Kisiizi Hospital

Today we went to Kisiizi Hospital. (We didn’t find out about the fighting at the DRC border about 60km away until we got back!) The main reason was to take a Global Care sponsored

boy there, who had been seen by the local doctor but was still unwell. I also wanted to see the place, as we’d heard how good it was locally, and because there is a big waterfall there.

Moses thought it would be a two-hour drive south so advised we should set off at 6, to be well-placed in the queue for treatment. So we were treated to a beautiful African sunrise and stunning hill scenery as we drove, initially along a tarmac road, and munched our take-away chapattis made for us last night. This road is called “Besigye’s Road” because the leader of the opposition made so much fuss about the roads in his district that the Government had to cave in and improve it. However, the area where his rather grand home is situated is one of the few round here not to have an electricity supply, so his neighbours are suffering with him for his politics. I digress. We turned on to a murram road, most of which was surprisingly good, though I have to say I would have slowed down more through the villages and my photos out of the window are all unusable due to shaking.

To our surprise the trip only took an hour and we were fourth in the queue at 7am. As nothing much was happening by 8 we left the lad waiting and followed the call of the drum to the morning service in the packed chapel, where we were introduced to the staff. African church singing in harmony accompanied only by drums and clapping is marvellous. We were warmly received in the hospital and chatted to a lot of people and we were jumped up the queue a little. Our patient was eventually seen and tested for HIV, brucellosis, anaemia and UTI. Meanwhile we were given a tour of the hospital by a supporter from the UK. It was better than I had seen elsewhere in Uganda, no suggestion of corruption, cleaner and more respect shown to patients. They manage to keep premature babies alive before 30w gestation, which is pretty good, and have a psychiatric ward, of which there are few in Africa. Barbara was impressed with the use of large paint tins to provide traction and lift the bed foot in the orthopaedic/surgical ward. Medical wards seemed to have some vacant beds and we were told that because the plantain crop locally was damaged by an outbreak of banana wilt bacteria, there were fewer patients because they couldn’t afford to attend. Several UK doctors and nurses were working there by various routes, and we saw some good work being done in rehabilitation, including the making of bespoke seating out of stiff cardboard reinforced by papier mache made with paste from cassava flour. We wondered if these skills could be disseminated more widely.

Back at the consulting room about 12 o’clock we found out that our boy was mildly anaemic and might have a peptic ulcer. I am not entirely sure we have got to the bottom of his problems but Moses will take him back if he doesn’t respond to initial treatment. We chatted to some expat staff over drinks and bananas in the staff room and went out for some snacks before walking across to the falls. It’s a 30m drop so quite impressive, despite some of the flow having been diverted to provide hydroelectric power to the hospital and surrounding communities. Apparently it used to be used to discipline young women who went astray, by tying their limbs and throwing them off the top to drown. We are assured this is no longer the case.

Chilli Children

I had a day off blogging yesterday. Once again we have all been everywhere together today, so please see Barbara’s at darton2soroti.blogspot.com for details of school visits. My highlight today was the visit to the North Kigezi Anglican Diocese offices to talk about their work with children with disabilities. They are wonderfully supported by another UK based Christian charity, which is called Chilli Children because one of the brilliant things they do is help poor families to grow chillies as a cash crop, which the project buys from the growers. We were generously given more than an hour to talk with the occupational therapist/manager, a lovely lady called Evas. She confirmed our impression that most people locally have very little understanding of the nature of various disabilities, she is the one who will assess them and advise on what kind of help they need, whether surgery, education on life skills, learning therapies to do at home, income generation, etc. When the project has enough funds it supports children to travel to hospital for any needed surgery. The nearest adequately equipped one is at Kisizi two hours away, where we plan to go tomorrow. However some children need to travel as far as Mbale, more like two days travelling, if they need major orthopaedic surgery or shunts for hydrocephalus. We do seem to have a lot of spina bifida, hydrocephalus and microcephaly in this district; it probably has a nutritional basis. Evas suggested ways in which Global Care and they could work together, which was really the purpose of our visit today, so we will have some ideas to put to GC when we get home.

It was quite noticeable in schools that we saw hundreds of children today but hardly any with a visible disability, though we met some deaf children. Access to school is very limited if you have problems getting about. There are few special needs teachers in the country and teachers generally are disgruntled and often not at work because their pay is too low to live on and they are trying to make money somewhere else; there is no enhancement for special needs and no incentive to come and work in remote areas.

Some of my readers know that I have a limited diet due to food intolerance / allergy, and while I hate to make a fuss about this here, I do try to stick to it or I will not be well enough to do what I have come for. As a result the last three evening meals have been chicken and cassava as the town has more or less run out of fish, which I was alternating previously. Mealtimes are enlivened by persistent harassment from an admittedly nice looking ginger cat. It has a remarkable tolerance for physical violence, I have discovered.

