Jurjen's blog

23/02/08 Lake Bunyoni – The island Bushara

Fluffy balls at bushara

Jurjen in dug out canoe

In the weekend of February 23^rd we went to lake Bunyoni, a beautiful lake in the lower south of Uganda just 10 km from Kabale and near the border of Rwanda. We stayed on an island called Bushara and it was a lovely break! It was a beautiful island with a really nice restaurant. You could choose for a tent or a cottage to sleep in. We chose the tent. But if you check out the pictures, you can see that it was really comfortable. In the evenings there was a nice fireplace at the restaurant. The nights were amazingly silent and the stars brighter than anywhere we’ve seen.

The tent

I, Jurjen was caught up by this book called ‘The Shadow of the wind’ by Carlos Ruiz Zafon. Beautifully written and utterly gripping… I read the whole book in three days.. a highly recommended read. We just enjoyed the good food, like roasted pork with chips, pizza and in the morning amazing lemon scones and French toast with filtered coffee (for a change). The island is known for its birds. Quite divers. One of the days we hired a dugout canoe and peddled around the island. We really returned to Kisiizi blessed and refreshed.
 

Flower on bushara

Bird on bushara lake bunyoni

01/03/08 5th week Out Patients Department (OPD)

I have seen many patients this week. Every patient who is admitted in the hospital, or can be treated at home, comes via OPD (polikliniek). With the help of a translating student-nurse I have seen, examined, and diagnosed many patients.( Sometimes I felt really lost in translation!!! But I now know very useful words in Rukiga language, like ‘vomiting’, ‘pain’, ‘diarrhoea’ etc.) The first days I consulted one of the other clinicians after each patient, but later on, I have been working more independently. One of the reasons for that is that often they are not around when they should be… It was good to notice  that during the week I got more and more used to it, and felt more confident of what I was doing. I tried to stick to the UG ( Ugandan Clinical Guidelines) of which I am the only user. The lab investigation that I definitely used most was a blood smear for malaria! It felt very unreal, to admit two newly diagnosed TB patients, after requesting a chest X-ray. To send people for HIV testing, and they report back positive. To see patients come in, so very sick, carried by relatives, travelling great distances.  It was almost a relief to discover, that even here people consult a doctor for a simple headache!

Vitamin A fights diseases and protects lives

28/02/08 Ugandan Health Care

Although conditions here can be quite shocking, the health care in Kisiizi hospital is so much better than in government hospitals, where you have to bribe a nurse to dress your wound or give you drugs. Where you have to pay the doctor to come out of his private clinic and in order to assess you. The other day the nurses and doctors were on strike in one of the government hospitals in the country. Eleven dead patients were lying on the ward, but nobody there to take them away! People from far away places visit Kisiizi, because they know there is a good over-all health service. Many people from this area however are still unable to pay, and are unable to access he healthcare facilities. They stay in their villages, up in the mountains.

23/02/08 4th week: surgical ward/theatre

Theatre. The nightmare of all western hygiene. Doors open immediately to the outside world. Sterility has a different meaning here. Dressed up in blue operation clothes, rubber boots, a plastic apron and a sterile gown, I have spend many hours in one of the oldest buildings of the hospital.

