June 2017

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June 2017

June 30th – Hoima Hospital

Hoima Hospital, Uganda.

What a life-changing experience! Diversity brought together, striving for unity in the most inhospitable of places. Life cheats death and death greets life, dictating healthcare professionals’ cues for action. In the midst of this turmoil of emotions what am I – an apprentice in the art of practicing safely and effectively – I can offer reassurance through a smile, entertainment with bubble blowing, show urgency and assertiveness in life-compromising situations and improvised clinical skills where there is a significant lack of resources. I suppose that by now, I have undressed my armour of righteousness and embraced the Ugandan style: take it easy and get on with it, and whatever happens is for the best.

Ana

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June 2017

June 29th – EDPA

Despite being hesitant to attend EDPA clinic today after spending two days on the chaotic wards at Hoima hospital, I was pleasantly surprised to see clean floors, one patient to a bed space, sufficient equipment, good staffing levels and an environment that I would feel confident to be treated in myself. Sam, Mariann and I were welcomed with smiles from the staff we were introduced to and the staff were very willing to take time to explain what they were doing and why. This really boosted my confidence and made me feel part of the team. Throughout the morning I played an active part in the ward round. This included taking observations and learning new skills such as; administering medication and dressing a severe burn. Unlike my experience in Hoima hospital the ward round only took two hours and I feel this was done in an orderly and professional manner. The doctor documented clear clinical notes and explained his findings and plan for the day to his patients.

During my time at EDPA I also spent some time working in the labs where I did my first ever blood test, yayyy! This made me feel proud and excited to tell my friends and family back home! My overall experience of the EDPA clinic is that patients are treated with respect and dignity where possible and confidential issues can be taken to a private room if need be. I am looking forward to returning there tomorrow.

Rachel

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June 2017

June 28th – Azur Clinic

To kickstart our week in Hoima, Katie, Claudia and I spent two days at the Azur Medical Clinic situated in the community. The clinic provides private paediatric, adult and maternity services and also has an onsite theatres department dealing with minor procedures. We spent the majority of our time in the paediatric department gaining insight into clinical processes and practices, however, we also had the opportunity to widen our knowledge by rotating around other ward areas.

On first impressions I was pleasantly surprised to see that the paediatric department was colourful with pictures painted on the walls giving the environment a child centred feel, although, at the same time immediately found myself making comparisons to healthcare systems and settings in the UK. The clinic itself was great in terms of serving its purpose and supporting members of the local community to try to improve health, however, I did not expect to see such a difference in the way that care is delivered to patients. For example, treating children without testing and confirming a diagnosis, one member of nursing staff co-ordinating an entire ward and doctors prescribing medication just because it is the only drug available in the pharmacy, were all practises I have never witnessed in our UK hospitals. All these things reminded me how lucky we are to have such a wonderful NHS and suitable resources to keep patients healthy and safe.

From following ward round, it was apparent that space proved an issue, as patients could almost touch one another from bed to bed, parents were sharing their child’s sleeping space, cubicles for infectious patients did not exist and cleanliness of the clinical environment did not seem a priority compared to standards set in the UK. Patients and families were denied confidentiality as all other parents could listen to one another’s consultations and even something as simple as a bedside curtain was unavailable, therefore, not allowing patients and their families privacy within the setting.

Another difference noted was that hospital admission and treatment was costly for patients with the daily rate for a paediatric bed including treatment costing families 20000 shillings, approximately £5 to us in the UK. Although as brits we view this as a small sum, £5 to a family living in poverty and poor conditions in Africa is a huge bill to pay.

The highlight of our experience at the clinic was having the opportunity to witness an emergency cesarean section. Again we noticed many differences in practice throughout the theatre/surgical process, but it was a complete privilege and honour to witness a precious life being brought into the world and is something we will all treasure forever.

From working with the team at the Azur Clinic it has made me think more about how important our NHS is and how truly lucky we are to receive such fantastic care with easy access to resources in the UK. I will forevermore remember my experiences of the healthcare system here in Uganda and will always appreciate everything the NHS provides to patients in need.

Bonnie

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June 2017

June 27th – EDPA

To be honest I don’t know where to start… we have just spent the last two days at EDPA clinic, the only way to describe my initial feelings is shocked.

EDPA is a private healthcare clinic but is nowhere near anything you would expect from private care at home in the UK.

On walking into the clinic the first thing that crossed my mind was how different the approach was in regards to infection control. The wards were far from the standard of clean expected in the UK, with dusty curtains hanging in doorways that nurses would push trolleys through carrying medical equipment. The beds in the wards were touching, and there was no arrangement of infectious and non-infectious patients. There was a little girl in one bed, who the doctor had told us, had sepsis but also pneumonia, as we turned to the next bed space we were told that the patient had pneumonia, all we could think was, is that why?

