Kitgum Town

Kitgum Town
Kitgum Town

Friday, October 14, 2011

Battling the menace of Malaria

This morning when i walked into Peters consulting room he had a young girl lying on the floor with a high fever. She had slight jaundice and an enlarged spleen, but she also had some signs in her chest. We thought it may be Pneumonia but were able to order a Malaria smear on site and found she had a heavy infestation of parasites. It was good to be able to look down the microscope at the blue rings which scattered across the film and be able to make an accurate diagnosis. She was admitted to our day ward and given the latest and most efffective malaria therapy, intra  muscular artemether along with IV fluids and antibiotics for the pneumonia.  When I walked past her bed in the afternoonn she was looking so much brighter. Its times like this that all the work and obstacles and frustration is worthwhile !

A special photo tonight for Andrew and Rowena Rowe . I delivered a present they sent for baby Dennis. His mother was lying on the verandah with him tonight, recovering from a hernia operation. her face lit up with a smile when i delivered the gift!

Dennis gets his pressie from Weena

I love the african children , so here too  is a shot i took today of baby david who had the emergency surgery this week and is doing very well.
isnt he so cute? he smiled at me as i walked past and chatted to him today.


 My last day here today and all of a sudden has come the promise and potential of a new exciting partnership with local medical practitioners which has the potential to mmake a major contribution to primary health care here . It is a story of an amazing roller coaster ride which is too complicated to share at the  moment...but.. more details later...

Andrew and Doc Vincent talk about new possibilities

 The big bus trip tomorrow, with my travelling companion Doc Laurel, then a long flight home on Sunday. Thanks so much to you for your emails and messages and prayers and support
The last few days have been pretty tough going here . I have really felt the power of your prayers  , especially in the last couple of days when some pretty amazing lows and highs have been happening... but i am leaving with hope and believe i will be back !

Thursday, October 13, 2011

My work here is almost done

Malnourished child from Sudan
The medical superintendent at St Josephs Hospital has aked me to come and help in the childrens ward at some time next year. I spent some time there today with Dr Laurel and it brought back memories of  working there in 2003. I enjoy working with children and will give some consideration to returning and being involved with the 100 bed ward, the nutritional unit and a planned neonatal ward.  There have been some significant improvements in the hospital since i worked there and there is a good atmosphere there.  There is a lot of need.
Today we saw a little 1.8kg premature baby being nursed in very simple surroundings with no technology. You have to be tough to survive here!

premature baby 1.8kg with mum on the floor

 LAst night we had the privelege of visiting the home of the IGF Clinical Officer, Peter, meeting his wife Sheila and son Shadrak as well as his mother. What a simple life he lives outside of work!  I really admire this guy.
The clinic at IGF is now functioning well and can operate independently under the direction of Peter.  My "to do" list is complete with all the half finished jobs from my last visit tidied up and patients from the community being seen. the pharmacy is also working well. Please pray that the team here will work well together and be effective and receive support from the IGF administration in their work.  My influence is going to be significantly reduced when I leave on Saturday.

Tuesday, October 11, 2011

Judge Judy African style

Prime real estate in Kitgum
Yesterday I was asked to resolve a dispute which had arisen on some land which i purchased in 2003. At the time I was considering developing a medical clinic on the site but since then have got involved with helping Irene at IGF to expand her facilities on site. The land is a short walk from IGF on the way into town. There are two families living on the land. John Achola ( terribly disfigured as a result of LRA atrocities) and his wife wife Grace and their 4 children, living alongside a widow who works as a chef in the AIDs hospice, and her 7 children !  Quite a little community. I also discovered there is another man living in a tiny room on the land, paying rent to the previous owner !
A dispute arose over fights between the children and became quite acrimonious, leading to a district official being involved and a fine being made.
So in the hot sun, I walked up with Peter my interpreter and put on my family court (Judge Judy )hat to try and settle everything down and avoid blood shed on my land !  I believe it is settled now and i am considering what more to do with this rather nice place where the vegies are thriving.
with some african guys on the block

Today the building guys moved one step closer to completing the incinerator and ash pit. I was intrigued to watch them lifting the pipe and supporting slab up onto the top lof the chimney.. quite a precarious undertaking... i was tempted to shut my eyes on a couple of occasions.

