When Nurse Becomes Patient!

Karen:

Christmas was always going to be a bit different this year with us being in Africa…but we had not quite expected the festive period to be quite how it’s panned out! Our plans of a pre-Christmas safari, Christmas Eve dinner and Christmas Day BBQ were somewhat disrupted when I fell victim to Ugandan germs and was struck down with a bout of horrendous food poisoning. Never one to do things by halves, a sequence of dramas unfolded – it has been a surreal two weeks!

Upon waking one morning feeling a little nauseated, I attributed it to my own cooking the previous evening. Debbie felt fine and so I thought nothing more of it and off to work we went. As the morning progressed, I felt increasingly unwell and our ward Dr insisted on a malaria screen…we were astounded when it came back positive and cursing the savage mosquito!

So home to bed I went as Debbie went to get the relevant malaria medication from the local pharmacy before returning to play nurse. Despite the medication, I became sicker and our bedroom soon transformed into a mobile health clinic! Unable to tolerate oral medication, poor Debbie had to stab me with needles and put me on a drip with my mosquito net pole becoming a drip stand! With advice, intravenous quinine was commenced to treat the malaria…what I now realize is an incredibly potent drug with harsh side effects. My condition continued to deteriorate as I became increasingly dehydrated and it was decided that I needed hospitalising, Expecting to be transferred to Kampala, we were thrown into turmoil when the insurance company informed us that I would be airlifted to Nairobi, Kenya…within the hour!

As I lay delirious on my bed, Debbie frantically threw some belongings into a bag, liaised with our UK and Uganda colleagues, made alternative arrangements for the dog we were looking after, and somehow managed to preserve her sanity! Before we knew it we were at Gulu Airstrip, accompanied by our friend and colleague Dr Lucas, who along with Debbie was to be my medical escort! Our micro plane landed, out jumped a very jolly pilot called Howard, who ushered us immediately on board. Definitely the most informal airport I have ever passed through – no check in, no paper work, no security, nothing! And off we went on the 60minute flight from the north to the south of the country. It was a shame I felt too unwell to enjoy the flight as the views across the lush landscape of Uganda interrupted only by the meandering Nile were quite spectacular!

We landed at a small airstrip where an ambulance met us for the transfer to the international airport. Whilst I was whisked off into the waiting air ambulance, Debbie had the anguishing task of getting us through passport control minus tickets.

Debbie:

At Entebbe airport Karen stayed in the ambulance while I went to show our passports to security. A very ‘direct’ lady said that I was to leave Karen in the ambulance, take all of our bags and go through security and passport control stating that I was on the AMREF (medical transfer) flight. Sounded like a simple task (apart from trying to carry our 4 bags!) but somehow it turned into a bit of a pantomime! I have never met so many blank faces before in my life! At the main door the man had never heard of AMREF, Security had never heard of AMREF or air ambulance. After a slight argument with 3 people security let me through to the next hurdle which came in the shape of the Immigration desk who had never heard of AMREF and told me to go back to the first ‘direct’ lady………frustrations and emotions running high I then went to the passenger help desk who proved to be very unhelpful….this was all too much and I had a mini emotional breakdown!!! In Uganda people don’t really show emotion very freely so the airport workers probably thought I was going mad (which was actually quite possible). I ended up having to harass poor Karen on the phone as she tried to rest in the ambulance. It turned out the flight was waiting for me and soon the Captain of the plane came to rescue me! One of the ‘helpful’ airport staff then sent him to Gate 2, saying that I was waiting there so about 20 minutes later we finally found each other. Immigration were only too happy to let me through with our flying Doctor friends who were all brilliant.

Karen:

The air ambulance was smaller again – enough room for the crew of 2 doctors, Nurse Debbie, the captain, his co-pilot, and myself the patient. The plane was so sophisticated that had James Bond appeared with a martini in hand he would not have been out of place – and I think Debbie could have done with a medicinal drink by this point! I cannot commend the AMREF air ambulance staff enough – extremely professional and helpful in our hour of need!

An hour later we touched down in Kenya and were whisked off to the Nairobi Hospital Emergency Department. We were very relieved to find ourselves in a ‘normal-looking’ hospital, not too dissimilar to the UK. In fact it’s the cleanest hospital we’ve ever visited! Minus a 4 hour target, we had expected to spend the night in A+E so it came as a pleasant surprise to find ourselves in a room on the private ward 2.5 hours later. Thankfully Debbie could stay in my room as my ‘lodger’ and the staff took good care of her too!

