HOMEWARD BOUND!!!

KAREN:

Our Uganda experience is now officially over! Eight months, 33.5 weeks, 235 days and we now find ourselves homeward bound as we sit in Dubai airport waiting for our connecting flight onwards to Manchester. It's quite a culture shock to be in such an extravagant and immaculately clean environment after the simplicity of Uganda...and constantly being covered in a hue of orange dust!

Uganda is a phenomenal country and our experience has far exceeded our expectations. To have the opportunity to work at Gulu Regional Referral Hospital (GRRH) has been a true honour. The hospitality of the Acholi people has been remarkable as we were always welcomed us with open arms! We have been proud to call Gulu our home and make so many friends both from the local and the international community. After 22years of civil war in Northern Uganda and being subjected to so much suffering, loss and poverty, you could expect much sorrow, oppression and negativity. Instead the people are the most upbeat, happy and friendliest individuals we have ever met, contented by the simple pleasures in life. They are a true inspiration!

DEBBIE:

The last 8 months has been filled with such a fantastic range of adventures, professional learning and personal development. Our work was intense and at times very difficult but our whole experience at GRRH was one that we will treasure for years to come. There were many extremely sad and demanding days but our spirits were raised so much by those few patients who against the odds survived. Simple procedures and processes proved to be complicated due to the lack of resources and huge number of patients on the ward but this meant that we felt even more proud of all of our achievements. We developed such strong relationships with the hospital staff and found it interesting to learn about our colleagues' lives and stories of living in Gulu during the war. As Karen has said, the people that we have met are all so inspiring and it is hard to believe the suffering and hardship that they have been exposed to. We are very proud of the work that we have done at the hospital and feel that we have made many lifelong friendships.

Leaving Uganda has caused us to experience such a range of emotions. We are both so very excited to see all our families and friends! We're also feeling saddened that this incredible experience is now over. We had both always dreamed of working in Africa and having made that dream a reality has been amazing. Leaving friends and the ever changing international community behind in Gulu has also been difficult but we now have future opportunities to visit these great friends in some beautiful places around the world. In the last few days in Uganda we found ourselves soaking up the sights and sounds even more and trying so hard to capture those special details that we just can't let ourselves forget, for example: the vast sky that is full of cartoon-clouds, the ever smiling faces of Ugandan people as they greet you, ten thousand people trying to fit into an 11 seater matatu (minibus), the sight of someone tucking into a plate piled unbelievably high with pocho, rice and beans, the buzzing, social activity of the market place, the way people carry 30 kilos on their heads like it's no big deal, the way that the children look at you in awe when you walk past them because they've never seen a 'mzungu' (white person) before....the list goes on and on and on.

KAREN:

We hope you have enjoyed following our journey and that our blog has brought you all closer to Gulu and to Uganda and to the reality of life in a developing country. We sincerely thank our families for their endless love and support and for sharing in our smiles, our tears, our adventures, our trials and our tribulations. To all our friends and colleagues - we thank you for the ongoing support, emails and messages which have been hugely appreciated and encouraging, particularly after a difficult day at work!

...photos to follow once once we are re-united with a decent internet connection back home!

So from Uganda, and from the Gulu Girls it is officially over and out!

FINAL COUNTDOWN!!!

Apologies as this entry was written nearly a week ago but due to no power or internet uploading has been delayed!

KAREN:

Time seems to have been flying by on our travels as we now find ourselves in our final two weeks in Uganda! The countdown to home brings a mixture of feelings from excitement and elation at the thought of seeing our families and friends, to sadness that our 8-month Uganda experience is drawing to a close. To be spending time exploring Uganda is definately proving to be the perfect way to end our adventures and definately a good reward after 6 months of hard work in Gulu!

Our journey has now brought us to east Uganda where we are staying in the Mount Elgon region. At 4321m Mount Elgon is the second highest peak in Uganda, and the eighth highest mountain in East Africa. I'd like to say that we have great intentions of making the four day climb but I'd be lying...the pain in our legs after one day of walking, mostly uphill I must add, has left us wondering if our legs really do belong to us so instead we'll continue to admire the mountain from the surrounding areas! Being in the mountains we are very aware of the drop in temperature and are wondering how on earth we will cope as we return to the milder climate of the UK despite the reports we have heard about recent good weather back home!

Not to neglect our clinical interests, on our travels we have found ourselves visiting two different health care establishments. Firstly, whilst in Bwindi Impenetrable National Park to trek the mountain gorillas, we visited the local hospital which we stumbled upon in a quest to locate internet facilities. Serving a catchment area of 60,000 people, this 60-bedded missionary hospital proved to have an impressive set up. By African standards, the hospital was spotlessly clean and appeared to be well organised. Schemes such as the sale of reduced-priced mosquito nets seem to be having a positive impact on the health of the community as well as the introduction of a low-cost health insurance whereby patients make an annual contribution of 6000 Uganda Shilling, approximately £2. It was encouraging to see such an efficient clinical environment here in Uganda giving us hope for the long term collaboration between the University Hospital of South Manchester (UHSM) and Gulu Regional Referral Hospital.

Our next clinical visit took us further north to a small suburb of Masaka called Kamatuuza, approximately 3 hours west of Kampala. We knew of a doctor from Cheshire who has set up a paediatric health centre in this district as part of the work of the charity 'Just Care'. It turned out that she was visiting the region from the UK and so we arranged to visit. In true Uganda style , nothing is ever that simple! The journey began with a taxi driver assuring us he 'knew the place' when asked if he could drive us the supposed 20 minute route to Kamatuuza. Whilst the driver ate a nutritious breakfast of cake and soda at the wheel, we began to feel doubtful that he knew where he was going as the journey appeared to take a long time. 45km and almost an hour later he proclaimed to have arrived at our destination yet there was no health centre nor indeed any signs of civilisation. Eventually we learnt from an intrigued collection of local people that there were two places called Kamatuuza in the region and the one we wanted was 60km away in the other direction! The driver didn't seem to understand why this was a problem and drove off leaving us stranded at the side of the road! Eventually, after a long and squashed drive where a 6 seater car somehow managed to accommodate 12 adults and a baby, we reached the correct destination...3 hours late! The warm welcome we received from Dr Pauline and her team certainly compensated for the frustrating start to our day. We accompanied them as they distributed mosquito nets, mattresses and clothing to families within the community before visiting the children's health centre. Again this proved to be another well run and organised health facility run by a small team of friendly staff giving Just Care cause to feel very proud of their work!