Man about to go into theatre

19.30h Wednesday evening. I am still in theatre, an emergency operation. A man who has been operated upon a few days earlier was send home too soon. Now he is critically ill. Severely wasted, breathing fast, his body fighting against a terrible infection. A horrible smell comes from the wound in his abdomen. His bowels started ‘leaking’, due to the poor bowel surgery he had a few days earlier. This was the closest I have been to fainting in what I have seen (and smelled) here or in Holland. After a few hours were are done. In spite of all efforts, the man dies the following night. This week I have been in theatre with the English surgeon who has been here for nearly 9 years. He is a great doctor! Very straight forward, sometimes giving me the third degree during bedside teaching or operations. But I have learned so much from him. He does general surgery in the broadest sense of the word. It will be a great loss to the hospital when he and his wife leave for the UK in April. There is an overload of theatre staff, and still the surgeon has to do everything himself. Patients are not prepared, equipment is not ready, staff is missing (taking a longer break). I can imagine how hard it must be for dr. Shutt (the surgeon) sometimes. His conclusion is that nothing has changed in 9 years. People are not thinking ahead, and not taking responsibility. He has tried very hard. That is why he only does ward rounds two times a week, so the other days the other doctors and nurses are responsible. The practice is however that they rely heavily on him. I really felt the tension between giving good patient care and trying to let others take over. I have seen so many things this week; amputation, resuscitation (reanimatie) of a heavily burned 1 year old boy. Dr. Shutt had to cut the burned skin completely open so the boy could breathe again. Bowels, stomach, prostate, ulcers, bones. One of the operations that can also be performed here are VVF operations. Due to prolonged labour in women who give birth in the villages, some develop fistulas (openings) between the vagina and the bladder. They become incontinent for urine. Most of these women are poorly educated, very young and either raped or given in marriage. (because the chance of HIV in young women is lower, so they are preferred by men). When they are incontinent, they are often sent away by their husbands, out of their homes. They are very disabled and looked down upon. They are not able to work for money for the operation, often they become malnourished. Luckily the hospital has a budget to help some of these women in these miserable situations.

25/02/08 The road to Nyarushenje

matoke trees alongside the road

Imagine a landscape so beautiful, so green, so paradise-likeJ.. That’s where we are staying. Leaving Kisiizi on the red earthen road I am immersed in the beauty of the mountains. Slopes full of matoke trees (green banana trees), houses scattered around the hills,  the sound of the running river. Every now and then a loaded truck with charcoal and many people is speeding by, creating clouds of red dust, filling your every pore. Sometimes a steep walk uphill. People  walking by or sitting at the side of the road, carrying bags on their heads, children on their back. Children with bright yellow jerry cans, laughing and full of excitement with the passing muzungu. The whole scene is so bright and colourful…Last week when I was walking alone, I had more than ten children following me, the sounds of their flip-flops and giggling following me, whenever I slowed down they did too, registering my ever move. Walking quietly here, going unnoticed, is absolutely impossible.. Sometimes difficult, when you realize that there is such a gap. We will never be one of them. Seen as curious beings. Unable to communicate with them in a meaningful way. Sometimes just waving back, laughing at their excitement.  On one occasion I’ve been walking with Abius ( a medical assistant) all the way to Nyarushenje, an hour and a half, to the monthly market. Our goal: to buy me a pair of closed shoes… because I didn’t pack any, and I really needed them in the hospital. After much bargaining ( the word spread fast that there was a muzungu at the market, which made the prices rise immediately!) in a crowded, massive marketplace, with heeps and heeps of black shoes, I became the owner of the most decent black shoes (ecco!!)  I will ever have! It was great being there, seeing local life. Visiting some relatives of Abius (including a few of his father’s wives) who were camping for a day just behind the market, having a cup of African tea. It was a very genuine experience.

17/02/08 Visiting Allen and Robina

The family of Allen and Robina and us

On Sunday the 17^th we went to visit Allen and Robina, an African couple living close to the hospital. Allan had been assisting me on the electricity project and so he invited us to come over and eat some real African food. His wife Robina is an administrator on the hospital’s primary school. Being both employed they are quite well off. They invited us to go to their church on Sunday and then have lunch. We, off course, had to stand up in the middle of the service to tell the congregation who we were… At the end of the service there was an auction for the church. The object was a piece of fruit! A sort of pumpkin, but then a type that you could eat straight away. We bid up to 6000 shilling (€ 2,50) but we lost! A guy bought it for 7000 but then gave it to us… The pumpkin would cost only 200 on a market (€ 0,40) but it was a fundraiser for the church. Normally, we were told later, people would bring in goats and sheep and stuff like that for auction but it was a quiet Sunday apparently. After church we went to Allen and Robina’s place.