Following a series of blood tests, we found out that I had been inaccurately diagnosed with malaria as I did not have the malaria antigen in my blood. “Not the first false-positive malaria test” as the Consultant stated. Several different tropical diseases were suspected before I was eventually diagnosed with food poisoning, and thankfully responded well to intravenous antibiotics and fluids. During my 6-day hospital admission, I also learnt the hard way that I have an allergy to the drug buscopan as I had two severe allergic reactions in one day – how to kick you when you’re down!

The best Christmas present ever came on Christmas Eve…I was discharged from hospital – and for all intents and purposes, as was Debbie!!!! And so our mission to get home by Christmas day began! I’m pleased to report that SOS Insurance came up trumps and managed to book us seats on the last flight of the day back to Uganda. Arriving late, we were accommodated in Kampala for the night, and the follwoing morning we were “driving home for Christmas” and relieved to arrive back in Gulu to enjoy the later part of the Christmas day! A race against time but we made it!

We have been extremely grateful to everyone for their support during this rather unpleasant and stressful time. Being unwell so far away from home compounds the difficulty and upset, but all the messages and phone calls have helped to lift our spirits enormously. I personally would like to thank Debbie for being my pillar of strength and my rock. I don’t know how I would have coped without her continuous reassurance, help, and positivity. I would also like to thank Marian Surgenor, our link lead for her ongoing support, phone calls and UK based assistance which helped more than I can say. And a special thank you to Steve Hawes – Wythenshawe Hospital A+E Consultant – for your advice, and support and knowing we had you at the end of the phone when we needed you!

So everyone, here’s to a very merry Christmas and a happy and HEALTHY 2010!

Karen:

NEWS FLASH: The Medical Ward has finally moved to its new building within the hospital grounds!!! This is a significant event and has been on the cards for a very long time! Upon arriving in Gulu 8 weeks ago, the proposed date of the move was "maybe next week" so we are overjoyed that this has finally happened! The ward has moved from it's temporary base within the paediatric unit and a nearby outer building to one large purpose built ward, divided into male and female sections. At the latest count there were 40 beds...but this is on the increase daily! To any followers of the blog, all of the beds made it without falling apart and were even given a lick of paint to conceal the rust! Finally the patients are accommodated in an environment which demonstrates respect for human life. The ward is clean, spacious and fresh. It is a huge morale boost for everyone - the staff, patients and patients relatives. New bathroom facilities have been erected - the sight of a latrine has never excited me so much - and I'm sure it never will again!!

Whilst a new ward cannot alone eliminate the many clinical challenges that exist in the health care system here in Gulu, it is a big step in the right direction. Whilst we are frequently frustrated by working in a resource-limited environment, what we try to remind ourselves is that what IS here is better than nothing at all. Whilst the hospital is far from perfect, at least there IS a hospital, and being government run, the patients have the reassurance that they have access to free health care. Gulu is a Regional Referral Hospital and so it covers a very large area. Uganda is a developing country with a developing health care system. War only ended in Northern Uganda a mere 3 years ago and from what we have been told, the hospital has much improved since the area found peace.

We have just returned from a few days in Kampala, the capital of the country which is a 4-5 hour drive south from Gulu (on a good day!) The stark contrast between the north and south of this country is something which I have struggled to come to terms with. Kampala is a bustling, chaotic city congested with traffic. Whilst it is far from being an affluent city, it is far more developed than northern towns like Gulu. It has shopping malls, supermarkets, bowling alleys, cinemas, night clubs and even car washes. I find it difficult to see people having their cars washed when, in the north of the country, there are communities that don't even have access to a well for the provision of water. In response to such thoughts however, I cannot condemn development when that is the exact nature of the work that we are doing here in Uganda, and Kampala is evidence of the capabilities of this country. It just seems that such disparities are so unjust when you consider such basic human needs like access to water, food and sanitation.

The poverty that exists within this country is however, not in any way, shape or form reflected in the people. Living in such poor conditions you would expect people to be full of sadness and negativity. The reality is in fact the complete opposite-we have never met a populations so upbeat, happy and contented, and heard so much laughter! Everyone greets you with a smile, a hand shake or a wave! It's very humbling to say the least.

