I'm still here

It’s been a fair while since I updated my blog, so I suppose it’s about time to try to prove that I am still here in Uganda and actually doing some work. I left the hospice in Mbarara in October and after going back home for a few weeks to catch up with friends and family, started with the Palliative Care Unit at Mulago hospital and Makerere University in Kampala.














We have a small but perfectly formed team consisting of two other doctors in addition to me – Dr Mhoira who’s head of the unit and Dr Liz who’s the same level as me, training in palliative medicine.
We have 5 fantastic specialist palliative care nurses and a team secretary who’s fantastic.









Mulago hospital is the National Referral Hospital with around 1500 beds but probably around 2000 in-patients as many of the patients are squashed into and outside of the wards. We see patients on any of the wards who have life-limiting illnesses and require pain and symptom control, but due to the current morphine shortage are also seeing patients on other units with severe pain. In the last few months we’ve had many referrals from the burns unit to assist with pain control.




A Patient on the Burns Unit who we assisted with pain control







As well as my clinical role, supporting the nurses in reviewing the patients, I’m involved in developing some research projects, teaching undergraduate and postgraduate students and continue to work one day a week at Hospice Africa Uganda with the ongoing development of the BSc in Palliative Care. That keeps me fairly busy but is incredibly exciting and rewarding although a bit different to my recent work in Mbarara trekking through banana plantations to visit patients.

I should just briefly mention the recent morphine crisis which has been causing us lots of distress in recent months. Basically, the ways of ordering morphine through the government system have changed recently and the result has been that there has been no morphine available through the government sector for several months. The morphine is supplied to all hospitals and health centres across the country and also many of the non-governmental organisations such as some of the smaller hospices. This has meant that for the majority of patients in the country the strongest painkillers they can access are codeine or tramadol which are also very expensive and not the most effective analgesics for managing severe pain from cancer or HIV/AIDS. Hospice Africa Uganda (HAU) however imports its own morphine powder to make up into liquid and therefore continued to have a supply, although not sufficient to help everyone in need in the country. Our unit came to an agreement with HAU that they would supply us with morphine liquid so we could continue to help the patients in Mulago. With the support of many friends and family via Cairdeas (a Scottish charity of which Mhoira is the medical director and which supports Mhoira and myself over here), we managed to raise over £4000 which meant we could pay HAU for providing morphine for the patients in Mulago. Without raising this money HAU would not have been able to give us the morphine needed to treat all these patients. As for the future, it looks like morphine should be available to all the government hospitals in the next few weeks (hoping and praying lots!).

Supply of Morphine from HAU














Life other than work is pretty calm at the moment. I’m living on the same compound in Kampala as I was before but in a different house and have lots of fabulous neighbours. I’ve gone back to the very lovely Baptist church I was attending before so get my weekly fix of singing and dancing (and some spiritual input) which keeps me going. For once I don’t have lots of photos from exciting trips I’ve been on (although the UK at Christmas with lots of snow was loads of fun!) but so as not to disappoint I am heading off to India later this week for a palliative care conference and to do some teaching so hope to have more exciting photos on my next blog!

So I’m going to end here for now. The invitation is still open to friends and family who fancy a trip to Uganda – free accommodation in Kampala included! Until next time……

India and other exploits

I’m aware the time between my blogs is increasing, my excuse is being very busy rather than just being on one long holiday though, although read on to discover if this is really the case……

So I should start off with my trip to India. As I mentioned in the last blog, I went with Mhoira to help out on teaching the Palliative Care Toolkit to some doctors, nurses and social workers in Lucknow, in Uttar Pradesh (UP) in the north of India. I arrived in Delhi to be met by Mhoira who’d already been in India for a couple of weeks doing some visits and teaching, and stayed with some friends of hers in Delhi for a couple of nights (Dr Chitra who came with us to UP and her husband). We went on a rushed shopping-trip the day I arrived to kit me out in suitable clothes for the 45 degree heat – loads of beautiful clothes and I had to stop myself getting too carried away. We flew down to UP the next day and were joined by Nicholas who is from the UK, and has been developing an organisation with Mhoira and others to sponsor Palliative Care education and training in developing countries. He came along on the trip to find out how the training toolkit works. On arrival, we were treated to a tour of Lucknow including a stop-off for bun-butter – a bit like cream buns, but with buffalo milk filling, and Indian chai, followed by amazing kebabs in the evening in a back-street kebab house.



