Perils of a left-handed pee!

VSO promises you a new experience. One I had not planned for is a left-handed pee. We’d had a pretty straightforward week and were wondering what to put on the blog. Maggie went off with Sallie to Kampala to shop for the hotel and I was planning a quiet weekend at home. I’d finished off a report on the chronic care clinic whilst sitting on the patio watching the birds. I then made a stupid error. I decided to try and fix the gutter which had been leaking. It’s fairly easy climbing up a ladder but it’s so much quicker falling down! I landed on my back on the concrete with my right arm underneath me. Luckily I did not hit my head. Once I had collected my thoughts I realised my shoulder was ‘spoilt’. I thought I’d dislocated it and tried to remember how to relocate it. Unfortunately this was extremely painful and I started to feel 'a little unwell'. As I was on my own, I was concerned I was going to pass out but managed to phone Olav, a fellow volunteer, to get him to come round. By the time Olav arrived I realised that I needed an x-ray. This isn’t a simple procedure in Masindi. I knew that the hospital didn’t have any x-ray films so we phoned the Supreme Clinic. Their x-ray machine was ‘spoilt’ but Daniel, the Clinical Officer, said to go down and he would look. Luckily Wilson, the radiographer from Masindi Hospital, was at the clinic. He said he would take a film from the Supreme to the hospital and x-ray me there. Wilson had had a stroke several months ago and had a left-hand hemiplegia. While I struggled to get into the front of Olav’s car with a very painful right arm, Wilson struggled to get into the back of the car with a hemiplegia. The x-ray was duly taken and showed a very nice fracture of the surgical neck of the humerus. By the time I arrived at the hospital, Rose the cleaner, Solomon the askari, plus Daryl, had all arrived to see how I was doing. I don’t know much about bones but I realised this fracture would need surgery and I would have to go to Kampala. I plucked up courage to phone Maggie and admit my stupidity and a taxi was arranged to take me to meet her in Kampala. The four hour trip with an unstable fracture is another experience that I hope never to repeat. Thanks to the VSO medical insurance I went straight to A & E at the International Hospital. After a quick assessment, Doctor Victor decided to put a back-slab on to stabilise the fracture and to admit me. He also gave me a shot of pethidine for which I was most grateful. Sunday morning I was seen by the orthopaedic consultant who said that the fracture needed to be plated. Unfortunately the special plate is not available in Uganda so he recommended re-patriation to the UK. Somehow the insurance company managed to get us a flight to Heathrow at 9.45 the following morning (flashing lights and sirens in the ambulance to Entebbe and then Business Class no less!). From Heathrow we were transferred to St George’s Hospital and now it is a matter of waiting until they can perform the operation. We don’t know when we will be able to return to Uganda.
Meanwhile, Chris is learning to do things left-handed; peeing is possible but cleaning teeth is a real challenge!

All quiet in Masindi

This has been a quiet week in Masindi, no floods or burglaries so what is there to write about apart from the tragic loss of a family heirloom. Unfortunately the kids will not have the pleasure of fighting over Maggies favourite cooking knife she has treasured for 30 years after our demise. The sturdy knife was no match for a green coconut and Daryl. Daryl a volunteer from the Philipines offered to show Maggie how to open a coconut. She not only failed to open the nut but snapped the blade.
Coconuts do not grow in Uganda for some reason but Maggie had asked some one selling vegetables for a coconut 6 weeks ago. He arrived this week with a lovely bunch of coconuts he had brought from Tanzania. He was a bit disappointed when Maggie only wanted one but the others all turned up on the market so he had good business. You have to be careful what you say here as people are so keen for sales they will sometimes go to extraordinary lengths to get you something. Strangely, on the market, stall holders often refuse to sell you poor quality items but take you to a competitors stall that has better ones. Presumably they feel that in the long term you are likely to go back if they show concern.
This week we had the monthly meeting of the Chronic Care team. This is supposed to happen every month but is often cancelled and poorly attended. I suggested we put review of allowances as an agenda item to encourage attendance. This worked but a meeting scheduled for 10.00 did not start until 11.00.All meetings start with a prayer then there has to be laborious reading of the last minutes which have been written in great detail. The real business does not start for a good half hour. We did have some useful discussion. I had persuaded Maggie to make a banana cake as people here had never heard of one in spite of the fact they are surrounded by bananas and eat matoke most days. The cake was cut with due ceremony complete with photos! Every one seemed to like the cake and a short speech of gratitude was made. Cake has been ordered for the next meeting.
On Friday we made a rare trip out to see a patient with HIV who had not been seen for 9 months. He had had a stroke and could not get in to the clinic. His treatment supporter regularly collects his medication. He lives about 12 km from Masindi right in the bush. We travelled by special hire taxi. As we did not know exactly where he lived we had to ask a couple of people, the last of whom turned out to be his sister. We arrived at this hut and were invited in to meet the patient. He was lying in a small room on a single bed. He could not see out of the window and obviously very rarely leaves the bed. I was greatly surprised when he greeted me in perfect English. He evidently used to be a lecturer in agriculture at the local college. He had had a devastating stoke and was obviously trapped in the hut. He was remarkably cheerful but I could not imagine how he passed the time. He had no books, no radio and seemed only to have his aged sister for company. Unfortunately his blood pressure was very high and he is a candidate for another stroke. We started him on treatment but he will obviously need monitoring .On the way back to Masindi we called at the local health centre and asked that they check his blood pressure and keep us informed. I will be pleasantly surprised if that happens but it is what should happen and one of the reasons I am here to improve primary care.