Over the past couple of weeks there have been two patients on the ward in particular that we would like to pay tribute to. The both share the fact that they passed away aged just 21. We grew very fond of both patients and it was hard to learn of their deaths on the days that we were off duty.

The young male patient had been on the ward since we started working at the hospital. He underwent pretty much every investigation that could be performed at the hospital, and had been on a multitude of medications. Yet despite all interventions, his daily temperature averaged at about 40 degrees Celsius (normal:35.5-37 degrees) and the cause remained unknown. He became increasingly weak due to significant weight loss and he spent the last week of his life in a state of delirium before he died. It was exceptionally distressing to see his deteriorating condition and have no answers-such a tragic waste of a young life when you imagine how the average 21 year old should be running around football pitch or arranging to meet his friends at the pub.

Our other friend was a young girl. She presented with excruciatingly painful skin lesions as a result of the medication that she was taking for HIV. Literally every inch of her emaciated body was covered in weeping wounds and she was exceptionally frail and weak. Our initial thought was that she would die within days as she was so sick. During the first few days of her admission her attendant doused the wounds with 'gentle violet solution'-a treatment that seemed far from gentle as it was agonisingly painful for her to the point that she would scream in pain. You can imagine our amazement when, after a few weeks, she began to show signs of improvement and despite being unable to speak, a smile began to adorn her face-and she had the most beautiful smile! Everyone was overjoyed when after 6 weeks of being bed bound she took her first steps off the ward to go outside. In a tragic twist of fate, over the course of a weekend her condition deteriorated rapidly. She experienced abdominal pains, became exceptionally anaemic, and experienced a gastric bleed. Thirty-six hours later she died completely unexpectedly leaving everyone shocked and upset.

Some patients you never forget and the bravery and courage shown by these two special individuals despite their suffering, we will never forget, May they Rest In Peace.

So Long, Farewell, Afoyo Matek...

So the time came for Sally and Nik to return to the UK. A difficult time for Karen and I, as we had valued their presence so much as part of our Gulu family! We were really privileged to have had Sally and Nik in Gulu when we arrived as we were instantly welcomed and immersed into Gulu life. Working with two professional and extremely competent Doctors made settling into work at the hospital much easier for us. It was great to have them on hand at work to answer the many queries that we had in the first few weeks. The daily debrief on our porch was always welcomed to help us cope with the sights and situations we'd seen during out day at the hospital.

From another perspective I can honestly say that I don't think we've had so much fun with a group of people as we had with Sally, Nik and Joe when they were here. From making a Flintstones car at Halloween to hiring a local band for Sally's birthday there was always something going on that we could enjoy all together. They also helped to expand our group by bringing Steph (Nik's girlfriend), Christian (Sally's boyfriend), ther dads Ian and Paul and Sally's sister Nicola over to Gulu. It was great to meet all of them and share some fantastic experiences together.

We spent our last weekend together: on Saturday we went to some waterfalls about an hour away from Gulu which were amazing! During the last part of the drive the grass was as high as the car and it felt as though no-one had ever ventured that way before. When we arrived the view was incredible- like something out of 'The Lion King'. As we explored we found three different waterfalls, had a picnic by the water's edge and spent the day relaxing, chatting and going for a dip in the water. On Sunday we decided to cook a roast (Head Chef Sally!). We cooked up a feast for the four of us and a few other friends and all had a lovely evening. After a few frantic days and one last night out we were travelling down to Entebbe before we knew it.

We left for Entebbe early in the morning and as we departed Gulu we watched the most incredible sunrise over the mist covered fields. After a short stop in Kampala so that Sally and Nik could fill their cases full of presents we travelled on to Entebbe where we had a relaxing evening at a lovely hotel after a very crazy week. The next morning it came to saying our goodbyes. While Sally, Karen and I were openly finding it quite difficult to hold ourselves together, Nik appeared to develop the need to keep his sunglasses on (on quite an overcast day in Entebbe- hmm, interesting.)

Karen and I are so glad that we were able to meet two fantastic people like Sally and Nik and share so many amazing/difficult/crazy/entertaining/challenging/hilarious/fun/poignant/brilliant moments with them: friends for life.

