June 2015

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June 2015

Both yesterday and today, myself Sam and Isabella went to St Francis Clinic in Kasambya, this is a private clinic where patients pay for their treatment. On arrival we met Goretti and the rest of the team who we spent the day with. During our time at the clinic, we practiced and observed a range of clinical skills, including medication administration, cannulation and observed the insertion and removal of implant contraception. Also we learnt about communicable diseases and saw many cases of malaria. Sam and myself spent our time on the dispensary, this is where patients who had returned from blood tests, and visited the clinic for health advice received medications.

Prior to working at St. Francis clinic our expectations were very similar to that of EDPA, the private clinic we worked at in Hoima. However it soon became apparent that the clinic is more community focused. The nurses provided care for families who could not afford the laboratory fees. This was a major difference to what we have previously experienced, as we have seen people being turned away before due to a lack of funding. Although, this was very uplifting to see, as in the UK many people take healthcare for granted as we have the NHS. Seeing the clinic working with the community was different to what we expected in Uganda.

Another issue, which the team found difficult to understand, is safe clinical practice, in the UK the use of sharps bins is vital whereas in Uganda it appears any surface is the sharps bin. Hearing a nurse say ‘I have never had a needle stick injury’ left us wondering how. The Ugandan practice left us feeling very frustrated and vulnerable, we were trying to improve the care and environment we were working in but as much as we tidied there were still used needles, glass ampoules and other sharps around and we were left feeling helpless. I think we were initially shocked to see how the clinic unintentionally displayed carelessness when disposing of sharps. However after talking with the nurses and explaining the importance of sharps safety they mentioned how they were worried but for them it is normal practice. This left us feeling confused and we tried to overcome this by demonstrating safe practice and we felt the nurses soon picked up on this.

The highlight of my time in St. Francis was being able to administer medication and learn a lot about sexual health and different types of contraception. The clinic was very focused on female contraception’s and the nurses were very knowledgeable and encouraging in teaching us about these. Opposite to this, my most challenging moment was seeing how some health procedures in Uganda can go terribly wrong, and in some cases their way of fixing it is to prescribe paracetamol and see if the infection improves. Which would not happen in the UK as professionals are more knowledgeable of different types of antibiotics and their uses. When back in the UK, I will be more considerate when using resources, understanding their value and how far they can go. Here in Uganda we have experienced first hand what can happen if the resources are not available or if they run out. Uganda has taught me a lot about healthcare and how much we can take for granted, it is something that should be experienced first hand in order to see how it can have an impact on you as an individual and a professional.

 

Gemma Pook

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June 2015

I spent my week working at the St Francis outreach centres, which are all part of a project solely funded by us, giving local populations access to free healthcare in their local community. We were able to access over 1600 during the four days, targeting our care towards people who cannot afford medication or even transport to the nearest clinic. The aspect I will be focusing on will be working in the dispensary, which loosely translated, was a table in a field, stacked with basic medication that we had provided. I thought I had the easy end of the stick… I was wrong! My first challenge was a familiar one from the UK, namely the complete inability to decipher doctor’s handwriting. Luckily I made friends with a Ugandan nurse (my future wife, of which I had no choice) who could translate for me. However, this did not simplify my life, as I now had to get my head around the (lets call it unique) Ugandan prescription system. After wasting time at the beginning of the day trying to conquer this, I then opted to override this and adopt my own system and distribute medications at what I knew to be a safe and therapeutic level. Alas, this was not the end of my challenges. Once meds were bagged up and ready to go, I faced the daunting challenge of shouting out illegible and unpronounceable names, whilst facing 100 Ugandans, rolling on the floor, laughing at my attempts.