Nicholas and I were also lucky enough to visit the Bara Imambara – a muslim shrine in Lucknow and had a whistle-stop tour by an Indian guide who spoke incredibly quickly and practically ran round the building, stopping periodically to spit – extremely random but quite entertaining.



The next 5 days were spent at the Sanjay Gupta post-graduate training institute (SGPGI) running the Palliative Care toolkit. This was developed by a team of Palliative Care experts from several different countries as an introductory course to PC for healthcare professionals and includes a manual for students as well as a training manual for those teaching to assist with the training. We had around 25 students for the week, mainly from Lucknow but also from other parts of UP. At present, UP has a population of around 160 million people, with only 2 centres who provide PC, so there is a huge need for training there. I met lots of inspirational people attending the course who are hoping to try to develop PC in their settings with very few resources and usually no extra remuneration for the extension of their role. It made me feel very humbled. We were also able to visit a couple of hospitals during our visit and met with other doctors and nurses hoping to set up PC services. Cairdeas, the organisation which Mhoira is sponsored by helps to fund some of the training and development for such groups.

A definite highlight of my trip was my visit to the Taj Mahal – absolutely stunning despite the 45 degree heat! The food was also incredible – so much flavour, spice and variety compared to the matoke which is served everyday in Uganda!

For the last few weeks I’ve been in Mbarara, settling into the hospice and really enjoying the clinical work. I think the trip to India training other professionals reminded me why I love the job so much. We’ve continued to see lots of challenging cases and it can be really difficult to know the right decisions to make sometimes, but the clinical team are fantastic and we can always come up with what we hope is the best solution for the patient and their family. One example is a 3 year old girl we saw a couple of weeks ago. She’d been referred to Mbarara hospital for chemotherapy from another hospital about 4 hours drive west where she’d been receiving treatment by the surgical team for about 5 months. At the age of 1, she’d had both eyes removed because of a tumour called retinoblastoma which is genetic and had affected both eyes. A few months before we saw her, she had developed a tumour on her right thigh, which had gradually increased in size, despite several attempts at removing it by the surgical team. She’d been under the care of the local palliative care team in the hospital who’d given her oral morphine as she had lots of pain in the leg. She was brought to hospital by her mum and dad who have 5 other children, the youngest of whom is only a few weeks old. Her dad had sold all their animals in order to pay for her treatment. We saw her initially on the surgical ward (children under the surgical teams in Uganda are kept on the adult wards, mixed in with either the male or female patients), when she was in loads of pain, despite her dad giving her the morphine regularly. The bandage on her leg had also not been changed for several days as the ward had run out of dressings. We increased the morphine and arranged for one of the paediatric doctors to see her and transferred her to the paediatric ward where we changed her dressing and discovered a huge tumour on her thigh which was bleeding as the dressing had become stuck to it. After lots of discussions with her parents, we eventually together made the really tough decision that no further treatment was possible. The tumour she had would be unresponsive to chemotherapy and her parents decided to take her back to the village where she could be with the rest of her siblings for whatever remained of her life, but with her pain better controlled. I’m continually humbled over here by the ability of people to cope with really tough situations and to never complain, but actually to be very grateful for the care they have received, even if it seems to me that the care has been inadequate.

Roadside Visits with my translator Carol
During the last few weeks I also went on outreach with the team again, but this time going ‘Roadside’, which means stopping every so often to review patients in small clinics, in rented rooms or under trees. As our patients live such long distances from the hospice, over the years they’ve developed mobile clinics so we are able to see our patients closer to their homes whilst not being able to visit all of them in their home individually. There is a fantastic system of community volunteers who have been trained by hospice to identify patients in the community who may benefit from palliative care, but also do lots of work on early identification of potential cancers and prevention of other illnesses. We visited one of their clinics where they bring the patients who we are reviewing every month and they had lots of posters they’d made about HIV prevention, healthy eating and checking for possible cancers – all very inspiring.