Save it for the weekend...

Although our main aim in Uganda has been to come and work at Gulu Regional Referral Hospital, Karen and I have been taking the opportunity at weekends to travel away from Gulu and see some more of the beautiful country we're living in! Two places that we must mention are Jinja and Murchison Falls.

Our trip to Jinja was a short one as it is quite far down South from Gulu, about an hour outside of Kampala. However, we made the most of the beautiful scenery by going white water rafting down the Nile! The 32km of rafting (!!) was fantastic fun, if a little exhausting, and was topped off by a barbeque at sunset near the source of the Nile. Amazing!

Last weekend a group of 8 of us from Gulu took a trip to Murchison Falls which was breathtakingly beautiful! It was a bit of a bumpy drive down but once we entered the National Park the scenery was amazing. On the way into the park we saw Giraffes, Buffalo, Deer and Warthogs and, as we waited for the ferry over the Nile to reach our campsite, there were Hippos waiting to greet us! We went on a boat ride down to Murchison Falls which are very impressive. We saw loads of animals on the banks of the river including Elephants and Crocodiles! A game drive on Sunday finished off a brilliant weekend with yet more animal sightings (unfortunately we didn't see lions but there's always next time!)

This weekend we stayed in Gulu as our link lead, Marian Surgenor, had organised for us to do a very important job! She had sourced a donation of some Manchester United and Manchester City kits that we had the great honour of distributing to 2 local football teams. We went to a village called Awach and delivered the eagerly awaited strips to the players. Awach is a small village not far from Gulu where our contact and guide 'Dr Freddy' grew up. The drive up to Awach was very scenic and as we took in the sights we learned from Freddy that there had been around 10,000 people living in an IDP (Internally Displaced Persons) Camp there during the war. It is really hard to imagine that number of people in such a small place. Freddy said that the road that we travelled on had been a danger spot where many abductions and murders had taken place. A vision that is difficult to imagine when for us it had been a serene drive through the lush Ugandan countryside. On arrival it seemed as though every family from the whole village had turned up to watch the teams play and they were all so welcoming. It's really hard to put into words how electric the atmosphere was. As we looked around at such a fantastic community it was hard to imagine the suffering that many of the people there had experienced some 3 years ago.
We had a formal handover of the kit with speeches and photos, after which an official presented us with some beautiful hand woven baskets. We both felt so humbled to be there and to have such an incredible welcome. Some of the players were playing barefoot or in flip flops so we're hoping that we'll manage to obtain some boots for them at some point in the future. We watched the match which ended Awach 1 Paicho 0. The crowd from Awach were going wild!!!!!

Back to blogging...

The last couple of weeks have been quite busy here in Gulu with visitors from the UK, and subsequently we have somewhat neglected our blog - sorry!

Marian Surgenor, the head of the link between University Hospital South Manchester and Gulu Regional Referral Hospital, spent a week out here with us (and brought us advent calendars!) Her trusted side-kick was Dr Peter Yeates who works in Medical Education at Wythenshawe Hospital, Manchester. It was great to have the support of our colleagues and share with them our experiences of the hospital as well as share with them this wonderful country!

Peter certainly didn't have a positive introduction to the medical ward. With in his first 5minutes on the ward, he witnessed a 36year old man have a seizure followed by a cardiac arrest. In this situation, resuscitation is not even attempted here as there is no further care that can be offered to support life even if we were able to revive him. To not even attempt resuscitation goes against all that we would instinctively do back in the UK so you can imagine our frustration and distress (and tears!) The average life expectancy in Uganda is 50years so we have seen many people die at what we would consider to be a young age.

KAREN:

Last week we found ourselves caring for our youngest patient yet - a 4year old little boy. Along with his younger sister, he has been staying on the adult ward with his mother who is an inpatient with no one to care for her children whilst she is unwell. It is not uncommon for children to be sharing the bed of their mother during her stay. Usually he is an energetic little boy always wanting to play or have a 'high five!' as you pass him by. So when his mother indicated that he was sick, I was concerned. I became even more concerned when I examined him and realised that he had a soaring temperature and was floppy! Alarm bells ringing, I was relieved to receive the help of our ward Doctor! When a 4year old doesn't even flinch when you take blood and inject him with medication, you know there is cause for concern! He was rapidly commenced on a drip and treatment for malaria. Usually a child of this age would be cared for on the paediatric unit, but in this case he was admitted to the adult ward in order to stay with his mother. We have actually been very surprised to learn that the upper age limit for admission to the paediatric unit here is a mere 12years or age! We left the ward wondering what the outcome would be for this brave little soldier...