The first day was difficult, we started off with the doctor on ward round, which was interesting and he was very willing to answer our questions, however we found it hard not to question the lack of confidentiality, patients would just be discussed over the top of other patients. The afternoon was spent with the nurses and we honestly felt like they didn’t want us there, Ella spent the afternoon doing nothing, despite offering her help lots. We are struggling with aspects of the culture, like how the nurses speak to people, back home it would just be considered rude. We went home close to tears.

The second day was so much better, we spent it in the labs with the lab technicians Mike, Sam and Oyet. They were amazing and we learnt so much, we had the opportunity to take blood, run tests and look at malaria parasites in blood under a microscope. They completely turned our negative experience around and we could not be more grateful.

The majority of the patients in the clinic were under five, despite this the clinic has wards for adults, so these wards were filled with children too.

Some of the practices felt very unsafe, nurses would attach drugs in syringes to cannulas and walk away. They use syringes repeatedly, unaware of what they had been used for before, saline flushes were also used on multiple patients. I understand the lack of resources here, but cross contamination of drugs can be dangerous. The use of syringes on patients with malaria and then patients with pneumonia makes me wonder if some of the illnesses could be avoided.

It’s made me feel saddened that we complain about the healthcare available to us in the UK. Our NHS is so much safer and more pleasant, the standard of care much better and yet we don’t appreciate it. If we need something, it’s there.

One little girl, perfectly healthy had just swallowed a coin, the doctor had told us that she wouldn’t safely pass it, but when we asked if she would be offered surgery he just shrugged.

I wish I could fix the unsafe practice here, but I think that we need to accept that all the change theory in the world won’t make a difference, and we just have to do what we can with the little time we have.

All this at a private clinic, I haven’t yet been to the hospital run by the government, I can’t imagine what it will be like there.

Emma

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June 2017

June 26th – Hoima hospital

For the past two days, six of us visited the children’s wards in Hoima Hospital including the neonatal intensive care unit. Sam, Rachel and I decided to stay on the general paediatric ward, while the others chose to work on NICU. I was both excited and anxious waiting for the matron to come and take us around. By now we have all learnt about the Ugandan concept of time and punctuality, so we were not surprised in the slightest, when she slowly toddled up to us a good 40 mins late. She was full of smiles and we were of course most welcome, which somewhat prepared me to embrace whatever the day had in store for us.

My initial positive thinking however quickly disappeared the moment we stepped inside the room full of sick children. Everywhere I looked I saw something wrong. All of a sudden I realised that this time I wasn’t watching the news or some kind of documentary from my comfy arm chair about children suffering in Africa. I was living the experience right there and then.  I shook myself and found my “get over it” switch and I kept using it over and over again as I went through my imaginary list of horrible things: children of all ages, gender and diagnosis crammed in one open area with no privacy regardless of infections, their physical state or the severity of their medical condition. The lucky ones had a rusty old bed, others were left with a mattress on the concrete floor. No running water in the building, not for drinking, not for washing hands. The odour was crushing, a stench of sweat, urine and vomit that took some time to get used to although I can still smell it a little just thinking about it. “It’s OK, we have nurses to guide us, it’s is safe, it is a hospital” I kept assuring myself until reality hit again. There were no nurses in plural but only one person trying to attend to nearly 50 children, of whom most were severely distressed from anaemia as a result of Malaria. There were little or no resources to tackle seemingly straight forward problems. For example inserting a cannula would never be an issue back in the UK. Basic things that we take for granted such as gloves, syringes, needles were not available when needed. A simple blood test enabling patients to have a potentially life saving transfusion was often a privilege and children without it were sentenced to death.

Despite all of the horrors, everything seemed to be tolerated in silence as if it is the norm for both staff (doctors, nurses and students) and parents. There was not a single complaint or moan about medication that was overdue or missed, about being forced to sit on the floor or not having a bite of food in 48 hours. These are conditions that are unimaginable to people living in developed countries like England.

Sadly, I found my greatest disappointment in the attitude of people working in the hospital. They didn’t appear to have any sense of urgency, awareness of prioritising their workload or what we know as basic nursing values like compassion, commitment, courage or even care. Have they given up? Have they stopped caring or did they even have the means to help at the beginning? Would I be the same if I had to work in such a “hopeless” environment on a daily basis? These are questions I don’t know the answers to. Here is what I know however; with the right attitude there are no limits to what I can achieve and I don’t ever want to stop believing that I have the power to change the world or the world of some people. This experience has been one of the toughest I have ever had to face in my life yet I treasure every minute of it and wouldn’t change a thing.