The Volunteer Team and Betty, one of the hospice nurses







The next few weeks are going to be fairly hectic for me here – back to Kampala to continue the face to face teaching for the BSc – first and second year students together this time though – action-packed couple of weeks! In September I’m off to Namibia for the African Palliative care association conference, then back to the UK for a few weeks in October to catch up with friends and family and prepare for my second year in Uganda – all very exciting.

Future Plans

I can’t quite believe it’s June already – time is racing away over here. I had a fantastic couple of weeks with my sister Kate, brother Hugh and brother-in-law Steve a few weeks ago. Kate and Steve were here for a week and Hugh stayed for two. We spent the first week in Jinja rafting again, then we went to Murchison Falls on safari again (don’t think I’ll ever get bored of this). We had a fantastic week and I think Kate and Steve got to see a fair bit of Uganda and were entertained by Ugandan driving and the amount people can carry on the back of motorbikes! The second week was spent with Hugh, Mhoira, another of my friends from Kampala, Amanda, and her brother Andrew, climbing Mount Elgon in the east of Uganda on the Kenyan border. I would describe this as an experience – probably one never to be repeated by myself but something I’m glad I did. The climb took 5 days in the end, and we made it to 3945m – not quite to the peak but still quite impressive! It was my first experience of ‘rough camping’ very different from years of family trips to camping club sites in the Lake District! The first day was probably the worst. We started climbing a bit late partly due to a massive downpour on the way to the start-point, driving along a rather flooded and slippery road which was not my best driving experience so far in Uganda. The first day was walking through woods, which turned out to be very slippery when it was raining, and not much fun in the dark for the last hour. We arrived at our first camp which was a cave full of bats and giant rats with no latrine of any kind- we just had instructions to go behind a rock! Our tent was sited on a rock which the thin bed-roll didn’t really provide much padding for! I think we were so exhausted from the climb that we did manage to sleep for a few hours. We had considered just packing up the next morning and heading back home again, but with the sun shining felt more up-beat and decided to continue. The second day was the most enjoyable of the trek. The weather was sunny but cool, the scenery fantastic and company excellent. We also arrived at our campsite in the light and spent a few hours just chilling out (I was also able to wash my hair in a bucket of warm water – simple pleasures!). In the evening our porters entertained us with a ‘circumcision dance’. The youngest of them was 18 and was due to go through the procedure was real in a few weeks time – it was a very surreal moment.

We reached the Caldera on the third day – the highest point of the climb – which we had initially thought would be a valley with a small lake. It was a valley but contained plants like something out of space with giant lobelias around 6 foot tall and other weird and wonderful fauna. Our excitement for making it this far was somewhat dampened by the rain and the lengthy climbing uphill for what seemed like days. We were meant to complete our descent on the fourth day but it absolutely bucketed with rain so we decided to stay another night rather than complete the last section in the rain and the dark (a decision we were extremely glad we had made when we found out how long the descent was the following day). The last bit of excitement on our epic trip was when the taxi taking us back to our cars at the start point got completely stuck in the mud and needed many Ugandan men to physically lift it up to remove it from the big rut where it was wedged – quite impressive as they’d just spent the last few days trekking with us and carrying all our stuff! We stayed the night at Sipi falls and I don’t think I’ve ever enjoyed a hot shower and a waragi and tonic more!

