Time flies

THE PICTURES ABOVE ARE OF TWO BROTHERS WITH EARLY LEPROSY BEFORE NERVE INVOLVEMENT. THE PHOTOS SHOW EARLY SKIN LESIONS.

THE PICTURES BELOW ARE FRANCES THE OLDER BROTHER WHO HAS HAD LEPROSY FOR SEVERAL YEARS AND HAS ADVANCED DISEASE WITH SEVERE NERVE INVOLVEMENT. HE HAS ANAESTHETIC HANDS AND FEET WITH LOTS OF DAMAGE.





EARLY TREATMENT WOULD HAVE PREVENTED THIS DAMAGE.

Some how we missed out on last weeks blog. As we enter our last four months time seems to be going quickly and a week can pass by with out you noticing it. It is also hard to find something new to write about. Things that seemed really novel and interesting this time last year are now not even noticed.
Money has always been a big issue here in all sorts of ways. Even as a volunteer you are seen as much better off than every one else which is true. This does not appear to provoke jealousy but does mean that people regularly ask for money. This week the children have returned to school so school fees are due. Although primary education is free many families opt to send their children to private schools as they hope that the education will be better. Many schools are boarding schools so for much of this week people have been away from their jobs delivering children. It seems to be accepted that a few days off work to take your children to school is reasonable. Families make real sacrifices to send their children to school. Any member of a family who has a job will be expected to support not only his own children but other children as well. Unfortunately the local government has not paid salaries for the last two months so all health workers, school teachers and police are struggling to meet their school fees. It is hard to believe that salaries can just not be paid but it is not uncommon here. When I ask colleagues about it they just shrug their shoulders and say “this is Uganda”.
Most patients are from the villages and are basically subsistence farmers. They have little spare cash but health care here costs money. The health service is supposed to be free but only if the drugs and resources are available. We have not had any X-ray films for over six months and there is no ultrasound. If a patient needs the investigation they have to go in to town and pay 15000 ush for an x ray or scan. I frequently see patients in need of x-rays especially to rule out TB. If they have not got the funds I am able to use some of the money that was donated before I left Hull. This month I have been dipping in to that fund quite a lot. There was the case of the women who had been bitten by a dog that was ill and acting strangely. There is rabies about in Uganda even though cases are rare. The government should supply rabies vaccine but there is none available in the hospital so it has to be bought from a private clinic. There is no chance that this woman could afford 120000 ush for a course so the fund stepped in. It would have been difficult to send her away. Tomorrow I will use some of the money to pay for a special hire taxi to take a baby with a heart defect and a young boy with Burkitts lymphoma to Kampala for assessment. Unfortunately I think the baby has a serious problem requiring surgery which is unlikely to be available here.
By chance this week there has been a team of American medical missionaries visiting. One of them was a nurse who works for a charity in the states that takes babies to the US for corrective surgery.It is just possible that Rita the infant may get her surgery there.
I managed to get out on Wednesday to follow up some of the leprosy patients. One of them asked to see other members of his family. It was an isolated homestead but it was worth the effort as two of his brothers had definite leprosy. Luckily they were early cases and did not have the severe nerve damage that Frances has. It is satisfying to find new cases, I am afraid without my encouragement the leprosy nurse would not have bothered to chase them up. There is a major problem with searching out new cases and getting them on treatment early. One of my aims before I leave is to get the district to recognise that they have a problem with leprosy and must be more active.

LIBRARY UPDATE
On my first day we got off to a slow start. First of all, I should have been going on Wednesday but as Ritah had to go to a burial we postponed until Friday. It was a common 'man with the key' problem. Once we'd gone round the houses, literally, to find the key it was almost lunchtime. As it was the first week of the new term the children were occupied with cleaning classrooms and digging the compound. This meant that the library was not open for business as usual but it did give us an opportunity to start sorting the long awaited shipment of books.It seems that this shipment from the UK has been stuck at customs in Entebbe for quite some time. Also, Ritah did not want the children in the library until some of the girls had taken the mats down to the well to be washed.
My second day, today, turns out to be Martyrs Day and therefore a national holiday so the school is closed. I will hopefully get to work on Friday. Flexibility is the name of the game!
Maggie

Nyabyeya and school library

Here are a few photos of my first trip to the library:


The library is the room in the centre with the new shutters and roof, next to the condemned classroom which is still in use.