Mince pies in Masindi

HAPPY NEW YEAR!
New Year’s Eve, like Christmas, was very low key. We managed to watch a few episodes of Green Wing on DVD before falling asleep! We were determined to make the most of Chris’ day off on New Year’s Day and hired a car plus driver. On a previous trip we’d spotted a church on a very remote hillside about 10 miles from Masindi. This turned out to be a catholic church built by Polish refugees in 1945. By coincidence, as a result of VSO using Chris’ profile for fund raising purposes in the UK, we received a very moving letter from an elderly lady who had been one of those refugees. She had been one of many Polish families sent to the Russian Syberia in 1940 soon after Stalin’s Army crossed the Polish border. She spent 20 months there in a labour camp surviving starvation and very cold weather, though many did not. Eventually Stalin agreed to release prisoners from camps and jails to form the Polish Army. Her father and husband were fighting with the British Army; their families were sent to safe camps in various parts of the British colonies, one of them being Masindi. Her letter describes the five years of life in the camp at Masindi as being very simple but happy times.
As well as the church, they had built their own houses of quite a unique style amongst the trees and also a school and hospital. On her request we took lots of photos to send to her.

On our visit we were fortunate to arrive when there was a service in full swing. We were made very welcome. It is one of the few churches around which still uses the traditional instruments for music for the services unlike Masindi where they use electronic equipment and microphones at 5 a.m.!
The afternoon was spent having a lazy swim and food at the Kinyara Sugar Factory social club.

As we are feeling more settled I am beginning to enjoy the surroundings and have even surprised myself at becoming a bit of a twitcher! We have a beautiful view from the house across to the hills. We now have some wicker to sit on the terrace and watch the subtle changes of the countryside. Very early in the morning (yes, even I have been known to witness it on the odd occasion!) there is a beautiful sunrise with mist down in the bottom of the valley. It is always sunny though sometimes hazy. At times it is very clear but, whenever I look, I see something new. The bird life just in the garden is amazing. It’s quite hard trying to do the washing up with binoculars and bird book in one hand! I get quite excited when I see a bird for the first time and even more excited when I can actually identify it. Just the other morning I spotted a Northern Black Flycatcher, an African Blue Flycatcher, a Village Indigobird, several Speckled Mousebirds, a ‘Greenish’ Yellow White-eye, a Pin-tailed Whydah, several Red-cheeked Cordon Bleu and a Fork Tailed Drongo! I am not disheartened by the fact that, according to the book, they are all very common here!

The highlight of the week was a parcel arriving from Sheila in Duns containing delicious homemade mince pies. They were slightly battered but that didn’t detract from their deliciousness! So, thank you again. The internet has been abysmal for three weeks over the Christmas/New Year period. We are just beginning to catch up on e-mails but want to wish you all a very happy and healthy 2008. Don’t forget, the spare room is now up and running! We thought we’d got rid of the bats with the flood. They’re back, but don’t let that put you off!

Maggie

Happy New Year

It has been 4 weeks since we managed to post a blog. Today the internet is working but not reliably so a short piece to say we are well and looking forward to 2008. Today is a public holiday so we hired a taxi and went off in search of the Polish Church. This is a Catholic Church built in 1945 by women and children from Poland who had been released from Stalins camps by the British and sent to safety in Uganda. It is a remarkable story and a really beautiful church in the bush. It is well used and there was a service there today complete with a choir and traditional instruments.


