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Tuesday 8th October 2019

We all started this morning at the University. Things didn’t go quite as planned and adaptability is definitely the name of the game out here.

Judy and Emma were meant to be finding the year 3’s on the wards to teach them suturing but only found one in the end. Then Judy’s luck changed and she stumbled across a pathologist- One of only 5 in Uganda!! A two hour discussion ensued and the beginning of a long term plan was hatched.

They discussed breast cancer diagnosis in the community, training health care workers to provide a breast care pathway……. And the missing piece in her plan had been a Ugandan Pathologist. She is super excited and has written her proposal.

Emma detoured into theatre and found a white board from somewhere and started to refresh the theatre team on swab counts and team working.

Frankie had a long meeting with Doctor Okelo Tom, to finalise the organisation the Primary Trauma Course that we want to run next week. A lot of negotiating but there are 20 people signed up for the first course and he has agreed to release some of the new interns so that they can do the course as well- great news.

I went to the medical wards and joined a ward round on the medical ward. Case mix was surprisingly similar, stroke, heart failure and pneumonia. Great as a geriatrician to see one patient over the age of 80!! Was fab to see the drug charts Frankie introduced last time in regular use – they are now standard practice on the medical wards. Only one nurse on the ward at a time, there ward stock of drugs are a pile on the table, and inpatient have to be transported by relatives to town to get investigations…….they still request a surprising amount of tests.

I spent an hour in outpatients, was a general outpatients which the doc who’d just done the medical ward round went down to do, he saw anything that came through the door and the first 3 notes he was handed were a mix of surgical of surgical and gynae. I detoured into the diabetes/hypertension and gen med clinic, its quick and the patients are written a list of tests they need and sent on their way to organise them in town. That is if they need an x-ray or a ultrasound or blood tests. The nearest CT is 3 hours away and MRI is 5 hours drive away in Kampala, more than half of the patients can’t afford those tests and some of them can’t afford the journey. It really is a totally different set of circumstances.

This afternoon we all went over to the regional referral Hospital after a lunch of the ripest avocados and pineapple you can imagine. Washed down with water infused with limes off the tree in our hotel garden. Delicious!

Frankie and Emma went straight to theatres and to their delight were not allowed in as the Ugandan staff had asked the patient permission who had said no. So good to see consent being asked and respected for this kind of thing.

They looked through the Theatre log books and Emma got some ideas to bring back to the UK – a great example of a health partnership in action.
They got into theatre for the next case: a below the knee amputation of a diabetic with a blood sugar of 30 and a Hb of 4, done under spinal. Optimisation is different out here.

Emma has come home tonight full of ideas about how she can slightly modify the WHO Theatre checklist to make it more likely to be used sustainably here.

Judy went off in hunt of some nursing/ midwife students to do a practical session in suturing, she gathered a few and was directed to the empty labour room to teach them. Word obviously got around as next time she looked up there were 25 of them all packed in a small room, and a lady had been brought in to the labour room and was busy in the process of delivering her baby behind the curtain…………. Freyja bumped into some of the students later and they were so enthusiastic about the teaching they had just received.

I went to the female medical ward and supported the new intern (he started last week as a doctor) on a ward round. Not so much in my comfort zone here as the female medical ward starts at age 7. My cheat sheet of normal paeds obs came in handy, as we started with an 8 year old girl with presumed nephrotic syndrome, facial oedema and clinically an almost total right sided pleural effusion. She was having one set of obs a day. She hadn’t had a chest x-ray as her mum had no way to get her into town.

A thought provoking day for me, everyone is working hard, but there is so much scope for getting the basics done better and improving outcomes.
The daily detour to the market on the way home led to some passion fruit purchasing and the tangerine lady hunted us down……and gave us some samples, which led to tangerines making into our fruit collection too. She also was very keen for multiple posed photos of us……and dragged us to pose in front of a lorry…….(see above).

An incredible dramatic storm blew in very quickly just as Frankie had hung out her washing…….. intensely heavy rain, deafening thunder and lightening that lit up the whole sky, amazing to watch. Five minutes of power cut, surprised it wasn’t more.

Independence day tomorrow so no students and minimal staff at the hospital……..so we will see what tomorrow brings.

Freyja



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