Maggie missing from Masindi

THE PHOTOS SHOW THE SPECIAL BOARD AT COURT VIEW AND VILLAGERS FROM KIHAMYA WAITING TO BUY NETS

This has been a strange week with Maggie returning to the UK. Every body keeps asking where is Maggie and when is she coming back. The staff at Court View still do not really believe that she has left there and are still hoping she will go back.

Masindi has been full of Muzungos this week with delegations of Bristol teachers and a christian group of over twenty. It is strange to see them all coping with the culture shock that we experienced in 2007. It makes me realise how I have adapted and things that horrified me when I first arrived I now just accept. I am not sure if that is a good thing and whether justified rage would be a better position but you can only stay angry for so long. The people who you really should be angry with are not in Masindi, they are in Kampala in the ministries and their air conditionned offices.

So I did not fly in to a rage when the medical superintendant told me that he could not get morphine for a woman dying from uterine cancer, nor did I get angry when he said there were no sticks for the glucometer so I will have to guess at the values for the diabetic patients. I was pleased that somehow he managed to get hold of some insulin so I did not mind that we do not have any other diabetic drugs. We do not have amoxil, pain killers or hypertension drugs either. The two patients with severe TB I saw on Friday will have to wait for their drugs because we have run out of anti TB drugs again. We do not have leprosy drugs either and there are at least 4 new cases to be assessed this week. We do have ARVs and we were sent some "Plumpy Nut Sachets" to use for malnourished children. Unfortunately they are due to reach their use by date in March so we can not use them properly but at least some of the kids will get a short time benefit.

In spite of the shortages there are successes here and every day you see patients who have benefitted from treatment. Most days the hospital performs caesarian sections for difficult births which undoubtedly saves lives. The maternal and neonatal death rate here is still high but it would be much higher without the skills of the surgeons who operate. Many of the patients with malaria would die without appropriate treatment and it is unusual for an adult to die in the hospital from malaria. Unfortunately often they do not get prompt treatment and the nurses forget to give them their quinine but most survive. Patients with pneumonia usually survive unless they are complicated by HIV. Most of the TB patients do well if they take their treatment and TB is one of the most satisfying things to treat here. Lots of patients have severe TB and look like walking skeletons when you first see them but after a few months treatment they are unrecognisable.

The big problem here is prevention so that is why we are trying to provide mosquito nets and get people immunised. The meningitis has gone but there was a death from neonatal tetanus in one of the villages. All it takes to prevent neonatal tetanus is to give the mother a single shot bf tetanus immunisation in her pregnancy. This mother had attended 3 ante natal sessions but was not given an injection so the baby was not protected.

We have purchased another 1000 mosquito nets for distribution this week. The vehicle is off the road but some how we need to get out to 3 more villages. We may have to take a special hire as the district appear incapable of providing vehicles and do not see the project as a priority. This all costs extra money but it is money well spent.

Obama in Masindi

PICTURE OF ISAAC AND STEVEN

PHOTOS ARE OF MURCHISON FALLS TAKEN ON OUR LATEST TRIP.

OBAMA AND MASINDI
Happily the meningitis outbreak appears to have finished as there have been no more cases after the emergency immunization campaign. I have been visiting some of the villages involved and was surprised when John one of my senior colleagues who I travel with told me that the villagers had been asking whether I was Obama come to help them. Obama is a real celebrity in Uganda and every one is expecting great things from him but why villagers should mistake an elderly muzungo for a young Afro-American was beyond me. Thinking about it I realised that if you live in a village you will never see a picture of Obama. TV here is rare and only ever seems to show premier league football, never the news. Newspapers and magazines do not reach the villages and all news comes from the radio which most people listen to. People have heard of Obama but have no image of him. The idea is that if any one from abroad is taking an interest it must be Obama. I hope he has time to sort out Masindi among his other problems, it needs all the help it can get.
We have a great time the last week with Hannah and Sara visiting us from the UK. Our trip to Murchison Park was wonderful as usual and we saw some magnificent elephants and other wild life including a beautiful chameleon on the road. Unpacking the vehicle on Sunday night we realised Maggie’s camera was missing. After intense questioning and threats of torture I confessed that I had hung the camera on a mango tree in the car park at the top of the falls. No one could face a two and a half hour journey back to the tree in the dark over unmade roads. We were advised to report it to the park authorities. I went to the office in Masindi at seven o’clock and was surprised to find a ranger there. Do not worry he said, tell your wife not to beat you these things happen we are all human. He radioed a colleague in the park and they promised to look for the camera the next day.
On Monday morning Maggie went to the office and was told that the camera had been found. They said it would be taken to the foot of the falls and given to the boatman. He would then take it to the office at Paraa. Simon said that when a vehicle came in to Masindi they would bring it with them. In fact the next day we had a call to say that the camera was at the Park Gate 20k out side of Masindi. Simon the ranger said if we paid for his fuel he would go on his motor cycle to fetch it. The camera was returned for the cost of 3 litres of fuel, 10000 ush or £3. A cheap price to save a marriage!
It amazes me that simple things often never happen here but complicated things work out. If I had left a camera hanging on a tree in Pearson Park in Hull there is no chance I would have got it back.

