Zanzibar

Think coconut palms, delicious seafood, a laid-back way of life and miles and miles of white sands lapped by warm translucent turquoise waters and you have Zanzibar. Of course there is much more to it than that - Zanzibar has a fascinating and turbulent history. Denise, Sallie and I began our trip in Stone Town, on the west coast, which is a labyrinth of Arabian-style alleyways packed with nineteenth century mansions, palaces and bazaars. We were lucky to have Farid (a friend of a friend) to show his us round his home town which he was so obviously passionate about. He introduced us to people and places which I’m sure we would never have found on our own. For instance, the tiny electrical shop whose owner gave us Zanzibar coffee served from deep down behind the counter, the little cafe serving a bowl of bhajia in a coconut and chilli sauce (that’s the only dish the owner has been selling for the last 20 years), to the very busy dhow port where we mingled with the fishermen and watched them at work. To the other extreme he took us to the roof top terrace of a house belonging to a very wealthy hotelier to watch the sun go down. We visited and supported (i.e. bought lots of nice goodies) the Arts and Cultural Centre which Farid owns. The centre provides training and employment for women. Stone Town is famous for it’s doors which were an important way to show the wealth and status of the person who lived there. They are elaborately carved and studded, each one telling a different story. It’s almost unthinkable to go to Zanzibar without going on one of the many Spice Tours on offer. This was a half day trip out to the farms, followed by lunch prepared using the local spices, of course, which we ate sitting on the floor of a traditional village house.
After a few days in Stone Town we moved across to the east coast to a hotel where our rooms were literally a few feet from the beach. Its remoteness meant we couldn’t help but relax. The nearby fishing village looks as though it has never changed. Men, women and children were fishing or collecting seaweed, the latter mostly for export to places like Japan and China for culinary purposes. We watched lobsters, prawns, crabs and fish being caught using traditional methods. We did our bit to support the local economy and ate very well that week! Despite tourism, Zanzibar is still a very poor place. When walking through the fishing village there wasn't a child who didn't hold out their hands and say 'pay school'. I'm sure most of them didn't even know the meaning of the words, in fact many weren't old enough for school, but they knew they were asking for money.
Other news: it was back to reality on Tuesday. Back in at the deep end at work with lots of issues to sort out. A couple of medical students, Susie and Steph, arrived from the UK whilst I was away. They are in Masindi for four weeks and stayed with us for the first few days. It seems that theft is on the increase in Masindi so we have now employed another member of staff - a daytime askari to guard the place. We are trying to see how many local people we can employ! We now have Rose, the housegirl, who lives in a separate house in our garden with her five children and husband Abdul (who is the askari at the hotel), Sam the gardner, Solomon the night-time askari and now Rasul the day-time askari. At least he can help keep the monkeys off my vegetables - there’s not much else for him to do!
Coming up ……...another trip to Fort Portal!

Where has all the blood gone

A day late for all those fans waiting anxiuosly around the world to see if I have survived a week of my own cooking.Surprisingly I have with a little help from some friends.
It has been a strange week not just because Maggie is in Zanzibar. Our first UK students arrived and it has been a good distraction showing them around the delights of Masindi and the hospital. They are here to do research which is difficult in the best of places but a real challenge here. Hopefully they will get something useful out of the experience.
Medicine has been a bit bleak here. The child with a cleft palate seems to have disappeared. no one onn the ward remembers him going but he isnt there now. It looks like the parents decided against intervention and took him back to the village to die.the fact that they already had six children probably influenced the decision. the logistics of surviving in Kampala must have appeared unsurmountable.
We have 4 patients on the ward awaiting blood transfusion.They all have haemoglobins below 5 .One is said to be at 3g.l. There has been no blood at the hospital for 10 days. More worrying is that there is no blood at any other hospital. We phoned the national blood bank today and they had none but hoped to get some tomorrow.It is likely that our patients will have to hang on for another week. Evidently this is a regular occurence when the kids are on school holidays as much of the blood is taken from students.We are not allowed to collect blood locally as we do not have facilities to test for hepatitis and HIV.
The drug supply is still precarious but we have been given permission to order some relevant drugs. let us hope they are in stock. we have the wrong testing strips for the glucometers that the ministry gave out. No one is sure whether the right ones are available in Uganda.
Time is really passing quickly. This week we shall have been here 8 months which is a third of our time.I am still not sure what we are achieving in the long term but every one still seems happy we are here. Ugandans are forever saying thank you and well done and I am not sure why.
I am sure Maggie will want to post her news from Zanzibar when she gets back. She is due home tomorow.


