Support a Physio for Kumi Hospital, Uganda!
SINCE RETURNING TO THE UK ....
Leaving Kumi was difficult, but has definately left me with a need to return! The 6 months that I spent there were full of friendship and joy, but also highlighted so many areas where a change can occur if only it was instigated. It was through this that I would now like to start a charity - FRIENDS OF KUMI HOSPITAL that can be dedicated to helping to develop the hospital further.
Please continue to check the website for updates on the charity's progress and eventual own website once it is up and running. Please also check this website for attachments of presentations made of the hospital and work done in my 6 months.
Many thanks for all your support.
Log 9: 16th December
Dear everyone,
I am sad to say that this will probably be my last greetings from Uganda, as I leave next week (22nd) so my emotional state is bit all over the place currently!
Things have really been winding down here at the hospital - partly to do with it running up to Christmas - half the staff don't turn up (?!) and less partients as they don't want to come to hospital unless it's an emergency over the christmas period! The response to my question of where our general surgeon was the other day had me in hysterics "He's gone home, he's tired" which is generally the way things can be done here.
However, I've been nagging our poor workers who have been refurbishing the surgical ward, whilst in my Miss Project Manager capacity and it has been finished inside, was fumigated yesterday and should be re-opened for patients by tuesday. So they assure me. Have taken loads of photos - it looks amazing.
Have nearly finished the write up for the orthopaedic paper, so should be able to come home with a copy me to do with whatever I can think of with it, whilst Dr Ekure will be presenting it next year. Very interesting results. Particularly the infection rates - 87% amputees getting wound sepsis! (Personally I wasn't suprised and when you see the photos you prob won't be either).
Pretty much done all that I can really with the physio dept. Now has a computer and printer, educational wall charts, an amazing library thanks to GSTT physios (still receiving the other packets of books), I brought over some more gel hot/cold packs which we use loads as there isn't enough pain killers generally, so any alternative is needed. Thinking of buying a TENS machine whilst out here, as that will be used loads as well. (For the benefit of the non physios, it is a machine that electrically stimulates muscles or nerves dependant on where you put it, providing pain releif). I have done much less hands on clinical work in the past month (few intermittent outpatients that I've seen) as I have been so busy trying to get all the other things finished.
My next job is going to probably be one of the hardest - when I'm home I have 3 weeks only to try and write and make all my presentations to try and link several institutions (medical schools and hospitals) with Kumi hospital. There is actually loads of benefits for both parties. I just need to show this to the right people - so prayer requests would def be for me to be able to achieve that!
When I last wrote I think it was when my mum was here - it was great having her out here, and we finished with the most luxurious safari tour for 4 days - in complete colonial lodge, and our names were in the guest book on the following page from Prince Phillip after his visit for CHOGM (commonwealth heads of government meeting)which was held in Kampala. Kampala was a very entertaining place before and after CHOGM - all the areas that the queen was visiting have been redone, sweepers on all the roads all day long etc (several km away are the slums where she won't be visiting where there has been no impact what so ever!) and then after, all the new street lights have been stolen within 3 days of her leaving!
Anyway. Think of me in my last few days of having to do the hardest thing which is saying goodbye, my new home will soon be very far away. But I will definately be returning.
See you all for Christmas, or in the new year!
Fran xxxx
Log 8: 22nd November
Hi all,
Just to let you know I am now safely back in Uganda, and have managed to get back to Kumi before all of the comotion of the Queen arriving in Kampala and all the roads being closed!
I tied my trip back with a visit to the medical store to collect another 110 sets of bedsheets and 50 sets of sterile nursing dressing sets (stainless steel so re-usable), so was really pleased with that (as there are 65 patients and they currently only use
15 sets, you are meant to have 1 per patient!)
Immediately on my return I had 2 days of alpha training with the clergy which went really well and we now have start dates for 3 alpha courses to start in the kumi diocese at the beginning of february. very exciting.
Went to the hospital for the first time since my return (ok was only a week ago since i left!) and am so pleased to see all the renervation work that has started. THe new door is up, all the new wire mesh around the windows are up and painting has started inside. Mattress covers have been done and are having the finishing touches and once the insides are all sorted we can fix up the mosquito nets and do the fumigation.
Have nearly finished the write up of our clinical audit paper and got some really interesting information.
Plus - following my army interview in the UK I have been offered a commission in the army and have signed all my papers and been given a MASSIVE uniform list that i have to get made from the tailors for start of officer training on the 26th January! Am no longer unemployed!!!!
So, all is well here, got mum with me for the next 2 weeks and going to do my touristy bit for the first time since i have been here and do a safari with her, which am really looking forward to. Whilst she is here she is visiting children who are on a sponsorship scheme to do her bit as well!
Is only a quick email, so shall continue with news another time, hope you are all well. See you in January!!
Ps - my uganda no has decided to die so until next thursday I shall be on my english no, and then hopefully sorted out the problem!
(pps amanda - could you poss be an angel and forward to the physio dept for me..... with ENORMOUS thanks from everyone here for all the books, I managed to get them all out here in my luggage - I swear is the best physio library in the country! Will take photos!)
Lots of love, Frances xxx
Log 7: 29th October
Dear all,
It feels like forever since i last sat infront of a computer to write what has been going on in my life, so i shall attempt to be as brief as possible.
I think when i last wrote i was in Nairobi, enjoying bliss of luke warm showers and a television in my room for a few days. The alpha conference was absolutely fantastic and having returned home we are now organising a days conference with all of the clergy in the kumi diocese ... err which involves me having to do 2 40min talks to 60 clergymen in 2 weeks time, now mildly anxious! We then are doing a 2 day leaders training course with the help of the alpha uganda team from kampala and aiming to start the course here in January. For all of those of you who are wondering what this alpha melarky is have a look at one of the links from my website. it explains all. Chuchy evangelism thing for brief explanation!
So anyway, the return journey was definately better. Still 12 hours (probably quite unavoidable as was 12 hours to get there, odds are is going to be pretty similar on the way back) but got to sit at the front all the way back so not quite as much of a rollarcoaster ride. (don't actually know how to spell that).
Life back in the physiotherapy department at kumi has been busy for the past 2 weeks - i was wondering about the success of my attempts to start an outpatient service for adults here, and it has been good, the orthopaedic surgeon is now behind us and sending us patients, and i have been rounding up patients to come for follow up appointments when working at his clinic. So the past few weeks i have been seeing around 2-4 musculoskeletal patients a day which I have completely loved. Considering that there are only 2 physios for all of the inpatients and clinics that we run here, i need to be careful to keep it to no more than 4 patients a day as the physios will never manage once i have gone. I'm also attempting to do a load of musculoskeletal teaching but so far have only got through the knee and the shoulder. Few other body parts to finish before i leave.
Most of my time though has been spent doing a clinical audit of orthopaedic patients seen and operated on between 2005-2006 for a paper that we want to submit at the end of October, looking particulary at sepsis rates as well as common orthopaedic conditions seen here. wasn't helped by the fact that the computer i was working on crashed once (without a hard copy of the 300 patient records i'd spent gathering info on) so i started all over again, thoughout the weekend as time was running short, before the computer finally died and i had to do it ALL OVER AGAIN! now have it saved on CD as well, so just finishing the analysis of the data now, before we do some write up!
Really good news as well. Dr Olupot and i had a meeting with contractors and we have work starting on the refurbishment of the surgical ward next week. This weekend i have to go to Kampala to deposit a large sum of money for supplies, as well as shop round all of the medical stores for best prices on bed sheets, mosquito nets, hospital blankets and fumigating pumps!
The money that i raised before i came covers all but re-doing the celing and doors on the ward, so if anyone wants to do any fundraising please get in contact with me and i can give you more info. The reason behind the clinical audit is particularly for me to show the high sepsis rates partly because of the unhygenic environment which i hope to have an impact on. we are also having to address a lot of practises as well, which we are doing through the infection control commitee.
Hope i havn't bored you all! Good news is that i have an interview for the army (they are interviewing 12 physios, don't know how many jobs available!) and i shall be back in the uk for this on the 14th, and in LONDON on the 15th. I would love to meet up with as many of you as possible - I will be somewhere on thursday night with my dancing shoes on, and will circulate info when i know, but during the day plan on coming to St Thomas' to collect some books that lovely Amanda has organised for me .... does anyone there want to do lunch? anyone fancy organising?
for WILTSHIRE people i'll be there on the friday night (16th) before heading back to Uganda on the 17th! But I shall be back again for christmas, so there should be more time to see people then if you arn't around.
Lots of love to you all, prayer requests are for the surgical (Ojikan) ward and all that is planned for it.
Frances xxx
Log 6: 25th September
Hello my everybodies,
Has been a very long while since i updated you in what has been going on over here, so apologies, but life is not so simple as to go to another room and log onto the internet. Especially when there is no electricity. And it is a 20 minute bike ride to town to use the computers there, after finishing work. But no excuses, promise will do better in the next coming weeks.
So - Since last writing, the physio department has continued ticking along. I have been attempting to assess whether it is realistic to try and provide some sort of adult musculoskeletal outpatient service here, and still not reaching any solid conclusions. The problem is there will be 2 physios here when I have left, and their salary is funded by the CBM (christain blind mission) program that runs here and subsidises children's treatment for disabilities. However CBM isn't too interested in adults. Unfortunately that is very much a common view here, once you are over 18 you are on your own, the entire focus is on children, which is good in one sense, but means that services are not offered (at least to those who can't pay large amounts) to adults. So i am treading carefully regarding where the physio's time is spent. If we can offer this service it wouldn't actually take time away from treating the children though as it is outside of the clinics that we run, but I have to be very careful with regards the orthopaedic surgeon who runs an adult clinic in town on Saturdays, and I think is worried that we will take away his business (I have been working in his clinics with him and most of the cases are really just needing physio inputm which up until now I have been doing there and then, but these patients then don't have a review with him for several months again, and some would really benefit from regular physiotherapy).
