Impressions

The People – Incredibly welcoming, generous and friendly. When we walk down the street, we’re struck by how cheerful people are. It’s clearly a very close knit community, lots of people bumping into old friends, shaking hands, always with a smile. On our way from Kampala, our driver thought he’d splashed a pedestrian when he drove through a pot hole. So he pulled over to check he was ok and apologise, turns out the man hadn’t even gotten wet!

The Pace – Slow! But then, when a nurse only earns £75month, £50 of which goes on rent and most of the remainder on food, what’s the rush. There’s not much else to do except make things last. And to add to the above point, one of the nurses from Manchester who has been working in Gulu for the past 6 months had a leaving party last night. Despite the relative poverty with which people live here, she got generous gifts from a number of the nurses on her ward, all beautifully wrapped.

The Food – Well, it depends if you like boiled goat, dried fish and LOTS of carbs. No, I’m being unfair. It’s ok, perhaps a little less interesting than the choice we have back home, but when the electricity goes off every other day for between an hour and 2 days, anything that needs to be refrigerated is kind of out of the question.

Meal Times – Amusing. Dave and I have been to a couple of people’s houses for lunch. On both occasions, this began with a prayer, followed by a hand washing ceremony, and then the TV was switched onto soap! The first time this was a Philippino soap, the second time it was a Spanish soap – both horrendously dubbed with American voices, and even one random very British voice. Although it seemed a little strange to us that you would have guests for a meal and insist on watching the equivalent of neighbours, we actually really enjoyed it and so thought not much more about it. Until, when we were out for dinner last night at the leaving party (comprising all the staff from the surgical ward, including the chief exec of the hospital), we spotted a TV in the corner of the wooden hut at the restaurant. I actually joked with Dave before the meal that it must be for watching soaps whilst eating. I spoke too soon. No sooner had grace been said, the dubbed Spanish soap crackled onto the TV. Unfortunately, the reception wasn’t very good because there was a tropical storm raging and so after 5 minutes of moving the aerial around, the TV was switched off and scanty conversation ensued.

The Hospital – A HUGE challenge. From talking to the nurse from Manchester, it sounds like the surgical ward is significantly better organised than the medical ward, which is so far from what we know as a hospital in the UK. For those of you who don’t know, in the UK, the nurses do regular observations on all patients such as blood pressure, heart rate, respiratory rate etc. This enables them to identify patients who are unwell or deteriorating. They can then either implement a treatment themselves or request a review by a doctor. This is not done on the medical ward. So, other than walking up and down the ward trying to identify any sick-looking patients by eye, which encompasses most of the patients, there’s no way to prioritise who you see first when you arrive on the ward. It also means that our review of patients always begins with doing the routine observations ourselves. This is particularly frustrating when you can’t get an accurate blood pressure reading because the cuff is too big for almost every patient’s arm (we have the opposite problem in the UK as you might imagine). We had our first death this week, a girl in her 20s with HIV. We don’t know the exact cause of her death but we do know she had a haemoglobin level of a quarter of what it should have been (and in fact, it was a nurse who took the blood and asked for an urgent haemoglobin check once she spotted that the girl looked unwell). She died whilst she was having a blood transfusion. It’s really sad to think that maybe her life could have been saved on that occasion if she’d been identified as being the most unwell patient and therefore the priority to be reviewed that day.  There are many other frustrations and difficulties, including the lack of investigations, drugs, and doctors (apparently there are no doctors on Thursdays and Fridays because the ward doctors are at clinic and thus the ward is run by well-meaning medical students).

Anyway, lots to think about. And things are no doubt on the up. In fact, US Aid are currently building a brand new laboratory for the hospital – a much needed commodity that will no doubt save many lives.