DEBBIE:

After our intrepid travels through Queen Elizabeth National Park and Bwindi Impenetrable National Park we made our way further south. After several nights filled with an array of animal noises we were extremely happy to arrive at the tranquil and peaceful Lake Bunyoni. We travelled from the mainland to one of the 29 islands by dugout canoe and settled into our accommodation named a 'geodome', which consisted of a very basic hut with no door! Having been used to the scorching heat of the north for 6 months we weren't convinced that we would survive the cold of the night by the lake (with rather drafty accommodation!) A sleeping bag and 3 blankets each helped us to survive the night and the view that we woke up to the following morning was absolutely breathtaking! We spent an amazing 5 days reading books, relaxing and exploring the islands!

After resting in Lake Bunyoni and visiting our friends to learn about their inspiring projects in Masaka we travelled to Lake Mburo. Having seen lions, elephants, hyenas, gorillas, hippos and giraffes in Uganda there was only one species that we still had to tick of our list - zebras! We went on a beautiful boat trip on the lake where we saw many hippos and different varieties of birds. We then went on a game drive early in the morning and saw a herd of zebras meaning that our Ugandan animal spotting was complete!

Animal Kingdom!

DEBBIE:

The beginning of our trip involved a few slight setbacks in the form of purse-theft in Kampala followed by tricky bank troubles in Fort Portal. However, after a couple of stressful days we put these inconveniences behind us and started to enjoy our newfound relaxed and stress-free lifestyle!

Fort Portal, in Western Uganda at the foot of the Rwenzori Mountains, offered us the chance to stay at the interestingly named ‘Exotic Lodge’ which cost us a grand total of £1 each for accommodation per night! Although far from exotic the rooms were clean and the staff were kind, which made our stay really enjoyable. The weather here was a far cry from the super hot Gulu that we were used to but with our raincoats packed we decided to take a trip out of the town to explore the countryside on mountain bikes. The views from the hills were quite spectacular and as we were cycling we constantly heard the choruses of the local children shouting ‘how are you, how are you, how are you!!!’ Mzungus (white people) on bicycles seemed to cause the locals a lot of amusement as they stared and giggled at us. We were unfortunate to get stuck in an almighty rain shower on the way back to Fort Portal but we warmed up with some good local style food back at the lodge.

KAREN:

Our onward travel took us to the Mweya Peninsula in Queen Elizabeth National Park – 1978 sq km of animal heaven! Staying deep within the park perimeters, the night air was filled with the sound of roaring lions, laughing hyenas, grunting hippos (‘ho ho ho’) and trumpeting elephants. Hearing activity outside our bedroom we were astounded by the sight of two elephants passing by our window! Watching the rangers trying to move them on was like a game of cat-and-mouse as more elephants continued to arrive and tear down trees! During our time in the park we saw hundreds of elephants, often way too close for comfort as they came within metres of our vehicle. An evening game drive proved to be the most exciting but perhaps the most hair-raising and exhilarating of our experiences. Driving back to our accommodation, a sizeable herd of elephants reluctantly took their time to clear from the road. A few minutes later a baby elephant stood alone in the road distressed at being parted from the main herd. Almost immediately a hippo ran across our path followed by 2 savage hyenas. We sadly learned that the elephant calf later became dinner for the hyenas. I can only describe Queen Elizabeth National Park as one of the most magical places on earth!

DEBBIE:

From the north of Queen Elizabeth National Park we travelled south to Ishasha, hoping to see the native tree climbing lions. After 7 hours of game driving in Mweya without spotting any lions, we were hoping to catch some down in Ishasha. As we drove from the park gate I heard a gasp from Karen sitting in the front seat of the car and we stopped to see 2 lionesses sitting by the side of the road!! We were also lucky enough on our game drive the next day to see a male and a female lion on the roadside. We were ecstatic to finally see these amazing creatures.

Our accommodation resembled a local style hut with great views over the savannah. The ranger who guarded the site was not too reassuring when he told us that, the previous night, the campsite had been stalked by 4 lions! The evening was full of animal noises (which was slightly scary) and we had a visit from a bat in the middle of the night which caused us some amusement as we tried to coax it out of our room!

KAREN:

Bwindi Impenetrable National Park became our next stop. With an altitude span of 1160-2607 metres, the steep rolling rain forest mountain scenery and countless tea plantations felt very unlike Africa! The purpose of our visit...to trek the endangered mountain gorillas. The Ugandan jungle-forest is home to half of the 700 surviving gorillas worldwide. The remaining populations live over the borders in Rwanda and The Democratic Republic of the Congo. Conservation efforts only allow the Uganda Wildlife Authority to release 24 permits a day to trek 3 different gorilla families within the park and so it is a privilege to view these magnificent animals. Our trek followed the path of the Rushegura gorilla family. Lead by a humungous silver back male we were fortunate to view 16 of the 19 family members, including two babies. Such breath-taking animals! Visitors are restricted to 1 hour viewing and a 7 metre distance rule to prevent the gorillas becoming overly familiar with human contact and to reduce the risk of disease transmission. As we watched on, the unruly group ran down the hill onto community land and wreaked havoc in a banana plantation, causing much damage to the crop, and indeed the livelihood of a local farmer. Pulling down trees and crushing the crops, the animals had a right old feast, swallowing bananas whole before the rangers eventually chased them away. We were relieved to hear from the land owner that gorilla-trespass is only a bi-annual event.

To have viewed so many animals in the wild has felt like a dream come true and the most magnificent reward for all our efforts and hard work over the last 6 months. May the good times continue to roll in our remaining 3 weeks in Uganda!

(Disclaimer: Photos to follow when decent internet connection available, in the mean time we encourage you to use your imagination! Thank you very much for your patience!)

Good Bye Gulu!

KAREN:

The time has come to say goodbye to Gulu! Our mission is now complete! What an incredible 6 months we have had here in Uganda! Whilst volunteering at Gulu Regional Referral Hospital has been the challenge of a life time, we will forever cherish the memories and friends created by this experience. Goodbyes have been far from easy...

