Continuing medical education

THE  TEAM !

Doc Laurel has taken a couple of training seminars on the topic of Palliative Care and Pain relief. This is an important topic here as many patients present with advanced disease  which may not always be amenable to cure. Many suffer in considerable pain and discomfort and one of the primary goals of good health care is to assist in alleviating this by appropriate nursing care and use of available medications, including Morphine.
Laurel spoke to a group of doctors at the St Josephs Hospital and then later to some clinical officers and doctors who work in the community in medical clinics. This little group gathered in our house and it was really good to see them sharing together .WE were able to identify in the community some impediments to delivery of best medical practice and talked about some solutions which might help people receive better pain relief and management of end of life symptoms, assisting people to die in dignity.
On the medical front, Andrew has been sitting in with the clinical officers at Bregma , observing, giving feedback and mentoring . We saw a lady with Diabetes today who is on medication but has no blood glucose monitoring available and many of the tests we do in Australia to check on control are not available here, so it is a matter of modifying many of the protocols we use back home to this particular place.
Malcolm today was able to help Lois Ford raise her used shipping container off the ground to stop the termites eating the floor away. A local mechanic, Samuel was able to help, providing a car jack and other assistance.
The generator Malcolm helped repair at Bregma is working well . Power is off 50% of the time and having a generator means the XRay machine can be used. Solar Power keeps the other parts of the clinic going.
Anne spent this morning at Bregma talking to staff and patients and just listening to their stories. Many of the stories involve suffering and loss and hardship. It is quite humbling and overwhelming.
Shirley is spending a considerable amount of time in the YOTKOM office, at the back of the drug  shop, sifting through receipts and invoices and using MYOB to get the bookwork for the drug shop and the yotkom project up todate. This is a great help to us in improving transparency and accountability within the Yotkom Project. Things will be set in place which will be ongoing.

Shirley slugs it out in Yotkom office with a packed lunch!

Andrew is  meeting with some key people in the next few days to further secure the land title on the proposed site of the purpose built clinic in Kitgum.
Today,Andrew sat down with Lucy, the  Bregma practice manager and looked at the last few months expenses, income and profit and loss for this important Primary Health Clinic. There are very many challenges to the successful operation of a private medical practice in this setting. Every day brings new set backs, disappointments, frustrations and unexpected  black holes!  Despite this, the medical practice overseen by Dr vincent is continuing to operate and deliver good health care. Without the boost given by Yotkom in the way of clinical officer salaries and capital input this clinic may not have been able to continue running. Dr Vincent may well have chosen to leave town and he is a great asset to this community.
Most of the Kitgum community regard the Yotkom sponsored Bregma Clinic as the best in the town and vote with their feet. WE can see some visible improvements since our last visit.
Laurel, Lynnette and Hannah left at 730am on the homeland bus this morning to make the arduous journey to Kampala. It took them 4 hours to make the first 100km due to a truck being bogged and needing to be dug out of the mud. We are going to miss them.
Yesterday Andrew and Anne went to out to the village to visit Cyclops, one of the laboratory technicians who was working at Bregma. Recently he had been so depressed he took an overdose of diabetic tablets and BP tablets, resulting in a severe low blood sugar and low Blood pressure. It took some hours for him to be brought to medical help and by then he was having seizures and sustained permanent brain damage. He has been discharged from hospital but is unable to speak more than a couple of words. There has been some slow improvement. Please pray for his continued healing and for the pastoral care needs of our Yotkom team and the patients who visit the clinic. We are looking at some ideas to address this issue.


Cyclops with his mother who is currently caring for him

 

 

Hello from Africa - this is Anne reporting of some of my african experiences.

 

Well everyday brings new challenges and stories of peoples lives.  Today we have finally got our toilet fixed which we had to repair with a stick until today.  Power is off again.  Making our way along african roads full of pot holes - and may I say Big Pot Holes - roads washed away which have had not maintenance for years.  Avoiding human traffic, bicycles and boda boda's is a constant challenge, and very time consuming - in this hot dusty environement.  But it is the people who make this place.  Though so poor they are welcoming and happy and we have had the privelege of visiting both our clinical officer's homes and their families for soda and biscuits.  Our watchman John is a lovely man and speaks good english.  He is protecting us with his bow and arrow.  He sleeps in his little hut at the gate on a cement floor with cardboard.  I couldnt have that so gave him the money to buy a matress so he is now sleeping better at night.  He also had a bicycle but couldn't ride it because it had no seat.  So we fixed that too.  One of our team found him some reading glasses which he said is a miracle and a bible is on the way - He is so excited and thankful.  Sarah our cleaner is a widow who has two children to care for - she is struggling to pay school fees as so many are here.  The government schools have 90 to 100 students in each class and are not teaching much from what I can tell.  So everyone wants to send their children to a private school to get a better education as a way out of poverty.  We have had so many request for school fees.