Mariann

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June 2017

June 25th – Family Visits

This afternoon we split up into three groups and each went on house visits. Our group, accompanied by Julius, went to visit four families living just a short drive away from our accommodation. We pulled up a few metres away from the first house and got out of the car, straight away I was struck by how many children were playing outside the tiny brick structure we were heading towards. We were all greeted by mum who welcomed us into her home.

Now I’m sure we have all seen footage of the kinds of houses you’d find in various parts of Africa and I should have been prepared, having just visited the slums in Kampala last week. For some reason the homes I was expecting to find in Hoima were not the reality. Inside there was barely room to fit the six of us, let alone the family of eight it was supposed to accommodate, there was a bench against one wall, a small table in the middle and a small bed against the opposite wall.

My partner and I live in a two bed basement flat, which at one point we shared with two other people. I remember how we all used to moan about how little space we had, and how we felt as if we were living on top of each other. Our flat is a palace in comparison to this family home, their entire house could have been comfortably squeezed into my bedroom.

Julius explained to us that the mother and her youngest child were both HIV positive and mum had recently been very unwell in hospital, leaving her children in the care of their older sister.

The mother then told us that her daughter had been admitted to hospital yesterday morning, her daughter had got a Boda-Boda (a cross between a motorbike and a taxi) home and the driver had carried on driving past her home, so for her own safety, she had to jump off.

As mum is the only parent in the family she must provide food for all of her children whilst coping with her illness. She explained to us how the summer months are easier, as she is able to pick mangos to feed the family. She then thanked us for coming and pulled a cloth off a bowl on the table to reveal it was full of mangos, she then proceeded to put all the mangos in a bag and handed them to us. We then had a photo and said our goodbyes.

Once back in the car, I found it very difficult to compose myself, after being given what was quite possibly the families dinner for that night. People in this country are so welcoming and generous and I feel so guilty with how much they appreciated me just for showing my face for ten minutes.

The positives I got out of this experience was hearing how KISS supports children from these families by providing school fees and clothes. Many of the families had received a mattress from KISS to make their nights a lot more comfortable.

The children are also being taught various crafts such as bracelet making, which they can sell for a small profit.

The more time I spend here in Uganda the more I realise how much I take for granted in my life. I have never had a day without a warm meal. I have a comfy bed to sleep in each night. I have more clothes and shoes than one person could possibly need. If I get ill then I have the NHS to pay for my treatment. This trip has taught me that it’s time we all started to appreciate what we have in the UK a little more.

Ella

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June 2017

June 24th- Journey to Hoima

Today we left Kampala and travelled approximately 4 hrs to our new destination: Hoima. We stopped at cafe Java and had, what I would call, the BEST BREAKFAST EVER! After stuffing our faces we hobbled back to the minibus and journeyed across various villages and into Hoima. Upon arriving we were greeted by so many children and their families, all of whom had been waiting for us to arrive since the morning. They were holding up banners for us, dancing, chanting, hugging us and constantly telling us how they’re so grateful to have us there. We then followed the children into the school and were surprised with a beautiful traditional dance and songs from the children. This welcoming was truly a day that I could never forget. They made me feel so warm and thankful to be there….I also felt as though I didn’t deserve all the love and appreciation they were expressing, I’m not too sure why I felt this way. The way the children are, is so different to children in the UK. These children are so full of life, spirit and positive energy to the point that it becomes contagious. You could be in the foulest of moods but just looking at one of their smiles changes everything. They appreciate everything in life and are not fixated on materialistic objects like the modern British child. These children are full of life. I look forward to spending more time at the school and getting to know the children more.

Claudia

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June 2017

June 23rd- KCK

This week we have been delivering health promotion presentations to young people in schools and communities associated with the charity Kids Club Kampala. My personal subject area is sexual health which I knew would be challenging to deliver, particularly within a conservative Ugandan culture.

When I presented my preparation to the charity panel to screen the content, it received mixed views. I had given the approach that sex is a normal, natural act and is part of life and should be enjoyed however one should be protected and cautious with it. Being a Christian charity, some of the panel disagreed with this – sex should be promoted within marriage alone and protection should only be used as a last resort, or once a couple have had children. Indeed, the most promoted method of contraception in Uganda is abstinence. However others raised the view that although this was the ideal, the reality was very different and there was no benefit in ignoring this. Some mentioned in certain communities, children share the same living and sleeping spaces as their parents and witness sex regularly. Based on this children simulate a ‘mum/dad’ role and engage in sexual activity from a very young age. Other children fall victim to sexual abuse and non-consensual sex. This was all discussed in view of the topical debate concerning the government introduction of compulsory sex education into primary and secondary schools. In contrast to this, the Ugandan National Teachers Union (UNATU) have recently reported they will not teach sex education in schools as it will lead to sexual immorality in Uganda:

“As UNATU, we are opposed to sex education at primary and secondary levels and our members are all aware of this because we believe the right age to introduce the subject should be at a University level when students are mature enough to make a clear judgement.”