DEBBIE:

The next day I went to the ward alone as Karen was doing work elsewhere in the morning. On the way in, as usual, I picked up the blood results from the lab. I noticed alarmingly that our little patient's malaria film had come back as 4 plus!!! On the scale this is the worst case of malaria that you can get...it means that the number of parasites in his blood was extremely high. When I got to the ward the report did not mention our little paediatric lodger and he was nowhere to be seen. Feeling quite worried for the 4 year old I went on a hunt to find him and his mother. Through translation from one of the nurses and help from another patient we deduced that mother and son were off the ward fetching water. I was quite relieved to hear that he was feeling better (he hadn't been able to get up from the bed the day previously) and glad to reflect on the fact that Karen had taken the initiative to help the little boy the day before. I went to hunt down his notes and found them on the paediatric ward. Once patient, mother and notes were reunited I spoke to our medical intern about what to do. Because the notes had and patient had been separated he had not had any treatment since the day before. I made up his next dose of malaria treatment and started the infusion (with help from the Dr who had to cannulate our little trooper about 4 times as his veins were poor). Whilst he was hooked up to his drip the Dr and I managed to get a small smile from our brave little man by tickling him with a glove balloon!!

Yesterday when we went onto the ward the little boy ran towards us all smiles and jumped up into our arms!! No matter how upsetting or frustrating it can be out here success stories like this are a huge reward for us reminding us exactly why we came to Gulu.

And when you got there, the cupboard was bare!

So another working week draws to a close -a definite bonus for us here in Gulu is that we are free of shift-work, and we work Monday to Friday - a rare luxury to nurses! Our shifts are 8am to 5pm...although the locals perceive time keeping as a problem and work to 'Gulu time' - trying to make time-dependent arrangements is problematic to say the least when its accepted that you can be up to 1.5hours late!!!

We are certainly learning to become very resourceful nurses! This week the hospital has run out of so many essential items. There's a permanent shortage of gloves with supplies running out daily. The hospital also ran out of a large proportion of oral antibiotics, supplies of intravenous antibiotics completely ran out, as well as all intravenous fluids, and to top it all off we ran out of cannulas (drip ports!) The radiology department remains closed due to no availability of Xray film, there has been almost a permanent power cut to the hospital all week, and a problem developed with the mains supply of water! So all week there has been no running water to the hospital. Handwashing has been done in vats of rain water -thank goodness for frequents down pours (oh it can rain here!) and alcohol hand gel!

Over the last couple of weeks we have seen an increasing number of cases of Methanol poisoning. A bad batch of 'local spirit' has been doing the rounds and the consequences have been fatal. Ironically the antedote for methanol poisoning is pure alcohol! The nearest thing that is available here is the local spirit called 'Waragi' - tastes a bit like a mixture of surgical spirit and gin! So Dr Nik has literally been prescribing shots of alcohol to his patients in casualty making the unit not too dissimilar to a UK A+E department on a Saturday night! The sad reality however, is that a huge number of people have now died from methanol poisoning, or are exceptionally sick, and many have gone blind. Apparently it only takes 10ml (two teaspoons!) of the drink to make you loose your sight. And these people all just thought they would have a good night out. A very sobering thought.

A comedy day at the pharmacy...