So apart from that my new work now is with infection control on the surgical ward. I think I might have mentioned before that this was something that was really on my mind to address, and I have had several meetings with the general surgeon with regards how we start (he is chair of the new infection control committee, which I am now a member!). What it has led to is me now writing a paper with Dr Ekure (the orthopaedic surgeon) doing a retrospective study of surgery from last year, with his intent to analyse the types of cases (and 80% of them are coming out as poverty related problems) to fundraise on a larger scale to build a second surgical ward (the overcrowding is one of the large problems, as he is the only ortho surgeon in the whole of this region, meaning there is too much work, and they never turn anyone away!) whilst I am focusing more on the sepsis rates and anaylising them. Pretty much the results are turning out to be what I was expecting, but lots of work to be done yet. My aim is to look at short term solutions to address the hygeine problems until a new ward can be build (may be many years away) and I am sending Meg a CD with lots of photos on so that she can circulate them all and put them on my website for me.
Actually can't think of a better way to prepare me for my trying to get into the army, as the majority of my work these days doesn't include the physiotherapy aspect! But it is really interesting, and I just keep praying that I actually achieve something here. Is very easy to get bogged down in what seem like unsolvable problems.
Currently am living the life of luxury (as in having electricity and hot showers) at a Hotel in Kenya, for the Alpha Africa conference which starts tomorrow! Have successfully gathered and brought with me 5 delegates from Kumi, and have been exploring Nairobi with them today. The 12 hour bus journey last night was not improved by the fact that I had to have the FIRST time with a gyppy stomach ON THE BUS TRIP!!! And yes I did say 12 HOURS. So not pleasant. Especially as the road to Nairobi is even worse than those that I've mentioned before, literally was bouncing out of my seat non stop as the bus powered over the pot holes and STONE TRACK. Still recovering.
Anyhooo, got a swimming pool to recover in for the next 3 days so that makes it all better, plus very excited about seeing my first wild zebra / giraffe / hippo / anything really!
Really good news about Josephine, the girl that I mentioned before - she has now had POP on (plaster, for non medical people!) both legs for the past 3 weeks and I have been working with her playing whilst standing (she likes drawing, so bought her some crayons) plus lots of strenghening her upper limbs through play, and saw her walking between the parallel bars the other day. I have started a new regime of keeping a jar of sweets for all the children that we treat as inpatients with the intention that when they come and see us for their exercises they don't come looking as though they are there for corporal punishment! THink is starting to work.
Anyway, have written another novel, so sorry if you are all asleep having got down here. I think my main prayer request is for efficiency of my such small time left! (plus quite dreading the return journey to Uganda, so if you feeling generous spare one for that as well please!)
Missing you all (quite a general statement, but probably true!) keep me entertained with your emails, I love getting them, and thank you to all of you who have been doing so,
Ps - only 6 weeks or so now until I will be back for 1 WEEK in November for the truly terrifying ordeal of my army interview, so I'll keep you posted of my movements when I know them, there will be a visit to London and Wiltshire ....
Am actually going now,
Fran xxx
Log 5: 2nd September 2007
Greetings from Kumi,
Am sorry has been a while since last wrote, but getting access to internet has been little tricky. Oh so many things have happened so am going to do a whistle stop tour through them!
Kampala - Maxwell's wedding was fantastic, the reception afterwards was full of flair, massive bows and flowers, sparklers, fairy lights etc everywhere and about 15 cakes that then had to be presented to important people. Unfortunately had bag stolen from car the following day, so now been coping 2 weeks without make up - a definate achievement for me (luckily was just my little luxuries like that that was in it, important stuff in other bag)
Following week we had the AMREF (African medical research something foundation!) Hand Surgery workshop here - so completely thanking God for placing me in this hospital, as has the only orthopaedic surgeon in the area for miles, and he has included me in everything, so getting to do loads of the work that I like, which i wasn't really expecting. THought of everyone on the hands and plastics rotation, you would have been very jelous - had a week of clinics with all the hand surgeons in east africa, so learnt loads and tried hard to keep up the face of physiotherapy!
Last weekend one of the doctors had an introduction ceremony - is their traditional wedding, which is then followed by the christian wedding some months later, and was asked to participate - they have to present several groups of 'maids' to the grooms family for him to choose his bride out of them. So Carolyn (only other muzungu here) and I were asked to dress up in the traditional dress and come out pretending we were twins, for the grooms family to say - sorry, but we weren't the bride. Very entertaining. ALso in front of bout 500 guests, was very nervous! Photos to follow, i promise.
THen this week we have been getting through all the work that the hand surgeons left after all the operations, wishing brought out some hand rehab equipment, but getting on ok. Also trying to sort out the physio outpatient service here, is tricky though, as often patients have to travel several hours on a bike etc to get here, so not really ideal. Did another field work day on thursday, saw 60 patients in the space of 5 hours, was exhausted! One made me laugh - they came with some notes from another hospital that they had attended, and all it had written on it was - 'Child has some sort of mental problem, can't stop laughing'. What am i meant to do with that!!!? So we advised them to continue treatment at the other hospital! THen another one, where they came complaining of the child had incontinence, and then also complained that the child bled when beaton. !!! (didn't know whether to laugh or cry!)
The child josephine that i mentioned is doing slightly better - she is now in POP on both legs to straighten out her knee contractures, but unless we can strengthen her arms more she still will have trouble walking as she needs to use crutches. She has a tendancy on crying every time she sees us though, which makes it tricky! However, now the hand surgeons are gone, hopefully can spend more time on her again. The 2 malnourished children have been discharged home and have been given an appointment to see us in our CP clinic. I hope they turn up.
I have also joined the infection control committee! I will send photos of the ward and then you might understand why every surgical patient is getting massive infections in their wounds, often needing them to return to theatre for debridement or amputation of whatever is infected. Or dying of sepsis. Am hoping that should be able to use some of the money towards addressing some of the hygeine problems here. Will keep you posted.
ALpha news - going to the Alpha conference for Africa in Kenya at the end of September as part of the workforce! Also taking with me 5 vicars from Kumi district, with the intention of setting up an alpha training in Kumi in October. Very exciting, also means i shall get to see lots of wildlife on the journey. Can't wait!
OK, need to send this before the computer crashes. Keep replies coming, love to hear from you all.
Prayer requests - Infection control (insight into where on earth I start and how it can be effective) and the set up of the outpatient physio service here (and that it lasts)
Love to you all,
Fran xxxxxxxx
Log 4: 18th July 2007
Hello all,
Been a very busy ... and interesting week at Kumi. The day that I last wrote (Sat) there was a large netball and football match between Kumi and it's neighbouring town Ngora (they asked me to join in on the netball, but I assured them that having not played for approx 10 years didn't think I would be much of an asset!) and these were then followed by a dance that night - big stuff for Kumi, as the nearest dance hall is in Soroti about 30mins drive away. It started with the traditional dances for various areas around Uganda and the Congo (very energetic, no way can attempt to copy them!) and then moved onto something I felt slightly more able to shake my hips to ... so I was pursauded to join in, and was grateful for Gerald (other new physio) who was there to be my bodyguard - never managed to attract such a large crowd on the dancefloor in England! He kept having to beat them away as they all kept coming to dance around me, but without that comfort zone of say 10cm personal space! Also tried some of the local beer (as in a sip - not nice tasting stuff) which they mash up in a large pot, add water and sit round with enormous straws to drink out of 'the pot' (warm and disgusting, have now done my bit tasting it!)
Sunday the Bishop came to do the confirmation service at the church ... started at 10am (as in we were there at 10 - the bishop didn't arrive until 11am!) and we finally left church at 3pm - next time your vicar goes on in his sermon think of me! Was very enetertained as Dr Opolot, the Medical Superintendent of Kumi Hospital was sat next to me, and congratulated me at the end on making it through the service - and promptly informed me that he had fallen asleep at least 3 times! We then had lunch with the Bishop, and being a Muzungu (white person) I was asked to sit on the top table. He was very entertaining actually - and at the end was presented with a gift ... a live turkey, which they handed to him over my head! (the doctor next to me was very entertained as they passed the turkey over me he could see me trying to avoid it's flapping wings and legs!) Then as I walked home from lunch (at 5pm!) I was mobbed by a group of about 15 children who literally walked on top of me, all started touching my skin and then couldn't stop laughing on finding out that I neither had children nor was married. Plus they kept looking behind me at my bum. Not sure why and it concerns me - especially as checked when I got home and I didn't have anything on my skirt. Hmmm.
Anyway, I then started off the working week spectacularly with feinting on the monday morning ward round, in front of all the staff and patients! Well done to me - the doctor had returned and we were inspecting the wound of an amputee patient - but as the nurse opened up the dressing I was rather shocked (to say the least) to see the bone sticking out, and an open leg (I later found out that the skin and tissue had started to die and they had taken him back to theatre to removed it, next week they will shorten the bone and close up the wound) .... thought am ok, I'll just take some deep breaths ... then the vision started to go, by then I was holding onto the end of one of the bed assessing whether I could make it out of the bay, decided I couldn't. Was concentrating so hard on staying upright, Eddie and Flo (physio assistant) managed to catch me and help me out to a side room before I hit the floor! Oh well, all in a good days work!
The 2 children from the nutritional unit are doing better this week, they are coming to the physio department every day, and we have been helping the father and grandmother to play with them, they are now showing interest in toys and Sam (the boy) laughed the other day, and attempted to crawl when put on all 4's, which was massive progress! Josephine now has POP on both legs above the knees to try and correct her contractures, and I am working on making physio a less terrefying experience with good old bribery with sweets.