My first meeting with Ritah.


During our meeting some boys came in and made themselves at home! Also in the picture is Cathy.



The 'Interesting Corner' which at the moment mainly focuses on football!

About 30k outside Masindi, on the outskirts of Budongo Forest, is a small village called Nyabyeya. Most of the inhabitants are subsistence farmers, though there is also a small gravel pit where women with babies on their backs work all day digging and grading the gravel. In the village there are a few small shops selling the bare necessities such as kerosene, oil, soap, home-made rope, etc. and a few roadside stalls selling fruit and vegetables. It’s a typical village with groups of men sitting around enjoying the local brew and playing cards.
The journey from Masindi to Nyabyeya is along a marram road which, when dry, makes driving difficult with the clouds of dust but, when wet, is probably worse as the surface becomes like a skating rink. I’m always amazed at how many people walk this road, day and night, often with young children and babies. Some are carrying jerry cans of water, firewood or baskets of produce from the land balanced on their heads. On a good day the journey is quite pleasurable and if you’re lucky you can see colobus and vervet monkeys, baboons and the occasional chimpanzee.
Just outside the village is the Nyabyeya Forestry College and in Budongo Forest itself is an important Field Station carrying out work on chimpanzees.
Nyabyeya also has its own primary school. It is here that the Budongo Forest Conservation Trust have opened a small library to try and raise the academic and language skills of the children. It will also be an important meeting place for the children where they can be taught extra-curricular topics such as conservation and skills which will help them become useful citizens to the Budongo community. The library is funded by the Trust which has paid for the renovation of one of the condemned school buildings and also pays for a full-time librarian called Ritah. So far all the books have come from donors in the UK. The library has a long way to go. It needs many more books, particularly text books, and resources such as charts, posters and other teaching aids.
It is through a friend of ours, one the chimp researchers from the UK who lives at Nyabyeya, that I have been asked to help for one day a week. Cathy and her mother have been involved in raising the money and setting up the library. I have never thought of myself as a librarian but have decided to give it a go! My new jobs begins next week with the start of the new term.
Here are some photos of the library. As you can see, it looks quite sparse at the moment and we only have mats to sit on, but a lot of work has been done to create a safe environment. The roof has been replaced and there are new shutters and doors. The adjoining school rooms remain condemned, with roofs that leak, no windows or doors, but they still have to be used as there is no alternative. The school has a few newer rooms but they are not enough for the number of pupils.
Maggie

A better week

Uganda does have a lot of compensations. Two week ends ago we went to Lake Albert to stay in a safari lodge overlooking the lake. The lodge is on a cliff and you can look down on the Lake and see the mountains of the Democratic Republic of the Congo on the other side. The setting is superb and the sun setting over the lake was a wonderful sight. There were lots of new birds for Maggie to tick off on her list as well as some beautiful butterflies.






This last week end we stayed at home and entertained friends. Maggie produced wonderful meals including ice cream. She managed to make it out of tinned cream and dried coconut milk. The time it took in preparation was more than it would have taken to drive to Kampala and back but it was really good and every one thought it was worth her effort. On the Sunday morning we had brunch complete with kedgeree. Smoked tilapia off the market made a good substitute for haddock.
After all Maggie’s hard work I had to wash up but its not a bad job here when you can watch Paradise and African blue fly catchers outside your kitchen window. The bird life in our garden has increased with the rains, they are all displaying and building nests. It is easy to spend an hour just sitting and watching. The monkeys have not been around for several weeks. I hope the building work has not frightened them off. Hopefully the mangoes that are just ripening will attract them back.
We are due the first of our visitors from England this week. We should have a string of people coming until September. It is good to have them as they make you look again at Uganda and is an excuse to visit more places.
At work we are celebrating because we finally have a supply of TB drugs. Unfortunately it looks like we may run out of ARVs for HIV next week. Nationally Uganda appears to have no ARVs in the national stores. By using the muzungos network and making lots of phone calls and e mails we have a promise that drugs will be supplied next week. I hope that happens as the consequences of stopping drugs can be serious.