 

I have sat down with a number of people and asked them to tell me about their lives - and out it comes.  Stories of poverty, war, family members lost, children lost - there seem to be so many funerals here.  The lady who is cooking for us was shot through the arm by the rebels when she was sitting on the floor of the hospital with her baby in her arms.  You can see the scar where the bullet went through. The rebels also killed her first born son who was eight years old.  And so the stories go on.  One mother at the clinic I was talking to this morning lost her son who was 19 months old when he inhaled a nut and even though he had surgery died in theatre.  Last night at the clinic in the night a 2 year old boy was admitted with a temp. of 39.5 and put on a quinine drip and by this morning temp. was down to 36.5 and patient sleeping peacefully.

 

Well bye for now - need to go and get the dinner on - the lady who has been cooking for us has gone to a funeral today - so lucky I brought some packets of dry food from Australia.  As the kitchens here are very basic - but we do have 2 gas plates.

 

 

The team in full swing

On Sunday we enjoyed doing church African style and re established friendships

 

We went to visit Lois Ford at Tender Trust , spending time with her and the 100 children she provides care for in her home. We were abloe to deliver some spare wheels for the wheelchair used by Ben, who is a paraplegic as a result of a terrorist bomb blast in Kampala 3 years ago. He is an important part of the community within Lois Ford's project and often reads to the children.

Today, Tuesday, Our two nurses, Lynette and Hannah have just returned from St Joseph Hospital after working in the matenrity ward and delivery suite, seeing an African baby born.
Three of us visited the New Life Clinic here in Kitgum where there is a focus on diagnosing and caring for HIV AIDs patients, and preventing maternal to child transmission of this disease. The clinic receives funding from Blood Water mission in the USA as well as Food for the Hungry.
It was exciting to see Robina, a laboratory technician , working in this clinic. She was partly sponsored by Yotkom about 5 years ago to do her studies and is now working back in her community as an important part of this health team
Andrew spent some time in Bregma Clinic with Dr Vincent and our clinical officers, Peter and Richard  and then visited a dental clinic in the town to get more information on dental services as there may be some interest in a dental team coming from Australia in the future. There is no Dentist in Kitgum, the nearest one being 100km away in Gulu. There is one private dental assistant in the town and she is able to do dental extractions and fillings. There is also a dental clinical officer at the local Government hospital
Shirley has been working  all day on getting our financial statements up to date in the Drug Shop and within the Yotkom office.She took a  packed lunch with her today.
Yesterday we had lunch with the IGF/Childcare leadership team and talked about the plans for health outreach at their facilities.

Tomorrow Doc Laurel is delivering a teaching session to the medical team at St Josephs Hospital and also to the Bregma Clinic team and some other primary health workers in the community. The topic will be on Palliative Care and Pain Management. She has been able to encourage the hospital to build up a good supply of oral morphine for the patients.

Here in our house we have had some challenges. We have to be cocooned in mosquito nets every night and its quite an undertaking to extricateyourself  in the night.

Andrew trapped in mosquito netting, wearing his favourite Kitgum boxers

This morning I had quite a sore back after lifting jerry cans of water yesterday. The water taps have run dry and so washing and cleaning is a bit of a challenge-- makes us appreciate the burden the women and children have here in carrying water long distances.  We are veryt thankful for food cooked for us by Joyce. She is a lovely lady and the fresh paw paw and mango and pineapple is particularly appealing.

Doc LAurel cooked scrambled eggs on Sunday

There are some beautiful things here too!

 

 

 

Generator fully functional

Malcolm spent most of today working with a local Mechanic, Samuel on the generator at Bregma Medical Clinic which has been out of action for many months. We brought essential parts from Australia and relied on valuable advice from one of the Yotkom support team, Lucas Levy along the way.  The parts fitted perfectly and Malcolm was very impressed with Samuels skills and ability to improvise. An electrician helped to hook everything up to the switchboard. This will greatly assist the smooth operation of the clinic during frequent power outages, especially with medical devices and diagnsotic equipment which require more power than the solar can deliver. The Xray machine is a prime example.  Dr Vincent and the team are very excited to see this new development in capacity.