Challenges aside, this was one of the moments during our whole experience where I really felt I was making a substantial difference and directly affecting peoples lives. There were many people there who had chronic lifelong conditions, we could only alleviate their symptoms with the limited medications we had, I personally found this really difficult, however a majority of our patients at outreach were here for malaria and HIV tests. The amount of malaria we diagnosed and gave a full course of anti malarial treatment was quite simply both terrifying and heart warming in equal measure. We have all heard of malaria, but seeing firsthand how many children and adults are diagnosed with it was shocking. At least 40% of people in the remote village were positive, but if it wasn’t for our outreach project most of them could be dead by the time you are reading this. The fact that Malaria is so easily treated, and yet still millions die because of it every year, is to me, unacceptable.

To go home at the end of the day, knowing you have potentially saved countless lives is not a feeling I have quite understood myself, never mind be able to write down in this blog. This experience is nothing that I can compare to the UK, as luckily, we are not in the situation of people not being able to afford simple but life saving treatment. I truly feel privileged to have had this experience and only wish I could do more.

 

Neil Gibbons

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June 2015

St Francis’ Clinic is a private clinic that caters for the health needs of Kasambya, which is rural area in Southern Uganda. But while patients do have to pay for their treatment, the clinic is so community focused that they sometimes negotiate a patient not paying if they really can’t afford it. The clinic is split into two main parts consisting of the laboratory- where tests are conducted, and the dispensary- where the nurses prescribe medication and give it out, and attend to the needs of the patients. I had the opportunity to spend time in both these parts, and feel like the opportunity benefitted me, and helped me to understand the treatments for the diseases that are so prevalent in Uganda, yet absent in England.

Once again, like the hospital, the overwhelming problem that seems to arise was malaria, in various stages of severity. On my first day, where I spent the day in the lab, it was shocking to see the amount of people coming through the door with various complaints, and leaving with malaria, and hardly seeming to bat an eyelash at it. The easy acceptance of this disease shocked me, but not so much as looking through the books and seeing how many people had been diagnosed each week- in one week 230 patients had confirmed malaria. After the diagnosis, they then went to the dispensary and nurses would prescribe them medication, and see whether they needed to be an inpatient or outpatient. The whole experience was vastly different to the UK, firstly in the sense that for the whole time I was there, I didn’t see one doctor- it seemed like the nurses ran the clinic. They also prescribed drugs, inserted cannulas, and did basically everything. They really were amazing, but it was such a shock to see the amount they are expected to do, but on the flip side, they thought the same of us.

While there are many patients I could talk about that were physically sick, and at the clinic for treatment, the child I want to talk about was physically well, but someone that struck me all the same. Jenny and myself were working at the dispensary at the time, which looks onto what I think is a main road. (It’s hard to tell, because all the roads are made of dirt.) A couple came in with their child and the nurse told us that they saw us in passing and hoped we would adopt their child, or pay for their treatment- neither of which unfortunately we are able to do. Upon examining the child, it was easy to see that he had some type of neurological condition that had impaired his development, because at 2 years of age, he was still unable to walk or even crawl. We tried to come up with solutions to help the parents, like a referral to physiotherapists, but it was frustrating to learn that this wasn’t really possible, and in the end we just had to give tips to the parents on how to possibly help him crawl.

I used this example because it shows the difference in care that people in impoverished countries face compared to the UK. With the NHS we are fortunate enough to have specialist doctors, physiotherapists, speech and language therapists, dieticians and nurses to help a developmentally delayed child grow, and reach their milestones. But here, that’s not really possible- especially in a rural area like Kasambya, so it’s difficult to say what will happen when this child gets older, and upsetting to see that they aren’t receiving the care they need.

 

Katrina Lancaster

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June 2015

Today we went to a mud hut/ church in the middle of nowhere to help with the outreach programme, which our money had helped to fund. In this hut, we were assigned to two main stations, the dispensary where drugs were sometimes prescribed, as well as, given out free of charge and the laboratory where HIV and malaria tests were carried out. The day began with Gemma and I in the lab and I was the designated “stabber”. Luckily we didn’t have to communicate much because very few people spoke English but they knew I was the stabber and helpfully presented their finger with little instruction needed.