Not a good week

Unfortunately last weeks smiles were a bit premature. On Tuesday morning I received a phone call from Chris the clinical officer saying that he had been asked to see Slyvia the little girl with diabetes who had been readmitted. She was dead. The story was that she had been admitted through a private clinic in coma. They had given her a shot of insulin and sent her to the hospital. The doctor on call saw her later and ordered a blood test for later in the morning. She did not survive the wait. She had obviously been given too much insulin and should have been treated urgently with dextrose. A simple injection would have saved her but no one thought of the right diagnosis. It is such a pity as she was doing well when I saw her in the clinic last week. Diabetes is not well understood here. It is only just being recognised as a problem in Uganda. Most of the emphasis has always been on infectious diseases which still represents the major risk here. There needs to be a big education programme and I am scheduled to start it next week. You realise how basic the training has to be when you realise some of the nurses do not know how to read urine dip stix.
If I can teach people that unconscious diabetics should be given dextrose then may be Slyvia will not have died in vain.
Th other big problem this week is lack of drugs. I have become used to shortages of antibiotics and anti malarials but we are about to run out of ARVs the essential drugs for treating HIV. These drugs have revolutionised the management of HIV and allowed people with HIV to return to normal life. The drugs need to be taken every day without missing any doses. Even missing a single dose allows the virus to mutate and can produce resistance. Now it looks like patients will be forced to have breaks in treatment and the consequences will be extreme for some.
Lets hope next week is a better one.
May be I should have gone to church!

Smile for the camera

This Sunday we were invited to another thanks giving at the cathedral. Twice in one month seemed to be excessive and in view of all the thunder and lightening this week we made our excuses. So today we have had a quiet day at home catching up on mail and avoiding filling in a tax return. How come Alastair Darling has time to worry about me this week of all weeks.




PICTURES OF THE PYLON BEING ERECTED.ON THE LARGER PICTURE YOU CAN SEE THE FOREMAN TAKING A REST ON THE TOP GIRDER (IF YOU HAVE GOOD EYES)


This week there has been major excitement at the bottom of our garden. For several weeks there has been building work going on late in to the night and we thought someone was having a house built. As the structure developed it was obvious it was offices and we now find that MTN the mobile phone company has had the offices built. They began erecting a mobile phone mast at the end of last week. It has gone up very quickly built by six men with the aid of a tree trunk with a pulley on the end as their only crane. The men seem to have no fear of heights and walk about the structure with out holding on. Some of them seem to have harnesses but they do not appear to use them. One of the men stands on the top girder and waves when ever Maggie goes out to look. It is an amazing example of building and has absolutely no regard for health and safety. Ugandans are very fatalistic most of the men do not expect to live a long time so they do not consider risks. But considering the statistics those men standing on those girders probably have less chance of dying on this job than a women in the village every time she gets pregnant. Maternal mortality is high in Uganda and even higher in Masindi (over 500 maternal deaths per 100,000 live births). I presume the men get well paid for the job.




