Judy report October 2025.

Judy report for PAL trip to Lira 12-26^th October 2025.

A wonderful and rewarding trip overall with a lovely team.

Lira referral hospital.(LRRH)

What a huge change since my last visit 2 years ago. Notably in the clinical efficiency: certainly for surgery and obs & gynae, there are early morning department meetings with active auditing of patient care from the previous day or two, and troubleshooting challenges. The gynae ward too showed excellent resuscitation of a collapsed patient that was brought in. The clinical leadership is palpable. The OPD department has now been restructured along the new integration plans where patients are triaged into acute and chronic and directed accordingly to the appropriate clinics. It seemed much less chaotic in the waiting areas due to this. This is rolled out into the community to increase more efficient referrals the appropriate days.

There is now piped oxygen to all clinical areas – the only exception is NICU where they use the oxygen concentrator we gave them.

The big difference in infrastructure is the new laboratory. This is an MOH satellite lab funded by the World Bank as part of the preparedness project (UCREPP). LRRH did particularly well with its management of COVID, and the minister of health is local so was selected for good funding. There is a state of the art histology processing equipment and nearly cried. For years the north has had absolutely NO histology let alone a pathologist, so this is a huge game changer for cancers amongst others. No reagents or pathologist yet, but will come soon.

The whole hospital is computerised now.

Teaching in the LRRH

As the infrastructure is changing quite fast we as a charity also need to change with it. We cannot just turn up now and teach on the wards, and I think if we did we would get a quizzical cold shoulder. The process is clear :

• Ward teaching: we need an introduction to the ward in charges (IC) first, preferably with some useful medical items ( small consumables) . We did this through a tour on the first day which worked well, however, staff change so need proper formal introduction and permissions before going on the wards.
• To teach specific groups ( e.g interns, nursing students, specialist medical departments) it is essential to organise it through the senior doctors or relevant nursing hierarchy or it will be cancelled. We are compiling a list of the relevant people. We didn’t have time to go to the green nursing school to talk to the senior staff there, but this will need to happen. It is also important to know their curriculum dates. They were all being induced during our fortnight so we couldnt get a crowd of them to teach.
• Teaching in the OPD clinic. The key person here is Sr Doryn. There is a boardroom in the OPD we can use for teaching which she can book for us. There are lots of students in the clinics – probably too many so pulling out some, or having specific topics would work well. Weds is abnormal antenatal OPD, Thursday is general surgery OPD. ENT and sexual health clinics run daily. The chronic medical diseases (Diabetes, hypertension, respiratory and HIV ) are run in the adjacent block on an appointment system. Paeds is in another adjacent block with no overlap with the adults. It is rewarding to join the clinics and get involved with ad hoc teacahing if agreed.
• Parliament is on a weds am in the big boardroom. Very useful to get a shout in this early on to alert all staff we are around.
• Planning. It would be useful to have preplanned dates . To then inform Dr Peter Okello the hospital administrator who will then pass this on. We can then liaise with individuals about teaching plans and they can let us know what they want.
• Suggest that we need a suitable person such as David to act as a liaison to help set this up.

Medical items .

Bringing items into Uganda at Entebbe . The new(ish) drugs authority do not allow much . needs to be in date and labelled as not for human use. The process is this

• Have a list of items and send to Dr Peter Okello
• Lira hospital will then send this on to the drugs authority asking for their permission to bring these in. The letter will then go back to LRRH and they will pass it on to us for customs.
• All major items need to go through the procurement officer at LRRH so that the item is accountable and then less likely to disappear. Consumables for the wards just need to be handed over to the senior IC.

Predictable issues ….. departmental meetings can stretch out for ever so if a room is booked for teaching we might need to wait….. for hours! Some IC can be non receptive and need warming up. IT might not work well.

Lira university

• Past students. I have met 7 previous students we have taught out in the community now. They remember us very well. They are all high calibre and doing really well making a huge difference. A particular shout for Sr Jennifer who has taken on a failing level 3 clinic and completely transformed it onto a thriving clinic with plummeting maternal death rates and high up take for earlier antenatal care.
• General teaching. I found a lot of our teaching is being done by the school and university. In order to really add value we need to focus carefully on the type of teaching we offer to avoid duplication. I think we are best at the scenarios and workshops. I think the days of teaching subjects outside our own expertise have gone.
• Timetabling . This is a huge problem and will always be a problem until we are given our own slots in advance when they plan the trimester a couple of months before it starts. The tutors a who have initially been given the slots are not informed we are teaching and they also have their own plans – e.g one tutor had used our slot allocated by Felista for a mid term test. I don’t know if allocating us teaching time will impact their salaries for teaching as this may well be the reason this happens. Communicating with the class leaders directly is really helpful. We were able to organise extra times for teaching through this. The masters students are particularly enthusiastic for teaching.
• The medical students are also very keen for teaching. A session was arranged for me on chest and abdominal trauma which I would have loved to give .. but no-one informed me!
• There is a big call for practical procedures such as chest drains, 3^rd degree tears, obsterics emergencies , paracentesis, clinical assessment of sick patients, contraception( IUCD insertion). Screening , communication and bereavement are really good areas for covering.

Community. We had a great day in Dokolo health centre IV with an awesome team wading through 250 women ( and a few men) for breast screening . The message is getting through to the community and patients are now coming earlier with their lumps. See individua report.

Looking forward to the role of PAL. I think we need to :

• Focus on teaching practical procedures to fill gaps rather than duplicate already excellent academic teaching provided.
• Continue our presence in both hospitals as it is definitely hugely appreciated
• Focus on specialist exchanges (am linking up with Wessex global health on this and HEE) with LRRH initially .
• Encourage externally funded parallel projects running in parallel such as the SICRA antimicrobial and the Breast clinic which are both recognised and appreciated and strengthen the PAL linkage.
• Have dates for the next visit already planned by the current team to facilitate efficiency of teaching and have up to date lists of the medical staff to liaise with, and 1 or2 key people to liaise with .
• I think we could think about a more tailored PAL top, but if funds are low it isn’t a priority. Also good badges.

My only negative comment is that the Kanberra hotel has cut down its mango tree and replaced it with a soulless office block/eating room! And it’s been painted the colour of a cranberry.