After dropping Hugh at the airport, I spent the weekend in Kampala with my old neighbours then headed back to Mbarara and finally moved into my new house where I’m really settled now. The last few weeks at work have been really good. There’s still a lot of frustrations with patients not being able to access treatment for cancer that they would at home or even if they were in Kampala, but I still feel we’re making a real difference to the quality of people’s lives in relieving their pain and other symptoms. I had a really good meeting with about 15 of the senior staff nurse in the hospital where I explained about the role of hospice in the hospital, the need to try to refer patients to us early and prescribing of morphine by the hospital doctors. One of the senior nurses has recently been on a palliative care training course run by hospice Africa Uganda and is keen to start a small team in the hospital to identify the patients with palliative care needs earlier – this is an exciting development which I’m hoping to help out with. One of the things I feel really passionate about is trying to develop palliative care within the government sector rather than relying on NGOs, such as the hospice, to provide all the care. This leads me on to talking about my plans from September onwards. As most of you are probably aware, my placement here is for a year, with the plan to return to my palliative care rotation in London in October. However, I’ve been rethinking this plan and at the moment am applying to stay here for another year but return to Kampala and work with Mhoira at Mulago hospital and Makerere University, developing the hospital palliative care service and doing some research amongst other things. This isn’t definite yet but it really feels like the right place for me to be. One of the things I’m still working on is how to finance the extra year. This year has been financed by a bursary arranged through Hospice Africa Uganda, but I need to try to raise some funds for another year. I’m rubbish at asking other people for money but if anyone feels like contributing to keeping me in Uganda, all help would be appreciated. My brother and my dad are planning to do a sponsored cycle in a couple of weeks to raise money for HAU and Cairdeas (the organisation which support Mhoira’s work here and would be helping to support me - website is www.cairdeas.org.uk) so any sponsorship would be much appreciated – I’ll let you know the details when I get them.

I’m off to India next week to help out with teaching on a 5 day introductory course in Palliative care for health professionals (may also be doing a bit of sight-seeing during my trip – don’t want to dispel the myth that I’m still on one long holiday this year!) which I’m really excited about – more about that in my next blog. Until next time…..

Frustrations

Thought I should try to update my blog before heading off on another holiday (don’t want to dispel the myths about this being just one long holiday!). I can’t believe I’m over half way through my year here – time is just racing by! I’ve settled into life in Mbarara really well and will finally be moving into my new little house tomorrow. It’s about 5 minutes walk from hospice and has 2 bedrooms and a lovely veranda. The view of the hills would be stunning if it weren’t obscured by a very high fence with barbed wire on the top to prevent any intruders – can’t have everything I suppose.

Life at the hospice here is pretty hectic with lots of staff changes so we’ve only got 5 full-time experienced clinical staff at the moment. The others are really enthusiastic but will little experience of palliative care so can’t really see patients without supervision yet. I’m loving seeing patients on my own though with the help of Carol – a volunteer at hospice who’s a trained counsellor but looking for a job – who translates for me and is also my dancing buddy. I’ve been going to the hospital a lot as the others find it rather tough and frustrating whereas I’m enjoying the challenge although have some rather frustrating weeks there too! We’d been reviewing a 14 year old girl who’d been on the surgical ward with massive neck swellings and difficulty breathing and had been referred to us for pain control. The swellings were getting worse and she was becoming weaker but unfortunately none of the doctors on the surgical ward seemed to think she was a priority. We thought she probably had lymphoma but she needed a biopsy to confirm this before she could start chemotherapy. Unfortunately the surgeons have rarely been operating for a number of reasons – no oxygen, no drips, no sutures…. and she never got her biopsy but died in the hospital. Absolutely heartbreaking and we felt so helpless. The junior doctors on the ward couldn’t do anything, neither could the ward sisters who were equally frustrated and we never see the surgical doctors in charge. There have been a couple of other young patients dying in the hospital over the last couple of weeks too. We have seen them and managed to control some of their symptoms but they unfortunately came to the hospital when their disease was too advanced to be able to have any treatment. On the more positive side at the hospital though is that they have morphine again from Kampala and the junior doctors are happy to prescribe it for the patients following the training they received from the hospice education team during their undergraduate years.