DEBBIE:

We've had a week of saying our goodbyes to the great people of Gulu...and what an emotional week it turned out to be! We were overwhelmed by the reactions of our Gulu friends to our leaving.

Our friend Rosemary who is a tailor in the market spent a whole afternoon trying to find us at the hospital and around town to present us with a bag and two purses each that she had made for us! Such a generous gift from someone who has very little for herself. She found us sheltering from the rain in the local cafe where, minutes earlier, we had reduced our waitress friend Maggie to tears when we had told her that we were leaving the next day. We had explained a week previously that we were leaving Gulu but Maggie said that she had thought we were joking! She then wrote us both lovely cards thanking us for being great friends to her and her niece Rita. A phone call then came through saying that Flavia, one of the nurses from the hospital, had arrived at our house with gifts for us! Flavia left us two wonderful figurines of Acholi people in Ugandan dress on bicycles which will be great reminders of the alternative travel that occurs in Gulu! Karen's had a pregnant lady on the back of the bicycle and mine had a huge pile of Matoke strapped to the back! (savoury green bananas). The kindness shown to us has been amazing.

We were fortunate to be able to share our final week with some very enthusiastic colleagues from UHSM who were busy teaching the medical students of Gulu University. It was a great opportunity to share some of our experiences and have a small piece of Manchester with us as we said goodbye to Gulu. The group were full of great characters and although the week was extremely busy for all involved (courtesy of the Icelandic volcano!) we enjoyed having them to stay and we hope that they enjoyed their visit...despite a gas leak, constant power cuts, water shortage and then, ironically, a flooded house!!!

KAREN:

The hospital arranged a farewell party in our honour. Expecting nothing more than a small gathering of staff, we were quite taken aback when an hour before the party we were presented with a formal agenda of speeches, and a marquee was erected in the hospital grounds! It really brought home to us how much our work has been recognised and valued by the hospital staff. Many kind words of gratitude were spoken compounding the emotions we were already feeling at saying goodbye to people that have not only been our colleagues but also our friends. Sadness soon turned to laughter when the 'Master of Ceremony' declared that at the end of our speech, Debbie and I were to demonstrate our best Acholi dance moves! We hope and pray the video footage is never made public!

DEBBIE:

Our final contribution to the Medical Ward at Gulu Regional Referral Hospital was one of the most satisfying achievements that we could mention. With the remainder of the money from the Easter distribution and some new donations, we hoped to provide every bed on the Medical Ward with a mattress with a waterproof cover. Unfortunately, when we went to the market to do some research with the Senior Principal Nursing Officer from the hospital we found that the best quality mattresses were far more expensive than we had anticipated. We decided to order mattresses for half of the ward, feeling frustrated that we were unable to fund the whole ward. It has been extremely upsetting for us to see so many sick patients lying on bare bed springs and we really wanted to change this for all of the patients.

In a great turn of events, after Marian Surgenor, our Global Health Link Lead, discussed the situation at the hospital, the Medical Superintendent agreed to match what we had been able to buy ensuring that the WHOLE ward could have new mattresses! Karen and I were overjoyed and can't wait for them to be delivered next week! Thank you to all those who donated towards making our patients on the Medical Ward much more comfortable.

KAREN:

Despite all the tears, frustrations and sorrows, our Gulu experience has been nothing short of amazing and thankfully the good times have far outweighed the bad. It would however, be fair to say that coming to terms with the clinical conditions at the hospital was difficult to say the least. Words and photos fail to do justice to the poor conditions and the reality of life in Northern Uganda. Working in a developing country, we expected resources to be limited but when basic necessities like gloves, needles, syringes and cannulas weren't available, with a constant absence of essential drugs, it made for a desperate situation.

I like to hope that Debbie and I have made a difference, even if its just a ripple in an expansive ocean. If nothing else, we made patients and their relatives smile as we amusingly attempted to master the local Acholi language! In a farewell speech, one of the consultants commented that he thinks patient number may have increased during our time at Gulu Regional Referral Hospital as many local people wanted to be cared for by the two 'mzungu' (white) nurses in town...I'm not sure our aim was to actually increase the burden on hospital facilities!

The support shown to us by our families, friends, and UK colleagues has been overwhelming and has meant so much and been extremely encouraging. We were particularly spurred on in our final weeks when we learnt that we had received a 'One Talented Team' award from the University Hospital of South Manchester (UHSM) for our work in Gulu - we are now officially award winning nurses! Now the time has come to hang up or uniforms and spend the next 5 weeks travelling around the South, East and West of this beautiful country that we have been fortunate to call 'home' for the last 6 months. Watch this space for the next chapter of the Karen-and-Debbie Uganda travel adventures!

Our Mission is almost Complete!

KAREN:

As our time in Gulu draws to an end we have been reflecting on what an amazing experience we have had in Uganda. The last six months have been challenging to say the very least but thankfully the good time have far outweighed our sorrow and frustrations!

We finished work at Gulu Regional Referral Hospital last Friday. Saying that we still have a series of lectures and presentations to make and so our mission in not yet complete! Our send off from the hospital staff was very moving with much praise from the Senior Principle Nursing Officer and the Chief Nurse for all our efforts at the hospital. By the end of their speeches we resorted to feeling like we were once again 10 years old and the 'teachers pet!' We were glad to have an opportunity to offer our thanks to the staff for all their support and new found friendships. Our official duties were completed by the staff singing us the Uganda Nursing Anthem:

"We have been chose, we have been chosen (high pitched!)

Chosen by God, chosen by God,

Chosen to be Nurses, chosen to be Nurses,

Our Holy people, to love and serve."

A thank-you and farewell party is being planned by the hospital staff in our honour for tomorrow night! Such gratitude has been show to us for our work and many of the nurses have thanked us by inviting us to their homes and preparing us a feast of local specialities: beef or chicken stew (chewy meat no longer repulses us!), malekwang (green leaf in peanut and sesame sauce), posho (a white bouncy lump of maize), kal (a brown bouncy lump of millet), rice, chapatti, sweet potato, bans (obligatory!), boo (pronounced 'bo') and dodo (chopped flavoured green leaves). One spread even included the local delicacy of 'bush rat' - you may well wretch - I certainly did! The challenge is to eat until you are ready to explode...and then eat a little more! We are always humbled by such a spread of food as people here have so very little yet always share so much. The average pay of a nurse is £100-£200 a month and often wages are late in being paid.

