A day in my life in Jinja

Breakfast

I realise a few of my posts have been somewhat somber, which might have given a skewed perception of what life is like here.  I thought I should give you a quick synopsis of what I get up to on most days, it does vary a little from time to time but this might give anyone planning a similar trip a rough guide.  My first alarm goes off at 5.45am; it is in fact the much-discussed rooster near my window. I ignore it as I know there will be another warning in an hour. True to form the next alarm rings at 6.45am again it is the rooster so I wait for my set alarm at 7am. I climb out of bed in a daze, change into my exercise clothes and off I go to meet Sarah for 45minutes-1 hour of torture in the name of exercise. Then I spend the next hour or so getting ready for work, with a substantial amount of time spent eating a nice breakfast thanks to Zaina (Sarah’s housekeeper) and thanks guys for the heaps of teabags sent all the way from England.

We slowly saunter to Nalufenya, well grudgingly really, dreading whatever awaits us. The walk is pleasant with lovely green shrubberies; it takes approximately 20 minute but can be a little muddy on rainy days. Ward round starts about 9.15, on Monday, Wed- Thursday we spend the morning in the emergency room alongside a local paediatrician, seeing all the emergencies, new admissions, neonates and the dehydrated patients (D and V patients). On Tuesdays and Friday, I am on the newborn unit on my lonesome.

Entrance to walk on a dry day

  At the paediatric side, we see approximately 30-50 patients on the round, which ends roughly at 2pm if there are no emergencies. We have a lot of students on the ward rounds; the room can be very crowded with up to 4 patients per bed. As usual the heat is relentless so I spend a large amount of the ward round fanning myself and drinking water in an attempt not to faint. The hazard of drinking too much water is that you inevitably need to urinate; unfortunately this is not possible, as we do not have a working toilet for staff at the hospital. So I try and minimize my drinking at work but I am not complaining at least the students are learning on the round! That is sustainability!

After the emergency ward round, we often do another round on the Malnutrition unit which has 10-20 patients but these days some of the other doctors get to it before we do. After lunch our afternoons are spent teaching, or doing community work. We have been involved with a couple of NGOs ran by expats, some of my afternoons are spent helping at some sort of clinic or the other for children from the slum looked after by a charity called 1morechild.  We also spend our afternoon teaching clinical officers a as well as community health workers; this mostly draws to an end by 6pm.

Garden of one of the nice cafes in Jinja

6pm- 8pm varies, it can be spent in nice cafes,  or in the back garden of a few of the expat friends we have made; drinking Earl grey tea and eating scones (absolute luxury!).  I often end up running around the garden with the little clever English kids who are ever so confused about who I am.  They ask such interesting questions for instance ; why my hair is black?, why is Sarah white? Why do you not speak like the Ugandans? Are you Sarah’s sisters? Amusing really! On those days when I do not have such entertaining evenings; we read, prepare teachings session, work or watch back to back episodes of  recent popular TV series. We are watching The Good Wife at the moment, it is very addictive.

Then it is 8pm a.k.a Carbohydrate'o'clock, we have a nice spread of Ugandan food whilst watching 1 of 2 programmes, a Mexican soap or Ugandan soap, both equally infuriating but addictive and often generate a lot of discussion. We sometimes have friends over for dinner or eat out.  My evenings generally end with more reading (fun or work related), teaching preparations, skyping and talking to you lot or more episodes of the good wife! Then I trot off to my house next door,  off to bed and the whole thing starts again tomorrow….

Mwebale- Thank you!

I have not had much time to write in the past few weeks due to work, pesky diarrhoea and vomiting illness (I am much better, thank you all!) and of course social commitments.  But I thought it was very important to drop a note to say thank you to you all for your encouraging words,  well wishes and general comment. Some days are overwhelming here as you have probably gathered from my posts but all your wise words have been armouring me on.

I will also like to add that, although work can be emotionally draining. Sarah and I have made some good friends here and as you can imagine there are indeed some perks to living in Africa. Our daily early morning "ultimate workout" is keeping us sane. The beauty of this continent and it's every colourful way of life never ceases to put a smile on my face.  No matter how much I lament, I am not coming home till this "mission" ends so stay tuned for more of my adventures….

This is Africa (TIA)

Kenyan Coast

Last week Sarah and I took some time off over the Easter period to meet up with a couple of the other paediatric volunteers working in Kenya. We met at a beautiful part of the Kenyan coast and spent a significant amount of time sharing war stories.  It appears they both work in much better resourced hospitals (one hospital had a CT scanner!) and they were very shocked at how basic care was in our hospital.   This is not to say they did not have any challenges, they both had faced difficulties and dilemmas during their time in Kenya thus far.