Quick plea to physio's (particularly any neuro ones) - does anyone know of any research or what the evidence is for muscle stimulators for post nerve damage? The reason that I ask is that as I have previously mentioned Post Injection Paralysis is massive here in children following injection of quinine into the gluts, (often poor technique hitting the sciatic nerve, or where it hasn't been diluted and should have been - so it burns the sciatic nerve as well) and I am told that in the large hosptial in Kampala they use muscle stimulators to help treat the foot drops ... but nothing is evidence based as far as I am aware, and I'm relucatant to just get a load if it isn't actually doing that much good (especially as they appear to still love all forms of electrotherapy regardless here) ... any ideas of what the cost is in the physio med catalogue? (they have promised me a 25% discount)
We had another field trip yesterday - drove for 3 hours to the area that had been organised, only to find that the guy in charge had got the date wrong and the patients had all been told the Saturday, so we then had to get in the car and drive 3 hours back again! Gerald and I listened to my IPod. Mum and Dad, am oh so grateful!
I'm now in Kampala to go to Maxwell (friend from Alpha Uganda)'s wedding tomorrow (that journey started at 4.30 this morning, as managed to catch a lift with one of the hospital vehicles .. a 5 hour journey with 10 people crammed in the jeep!) I promise that I shall now start taking lots of photos!
Prayers - for continuity of the service that we are developing in the physio department, lots of new things happening, but short amount of time for them to be initiated and then kept in place, Plus still for Josephine and the malnourished children.
Lots of love to all, and as the Ugandans say - well done!
Frances xxx
Log 3: 11th July 2007
Hello to all, from way accross the ocean!
That probably sets the tone a bit of this message. Hope it doesn't come across as too much of a rant, but need to let off a bit of steam. Had a week here where the orthopaedic surgeon is off at a conference, the general surgeon is acting up as medical superintendent as the other doctor is on leave and therefore in lots of meetings and not around for ward rounds etc, therefore fell upon me, Eddie (physio) and Fred the orthopaedic officer (does ortho training but not medical training, so not quite a doctor) to do the ward rounds! Which brings me to comment bout the nurses here ... I swear that any of you could do a better job (even with no training) (ok def in rant mode now, but with reason) - basically there appears to be no own initiative whatsoever - I now know exactly what necrotic (dead) tissue smells like, as wounds are left undressed and uncleaned unless someone tells them to do it (even then they are sullen about being given something to do!) a lady who had a catheter in was left with an empty catheter bag and full bladder and complaining of abdominal pain, so after us nagging the nurse to change the catheter which was blocked (also sullen bout, actually asked us why we didn't do it) the nurse then did in full view of the ward with no screens around etc. Anti-biotics ran out last week as well - so infections are rife, and not a lot to do bout it - not sure if that is because the order hasn't been made or just not yet received. The painkillers in one ward had run out, but there were still paracetamol left, but no-body thought to give the lady with a broken leg and massive pressure sores a paracetamol, because she was written up for Tramadol and that had run out.
Ok rant over. Keep having to remind myself of the serenity prayer (think it goes something along the lines of - Lord, grant me the serenity to accept the things I cannot change, the strength to change the things I can and the wisdom to know the difference) Think it shall be my new daily mantra.
Contrary to above rant, other things are going well here. The physiotherapy department has a new member - another physio fresh from university in Kampala - he comes from round here so speaks the language which is tres helpful. In Sept we have a physio from the UK for 2 months who comes every year and is very experienced in paediatrics (thank goodness) so we shall have 4 of us! what luxury! We have been spending some time going round the different parts of the hospital looking at what we need to do .... and the result was a lot! Currently there is a village here for children to stay in, rather like our intermediate care - but there is no medical personnel overseeing it - we discovered a girl there who has been there for 3 weeks, but just sits outside her hut all day - she is 7 and fell over about a year ago and broke her hip, but on being taken to hospital her mother removed her as she couldn't afford cost for treatment. Since then she therefore hasn't walked, often doesn't feed herself and so is prob also malnourished, has flexion contractures in her knees, fixed foot drop and limited upper limb function (stiff and weak purely from lack of use). We have now got here coming to the department every day and after 3 days making a bit of a breakthrough - not physically but psychologically - where as before she just sat and cried, yesterday after an hour she actually made eye contact with me and spoke a word!
It is quite difficult treating the children here sometimes - their reactions to me vary - from the young ones often just bursting into tears on looking at me (nice!) to sheer terror and lack of any response, where as some of the older ones rush up and hold my hand, asking 'how are you' again and again (how they greet here). Either way, will have a lot of paediatric experience by the time i leave, whether I like it or not! Havn't even got round to assessing the need in the HIV outpatient clinic - that one will have to wait.
I was worried that i was getting too hard hearted, at lack of emotional response to some of the things that I have seen here, a worry that disappeared after the other day. Starting with our CP (cerebal palsy) clinic - 2 children were brought in from the nutritional unit - they don't have CP but were sent to us from the nurses due to lack of any development from neglect. THey are siblings -aged 5 and 6, and on assessing them it was the first time that i welled up. THeir mother tried forcing them down the latrine (hole in the floor as a toilet) last year after long term neglect but was stopped by the father. She then left and he was looking after them - in the loosest of terms. He was an alcoholic and the neglect continued, they were rescued by their grandmother who brought them to Kumi hospital. To look at them you would think they were toddlers - they are barely able to sit, and generally lie, unseeing, not paying any attention to what is around them. I couldn't help myself - I sat and hugged the little boy whilst 'assessing his leg movements', but they barely even notice you're there. THen the next day, we were doing our paediatric clinic (Me and Fred, as ortho doctor is away!) and heard huge screaming next door - on closer inspection was Eddie and Gerald (new physio) trying to manipulate a fracture of a 10 year old without any anaesthetic / painkiller etc, they had finished by the time that I found out, but I felt sick with the knowledge.
Oh dear - have appear to have gone gloomy again. On a lighter note there are some habits that I will be well into by the time that I return - everyone here shakes hands with each other on greeting - even if you only saw them that morning, and often enough keeps holding hands afterwards, sometimes even patting and stroking the hand whilst talking. Although quite a tactile person, I had to adjust to complete strangers coming up and holding my hand (frequently leading you around by holding your hand). I know some of you will be asking yourselves when I became such a prude, but you know what I mean! However, when I come home please don't be surprised if I hold your hand whilst chatting to you! I am also getting used to being stared at - it wouldn't surpise me if I turn into a complete attention seeker so that people look at me when I get home, as I won't understand why no one looks at me when i walk down a street. Gave the villagers some entertainment last night by going for a jog - people actually stopped walking to stare!
Prayer requests - Josephine (the 7 year old girl from the childrens village) - for progress on all levels and healing of psychological trauma and for God's hand on the 2 neglected children particularly.
Anyway, have now definately written a novel, so congratulations if you have made it this far without getting bored - not written for 2 weeks though, so lots to say. Love you all, thanks for all your responses, keep them coming, they keep me cheerful.
Frances xxx
Log 2: 28th July 2007
Greetings from Kumi Hospital!
This message can't be so long as internet mind numingly slow here and keeps crashing!
Since last writing I ventured into the booming metropolis of Kampala - truly terrifying place when on own (and white!) Everyone trying to get your attention to sell you something or just ask for money and feeling very vulnerable!
Then met up with a friend Rosie who works in Kampala who took me to the Expat parts which was the first time had seen tarmac civilisation in a whole week, was very excited!
Bus trip to Kumi was interesting - the bus managed to knock over someone on thier motorbike (it was their fault obviously as they were smaller) and we had to stop for an hour at the police station to report it ... took 5 hours just to Mbale in the end so stayed the night there and did last leg next morning.
Kumi is lovely - very welcoming, feeling very at home already and very pleased to announce that am working as part of a team! They had literally just employed a permanent physio from Kampala who has just finished university, so we are able to combine his knowledge of Africa and its common problems with my 3 years postgrad working experience. THere are 2 physio assistants here who have been running the service for all the years when there has been no physio - clearly have picked up loads of things from the other physios so that was a great suprise to me. I shall definately come home multitalented - as everyone seems to do everyone elses job here ... have already taken off and applied POP (plaster of paris), been expected to remove pins (just watched that one but will have to do next time ... very squemish at the thought! ... pieces of metal just sticking out of someone's skin needing to be pulled out - often enough with no pliers to hand!) and done a clinic in the community to screen those who need to go to hospital and those who don't need to spend the money on transport but need some advice - now also seem to be working as paediatrician!
First days work - was the cerebal palsy clinic - worked 9-2pm seeing babies that have developed CP usually after contracting malaria and now subsequent paralysis, spasticity etc. Felt amazingly out of depth as not done paediatrics since studenthood and wondering what on earth to do with them! They also have no toys/resources to help aid these childrens development - so would like to send out a plea for babies soft toys - particulary those designed to attract attention and have different textiles and textures - as all they have here are building blocks which are innappropriate for 3-6 months old babies! Also - if anyone has or could get hold of a book about paediatric physio and childrens development would be oh so grateful!!!
Am so pleased to say that am getting to use all my musculskeletal skills - done 2 orthopaedic clinics - one for children which is mainly club feet (thus all the POP's) and post injection paralysis - a massive problem here - the children who contract malaria are injected with quinine (although pills are just as effective apparenlty the parents don't believe they have received treatment unless they get an injection, and they don't like IV as it means they have to be admitted) so poor training has resulted in loads of people hitting the sciatic nerve and all these kids ending up from paralysis in that limb to surgery to remove the gluteal tissue as the quinine just dissolves it. Therefore an entire population of children needing rehab which should have been avoided. The adults clinic is a bit more familiar - I saw 20 patients this morning, assessed and treated (about 90% were back pain) and was finished by 2pm - so you guys in the fracture clinic no more complaining! The orthopaedic surgeon here is fantastic, i think I shall learn loads from him - scrubbing up and going to theatre with him next week.