Unfortunately, malcolm missed out on a beautiful lunch prepared by Winnie, the wife of John Paul Kiffasi,  chief administrator at IGF/ Childcare. 

They kindly invited us all over for a meal in their home and it was s special opportunity to reconnect with the IGF team and hear more about their direction, vision and plans for the future, especially in the provision of health care  services to this community.
We also enjoyed hospitality at the home of our clinical officer, Peter spending time with his wife Sheila, son Shadrack and Mother Bensi.

Earlier in the day some of the medical team attended St Josephs Hospital. Childrens Ward, Medical and Surgical Wards

 

 

 

Dr Vincent  was very excited to receive the XRAY plates sent over by Sue Reid after her recent time in Kitgum. This will help the Bregma Clinic Xray capacity.

 

Settling in

 

We are finding our feet here after a busy initial couple of days getting settled into a base. We went for a walk last night and met some of the local families.

Today we attended the St Josephs morning meeting including a teaching session, then we split up to go to medical, surgical and paediatric wards to work alongside the African health professionals. Its a difficult time of transition, trying to adjust to the different way of practicing medicine here and being confronted with advanced disease and suffering in a setting which does not provide adequate health facilities, drugs or support.  Doctor Laurel saw a 15 year old girl suffering uncontrollable muscle spasms as a result of Tetanus and was also quite concerned to help the hospital provide better pain relief and symptom relief for those suffering terminal illness and medical procedures.

Andrew found it quite a new experience to wear a white coat on the ward rounds ! He saw cases of Sickle Cell disease, malaria, pneumonia and severe anaemia amongst the 50 children on the ward.  A very breathless child was also found to have an acute air leak (Pneumothorax) and required a chest drain.  We all found it a very medically challenging day but we hope to get into a routine of attending the wards every morning. At the Bregma clinic they have an established vaccination program which is good to see and have also recently been approved by the government to be a HIV /AIDs testing and counselling centre.

 

 

 Malcolm has been able to drive dr vincents car around the town and is quite adept at dodging massive pot holes . Shirley has started to tackle the book work at the yotkom office and drug shop, helping to get good reporting in place. Unfortunately, Hannah has been sick with gastric symptoms and had to stay home and rest today.  We have been very blessed with some helpers to do our washing (Sarah) and cook some nice meals for us (Joyce).

 

We have a HOME

Thankyou to all those praying for us to find a place to stay in Kitgum.
We were left in a difficult situation after the original offer of accommodation was withdrawn at the last minute.
Our African colleague Dr Vincent was able to locate a house for rent and we have spent the day collecting items of furniture and bedding and trying to put together a liveable home which we can use as a base for the next three weeks.
Its been challenging and tiring but we are planning to sleep here tonight and welcome our other team members, Lynnette, Hannah and Laurel after their long drive up from Kampala.
Tomorrow we hope to give something back to the community in the way of medical work and other practical assistance. Our African friends and the team hetre have been very resourceful, generous and loving to us.

 

Team arrives safely in Uganda

Andrew and Anne Wright are currently travelling on route to Kitgum with Shirley and Malcolm Kampe. We have stopped over for two nights at Murchison Falls as part of the road journey north from Kampala, the capital city. Kitgum  is about a 8 to 10 hour bus trip from the capital .
While at the National Park we have been able to see some african animals and scenic beauty.
Our Australian colleagues, Lynnette and Hannah, Nurses from Sydney will be joining us in Kitgum during  this week along with Laurel Coleman from the USA. Our focus will be on improving quality of medical care , teaching, mentoring and sharing knowledge between us and our Ugandan medical professionals.  Other activities include repairing the generator at the health clinic and building up our business and project reporting and accounting. Please pray for our time in Kitgum which will be close to three weeks . We will seek to keep you updated .

Malcolm , Shirley, our driver Grace, Andrew and Anne

Thankyou Gateway Baptist for gift of SOLAR

Thankyou to Gateway Baptist Church Brisbane for the donation which allowed Yotkom to install Solar power at Bregma Primary Health Clinic in Kitgum.
This has provided an ongoing significant boost to the medical team working here .

In January 2013 our small team from Australia were able to assist with  this process.

A short 5 minute video is available on the link at top right of this web page.