 

It was similar to doing finger/ heel pricks for blood gas monitoring minus the helpful equipment. There were no nice prickers, instead we had to use a needle or a lancet, both of which required a bit of brute force. It was difficult to know how much pressure to apply, sometimes I pressed to lightly and ended up pricking them twice and other times I’d have blood to spare. Once pricked, we had to suck up the blood with what looked like short pipettes from a school chemistry lab, they were not the capillary tubes we were used to back home that suck the blood up with very little effort. After many failed attempts at using these pipettes, we mostly aimed and dropped the blood directly onto the test, eventually we got the hang of using the pipettes and properly applied the blood to the test.

 

All in all we had a good day and we were happy and proud to know the tests and drugs in the hut, we had helped to fund and we were able to see them first hand helping people. It was refreshing to see so many people come for HIV testing and even better to know they were all negative and received counselling about safe sex. This hut enabled people to come and have a malaria test for free, whereas everywhere else we had been, people had to pay. People who didn’t’ particularly have any symptoms came and were tested which enabled them to get treatment promptly and again free of charge and therefore we actively had a part in preventing their death.

 

Isabella Hunte

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June 2015

So today was the day that we left Hoima, and began our final stretch of our trip to Kasambya. Ready at 9 we had all our bags packed and waiting by the minibus, and Denis’s car. Watching the guys strapping the cases to the roof of the vehicles, we all began to worry if it would rain, as some bags weren’t waterproof, and if we would even make it to Kasambya, with all of our bags intact. Once the bags were all loaded, it was time to split the group and decide who would be in which car. We decided to put the people most likely to suffer from travel sickness into Denis’s car, and the rest of us piled into the minibus. Trying to figure out which seat would have the most leg room, I squashed myself into the back with the 15 odd bottles of water, and everyone bags. At this point I don’t think anyone quite realised that they were in for the most bumpy, and horrific car journey of their life.

At least 15 minutes into the journey, Neil realised his foot and bag were getting wet, to look down and realise a bottle of water was leaking. After some rearranging in the back we set it up so it wouldn’t leak. Soon after, Catherine then pointed out Witchcraft Mountain, explaining how tribes sacrificed animals, and helped to heal sick children by covering them with animal blood. However thoughts were soon distracted from this when we flew over a giant bump in the road and everyone was thrown about in their seats. To help relieve the tension of the journey we all began singing along to an ipod and were shocked to find out that Samantha, not only didn’t know the words to Bohemian Rapsody, but she hadn’t even heard of it!

Continuing along the bumpy road we slowly came to a stop with a few cars in a traffic jam, all being typically British and nosey, we vacated the vehicles and went to see what was going on, walking past a car with a coffin strapped to the boot (lets just say we hurried past that car) we walked up to where a group of people were standing staring down into a hole watching some work men. I totally wouldn’t have realised they were laying pipes, until another member of the group mentioned it. We were told they would be an hour, I mean, who lays pipes in the middle of the day?! And this is Uganda, we all expected it to be a Ugandan hour and would be waiting at least three hours, all sitting on the floor and grabbing snacks, some members of the group decided to pour themselves some wine, and make themselves comfortable in the middle of the dirt track, in the middle of no where.

To our surprise though about an hour later the traffic was actually moving, and our bumpy journey was about to begin again. Not long after we passed a heard of cows that passed so close to the vehicle, it was nothing like your English motorway. I think the bumpy journey was beginning to get to everyone, with each giant bump I sank down in the chair some more to prevent hitting my head, and soon figured out that the bags on the back seat were wet and so were all my trousers, great, more leaking water, sure enough I had leg room, but now I was sitting in a giant puddle, just as we finished rearranging the car pulled over and Catherine had to vacate as the travel sickness set in. After a quick breath of fresh air, a couple of toilet stops, and some more rearranging of water we were on our way again. It wasn’t long however, before we pulled over again for another breath of fresh air from travel sickness. Not long after we started the journey again though we were on a nice flat tarmac surface, brilliant, this was definitely the time to try and get some sleep.