We were also excited to receive our drug order for the month from Kampala, ready to stock the pharmacy.

We did ward rounds in the AIDs Hospice this morning and it was a great opportunity for Dr Laurel to do some teaching of the medical team.

Ward rounds

the top of our incinerator lifted into place !

Monday, October 10, 2011

Visiting an amazing Kiwi

Lois Ford is an amazing Kiwi woman who has been working in Kitgum for some years. She has a  project called Tender Trust  which provides residential care to about 100 disadvantaged, at risk and in many cases disabled young children. Steve Curtis Ch children and she has Ugandan assistants on site. We visited and Lois treated us to a feast of western food which she prepared in her kitchen. Thankyou Lois , it was soooo good! I was expecting beans and pocha (maize) but a real surprise to have shepherds pie, cooked tomatos, cole slaw, rasperry cordial, plunger coffee and finished off with banana cake.  MMm ..highlight of the day!
Its always very emotional visiting Lois and meeting her children because they have so many struggles.  Also, she is caring for Ben, a young man who had shrapnel in his neck inflicted in the Kampala terrorist bomb blast about 12 months ago. He has been left with a serious spinal injury, meaning he has very little movement in his arms and none below the neck He also needs a tracheostomy tube permanently. He is a lovely guy . We spent some time with him and prayed with him.

During our visit the children were playing happily  in their yard, collecting water from the water bore, having a wash after the hot day, and then enjoying some food prepared in their big kitchen,.

After that we could here them singing downstairs while we chatted together upstairs, at times in the dark, due to the power going out.

It was a good time.

Sunday, October 9, 2011

Saturday, October 8, 2011

A day away from work

my little friend Dennis
A more relaxed day today. Nursing babies, and listening to talented african dancers and singers compete in a local competition.  The building was packed with about 5000 people crammed into the church building on site here. People were also hanging out of trees outside so they could see the performance. The judges were George (exodus) ,gospel singer from Kampala and his mates, Titus, Jimmy and Gilbert. There were some pretty impressive displays of gymnastics and creativity from the young people in this recovering war zone. 
Tonight for tea we went to the chief administrators house and were treated to cooked antelope and warthog among other delicacies !  His wife Winnie also specialises in a superb fresh guava juice.  There was alos some major excitment in the house as we watched the soccer match between Uganda and Kenya being televised!

Doc Laurel and I also spent some time evaluating our experiences today and preparing some written recommendations for Irene and JP next week regarding the health project here.  Please pray for a sense of unity in purpose and direction. There are many challenges .

JP has an electrified tennis racquet to swat and frizzle nasty malaria carrying mosquitos !

Friday, October 7, 2011

Geoffrey is our sponsor child at IGF, He is attending the vocational training school and was having lots of difficulties getting to classes on time as he lives about 12km out of town and has to walk to and fro. Anne and I decided to give him a push bike and he was very happy when I presented it to him today!
We are working hard to get a functioning pharmacy and establish an accountable storage process. Janet Riessen from South Australia has worked in pharmacy dispensing so has been an invaluable asset at the current time.
Janet with Benson and Justin (our book keeper) in the pharmacy
The shelves have been set up and our existing drugs put in some order. We have an order for 1 month supplies, due to be delivered next Tuesday .

I spent a lot of time pursuing and stalking all the builders and administrators in an attempt to get some half finished jobs completed. I find this exhausting but necessary.

I am spending some time with each of the health workers listening to their concerns.  WE had a meeting of all the nursing staff today and heard about many challenges .