The church of Allen and Robina

It was really encouraging to see this special couple. They are definitely not like the average African couple. They really loved each other and Allen is quite involved with family life which is not common. He really shows affection to his kids. We also sensed that their faith in God is really genuine. Like I said, they are quite well off because Robina is an administrator and Allen is a constructor. He builds houses. They also own some land with Matoke trees (type of banana) and some other vegetables and fruits. He also owns two cows. They take care of more children than just their own. They have four children but they pay school fees for 10! Allen lost ALL his brothers and sisters. He is the only one left of six... Robina cooked us a real African lunch. Matoke bananas, rice, egg tree, some other vegetables and ground nuts. Their hospitality was thrilling.

16/02/08 Playing with the children of Dawanguvu Primary school

Kids at Dawanguvu primary school

On february the 16th we went with Christian Kirk (the Irish guy) to one of the schools they are supporting to see whether we could hang out with the children there and play with them. So we did… check out the video for an impression! It was really encouraging to us as well being able to just be with these children showing them love, affection en interact with them. Here in Africa parents and teachers don’t really play with children.

We both really felt a deep sense of God’s love for them. Just sharing life. For Stefanie it was also just really good to bring some fun and joy instead of having to examine (mostly chrying) kids. For me, not being naturally the most gifted one to work with children, it was just encouraging. They were so easily entertained. Totally not like children in the Netherlands who would probably be bored within five minutes. Already making photo’s and showing them was loads of fun. This was Africa with a smile for a change!! We really felt that playing with these kids was really significant for them. And definitely would like to go back some time.�

Video made of our visit at Dawanguvu Primary School

17/02/08 Bonita

One of the little babies on children’s ward died this week. Bonita was a few months old baby girl. She had suffered from meningitis (hersenvliesontsteking), and as a result she had probably developed some brain damage. A staring gaze, little hands clenched into fists. When I did wardrounds I found her, breathing heavily. I could hear her lungs were filled with mucus, probably because she wasn’t able to swallow correctly anymore. I am glad that I asked the doctor to review her, because I didn’t trust the situation.  She was a bit better when we saw her again… and we asked the physiotherapist to give her chest physiotherapy to relieve her breathing. When I went to see Louise (the Irish physiotherapist) she was laying her hands on Bonita, gently and rhythmically tapping her chest. Bonita looked so peaceful, finally dozing off after a night of difficulty in breathing. Her eyes closing slowly under this soothing treatment… That night she died. When I heard this news the following morning, I went inside the guesthouse. I broke down and cried and couldn’t stop anymore. I felt so overwhelmed by sadness, and knew God’s heart was breaking too. Probably I was also crying over all those other difficult and sad things I am encountering. After a while Jurjen and I read Psalm 139. He was Bonita’s Creator, made by Him in the secret place. He knew her. And I am sure she is with her Father now. And I felt very strongly that when I read “You have laid your hand upon me” (verse 6), that when Louise was placing her gentle hands on Bonita, that they were the hands of the Father..

17/02/08 3rd week: Children's ward

Stefanie doing ward round II

Over 40 children occupy the beds. Some are sharing one. Some are crying, some are too sick for that. Others are recovering. Mothers are attending their children, sleeping in the same beds. The last three mornings I have been doing  wardrounds on my own,  again quite stretching. .. So many children to be seen and examined, decisions to be made on treatment, figuring out what the accurate dosage is for medication.  It can make my head spin sometimes. Many burst out in tears when they see such a white person approaching. In some cases the comfort of their mother’s breast calms them down. On the other side of the building is the open kitchen where the attendants of the patients can cook their meals. Black walls due to the smoke coming from the cooking fires. Smoke also comes in via the open windows. It is also used by the nurses of the children’s ward. Here they educate mothers on how to prepare nutritious meals for their children. 