Before long myself and probably a few other were woken up by the horns of boda bodas (motorbikes). The passengers were waving leaves and seemed really excited to see us, they escorted us into the KISS site, where we were greeted by children, families and workers. Everyone was smiling, waving and dancing. The bus pulled over and we all piled out. Parents hugged us from all angles, children grabbed our hands. Everyone was really welcoming, and it was such an overwhelming experience, thinking that all of these people had waited for us, even to the extent that they could escort us into the KISS site. The families were so grateful for our presence and their happiness was so infectious. I’m sure over half of us steped out of the cars feeling slightly groggy and seeing the children and parents laughing so much and being so happy just put a smile on all of our faces. It was such an amazing experience being greeting by so many excited people.

We entered an outside area and made a circle. There was a group of young people and children who sang for us and made us feel really welcome. Looking around at the other group members there wasn’t a single person from the group who wasn’t smiling, we had all cheered up pretty quickly. Before we had a chance to protest we were dragged into the circle and were being ‘taught’ a dance. I’m pretty sure the rest of the team don’t mind me saying, none of us were anywhere near as good as the children teaching us. We introduced ourselves and were welcomed and cheered to by the children. I think it was a moment that made us all proud to be here, to see how grateful the families are for us being here, and for the money we raised that goes towards them as a community. It is definitely something that future groups should experience, to see how much love the children have. And to see how much the money raised can help improve the children’s lives, and to put a very contagious smile on their faces.

Sarah Warnock

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June 2015

I spent 3 days in Hoima’s government run hospital exploring adult nursing care in A &E. The department was full and busy, there were people sitting and lying on the floor, waiting for treatment and I seemed to have fallen into a very disorganised drug round. Whilst on the round I noticed a very unwell lady. When I asked the nurse what was wrong, she said that the lady was awaiting surgery for an obstruction in her intestine. I was overwhelmed by how unwell this lady looked and there appeared to be no concern or urgency for her care.

The next morning when I started my shift, I was greeted by the night nurse who was ironing his trousers. He showed me where I could leave my bag and then he suddenly disappeared. I was left in the A & E department by myself, no handover, no other staff and a new set of patients that were not there the day before except the unwell lady (who had obviously not gone to surgery as planned). After a quick observation to ensure patients were reasonably comfortable and breathing. I searched for their files to familiarise myself with what was going on, especially with the unwell lady as she appeared even more drowsy. The documentation was very unclear. There was no observation chart and she had appeared to have had no medication since 14:00 the day before and there was an empty fluid bag up. Due to the limited resources I could only take her RR, HR and GCS. She had a GCS of 8, the patient was lying in a wet bed, she had a sister present that was unable to speak English and still no signs of any staff. By this time it was nearly 10am and there was suddenly an appearance of doctors and a student nurse turning up for their shift, which started at 8am.