Our friends homes have ranged from modest houses to simple mud huts. With the UK housing market being so expensive we are contemplating building ourselves mud huts on our return to Britain! To be invited to a local village is something we always feel is a real honour especially when the whole community want to greet us and the children run up to us shouting "mwnw, mwnw, mwnw!" (white person) with such excitement and giggle when we respond with a smile or a wave! With such pride, Sister Caroline, our Chief Nurse, took us for a walk around her village introducing us to the community by our Acholi names: Lamaro Karen - meaning I show passion and dedication, and Aber Deborah meaning beautiful good girl. Traditionally if an Acholi name is shared with an elder, a chicken should be offered which means that by now we would have our own chicken farm! Sister Caroline showed us the spring where water is collected for cleaning and washing and the bore hole from where drinking water is pumped. The heavy canisters of water are then carried home on the heads of local women. She also gave us a cookery lesson teaching us how to prepare local food and showed us how to plant ground nuts on her land. We are now officially Gulu Girls!

DEBBIE:

Along with the great friends that we have made by working with the nurses at the hospital we must also mention the patients. We've met some truly inspirational patients and relatives on the ward who cope with so much in such a humbling way. Relatives here (referred to as the patients 'attendant') have to care for their family member 24 hours a day and their dedication is amazing. Some people, however, do not have adult family members to preform this vital role and so the responsibility falls on their children. Here is an example:

A patient was admitted onto the ward and was very sick with chest problems. When she arrived she was sitting on the floor by her bed looking like she didn't have the energy to move. A young girl followed and began attending to the woman and helping her into bed. This young girl, aged around 6 or 7 years, was the sole carer for this patient: her mother. Each day she cooked food, fetched water and cleaned clothes for her mum. The girl and her mother had very few belongings and it transpired they had fled from the Democratic Republic of Congo to Uganda for safety, speaking volumes about the state of affairs in the Congo. The isolation felt by this mother must have been huge as she could not speak the local Gulu language of Acholi and spoke little English. Thankfully one or two nurses were able to speak her native tongue of Swahili but these staff were few in number.

One day on the ward we brought some sparkly masks left over from a Christmas parcel we had received. The little girl was fascinated with the mask and wore it all day! From this day forward we were considered to be her friends and every time she saw us she ran up the ward to give us a cuddle and a huge beaming smile! Her mother was diagnosed with Tuberculosis (TB) and thankfully started on the appropriate treatment but remains very sick. This situation seemed so desperate to us but is simply accepted by these two strong-willed ladies who coped so well. Extraordinary!

An Easter Present...

At Christmas time some friends from the company 'Cargill Cotton' worked hard to raise money for our patients at Gulu Regional Referral Hospital and we also received some very kind donations from friends and relatives. With the money we had planned to give each patient at the hospital a small Christmas gift. Unfortunately, Karen fell ill the week before Christmas and so we were unable to carry this out. However, as Easter came around we thought we'd try again and provide an Easter distribution instead!

We decided to give each patient a very English treat - tea, milk, biscuits and sugar! With 250 beds at the hospital the scale of organisation could not be underestimated as Karen and I went to the market and bought 300 sachets of tea, 15 kilos of sugar and 23 litres of milk! We made some of the market sellers very happy that day. We also needed something to package the gifts in and so we went to an older man in the market who sits selling plastic bags all day. Whenever we see him he always tests our Acholi language skills and gets very excited when we can answer his greetings! When I asked him for 300 'caveras' (bags) I don't think he could believe his ears! He was overjoyed when I handed over 30,000 shillings (just under 10 pounds).

On wednesday night, while the local bakery were making the 600 biscuits we had ordered, Karen and I started a production line arranging the sugar and tea into all of the bags. This job took us 3 hours into the night and left Karen and I feeling slightly hysterical with tiredness and absolutely covered in tea and sugar!

Thursday was distribution day. After hiring a vehicle to transport everything to the hospital one of the lecturers at the medical faculty very kindly let us use his office to sort out what was to go where (we rewarded him with some left over biscuits). We started by going to the Nutrition Ward and Paediatric Unit where the mothers were extremely grateful for our little gifts and we had a great time greeting all of the patients and talking to the staff. We even got a round of applause when leaving the Paediatric Ward! We then went to the TB Ward, Acute Paediatric Unit, Casualty, Surgical Ward, Medical Ward, Maternity Wing, and Mental Health Unit. We had some amazing reactions while going around the hospital. One older lady in the Surgical Ward gave both of us a huge hug and had the biggest grin on her face - it was priceless. We had extra parcels and so managed to share these with members of staff that were on duty who were also very grateful. Such a small present caused such excitement around the hospital, it was so great to see. Thank you so much to all of our donors for allowing us to distribute an Easter present to each and every one of our patients! It was a day that Karen and I will never forget.

A Taste of Paradise!

I had a dream of powder white sand beaches, vibrant aqua marine crystal waters set against perfect blue skies, palm trees in abundance, endless rays of sunshine, and a daily feast of freshly caught fish brought directly off fishermen on the beach...then I realised that in fact I hadn't been sleeping... we had been on holiday to Zanzibar!

Physically, emotionally, and mentally exhausted, Debbie and I pressed the 'stop' button and along with our friends Apolo and Ben, left Gulu for a holiday. Zanzibar is radiantly beautiful and can only be described as paradise on earth! Words and photos cannot do any justice to this picture-perfect Tanzanian island. A traditional palm-roofed house was where we lucky enough to call home for a week - 'White Sands' so aptly named for its idyllic beach front location with jaw-dropping views across the ocean. One morning sleeping out under the stars, I was lucky enough to awaken to the most amazing sunrise I have ever seen - I thought my eyes were deceiving me as the burning red sun rippled through the clouds with the colours glowing vibrantly as they reflected off the peaceful waters. A sensational way to wake up!

Uganda is a remarkably beautiful country and we have enjoyed many a weekend adventure visiting the Rwenzori Mountains, exploring game parks, trekking rhinos, white water rafting, camping on the banks of the river Nile, and swimming in waterfalls and crater lakes. This time we decided to head a bit further afield and experience a bit more of East Africa and stay in a place with very few physical demands. Whilst both Debbie and I are relishing the opportunity to work in a resource-limited developing country, owing to the nature of our work at the hospital, there is only so long that it is possible to work without a break. And Zanzibar certainly proved a perfect way to recharge the batteries.

