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.