I’d like to thank you all for taking the time to share in my experiences. I hope you’ve enjoyed it – I’ve truly appreciated your company along the way. At the very least it’s encouraged my grandparents to learn how to use a computer.

As you leave, please take a few moments to ‘sign the guestbook’ by clicking the link at the top and adding a comment.

The blog will still be here for the next few months, so there’s plenty of time to catch up if you missed anything. (If you’re interested in hearing more, I’ll be speaking at the 6.30pm service at St Paul’s church in Bournemouth this Sunday 25th October).

A few facts about the blog…

• Average visitors per day: 30
• Maximum number of visitors in a day: 71 (16/9/09)
• Most popular browser: Internet Explorer
• Proportion of people using Windows: 85%
• Ratio of Mac users to Windows users: 1:7
• Number of visitors (of the last 500) using an iPhone: 9

David Lodge has left the building.

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The flight back to the UK was half-full (or half-empty), and fairly unremarkable; I made best use of the free drinks and film selection (tip: don’t watch My Sister’s Keeper, read the book instead – much better). My parents met me at Heathrow, and we travelled back home in our own car along the tarmacked motorway.

I’ve spent today allowing myself to ‘reaclimatise’ to life in the UK. The sky is grey, it’s wet, autumnal, and very cold. The sun goes down slowly, and the nights are drawing in. There are pavements and tarmacked roads, everyone drives, everyone’s miserable. People smoke. Washing machines, pushchairs, TVs, planes. No mountains. Things have changed very little in the past 6 weeks.

But I feel that I’ve changed a fair amount. The things I have experienced as a medical student seem secondary to the experiences I’ve had as a person. Mainly, I’ve realised just how much we take for granted – clean running water, supermarkets, education, healthcare. Despite a silent frustration that life could be better, the Ugandans are so content with what they have and seldom complain. Life is very simple and often difficult, but they are grateful.

I never thought I’d enjoy travelling, let alone to Uganda, but I thoroughly enjoyed it and would recommend it to anyone. I sincerely hope to return to Kisiizi again one day – maybe when I’m a doctor, and can be more helpful.

Any regrets? Never! But next time I might take a rucksack.

Anyway, my apologies for not keeping you all updated. Let me fill you in on my last few days at Kisiizi:

Friday

On Friday it was my turn to stand in chapel and bid my farewells to the staff of the hospital – only then did it dawn on me that I was leaving. One of the doctors then publicly thanked me for spending my elective at Kisiizi, for making an effort to get involved, and for the contribution I had made to the hospital. I was surprised but pleased to think that the time I spent at Kisiizi had been more than just an educational opportunity for myself – that I had been able to give something back in return.

I spent the rest of the day saying my personal goodbyes to the hospital staff, and taking a few last photos.

Saturday

I was the only one left in the guesthouse at the weekend (everyone else went sight-seeing), so I took another walk up a mountain, and packed. The afternoon was my last opportunity to play with the kids on the children’s ward. They were sad to find out I was leaving, but they gave me a round of applause, and I told them (and the nurses) to make sure they had enough to play with. Hopefully I’ve made a difference to these kids’ time in hospital. Instructions for the best use of James will have to follow when I get home.

Sunday

Today was a long day of travelling – 8 hours on a bus (for £7), 1 hour in a minibus taxi (for £1), and the stress of Kampala. Fortunately two Kisiizi nurses were travelling in the same direction, and made sure I ended up in the right place. Highlights: crossing the equator, wheel spin (and going backwards) as the bus tried to climb a muddy hill, undertaking a convoy of tanks, and what looked like the entire Ugandan police force escorting international diplomats to a conference.

And so you find me exhausted in a motel near the airport on a Sunday evening, eating chocolate and watching an awful Ugandan film which fails to include actors, a script, editing, or a tripod for the camera. I’m missing Kisiizi already, but can’t wait to get home!

p.s. today’s picture is of Stella, the lady who runs the guesthouse, sings ‘good morning’ no matter what the time of day, and makes an awesome pineapple crumble. I thought it was about time she got a mention.