We filled our days swimming in the sea, reading, relaxing on the beach, and playing frisbee (yes indeed we really are big kids at heart!) and cooking up a daily fish feast of the fisherman's catch of the day - snapper (red, white, and black), sting ray, barracuda, lobster, and blue fish as well as others that remain nameless but tasted delicious! Physical activity extended to include windsurfing and I'm proud to say I am now 20meters proficient even if I did spend more time crash landing into the sea than upright on the board! For me a highlight was swimming with wild dolphins off the south coast of the island- a truly magical and unforgettable experience!

Our week in Zanzibar was poles apart from our life in Uganda. We knew we were back in Gulu when we returned home to a weekend minus power, an inconsistent mains-water supply, an empty gas cylinder, and a red ant invasion. As we sat on the porch with a glass of (poor quality) red wine toasting our holiday, we were attacked by flying ants and moths nose dived and drowned in our wine ...a proper local-style Gulu experience, and we wouldn't have it any other way!

THE CURSE OF NATURE

KAREN:

Nature can be so beautiful, nature can be so ugly. Nature can cause so much pleasure, nature can cause so much pain. On the evening of Monday 1st March 2010, tragedy struck Eastern Uganda when a landslide caused multiple deaths destroying four villages in the county of Bududa. Many people were buried alive as rocks, mud, stone, and water thundered down the foot hills of Mount Elgon submerging buildings, schools, health centres, and entire communities.

Stories and images of devastation dominate the news here in Uganda as a humanitarian emergency has been declared. Over 350 people are feared dead along with hundreds of livestock. Rescue efforts have been coordinated by the Uganda Government with the support of the military and humanitarian aid agencies. One week on and only 31 survivors have been rescued from the rubble and 89 bodies exhumed after disaster response teams and locals alike have been using hoes, pick axes, spades, and even their bare hands to dig in over 3.3 square kilometers of flattened terrain.

The 200m wide avalanche of mud and debris was triggered by endless days of downpours, more typical of the cool wet season, not the hot dry season that Uganda should be experiencing at this time of year. The affected villages of Nametsi, Kubehwo, Liira, and Matuwa have been declared disaster zones. Flooding due to the above average rain falls, is causing further problems in these regions of devastation. Over 1000 people in these villages have been made homeless. A total of 4000 people living in mud-slide prone areas have been advised and encouraged to evacuate their homes and seek refuge in temporary relief camps or in nearby villages. Oxfam, The World Food Programme, Save The Children, and UNICEF are amongst the aid agencies involved in distributing food, clean water, cooking utensils, blankets, and essential medical supplies to the people seeking refuge in the internally displaces peoples (IDP) camps. Medical teams have been flown in from Kampala, the country capital, reinforced by medical staff from nearby Mbale Hospital.

And with the flooding comes further misery in the form of water-borne infections and diseases from unearthed decomposing bodies. 80 cases of cholera have been confirmed in a neighbouring district - an acute intestinal disease caused by consumption of contaminated food and water which causes severe diarrhoea and dehydration. Minus prompt treatment, cholera can result in death. The concentration of people living in the IDP camps and temporary shelters can greatly increase the risk of disease exposure and transmission from over-crowding and utilisation of basic sanitation facilities. Aid organisations have been working hard to disseminate water purification packs in a bit to halt the introduction and spread of the disease and prevent the outbreak of an epidemic, with the International Committee of the Red Cross (ICRC) at the ready to treat 1000 cases should the need arise.

Although efforts to retrieve the bodies from the rubble continue, it is expected that President Museveni will declare an end to the search operation in the next day or two as chances of recovering bodies grows increasingly slim and excavation poses further public health risks. Not an easy decision when villagers so desperately want to provide the dead with a ceremonial and respectful burial.

Whilst response efforts are primarily focusing on immediate interventions in the aftermath of the landslide, longer term re-development planning is not being forgotten. In the proposed 5 year re-development programme buildings will be established to continue the education of the survivors of the 374 children in the affected areas. Homesteads will be constructed in safe locations. Land will be cultivated to replant the 792 hectares of damaged crops, predominantly consisting of maize, vegetables, cassava, banana and sweet potato, thereby contributing to future food security. Livestock will be replaced to compensate for the lost animals including 176 cows, 50 goats and 2000 chickens- essential sources of income and food for people in developing countries. Plumbing of water pipelines to the affected villages will be reconstructed, as well as sanitation and road infrastructures.

Living here in Uganda, it is difficult to know how far news of such a tragedy has spread to the outside world. And it is even more difficult to learn how such a tragedy has inflicted suffering in a country that has captured our hearts and that we have come to call "home" causing such loss to people and communities that already have so little.

Sadly the rain continues to fall...

Any one for a pint?

Last Friday I did one of the most rewarding things of my nursing career to date that perhaps directly saved a life...I donated blood to my patient. Returning empty handed from yet another trip to the hospital lab trying to acquire blood for transfusion for our patients, I felt compelled to help. Blood supplies are always in short supply in Gulu. Many patients here suffer with anaemia as a complication of malaria, and secondary to HIV anti retroviral medications. And when I say anaemia – I mean seriously low blood iron level. To any non-medical folk, a normal haemoglobin (HB) level is over 12.0, with UK patients receiving a blood transfusion at 8.0 or under. In Northern Uganda, patients are not transfused until they have a haemoglobin level of 5 or under – and it’s not uncommon to see levels at two or three!

My patient needed blood type A negative - a rare commodity at the best of times let alone from a blood bank with almost vacant supplies. Being a blood donor back in the UK, I was keen to offer a unit of my best claret to help my patient who was admitted with a HB of 4. Calling on my trusted side-kick Debbie, our interrogation of the Blood Bank staff began with us thoroughly investigating the Ugandan process of blood donation, and rigorously examining the blood collection equipment and ensuring the needles were indeed SINGLE USE! Assured by our findings we both decided to go ahead and donate! Before we knew it we had both donated 450ml of British blood to add to the dwindling supplies at the hospital. And just like home, the reward for your contribution...a sugary drink and biscuits – complete with smiley faces none the less!