Chris

Time flies in Masindi

This week began with a meeting on HIV at a local hotel. It was an important meeting with national facilitation but called at 2 days notice which is often the way in Uganda. I received a phone call from Chris the clinic lead on Saturday afternoon saying that we had been asked to provide a 30 minute power point presentation on HIV treatmen for monday morning. So we spent 3 hours on saturday preparing a presntation.
I arrived for the nine oclock start at 8.45 as the hotel is just down the road from our house.There was no power , no computer and no projector so no hope of power point. The rest of the delegates arrived over the next hour and the meeting began at 10.45. This is a fairly typical Ugandan arrangeent. Time is very flexible here and you have to adjust or you will go mad.Meetings and workshops are very popular here. Attendees receive a lunch and a travel fee. Sometimes there is an actual attendance fee as well. With salaries being so low people rely on these fees to top up their take home pay. Unfortunately it means that people will attend almost anything wheter it is relevant or not.Their is another workshop this week on palliative care in HIV which I want to attend to meet people from the nearest hospice which is in HOima. Palliative care is a neglectd discipline here.
The child with a cleft palate turned up this week looking very frail. The mother who has 5 other children had obviously been unable to feed the child. I admitted him to the paedriatic ward for naso gastric feeding. Unfortunately the ward had nothing to feed the child with so we had to give a little bit of money to buy milk.Hopefully the child will pull through and the father will agree to let it go to Kampala. By coincidence a nurse missionary passed through Masindi this week and stopped at Court VIew for lunch. She offered to come back to Masindi and transport the child to Kampala if they agree. Networks and chance meetings are important here.
Maggie as flown off to Zanzibar with Sallie and Denise two friends from Masindi.When you are this far from home you might as well make the most of it.
We were reminded of home this week when the Hull Journal arrived complete with articles about friends we have left behind.The journal is about as far away from life here as you can imagine but it looks great on the coffee table!

BWINDI TRIP

We had been planning a trip to a community project in the far south west for several months. VSO have had a GP and community nurse working there for two years Paul and Vicky. Due to communication problems we had had difficulty arranging a date so when we received an e mail on Saturday suggesting a trip the next week we jumped at the chance. By Saturday afternoon we had hired a driver and 4w drive vehicle, booked accommodation in Kampala, arranged a visit to Reach-out Mbuya a HIV community project and managed to sort out a meal out with Dan and Grania our friends in Kampala. Things can happen quickly in Uganda.
Reach-out is a community based HIV programme which provides excellent home based care for people living with HIV/AIDS. It is recognised through out Uganda as a centre of excellence. Pam and I spent the day there seeing some of the work they do. We were particularly interested in their nutrition programme. They have support from various donors and have been able to provide nutritional support to children and malnourished adults. This is an area we would like to develop in Masindi. At Reach out not only are they able to give out food but they have a training scheme to encourage patients to grow foodstuffs. They have an impressive programme of community support and every week visit patients in their homes. The project was started by a parish priest and still is concentrated on the parish. This means most of the homes are within walking distance.
After two nights in Kampala we set off for Bwindi. This is a ten hour drive the last two hours on marram roads. Luckily Soli are driver was very experienced and we arrived safely on Tuesday evening. Bwindi is on the edge of the impenetrable forest where you can go gorilla trekking if you have the $500 for a pass. It is a stunning location with mountains all around. The first two nights we stayed in a lodge just in the park and hoped we might just bump in to a gorilla but no such luck. One of the advantages of working in this area is that rich tourists can be persuaded to donate money to support the health centre. Paul and Vicky have been able to raise an impressive amount of money and the centre has grown enormously during there time. There are new wards and a maternity block is about to open complete with a waiting mothers hostel.
Our particular interest was to look at some of there preventative work. They had had a major programme of mosquito net distribution which had significantly reduced the impact of malaria. Their nutrition programme was impressive and there was an active educational element. Pius another VSO volunteer from Kenya has started a garden which produces an abundance of vegetables and shows people what is possible.
Vicky and Paul made us very welcome and it was a great opportunity to discuss the challenges of working in Uganda and learn from their experiences.
Every one we met was welcoming and keen to show us their work. Maggie threw herself in to it all and was soon helping out the nurses. On one morning Scott the founder of the project took her on a ward round and she is now an expert at listening to chests and feeling spleens! The children’s ward was a delight so light and airy with children running around and playing so different from Masindi hospital. They even had an outside play area and a mother’s garden.
On one day we went out on a HIV outreach to a district health centre. It was disappointing to see that it was as dysfunctional as those in Masindi. Staff rarely attend and the place was run down and filthy. The most worrying thing was that it was close to the district headquarters and should have been easily supervised.
One of the delights of Bwindi was sitting on Vicky’s veranda watching the red tailed monkeys. The veranda is surrounded by trees and the monkeys are fearless. They often get in to the house to steal food. They are the most beautiful vermin you could imagine. There are also beautiful birds and butterflies around all the time. It really is a beautiful place.
We left Bwindi impressed with their achievements with ideas which we could transfer to Masindi. There are major differences in the set up and working in the public service has challenges especially lack of resources but hopefully we can do something. On the journey back Maggie was able to buy some crafts for the shop. She is becoming very adept at haggling a true African.
It is ironic that after all my efforts to avoid the pharmaceutical industry in the UK this trip was partly paid for by a grant VSO received from Astra Zenica do not tell any one.