I grabbed a doctor to explain what was going on with this patient and my concerns. He informed me that because the hospital had ran out of oxygen, the patient was unable to go to surgery. I asked what had been done to make her comfortable and what was their plan of care now. He could not reply and said they have to wait for the ward round. Now becoming used to Ugandan healthcare I accepted this and decided to focus on other important interventions she required. I asked if they had a catheter, when they asked why, I had to explain that she was laying in a wet bed and now at risk of not only her skin breaking down but also a loss of her dignity. They also managed to locate a manual BP machine and a BM machine. One of the doctors did have their own oxygen probe, however this had run about of batteries and they where unable to locate replacements. We placed a catheter and I did another assessment with all my new found equipment. The patient had a BP 80/52, RR of 30, HR 110, GCS 8 and BM was 25.2mmol. By luck the doctor in charge of the ward round had now shown up. With this information he instructed for some fluids to be put up and to check her BM again in 3 hours as there seemed to be confusion over whether she may have had D50 (a fluid that contains some glucose) and if this was to be the cause of the high reading. The doctor then spoke with the family to inform them they were unable to go ahead with the surgery as there was still no oxygen. Their only option would be to take her to Mulago Hospital 4 hours away. The doctor left the family to decide. After the ward round, I asked the nurse if she could help me wash the patient (as her bed was so wet) the nurse said “no not now its too cold” as I bit my tongue in anger at this response I asked where I could find some stuff to wash her myself and they nurse simply repleied ‘we do not have”. I asked if they provided bedding and again my heart broke as she said “no the family has to provide”. By chance I had some baby wipes in my bag, I used these to freshen up the patient, I asked the relatives to bring in some new bedding to change her sheets and for a tooth brush so I could do some oral care. I went back to do another set of observations. There was already a great improvement in the patient, her BP was up and she was more alert. I informed the doctors and decided it was a good time to go for my break.

When I got back, I had noticed the fluids had finished, the patient looked drowsy again and observations showed a drop in her BP again. The patient’s brother (who spoke quite good English) also informed me they were unable to afford the transport to get to Mulago and for any treatment that they may have to pay for and wanted to take her home. I informed the doctor of this decision and requested for more fluids. The doctor by this point had great news that the hospital was expecting a delivery of oxygen so there was possibility of surgery.

The next day I arrived (again alone, not even a night nurse to greet me) and I noticed the patient was no longer there, 2 hours passed before any sign of any doctor or nurse life appeared and I could ask what happened. They informed me she went to surgery. I decided to go and find her after lunch to she how she was. I went to the female surgical ward to try find her, no sign of her, I asked the student nurses, they did not know what I was talking about, so me and the leader I was with decided to look elsewhere, luckily by chance the leader spotted her (in a male bay) just by the exit. As I walked over I was nervous about what I was going to find. She was sleeping but appeared uncomfortable. As I started talking to her brother, she woke up. I welled up as she grabbed my hand and her brother told me she recognised me. The patient was hot, had not fluids running and was using a lot of effort to breath. A few students nurses appeared and I asked for a thermometer and her patient file. As I made her comfortable and did some observations, my blood started to boil, as no observations or fluids had been documented since I last did them the previous day. It was now 13:00 and she had not received any meds and it worked out he had received only 230mls of fluids and an output of 1200ml. I asked for some paracetamol to be prescribed for her high temp and pain and the doctor said they do not have any paracetamol. I had some in my bag, I asked if I could give her them and the doctor was happy for me to do so. I made her comfortable, ensured she had fluids and told her I was leaving, she grabbed my hand and started to cry and her bother told me that she did not want me to leave her, as tears welled up in my eyes again and knowing it was my last day at the hospital, I decided I would come and see her the next day at 8am before we left, after some reassurance and some instructions to the student nurses to ensure she had some meds, telling them to ensure the fluids were kept up and to continue to check her temperature, I left.

The next morning I arrived and woke her gently. I was overwhelmed to see she looked much brighter. Tears appeared in my eyes when she grabbed my hand and smiled. After a quick check of her obs and fluid balance, I was upset to see nothing again had been documented, she had a cannula that had tissued, and from the notes it looked as if she had not received any meds at all the previous day. I spoke with the doctor and nurse and stressed the importance of this, I removed the cannula, freshened her up, ensured she had new fluids, gave the brother some paracetamol for the doctors to prescribe later for her, had some photos with her from new family members, that had turned up to thank me for my help and then it was time for me to leave. It was very hard to leave, not knowing the outcome of her recovery. However, I hold on to the hope she recovers well as she had improved so much over the 4 days I had known her. It was good leaving knowing she had plenty of family support and I hope I made some small difference to her experience of nursing care.