We’ve spent the last 2 days going to and from pharmacy to get drugs for the patients. After each visit we return to the ward empty handed after being greeted at the pharmacy with a chorus of ‘he is not there’ from the student pharmacists. ‘He’ is the pharmacy dispenser for the inpatient medications who we find very hard to pin down! He works between the HIV centre and the main pharmacy and so is often busy elsewhere.
Today we decided was THE DAY!!! I was most definitely going to arrive back on Ward 2 with a range of medication to treat the patients. So we decided to start early:
9:30am Notes sort out and first trip down. ‘He is coming’ they said (don’t be fooled, in Uganda this may mean in 5 minutes or could be in the next 6 months). ‘Come back at 10.’
10:15am Down through the hospital I walked again only to be told again ‘he is coming’. A very friendly student pharmacist invited me into the pharmacy to sit and wait (I was having slight deja-vu at this point as I’ve sat there for a good few hours on other occasions.) So I made myself comfortable and patiently waited.
10:45 It turns out that he’s actually not coming but he does have the key which someone kindly goes to get. So I wait a little longer….
11:10 The person that had gone to get the key must have got lost on the way I think because he didn’t return! So the student pharmacist went himself to find it. Wait a little longer….
11:25 The sacred key arrives!!!! A team effort in dispensing the 8 patient medications that we needed for the ward. He handed me the boxes and I counted out the tablets and labelled the bags (Nurse/pharmacist extraordinaire!)
11:55 Returned to the ward (with a very big smile on my face!) to give Karen the drugs so that she could start to give them out to the patients on the midday drug round…..and it’s back to pharmacy for phase 2! IV medication!!
12:00 Back in the pharmacy that I’m starting to call home the dispenser told me that I’d brought the wrong order book and that many of the drugs were not there. I was not going to be defeated though! So I enlisted the help of our Ward Manager who is a fantastic source of knowledge and she came back down with me to sort it out. (I was really wishing by this point that the hospital had a phone system!)
12:20 We managed to get about a third of the IV medication and fluids that we needed. He asked me to come back tomorrow for the others (something I can’t say I’m feeling to keen to do having spent the whole morning there!)
12:30 I arrived back on the ward feeling really happy and satisfied with what I’d managed to obtain (see photo above!!). Needless to say poor Karen had been running around like a headless chicken while I’d been away! It’s just crazy how long a simple job like that can take!
Total trips down to pharmacy: 5
Total time allowed for pharmacy related work today: 3 hours
Total drugs obtained: 2 courses of amoxicillin, 1 of septrin, 2 of prednisolone, 1 of ciprofloxacin, 1 of chloramphenicol, 1 of omeprazole, water for injections, IV normals saline 500mls 15 bottles, IV cloxacillin 50 amps, IV benzylpenicillin 25 amps.

A few pictures of us at work...

The Medical Ward. The main laboratory.

Debbie getting gauze from the 'sterile' pot.

Karen catching up on some documentation on the Male ward.

Karen outside A and E.

HOSPITAL LIFE...AND DEATH!

So we have written about our daily routine. For any nurses reading, you may think that our working day is not too indifferent to nursing back home in the UK...this couldn't be further from the truth!!!

We certainly never expected things to be easy working in a developing country, but at times we become so frustrated its untrue!!! Tasks that in the United Kingdom would be extremely straight forward and simple, can be incredibly time consuming here in Uganda. Blood tests are a fine example of this. Acquiring the correct sample bottle can often involve visiting every department in the hospital...only to return to the first place you visited, where the staff suddenly 'discover' they had what you needed from the outset!!!! Needles and syringes are like gold dust so locating them can take time. Then you arrive at the laboratory to find it is locked! If you are lucky, the results may eventually arrive the next day!

The processing of blood tests is often money dependant. Tests we take for granted in a developed world, like renal function tests, must be paid for by the patient or their family. No funds = no test. Can you imagine this?

Medications are also often subject to patients self funding the drugs they require. The hospital has a basic supply of drugs. Above and beyond this, the patient must pay for medications from a pharmacy in town. Again, no money = no drugs...I'm sure you can imagine what this means for the patients ultimate outcome.

Supplies of basic necessities frequently run out, grinding work to a halt. A prime example is gloves. With the main presentation being HIV and AIDS you can appreciate that no one is prepared to take the risk with bodily fluids. The radiology department is only just operating again after running out of X-ray film for nearly two weeks. TB is a huge problem here and so being without specimen containers for a week proved problematic.

A RAY OF LIGHT....

Despite our many frustrations, there is a ray of hope!!! A new medical and surgical ward have been built, and yesterday the surgical patients began to move into their new premises!!! This has been such a long time coming and is such a boost to the hospital, the staff, and the patients!

The medical ward is at present, temporarily housed in the paediatric unit, so the sound of children constantly crying is deafening! The male and female areas are separated by the nutritional ward. Passing through this area each day is heartbreaking - seeing so many malnourished children. One child I saw last week, about 2years old, was so weak he couldn't hold the weight of his own body. His mother was trying to get him to stand but his legs kept buckling. Unbelievably sad.