MERRY CHRISTMAS ( BETTER LATE THAN NEVER)
We have just returned from a two week break in the UK. It was great to see family and catch up with all the news. England was cold and Christmas was on everyone’s mind. It had been hard to think of Christmas in Masindi where it is so hot and dusty. I am afraid that we have sent few cards and bought fewer presents this year but we will be thinking of everyone on Christmas day. It looks like we will be having turkey courtesy of Sallie at the hotel. Maggie managed to bring some Brussel sprouts and a Christmas pudding back. I am not sure what they will taste like in the heat but we will enjoy and remember everyone back in the UK, especially our children and grandchildren who seem to be well organised for the festivities. Maggie did have to make Daniels favourite parsnip roulade for his Christmas dinner to leave in Hannah’s freezer but everything else they seem to have sorted.
The blog has been neglected for the last few weeks but lots of people in the UK said they
enjoyed our ramblings so we will try and keep it up to date.
We were in Kampala the last week of November for more VSO training. It was good to meet up with our fellow volunteers and share experiences. We felt lucky to have found such good accommodation and friends in Masindi. Most people were finding work challenging but were keen to continue. Half way through the training we heard that our house in Masindi was flooded. As Soloman, our night askari, put it “there is too much water in your house”. We had made sure the house was secure before we left and foolishly had not left a key. Luckily Masindi connections worked again and we were able to send a key back so someone could gain access. We thought that was sorted but the next day we still had ‘too much water’. Our efforts to make the place secure meant that we had locked all the internal doors and the key for the inner door was not where I thought I had put it. No worries, someone decided to switch off the supply from the water tank outside as that should stop the flow. Next day there was still ‘too much water’ so the water board was contacted but unfortunately no stop cock had been fitted when the water meter was fitted.
We arrived late Sunday night to find water flowing out of the door. I managed to gain access and climbed in to the loft to find the cold tank had fallen and the mains pipe was happily pouring water in to the loft. This was flowing out of a hole in the ceiling and we had our very own waterfall into the hall by our bedroom. There was six inches of water in the bedrooms so we had to abandon the place and stay at Court View. The next day a water board plumber managed to stop the leak and by pass the pipe. Once the leak was fixed all we had to do was brush the water out of the door and throw the mats out to dry. The advantage of concrete floors and no carpets is everything dries quickly. Luckily the ceiling did not crash down so we were able to move back in after 3 days. We then had to pack for our return to England for mum’s funeral and Ben and Faye’s wedding.
We are now back in the house after having spent only 3 nights here in the last month and are looking forward to welcoming our first guests next week. The spare bed will arrive once we have found a pick-up to deliver it. We have the slight panic ‘will it fit up the stairs?’ but there is no point in worrying; some how things always seem to sort themselves out in Uganda.

The internet has been impossible over Christmas but we hope to post this today Sunday. Christmas has passed with Maggie finally cooking the turkey on Boxing Day. We had four guests and all enjoyed a traditional English Christmas meal complete with bread sauce and sprouts. Simba, our guest from Zanzibar, managed to eat the regulation one sprout but it is an acquired taste so he did not ask for more! As usual we were left with large amounts of turkey but managed to have more guests last night for a turkey curry followed by Papaya Sherbet. Maggie is getting a well earned reputation as a cook in Masindi and as she has one of the few ovens every one is expecting great things for 2008. She has managed to make bread and this is the first decent bread we have had in Uganda as Ugandans like sweet bread.
We have also hosted our first guests this week. Dan and Grania came from Kampala and stayed the night. Luckily we had managed to track down a pick up and transport the bed from the carpenters. It took 4 men to lift it off the pick up and it then had to be taken to pieces to fit in to the room. But all was well in time for the arrival. Maggie finished the curtains and they were fitted just in time. The spare room is now complete for any one who wants to visit. .