We returned to the hospital ward with a standing ovation and a round of applause from our colleagues! And two hours later, after my blood had been screened and prepared, I was connecting it to my patient! Such a surreal feeling to know that it really could make a difference to the ultimate outcome of my patient! His family became so excited that they whipped out a camera and began snapping away as I went about connecting my bag of donated blood to the drip port cited in the arm of their relative. I was completely taken aback by this as I’ve never before seen a Ugandan with a camera!

And Im pleased to report that by today the patient was looking much better and has greatly improved. For once a success story where I feel incredibly proud to have played a significant role! Now we are keeping our eyes peeled to see if we are able to identify, by donor number, the recipient of Debbie’s kind contribution.

As the nurse in the blood bank said to us post donation “thank you for helping to save lives!”

A bit of a sad week...

Debbie:

The last 2 weeks at work have been tough on Karen and I as we've been faced with many patients have been extremely sick and been forced into the realisation that we can't do as much as we would want to for them. We'd like to remember them:

The first patient was a female aged 25 who, when she was admitted last Monday, was septic with an unknown infection. I cannulated her, took blood tests and started the antibiotics that the Doctor had prescribed. The next day we went to Pabbo Camp to help with the HIV clinic. When we returned to work on Wednesday I was happy to see that she looked better and appeared to be improving. The Doctors came onto the ward and started their rounds and Karen and I began assessing our patients, sending off blood, sputum and urine tests and giving treatment. I went to see the lady just before midday to check her observations and found that her blood pressure was unrecordable and peripheral pulses could not be felt. The Doctor had seen her earlier in the day and stated that her chest x-ray was poor but she had been alert and orientated then. By this point the lady started becoming slightly agitated and had difficulty breathing. I called the Doctors over immediately after realising that she was haemodynamically unstable but there was nothing that we could do quickly enough to save her. She slipped away before our eyes. Her mother was present and began praying and was obviously very distressed. Karen and I stood with her and bowed our heads as a sign of respect. I sat with the lady and put my arm around her. The only word that I could say to her that she would understand was 'sorry' which made me feel so helpless. When I sat next to her she put her head on my shoulder and wept. The patients sister then arrived and was so distraught. The loss of this girls life was so sudden and unexpected that it had shocked both nurses and family. To make matters worse, it transpired that the family were far from home and to take her body home they would need close to 100 pounds which they did not have. I hope they found a way to take her home. May she rest in peace.

Our second patient was a lovely young girl aged only 15 who had such a sweet temperament. She was admitted a month ago and so Karen and I got to know her and her family quite well. She had complications related to Rheumatic Fever and had developed heart failure, admitted with difficulty breathing and chest pain. Although the Doctors prescribed all of the medication that they could for her she deteriorated and passed away over the weekend. In the UK we would have had the resources to give her so much more and such a better chance at life. May she rest in peace.

Our third patient was a 34 year old lady admitted with a swollen abdomen and reduced appetite. The Doctors ordered an ultrasound of her abdomen which found that she had cancer. With no treatment available at our hospital we were only able to give her end of life care as the cancer was quite advanced. She did not complain once even though her abdomen must have been so uncomfortable and she would have found it difficult to eat, walk and do other normal activities. She also passed away over the weekend. May she rest in peace.

Karen:

An early morning knock at our door and there stood our housekeeper in floods of tears. Her relative had just died. That relative being a 13 year old boy who we had been caring for on our ward for the past week and fighting so hard to save his life. Her news was utterly devastating for to both Debbie and I as we united in her grief.

This was perhaps the most devastating death since we arrived in Uganda 4 months ago. We first looked after this HIV positive boy back in November , along with our colleague Dr Sally, when he was exceptionally unwell and suffering from nose bleeds and vomiting blood. Against all the odds, he fought back and walked out of the hospital smiling. This gave us optimism when he presented once again with the same symptoms, but this time complicated further by a raging temperature with an infection of unknown origin. He was found to be severely anaemic and suffering from thrombocytopaenia - a low platelet count resulting in the bleeding.

Every day his temperature crept up until it hit 40.9 Degrees Celsius. He received a cocktail of intravenous antibiotics and medications with an unrelenting fever, eventually thought to be TB Meningitis. He received in total 7 units of transfused blood over the course of the week. Acquiring the blood was no easy task. The laboratory had no B+ blood in stock and so obtaining every single unit he required was an ongoing struggle. Urgency is non-existent in Uganda and so when I ran into the lab saying I needed blood urgently they failed to react until I was almost in tears of frustration! By the end of the week, I think they were getting increasingly familiar with the sight of this crazed 'muzungu' nurse and responded with a little more haste! It was from a contaminated blood transfusion for a childhood illness, likely malaria, that he developed HIV 6 years ago, ironically on this occasion it was a blood transfusion that would contribute to possible saving his life.

This poor child continued to vomit clots of blood and developed bloodied watery diarrhoea. Towards the end of the week he was becoming increasingly weak, and began convulsing - a serious sign of neurological deterioration. He was such a brave young boy with an incredibly caring family who sat with him night and day. Debbie and I left work on Friday willing him to make it through the weekend to stand a fighting chance. In my last words to him, I urged him to keep fighting and that we'd have a party the day he was well enough to once again leave the ward smiling. Sadly this was not to be the case.

I spent Saturday morning with his family at the hospital as they prepared to take his body back to his village 2 hours away for burial. His mother spoke of how the death of her son was 'God's Calling'. I found it comforting that despite the loss of her child, she found so much strength in her faith , something that no-one can ever take away from her. His mother thankfully spoke good English and so I was able to communicate with her. So often it is frustrating not to be able to communicate with relatives when their loved one dies due to the language barrier, only being able to say 'sorry'.

All day Saturday we felt in mourning and questioned if there was any more we could have done for him. What is difficult about times like this is that we are minus our usual support network that exists at home in the UK. While there are a few medical folk here with whom we can discuss cases and 'offload' it is not the same as being with your good friends and being able to distract yourself by watching television, or a film, and the ease of being able to put a pizza in the oven for dinner! Our feelings are often compounded by the frustrations that exist at the back of our minds when we know what care the patient would have received in a developed country. But those sorts of thoughts almost become a form of self torture because those treatments and interventions just don't exist here.