SLYVIA AS SHE WAS GETTING BETTER AND JOSEPHINE SITTING OUTSIDE THE MATERNITY UNIT

SMILES
There have been things to smile about this week. The little girl with diabetes survived and went home on twice daily insulin. We were able to give her a supply of insulin and teach her mother how to give it. Of course she is still at risk, she lives in a village away from town and will have difficulty getting supplies but at least she has a chance. Most children with diabetes in Uganda die on presentation often without any one recognising they have diabetes. We received some fresh supplies of insulin this week and an Irish visitor left her glucometer and 100 testing strips so we are able to check blood sugars again. Slyvia (not Sylvia) the little girl had a lovely smile once she was getting better and it made me realise that most of the Ugandans are quick to smile and seem happy to greet you.
This week’s photos are mainly of smiles. Josephine the lady nursing the new born baby is a nurse in antenatal clinic. In spite of her own health problems she is always there to help her family or friends. The picture shows her nursing her latest grand child born eight hours earlier in the hospital. Monica the mother is one of the HIV counsellors and was at work on Wednesday, went in to labour Thursday night and delivered a 3.5 kilo healthy babe a few hours earlier. The maternity unit delivers between 5 and eight babies each day. Babies and children are every where in Uganda. The population growth is one of the highest in the world with the average woman having 7 pregnancies. It is not unusual to have 10 children

SMILEY FACES

Church and home

THIS IS A PICTURE OF RASOUL OUR WATCHMAN PLAYING LUDO WITH ROSE, AKIM AND ADETHA

This Sunday we were invited to a thanksgiving of one of my colleagues in the community department. Ronald was 58 and wanted to give thanks for his life and his marriage. He had helped as a translator during the workshops for the Miirya project but had become ill during the last workshop. He developed severe heart failure due to hypertension and was off work for several weeks. I visited him at home several times and managed to get his failure and blood pressure under control so he was keen that I attended the thanks giving service.
The thanks giving was part of the weekly English service at the cathedral which is the church that Ronald attends. The first service of the day is at 7.00am in Runyoro. We attended the 8.00 am English language service with about 600 other people. There were 5 muzungos in the congregation. You can not imagine 300 people waiting outside an English church for an 8.00 o clock service but that was what we found when we arrived. The other 300 seemed to be staying on after the Runyoro service. Ronald was there with several members of his family dressed in their finery. They invited us to sit with them in the choir stalls but we opted to sit in the ordinary pews. In spite of this we were spotted and had to stand up and be welcomed by the congregation. The service turned out to be dominated by an election of church wardens. This produced a dispute between members of the congregation and the vicar leading the service. The diocese has a constitution and the election of 12 wardens is not part of that constitution. After a heated discussion the election was abandoned but only after some youth volunteers had been elected. One of the youth did not want to be elected as she did not live in Masindi but her protestations were discarded and she was duly elected to serve the youth of the congregation. It was a shame that in spite of the enthusiasm of the congregation the service appeared to be dominated by politics and collecting money. Ugandans love religion but if this is an example of how the church works they are being let down. I am told that it is very different in the villages and much more joyous.
Maggie’s blog last week mentioned the wild life. She now claims that there is a mouse in the house. Every now and again she shouts out and says she has seen something run across the floor. She is the only one to see it and I am beginning to think she has had too much sun or too much waragi. People say it is a good sign if you have a mouse because it means there are no snakes in the house. The rains are continuing and every thing is growing rapidly. It is a great time of the year here and as long as the roads stay clear you are ok.
This week we have been holding meetings with the volunteers from the Miirya project. Happily most of the volunteers attended the meetings and seem to still be motivated to keep involved. We have nearly finished our first round of net sales and most of the volunteers reported that people had been pleased with the nets. A first look at what had happened to the nets revealed that some people were keeping them and not using them. There is still a lot of education needed so the project needs to develop. One volunteer reported a tragedy where a child had been put to bed in a net and had taken a candle in the bed. She was left alone and the net and bed set alight burning down the house and killing the child. Fires are not uncommon here as people have to use candles or paraffin lamps as electricity is not around in the villages. The villagers did not blame the nets for this tragedy but blamed the mother for leaving the child alone.The nets are flammable but very slowly and appear to be safe. I saw another burn this week of a 3 yr old child whose mother had let fry some eggs over the stove. She was an intelligent mother, a primary school teacher but she did not think that 3 years old was too young to cook. Childhood is very short here for many children. It is not unusual for children especially girls of six years to be caring for their siblings.Most children have jobs to do before and after school such as fetching water or fuel.There is little time to play and most children do not have toys.
Akim and Adetha who live in our compound are luckier than most. Rose is a great mum who spends a lot of time with the children in spite of having 4 jobs. Some one brought out a giant ludo and they love to play. Adetha is the champion at the moment. They also love to play chasing games. Every time we arrive home the boys run out to greet us.They then tig us and shout "Kabali" and race off,I usually manage to catch Akim but Adetha is really fast or may be I am just getting old.

