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.