I’ve continued to go on some interesting home visits trekking through Matoke plantations (this is the staple food of this region – green bananas basically which are cooked and mashed a bit like potatoes but much more stodgy – I haven’t discovered a love of them as yet!). There are constant calls of Mzungu Mzungu from all the children we pass – the rest of the team find it really amusing that I attract so much attention. We see patients at all stages of cancer diagnoses and also patients with more advanced HIV although only about 20% of patients on the Mbarara programme have HIV – the rest have mainly cancer. As I may have mentioned before there is lots of funding around for patients with HIV – I think there are around 50 different organisations registered in Mbarara caring for patients with HIV. Whereas we’re the only organisation looking after patients with cancer and struggle to find donors willing to give money for these patients.

As well as the clinical work I’ve been working on a research study for which I finally handed the protocol in today. I’m also continuing to work with the BSc team – was marking draft assignments a few weeks ago and writing modules for the second year which starts in August. We’ve also been submitting abstracts for the palliative care conference in Namibia in September which I’m hoping to go to (another excuse for a holiday I know!). I also have plans afoot to go to India in June to teach on a palliative care course with Mhoira (consultant from Mulago and Makerere university in Kampala and buddy from my old compound) – should be lots of fun – will update more nearer the time.

I’m going to leave it here for now – only have one more day at work then heading off on holiday again with one of my big sisters, her husband and my brother – can’t wait!!

Mbarara at last

I’m going to be quite controversial in this blog and talk mainly about work as I’ve not be off gallivanting around Uganda so much during the last month and have mainly been working. So, I’ve finally made it to Mbarara and have had just come to the end of my 3rd week here. The hospice here is much smaller with around 20 full-time staff and a much smaller clinical team. There are 5 nurses, 2 clinical officers (a position between nurses and doctors who have done 4 years of training and run a lot of the primary health-care around Uganda as there are many more of them than doctors), a dispenser to give out the medication from pharmacy, a doctor working one day a week and myself. We have around 500 patients enrolled on the hospice programme currently and see them weekly – monthly, depending on how stable they are. There is also no in-patient facility as hospice care in Uganda is generally home-based which is more culturally appropriate. We have 3 outreach clinics a month, run from community hospitals or church halls. As there are so many areas around south-west Uganda without palliative care, even though we official only cover an area of 20km radius around Kampala, in reality we see patients from a much wider distance. The outreach clinics enable us to reach patients who are unable to afford to travel to the hospice themselves, or who we are unable to go to their homes due to lack of time and resources. As part of the outreach clinics, as well as the team going to see patients in the community hospital clinic, we have a team who does roadside assessments where we arrange to meet patients or their relatives at a particular point such as next to a shop or clinic, then review them sitting under trees or in the hospice vehicle – not the best means of assessment but better than not seeing them at all. We always take a big suitcase full of medications with us which we then dispense by the side of the road to the patient or their relatives. It has been found to work well over the 10+ years it’s been running so far. I’m just amazed that the patients or their relatives will just sit waiting for hours by the side of the road for us to arrive, with no complaining at all if we’re delayed – quite refreshing compared to some of the moaning to be seen in GP surgeries at home!!

As well as the outreach clinics, we see patients at the hospice, in their homes and in the local hospital – Mbarara Regional Referral Hospital which is the major referral hospital for the south-western region. About 80% of patients under our care have cancer, most of the rest have HIV/AIDS. There are lots of organisations in Mbarara looking after patients with HIV/AIDS but we’re the only ones dealing specifically with patients with cancer. The hospital has some very good staff, but the facilities appear to be lacking significantly. Specifically for our patients, there is no oncology service. The only oncology is at the Cancer Institute at Mulago hospital in Kampala. Whilst we can refer patients there for treatment which in theory is free, the reality is that even if we assist patients with transport to and from Kampala, they are still required to take a family member with them to care for them whilst in hospital, they need to find money for food whilst they’re there and often need to pay for other tests and drugs which the hospital has run out of – an expense that most people can’t afford. I’m finding it extremely frustrating therefore that for patients who have conditions such as spinal cord compression, caused by cancer – either primary or secondary – of the bones of the spine which presses on the nerves to the limbs, potentially causing paralysis and incontinence, are unable to receive the proper treatment of radiotherapy to prevent the paralysis and incontinence as the 4-5 hour journey to Kampala is too difficult and expensive. This does mean that there is a huge need for palliative care here though as it really is the only treatment option for patients with inoperable cancers, of whom there are many as again many of them only come to see the doctors once the disease is very advanced.