This last couple of weeks have proved very difficult as we have experienced so many deaths on the ward. Looking through the death register book I sadly realised that of all of the deaths the eldest had been a mere 50, with most aged between 20 and 30.

May their souls rest in peace.

HIV and Health

KAREN:

• An estimated 40million people worldwide are infected with HIV


• 60% of those living with HIV live in Sub-Saharan Africa


• 7% of Sub-Saharan African adults are infected with HIV


• 2.1 million children worldwide live with HIV, with 90% living in Sun-Saharan Africa


• Approximately 7500 people are infected daily by HIV


• It is currently estimated that in developing countries, 1600 children are infected daily with HIV


• Africa has over 14million AIDS orphans


• The clinical course of paediatric HIV is more than in adults


• In developing countries, 9.5 million people require life-saving HIV drugs - only 4million (42%) actually receive the medications

Yesterday we travelled to a place called Pabbo to an Internally Displaced Persons (IDP) camp to help at a HIV clinic run by our friend, Dr George.

In the height of the war in Northern Uganda, people were forced to leave their villages to live in these camps for their personal safety from rebel troops. The camps comprised of thousands of mud huts built in very close proximity to each other. Since the end of the war 3 years ago, many people have left the camps to resettle in their villages, however, it is estimated that to this day, many of the camps remain 20% occupied. Pabbo was one of the largest camps with a population of 90,000 occupants! Today it serves as a functional community comprising of a school, church, health centre, and farming land. It is not uncommon to be greeted by a cow or a chicken as you walk around the camp!

Pabbo is a fairly remote area with limited access to costly public transport. Consequently Dr George and his outreach team frequent the camp to run a HIV clinic for the local people. HIV is a huge problem here in Uganda. Sexual transmission is a significant mode of transmission as well as mother-to-child transmission. Culturally men are permitted to have many wives. Coupled with little use of condoms, spread of the disease is rife.

The clinic was previously held outside under a tree, but now the camp have allocated a small room where the patients can be seen, blood tests can be taken, and medications can be dispensed. It was a busy clinic yesterday attended by 60 patients in total, including both adults and children. At the clinic patients can be counselled and tested for HIV, medications can be reviewed and altered, patients conditions can be assessed, and any new problems can be treated. Many complications accompany HIV including the herpes simplex virus, anaemia, and weight loss to name but a few presenting complaints. HIV patients are also at risk of developing life-threatening opportunistic infections such as pneumonia, tuberculosis, and cryptococcal meningitis as a result of a weakened immune system.

HIV delays the growth and development of children. This was our second visit to Pabbo camp. On our first visit we met two children living with their grandmother following the death of their mother to AIDS. The children were aged 5 and 7 years yet both looked about 3 years younger. Dr George explained that the youngest child had not long learnt to walk - at 5 years of age! Here in Uganda children are quite advanced in terms of development and are usually walking by the age of 10 months!

Antiretroviral (ARV) medications are a life line to a person infected with HIV. Minus these drugs, the average time from acquisition of HIV to an AIDS-defining opportunistic infection is approximately 10 years, with survival then averaging 1-2 years. Whilst the medications initially often have many side effects, it is vital to persevere to live as full and healthy life as possible.

Yet some people do not wish to know their sero-status and prefer not to know if they have the disease or otherwise, and subsequently decline testing. Despite the high prevalence of the disease here in Uganda, it is still associated with a certain degree of social stigma. Discovering you are HIV positive can often sadly lead to the breakdown of a relationship, and family isolation.

Only this week we nursed a 24year old man on our ward who had previously declined HIV testing, not wanting to know his status despite that his wife was HIV positive and on ARV therapy. He was exceptionally unwell and had a decreased level of consciousness. For many weeks he had been experiencing a fever, body weakness, weight loss, a decreased appetite, and a persistent cough. Sadly he began convulsing, and stopped breathing and died a short time afterwards. His blood tested positive for HIV. Had this young man been tested for HIV and commenced on appropriate medications, the story could have been different. The same day, I took the blood of another patient who was also found to be HIV positive. I felt devastated on his behalf and accompanied the ward Sister to inform him of his result. I was pleasantly surprised by the mans positive response. He said he had been previously tested by the results had never been bought to his attention. He informed us that he was glad of a diagnosis so that he could begin treatment! I was amazed at his upbeat spirit! Hopefully his story will have a happier ending.

Back to the classroom...

KAREN - TUESDAY

Today Debbie and I sponsored a 12 year old local girl to go to school for a year. It was an incredibly humbling experience when we learnt that it would cost a mere £70 for a child to be given the opportunity to be educated. The young girl, Brenda, is an orphan. We know no details of her father, but our friend Dr George cared for her mother up until her death through HIV at Christmas time. She is now looked after by her extended family members. As well as covering our school fees, our money also makes a contribution to the school of a sack of rice, and pays towards her uniforms, text books, stationary, toilet paper (yes indeed the kids must supply their own loo roll!)...and a broom! We are not kidding, apparently the children have to sweep their own classroom every morning!

We learnt that Brenda is a clever young girl, coming second in her class in Science, Maths, and English. The report however did say she must be less playful in class - glad to hear she has brains as well as a sense of mischief! The school year started here in Uganda this week. We were motivated to help her when we learnt that she attended for school last Monday and was sent home by the caretaker as no one had paid her fees. This is a little girl with a passion to learn - how can you deny a child the opportunity to go to school? In a developed society we would automatically attend school without question of funding. We see it as our human right to be educated and even have the privilege of which schools we choose to apply! In fact, parents are prosecuted if children play truant! It is often difficult for a child to attend school here in Uganda because family sizes are so large, often with 5 or more children. Parents struggle to feed and clothe all their kids let alone afford to educate them as well. Consequently, children grown up working from a very early age, and learn a skill such as tailoring, carpentry, cooking, metal work and farming.

We are meeting our young friend on Thursday. Debbie and I are excited to meet her and to visit her at school!

DEBBIE - FRIDAY

After meeting our young friend Brenda yesterday we learnt of another child in need of sponsorship named Mercy. Her mother was abducted at the age of 9 on her way home from school by the Lords Resistance Army (LRA) and was held in captivity for approximately 5 years. During this time, she was given as a 'wife' to two Commanders and subsequently gave birth to a daughter - Mercy. After a failed attempt to escape she was badly beaten but thankfully succeeded on her second attempt. Now she and her daughter are rebuilding their lives. Mother managed to finish the schooling she missed out on thanks to the help of a local organisation, and 6 year old Mercy is top of the class and wants to be a lawyer!!!

