Wednesday, 23 September 2009

Zen and the art of motorcycle maintenance... or bodaism and how it misaligned my chakras

Oh yes, there is a revolving restaurant in Kampala! So last Thursday Elizabeth, Pete and I decided that for kicks and giggles it was a must visit... Apparently it's only one of three revolving restaurants in Africa. Personally I don't understand why every town doesn't have one. Got some excellent views over the (pitch black) golf course. Actually we got some good views of the 7 hills of Kampala, and the food wasn't bad at all. 10 out of 10 for novelty value I say!

So what else have I been up to this week... Well all seems to have calmed down on the political front for now, although I'm not sure how long that will last for, and will be keeping my ear to the ground - my nose is fairly useless for this kind of thing, being anosmic and all.

I spent some time in theatre last week learning a little bit about how things get done here, how to book cases and so on. I spent the day wearing two right footed surgical wellies, one size 9 and one size 11. It was a special look and one I shall spend the rest of the year trying to perfect. If anyone wants to send me a pair of wellies the next time people come to Kampala, I'd appreciate it, size 5, the louder the better!

Saturday was spent visiting the black and white colobus monkeys in Entebbe Botanical gardens and generally kicking back away from Kampala. Sunday was spent visiting Owino market where you can buy ANYTHING you need. You can get adapter plugs from egg shops, mops from shoe shops and oven gloves from the shoe shine man. Immense. We then had a house barbecue which was really nice, met some mangey puppies and generally had a fun and frivolous time. Monday was spent going up and down Kampala Road trying to sort out my visa...

I went to collect my passport to check it wasn't missing, was told that yes, I could have a special pass and to speak to the cashier. You would think that a cashier is someone who takes cash from you, but oh no... the cashier tells you how much it is, gives you an invoice and sends you to the bank... three miles away. At the bank, you queue - and if you're me discover that you spent 20 minutes waiting in the wrong place - and eventually pay the fee. You need a receipt, which you can't pick up FOR AT LEAST TWO HOURS. So I smiled and nodded, ran a few more errands - booked gorilla tracking permits YAY! - and went back around 4, waited for another half an hour in a queue got my receipt and decided that I couldn't bear to go back again.

Tuesday was spent back at the passport office, where I was told that I have to go back again to pick it up today. I'll go when I have sorted the rest of my paperwork and there is not a document that they could possibly ask me for that I don't have - ahem.

Today, we presented our Malaria in pregnancy guideline. I've made flowcharts for the others we've produced and I need to get them printed as A2 posters. This is prohibitively expensive in Kampala. If anyone at home knows of somewhere they can be printed relatively cheaply, I'd appreciate it if you could get in touch. We're going to need at least 5 of each poster and potentially we could be looking at 100 posters in total once all of the guidelines are written. I can arrange for them to be brought out to Kampala from the UK by hand so that's not an issue.

I'm restarting the midwife teaching sessions tomorrow, and I'm surprisingly nervous about how it will go down. One of the midwives has asked specifically for a problem based learning approach! I knew PBL would take over the world eventually!

Had my first Luganda lesson last night, and it will come as no shock to most people that I'm crap at Luganda....

Wasuze Ottya Nnyabo... How are you madam?
Sula Bulunge... Goodnight
Embwa si nungi... the dog is not fine (no it's not it's still being a menace)

And what else has happened? Ah yes, it's been a week of Boda Boda dramas... Almost fell off a boda on Monday going to meet a friend who I used to play rugby at med school with, then yesterday, we followed some kind of presidential convoy on the boda which meant we got through the jam without any dramas, but then the boda guy drove straight into the side of a cyclist, who retaliated to being driven into by poking the boda guy in the arm. The boda guy tried to justify what had happened, even though before the impact I was screaming Ssebo at him like a woman possessed to warn him, denying blame, and then just drove away! Today, I saw a guy leaving the hospital with a coffin balanced sideways on the back of his motorbike. Wonders never cease.

Anyway, back to the grind... got a section proforma to produce and another guideline to write and I want to get them finished this afternoon... Stay in touch people, missing you guys and all the gossip!

Tuesday, 15 September 2009


Had a really interesting few days at work. I'm spending the week in the materno-fetal department, which covers all the high risk obstetrics. What is most interesting is that the majority of the stuff on the wards is the same as at home. The difference is that geography, and to a lesser extent social status, determine which women are admitted. Women often travel huge distances to get here or in some instances getting back to the hospital can be impossible due to money etc. The wards were relatively quiet, probably due to the riots more than anything else, so there were a significant number of women in the latent phase, false labour or women who had had previous sections awaiting elective caesarean. Other cases included HIV with extensive genital warts (by far the worst I've ever seen), malaria in pregnancy and a severe exacerbation of asthma.

I slept really badly on account of my sunburn (I know, I know) and then couldn't get a minibus so had to catch a boda-boda to work, which I despise because the guys are crazy and I hate motorbikes at the best of times. Too much excitement before work is more than the average girl needs, and boda-boda hair is not a good look!