Sister Esther’s cat, Mango, hasn’t eaten for a week, we suspected due to a bone lodged in the back of his throat. One shot of ketamine later and we found no bone, so we passed a baby nasogastric feeding tube instead and fed him some milk. (I’m fairly sure Sister Ann borrowed the surgical equipment from theatre).

Also today, Gilbert had his first go on crutches and was really starting to get the hang of it!

Today I found myself in the hospital laundry again, and surprisingly found it to be a hive of activity.

Inside there were three tailors working away hard on their old-school Singer sewing machines. They make all the clothes for the hospital staff (nurses, security guards etc), student nurses and primary school kids. The quality of the clothes is phenomenal. (The nurses’ uniforms are white – one nurse told me it takes her over an hour to get it clean!).

I was also in time to see the washing getting done. (Interesting fact: the laundry from Bournemouth hospital travels to Leeds to be cleaned (a 500-mile round trip), because it’s more cost-effective than washing it on-site). There are no washing machines at Kisiizi: all the washing – sheets, theatre gowns, blankets – is done by hand by people dressed a little like abertoire-workers. The blood-stained theatre sheets get a good scrubbing with a stiff broom before joining the other laundry drying outside on the washing line, being smoked gently by the fires from the kitchens next door.

Gilbert was looking much happier today, and sporting a new knitted hat (I’m pleased to say, in the colours of Brighton and Sussex Medical School). The school system here seems to work a bit like the USA, in that you have to pass a year before you can progress to the next. Also, some kids don’t start school until they’re a little older, so there’s a range of ages in each yeargroup. Gilbert is 7-years-old and in the first year at Primary School, and took great delight in showing me how he can write the numbers from 1-20. I thought his smile was worth a post of its own.

In other news, my sunburnt nose is peeling nicely.

I met Gilbert in the treatment room this morning – amazingly he was smiling and looking very relaxed as his wound was cleaned, and even managed a few high-fives! A complete change from the distressed, shocked child I saw a few days ago. I’d like to think his time yesterday with James the teddy may have cured his fear of medical intervention (or at least helped a bit), though more likely it was mostly due to the healing wound no longer requiring a bandage. This evening Gilbert was looking a little more upset: he had been looking forward to going home, but needs to stay in until his wound stops oozing pus. Nice.

James also attended the ward round on paeds today, and was generally well-received (though he did manage to frighten one child).

The Chester team arrived late to dinner and triumphantly revealed an x-ray of a padlock, a key and some gauze – they’ve been playing with their new x-ray processor, which is now installed to develop x-rays automatically (and rather well, too). It does mean the radiographers here will need to learn to ‘standardise’ their x-ray exposures, as they will be unable to alter the developing time to compensate for errors. Hopefully the Ugandans will be willing to embrace this new way of doing things… though I think it’ll take some convincing!

Sadly I arrived on the Special Care Baby Unit this morning to find an empty incubator: the baby with apnoea attacks died overnight.

Today was also the first time I’ve ever had to resuscitate a neonate. The baby girl was born four days ago with suspected birth asphyxia (lack of oxygen to the brain around the time of birth). Unfortunately this means she sometimes ‘forgets’ to breathe, and needs some encouragement with a resuscitation bag and mask. In the UK she’d be on a ventilator until she could breathe properly for herself, but there isn’t one in the hospital. She was still managing to remember to breathe this evening, so the 20% survival odds still stand.

This evening, the new ultrasound scanner from the Countess of Chester Hospital arrived in its new home. How to unload it off the back of a pickup truck? Why, simply recruit ten men to lift it! It was a good opportunity to take a look inside the ‘new’ imaging block, which now sports a newer x-ray machine, waiting room, dark room ‘processor’ unit, ultrasound room, tiled floor and toilet. Amazingly most of the work has been completed in the past week (the ultrasound extension was only a half-built wall when I arrived – see the scaffolding picture from September). X-rays haven’t been available for the past week while they’ve made the changes, so the Chester team are keen to get things up and running. Apparently the x-ray dosage here can be up to 200x what you’d expect in the UK, so some of us are having second thoughts about volunteering as subjects when they try out the new equipment.

Uganda is such a beautiful country – the camera really doesn’t do it justice. The best way to experience the landscape is to get some fresh air and trek up a mountain.