I have again been amazed at how much people here in Uganda tolerate. I’ve seen several patients in my first few weeks who’ve come to the hospice for the first time, referred either by volunteers in the community or by local medical services. They have been suffering from severe pain for months without seeking any treatment, and just assuming they should put up with the pain. Even when they’re seen by other doctors or nurses no-one thinks to put them on even simple analgesia. Once we’ve seen them, we start them on small doses of analgesia – often morphine – and their pain improves within a few days and they can start living their lives again. It’s incredibly rewarding to be able to make such a big difference to people but frustrating that they should have had to put up with the pain for such a long time with no-one to help them. This just further confirms to me how important our teaching programmes such as the BSc are to really improve the services on the ground.



Mbarara is much smaller than Kampala but a fairly lively town. My social life has continued – I was out dancing until 4am last night – lots of fun! I’m currently staying at a kind-of RC priests guesthouse about 30 minutes walk from hospice. It was used as a seminary for priests in training until fairly recently but is also used as a retreat centre sometimes so is very peaceful apart from the incredibly noisy birds who wake me up every morning!! I should be moving into my own place in the next couple of weeks although it looked like it needed an awful lot of work when I went to see it a couple of weeks ago so watch this space….


I will leave it here for the moment but attach a couple of photos if they’ll upload - of myself and Mhoira on my birthday,of Martha who’s in charge down here and also works as a nurse on the clinical team, and of some of the BSc students during their face to face teaching, with Flavia who's the head of Education and was teaching on the course. Until next time……

Mum and Dad in Uganda

I think my blogs have now officially gone from being weekly to monthly updates so I’m very sorry to those of you who were eagerly anticipating the next instalment and have been bitterly disappointed. It’s been a busy few weeks yet again but very enjoyable. Mum and dad came to stay for the last 2 weeks in January. For those who may not know, it was my dad’s first time on a plane and of course to Africa. We had a fantastic 2 weeks – exploring most of Uganda on a self-guided tour, arranged with the help of my neighbours. We travelled west to Fort Portal – about a four hour drive from Kampala – and stayed 1 night at a posh lodge overlooking one of the magnificent crater lakes – absolutely stunning. We had a relaxing day following the rather bumpy drive – mum and dad got very used to Uganda’s rather pot-holed roads – very entertaining at times. We then headed south to Queen Elizabeth national park and stayed a couple of nights. We went on a game drive bright and early in the morning, seeing a couple of lions, lots of buffalo and cobs and many amazing birds. In the afternoon, we went on a boat trip down the Kazinga Channel which runs between Lake George and Lake Edward and is a haven for loads of wildlife. We saw tons of hippos, loads of crocodiles and several elephants as well as loads more amazing birds. Dad decided to be brave and drive my car back to the lodge at the end of the day and had the experience of a herd of elephants stepping out in front of the car – about 15-20 of them with a few babies – absolutely more amazing! He’s more used to the elderly stepping out in front of the car at home – slightly less hazardous.

We then drove down through Queen Elizabeth park to our next stop – Ishasha which is part of the park and home to tree-climbing lions. The accommodation we were staying in was rather basic – a banda which is a round brick-built cottage – with rather basic facilities – dad’s first experience of a long-drop toilet! During dinner, I looked out of the restaurant to see 2 elephants wandering towards us in the dusk – rather amazing. Dad was kept awake by hippos and lions making lots of noise outside the banda, quite an experience! We went on another game drive the next day and saw a tree-climbing lion, we were able to stop the car just underneath the tree to watch for a few minutes. Our next stop was Buhoma in Bwindi impenetrable forest – the home of the mountain gorillas. Unfortunately, our budget didn’t stretch to gorilla trekking but we went on a very beautiful waterfall walk accompanied by two guards with big guns in front and behind. The final stop on this part of the trip was heading back to Bushara island on Lake Bunyonyi where I’d been for Christmas. We had two very relaxed days and managed a bit of swimming in the lake.