My accomodation is ok - the electricity and water supply are fairly temporamental, so looking forward to my long awaited bath today - hope there is enough water!
Have managed to write another book, so will save up next strories for next log! Sorry for all the medical talk for those who have no idea what am talking about!
Physio's - if you have any spare or old books would love if you could send out here - am trying to build up a resource library for Adam (the physio) - currently stands at zilch!
My address for next 5 months is: Kumi Hospital, PO Box 9 Kumi, Uganda, Africa!
(ps if anyone fancies sending any sweets and nice edibles I will love you forever as diet currently consists of rice, beans and whatever meat can pick off the bones here, plus bananas and pinapple! - I hope to come back skinny!)
Prayer requests - that our physio team gels and manages to achieve a good service - can forsee few problems with coming from different perspectives (I have no desire to be boss, but lots of things that need patience for me to have tact in implementing changes - more of that in next log. I think Adam sees himself as my senior because I am a white female visitor and I see myself as his senior as he has just finished university!) and both the physio assistants have got used to running the show their way (somewhat interesting routines, and not sure of extent of knowledge behind it) and may be resistant to anyones change! For now I have not been here long enough to do or say anything and so need patience mainly!
Love to everyone back home. Hope you are all well.
Frances xxx
Log 1: 21st July 2007
Greetings from Uganda!
I have now been in Uganda for just under a week and it already feels like at least a month!
The journey here was fairly uneventful – very long, as I changed in Dubai, then had a fuel stop in Addis Ababa (Ethiopia) before finally arriving at Entebbe. The next day I traveled up to Kiwoko which is north of Kampala, to stay with Alison Fletcher – a physiotherapist who has been working in Kiwoko Hospital for the past 4 years now, since setting up the physiotherapy service there.
It was really helpful seeing the hospital and helping out there for a few days – very surreal though. Because it was set up by Ex-pats it’s essentially set out and runs in a very similar way to what I have been used to in England, but then again you are in the middle of no-where, where the ‘town’ is up a dirt track, with all the houses and shops being pretty much shacks on the dirt track (I understand that Kumi town is fairly similar in size). Kiwoko Hospital has 2 adult wards – one male and one female that are split up between medical and surgical patients. It feels familiar walking in to go to the nurses station in the middle and getting out the medical notes to read, but feels slightly like I am a child playing at hospitals due to the notes being plain paper clipped together, and paper notices handwritten in felt tip everywhere (including the good old ‘wash your hands’ signs. It can also get quite cluttered as when a patient comes here they have to have an attendant who does all their personal care and gets them their meals etc, which leaves the nurses free to do the actual nursing, these attendants sleep on the floor next to the patients beds, so when it is full it is fairly crammed.
However, there is nothing play like about the medical service that the patients receive – they have 5 permanent doctors there, a nursing school which I understand students come from all over Uganda to attend, and now thanks to Alison, a fully equipped physiotherapy department (consists of Alison, Moses (a Ugandan physio) and a physio assistant.) They have one operating theatre which seems permanently busy, a pharmacy and laboratory on site, X-ray machine on site … and much more.
I joined with Alison in her daily rounds and found some entertaining things written in the medical notes – the Ugandan doctors are very blunt in their descriptions of the patients – phrases such as ‘old man’ (sorry to the more mature of you, but this generally applied to anyone over the age of 45!), ‘good looking’ (as in not ill looking!) and ‘this one’s a black one’ (?!) made me chuckle. Also is quite strange reading along the plan and finding ‘find some honey to put in the wound’ (apparently is a natural antiseptic).
There is actually quite a lot of orthopaedic trauma here (clinically good that I can still exercise my musculoskeletal brain) – just before I left I saw a guy who had ‘had an argument with a friend’ and got shot twice in the knee – for those clinical lot he had a undisplaced femoral fracture, lost the lower half of his patella (but the ligamentum patella was still in tact) and completely shattered his lateral tibial plateau – for the non clinical lot it was nasty! On my second visit to see him his leg position had notably changed (as in there was an increased bend where it shouldn’t be!) so I trotted along to one of the doctors as I wound in England to have a chat with them about this. The Ugandan surgeon was very understanding of my concerns and joined me to look at the leg, but kindly went through why it was still only splinted to a piece of wood – the orthopaedic surgeon only comes once a month and wasn’t due for another 3 weeks and the patient didn’t want to travel to Kampala (as I can well understand – more about that later). At this hospital they didn’t have the correct pins to do an external fixation and because the plaster that they have here is very cheap, the seeping from the wound had it soggy and useless in under 2 hours. So that was the only option really – we decided to get some larger bandage to strap the leg to the splint tighter, but not really much more could be done. At that point I felt very aware of the fact that I am a very green English girl coming to a place where lots of improvisation is needed and it really hit home the lack of resources over here.
So I am now in Kampala for 3 days before heading to Kumi on Monday and seeing what awaits me! I won’t have the luxury of a physio team to help me – particularly to interpret between me and patients – that is going to be the most difficult thing as I don’t know who is going to be available to help me. However, they appear to be looking forward to my arrival, so I shall start with joining the medical rounds and work my way from there I think.
The traveling is interesting here – looking at the map there appear to be a fair few roads, but then when you get onto the roads they are actually nearly all dirt tracks with loads of pot holes in them. There are a few MAIN roads (about 4 in the whole country I think!) where they have tarmac, but because I am told they have been done very cheaply and they are then pounded by large trucks traveling to the Congo, Sudan and Rwanda with aid, these are also riddled with pot holes. The road laws here are generally dependant on what size vehicle you are in – pedestrians are lower than low and get out of everyone’s way, then bikes (pretty much the same) followed by motorbikes, small cars, trucks and minibuses, right the way up to lorry’s and larges buses who rule the roads – even though it is a drive on the left country, people pretty much are all over the road to avoid the pot holes and if something larger than you is approaching you on your side of the road it is your responsibility to get out of their way! So prayer requests – safely when traveling I think!
I appear to have written a book – sorry about that, and I haven’t even got to Kumi Hospital yet! I will attempt to send an update when I can work out where I will be able to access the internet there. Any GSTT physio’s – could you forward this to anyone who might want to read this, thanks.
Love to you all and hope all is well back home, I now have a Ugandan phone – so if you want to call or text me please contact me on +256773269626
Frances xxxx
Prologue:
I am a 25 year old who is going to Eastern Uganda in July 2007 to do 6 months voluntary work as a physiotherapist.
I shall be going to Kumi Hospital which is based in the region of Teso.
Kumi Hospital was founded in 1929 as a leprosy colony, but in 1997 was transformed into a general hospital with a capacity of 290 beds and specialising in the care of people with disabilites. For the inpatients alone in 2003 Kumi received 10,129 admissions + outpatient clinics. The hospital has 215 staff of which only 4 are doctors, 5 medical assistants, 45 nurses and 15 paramedics. There is currenlty insufficient resources for a physiotherapist, though they have a physio department building and an orthopaedic workshop.
Kumi is based in the region of Teso whose main economic activity has generally been cattle trading. Between 1986 and 1992 the region was devastated by civil war and cattle rustling conducted by a neighbouring hostile nomadic tribe. The hospital suffered greatly having its water supply destroyed and losing 2000 cattle from the hospital farm, and it is still recovering from these troubles today. The cattle rustling remains a problem, particularly as the rustlers now have access to guns. Teso is also near the conflict in Northern Uganda between the rebel army (Lords Resistance Army (LRA)) and the Ugandan government. According to the World Food Programme, there are currently 1.4 million displaced people in northern Uganda, and an estimated 250,000 of these are in the newly affected north eastern area of Teso. In addition to their need for shelter, food and water these people also need access to health services, and this places an extra strain on the hospital.
As throughout Africa, Uganda has a problem with HIV /AIDS. Uganda was one of the first countries in Africa to acknowledge the existance of AIDS - the national rate of infection has fallen from 30% in the 1990's to 5% in 2003. However, the conflict affecting the north of the country means that this area hasn't shared in the progress achieved in other parts of Uganda. War and displacement are likely to hasten the spead of the disease and minimise the potential to apply the same HIV prevention and education programmes. Although incidence of infection has fallen, this doesn't change the amount of those already infected - most recent figures show 4.1% of the population is infected with HIV. Since 1993 over 800,000 people have already died in Uganda due to AIDS, with 1.5million AIDS orphans. Basic health indicators are also very poor - life expectancy is only 45.7 years and over 14% of children die before their 5th birthday. Nearly 1 in 5 of the population are undernourished at any given time.
The role of a physiotherapist for HIV patients is mainly treating the systems that have been affected by HIV - the respiratory system (acute respiratory care), nervous system (neuro rehab), the musculoskeletal system and the cardiovascular system. My clinical role will be wide whilst I am working in Kumi, being the only physiotherapist there. I will be treating both adults and children with problems due to HIV/AIDS, unrelated disabilities, and orthopaedic conditions. However, my aims during my visit are also to help towards providing a service that can continue once I have left - not only through the education of the nurses and health care assistants about basic rehabilitation and exercise principles, but also I hope to facilitate a network link with physiotherapists in Kampala (capital of Uganda).
I am going with the training support of 2 charities - Church Mission Society and Alpha International (Uganda office) where I shall be leading Alpha groups and getting involved in mission work out there.
To pay for the 6 months work I am fundraising with a variety of events and sponsorship - please see the Diary page for further information, particularly the upcoming event on Thursday 3rd May - Blagclub party with list of Auction of Promises.