This term however, Mercy was to be removed from school as no funding was available for her fees. We could not resist helping, and so now have two sponsors that we will enjoy seeing through their school years!

Gulu Celebrates!

KAREN:

HOME COMING

I'm pleased to report that I'm now feeling much better and travelled from the UK back to Gulu a few days ago. I'm now feeling back to my old self, full of energy, and raring to get back to work! Watch out Gulu here I come!!!

GULU GRADUATION

Saturday saw the whole town come alive with celebrations as the students graduated from Gulu University. Unlike formal graduation ceremonies in the UK, there was a true colourful carnival atmosphere with music, singing, traditional dancing, and a marching band. Ugandans certainly know how to enjoy themselves.

For the medical students, it was a particularly momentous day as they are the first medical students to graduate from Gulu University. Five years of training and they are now fully fledged qualified doctors. Graduation is a proud day for any student, but what really stood out is that these students in particular, began their studies when the area was still at war with an uncertain future. To now see Northern Uganda at peace must be such a heartening feeling and further add to their pride. Debbie and I felt very happy to see our ward doctors, who have become our good friends, celebrate their achievements!

The day began bright and early, and surprisingly on time at 8am with the inauguration of the newly built medical faculty building, adorned with banners and decorated with flags and flowers. I must say that the sweeping countryside views from the classrooms would certainly distract me if I was sat in a lecture! We then moved to the university campus where the endless speeches began - something Ugandans do so well no matter what the occasion! And believe me there were many speeches throughout the day! Acknowledgements and thanks take an eternity before the speech even begins!

The university campus was truly alive and vibrant with colour for the outdoor ceremony. It was highly amusing to see the university officials call for solitude and calm from the accompanying family members as they danced around and the women made their traditional guttural calls in chorus at the top of their voices as they rejoiced at the achievements of the students!

To be invited to join the events of the day was a real privilege, especially as we were joined by our Manchester colleagues Marian Surgenor and Mr Ged Byrne, and Marian's husband Tom. We were even mentioned in the University Professors' speech and referred to as his 'additional family members!'

The celebrations continued until way after dark as we joined the West Nile Graduates for an evening of more speeches, music, food, and dancing. A fun day and night were had by all!

It's back to work I go!

I must say that the first few days back at work without Karen have been quite strange! We're always a great support for each other and when things get a bit frustrating or upsetting we cope with it together. So, first day back I was slightly apprehensive about what the day would hold. However, I soon found that there was nothing for me to be concerned about because when I entered the ward I was greeted by numerous staff welcoming me back and asking after Karen (or 'Lamara' her Acholi name meaning loves her work/hard worker!)

Unfortunately, on friday, I sustained a small needlestick injury after inserting an IV cannula (the needle pierced my skin after being in contact with a patient). This is never an easy experience as you go through a range of emotions and worry about what might happen. Straight after the incident I followed the protocol that we are taught back at home and then I informed the Sister-in-Charge who was very apologetic and went to ask the Consultant for advice. The patient then consented to having a HIV test and I went home to get our emergency antiretroviral pack. On my return, feeling quite shaken and worried, the nurses on the ward were extremely supportive. They said that 'God would protect me' and that I shouldn't worry. The HIV result came back negative shortly afterwards which was a huge relief. The Consultant advised me that I should continue to take the antiretroviral drugs just in case the patient was in the window period where HIV cannot be detected. The Intern Doctor relayed how he'd had two incidences where he had needed to take the antiretrovirals and that everything would be ok. The Sister at the HIV clinic was very supportive and helped me to get the full course of medication from their pharmacy.
It just goes to show that, even when you might feel a million miles away from home, there are always friendly faces to offer help and support. I was really impressed with all of the staff at Gulu Regional Referral Hospital in this situation and, without my Acholi sister Karen with me, I was glad that I was surrounded by Gulu friends!

Today I went onto the ward to find two patients who were unconscious, one who could hardly breathe and then not long into the shift another patient started having an asthma attack. Now on days like these it's difficult to know where to begin and, with only one other nurse on the ward for 45 patients, I realised that we were in for a busy day!!
I started work going to look at our unconscious patients who both appeared to be surprisingly quite stable and not requiring anything urgently. I then went to a very unwell looking lady who was gasping for breath! After recording her observations and finding them to be extremely unsatisfactory I put up the fluids that were prescribed and went off to A and E to find the Oxygen Saturations machine (to measure her oxygen levels) and a Doctor as our Medical Intern Doctor has unfortunately gone on leave this week, leaving one Intern working between A and E and the Medical Ward. I luckily found the Sats machine easily but then two barriers stood in my way - one was the A and E Sister who wasn't very keen to lend it to me at first (I promised I'd bring it straight back!) and the other was that there were no batteries in it. So, having signed to say I'd return it, I went off in search of batteries. These purchased from a local kiosk, I went back to my patient and found that her oxygen levels were very low. I trundled back to A and E and presented the case to the Doctor who said that he'd come straight away.
We decided to put the patient on oxygen so we had to borrow the oxygen concentrator from A and E - the Sister said that she'd come and arrest me if I didn't return it!!(I can understand her worries as things go missing very easily around the hospital because it's so under resourced that every piece of equipment is in great demand!I think that it worked in my favour that I had just brought back the Sats machine complete with batteries!) So the Doctor came up and reviewed the lady and decided that she probably has TB...he asked for some further investigations and we are now giving her the maximum treatment that we can from the medical ward: 2 litres of oxygen (a very small amount by UK standards), IV antibiotics and TB treatment if her sample results come back positive. I hope she pulls through...

Another patient today was very quietly lying on her bed under a sheet and when I asked her name it transpired that she was having an asthma attack! She was very wheezy and really struggling for breath. Just as I was going to find a Doctor the Intern walked onto the ward and he reviewed her immediately. I cannulated her and gave her some IV aminophylline and within 15 minutes she was sat up chatting and giggling with her son and daughter. When I went back to see her she gave me a big grin and said Apwoyo Matek! (Thank you very much!)