This week I had to ask Isaac who runs the family spirit centre to see a boy in the clinic. This boy has HIV.He is looked after by his grand parents as both of his parents have died from HIV. This is not an unusual situation here. Unfortunately the grand father is disabled after a stroke and the grand mother is an alcoholic who regularly gets drunk and beats the boy. Steven had run away the previous day to his aunt 5 kilometres away. He is malnourished and has Stage 3 HIV. He needs to start ARVs. His grand father accepted he could not care for him and was searching for help. Isaac is a big man but as soon as he walked in to the room you could feel the tension disappear from Steven. Isaac just wrapped him in his arms and gently talked to him.This little boy relaxed and you realised he felt safe at last. It was very moving. It was agreed that he would go to the family spirit centre and live there. He will be looked after and receive an education. Hopefully he will respond to ARVs.

February already

PICTURES OF THE STORM AT COURT VIEW AND CHILDREN AT FAMILY SPIRIT WITH ISAAC THE FOUNDER

This has been a quiet week. The weather has broken and there have been some spectacular storms one of which removed the roof from the shop just out side are compound, luckily no one was around. The weather here is amazing it can change from bright sunshine to fierce rain within a few minutes. The rain is usually preceded by a wind which rattles everything in the house. You can often see the rain advancing up the valley. When it comes every one dashes for cover and everything stops. It may pass after a few minutes but sometimes you are stranded for much longer. The rain is just too fierce to walk out in it. I nearly got caught in a storm on Wednesday. The medical superintendent who is in charge of the hospital could not cash his salary cheque and needed some money to travel to Kampala on family business so he asked if he could borrow 200000 ush. I could go to the bank and withdraw it but he has no reserves. Even a man in his position is only just operating above the poverty line and has no spare cash at the end of the month. Most people here seem to live with out cash. Many people do not get a regular salary even when they are working it is not unusual for payment to be delayed. I have not had my salary from the district since July luckily we do not rely on it.
The rain hopefully will have helped bring the meningitis out break to a halt. The ministry sanctioned a mass immunisation campaign so the district rapidly trained staff and deployed them in the villages. I have not seen any one involved this week but I have not heard of a flood of cases and there have certainly not been any admitted to the hospital.It has been remarkable how the service responded to the out break once it was identified. It was not the most efficient response but hopefully it has worked. There has been no mass panic and hopefully no great loss of life.
This week has been busy with net sales. This has been the first time that the team have done it all on their own. I have not been out to supervise and it has been great to see that it all worked and three villages were visited. We are having a meeting tomorrow to plan the next stage. We still need to buy more nets and are now being approached by other villages demanding that they are involved in the project. There are no plans to extend to other villages until all the ones we identified have their nets but it is good that people are asking for nets. The rains will bring an increase in mosquitoes so it is important we get them supplied as soon as possible. A Peace Corps volunteer Chris has offered to arrange some fund raising in the US and we are hoping to raise some money when we return to the UK in March for Becky’s wedding. It looks like we will have to pay more for our next supply of nets but hopefully not too much.
I returned to the Family Spirit Centre this week end. A well wisher from the UK had sent some money for them. They had just been given two exotic goats by rotary international and needed a new goat house so the money came just at the right time. If all goes well they can breed from the goats and generate and income. I am always amazed by the centre. The children have so little but are always cheerful and polite. They are getting an education and somehow Isaac the founder manages to interest local people in the centre and gat them to offer services or food for the children. They are searching for a computer now as Susan the deputy has just done a computer course and wants to use her skills to keep better records. At the moment if they want any letters writing they have to go in to town and pay to use a computer and printer.

Meningococcal meningitis in Masindi

THE PHOTOS SHOW MAUREEN 24 HRS AFTER HER MENINGITIS TREATMENT SITTING OUTSIDE THE CLINIC AND ON THE BED WITH HER FAMILY.THE BUILDING IS PAKANYI HEALTH CENTRE WHERE SHE IS BEING TREATED.