We arrived back in Kampala for a couple of days and had enough time there for mum and dad to come with me into the hospice for a couple of hours and experience morning prayers and meeting the team. For the last couple days of their stay here we headed of to Jinja to the Nile where I’d been rafting before. Having been unable to persuade them to raft we stayed in another posh lodge next to the Nile instead and ate ridiculous amounts of very good food. I think mum and dad really enjoyed their time here – dad in particular was very proud of his sun-tan, which he’s shown off to everyone at home I hear! So for anyone else who’s interested I can do a very competitive rate for my Ugandan tour.

I realise yet again that I’ve spent lots of the blog talking about time off work. However, since mum and dad left I’ve been really busy back at work helping to run the degree. We welcomed the BSc year one students – 21 of them – at hospice for 4 weeks of face to face teaching on the 1st February. There’s a whole team of lecturers made up of hospice trainers – both clinical and non-clinical, as well as other members of the education and clinical teams. We also have a couple of lecturers who work for other organisations across Kampala who’ve been helping out. I’ve been teaching on a wide variety of topics including pain control, audit and evaluation and ethics. The ethics teaching was definitely my favourite. We had a debate on euthanasia dividing the group into 2 to take opposing sides. Things got very lively with some very interesting ideas about euthanasia being integrated into palliative care as a money-saving initiative – not something we’re really going to put into practice though! We’ve got one more week left of teaching then the students all go back to their respective countries and the rest of the year will be distance-learning. The students are all really lovely – from 6 different African countries, and mostly already working in palliative care as clinical officers (this is someone who’s completed about 3 years training and can do some of the things that doctors at home do but isn’t as qualified) or nurses. I’ve been invited to go and work at one of the hospices in Malawi (very tempting but I really need to finish my training in the UK first) and would love to go and visit some of the others to see what they’re all doing with palliative care in their different countries.

So, I have one more week of teaching for the degree then I’m finally heading west to Mbarara for the other 6 months of my year here. I’m looking forward to getting back to doing more clinical work but will really miss my lovely neighbours in Kampala and all the friends I’ve made at the hospice here. However, I’m looking forward to meeting loads more interesting people and seeing more of Uganda.

I’m going to sign off now and see if my internet will work for long enough to enable me to upload this and hopefully some photos. Hope everyone at home’s doing well, thank you for all the lovely emails and messages for my birthday – I had a fab day which ended up with champagne and sushi with my neighbours – not that Ugandan but great fun!

Happy New Year

Happy Christmas and Happy New Year to everyone! This blog is well overdue and part of it is because I have been working fairly hard but I’ve also been away doing some relaxing things and some slightly more crazy activities. I hope everyone had great Christmases and fabulous New Years – would love to hear how everyone’s doing – photos are always welcome.

Okay, I’ll start off with some of the work stuff first. I’ve spent the last few weeks concentrating on BSc stuff and not doing any clinical work as there’s a fair amount of work to be done and not very much time. We’re now a bit more on course and looking forward to welcoming the 1st year students in about 4 weeks time for their 4 week teaching block. I’m then heading off to Mbarara to start my job there belatedly which will be mostly clinical – lots of home visits and clinics under trees – can’t wait! I will miss the team in Kampala though. I feel like I’ve really settled in there and have met loads of great people. We had a couple of events before Christmas which were great for getting to know people – the patient’s party and the staff Christmas party. The patients party was really good fun. I spent most of the day with the children – both children who are on the hospice programme as well as children of some of the adult patients. They had a bouncy castle and no mention of health and safety – probably about 30 children on the castle at any one time and remarkably few injuries by the end. I also taught some of them to play Jenga which they were fascinated by and also very good at! A lot of the more unwell patients spent the day lying on mattresses under a tent in the sunshine which they all seemed to really enjoy. They all received presents from the hospice – for the adults this was a plastic bowl for washing filled with sheets, rice and other food – much appreciated. There was a bit of a stampede when we were giving out the children’s presents – they all had to be given tickets or they kept going back to the end of the queue to get a second present.