Kenyan Coast

The break was a much welcome luxury; the Kenyan coast is one of the most beautiful places I have visited. Although the children at Jinja played on my mind constantly, I was very happy to have this time to relax and reflect on the work we are doing.  I have never prayed as much as I have in the last 2 months, each day I find myself quietly hoping that no child dies on our watch. I worry about the ones we have seen, the ones we couldn’t see as well as the ones I sent home because they were getting better and the parents could no longer afford to take time off work.

Most days, the work feels overwhelming and I wonder if we are doing anything to help. At such times I think of those children that have recovered, the once malnourished kids who are now a picture of health, the less than 1kg babies who made it home safe and are gaining weight and the joy on the faces of the parents as they thank you for the care you have given their children. Those famous words on the ward round “Well done, doctor”, is what has kept me going last week on our return to Jinja.  Despite the lovely break, the situation at work on arrival made the holiday seem like a dream. Things appear to be at an all time low, we now have less resources than we did a week ago!

Moonlight by the coast

We no longer have syringes, needles, or cannulas; parents have to buy these things so that their children can be treated, whilst you as the doctor wait anxiously, hoping that in that period nothing happens to the child. On arrival at work back off our holiday there was a child in shock who needed intravenous fluid immediately but we did not have anything to give the fluids, so we waited with bated breath whilst the mum ran to get them. Across the room a 6-day-old baby was having a seizure, ironically we had the medication to give but no syringes or needles to draw it out and administer it to the patient. Neither Sarah nor I were prepared for this, before we left we had syringes at least! We now “accidentally” have syringes/needles and cannulas in our pockets for such emergency situations or for those parents who do not have any money to buy these things.

I think the monkey understands my plight.  It stole my chair!

But I ask myself, is this sustainable? When we are gone who will “accidentally” find these things in their pockets? Where has the stock gone and who should provide them? These are all rhetorical questions; the resounding answer is “this is Africa” (TIA).  Such is our plight!

"Are you adopted?"

Easter is here and I am enjoying travelling around east Africa during the break. However, before I proceed with the rest of the post, I just want to reassure some of my worried readers - the noisy rooster is still alive and will not be the main course for Easter. In fact I now get concerned for the poor thing if I don't hear it in the morning. The noises from the rooster, the frogs, the random birds, crickets and the boda bodas (the forbidden motorbike taxis)have become part and parcel of everyday life in Jinja for me.  What I will miss this Easter though, are Easter eggs and daffodils; I do like spring at home.

On one of our escapes from the hospital a couple of weeks ago something very funny happened and I thought I would share it with those I haven't already told. We were out at a meal for one of our housemates’ leaving do before he went back to England. At the table, there were several people from around the world, a few Danish girls (young student nurses and student teachers), myself and Sarah, the boys and our Ugandan host family. One of the Danish girls was new to the group and had to be introduced to everyone. At the end of the meal, this 19 year old lady curiously asked me where I was from, she said she was confused by my accent. I did the usual explanation of my dual nationality, Nigerian by birth but have lived in England for a long time. She looked at me with utter confusion and said: "How come? Are you adopted?", at which point I nearly spat out the drink in my mouth as I could not stop laughing. Everyone at the table that heard this looked somewhat shocked. I politely explained migration to her and we all laughed about it.  My biggest regret was not replying with a line that Sarah later suggested... "Yes I was adopted, I am one of Madonna’s kids".

Interestingly, I was not offended by this young lady - this was her first time in this part of Africa, she works in a village teaching young children and to her all she sees of Africa is lack of education and poverty. She only knew one side of the story.  I do not blame her at all as I also often worry about the lack of education amongst some of the parents and children I see in the hospital. Uganda is an ex-British colony, this means that English is an official language in Uganda, in fact lessons in school from as young as nursery classes are taught in English. Despite this, more than 60% of the mums and children I see do not appear to speak or understand English - maybe the problem is mine and Sarah's accents. However, on top of the language difficulties, the majority of mums here are less than 18 years old, some as young as 14 years. This suggests they are not in school or at least not in Secondary school/higher education. This is a huge problem and it contributes greatly to the high child mortality rate we see in these hospitals.

Lack of education plays a major role in child mortality and of course has an enormous impact on the level of poverty these mothers and their children will face. An educated woman is more able to advocate for her family, more likely to seek appropriate health care promptly, less likely to be forced into unwanted relationships, less likely to believe health misconceptions, and be more likely to find a job and help provide for her family. This is why female education and empowerment is one of the millennium goals I wrote about a few weeks ago. The UN identifies how important it is to educate children and not exclude girls from school; in fact, we know that maternal education is the single most effective health intervention we can implement. My recent experiences have shown me the truth behind this statement. As President Kim said: "Education is not only a basic human right, it is a fundamental to ending extreme poverty". More work needs to be done in the community to encourage these young girls to go to school, though sadly, girls are often passed over for education and their brothers preferentially encouraged to attend school.