We will atempt a better blog next week when hopefully we can send some pictures

Sad Week

Unfortunately this week Chris's mum became ill and died in St Georges Hospital London. This was difficult and made us realise how far we are from family and friends. We have arranged to return to the UK for the funeral and to be with the family.
Mum was a wonderful person and an inspiration .She never really understood why we came to Uganda but always supported us. She valued life and was always conscious of the good life she had with dad. At 86 she was an age that very few Ugandans will ever reach. Death at a young age is a common occurrence. Eighty percent of the deaths are from preventable diseases and that is why we are here. Somehow we have to make a difference so that Ugandans can look forward to old age as we do in the developed world.
We have been in Kampala this week as part of VSO training. It has been a great opportunity to meet up with fellow volunteers and share stories and frustrations. We are all finding difficulties in our placements but we have learned from others that there are ways forward and hopefully we can use these ideas in Masindi.

Safari salaama

While Maggie was in Kampala I took the opportunity to visit the Family Spirit Centre. I had met the founder Isaac at the clinic and he had told me of the work he had been doing. He looks after over 20 orphans and vulnerable children from the age of 3 to 15. He has been doing this for several years and seems to have financed this on his own. As the venture grew he decided to open a school to give the children an education. He now has a school for 50 children and attracts some from the local village. These children pay a small fee which he uses to subsidize the orphans. He has some paid and some volunteer teachers.
I was impressed by the centre. The children all seemed well nourished and lively. I was given an impromptu concert of songs and nursery rhymes after a prayer led by a 4 year old! The children all seemed to have a good relationship with Isaac and many called him daddy. For a lot of the children he was the only father they could remember. There were 4 children who had arrived this week. The oldest girl was about eight and she was looking after the 3 younger children. They had been abandoned by their family and were sad and lonely among the other children. This process of vulnerable children being left is happening all over Uganda. The childrens’ families are destroyed by war, poverty or illness. It is left to people like Isaac and the staff of the centre to pick up the pieces and help these children.

As Chris says, I had yet another trip to Kampala. So far I’ve always managed to get a lift with Sallie; we stay over for two nights as she has business to attend to. This gives me a great opportunity to shop and stock up on supplies but, believe me, it is far from pleasurable! I’ve been persuaded to buy an oven and as I’ll be the only volunteer here with one I can see I’m going to have lots of orders for cakes and puddings (they’re non-existent in Masindi unless you count drinking yogurt in a bag). We return from Kampala feeling incredibly hot, sticky, dirty and tired. On a good day the trip only takes three and a half hours. Unfortunately yesterday was not a good day! We were already running late and didn’t leave until 4.30. As we pulled out of the car park onto the road, I looked out of the window and noticed that the front passenger side wheel was suspended in mid-air over a ditch. Sallie couldn’t move in either direction. Luckily help came and a few men ‘lifted’ the Land Cruiser back away from the ditch. On the way home we got a puncture. We were in the middle of nowhere, and the only traffic was the occasional lorry or bus pelting past at full speed. It was dark, very dark, as only Africa can be but a lady appeared from out of the bush with a lantern. We tried to find appropriate tools which meant emptying the boot - I wasn’t very popular with all my shopping! We failed miserably to change the tyre. The phone signal was intermittent but luckily we eventually managed to get hold of someone to send a mechanic. We then got a call to say that someone had seen the Masindi bus leaving Kampala after us and they would phone the conductor and tell him to look for us and help. So much for travelling safely in day time! The crowded Masindi bus arrived and came to the rescue. The car we were driving happened to belong to the owner of the bus. Networking here is great. In fact, everything relies on it.
Kampala is crazy at the moment. CHOGM (Commonwealth Heads of Government Meeting) is being hosted there this week and for months it is all everyone has talked about. An obscene amount of money has been spent to ‘beautify’ the City. The infrastructure is nowhere near ready and everywhere you go there are construction workers working around the clock. Some of the repairs on roads that will take our Queen from the airport have already been washed away with the heavy rains. It is easy to see which route the VIPs will take. A huge amount of money has been diverted from other essential areas just for these three days. A school and teacher training college in the centre of the City was bought (allegedly for 10 dollars!) by a Saudi prince so that he could demolish them and build a hotel for CHOGM. After demolition he changed his mind. Many hotels have sprung up (with worrying speed) specifically for this occasion but apparently some countries are not happy with standards and are even planning for their VIPs to stay in Nairobi and fly them into Entebbe everyday.
It is an everyday occurrence to hear of many injustices and nothing seems to shock anymore. It’s also easy to become cynical living here.
Perhaps I should go for my Sunday swim and relax a bit!