A week later we had the staff Christmas party which started 3 hours late (usual Ugandan time). We had a secret Santa which was not so secret as you were supposed to write your name inside the present so people would know who’d bought it. There was a huge ceremony involved in giving out the presents – you had to walk round with the present on your head dancing to find the person who’d bought it for you surrounded by members of your team. There was then lots of embracing and photos. I’ve become much more comfortable about public performances such as this since coming to Uganda! I got a very lovely traditional African dress from one of the drivers which I had to wear and then dance round in – I may not be doing a repeat of this when I come home to the UK.

For Christmas I went away with 7 others – Cliona and Mhoira two of the other doctors from work, Cliona’s parents and brother and a couple of others. We drove for many hours to Lake Bunyonyi which is down in the south-west of Uganda near the Rwandan border. We stayed on a small island in the middle of the lake which was absolutely stunning. We had candlelit 9 lessons and carols on the balcony of our cottage overlooking the lake on Christmas Eve, then woke up to sunshine and beautiful blue sky on Christmas day and paddled over to the church on another island in a dug-out canoe. We unfortunately only made it for the last hymn but managed to sing some carols with the villagers after. We spent the next few days generally relaxing, swimming in the Lake and playing games. Unfortunately Christmas morning proved to be the sunniest day and it was rather cool and wet for the rest of our time there (not quite as cold as it has been at home obviously!).

For New Year’s we headed off to Jinja again and I was the only English representative surrounded by 6 others all from Ireland (I was honorary Irish for New Year). We’d booked to go rafting again with Cliona’s family but a more sedate trip with guaranteed no flipping of the boat. It was a fantastic day and very novel to be going down rapids and actually staying in the boat and not being washed down the Nile. The evening was a bit more lively and was spent in the bar which overlooked the Nile knocking back a few Nile special beers and more local gin. During the evening we watched the rafting DVD from a group who’d gone down the Grade 5 rapids which I’d done a couple of months ago and included some people riversurfing. Cliona and I thought it looked like really good fun and were persuaded by a south-African chap that we should all go the following day. We had to stay up until after 3am so we could celebrate the start of 2010 at home as well as in Uganda and treated everyone to a chorus of Auld Lang syne. The next morning the riversurfing still seemed like a good idea despite my slightly sore head so we booked ourselves in, not realising fully what it involved. We had life-jackets, flippers (or whatever the proper name is for them) and helmets on and were given an inflatable body-board each. We were straight into the Nile and had a practice run on a Grade 1.5 rapid which was quite good fun before being told we were going to leap off the bank straight into a Grade 5 rapid (Bujagali falls which is in the photo above) and supposedly surf it! It was quite possibly the most terrifying thing I’ve ever done and I failed miserably at staying on the board and managed to end up completely sucked into the rapid and spun around much like being in a washing machine then chucked out the other side! This was repeated on 2 more Grade 5s before I got the hang of lifting the board up a bit to try and actually ride over the wave rather than directly into it. I think we’ve definitely set the bar rather high for the year but I blame the Ugandan chap on the DVD whose catchphrase was ‘Why not?’ something I’m adopting for the year I think!

Anyway, I’m now back in Kampala again taking life at a slightly slower pace again. I’m really enjoying doing all the writing for the degree as well as planning assessments, mentorship, timetables etc. We have students coming from probably 5+ African countries other than Uganda which is fantastic for palliative care as they’ll be able to continue developing Palliative care in their countries with the qualification.

I’m going to leave it here for now and will be continuing my trend of just one long holiday over here as mum and dad are visiting very soon – any excuse to go rafting again!!