company but that is not the reason that the GMC have deregistered me that is another story.