 

Katie Rothwell

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June 2015

During our time in Hoima, we spent a few days at a private clinic called EDPA. EDPA is more like an A&E than a clinic. Patients walk in and are seen by a doctor. Many of them are then taken to the laboratory to have blood tests. They are then triaged and admitted to the wards if necessary. Most of the patients we saw suffered from severe malaria and typhoid. Whilst we were at EDPA we were involved in drawing up, dispensing and administering medication. We also took part in wound dressings, ward round and laboratory tests.

 

One thing that shocked us the most, was poor sanitation and hygiene. We were not expecting the sanitation to be as good as it is in the UK, but some of the practice was worse than we ever imagined. For example, patients would line up outside on a bench waiting to be cannulated. The nurse would prepare her equipment, which involved sticking tape to the wall ready to be used to keep the cannula in place. This really shocked us as in the UK we ensure sterile tape is used to prevent the spread of infection, but out here that is not the case. Also, in the UK we make sure we use an Aseptic Non Touch Technique when drawing up our medications. However, at EDPA medications were drawn up in a cramped room that was anything but aseptic. Staff would not wear gloves/wash their hands before drawing up medication and once the medication was drawn up it would be left on the side for up to 2 hours before being administered. This probably explains why needles would be found on the floor.

 

It was clear that the lack of funding and facilities was affecting the sanitation in EDPA. For example, they could not afford to change the IV giving set so the same line would be used for different drugs even if it hand been dangling on the floor. However, knowledge and understanding was also a huge barrier to good/clean practice. For example, when mentioned that they should change their gloves between patients the staff seemed to be reluctant and lacked understanding about why this is important. We feel this could be reiterated more to save lives through preventing the spread of infection.

 

This is what challenged us the most, as they were so stuck in their ways, we feel they will continue bad practice which worried us. However, we felt positive that

the nurses are very efficient and caring towards patients. They provide the best practice that they know and work as well as they can with the resources/funding that they have. We also feel that we made a positive impact on patients care and educated the staff as well as we could which we hope will make a difference in future practice.

 

We feel this experience will make us appreciate the equipment that we have at home from small things such as clinell wipes, gloves, water, soap and antibacterial gel to things that are more expensive such as IV giving sets, medications and laboratory tests free of charge. We are lucky in the UK to have the NHS and training that helps us provide best practice and hygienic care to patients.

 

Jess & Sam

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June 2015

After visiting Mulago hospital and experiencing how a general government hospital is run, I thought I would have an idea of what to expect working on a paeds ward. But the visit didn’t prepare me in the slightest for what it was like to actually work there. The first thing that hit me upon entering was the smell, it stunk of urine, the ward was dirty, with used equipment on the floors and beds, it was old, and had broken windows at head height of small children. The other noticeable aspect was the complete lack of any staff bar the cleaning lady. From working there I learnt that the nurses turn up and leave whenever, as the government for months at a time can regularly not pay them.

So, there we were on our first day on our own. There were multiple times where it was just me, Sam and Neil on our own looking after a 49 bed ward, completely out of our depth, and looking after children with severe malaria, anaemia and sickle- cell. But not only did we lack the support that’s so abundant in England, we also lacked the equipment and medication that was so vital for their care. The whole situation made me feel helpless and frustrated, and I can say with certainty that volunteering there was possibly the most emotionally exhausting experience I have ever had. It made me appreciate more than ever the support, and the medical care that’s available to us free at the point of use, though I also felt ashamed that this is not a worldwide thing. It made me appreciate that medication is always available, and that if its not, an alternative is given. Whereas at Hoima Hospital, if the medication isn’t available the parents have to pay, which they can’t always do, so treatment isn’t given. Even when it’s available, we saw many patients that just weren’t given medication, and it was so frustrating to see. Basically, the whole experience brought on a emotional cocktail, and most of the time I wasn’t particularly sure what to feel, ecstatic someone was improving, upset, useless, angry, it all sort of interlinked.