Late news
Maggie is not hallucinating. The mouse is real!

Wildlife

Above: a weaver bird collecting grass
Below: nest building



The finished result:



When we think of wildlife in Africa we automatically think of the big game and going on safari in a large Landcruiser or similar. But wildlife is also on our doorstep in the form of tiny insects, butterflies and birds. It’s around us all the time but is even more evident after a good rain storm. The seasons are not well defined though there are periods when it’s even hotter than normal. At these times there is a lot of dust but still everything looks quite green. However, when the rains truly begin we really know about it in more ways than one.

Almost every day for the last two weeks we’ve had a good rain storm at some time during the day which has helped to bring the temperature down. The storms don’t necessarily last long but we have torrential downpours and sometimes we are treated to fantastic light shows from the lightening over the hills. The roads can become quite treacherous and most people prefer to just put everything on hold and stay put until it’s cleared. That includes not going to work, appointments, etc!

Anyway, back to wildlife…….. there are some amazing sights after a good rain storm. We have flying ants with huge white wings which, as they hatch, rise up from the ground in great swarms. They shed their wings which cover the ground like petals and the remaining bodies are hurriedly collected to be eaten. People compete with the birds and frantically gather them up in whatever vessel they can find, even in a scrap of cloth or old piece of paper and then take them home to cook. They can be fried or boiled and are apparently highly nutritious. I’m reliably informed that they’re also really tasty which I confidently believe as I’ve no intention of trying them!

Of course we also have swarms of flies around which attract the flycatcher birds. In our garden we have many different species and just this morning I’ve seen the Northern Black Flycatcher and the African Blue Flycatcher. The garden is a hive of activity with the dozens of different birds and at the moment all I can hear is their birdsong. There are too many to even try and distinguish them. I wish I had a way to record them. On my way into town there is an amazing sight of weaver birds building their nests. One tree is full of them beavering away, as if in frenzied competition with each other. The birds have such skill in home-making. The little nests hang precariously on the tips of branches with the entrance at the bottom. Inside the nests they build small chambers to contain their eggs and offspring, to prevent them from falling out and also to deter predators. Sometimes you can look up and see a cluster of little mouths wide open, eagerly awaiting some food. Also, I noticed the other day that the drain alongside the main road, which is full of very dirty muddy water, is now full of tadpoles. As far as I know, no-one here eats frogs which I find quite surprising as I’ve heard that bats and rats are eaten in some areas. One of the disadvantages of the rain is that there is an increase in mosquitoes. There is a belief that the mangoes bring the mosquitoes; it’s just that the rain brings the mangoes!

Another common sound at the moment is that of women and children hoeing the ground in preparation for planting. Children are expected to help on the land and have to fit it in before and after school. Even the schools recruit children to do the digging. Most people have some land where they grow their own crops for feeding their families and what they don’t eat they sell at the market. At home we are now enjoying our new season of avocados and pawpaw. The mangoes are still a little bit small but the salad and herb crops are all growing well. Soon we will have peppers, aubergine and courgette again.

We enjoyed a relaxing Easter weekend. On Sunday we visited friends who are researching chimps in the nearby forest and live near the village of Nyabyeya, about 30k out of town. We had a barbecue and just to remind us of the UK it rained! Even though Masindi is a small town it’s good to get out into the rural areas. There are always new things to see.