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Home | Reports and News | Update from Volunteer Dr Jim McWhirter report number 3
My second visit to Uganda, July / August 2009 – third report
Only 10 days to go – I can hardly believe it! This is a busy time – I visited Kyambogo Rotary Club in Kampala last night. This is the Club through whom my visits are organized and they have been associated with the hospital since 1995. Jill came with me and we also took Josephine and Phil Malone who will be coming to the hospital this weekend to make a film about the work here. We were given a very warm welcome and I updated the Club on projects in progress at the hospital. Three members of the club visited the hospital a week ago and we had an excellent discussion about various projects that they may get involved with. Most helpfully they have a member who is an electrical engineer and will produce a plan for helping to mitigate the effects of the power cuts which constantly beset us. I know that some members of my own Club are keen to get involved with this and the Germans I mentioned in my last e-mail may be able to help with some funding.
Talking of visitors, this weekend we had two American radiologists who have selected Kamuli district as the first pilot site in the world for a project to bring cutting edge ultrasound diagnostics to village level. Images will be collected by non medical people according to standardised protocols and transmitted via the Internet for interpretation by volunteer expert radiologists who will send text messages back advising if hospital referral is necessary. There are lots of problems and challenges (technical, financial, cultural, etc.) but initial trials suggest it is possible, hence a pilot in the field. When they started talking about increasing the medical resources of the hospital to cope with the anticipated increase in work generated by diagnosis at village level, it began to be interesting. We shall see!
Back in the real world, the cycle of birth and death continues. One mother had died of acute renal failure following hysterectomy for ruptured uterus and another died of a cerebral infection which we were unable to diagnose in spite of doing a lumbar puncture. It is bad enough to lose a mother but very upsetting and frustrating not to know why.
The old chestnut of diagnosing a psychiatric cause for what is really a physical illness came up when a young girl with bizarre repetitive head and mouth movements came in at 20 weeks of pregnancy. She had been expelled from school as a result of pregnancy. It turned out she had acute microfilariasis and responded better to treatment for the infection than she had to sedatives!
One evening I was called to the paediatric ward as no one else was about. A one year old had deteriorated during the day. I diagnosed intestinal obstruction but sadly he died while I was examining him before surgery could be arranged.
The labour ward has been unusually quiet for a few days, so we took the opportunity of visiting the adjacent primary school. I thought hospital facilities were limited but the school was relatively much worse off:
· 548 boys in primary years 1 to 7 starting from age six
· 13 teaching staff including the headmaster plus one cook and one night-watchman
· Old buildings in a very poor state of repair
They listed their major problems as:
· Many children unable to afford the fees each term (£2 for tuition, £6 for school meals, £2.50 for uniform, £1.50 for extras. They also have to purchase all writing materials, pens etc.)
· No electricity in the school apart from in the senior class room.
· Security – for example their duplicating machine has been stolen and they have to use one at the sister school for girls nearby.
We have been joined by the regular visiting UK fistula team. Glyn Constantine has just started work and Brian Hancock comes in a couple of days, so we are awash with surgical expertise for 10 days or so! They do a wonderful job for women who have been injured in childbirth leading to constant leaking of urine. Without this surgery they would face divorce, becomes socially ostracised and might even be driven to suicide. Thus, their lives are totally transformed.
Glyn has kindly brought some stoma bags requested by Jill for a 10 year old boy with an abdominal wound following a road traffic accident. Now, at last, he is spared the horror of a constant flow of faeces from his abdomen which previously could only be dealt with by cotton wool and gauze padding. Sadly his general condition continues to deteriorate as we have no means of providing him with intravenous feeding. His capacity to absorb food by mouth is very limited. Jill continues to work and teach wound care with the very limited resources available on the surgical ward. She is also giving some formal lectures to general staff and at the nursing school. She has just purchased 80 yards of cloth with which to make some curtains to brighten up the surgical ward and also improve the patients' privacy.
The two Rotary Clubs of Henley have together raised £3160 for a water project which will provide a reliable supply of water for the operating theatre. It will also boost the water supply to the hospital as a whole by supplementing the borehole water with water harvested from rainfall during wet season. Work began on this project today and I hope to see it well on the way to completion before I leave.
Jim McWhirter, 6 August 2009