Yesterday morning I got up early and conquered Muhenvu, the mountain I attempted last weekend. The view from the top was amazing – it was easily the highest mountain around, and you could see for miles (almost into Rwanda). From the top it was easy to see how agricultural the country is, with fields and plantations stretching up mountains and into the distance.

Once again I found myself getting lost among the bananas coming down the mountain, and once again the locals showed me the way – they are all so keen to help, despite the language barrier. On my way back I met a very friendly man called Mr Andrew (he insisted on holding my hand whilst talking to me for a good five minutes), who seemed to be the village ‘elder’ and whose dream is to fly to America – sadly, I don’t think his dream will ever be fulfilled.

Unfortunately the breeze was a little deceptive, and I managed to get myself rather sunburnt in the process. Hopefully the red will turn brown, and it might actually look like I’ve spent the past 5 weeks in Africa.

It rained (power-shower style) yesterday afternoon, so I went onto the children’s ward again and played catch with the older kids. I was just about to leave when I spotted a child being lead to the treatment room for another cannula to be put in. I followed him in, and managed to keep him distracted enough (with some very poor improv juggling) that he didn’t really notice the needle going in. I took him back to his bed, and carried on playing catch to cheer him up. It was by far the most worthwhile thing I’ve done all weekend. (The matriarchal nurse even thanked me!).

Today after chapel the mzungus trekked up nearby Rubiriizi mountain for another 360-degree view, a following of small children (‘how are you?’), and to inevitably get lost in the bananas coming down. A highlight was seeing pineapples growing in a field – I’d always assumed they grew on trees, but it turns out they come from a bush! You learn something new every day.

Today was Independence Day in Uganda (celebrating independence from British rule in 1962), and a public holiday. The hospital was noticeably quieter, but still functioning.

As part of the holiday, this afternoon the Kisiizi sports teams played some visiting teams (possibly from a school to the West?!). It started off with volleyball (which we lost), then netball (which we also lost), and finishing with football (which we won, and which actually matters here). There was a great atmosphere, with about 500 people watching the football, and a choir of children enthusiastically chanting support for Kisiizi. Every time we scored there was a pitch invasion!

I also spent time this afternoon opening banana boxes – these are the boxes of donations sent over from England in a container, taking up to 5 months to reach here. The contents of each has to be sorted: clothes for babies, children, men and women, blankets, and other items such as pencils, books for the school, bible reading notes and toys. I was amazed to find several boxes sent by members of my church in Brighton!

On another note, James the teddy bear is finished! You can see pictures of him by clicking the link at the top of the page. Hopefully next week I’ll get a chance to use him on the children’s ward. Just as important is for the kids to play – throwing a ball to them each evening before dinner is enough to make them happy. (There’s a two-year-old with a throw better than most girls I know…).

Also today, a lady didn’t quite make it to the maternity ward in time, and gave birth on the steps outside the outpatient department.

Some people go into medicine knowing exactly which type of doctor they want to be when they come out the other side. Some change their mind as they go through. I’ve arrived at the fourth year still not really knowing what I want to do, but seem to be heading towards paediatrics: today I watched four births, and found I was far more attracted to the cute new life than its distressed mother (perhaps understandably so?).

There were 2 c-sections – during the first I had the responsibility of ‘receiving the baby’ (catch it, try not to drop it, wipe it, make sure it cries lots), a role reserved in the UK for the paediatrician. The other two births were firsts for the mothers, so things tend to take a bit longer (I did see a woman on her 12th birth the other day – family planning obviously still a foreign concept). One baby needed ‘suction’ to help it on its journey, involving a machine resembling a sink plunger attached to a bottle of apple juice and a bicycle pump – but it seemed to work, and the mother was rather relieved having been in labour for the past five days.

Sarah owes me a soda for correctly predicting the sex of all three babies.

Also today:

• I went for a run/altitude training down the road first thing this morning, joined periodically by children on their way to school (at 7am)
• I saw a woman on the isolation ward round catheterised for urinary retention – they drained 3 litres of urine (I thought the bladder capacity was only 1 litre…)
• Four new people arrived from Chester – 2 sonographers, 2 radiographers. They’re here for 2 weeks to train staff in how to use the new ultrasound machine, and to improve the x-ray side of things (and one of them’s been reading the blog!)