Doc Laurel and I are going to spend some time this weekend , reviewing the week to date and coming up with some proposals to bring to JP and Irene next week

Joel doing some microscope work in the lab
The gospel singer, Exodus and his wife Brenda as well as co singers Gilbert, Jimmy and Titus are here in Kitgum for the weekend to participate in a music festival. It is Independence Day.

George and Brenda in Kitgum

Thursday, October 6, 2011

Baby David with painful inguinal hernia
I thought  I should provide some medical input  tonight. Its a story with a good ending .  Little David who is one of our children receiving nutrition and being nurtured by local pastors wife, presented  to our clinic today in pain with a lump in the groin which had been present for 3 hours. We diagnosed  an obstructed hernia and he was rushed up to St josephs Hospital  with Dr Laurel Coleman , a physician from the US who is working here with IGF at the moment. He was operated on quickly and the bowel was saved from gangrene so it is a very pleasing outcome.
Earlier in the day, Doc Laurel, myself and the medical team members did a ward round and we found Laurel's experience in Palliative Care and AIDs patient management in the US very helpful in teaching. (Laurel also has a blog site : )
We had  quite a busy day in the clinic seeing patients and tonight we broadcast on FM radio and announced that the clinic will be receiving patients from the community from next week.  We are trusting that the inflow of patients will be manageable !      Other good news is that we have identified a great fridge for the clinic and will be ordering this .  Time is travelling fast here and each day brings new surprises and challenges  .  More updates tomorrow !
surgical treatment underway

Wednesday, October 5, 2011

Meeting the top brass

Peter (CO), Andrew and Benson (RN)
 I am enjoying working with my african colleagues. We are seeing some patients together and getting familiar with computer records.
This morning at 9am Peter and I walked to the district health officer and met with the director , Dr Alex Olwedo ,to discuss the assistance we may receive from Government sources. He was very freindly and helpful , promising to forward our documents of registration to Kampala and indicating that next financial year we will be eligible for Government grants.  We are also able to freely obtain all vaccinations from the Health Department and administer these at the clinic.  We are awaiting the purchase of a suitable fridge. We had decided on one in Kampala but had to cancel at the last minute as it became evident that frequent power failures would be a major risk to our vaccines. So, we are searching for the right dual electric and gas powered fridge. Thankfully a donor in Australia has forwarded funds to pay for this for which we are very thankful. Having the fridge will allow the clinic to do effective preventive health care and potentially save many children from sickness and death as a result of preventable diseases like measles, polio, whooping cough and meningitis.

meeting the local brass
 Today we had an inservice training for the medical team and Benson, one of our comprehensive nurses did a very informative talk on vaccinations and maintaining the cold chain.

I am having some concerns about one member of the health team here and will be needing some discernment regarding his future.

Tomorrow night Peter and I will be on FM radio to do health promotion. We may also take the opportunity to explain about the new health facilities at IGF and invite more access by the wider community.  Tomorrow I will be joined by Dr Laurel Coleman  from the US and it will be good to work with her and explore ways that we can co operate in supervision and teaching of the health services here.  I must admit at times I am feeling somewhat stressed and overwhelmed by the troubles and problems that people share with me here. There are sometimes expectations that i can help but I just have to accept i have limited resources.  Also plans dont always go smoothly and obstacles crop up. There is a saying here when things go all topsy turvy and awry, and the best laid plans get stuffed up !!.. "TIA": This is africa !