It is heartbreaking to see those little ones who are admitted because of malnutrition. Not always skinny. At the moment we have a 5 year old, very small, but completely swollen due to lack of protein and leaking cell membranes, his skin is open in some places. His hair not black anymore, but pale and thin. They are highly susceptible to infections.  Most children are admitted with either pneumonia (longontsteking), malaria, or dehydration due to diarrhea and vomiting. Sometimes you can see the therapeutic scars/wounds, afflicted by the herbalists or witchdoctors. In some cases they makes situations worse. Burns are common here, due to the cooking on wood fires.  Some of them are burnt terribly, scarred and disabled for life. One of these patients is a girl with epilepsy. She wasn’t on  any treatment previously, due to the great stigma on epilepsy in this culture. She has fell repeatedly in the fire because of here convulsions…Toys are there, but they are taken out only seldomly. And when they are taken out by the nurses, you can see that the children are not used to playing. Every Thursday afternoon there is singing, a bible story and one pencil each to draw with… In the afternoon I’ve been going to theatre, assisting the visiting orthopedic surgeon. In one week he operates upon some 30 patients, all children. Clubfeet (klompvoet), paralysis, neglected osteomyelitis. The latter one being an very destructive infection of the bone, which can make bones disappear completely, and leave terrible deformities.

Stefanie doing ward round

It is unimaginable, that through what starts out often as a simple infection of the skin (often combined with malnutrition), can cause such huge disabilities. I was glad I was wearing my protective glasses, cause it involved a lot of bone cracking, hammering and pulling legs (quite heavy, I came home late and tired!!).. Later on in the week I’ve been doing some minor surgery, while the doctor was supervising me. Adding to my experience once again…

10/02/08 2nd week: Maternity ward

Saturday morning  10th February.. I am just getting out of bed. Then I am beeped. Beeping is calling someone on their mobile phone, and after it went off once to hang up again. It’s a way of communicating that is cheap. ( when you are a muzungu you are the one who is supposed to call back). I hurry to put some clothes on and rush to the labour room.  This week I’ve been on maternity ward, and had the privilege to deliver three babies!! ( and hopefully many more to come, the beeping system is excellent to let me know if there is any woman in second stage, in other words, who is about to start pushing).  It is so special to be the first one who holds such an alive, warm, tiny, beautiful baby in your hands!  I was even allowed to do an episiotomy ( een ‘knip’), though the scissor was really, really blunt, and I had to cut at least 5 times! Au!! Afterwards I was also allowed to repair it. That happens with a very big needle (echt een pook!!), no good light, no stands for the women to place their feet on. It is something to be really careful with, regarding the high prevalence of HIV/aids.. so I am really stretched in my experience.  What a world of difference…Here women don’t have the rituals of ‘puffen’ (sorry don’t know the English word) during contractions. Husbands are not present.  Showing pain, or shouting is not very appreciated. Midwives were even laughing at a woman who was already on the ward for a few days. The child inside her had died some time before, and we had tried to induce labour. She had been waiting for days.. I was there when we tried to stimulate the contractions, knowing she was going to have a dead child. But the midwives were asking me questions about the Netherlands, laughing and talking next to this woman. I felt so akward. No privacy, no empathy. When she was finally in labour, she couldn’t handle it anymore, she  screamed for help, only to be met by harsh words… At that moment I was conducting another delivery, which was a beautiful baby boy. The mother though, had wanted a girl. The first words this baby heard were coming from the midwive: Your mother doesn’t want you”.  I hope these words were contradicted by my prayers.  My experience has grown also by doing wardrounds (visite lopen) each morning. In the end doing them alone, without a doctor. Cesarean sections (keizersnedes), pregnant women with malaria ( my specialty J , because I did my medical research in 2004/5 in Zambia on this issue). And downstairs (gynaecology) a lot of hysterectomies (baarmoederverwijdering). A very common operation here, due to lack of alternative treatment for many conditions.  It was an intense week, filled with both happy and sad moments.