For teachers to deny or decline an opportunity to educate is an unexpected paradox. As I delivered some of my presentations in slum communities this week, some teenage girls approaching university age were quite clearly pregnant or already nursing their own newborns. Somehow demonstrating how to use a condom and protect oneself from STIs and unwanted pregnancy seemed to fall a little flat amongst this audience.

Despite concerns, the charity felt my presentation content was relevant and useful and that I should go ahead and deliver as I had planned. I separated my content into three sections – puberty, contraception/prevention of STIs/HIV/unwanted pregnancy and thirdly, the right to consent to sex.

The third section appeared to resonate with students as I emphasised the right to consent to sex and being able to say ‘no’. Support networks were identified and children were encouraged to speak out should they feel that they or others were mistreated either sexually or in other ways. It is highly apparent that more discussion and education is needed in this area, with gender roles and stereotypes to be broken down and understood.

Mostly, the children I worked with seemed to enjoy and find the content and activities I delivered useful. The expected giggles and nervousness was present at points such as discussing menstruation or when I demonstrated the use of a condom on a banana. It was clear from some of the questions asked that there was an uncertainty in this area that needed to be addressed.

What I’ve taken most from this week is that although this is all set within a conservative, religious culture where sex is a huge taboo, it is very similar state of affair in the U.K. In an age of sexting, social media and pornography, children can be easily exposed to situations where they may not be appropriately prepared. Recently I had a discussion with some nurses who thought that sex education for children was almost perverse. Yet it was the same nurses earlier in the day who had cooed over ‘handsome’ babies who would one day break hearts. Although seemingly innocent, it labels and links to sexuality.

The Netherlands report some of the lowest rates of teenage pregnancy in the world as well as low rates of STIs and they start sex education as young as four. The common misconception here is that sex education comprises solely on reproductive health. It includes healthy friendships and relationships, gender differences and respect and openness for sexual preference and choice which are just as, if not more important.

I believe children have the right and deserve to receive frank and open information about sex, especially in exposed and fast changing world. To normalise something that is natural seems an absurd statement, yet this is the case. Providing this education in Uganda has sparked an interest that I intend to explore further to benefit my own society also.

Moeen

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June 2017

June 23rd- Hands for Hope

Our first week is over and tomorrow we’re moving on to a new venture. It’s my task to write about our last day with the children at Hands for Hope. It will be hard to stick to 500 words as there are so many thoughts and emotions rushing through my head.

I’d like to tell you about a little boy we met yesterday. I’ll call him Daniel to protect his identity. Daniel is 4 years old and had previously been identified as a possible candidate for sponsorship at Hands for Hope. The group, along with the H4H social worker went to visit Daniel and his mother in the slum community in Kampala.

I’m actually not going to talk about the impoverished conditions in which little Daniel lives with his mother, father and older brother. Since he lives in the slums, that goes without saying. What I’m going to talk about is his physical health and the impact that witnessing a little boy with some serious health issues that can’t be adequately dealt with, has had on me and the others in our group.

As soon as I saw Daniel it was clear that he had significant neurological impairment and needed some urgent medical investigations. He had a constant facial twitch and right sided twitching with a dystonic right arm. His voice and speech were also affected and he walked with an unsteady gait.

I got a medical history from his mother, who reported that he was a normal boy until last December when he had a febrile illness for a week. He had no other symptoms; no cough, cold, diarrhoea or vomiting. It was after this fever that the neurological symptoms developed. He also appeared to have a tonic seizure while we were visiting and his mother said that these were a common occurrence.

Daniel’s mother said that she had taken her son to a medical centre but that the doctors there wanted to scan his brain and she had no money so she left and did not return. It can be very hard to get a clear medical history from parents such as Daniel’s. Usually lacking in education, and trying to survive on meagre amounts of money and food makes life very hard and makes focusing on anything else difficult. Additionally, there are cultural issues which make understanding disease and diagnosis challenging. Daniel’s mother had no records of the previous visits to the medical centre so we had to try and piece the information together from nothing but her verbal account.