The medical ward where we are working is yet unable to move as the bathroom facilities remain incomplete but at least there is light at the end of the tunnel! Unfortunately a new ward does not mean new furniture, so all the old decrepit beds will be going with us...if they don't fall apart when moved! Watch this space!!!!

A day in the life of Karen and Debs.....

Wakey wakey, cold shower!

Breakfast with the family (Sally, Nik and.....leaving Joe in bed).

A gentle wander through the dusty streets of Gulu past the green fields in the hot sun to work.

Morning mango juice from our local street seller.

Arrive at work: try and find patients and match them to their notes - patients are often outside, have swapped beds, be on the floor, or in some cases have 'runaway' (self discharged). The notes are often in disarray and so even finding them can be problematic!

Observations: We try and get around to each of the 35 patients and record Blood Pressure, Pulse, Temperature and Respiration Rate identifying the most sick patients on the way around. We're learning so much about clinical examination though as patients here seem to compensate for so long before their observations reflect it. Observations can take quite a long time as everything is done manually.

Ward Round: the Intern Doctor (house officer), Sally or Consultant Doctor will do a ward round. So many students come to watch that it is quite chaotic on the ward and it's quite difficult to get things done! We try and go on the ward round though so that we can pick up jobs on the way and listen to the plan for each patient.

Medication round: no easy task as there are no prescription charts and a large percentage of the drugs are not stocked on the ward. Sometimes the patients are missing which makes it a bit harder!

Jobs, jobs jobs! These include taking blood tests, trips to pharmacy or HIV centre, trying to contact the Social Worker or Physio, going to the lab to take specimens or get specimen pots, siting cannulas, admitting new patients.

There is a small distance between the male and female parts of the ward and we are often cheered up by 2 little friends who seem to live around the back of the hospital with their mother. The 2 little boys always have a high five, whistle or great big grin for us!

End of the day: exhaustion, exhilaration, frustration and a sense of achievement washes over both of us and we plod home debriefing on the day that has gone before. We go and watch the lovely sunset over our house and generally fall asleep soon after dinner!

Yabadabadoooooooooooooooooooo time!!!!!!

So Gulu was taken by storm with a halloween party extravaganza on Saturday night! We tried to explain to the locals what halloween is all about with little sucess, and many stares as Flintstones, Ninja turtles, trolls, cowboys and indians amongst other characters walked around town!!!!! It may seem ironic that we are partying when we have written how some people are living in such poor conditions here -please forgive us for needing some degree of normality in our lives out here!
The Manchester gang transformed themselves into an award winning family of Flintstones, complete with car that we spent many hours building...which we later crashed on our lap of honour around the grounds of the party venue - its now officially declared a 'write-off!' But it help us secure the award for 'Best Innovative Group' and so we felt very proud of our efforts! Much fun was had by all, culminating in a street dancing to a group of local musicians playing the most fabulous music our ears have heard since arriving in Uganda!

Updating our blog is proving to be somewhat of a challenge: it relies heavily on power!

• Electric power - there are frequent power cuts.
• Brain power - this is severely lacking after a hard day at work!

The Gulu Walk.

Last saturday saw thousands of orange-t-shirt-clad people take to the streets to participate in the annual Gulu Walk. This is an international event in aid of the children of Gulu. It remembers the 'night commuters' - the children who walked into Gulu from the surrounding areas at dusk for safety from the Lords Resistance Army. It also remembers those children who were, or still are, abducted by the LRA and used as child soldiers.

In the intensity of the African sun the walk wound round the streets of Gulu, the music and local people creating a real carnival atmosphere. By the time we reached the events field at the end of the walk we had acquired quite a congregation of children around us. We danced with the kids as the band played. We tied a rag from our t-shirts around the wrist of a little girl and before we knew it we were besieged by children wanting an 'orange bracelet'. We were literally tearing out t-shirts to threads to ensure that everyone had one. Can you imagine children at home getting so excited about something so simple?!

A great day had by all!

The Hospital.