If you enjoy reading the blogs, please also visit GlobalCare site for more information and stories about Uganda and the other projects.

Families day at Global Care Rukungiri

“Thank you for the care and attention. Other people look negatively on us with our disabled children but you have shown that we matter to you, you treat the children kindly. We shall love you and pray for you. Thank you.”

Comments like this make it feel worthwhile to spend a few pounds buying a drink and a bread roll for children and their guardians and to spend a little time listening to their stories.

“When I go to church the people aren’t happy because of the way my child behaves, and the people in the village won’t come to my house.” It’s not her fault that her daughter has global development problems and can be noisy and disruptive, dribbles and spits. Would you accept this family?

Two girls, one with a deformed ankle and one with a spinal deformity, both report that their schoolmates laugh at them because they look different. Children here customarily walk to school on their own, so those who have impaired mobility have a problem. Even if the parents were willing to take them to and fro, they often have other children and business to attend to.

We haven't seen any wheelchairs yet, though they are needed for some of children we saw, notably those with spina bifida and hydrocephalus.

On the other hand, an 8 year old boy, who is deaf following a bout of meningitis in infancy and cannot speak, is very popular in his community and friends with everyone, though his ability to communicate is limited to rudimentary sign language. His mum was one of two wives so when her husband died unexpectedly without leaving a will, she had to go to court to gain some of the property, and even now is afraid to stay in her former home, lest the other widow might kill her children. She has a little land and income, but even so she will struggle to afford the school fees for the deaf school when her son starts next year.

Death creates other problems. We met an incredibly old looking man with a little girl who was very chatty and sociable despite not being able to stand and having limited vision. She is a double orphan, most likely due to AIDS. It’s hard enough for elderly grandparents caring for a healthy child but when the surgery she needs is only available at the other side of the country and her needs are so great, I couldn’t imagine how they cope, and the future looks grim unless they get some help. Another woman is caring for six grandchildren after her daughter died. One of the children also has HIV. They can get treatment locally but not help with food and livelihoods. This grandmother cannot do much physical work as she lost a foot in a car accident, so even though two of her children are sponsored, she has difficulties making ends meet.

A young woman told how she was beaten and sent back to her parents by her husband’s family after she gave birth to a disabled child. Her family want her to go back to him but she knows that no-one has been able to change his mind about his wife and daughter.

The last person we talked to today left us feeling crushed. Although I often deal with depression, I have rarely seen a man look more defeated. He could hardly speak through his tears and sighs. He arrived cradling his little girl, the firstborn. She is severely disabled and stunted, deaf and cannot walk or hold an object. She doesn’t smile, either. As he has no land, he tries to make a living by hiring himself out as a labourer to dig other people’s land, or by buying and selling a few bananas. His wife has to work too so they have made a kind of pen in their house and lock her in for half a day, cleaning up when they come back. I believe that if she could receive day care, she would be able to develop better, and everyone would be relieved of the guilt and shame we all felt that someone has to live like that.

We are visiting Rukungiri in the hope that Global Care will be able to set up a disability centre here as well as the one in Soroti. The problems are just as great, but extra funding will be needed. Moses said he felt great after today, because we are uncovering the problems we should be dealing with, if we want to help the most needy. If someone reading this is able to help, please get in touch! If you can’t show what Pope Francis recently called “global solidarity” in this way, perhaps you can show kindness and acceptance to a child living with disability or chronic sickness near you.

A visit to the game park.

We decided to take a day off on Saturday and visit Queen Elizabeth Game Park. My plans were reduced in stages from a two night stay to a day visit. This did mean that we could take Moses and Allen, our co-workers here, with us. Allen remembered a visit from her school days but Moses had never visited the park. There was considerable discussion with (driver) Charles and Moses about the route and the quality of the roads. All the options are unmade murram roads but their condition varies. Charles agreed to come for us at 6.45 as we expected the drive to be 80km and take a couple of hours. There was a power cut at the hotel, the staff were late appearing to make our breakfast, we had to call the driver and make another failed attempt to get cash from the ATM before we finally got under way. From my map it looked like a 60km drive but after a short while Moses told us the bridge was down (for the last two years, it will probably be repaired when the election is due) so there was a substantial detour. Some roads were quite fast, others very poor. Eventually we realised we were in the park having taken over three hours. We paid $94 to enter the Ishasha circuit, but no guide was available. We saw elephant, Uganda kob and some antelopes. After an accidental detour into the DRC we found the right place by the river and had a great time viewing hippos. Then it was decided we would go to a fishing village on Lake George that Allen remembered. In the village the women and girls were sorting out tiny shells and packing them in sacks, while the men and boys were preparing the nets for the next night’s fishing. A mentally challenged drunk man pestered us. A wide assortment of birds; waders, hammerkops, herons, egrets, storks, kingfishers were doing their business on the creek under the eye of the buffalo. Allen undertook a lengthy negotiation for two nice catfish. I wasn’t looking forward to their company on the drive home but it turned out they were to travel attached to the front of the vehicle. They drew some curious glances from people by the road, in addition to the usual squeals of “Mzungu”, grinning and waving by small children.