Today I spent the morning in antenatal clinic. There is no true appointment system. Women turn up first thing in the morning and wiat their turn. The system actually runs fairly efficiently. They attend, their files are pulled, they have HIV screening if it has not already been done, they are then seen by a midwife or a doctor depending on whether they are high or low risk. Bloods and scans are arranged where appropriate. I saw a good case mix of twins, HIV in pregnancy, follow-up of women who have had malaria, cervical carcinoma and cervical incompetence. It's certainly a more interesting case mix than at home! The challenge of the language barrier is massive. Already I'm adapting my English to the African syntax, even down to how I ask people what time it is ('how do you make it?'). I am also trying to adapt my practice to the population. In Mulago women are admitted for things that aren't an issue at home, simply because of the difficulties with accessing healthcare, concerns for example about obstructed labour, that would potentially result in a disastrous outcome. I know that my mindset is beginning to change, but also that now my face is becoming familiar to the doctors and midwives here we can discuss things more easily. When I am asked about how we do things at home, this is sometimes a good springboard to talk about differences in management, and explore the evidence base. I am already questioning my own practice more than ever, I realise that some things are just taken for granted in Western obstetrics and that we don't always question the minutiae of what we do.

This afternoon I had a successful meeting with Interpol, got my letter of good conduct, so I'm ready for round 3 of the Immigration Title Match. I've also made enquiries about gorilla tracking in January when my Mam is coming over to visit! I'm SO excited! Tonight, I'll be working on a guideline, having a glass of wine and getting some sleep.

Sunday, 13 September 2009

All quiet on the Eastern [African] Front

Things in Kampala appear to have calmed down a fair bit. There was a small amount of trouble reported yesterday in some of the suburbs, but not to the level of Thursday and Friday. We barricaded ourselves in the house and played Scrabble and watched Men in Black, because we're so grown up. We had a brief interlude when cabin fever very much got the better of us and we had to go outside into the real world... to the shopping mall... where we bought junk food. We had a small altercation with a local vendor in the godown when we tried to buy 6 chapattis... although I suspect it was because of the 'fat b@stard' element to two of us asking for that many!

Today I went to Entebbe for a day trip with Kate, Jamie and a guy called Tom where we lazed around a swimming pool for the afternoon, ate Tilapia and got sunburnt. Was nice to get out of the city after the last few days.

Back to work and hopefully normal. Will post again later in the week and let you know what transpires...

Friday, 11 September 2009

Watching the people get lairy...

It's not very pretty, I tell thee, walking through town is quite scary, and not very sensible either....

The Kaiser Chiefs could well have been writing about Kampala yesterday and today. There have been big clashes in the city between the police and Baganda protesters. At least 7 people have been killed and many others injured. There was a steady stream of ambulances to and from Mulago yesterday and volleys of bullets and sirens were clearly audible from the hospital site. Protesters burned through the city centre and Wandegeya (where the hospital is), setting alight anything they could, throwing stones at police who returned the assault with gun fire and tear gas. Essentially the protest is against the government banning the King of Buganda from visiting an area just north of Kampala, called kayunga. It is populated by a break away group called the Banyala who have seceded from the Baganda tribe and are apparently not happy about the visit, hence the ban.

Needless to say that I didn't go to the hospital today, since I didn't bring my flak jacket with me. We are barricading ourselves in the house with our evil dog that we hate and hoping that it will burn itself out (both the riot and the dog), so long to a weekend of partying.

Other things happening in the news this week...

Dong.... Kate has surrendered her passport to immigration (before the riots), which happens to be on the main road into the city, for a visa extension... will she ever see it again?

Dong... Kate had to pay a visit to Interpol for fingerprinting to get a certificate of good conduct so she can apply for a working visa...

Dong... Kate would have spent more time on emergency gynae had the above political crises not occured...

Dong... APH guideline has been produced and accepted...

Dong... the fridge broke...

Dong... the dog is suffering from a borderline personality disorder...

Nothing else really exciting has happened. Loving the new house, housemates are cool, found myself a drinking buddy, it's a bit like being a student again! Will keep you guys updated over the weekend about what's happening in this crazy place!

Saturday, 5 September 2009

Mulago musings

Well, it's been a week and a bit. Have been able to focus a bit more on the clinical side of things, although I still have a couple of guidelines to write, which are a bit distracting. Started getting my hands dirty, even though I have been trying to 'observe' and get some idea how things run at Mulago, and also how specific conditions are managed. Delivered a set of twins with forceps, not commonly done here as few people are trained to use them, because there was no other equipment. Feel like I'm beginning to settle as I'm getting to know the doctors and midwives, and getting the opportunity to show people what skills I have. We had the midwife of the month award on Friday, which is a brilliant initivative, set up by the previous fellow. It's an award involving a sizeable amount of money and offers a massive incentive for improving morale and practice. The press came, so I'll be scouting for clippings and posting them here if I can.

Moving into my new house this weekend, when I think it will suddenly sink in that I'm not actually on holiday! This week I will be mostly registering with the medical council and trying to sort out a work visa, which I am led to believe is a challenge at the best of times.

Haven't done much else since I last updated you, but I do feel much more at home here. The mosquitoes are biting... I was winning before. Thanks goodeness for nets and Lariam! No other huge news at this point. Please stay in touch with all your news.... A couple of personal messages...

Ben, get well soon, hope you're better in time for Barcelona
Vicky, happy 21st!
Gran and Grandad, HELLOOOO!!!! Missing you and love you millions, hope the knee operation goes well