Leaving Kumi was difficult, but has definately left me with a need to return! The 6 months that I spent there were full of friendship and joy, but also highlighted so many areas where a change can occur if only it was instigated. It was through this that I would now like to start a charity - FRIENDS OF KUMI HOSPITAL that can be dedicated to helping to develop the hospital further.
Please continue to check the website for updates on the charity's progress and eventual own website once it is up and running. Please also check this website for attachments of presentations made of the hospital and work done in my 6 months.
Many thanks for all your support.
Log 9: 16th December
Dear everyone,
I am sad to say that this will probably be my last greetings from Uganda, as I leave next week (22nd) so my emotional state is bit all over the place currently!
Things have really been winding down here at the hospital - partly to do with it running up to Christmas - half the staff don't turn up (?!) and less partients as they don't want to come to hospital unless it's an emergency over the christmas period! The response to my question of where our general surgeon was the other day had me in hysterics "He's gone home, he's tired" which is generally the way things can be done here.
However, I've been nagging our poor workers who have been refurbishing the surgical ward, whilst in my Miss Project Manager capacity and it has been finished inside, was fumigated yesterday and should be re-opened for patients by tuesday. So they assure me. Have taken loads of photos - it looks amazing.
Have nearly finished the write up for the orthopaedic paper, so should be able to come home with a copy me to do with whatever I can think of with it, whilst Dr Ekure will be presenting it next year. Very interesting results. Particularly the infection rates - 87% amputees getting wound sepsis! (Personally I wasn't suprised and when you see the photos you prob won't be either).
Pretty much done all that I can really with the physio dept. Now has a computer and printer, educational wall charts, an amazing library thanks to GSTT physios (still receiving the other packets of books), I brought over some more gel hot/cold packs which we use loads as there isn't enough pain killers generally, so any alternative is needed. Thinking of buying a TENS machine whilst out here, as that will be used loads as well. (For the benefit of the non physios, it is a machine that electrically stimulates muscles or nerves dependant on where you put it, providing pain releif). I have done much less hands on clinical work in the past month (few intermittent outpatients that I've seen) as I have been so busy trying to get all the other things finished.
My next job is going to probably be one of the hardest - when I'm home I have 3 weeks only to try and write and make all my presentations to try and link several institutions (medical schools and hospitals) with Kumi hospital. There is actually loads of benefits for both parties. I just need to show this to the right people - so prayer requests would def be for me to be able to achieve that!
When I last wrote I think it was when my mum was here - it was great having her out here, and we finished with the most luxurious safari tour for 4 days - in complete colonial lodge, and our names were in the guest book on the following page from Prince Phillip after his visit for CHOGM (commonwealth heads of government meeting)which was held in Kampala. Kampala was a very entertaining place before and after CHOGM - all the areas that the queen was visiting have been redone, sweepers on all the roads all day long etc (several km away are the slums where she won't be visiting where there has been no impact what so ever!) and then after, all the new street lights have been stolen within 3 days of her leaving!
Anyway. Think of me in my last few days of having to do the hardest thing which is saying goodbye, my new home will soon be very far away. But I will definately be returning.
See you all for Christmas, or in the new year!
Fran xxxx
Log 8: 22nd November
Hi all,
Just to let you know I am now safely back in Uganda, and have managed to get back to Kumi before all of the comotion of the Queen arriving in Kampala and all the roads being closed!
I tied my trip back with a visit to the medical store to collect another 110 sets of bedsheets and 50 sets of sterile nursing dressing sets (stainless steel so re-usable), so was really pleased with that (as there are 65 patients and they currently only use
15 sets, you are meant to have 1 per patient!)
Immediately on my return I had 2 days of alpha training with the clergy which went really well and we now have start dates for 3 alpha courses to start in the kumi diocese at the beginning of february. very exciting.
Went to the hospital for the first time since my return (ok was only a week ago since i left!) and am so pleased to see all the renervation work that has started. THe new door is up, all the new wire mesh around the windows are up and painting has started inside. Mattress covers have been done and are having the finishing touches and once the insides are all sorted we can fix up the mosquito nets and do the fumigation.
Have nearly finished the write up of our clinical audit paper and got some really interesting information.
Plus - following my army interview in the UK I have been offered a commission in the army and have signed all my papers and been given a MASSIVE uniform list that i have to get made from the tailors for start of officer training on the 26th January! Am no longer unemployed!!!!
So, all is well here, got mum with me for the next 2 weeks and going to do my touristy bit for the first time since i have been here and do a safari with her, which am really looking forward to. Whilst she is here she is visiting children who are on a sponsorship scheme to do her bit as well!
Is only a quick email, so shall continue with news another time, hope you are all well. See you in January!!
Ps - my uganda no has decided to die so until next thursday I shall be on my english no, and then hopefully sorted out the problem!
(pps amanda - could you poss be an angel and forward to the physio dept for me..... with ENORMOUS thanks from everyone here for all the books, I managed to get them all out here in my luggage - I swear is the best physio library in the country! Will take photos!)
Lots of love, Frances xxx
Log 7: 29th October
Dear all,
It feels like forever since i last sat infront of a computer to write what has been going on in my life, so i shall attempt to be as brief as possible.
I think when i last wrote i was in Nairobi, enjoying bliss of luke warm showers and a television in my room for a few days. The alpha conference was absolutely fantastic and having returned home we are now organising a days conference with all of the clergy in the kumi diocese ... err which involves me having to do 2 40min talks to 60 clergymen in 2 weeks time, now mildly anxious! We then are doing a 2 day leaders training course with the help of the alpha uganda team from kampala and aiming to start the course here in January. For all of those of you who are wondering what this alpha melarky is have a look at one of the links from my website. it explains all. Chuchy evangelism thing for brief explanation!
So anyway, the return journey was definately better. Still 12 hours (probably quite unavoidable as was 12 hours to get there, odds are is going to be pretty similar on the way back) but got to sit at the front all the way back so not quite as much of a rollarcoaster ride. (don't actually know how to spell that).
Life back in the physiotherapy department at kumi has been busy for the past 2 weeks - i was wondering about the success of my attempts to start an outpatient service for adults here, and it has been good, the orthopaedic surgeon is now behind us and sending us patients, and i have been rounding up patients to come for follow up appointments when working at his clinic. So the past few weeks i have been seeing around 2-4 musculoskeletal patients a day which I have completely loved. Considering that there are only 2 physios for all of the inpatients and clinics that we run here, i need to be careful to keep it to no more than 4 patients a day as the physios will never manage once i have gone. I'm also attempting to do a load of musculoskeletal teaching but so far have only got through the knee and the shoulder. Few other body parts to finish before i leave.
Most of my time though has been spent doing a clinical audit of orthopaedic patients seen and operated on between 2005-2006 for a paper that we want to submit at the end of October, looking particulary at sepsis rates as well as common orthopaedic conditions seen here. wasn't helped by the fact that the computer i was working on crashed once (without a hard copy of the 300 patient records i'd spent gathering info on) so i started all over again, thoughout the weekend as time was running short, before the computer finally died and i had to do it ALL OVER AGAIN! now have it saved on CD as well, so just finishing the analysis of the data now, before we do some write up!
Really good news as well. Dr Olupot and i had a meeting with contractors and we have work starting on the refurbishment of the surgical ward next week. This weekend i have to go to Kampala to deposit a large sum of money for supplies, as well as shop round all of the medical stores for best prices on bed sheets, mosquito nets, hospital blankets and fumigating pumps!
The money that i raised before i came covers all but re-doing the celing and doors on the ward, so if anyone wants to do any fundraising please get in contact with me and i can give you more info. The reason behind the clinical audit is particularly for me to show the high sepsis rates partly because of the unhygenic environment which i hope to have an impact on. we are also having to address a lot of practises as well, which we are doing through the infection control commitee.
Hope i havn't bored you all! Good news is that i have an interview for the army (they are interviewing 12 physios, don't know how many jobs available!) and i shall be back in the uk for this on the 14th, and in LONDON on the 15th. I would love to meet up with as many of you as possible - I will be somewhere on thursday night with my dancing shoes on, and will circulate info when i know, but during the day plan on coming to St Thomas' to collect some books that lovely Amanda has organised for me .... does anyone there want to do lunch? anyone fancy organising?
for WILTSHIRE people i'll be there on the friday night (16th) before heading back to Uganda on the 17th! But I shall be back again for christmas, so there should be more time to see people then if you arn't around.
Lots of love to you all, prayer requests are for the surgical (Ojikan) ward and all that is planned for it.
Frances xxx
Log 6: 25th September
Hello my everybodies,
Has been a very long while since i updated you in what has been going on over here, so apologies, but life is not so simple as to go to another room and log onto the internet. Especially when there is no electricity. And it is a 20 minute bike ride to town to use the computers there, after finishing work. But no excuses, promise will do better in the next coming weeks.
So - Since last writing, the physio department has continued ticking along. I have been attempting to assess whether it is realistic to try and provide some sort of adult musculoskeletal outpatient service here, and still not reaching any solid conclusions. The problem is there will be 2 physios here when I have left, and their salary is funded by the CBM (christain blind mission) program that runs here and subsidises children's treatment for disabilities. However CBM isn't too interested in adults. Unfortunately that is very much a common view here, once you are over 18 you are on your own, the entire focus is on children, which is good in one sense, but means that services are not offered (at least to those who can't pay large amounts) to adults. So i am treading carefully regarding where the physio's time is spent. If we can offer this service it wouldn't actually take time away from treating the children though as it is outside of the clinics that we run, but I have to be very careful with regards the orthopaedic surgeon who runs an adult clinic in town on Saturdays, and I think is worried that we will take away his business (I have been working in his clinics with him and most of the cases are really just needing physio inputm which up until now I have been doing there and then, but these patients then don't have a review with him for several months again, and some would really benefit from regular physiotherapy).
