Report on visit to Lira May 2023 written by P McEwan

Report on visit to Lira May 2023 written by P McEwan, Consultant neonatologist

Team composed of 2 breast surgeons, dietician, physio, scrub nurse, elderly medicine ANP and me

Main points to take forward on other trips

Get to Lira early and start work late if at all possible (we had twenty four hours of just seeing where the hospital and university buildings were – very helpful – given that the overnight before arrival Entebe is not good for sleeping and the drive North is arduous)

Bring Penicillin style oral medication for the penicillin allergic traveller (insect bites that get infected etc.) Suggest Clarithromycin – in place of flucloxacillin – which we had – but please seek microbiology advice on this.

I brought UK Mastercard – seems to work out fine and no need for exchanging very much currency into Shilling – which seems to take a lot of time (cash point is quick). Not sure what the exchange rate from a cashpoint is – but the stuff is so cheap – it hardly matters.

WiFi now excellent in Kanberra Hotel and University, (not sure about Lira Referral Hospital) – seems to negate the need for many team members to acquire local Uganda SIM cards -we had only one – and the others managed to communicate fine using Whatsapp, And the process of getting and registering a local SIM still seems to take ages.

Only disadvantage of Hotel is the cock crowing every morning from (I think) about five. Brought earplugs but didn’t wear because not sure if alarm would then be able to wake me up. Hotel clean, friendly, efficient – and food great – suited the non-meat-eaters fine – in that there’s always something to eat – but is usually a bean mixture in addition to the starch.

Overall teaching experience

Class atmosphere was a bit wild on the first day Laura (dietician) and I gave a talk on malnutrition preceded by a “warm-up” type class where the class members tried to put Ugandan foods into “Food groups”… Got a bit out of hand – in fact at one point – Laura had to put her hand up n order to say something. I think I had forgotten that some of the class members can seem quite young – and there’s clearly quite wide variation in this.

I had forgotten (having come a few times before) that our general experience is that class members – this is still at Lira University) – seem to have a very “knowledge-based” rather than “skills-based” education up to this point.

Two examples which came up: on being given a question on which diseases in baby result from too little folate intake in mum – the class knew not only the heading (“neural tube defects”) but also three actual pathologies – one of which I wasn’t sure of – and they were right. But nobody in the class group (third years) had heard of or seen a growth chart. Also – teaching adult BLS – one student – in a group where very few of them appeared to have ever tried to resuscitate a manikin – wanted to know how one would act differently – in the resus scenario – if the person seemed to be the victim of organophosphorus poisoning. I still don’t know if that’s a question about personal risk to the rescuer – or a general question about whether they attempted suicide in the first place.

It seems to be worth breaking up any session where the natural course is to give two lectures – by doing a lecture then something practical or a quiz. Not just Brit fall asleep in this heat!

Lira referral hospital experience

Lots of people around during the day in neonatal unit. Far more so than previous years. Medical Officers (mainly Somalis) medical students (I think all are from Kampala International University – could be wrong) and ward rounds are led by doctors (previously this was always Caroline -sister). Caroline seems to mainly take care of outpatients – ex NICU babies – usually three or four being seen and weighed at any given time – not sure how much else goes on for outpatients.

Book of inpatients – still very diligently completed – with mum name, baby weight, diagnosis etc, has listed babies admitted in the last few months that I read. Death rate looks possibly slightly lower than before, but obviously referral pattern may have differed- given that some babies are brought from further afield – not just labour ward.

Oxygen/respiratory support situation: this is unchanged. CPAP (“bubble CPAP”) machine brought by Poole Africa Link not seen – said by Caroline to be broken. Looked at two babies (both preterm – gestation not known) who had been born in previous 24h – both connected to same O2 concentrator – running at 4lpm for the two of them – so roughly 2lpm each of 100%O2. Disconnected O2 and used (PAL) oxygen sats probe on both. Neither dipped sats below 90% – so fine if actually preterm (90-95% is recommended), but one did develop resp distress, meaning that the FLOW was beneficial – just n9t the oxygen.

Next door big room to that has very many and sophisticated gadgets – all gathering dust. (High flow circuit, Hewlett Packard monitor, something else – probably a ventilator – that I didn’t recognise) said to have been given to hospital in time of COVID. Seems crazy in light of the above that these are unused. Will correspond with Daniel (biomedical physics) at this address when think of a plan of campaign. Somali medics may know less about this than Caroline – who has resisted change in the past. obiadaniel@gmail.com, +256 782 4572064. He now has computer, gifted by charity.

Lira University Paeds ward

Very friendly Dr Muzungu was there every day seeing outpatients. Didn’t join him for any of his ward rounds (roughly between three and seven inpatients there every day) – one said to have been suffering from liver and renal failure – the only long-stay patient – other acute infections mostly. He said he was in contact with a consultant paediatrician if complicated things came up – his background prior to this had been as general medical MO I think – Kampala trainee, seems to have rooms beside the hospital – not sure if he is theoretically on call all the time. He clearly has access to blood tests – but was interested to find that he thinks of Lira Referral Hospital as “onward referral” from him. (a patient was sent there because University Xray machine broken while I was there, and supposed pathway of referral is to LRH if patient needs physio). He does have access to blood tests though – electrolytes, renal function and LFT – not sure re microbiology – not sure of ability to do bloods at LRH – but seems there are patients receiving dialysis there – and I saw blood being taken from one of their patients.

Organisational challenges

Hurriedly organised due to last minute changes in personnel but organisation at least as good – if not better – than other trips I’ve been on. I had COVID in the five days prior to trip, and four of us have now had gastro symptoms plus or minus fever. Package of lectures offered by the group known about by Uni tutors in advance – seldom stuck to, but we did manage to meet students (some two hours after the appointed time) – on all the occasions we were meant to meet them