We've completed our first full week at work and are feeling both physically and mentally exhausted! As we'd expected it has been a challenging week and the reality of the hospital has hit us quite hard. As a patient's relative today explained, people only present to the hospital when 'the situation is at it's worst' - this basically means that they have probably been sick for some time before presenting. Subsequently these patients require a high level of care and often the facilities and medications are lacking. As a result the staff have to be very resourceful at times. A fine example of this was a patient who needed a chest drain for a pneumothorax (for all you non medical people this was to help re-inflate a collapsed lung). A bottle of saline, a giving set and a green needle later and the chest drain was in place! We will never complain about the NHS ever again!!

Our first week...

We are coming to the end of a very interesting first week here in Gulu. As well as an introduction to the hospital, we have tried to master the local language of Acholi, ridden the local boda boda transport, tried the local tipple waragi (otherwise known as poison) and spent an evening at a local home watching traditional African dancing! The Ugandan people are exceptionally friendly and always prepared to share a smile!

GULU REGIONAL REFERRAL HOSPITAL

The hospital is very run down and dilapidated. It was built in 1934 and looks like it has never undergone any renovations. The hospital is severely lacking in equipment and facilities, even the most basic of resources such as gauze to clean wounds. The patients are incredibly accepting of the hospital conditions and never complain. The beds are less than 50cm apart, and privacy and confidentiality are non existent. Many of the beds lack mattresses and bedding must be provided by the patient. Each patient must have an ‘attendant’ - often a family member, who provides for all their personal needs. Large groups sit outside the hospital preparing food for their relatives, otherwise they go without. On a plus note, a new medical and surgical ward have been built and are awaiting to open once the toilet block has been complete. The male medical patients are however currently housed in what can only be described as a barn, and the TB ward is a shack– considering it’s the rainy season with heavy down pours – the windows are sheets of plastic flapping in the breeze! The hospital also appears to have resident chickens that just run around the place – infection control at its best!!!

We’ve spent the last 3 days shadowing Nik and Sally on A and E and the Medical Ward. It’s been really interesting to see the great work that they have been doing at the hospital and be able to prepare ourselves for starting work on Monday. Here are a few stories of the week!
I know Nik has explained this story on their blog but I think it deserves a second mention….A taxi pulled up outside A and E and Nik went to ask if they needed any help. The taxi driver said ‘fine’ so we sat down and started discussing the other patients….about 5 minutes later the Sister came over and said ‘I think there is someone in the taxi who is not breathing so well’. We went straight over to see the patient…..he had already died. He can’t have been older than 20 and his mother was asking us over and over to do something for her son. We asked the Sister what happens next and she said that they would just have to take him back home.
The A and E department is literally a room with about 7 beds. A man came in saying that he thought he had malaria. Nik started taking the history and then the man said that he was going to be sick…I asked the Sister if we had any vomit bowls and she said no, he would have to go outside. So the man had to go and be sick in the gutter outside…he was not looking well at all and there were no beds in the department so we had to examine him outside on the pavement with chickens running around…so surreal.
On the Medical Ward there are some seriously ill patients that would normally be in HDU in the UK. We have been looking after a patient with Sally this week who is HIV positive with cryptococcal meningitis. The patient is desperately in need of anti retroviral therapy and it has been so hard to get the medication to him. Sally has been going to the specialist centre every day but the medication was unavailable and, with no money to buy any, the patient will not recover. After 3 days of trying Karen and Sally ended up going into town to buy them for him as a short term solution….3 pounds to us may seem like nothing but out here it can be so important.

And so the story begins......

We've been here a couple of days, enjoying and acclimatising to life in Uganda!

First impressions:

• GREEN - Uganda is so green and lush, not at all how you'd imagine stereotypical Africa.
• RED - Clay roads...we are constantly covered in a hue of red dust!
• BLUE - Lake Victoria - vast, so vast like an ocean!!

Gulu:

A very bumpy, pot holed, 5 hour ride from Kampala to the place we'll call home for the next 6 months! We've been welcomed with open arms not only by Sally, Nik and Joe (our team from manchester) but also by the NGO (charity) community - very social!!
We've been trying to find our way around the maze of dusty streets in town. There's a huge local market selling everything from live chickens to second hand trainers!

Gulu Regional Referral Hospital:

We visited the hospital today and met the Medical Superintendent and Head of Nursing who were very welcoming. Conditions are far removed from those in the UK! We're feeling positive that working with Dr Nik and Dr Sally, we are going to have a valuable experience.