So apart from that my new work now is with infection control on the surgical ward. I think I might have mentioned before that this was something that was really on my mind to address, and I have had several meetings with the general surgeon with regards how we start (he is chair of the new infection control committee, which I am now a member!). What it has led to is me now writing a paper with Dr Ekure (the orthopaedic surgeon) doing a retrospective study of surgery from last year, with his intent to analyse the types of cases (and 80% of them are coming out as poverty related problems) to fundraise on a larger scale to build a second surgical ward (the overcrowding is one of the large problems, as he is the only ortho surgeon in the whole of this region, meaning there is too much work, and they never turn anyone away!) whilst I am focusing more on the sepsis rates and anaylising them. Pretty much the results are turning out to be what I was expecting, but lots of work to be done yet. My aim is to look at short term solutions to address the hygeine problems until a new ward can be build (may be many years away) and I am sending Meg a CD with lots of photos on so that she can circulate them all and put them on my website for me.
Actually can't think of a better way to prepare me for my trying to get into the army, as the majority of my work these days doesn't include the physiotherapy aspect! But it is really interesting, and I just keep praying that I actually achieve something here. Is very easy to get bogged down in what seem like unsolvable problems.
Currently am living the life of luxury (as in having electricity and hot showers) at a Hotel in Kenya, for the Alpha Africa conference which starts tomorrow! Have successfully gathered and brought with me 5 delegates from Kumi, and have been exploring Nairobi with them today. The 12 hour bus journey last night was not improved by the fact that I had to have the FIRST time with a gyppy stomach ON THE BUS TRIP!!! And yes I did say 12 HOURS. So not pleasant. Especially as the road to Nairobi is even worse than those that I've mentioned before, literally was bouncing out of my seat non stop as the bus powered over the pot holes and STONE TRACK. Still recovering.
Anyhooo, got a swimming pool to recover in for the next 3 days so that makes it all better, plus very excited about seeing my first wild zebra / giraffe / hippo / anything really!
Really good news about Josephine, the girl that I mentioned before - she has now had POP on (plaster, for non medical people!) both legs for the past 3 weeks and I have been working with her playing whilst standing (she likes drawing, so bought her some crayons) plus lots of strenghening her upper limbs through play, and saw her walking between the parallel bars the other day. I have started a new regime of keeping a jar of sweets for all the children that we treat as inpatients with the intention that when they come and see us for their exercises they don't come looking as though they are there for corporal punishment! THink is starting to work.
Anyway, have written another novel, so sorry if you are all asleep having got down here. I think my main prayer request is for efficiency of my such small time left! (plus quite dreading the return journey to Uganda, so if you feeling generous spare one for that as well please!)
Missing you all (quite a general statement, but probably true!) keep me entertained with your emails, I love getting them, and thank you to all of you who have been doing so,
Ps - only 6 weeks or so now until I will be back for 1 WEEK in November for the truly terrifying ordeal of my army interview, so I'll keep you posted of my movements when I know them, there will be a visit to London and Wiltshire ....
Am actually going now,
Fran xxx
Log 5: 2nd September 2007
Greetings from Kumi,
Am sorry has been a while since last wrote, but getting access to internet has been little tricky. Oh so many things have happened so am going to do a whistle stop tour through them!
Kampala - Maxwell's wedding was fantastic, the reception afterwards was full of flair, massive bows and flowers, sparklers, fairy lights etc everywhere and about 15 cakes that then had to be presented to important people. Unfortunately had bag stolen from car the following day, so now been coping 2 weeks without make up - a definate achievement for me (luckily was just my little luxuries like that that was in it, important stuff in other bag)
Following week we had the AMREF (African medical research something foundation!) Hand Surgery workshop here - so completely thanking God for placing me in this hospital, as has the only orthopaedic surgeon in the area for miles, and he has included me in everything, so getting to do loads of the work that I like, which i wasn't really expecting. THought of everyone on the hands and plastics rotation, you would have been very jelous - had a week of clinics with all the hand surgeons in east africa, so learnt loads and tried hard to keep up the face of physiotherapy!
Last weekend one of the doctors had an introduction ceremony - is their traditional wedding, which is then followed by the christian wedding some months later, and was asked to participate - they have to present several groups of 'maids' to the grooms family for him to choose his bride out of them. So Carolyn (only other muzungu here) and I were asked to dress up in the traditional dress and come out pretending we were twins, for the grooms family to say - sorry, but we weren't the bride. Very entertaining. ALso in front of bout 500 guests, was very nervous! Photos to follow, i promise.
THen this week we have been getting through all the work that the hand surgeons left after all the operations, wishing brought out some hand rehab equipment, but getting on ok. Also trying to sort out the physio outpatient service here, is tricky though, as often patients have to travel several hours on a bike etc to get here, so not really ideal. Did another field work day on thursday, saw 60 patients in the space of 5 hours, was exhausted! One made me laugh - they came with some notes from another hospital that they had attended, and all it had written on it was - 'Child has some sort of mental problem, can't stop laughing'. What am i meant to do with that!!!? So we advised them to continue treatment at the other hospital! THen another one, where they came complaining of the child had incontinence, and then also complained that the child bled when beaton. !!! (didn't know whether to laugh or cry!)
The child josephine that i mentioned is doing slightly better - she is now in POP on both legs to straighten out her knee contractures, but unless we can strengthen her arms more she still will have trouble walking as she needs to use crutches. She has a tendancy on crying every time she sees us though, which makes it tricky! However, now the hand surgeons are gone, hopefully can spend more time on her again. The 2 malnourished children have been discharged home and have been given an appointment to see us in our CP clinic. I hope they turn up.
I have also joined the infection control committee! I will send photos of the ward and then you might understand why every surgical patient is getting massive infections in their wounds, often needing them to return to theatre for debridement or amputation of whatever is infected. Or dying of sepsis. Am hoping that should be able to use some of the money towards addressing some of the hygeine problems here. Will keep you posted.
ALpha news - going to the Alpha conference for Africa in Kenya at the end of September as part of the workforce! Also taking with me 5 vicars from Kumi district, with the intention of setting up an alpha training in Kumi in October. Very exciting, also means i shall get to see lots of wildlife on the journey. Can't wait!
OK, need to send this before the computer crashes. Keep replies coming, love to hear from you all.
Prayer requests - Infection control (insight into where on earth I start and how it can be effective) and the set up of the outpatient physio service here (and that it lasts)
Love to you all,
Fran xxxxxxxx
Log 4: 18th July 2007
Hello all,
Been a very busy ... and interesting week at Kumi. The day that I last wrote (Sat) there was a large netball and football match between Kumi and it's neighbouring town Ngora (they asked me to join in on the netball, but I assured them that having not played for approx 10 years didn't think I would be much of an asset!) and these were then followed by a dance that night - big stuff for Kumi, as the nearest dance hall is in Soroti about 30mins drive away. It started with the traditional dances for various areas around Uganda and the Congo (very energetic, no way can attempt to copy them!) and then moved onto something I felt slightly more able to shake my hips to ... so I was pursauded to join in, and was grateful for Gerald (other new physio) who was there to be my bodyguard - never managed to attract such a large crowd on the dancefloor in England! He kept having to beat them away as they all kept coming to dance around me, but without that comfort zone of say 10cm personal space! Also tried some of the local beer (as in a sip - not nice tasting stuff) which they mash up in a large pot, add water and sit round with enormous straws to drink out of 'the pot' (warm and disgusting, have now done my bit tasting it!)
Sunday the Bishop came to do the confirmation service at the church ... started at 10am (as in we were there at 10 - the bishop didn't arrive until 11am!) and we finally left church at 3pm - next time your vicar goes on in his sermon think of me! Was very enetertained as Dr Opolot, the Medical Superintendent of Kumi Hospital was sat next to me, and congratulated me at the end on making it through the service - and promptly informed me that he had fallen asleep at least 3 times! We then had lunch with the Bishop, and being a Muzungu (white person) I was asked to sit on the top table. He was very entertaining actually - and at the end was presented with a gift ... a live turkey, which they handed to him over my head! (the doctor next to me was very entertained as they passed the turkey over me he could see me trying to avoid it's flapping wings and legs!) Then as I walked home from lunch (at 5pm!) I was mobbed by a group of about 15 children who literally walked on top of me, all started touching my skin and then couldn't stop laughing on finding out that I neither had children nor was married. Plus they kept looking behind me at my bum. Not sure why and it concerns me - especially as checked when I got home and I didn't have anything on my skirt. Hmmm.
Anyway, I then started off the working week spectacularly with feinting on the monday morning ward round, in front of all the staff and patients! Well done to me - the doctor had returned and we were inspecting the wound of an amputee patient - but as the nurse opened up the dressing I was rather shocked (to say the least) to see the bone sticking out, and an open leg (I later found out that the skin and tissue had started to die and they had taken him back to theatre to removed it, next week they will shorten the bone and close up the wound) .... thought am ok, I'll just take some deep breaths ... then the vision started to go, by then I was holding onto the end of one of the bed assessing whether I could make it out of the bay, decided I couldn't. Was concentrating so hard on staying upright, Eddie and Flo (physio assistant) managed to catch me and help me out to a side room before I hit the floor! Oh well, all in a good days work!
The 2 children from the nutritional unit are doing better this week, they are coming to the physio department every day, and we have been helping the father and grandmother to play with them, they are now showing interest in toys and Sam (the boy) laughed the other day, and attempted to crawl when put on all 4's, which was massive progress! Josephine now has POP on both legs above the knees to try and correct her contractures, and I am working on making physio a less terrefying experience with good old bribery with sweets.