The care that I experienced was a far cry from the NHS, and the ways it varied are too numerous to be listed, but I think the most potent one was the fact that in the mornings we would do a quick round to check all the children were actually alive and breathing, because there was no night nurse to hand over the care of patients, so we had no clue about their condition. It was like walking in blind every single day, and I dreaded this part of the day the most.

During the course of the time I spent there, there were many patients that stuck out to me, but there was a little girl that I don’t think I could ever really forget. She came in with mumps, pneumonia and was HIV positive, and when she was admitted to the ward, she had oxygen levels of 33%, which suggests that she would have suffered brain damage from oxygen deprivation. We had singled her out on the first day as the one to watch, and this continued into the next day. She struggled to breathe and even on oxygen couldn’t maintain adequate oxygen levels, and had a constant heart rate of above 210. She couldn’t maintain this, and we could tell she was deteriorating, but we were unable to do much to help her, as all the staff members had left to go to a lecture and we were left to manage the ward. When they did return, voicing our concerns to the doctors didn’t yield much concern from them, and it got to the point were I was so frustrated by the situation and the unfairness of it all that I had to leave. I found out the next day that she had died, but maybe not so peacefully, as in Uganda they will fight until the end, even if it’s not in the best interest for the child.

We all had our moments where we were so overwhelmed by what we were seeing, and that was mine. I don’t think anything could have prepared me for the obvious poverty present in these hospitals, and the way things are done. It shocked me to see that multiple children were dying of a disease that is actually treatable. At the end of the 3 days, I found it difficult to walk away without feeling like whatever I did, I would never make enough of a difference.

Katrina Lancaster

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June 2015

To say the past few days have been an eye opening experience is an understatement. Those of us going to work in the hospital awoke with little sleep, tossing over the day that would come. Breakfast and the car journey was full of anxious silence, a mere bye and thank you to Denis was all that was said. We split off from the Paeds team and Gemma and I went to NICU. As we entered the NICU unit there were parents lined on a bench with babies, more lined on a bed opposite and then into the next room with parents and their babies. 8:45 and there was still no nurse, so we decided to begin to assess the patients in what was called “HDU” which was a bed with three babies on it. The first had an extravasated IV drip, which had been running since 4pm the previous day – his poor forearm was the size of a marrow vegetable. The night nurse had not kept an eye on it and had left at six that morning, so babies had been there nurseless for hours.

We moved onto the next baby who had little response to pain stimuli, peripheral refill of 10 and central refill of 6, his respiratory rate was little in combination with apnoeic episodes, his temperature 34.6 and o2 saturations in the 70’s and a slowly decreasing heart rate. There we were on our first day, doctorless and nurseless. Finally a nurse appeared at 9:45 who we told to ring the doctor now before the baby dies, we explained the issues and she stopped us mid sentence and said “she was going to get changed into her uniform” (oh yes please do get changed that is definitely the priority) On her return she reported she couldn’t call the doctor as she had no minutes on her phone. I gave her our phone and said it’s urgent, to which in typical Ugandan style she took ten minutes to do. In the mean time we tried to suction vomit out the babies mouth but of course suction doesn’t exist in Uganda so a NGT with a syringe attached will have to do. The doctor appeared unsure of what to do and stood to think for time (because of course the baby had time….NOT!) He finally made the decision to move the baby into an incubator, and oh aren’t we lucky they have them! But only one that actually works and another one that only goes to a temperature of 35.c – so I’m not to sure if that even counts. We gave him o2 “suctioned” and finally stabilised him. And just to point out by o2 I mean a box that relies on electricity, which is as reliable as a Ugandan being on time. It only had one port so there we are make shifting extension o2 leads and connectors, so all the four babies that required it got it.