Whilst this educated young Danish lady can be easily forgiven for her blunder, what is ironic is her need for further enlightenment.  It is one thing to learn languages, sciences and art, it is another to learn about the world around you to avoid the problem of seeing only one side of the story (Click here to hear C. Adichie's TED talk). I am sure this lady will learn a lot on her travels.

Wishing you all a wonderful Easter.

Rant!

I will apologize in advance because this post is more of a rant than an informative post.  Both Sarah and I had a tough week last week; we both had moments of extreme frustration and upset. We had 8 deaths, 4 of whom were children less than 28 days old (neonates). I saw 5 children with severe malaria, 4 needing blood transfusion, and 1 child with cerebral malaria (malaria affecting the brain) and convulsions.  7 patients ran away because they were unable to afford the treatment and some because of the misconceptions I will discuss in this post.  Of these upsetting cases some were particularly heart breaking and it is those that stick in my mind. Sarah beautifully wrote about 2 cases on her blog (click here to read), and here I will write about some of the others.  The running theme amongst these cases is that the deaths may have been avoidable with some parental education.

In Uganda, parents associate 2 medical interventions with death. They believe these interventions kill the children as opposed to whatever illness had made their child unwell enough to require the intervention. They are:
Nasogastric tubes (a tube inserted through one of the nostrils into the stomach that can be used to monitor the stomach contents but also to feed children that are unable to feed. This tube passes through a natural orifice and although the initial insertion is uncomfortable for the child, it does not cause any pain or distress once it is in place)
A child being commenced on oxygen

For the last 4 weeks I have spent a significant amount of time explaining to each parents why these things are not the cause of death but lifesavers and essential for care. There seems to be an ingrained misconception about these 2 things. Death because of lack of resources, late presentation or overwhelming illness is one thing, but preventable deaths due to misunderstandings are incredibly upsetting.

One of the neonates that died this week had a gut infection called necrotizing enterocolitis (NEC). The mainstay of treatment is to stop feeds, rest the gut, insert a nasogastric tube and treat the baby with intravenous antibiotics until the gut heals.  We stopped feeds, inserted a cannula (which thankfully we had) and gave the baby intravenous antibiotics and fluids containing sugar and some of the salt the baby needed. We also the inserted a nasogastric tube (NG tube) to monitor the stomach content and help judge progress and aid reintroduction of feeds once the gut had healed.  Initially the baby improved, each day I stressed to mum why it is important not to feed, rest the gut and keep the tube in the stomach to monitor if the gut is getting better. I knew she was unhappy about the plan but there was no other way of treating this unwell preterm but to use the strategies mentioned above. After 2 days I was told by the nurses that each day they had to re-insert a new NG tube and a new cannula as the mum was pulling it out. She did not believe her child could survive with the tube in and no breast-feeding. Pulling the tubes out was her way of hoping she could avoid them going back in. What I did not realize was that she was feeding the baby when there were no medical staff around; 3 days into treatment this baby died of overwhelming infection.


The other case is a 2-year-old boy who weighed 5 kg and was on the malnutrition unit for stabilization and rehabilitation. At 5kg he weighs less than an average 6-month-old back home in the UK. After 2 weeks of intensive therapy following the WHO malnutrition guideline this boy was not gaining weight. On discussion with his mum it transpired that the little boy flatly refused the reconstituted milk containing the calories, micronutrients and fat he needed to gain weight. Whilst he would eat some dry food, he refused the milk as well as the plumpy nut (sweet-tasting calorific paste).  From his history, examination, a chest x-ray and some blood investigations, it was apparent that he had no other medical reasons to not gain weight or drink the milk, so it was decided that an NG tube was crucial as he was in fact losing weight on the nutrition unit. After an hour-long discussion with mum she agreed to have the NG tube inserted much to my delight. Unfortunately the following morning, this mum was nowhere to be found as she had ran away from the hospital with her little boy leaving me with a lot of dilemmas - should I have just left him without the feeds he needed? Would he have been better on the unit with some nutrition rather than running away? What will happen to him now?

In both these cases the mothers felt they were doing the right thing for their children and stopping the doctors from harming them.  This is a reoccurring theme; every day we fight a losing battle with parents about NG or Oxygen.  At the root of this problem is poor education and misconception, how do we go about educating such a large amount of people about these untruths in the short while I am here?   Shall I walk round my entire ward round with an NG tube in and see if that helps.  Maybe a radio jingle or a TV advert might help, either way something needs to change……