Tuesday, October 4, 2011

The right place at the right time

Its 6pm and the end of the day. Ive just had a wash and cold shower (not enough sun to heat up my black camping shower today)
Am feeling that i has been so right for me to return here at this time.
The project is at a critical phase and needs  to be pushed forward.
We had a medical meeting today with the administration. It was a long discussion and stressful but some good outcomes i believe.
As well as improving the pharmacy and dispensary set up , we are now planning to promote the clinic to the community . The radio broadcasts on Mighty Fire FM will  be one avenue for this. A new regular health promotion program on the radio is to be named "Mighty Doctor " !  We will be kick starting it this week.
Tomorrow, Peter and I will be meeting with the Government District Health Officer to talk about our involvement in Govt and WHO programs for vaccination and delivery of essential medicines. We are praying that some assistance will be available to us to provide better health services at an affordable cost to the communiity.  It is evident that the power supply here is not so great so we have decided to purchase a two way fridge with LPG gas back up to maintain the vaccinations in the event of inevitable power outages. This is likley to be delivered tomorrow from Kampala. We will be doing some teaching on vvaccinations and cold chains tomorrow to the team . The fridge will also allow us to store test kits for typhoid and brucellosis and other conditions here as well as possibly rabies treatment. There have been a considerable number of rabies cases in the rural communiities around here. One child died a few days ago and unfortunately there is no supply of antidote in Uganda.
My presence here is a major catalyst to change and progress.  Unfortunately many of the projects we left partly completed have not been finished off and need a muzungu (white person) of influence to railroad through. One example is the incinerator which 3mths later has not had the metal pipe and cap placed on the top so has not yet been operational ! So frustrating, but evidence of one of the main reasons I am here.
There are other examples which today with a few visits to the builders I have been able to get action on.
I am really enjoying working with the cliinical officer and have an increased confidence in him.
I am just being called to go too Pastor Alfreds for dinner so will finish this later.  More updates tomorrow . Please remember our meeting with the DHO tomorrow!

Monday, October 3, 2011

Re entry phenomena

Sorry, no photos..Ive been too "busy"
Adjusting  !
Coming back into the african setting is challenging me today. I must be getting soft as i have found the rough road trip up to kitgum and the basic amenities and limited food choices here are hard going .  Also  dealing with a very different culture and less rigorous and productive work pace and expectations takes a while to come to terms with......nevertheless, some good things have happened.....
I have spent the day shadowing Peter,  the clinical officer in charge here and am feeling encouraged by his skills and competency and character. The patients here have very complex problems and it is very time consuming extracting all the information especially with the language barrier. Its also very hard not having access to specialist care. Today we saw a young man who had a seizure while working , fell and sustained a very nasty fracture of his shoulder. The head of the humerus was totally snapped off and displaced. In Australia he would have been sent for emergency surgery to restore the normal anatomy and pin the fracture together. Here it is not an option. He will most likely have a very stiff and poorly functioning right arm as a result of this. Another patient has a painful abdomen and on examination an enlarged and tender liver. We cant do ultrasound or liver function tests so diagnosing the cause of this will be a challenge. Back in Brisbane I would send him up the road for these and have answers in a matter of hours.
Its good to see the new computer system operational and to log myself on and start entering patient details.
We are looking to centralise our pharmacy in the OPD and dispense from there.  Currently, a nurse called Alice is in charge of the store and we want to upskill her to be a competent pharmacist  !   Amazingly, there is a lady staying here, Janet Riessen who has worked in this role and has agreed to spend time with Alice over the next few days.  This week we are expecting delivery of the new vaccine fridge and also a months supply of medications which we ordered today.
Overall there are some encouraging things happening.... and some hard work ahead ! Thanks for thinking of us..and praying ! I think it is only God who can bring about significant and sustainable changes in this place !
Its definitely  a  task beyond the abilities of us mere mortals .
PS my mobile is not working so i have now a local SIM card: my number is +256792511418

Saturday, October 1, 2011

On the ground in Kampala

All good here. thankful for a sommoth trip over with emirates. the 24hr transit seemed to go relatively quickly with some valuable sleep on route. Met with Liam Chapman in Entebbe, a GP from UK who is involved in training village hhealth workers in Gulu, Northern Uganda. This is inn co operation wiith local churches. We enjoyed sharing and learning from each other.  Just preparing myself for the 8 hr bus trip to Kitgum.  Have a bag of bananas, muesli  bars and water. Looking forward to meeting again with my friends in Kitgum at CKS. Ready to start some hhard work with the medical team tomorrow!