We began to asses the other patients who hadn’t had weights or obs done in days. Oh and then the 1 pulse oximetry machine that we had on a baby began to bleep – it was our baby from the morning. HR – 70. O2 Saturations 55% in 4L of o2. He was unconscious and deteriorating fast – we called for the doctor but of course he was nowhere to be found. I grabbed the Ambu bag and began to give rescue breathes, we tried to “suction” and all we got back was blood, he then stopped breathing all together lying there pale and floppy, Gemma began chest compressions and I continued to bag. The doctor appeared and stood next to us like a garden gnome, I gave him the bag to take over, in the hope I would manage to find a smaller mask, but of course I couldn’t. I returned to the resus and the doctor remained standing there like a gnome – Ambu bag in hand. Gemma and I kept going and 45 minutes later as we continued to watch him get paler and paler and we watched as the dreaded flat line appeared. We continued but no matter how much we willed and prayed him to fight it was too late, we looked at each other, tears filling our eyes and stopped. The mother burst into tears and left as Gemma and I cleaned and wrapped him up, we gave him a cuddle and said goodnight. This was all before 11am.

We had little time to grieve for we had other sick patients to help, the day continued and the rain poured and then lightening struck which of course shut off the whole power. Gemma and I looked at each other wishing the lightening had not come, for no electricity meant no incubator and no o2. There was an emergency cylinder in the corner of the room but this now needed to be split between six babies, which now meant we were make shifting o2 delivery extensions with the use of tape (because of course tape fixes all). We finally succeeded in our “Art Attack” designs and were left feeling exhausted and drained. The shocking realisation hit us in the car home, the lack of everything in this unit, 1 monitor, 1 thermometer, 1 working incubator all to be split between 10 babies, and in the UK that baby could’ve been saved. There is such a need for equipment, guidance and knowledge at this hospital and you feel if only more knew the struggle, the care provided could be improved and less 22 year old mothers would have to be handed their baby to say goodnight to. It was a waste of a life created.

This is dedicated to the handsome little boy, who is now an angel in heaven, may you rest peacefully and watch over your twin.

 

Lots of love Gemma and Amelia

P.S We had a repeat the next day :(

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June 2015

On our first day in Hoima, we spilt into groups and went to visit families in the community that are supported by KISS. Neil and I visited three families, all whom are all in a lot of need, but one really stuck out to me. The second family we visited lived in a very small home made of brick. There were two tiny rooms with a thin mattress in each on the floor. The family welcomed us into their home and began to explain to us how KISS supports them and how they live their everyday life. The family consisted of a mother and two children, The oldest child was a teenage girl who had sickle cell, she frequently suffers from painful crisis, which she explained usually affects her joints. She used to get help from KISS for her medication to control her sickle cell but without enough sponsorship KISS have been unable to continue to pay for her medication due to limited amount of money in the medical budget. KISS still support this family and are making a huge difference to their lives, for which the family are very grateful. KISS pay for the children’s school fees and pay for the Rent on their home. Without the support from KISS this family would be homeless and the children would be unable to receive an education.

The child then began to explain that without the right medication her life is limited and will have an early death. What I found the most challenging is that if this child was in the UK she would receive the treatment for free but due to the family not being able to afford it, the child is aware she may die early. The child then asked Neil and I if there is any medication that could give her just one year free of pain. In this environment we both felt so helpless and wanted to just pay for the medication but there are so many children that need support and by working with KISS, it gave us hope that we are helping to make a difference.

The moment that stands out the most about meeting this family is seeing how grateful they are for any help they receive. They have so little but appreciate any small thing that is done for them. Before coming to Uganda I had seen on TV how people live in third world countries but being here and seeing first hand how different people live compared to us in the UK is very different than just seeing pictures.

There were many challenges that we faced throughout the day but we managed to overcome these by knowing we are making a difference to these families by working with KISS. They do great work supporting families and children, but the level of need here in Uganda is just too great, and they are just not able to do everything for everyone. It was reassuring to know that we had contributed towards helping people like the families we had met.

 

Sam Seago

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