As well as the normal farming homesteads and shacks we passed, we noted several extremely grand houses with big grounds, tarmac drives and imposing gated entrances. They belonged to officials and politicians who had profited from their positions. Many do not live in these houses but use them when they are visiting the area, for example for family funerals. Wealth is available in this country but not fairly distributed.

We went on a newly refurbished road over the mountain on the return journey, passing Rushasha Salvation school where we once visited and played parachute games with the children. We arrived back, sweaty and tired, about 5pm.

I also used a pit latrine today, 95% successfully, but my trouser leg soon dried.

Reasons for unscheduled stops along the road in the last few days:

• Strange sounds from the gearbox – a missing sump nut causing an oil loss
• Road blocked: a lorry grounded coming off a temporary bridge, eventually pulled off backwards by the bucket of a JCB
• Attempt to buy some travel sickness pills (no luck)
• Get some leaves from a eucalyptus tree to treat travel sickness (quite successful)
• Greet an uncle
• Photograph a kob
• Allow an elephant or two to pass by
• Numerous “short calls”, mostly in the roadside bushes

Sunday we are off to church then resting in preparation for a busy week. Please keep reading and sharing the blog, it's going to get very interesting I feel! Also see darton2soroti.blogspot.com for Barbara's. Thanks for looking!

Rukungiri day 2

Last night our sleep was interrupted by calls from our alarm system at home in England. Most likely they were false alarms but today I am suffering from lack of sleep.

Nevertheless we have done some preparation with Moses and Allen for meetings to discuss disability and HIV with local families, this included some training in facilitation skills, so we will see next week how much they have learned. In the afternoon we went with Rev Moses to TASO, the AIDS support organisation and received a warm welcome from Ambrose, the assistant counselling coordinator. They have a nice building there but also do lots of outreach work and we saw the bikes that are used to deliver ARV medications to families and heard about the counselling and treatment services they provide. They have some child-friendly facilities and staff so we think they will be a good option to help our clients. They readily work in partnership with other organisations and NGOs and have good stocks of medication. Where they lack a bit is in testing facilities; even fairly basic AIDS monitoring tests (CD4 counts) have to be sent to a regional centre for analysis. I’m not quite sure where they get viral load counts done, but I don’t think it’s a routine. They even have a palliative care team for the dying.

In contrast to yesterday it’s warm and sunny and birds are variously singing or squawking. I wish I had a book to help me identify them.So far the crowned cranes over the way are the only ones of which I’m certain but we’ve seen versions of crows, sparrows, swallows, storks, eagles, kites, ibis, wagtails and many less familiar varieties. We’re in a mountainous area and some of the views are marvellous.

Rukungiri day 1

I’m not sure when this will get posted because our internet access plans aren’t working out as expected, see below.

We had a great day today with Moses and Allen (female and how!) making our plans in the Global Care office for next week’s programme. We had a very interactive day and they are full of ideas for how to develop and improve what they do, in particular for children with disability and from families affected by HIV. They were also very alive to the challenges and obstacles, particularly working for an organisation that values educational achievement, and in an environment where sensitive issues around sexual behaviour are difficult to discuss. How should the organisation promote sexual health of adolescents when giving information about sex and condoms to younger teenagers is seen as encouraging promiscuity? It’s not as if Ugandan teenagers aren’t doing it already….

We heard some interesting stories. Abandoned children provided one theme, including one tiny injured one rescued from a goat pen where he had been kept alive by other kids (sorry) passing by with food.

On a walk round the town we visited the Orange shop in an (unsuccessful) attempt to get my phone on-line. That was going to provide our access point, so we are using the office system, when it works. We also failed to get money from two banks, bought water from Hilda the wife of Rev Moses in their shop, and to our delight were able to receive a big hug from our former sponsored girl Rebecca, now running her shop in the market area.

In the coming days we plan to meet with TASO (the aids support organisation) and then to talk to the guardians of our sponsored children about organising an HIV testing programme for them. Then we intend to meet with small groups of children with disability and their parents, to do some focus groups to identify the challenges they face and maybe some participatory investigation of root causes. We’ll also visit the local organisation and schools providing services to this group to understand what else is being done and make sure our actions are complementary.

My project of visiting the game park at the weekend has been wisely scaled back to a day trip on Saturday, but that means that more people can come with us, which will be great fun.

More news soon as time permits but someone else needs the computer.