Returning to Masindi was a shock. All those plans have to be put on hold because of work load. Monday morning found me doing a ward round alone. There where 6 mattresses on the floor with extra patients. There were the usual mix of patients some who should have not been there and some who were seriously ill. The number of malaria cases seems even higher. This week national TV news showed mosquito nets being delivered to Masindi hospital for use on the wards. There was no evidence of them and the sister had no idea they had arrived. I am becoming more confident in diagnosing TB or may be I realise that no one here is quite and my guess is as good as any ones. We seem to diagnose two or three cases a week usually a co infection with HIV. It is really satisfying to see the improvement on a few weeks treatment. Patients you really thought were at deaths door restored to health. One of the big problems here is following up patients to make sure they complete treatment. Only 38% of TB patients take the full eight months of drugs.
Some time this week I was asked to see a baby born in a village who was not feeding well. She had a cleft palate and will need surgery. By the time I contacted Andrew Hodges a plastic surgeon in Kampala the mother had run away back to the village. Luckily we knew the health centre that she attends and were able to visit there the next day and arrange to see the baby again. There is an opportunity for her to be operated on in Kampala but the question is can we persuade the mother to take her. We shall see.
At the moment JCRC have failed to send the grant to run the HIV clinic. Although we have drugs all the other things needed to run a clinic are in short supply. Worse of all for me is that the internet subscription has not been paid so I am having to rely on the internet café which is slow. We are still trying to get connection at home. The right phone has been located but the connecting cable is in short supply. Evidently they fetch a good price in Congo and the Sudan presumably because of all the NGOs wanting connection. All the cables have been bought up and exported. May be that is what is meant by trade not aid but it is annoying.

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Bwindi trip

We ended the last entry with the words mpora, mpora (slowly, slowly) but just to prove that some things can happen quickly I thought I would mention our trip to Bwindi. Chris and Pam wanted to visit a health centre in Bwindi where two VSOers are working and apparently having a positive experience and really making a difference. Communication with that part of Uganda is difficult and we made several attempts to contact Paul and Vicky. On Saturday we received an e-mail saying that this week would be good for a visit so within a few hours we had a car and driver booked and set off on the 4 hour drive to Kampala (overnight in Kampala) and then a 10 hour journey down to Bwindi. It's right in the south west about 1 mile from the Congo border (see map on right!). So, we are here for a week, returning to Masindi on Sunday. I'm sure there'll be lots to tell but it will have to wait until the following week! Have just managed to get a slot on the internet (it's apparently no good when the sun shines) but thought we'd let everyone know that all's well and we're having a great trip. Until next week ..............