Quick plea to physio's (particularly any neuro ones) - does anyone know of any research or what the evidence is for muscle stimulators for post nerve damage? The reason that I ask is that as I have previously mentioned Post Injection Paralysis is massive here in children following injection of quinine into the gluts, (often poor technique hitting the sciatic nerve, or where it hasn't been diluted and should have been - so it burns the sciatic nerve as well) and I am told that in the large hosptial in Kampala they use muscle stimulators to help treat the foot drops ... but nothing is evidence based as far as I am aware, and I'm relucatant to just get a load if it isn't actually doing that much good (especially as they appear to still love all forms of electrotherapy regardless here) ... any ideas of what the cost is in the physio med catalogue? (they have promised me a 25% discount)
We had another field trip yesterday - drove for 3 hours to the area that had been organised, only to find that the guy in charge had got the date wrong and the patients had all been told the Saturday, so we then had to get in the car and drive 3 hours back again! Gerald and I listened to my IPod. Mum and Dad, am oh so grateful!
I'm now in Kampala to go to Maxwell (friend from Alpha Uganda)'s wedding tomorrow (that journey started at 4.30 this morning, as managed to catch a lift with one of the hospital vehicles .. a 5 hour journey with 10 people crammed in the jeep!) I promise that I shall now start taking lots of photos!
Prayers - for continuity of the service that we are developing in the physio department, lots of new things happening, but short amount of time for them to be initiated and then kept in place, Plus still for Josephine and the malnourished children.
Lots of love to all, and as the Ugandans say - well done!
Frances xxx
Log 3: 11th July 2007
Hello to all, from way accross the ocean!
That probably sets the tone a bit of this message. Hope it doesn't come across as too much of a rant, but need to let off a bit of steam. Had a week here where the orthopaedic surgeon is off at a conference, the general surgeon is acting up as medical superintendent as the other doctor is on leave and therefore in lots of meetings and not around for ward rounds etc, therefore fell upon me, Eddie (physio) and Fred the orthopaedic officer (does ortho training but not medical training, so not quite a doctor) to do the ward rounds! Which brings me to comment bout the nurses here ... I swear that any of you could do a better job (even with no training) (ok def in rant mode now, but with reason) - basically there appears to be no own initiative whatsoever - I now know exactly what necrotic (dead) tissue smells like, as wounds are left undressed and uncleaned unless someone tells them to do it (even then they are sullen about being given something to do!) a lady who had a catheter in was left with an empty catheter bag and full bladder and complaining of abdominal pain, so after us nagging the nurse to change the catheter which was blocked (also sullen bout, actually asked us why we didn't do it) the nurse then did in full view of the ward with no screens around etc. Anti-biotics ran out last week as well - so infections are rife, and not a lot to do bout it - not sure if that is because the order hasn't been made or just not yet received. The painkillers in one ward had run out, but there were still paracetamol left, but no-body thought to give the lady with a broken leg and massive pressure sores a paracetamol, because she was written up for Tramadol and that had run out.
Ok rant over. Keep having to remind myself of the serenity prayer (think it goes something along the lines of - Lord, grant me the serenity to accept the things I cannot change, the strength to change the things I can and the wisdom to know the difference) Think it shall be my new daily mantra.
Contrary to above rant, other things are going well here. The physiotherapy department has a new member - another physio fresh from university in Kampala - he comes from round here so speaks the language which is tres helpful. In Sept we have a physio from the UK for 2 months who comes every year and is very experienced in paediatrics (thank goodness) so we shall have 4 of us! what luxury! We have been spending some time going round the different parts of the hospital looking at what we need to do .... and the result was a lot! Currently there is a village here for children to stay in, rather like our intermediate care - but there is no medical personnel overseeing it - we discovered a girl there who has been there for 3 weeks, but just sits outside her hut all day - she is 7 and fell over about a year ago and broke her hip, but on being taken to hospital her mother removed her as she couldn't afford cost for treatment. Since then she therefore hasn't walked, often doesn't feed herself and so is prob also malnourished, has flexion contractures in her knees, fixed foot drop and limited upper limb function (stiff and weak purely from lack of use). We have now got here coming to the department every day and after 3 days making a bit of a breakthrough - not physically but psychologically - where as before she just sat and cried, yesterday after an hour she actually made eye contact with me and spoke a word!
It is quite difficult treating the children here sometimes - their reactions to me vary - from the young ones often just bursting into tears on looking at me (nice!) to sheer terror and lack of any response, where as some of the older ones rush up and hold my hand, asking 'how are you' again and again (how they greet here). Either way, will have a lot of paediatric experience by the time i leave, whether I like it or not! Havn't even got round to assessing the need in the HIV outpatient clinic - that one will have to wait.
I was worried that i was getting too hard hearted, at lack of emotional response to some of the things that I have seen here, a worry that disappeared after the other day. Starting with our CP (cerebal palsy) clinic - 2 children were brought in from the nutritional unit - they don't have CP but were sent to us from the nurses due to lack of any development from neglect. THey are siblings -aged 5 and 6, and on assessing them it was the first time that i welled up. THeir mother tried forcing them down the latrine (hole in the floor as a toilet) last year after long term neglect but was stopped by the father. She then left and he was looking after them - in the loosest of terms. He was an alcoholic and the neglect continued, they were rescued by their grandmother who brought them to Kumi hospital. To look at them you would think they were toddlers - they are barely able to sit, and generally lie, unseeing, not paying any attention to what is around them. I couldn't help myself - I sat and hugged the little boy whilst 'assessing his leg movements', but they barely even notice you're there. THen the next day, we were doing our paediatric clinic (Me and Fred, as ortho doctor is away!) and heard huge screaming next door - on closer inspection was Eddie and Gerald (new physio) trying to manipulate a fracture of a 10 year old without any anaesthetic / painkiller etc, they had finished by the time that I found out, but I felt sick with the knowledge.
Oh dear - have appear to have gone gloomy again. On a lighter note there are some habits that I will be well into by the time that I return - everyone here shakes hands with each other on greeting - even if you only saw them that morning, and often enough keeps holding hands afterwards, sometimes even patting and stroking the hand whilst talking. Although quite a tactile person, I had to adjust to complete strangers coming up and holding my hand (frequently leading you around by holding your hand). I know some of you will be asking yourselves when I became such a prude, but you know what I mean! However, when I come home please don't be surprised if I hold your hand whilst chatting to you! I am also getting used to being stared at - it wouldn't surpise me if I turn into a complete attention seeker so that people look at me when I get home, as I won't understand why no one looks at me when i walk down a street. Gave the villagers some entertainment last night by going for a jog - people actually stopped walking to stare!
Prayer requests - Josephine (the 7 year old girl from the childrens village) - for progress on all levels and healing of psychological trauma and for God's hand on the 2 neglected children particularly.
Anyway, have now definately written a novel, so congratulations if you have made it this far without getting bored - not written for 2 weeks though, so lots to say. Love you all, thanks for all your responses, keep them coming, they keep me cheerful.
Frances xxx
Log 2: 28th July 2007
Greetings from Kumi Hospital!
This message can't be so long as internet mind numingly slow here and keeps crashing!
Since last writing I ventured into the booming metropolis of Kampala - truly terrifying place when on own (and white!) Everyone trying to get your attention to sell you something or just ask for money and feeling very vulnerable!
Then met up with a friend Rosie who works in Kampala who took me to the Expat parts which was the first time had seen tarmac civilisation in a whole week, was very excited!
Bus trip to Kumi was interesting - the bus managed to knock over someone on thier motorbike (it was their fault obviously as they were smaller) and we had to stop for an hour at the police station to report it ... took 5 hours just to Mbale in the end so stayed the night there and did last leg next morning.
Kumi is lovely - very welcoming, feeling very at home already and very pleased to announce that am working as part of a team! They had literally just employed a permanent physio from Kampala who has just finished university, so we are able to combine his knowledge of Africa and its common problems with my 3 years postgrad working experience. THere are 2 physio assistants here who have been running the service for all the years when there has been no physio - clearly have picked up loads of things from the other physios so that was a great suprise to me. I shall definately come home multitalented - as everyone seems to do everyone elses job here ... have already taken off and applied POP (plaster of paris), been expected to remove pins (just watched that one but will have to do next time ... very squemish at the thought! ... pieces of metal just sticking out of someone's skin needing to be pulled out - often enough with no pliers to hand!) and done a clinic in the community to screen those who need to go to hospital and those who don't need to spend the money on transport but need some advice - now also seem to be working as paediatrician!
First days work - was the cerebal palsy clinic - worked 9-2pm seeing babies that have developed CP usually after contracting malaria and now subsequent paralysis, spasticity etc. Felt amazingly out of depth as not done paediatrics since studenthood and wondering what on earth to do with them! They also have no toys/resources to help aid these childrens development - so would like to send out a plea for babies soft toys - particulary those designed to attract attention and have different textiles and textures - as all they have here are building blocks which are innappropriate for 3-6 months old babies! Also - if anyone has or could get hold of a book about paediatric physio and childrens development would be oh so grateful!!!
Am so pleased to say that am getting to use all my musculskeletal skills - done 2 orthopaedic clinics - one for children which is mainly club feet (thus all the POP's) and post injection paralysis - a massive problem here - the children who contract malaria are injected with quinine (although pills are just as effective apparenlty the parents don't believe they have received treatment unless they get an injection, and they don't like IV as it means they have to be admitted) so poor training has resulted in loads of people hitting the sciatic nerve and all these kids ending up from paralysis in that limb to surgery to remove the gluteal tissue as the quinine just dissolves it. Therefore an entire population of children needing rehab which should have been avoided. The adults clinic is a bit more familiar - I saw 20 patients this morning, assessed and treated (about 90% were back pain) and was finished by 2pm - so you guys in the fracture clinic no more complaining! The orthopaedic surgeon here is fantastic, i think I shall learn loads from him - scrubbing up and going to theatre with him next week.