The meningitis out break has continued and I have been able to get out in to the villagers to see what is happening. There have been no deaths in patients who went to health centres but there were 3 more deaths in the villages. Three patients had been seen in one drug shop and treated inappropriately. We visited the shop and found that it was illegally operating as a clinic and giving drips and injections. The nurse in charge could not speak English which means he had not been through secondary school or nursing college in Uganda. The owner of the shop claimed he was trained in the Congo but it seems unlikely. Hopefully the shop has been closed down but I suspect it will reopen some where else. There is money to be made.
Some of the patients had been treated in a Catholic clinic. It was unknown to the district officers but was of a high standard. The nurses knew what they were doing and the place was clean with separate rooms for patients. It had been decided to treat all the patients in clinics rather than bring them to the hospital. It was argued that they would get better care in the clinics.
The politicians have been visiting the area to look at the preparations. They were not impressed that the district had not provided fuel and transport for the health workers. Some sharp words were evidently said and hopefully things will improve now. Today they have sent vaccines so a mass immunisation campaign is starting. All gatherings have been banned and it looks like the schools will remain closed for an extra week. One of the politicians from Kampala was so concerned that he might catch meningitis he demanded the treatment just in case. The image of a politician having 6 mls of oily chloramphenicol jabbed in to his buttocks will be one of my memories of Uganda.
The weather has finally broken and is now much cooler and we have had some rain. This is good for the farmers and should help to stop the meningitis out break. The dust is settling and it is much pleasanter. It could be that this is a temporary respite and we could have dust and heat again but it is nice at the moment.
We had unexpected visitors from Hull this week. Mark and Jonathon had a 3 day job out side Kampala and paid us a visit. It is always good to see people from home and we had a great time catching up on news. Maggie took them on a day trip to Murchison falls and was rewarded by seeing a shoebill, a bird she has been desperate to see since we arrived. She is really enjoying the bird life and is very knowledgeable now.

Hot and dusty in Masindi

It is worrying when the Ugandans are complaining of the heatbut they are now.The last week has been very hot and every one is finding it difficult.By the time I have walked to work, ten minutes down the hill, I am ready for another shower. You sweat and smell all day until you climb the hill for home and another shower.We have it easy with indoor plumbing but most Ugandans have to collect there water from a well, river or borehole. You see children from about the age of four carrying water. It is part of their daily ritual and families will spend several hours a day collecting water.Often the water is not safe to drink so they then need to collect fuel to boil it. Obviously many families do not bother putting themselves at risk of diarrhoeal diseases.The dry season is hotter and earlier this year.People are worried that Uganda could be in for a drought and have to import food.This would have been unthinkable a few years ago but a poor harvest and increasing population could cause problems.It rained last night the first for 4 weeks but it did not last and by morning there was no sign.
With the dry weather comes Masindi's orange dust. This gets in to every thing and it is impossible to keep things clean. As you walk down the road you acquire an orange layer and ginger hair.The lorries are the biggest nuisance they throw up a thick cloud of dust that will envelope you for several minutes. Not only is this bad for your health and clothes but it makes you invisible to the next vehicle and many accidents are caused by dust clouds.
Last week there was an out break of meningitis in the district. There have been 6 deaths so far and several more cases. This generates a response from the district who try and manage the outbreak and limit its spread.Today I went out to the health centre to examine a new suspect. She was related to a previous case and had attended her funeral. The patient was 14 years old and had developed a headache and fever last night. By the time I saw her she was obviously very ill.The cases are looked after in the health centre in a makeshift ward with mattresses on the floor. I managed to do a lumbar puncture on her and prove that she had meningitis and she was started on treatment. Usually one shot of chloramphenicol is enough to treat the patient. There were several patients at the health centre who had been moribund a couple of days earlier who were now ready for discharge. It was impressive to see the nurses and community staff working together and saving lives.But the success is in spite of real difficulties.John who runs the community side has no budget for management of an outbreak. He had to borrow fuel from the Red Cross to get out to the health centre. There is no money for a radio announcement to alert villagers to the problem. There are no vaccinations for health staff and no money to pay their extra allowances. The sample of CSF needs to go to Kamapala for culture and he does not know where he will get the funds for the bus fare.
Money is tight for the routine care but seems available for HIV care. The latest NGO in the patch is just recruiting 48 staff and moving in to a big new office. Its role is to test babies and pregnant women for HIV. Unfortunately they are providing no funds for treatment which they are expecting the hospital to provide. Our clinic is struggling to provide care for are present work load.
On Wednesday I was able to order more mosquito nets thanks to the people who had given through the just giving web site. On Saturday 1000 nets arrived from Rwanda. Sometimes things in Uganda can surprise you with their efficiency. This week 3 more villages will be offered nets.