April Showers

The last few days have been cooler and the rains have started so it is not dusty just muddy! There is power this morning and the computer is working so only a day late with the blog.
The Gift Shop at the hotel is thriving. Word is getting around and people are coming out of the woodwork (or, more accurately, the bush) to sell me their work. Some of it is really creative and good but some is less so and I don’t like having to turn people away. The aim of the shop is to provide good quality, Ugandan crafts and to provide an outlet for people to market their products.
This week I decided to stock up on certain things but, like everything else here, that is not such a simple task. One of our suppliers is a project for women producing beautiful bas-ketware. Everything is made from natural resources, including the dyes. The women are taught the necessary skills and then they work from home and have a guaranteed income. The only problem is that their village is near Fort Portal which is an 850k round trip from Masindi via Kampala. As Sallie was going to Kampala early on Tuesday morning I ar-ranged a lift down with her. We eventually set off at 4 p.m. and arrived late in the evening and booked into a hotel for the night. Sallie’s driver, Godfrey, was taking me from Kam-pala to Fort Portal the following morning - we finally left at 4.30 and arrived at 8 p.m., far too late to go to the village. The bonus was that I got in touch with our VSO friends based in FP and they were celebrating Barbara’s 70th birthday. I gatecrashed their dinner party and stayed the night with them! It was great to catch up and hear how they are getting on. Unfortunately, Godfrey had to return to Kampala early that morning (we’re now on Thurs-day!) so on Wednesday night another driver, Sulliman, had to come all the way from Masindi to pick me up and do the last leg of the journey. He had a dreadful journey down - the road is made of marum (no tarmac) and treacherous when wet. His brakes failed about 50k out of FP so he had to rely on his handbrake. Consequently, the vehicle spent a couple of hours in the garage in FP on Thursday morning. This was the vehicle I was re-turning in so I didn’t feel too confident about the journey home. The garage, along with it’s mechanics, didn’t exactly fill me with confidence either though it was quite amusing when a lady brought out a stool for me and asked me to sign the visitor’s book! Late Thursday morning, after all the frustrations, we finally set off to the village to buy the bas-kets. After two days of travelling I was relieved to be able to do what I had come for - or so I thought………..we arrived at the shop to find it was closed! So Sulliman and I just did what every Ugandan would do and sat and waited. A lady from a nearby shop produced two chairs and I was harassed the whole time by a gentlemen who had obviously been sampling the local brew and seemed to think I was his Auntie. Quite entertaining actually. Patience paid and the shop did eventually open. I practically cleared the shelves - I had no intention of coming back for a long time! We took the short route home but had a 5½ hr bone-shaking journey along very wet, muddy, hilly roads with the car sliding all over the place, but at least the brakes held out. This road is only really passable with a 4 x 4 but the other option is a two day journey back via Kampala. I can sense all my friends in the UK reading this blog and wondering why I didn’t just order the goods by mail order. Things just don’t work like that here and nothing is ever paid for by credit card, only cash.
The one compensation is that the scenery in that part of Uganda is stunning. FP is in the foothills of the snow-capped Rwenzori mountains, also known as the Mountains of the Moon. The climate is cooler with more rain, but very green. It’s home to Uganda’s tea plantations, established in the 1930s by Europeans and Indians. Mineral water from the mountains, cooking oil and soap are also produced there.
Chris is still pleased with his vehicle, the Pajero, for work. It’s been spotted all over the place delivering goods, etc. but, more importantly, taking staff out into the rural communi-ties. Chris and Pam have been able to get out to the district health centres. It has been used for outreaches and this week in one clinic over 200 people were seen. The Pajero’s had three punctures this week because of shonky tyres but we can’t get hold of any new ones until May due to lack of funds at the district. Hopefully it will keep on the road next week.
Our motto is mpora, mpora (slowly, slowly, in the local Runyoro language) but sometimes you think you are not going slowly but going backwards!

