April 2026 Report by Chloe Balderstone

It is difficult to find the superlatives to describe this visit to Lira: rewarding, welcoming, fascinating, emotional, inspiring, brilliant… 

This was my second visit with PAL and I was met with so many friendly faces, new and old – my favourite of course being our guide Arnold. 

Firstly, the transport and journey was smooth, and we got off to an excellent start. Our welcome at both the university and referral hospital gave us a great basis to schedule the activities for our visit, and we settled into Kanberra hotel with the famous Ugandan hospitality.  

Gary led the Emergency Department (ED) and Paediatrics team with a seamlessness I found inspiring, gelling us as though we had all worked together for years. Our joint educational focus was primarily treatment and management of deterioration in both adult and paediatric patients and I felt we achieved this via lectures, workshops, courses, skills sessions, bedside interventions and teaching. 

Highlights for me included the rollout of our ED Patient Pathway project, and the new trauma workshop. Previous teams from Poole and Bournemouth EDs have introduced process boards and numbered bays on their visits, however due to some practical and staffing challenges, we discovered on arrival that neither were being utilised. Gary and I spent the first week engaging members of the LRRH ED in conversation about the obstacles of the historic projects and worked together, particularly with Sister Christine and Dr Nicholas to “reactivate” (in Christine’s words) this pathway. We spent time suggesting ideas, taking feedback, OKing the new plan, before formally launching it at the medical CME to the resident doctors and qualified nursing teams. We got positive feedback and thought-provoking questions from our audience, and afterwards went to launch it on the ground with the wider nursing teams and students. What we had envisioned being small groups around my laptop 2 at a time ended up with me holding court to the entire ED, including patients and relatives, to present this new idea. The motivation and commitment from all of the teams was remarkable and made all the hard work worth it, and I felt we were able to “stand on the shoulders of giants” from previous PAL teams who had come to the ED before and started this service improvement project. Saying goodbye to the team in ED was bittersweet, though we have promised to continue liaison and support to keep this project rolling to streamline the department. Seeing the team enthusiastically using the system without our physical presence by the end of the trip was so professionally and personally rewarding. Of course there were elements of working in the ED which were challenging, with patients sicker and presenting far later than I have experienced in the UK. It gave me huge respect, adoration, and at times sympathy to the colleagues in Lira, and also a renewed gratitude for the service we provide back home. 

Our trauma workshop was formulated after previously delivering a 2-day, more lecture-based course, but on this visit only being allotted a half-day slot to cover all major trauma. Unfortunately road safety is lax in Northern Uganda, and as such the LRRH ED see vast numbers of traumatic pathology, with limited resources to diagnose and manage them. Responding to previous feedback from candidates and students, we knew hands-on practical was the preferred medium for learning, so we spent some time in the days leading up to it conceptualising and designing this new format. Safe to say it was a hit; myself, Julia, Gary, and our new colleague from the ED and pre-hospital team James Peter delivered short talks before using breakout rooms to allow every candidate to try out C-spine immobilisation, airway management, and pelvic binders. The feedback was overwhelmingly positive, and having James Peter’s knowledge and skillset gave us an authenticity to the Ugandan perspective which we really appreciated.

As previously mentioned, our team worked together beautifully, and due to a shared agenda and skillset, we were able to mix and match, and I taught alongside every member of our team, and was able to attend some sessions as an audience member. I found this a huge improvement from my previous trip as I learnt so much from my colleagues! I was even able to assist in sessions teaching Helping Babies Breathe to resuscitate newborns, something I had not planned for but really valued.

We prioritised teamwork and support on this visit, as aside from Alice we had all visited before and knew this was vital for the endurance of the members. We intentionally scheduled in prep and planning sessions during the daytime, meaning we were never planning late in the night, and delivered high-quality sessions with well-organised resources. We also made sure to debrief every evening as a group, discussing our highs, lows, and learnings from each day, which highlighted the excellence of the team but also who may need some extra support, time, or reassurance after adverse events.

I will finish by mentioning the celebration party for Antoinette at Vintage Lounge on the last night; we were joined by faculty from the University and LRRH, and shared food, speeches, memories and dancing to raise a glass to Antoinette and all the work she has contributed in her time with PAL. I learnt over the fortnight how humble this wonderful clinician and woman was, with heaps of international experience, teaching, supervising, mentoring, chairing the charity, directing her department, raising a family, then recently retiring and becoming a grandmother. Dr Antoinette McAulay is an absolute inspiration to us all, and I am so fortunate to have learnt from one of the greats!