Happy New Year

New Years resolution was to make sure we did the blog every week end so we’ve failed on that one. At least I have managed to stay off the booze, drugs and single women.
Christmas has come and gone and the New Year has started. Christmas was different. Eating turkey, sprouts and bread sauce at Court View with all our friends was a good way to spend the evening but we missed family and friends back home. African dancers and drumming was a good substitute for Morecombe and Wise.
New Years eve was spend at Nabaye on the edge of the Budongo forest. Cathy and Roman are two research workers working with the chimps in the forest the held a party for all their staff. We had a great time with a big barbecue, dancing and fireworks. The night sky was fantastic with a million stars that you can never see in the UK.
Maggie and I had promised our selves a chill out weekend at Nile safari lodge to start the year. It was a great time and we avoided the game drives and just sat and read and watched the animals from the veranda. It is a special place and we love going there. Even the two punctures, the dust and the tsetse flies could not spoil it. We are going again next month when Hannah comes out.
The New Year has brought fresh challenges at work. We have now completely run out of anti TB drugs. This means we now have to say to patients yes you have TB, that is why you are coughing, sweating and losing weight. There is some really good treatment that would make you feel better within a few weeks. Unfortunately we do not have any, may be try next month. I can not understand how Uganda can run out of such essential drugs.
There was some good news this week. Vincent the baby with dislocated knees came to see me. He is fine very sturdy and taking his weight on good straight legs. His grand mother is very pleased and brought me a live chicken to thank me.

Sitting on our patio drinking freshly brewed Ugandan coffee and looking over the Masindi hills shrouded in a dust haze leads you to reflect on the past year. We have had our downs, breaking my arm was not a good way to start 2008 but there have been lots of ups.
Uganda is a beautiful country with lots to see and experience. It has been good to be able to share some of this with students, friends and family. There are not many places in the world where you can see chimpanzees in the wild raiding the sugar cane! The wildlife in Murchison Park must be some of the best in the world and it has been a real thrill to get so close to crocodiles and hippos. They are big!! The rhinos at Ziwa are fantastic. Walking towards wild rhinos and being able to get within 30 yards of them is an experience to be remembered. They are prehistoric looking animals and you realise how lucky we have been to be able to see them in their natural habitat. The bird life here has been a revelation and most weeks we see something new. Today we are trying to identify a horn bill we saw at Kinyara sugar works. Our walk with John and Rena on the Royal Mile in the Budongo forest must rate as one of our best birding experiences. Raymond the guide knew all the birds and was able to entice several out of the undergrowth by mimicking their calls. Wild life is everywhere in Uganda; we will not dwell on the bats, ants and snakes in the house!
During the year we have met many different people. Sitting in Court View Hotel there is a steady stream of interesting visitors. Some are tourists but many are working for governments or NGOs. You get to hear about various schemes and projects throughout Uganda. Some of the schemes fill you with hope but others are badly thought through and designed to appeal to donors but achieve little for the population.
Living in Masindi makes you realise the incredible difficulties facing the ordinary people. Development and aid seem to be a two edged sword. It is difficult to know the best way forward. There are thousands of NGOs in Uganda and billions of dollars of aid flow in every year. In spite of this there is no functionning health service, the schools are struggling to provide for their pupils and the universities have stopped giving an education to their students. Aid is almost seen as a right here and Uganda has developed a dependance culture. The answer to almost every problem is seen as 'find a donor'. This is true of government, both local and national, as well as individuals. As a mzungu people often approach you to ask for money for every thing from school fees to finance for weddings or funerals.
In the villages children still suffer from malnutrition and women and children are dying every day from malaria and diarrhoeal diseases. HIV and TB continue to devastate the community. Unfortunately many NGOs are seen as serving their employees and not the community. If you want to make money in Uganda you work for an NGO. If you want to make alot of money you go in to politics or the church.
Our project providing mosquito nets operates at the village level and there's little scope for any one to cream off money. It has been one of my high spots getting in to the villages and seeing the volunteers selling nets to ordinary people for use in their homes. I really feel this will make a difference to many families and reduce the dreadful toll of malaria.
Thanks to every one for reading the blog. Special thanks to people who have bothered to leave comments.