My accomodation is ok - the electricity and water supply are fairly temporamental, so looking forward to my long awaited bath today - hope there is enough water!
Have managed to write another book, so will save up next strories for next log! Sorry for all the medical talk for those who have no idea what am talking about!
Physio's - if you have any spare or old books would love if you could send out here - am trying to build up a resource library for Adam (the physio) - currently stands at zilch!
My address for next 5 months is: Kumi Hospital, PO Box 9 Kumi, Uganda, Africa!
(ps if anyone fancies sending any sweets and nice edibles I will love you forever as diet currently consists of rice, beans and whatever meat can pick off the bones here, plus bananas and pinapple! - I hope to come back skinny!)
Prayer requests - that our physio team gels and manages to achieve a good service - can forsee few problems with coming from different perspectives (I have no desire to be boss, but lots of things that need patience for me to have tact in implementing changes - more of that in next log. I think Adam sees himself as my senior because I am a white female visitor and I see myself as his senior as he has just finished university!) and both the physio assistants have got used to running the show their way (somewhat interesting routines, and not sure of extent of knowledge behind it) and may be resistant to anyones change! For now I have not been here long enough to do or say anything and so need patience mainly!
Love to everyone back home. Hope you are all well.
Frances xxx
Log 1: 21st July 2007
Greetings from Uganda!
I have now been in Uganda for just under a week and it already feels like at least a month!
The journey here was fairly uneventful – very long, as I changed in Dubai, then had a fuel stop in Addis Ababa (Ethiopia) before finally arriving at Entebbe. The next day I traveled up to Kiwoko which is north of Kampala, to stay with Alison Fletcher – a physiotherapist who has been working in Kiwoko Hospital for the past 4 years now, since setting up the physiotherapy service there.
It was really helpful seeing the hospital and helping out there for a few days – very surreal though. Because it was set up by Ex-pats it’s essentially set out and runs in a very similar way to what I have been used to in England, but then again you are in the middle of no-where, where the ‘town’ is up a dirt track, with all the houses and shops being pretty much shacks on the dirt track (I understand that Kumi town is fairly similar in size). Kiwoko Hospital has 2 adult wards – one male and one female that are split up between medical and surgical patients. It feels familiar walking in to go to the nurses station in the middle and getting out the medical notes to read, but feels slightly like I am a child playing at hospitals due to the notes being plain paper clipped together, and paper notices handwritten in felt tip everywhere (including the good old ‘wash your hands’ signs. It can also get quite cluttered as when a patient comes here they have to have an attendant who does all their personal care and gets them their meals etc, which leaves the nurses free to do the actual nursing, these attendants sleep on the floor next to the patients beds, so when it is full it is fairly crammed.
However, there is nothing play like about the medical service that the patients receive – they have 5 permanent doctors there, a nursing school which I understand students come from all over Uganda to attend, and now thanks to Alison, a fully equipped physiotherapy department (consists of Alison, Moses (a Ugandan physio) and a physio assistant.) They have one operating theatre which seems permanently busy, a pharmacy and laboratory on site, X-ray machine on site … and much more.
I joined with Alison in her daily rounds and found some entertaining things written in the medical notes – the Ugandan doctors are very blunt in their descriptions of the patients – phrases such as ‘old man’ (sorry to the more mature of you, but this generally applied to anyone over the age of 45!), ‘good looking’ (as in not ill looking!) and ‘this one’s a black one’ (?!) made me chuckle. Also is quite strange reading along the plan and finding ‘find some honey to put in the wound’ (apparently is a natural antiseptic).
There is actually quite a lot of orthopaedic trauma here (clinically good that I can still exercise my musculoskeletal brain) – just before I left I saw a guy who had ‘had an argument with a friend’ and got shot twice in the knee – for those clinical lot he had a undisplaced femoral fracture, lost the lower half of his patella (but the ligamentum patella was still in tact) and completely shattered his lateral tibial plateau – for the non clinical lot it was nasty! On my second visit to see him his leg position had notably changed (as in there was an increased bend where it shouldn’t be!) so I trotted along to one of the doctors as I wound in England to have a chat with them about this. The Ugandan surgeon was very understanding of my concerns and joined me to look at the leg, but kindly went through why it was still only splinted to a piece of wood – the orthopaedic surgeon only comes once a month and wasn’t due for another 3 weeks and the patient didn’t want to travel to Kampala (as I can well understand – more about that later). At this hospital they didn’t have the correct pins to do an external fixation and because the plaster that they have here is very cheap, the seeping from the wound had it soggy and useless in under 2 hours. So that was the only option really – we decided to get some larger bandage to strap the leg to the splint tighter, but not really much more could be done. At that point I felt very aware of the fact that I am a very green English girl coming to a place where lots of improvisation is needed and it really hit home the lack of resources over here.
So I am now in Kampala for 3 days before heading to Kumi on Monday and seeing what awaits me! I won’t have the luxury of a physio team to help me – particularly to interpret between me and patients – that is going to be the most difficult thing as I don’t know who is going to be available to help me. However, they appear to be looking forward to my arrival, so I shall start with joining the medical rounds and work my way from there I think.
The traveling is interesting here – looking at the map there appear to be a fair few roads, but then when you get onto the roads they are actually nearly all dirt tracks with loads of pot holes in them. There are a few MAIN roads (about 4 in the whole country I think!) where they have tarmac, but because I am told they have been done very cheaply and they are then pounded by large trucks traveling to the Congo, Sudan and Rwanda with aid, these are also riddled with pot holes. The road laws here are generally dependant on what size vehicle you are in – pedestrians are lower than low and get out of everyone’s way, then bikes (pretty much the same) followed by motorbikes, small cars, trucks and minibuses, right the way up to lorry’s and larges buses who rule the roads – even though it is a drive on the left country, people pretty much are all over the road to avoid the pot holes and if something larger than you is approaching you on your side of the road it is your responsibility to get out of their way! So prayer requests – safely when traveling I think!
I appear to have written a book – sorry about that, and I haven’t even got to Kumi Hospital yet! I will attempt to send an update when I can work out where I will be able to access the internet there. Any GSTT physio’s – could you forward this to anyone who might want to read this, thanks.
Love to you all and hope all is well back home, I now have a Ugandan phone – so if you want to call or text me please contact me on +256773269626
Frances xxxx
Prologue:
I am a 25 year old who is going to Eastern Uganda in July 2007 to do 6 months voluntary work as a physiotherapist.
I shall be going to Kumi Hospital which is based in the region of Teso.
Kumi Hospital was founded in 1929 as a leprosy colony, but in 1997 was transformed into a general hospital with a capacity of 290 beds and specialising in the care of people with disabilites. For the inpatients alone in 2003 Kumi received 10,129 admissions + outpatient clinics. The hospital has 215 staff of which only 4 are doctors, 5 medical assistants, 45 nurses and 15 paramedics. There is currenlty insufficient resources for a physiotherapist, though they have a physio department building and an orthopaedic workshop.
Kumi is based in the region of Teso whose main economic activity has generally been cattle trading. Between 1986 and 1992 the region was devastated by civil war and cattle rustling conducted by a neighbouring hostile nomadic tribe. The hospital suffered greatly having its water supply destroyed and losing 2000 cattle from the hospital farm, and it is still recovering from these troubles today. The cattle rustling remains a problem, particularly as the rustlers now have access to guns. Teso is also near the conflict in Northern Uganda between the rebel army (Lords Resistance Army (LRA)) and the Ugandan government. According to the World Food Programme, there are currently 1.4 million displaced people in northern Uganda, and an estimated 250,000 of these are in the newly affected north eastern area of Teso. In addition to their need for shelter, food and water these people also need access to health services, and this places an extra strain on the hospital.
As throughout Africa, Uganda has a problem with HIV /AIDS. Uganda was one of the first countries in Africa to acknowledge the existance of AIDS - the national rate of infection has fallen from 30% in the 1990's to 5% in 2003. However, the conflict affecting the north of the country means that this area hasn't shared in the progress achieved in other parts of Uganda. War and displacement are likely to hasten the spead of the disease and minimise the potential to apply the same HIV prevention and education programmes. Although incidence of infection has fallen, this doesn't change the amount of those already infected - most recent figures show 4.1% of the population is infected with HIV. Since 1993 over 800,000 people have already died in Uganda due to AIDS, with 1.5million AIDS orphans. Basic health indicators are also very poor - life expectancy is only 45.7 years and over 14% of children die before their 5th birthday. Nearly 1 in 5 of the population are undernourished at any given time.
The role of a physiotherapist for HIV patients is mainly treating the systems that have been affected by HIV - the respiratory system (acute respiratory care), nervous system (neuro rehab), the musculoskeletal system and the cardiovascular system. My clinical role will be wide whilst I am working in Kumi, being the only physiotherapist there. I will be treating both adults and children with problems due to HIV/AIDS, unrelated disabilities, and orthopaedic conditions. However, my aims during my visit are also to help towards providing a service that can continue once I have left - not only through the education of the nurses and health care assistants about basic rehabilitation and exercise principles, but also I hope to facilitate a network link with physiotherapists in Kampala (capital of Uganda).
I am going with the training support of 2 charities - Church Mission Society and Alpha International (Uganda office) where I shall be leading Alpha groups and getting involved in mission work out there.
To pay for the 6 months work I am fundraising with a variety of events and sponsorship - please see the Diary page for further information, particularly the upcoming event on Thursday 3rd May - Blagclub party with list of Auction of Promises.