We finished the assessment visit and walked back to the centre. As we walked, I started feeling sad and defeated that there was nothing that I could do to help little Daniel. The only option was to wait to see if he would meet the criteria for sponsorship in the programme.

Today when we arrived at the centre, it was announced that there was an opportunity to take Daniel to the international hospital to have a consultation with a paediatrician to see what options there were for any treatment needed. Since I had seen Daniel and had helped complete the assessment form, I jumped at the opportunity and so accompanied him and his mother, along with a H4H representative, to the hospital.

As soon as the paediatrician saw Daniel, she confirmed what I already knew; that he should see a paediatric neurologist and have a full assessment, including an EEG, MRI and lumbar puncture. Today all we could do for Daniel was have blood tests and an infusion of an anti-convulsant medication to see if the seizure activity lessened. These interventions then led to a prescription being issued for an antibiotic due to a bacterial infection and an anti-convulsant, as the drug administered to Daniel in the clinic had a good effect.

I left the hospital with more questions than when I’d entered. I saw the snowball effect of providing medical care to a child whose family are completely unable to pay for continuing care. We were able to get him some treatment to alleviate his symptoms, but not surprisingly, didn’t find the cause of his symptoms. Will Daniel ever be able to see a neurologist and have the tests he so desperately needs? And even with a diagnosis, will his family be able to afford ongoing treatment?

The feelings triggered by the social injustice of this situation, and so many like it, are overwhelming. I find myself wondering why this is happening in a world where international aid is poured into countries where poverty is rife. How can we tackle health inequalities in the poorest parts of society and ensure that every child has access to free, good medical care and education? These questions are largely unanswerable. A group of student nurses on a 4 week elective cannot save everyone. But what we (and I) can do, is make a difference, no matter how small, to the person standing in front of us. We showed Daniel’s mother we cared for her son and his whole family today. We hopefully bought him some time while Hands for Hope investigate ways in which he may be able to receive further treatment at no cost to his family. We can make a difference, where we are, to whoever happens to cross our paths at any particular time. It is a great responsibility but also a great privilege.

Lastly, please treasure our amazing NHS. If Daniel lived in the U.K., he would have been seen and treated for free. Don’t take it for granted – it’s a wonderful gift that we have.

Sam

 

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June 2017

June 22nd- KCK

Today we visited another school in the morning. We were given a warm greeting by teachers and students which was complimented by some kind of crawly creature biting my bottom as soon as I sat down- a bitter sweet combo. From there we split into two groups to present different topics. I helped present Moeen’s sex education presentation to an adolescent group. What struck me today was how much more educated children at school are in comparison to slum schools/ centres, despite being so basic. The children here in Uganda love to learn. You can see this in their attentiveness and concentration, as well as their desire to be involved in lessons. This seems a far cry from the education system in the UK where we have so many resources in comparison, but a debatable passion to learn and an equally questionable appreciation of education in general. It is also great to hear that the kids here want more sex education, too; a very controversial topic indeed.

In the afternoon, we travelled to Namuwongo slum- the largest in Uganda. The conditions appeared slightly better than Katanga and there appeared to be slightly more room through where we walked. Nevertheless, conditions were still horrendous with rubbish and sewage lying next to front doors where children play and eat. Once again we were mobbed by children, but fear not, we are now fully qualified Muzungus and know our role well!

I presented my tooth brushing topic for the second time, but had to adapt it slightly as we had very limited room and over 60 young children in a small room (or perhaps more appropriately, a furnace)! Something that has become increasingly clear is just how much we take simple things for granted- it feels as if we waltz into these classrooms, demanding children eat certain things, use certain equipment and wear certain clothes in order to maintain their health, but in reality, most of these children will not eat three meals a day because their parents cannot provide them, they will not have something as simple as a toothbrush and are wearing dirty, broken, old clothes passed down through the family because there is no other option… To combat this, I added in to my presentation the alternatives to using toothbrushes and pastes that not surprisingly, all of the children knew.

Driving through Kampala highlights how developed the UK is. However, despite our gadgets, sanitary living conditions and wealth, the Ugandans seem much happier and friendlier than the British. Their trademark is to relax and be in no rush, which the British are well known for here. It seems as if Ugandans look at us and assume that we are rich because of where we come from, yet many of us long for the happiness and contentment that even the most disadvantaged communities seem to exude here. The concept of being ‘poor’ is an interesting one- there is certainly a distinct difference between considering yourself poor because you cannot afford a holiday and not being able to eat a single meal a day…

Ugandans seem to appreciate absolutely everything they have, which is usually very little. Is ‘being rich’ about having money, or is it about what is in your heart?- I know my definition of ‘rich’ is rapidly changing.

Megan

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