Mixed week in Masindi

This week has been dominated for me by the arrival in town of the Elton John Pajero. This is the vehicle that was given 4 yrs ago for work in the community. It had been off the road for over a year but I gave some money from the donations I brought out to have it repaired. It has been a complicated process but it is back on the road. The first I knew of it was when I saw it delivering children at one of the local schools but after a few days chasing it was delivered to the hospital and handed over.
After the trouble we previously had getting out to the health centres it was great this week to travel in relative comfort and safety out to Kyateri health centre. I spent the day observing and working with the clinical officer, a young women of about 23 years. There were the usual cases of malaria and diarrhoea. One child had a pneumonia and probable malaria In the UK she would have been admitted to paediatric intensive care but here she was sent home with amoxicillin and Co Artem. The area has a high maternal mortality rate even by Ugandan standards. Although most women attend ante natal very few of them deliver at the unit, most choosing to stay at home and be delivered by relatives or friends. If there is a problem, then transfer to Masindi hospital 20 km away is the only option and that is if you can find transport. Theoretically there is an ambulance at the hospital to collect patients but this rarely seems to happen.
The health centre seemed to function quite well and was providing a good service to the community.
On Friday we used the vehicle again to visit a patient who had not attended clinic to pick up his drugs. He has TB and HIV and was ill the month before with a haemoglobin of 5.9.When he sent a supporter to pick up his drugs we were concerned that he might need admission so we arranged to go out to see him. This is just the reason why we wanted to get the vehicle back on the road.
He lives near Biso about 24 km from Masindi. The homestead was several km out of Biso down several cycle paths only just passable in the 4x4. Eventually we came to a group of mud huts where we were greeted by Godfrey the patient and forty of his relatives, several of whom spoke perfect English. Luckily he was improving and the last few days he had started to eat again and was feeling stronger. His family are originally from the Democratic Republic of Congo just the other side of Lake Albert. They fled in 1983 to avoid the war and had to flee again from Buliisa to avoid famine. They now live together in this homestead of 42 people. It was remarkable how well they all seemed to get on. Godfrey’s father had had 40 children but Godfrey only had 6. When the children arrived home from school they all knelt down before the old women as a sign of respect. At 6.00 pm Godfrey called one of his sons to get the radio and he tuned in to BBC world service. He said he always listened to World Service as he liked to know what was happening in the world.
We were introduced to a little girl of 8 years. She was severely stunted and Cushingoid. She had been put on steroids at a year old for arthritis and the family had been buying them ever since. The drugs had severely affected her growth and now it is doubtful she will ever be able to come off them safely. Godfrey’s brother was very concerned about epilepsy as one of his sons had developed fits. It appears that this is a common situation in the locality and no one is sure why there is such a high incidence. Hopefully we can go back there and collect some information to clarify the situation. Unfortunately anti convulsants are not readily available here.
On Saturday we were invited to our askari’s home. He was keen to show us what he had spent the 300,000ush loan on. Soloman has been our night watchman since we moved into the house. He comes every night at 7.00 and leaves at about 6.30a.m. His job is to protect us and the property. He is a likeable chap who does not seem to mind working 7 nights a week. This seems to be the normal situation here and he is glad of a job. He lives with his 10 children and other family members on a large plot of land which he farms. His father obtained the plot many years ago when he came to Masindi with the British from the Sudan. Soloman considers himself Ugandan but his roots are in the north. He has been building his new house for 9 years; whenever he gets any money he does a little more. The money we loaned him in January he used to buy iron sheets for the roof. He now has half the roof covered and he has moved into half of the building. He proudly showed off his land and his crops. He obviously grows enough to feed every one but there is no spare cash and I expect part of his reason for showing us his home was to ask for a raise or another loan. As we left he scooped up a duck, placed it in a carrier bag and gave it to Maggie for our meal. It is hard to refuse a live duck! We took it to Court View and persuaded the chef to kill and pluck it. We muzungos prefer our meat on Perspex trays wrapped in clingfilm.
Today we have walked the Masindi trail. This is a 3 hour walk around Masindi which was originally worked out by previous VSO volunteers. It incorporates some of the historical features of the town and was good fun but very hot in the sun. The Masindi volunteers are planning to organise a sponsored walk using the trail in June to raise money for a local HIV/AIDS charity and to raise awareness locally of the issues.
There are some photos attached.If you look carefully at the one of the pick ups you can see the second driver. Soloman our askari is the one with a big grin and his long suffering wife is beside him.The others are from the trail.