Chocolate heaven

The most important news this week is that a lone bar of Galaxy chocolate arrived at our Post Box much to Maggies delight. We have had a post box for the last 4 weeks but this is our first delivery. It arrived safely if a little misshapen after only 1 week. Thanks to Kare for her trust in Ugandan Post. We have a post box but so far do not have a key for it. Maggie goes every week to ask for the key to be told 'the man' has not made it yet so come back next week

Last weekend we had a visitor, Dada from the Philipines one of the VSO volunteers working in Kampala came to Masindi as part of her work on environmental issues. She and Daryll, another volunteer, cooked a wonderful Filipino chicken dish and we all watched Motor Cycle Diaries round the laptop. Who says you cant have fun in Masindi? This was the first time we had bought chicken here. You have two choices: buy a live chicken from the market or off the back of a bicycle, kill it, pluck it and then cook it, or go to the Shell garage and see if there is any frozen chicken in their freezer. At least Shell have a generator so you hope the freezer has not defrosted too many times. We opted for frozen.

Maggie has been busy at Court View Hotel. Sallie, who owns the hotel, has been in the UK and she asked Maggie to keep an eye on the place especially the kitchens. The first food hygiene courses were held this week and well received. One of the biggest challenges is to get the rats out of the kitchens. Another challenge this week was that Masindi had run out of gas for a few days so everything had to be cooked on charcoal. (notice we have adopted VSO's way of saying 'challenges' rather than 'problems'!) We are thinking of asking Gordon Ramsay to visit and advise. It would make a good TV programme. Court View is probably one of the best kitchens in Masindi but it is not quite to UK standards! Maggie is quite enjoying working with the staff who seem pleased that someone is taking an interest in their work. It is off putting eating there after Maggies description of what happens behind the doors but the food tastes good and we haven’t caught anything yet.

The HIV clinic is the main focus of my work. We see about 50 patients on Tuesdays and Thursdays. This week we have had 3 visits from the ministry of health . They are continually checking on what we are doing and looking at the documentation. Unfortunately this usually means stopping the clinic and keeping patients waiting for a couple of hours. Ugandan patients seem willing to accept long waits. We have supplies of ARVs but most other drugs are not available so it can be very frustrating trying to deal with patients' problems. This week I have needed to admit 2 patients from the clinic; one was dehydrated with dysentery and another had pneumonia and oesophageal candidiasis. Luckily we were able to access drugs to treat them. There are lots of patients with dual infection with TB and HIV. One of my tasks is to better coordinate their treatment as they can easily default from treatment which is a risk for the patient and the community. Another young patient at the clinic has cervical cancer as well as HIV. She was referred several months ago to the cancer specialist but as it is in Hoima 2 hours away she has not gone. She has no money for the fare and no prospect of being able to afford to stay in the hospital for treatment. Treatment is free in Uganda but you need to supply your own food and have an attendant to cook it and look after you. This young womans family can not support her so she will almost certainly die from her cancer if she does not succumb to the HIV. Another young woman with HIV on the ward has developed a stroke probably due to infection with toxoplasmosis. The treatment for that is not available so she has been taken home by her family to die.
The reality in Uganda is that many people are dying and it appears to be accepted. Patients are not demanding better treatment. There is a fatalism and people just say “this is Africa”. There is a lot of faith and that gives people the courage to carry on but sometimes it appears that it also prevents them from looking for solutions.

These are pictures I took in the HIV clinic - you can see how cramped it is. This was a quiet time. The guy in the fetching yellow outfit is a prisoner; we see lots of prisoners each clinic. The prevalence of HIV must be very high there. The man squatting has Stage 3 HIV and had dysentery. He looked alot better 2 days later after some antibiotics and fluid. His long term survival is unlikely I am afraid.

I also managed a trip in to the field to see some health centres. These clinics should provide most of the primary care but are sadly neglected. Staff are poorly motivated and often absent themselves from the job. The worst clinic we came across was anHC III which provided obstetric care. the delivery room had a foul smell which we traced to a dead bat in the corner. So much for infection control!

These pictures show patients at a health clinic plus the pile of used drugs and needles left on the windowsill.

Pictures of the market the clinic and health centres seem to go where they want and the captions go somewhere else. It is hard work being a blog virgin this posting has taken over an hour so hope you enjoy it.

It is Sunday morning and we have just had a walk round town but it is very hot. Morning coffee beckons and we have just had an invite for afternoon tea. It is tough in Masindi!