When you live in Kampala it's fun to go to Jinja for a break,
Its calm and laid-back, there's the Nile and the lake.
The best road in Uganda runs between each city,
And it's here where many die, it seems such a pity.
Strange but true, there's not a pothole in sight,
But a truck hurtling towards you can give you quite a fright.
Ugandans are relaxed, they are patient and calm,
But when in charge of a vehicle they develop a sense of alarm.
It seems essential to overtake, urgently and at great speed,
To know what lies just out of sight, there is absolutely no need.
Best not know what what approaches at speed in your lane,
Just pray you die quickly and feel little pain.
If you arrive at your destination you feel very fortunate,
But it's never guaranteed, I just put it down to fate.
Tuesday, December 15, 2009
The Ugandan Nurse
She is tough and resourceful, she leaves us far behind,
Some say she is lazy and not very kind.
But I say she's seen a few things in her time,
She works with few resources and in wards covered in grime,
In the morning she is damp dusting to make the place clean,
Then she deals with a tragic story behind every screen.
There is HIV and cancer too far advanced to survive,
Young people are dying, there's no way to keep them alive.
It's so hard for her to cope with, so she builds up a wall,
She just does what she can, but she can't help them all.
Some say she is lazy and not very kind.
But I say she's seen a few things in her time,
She works with few resources and in wards covered in grime,
In the morning she is damp dusting to make the place clean,
Then she deals with a tragic story behind every screen.
There is HIV and cancer too far advanced to survive,
Young people are dying, there's no way to keep them alive.
It's so hard for her to cope with, so she builds up a wall,
She just does what she can, but she can't help them all.
Ibulanku
Alanta and Pablo took us to their village far away,
And their Ugandan friends proudly showed us around for the day.
They welcomed us with a greeting, a handshake and a smile,
To greet everyone in the village took quite a while.
We were lead out to see the crops in the field,
They will never go hungry, it was quite a yield.
We helped hull the maize so it was ready to go,
To be sundried and somehow turned into posho.
They washed our hands and invited us to eat,
They made us feel special, it was quite a treat.
With a bag full of food they bid us farewell,
We left the village happy with an amazing story to tell.
So thank you Ibulanku for welcoming us from the start,
You will always hold a very special place in our heart.
And their Ugandan friends proudly showed us around for the day.
They welcomed us with a greeting, a handshake and a smile,
To greet everyone in the village took quite a while.
We were lead out to see the crops in the field,
They will never go hungry, it was quite a yield.
We helped hull the maize so it was ready to go,
To be sundried and somehow turned into posho.
They washed our hands and invited us to eat,
They made us feel special, it was quite a treat.
With a bag full of food they bid us farewell,
We left the village happy with an amazing story to tell.
So thank you Ibulanku for welcoming us from the start,
You will always hold a very special place in our heart.
Uganda - the best and the worst
The last week has shown me the best and the worst of Uganda.
Work - the Best
The best would have to be the incredible warmth and welcoming I have received from my colleagues on Hope Ward as I continue my clinical time there. I have been struck by the resourcefulness and courage of the nurses that work there. I felt a bit like a fluffy pampered Persian kitten in with all the alley cats. They take life as it comes, they rarely complain and they make do with whatever they can find. We made a bucket of saline from scratch, that is boiling the tap water adding saline and waiting for it to cool and we made a soap and water enema (yes I know it is unheard of these days) using soap and lathering it in between the hands until the right consistency had been obtained. People keep telling me that Ugandan nurses don't care, well I am not sure I agree. I believe that they care but I think that the extreme conditions they work under grind them down and they 'appear' not to care. I think they care a great deal but there is little support and they are just doing the best they can.
Work- the Worst
The worst of nursing work in Uganda would have to be the poor resources available in the hospitals and the poor condition of some of the patients. Nurses work with nothing, something we just wouldn't accept in Australia but something Ugandan nurses have no choice about. The only dressing supply available is gauze and subsequently it is used for everything even though it is useless against some of the extraordinary wounds that you encounter here. They did have hydrogen peroxide however, which got poured over a patients fungating leg wound, doing little good except for causing the man extreme pain and possibly killing what precious little good skin remained (if anyone from Clark is reading this don't tell Nik!).
The patients that you see here are very challenging in so many ways. The average age is much, much, much younger than what you would find in Australian hospitals and because of the lack of preventative health you see people presenting with end stage conditions which can only get palliative care as the condition is so advanced. This includes things such as cancers that are detected late to HIV/AIDS that is ignored due to the perisisting social stigma until it is way too late. It is a challenge for Ugandan nurses to be confronted with this every day. They are smart and knowledgable and they are caring for people with advanced conditions that could be cured if they were detected early. Breast cancer is a significant issue here but unfortunately there are not many survivors as early detection is an extremely new and misunderstood concept. As a result there are alot of fungating breast cancers that can only be treated palliatively. Now back to the good things...
Social - the Best
My friend Hazel and I went to stay with some other friends who have been working for three months in a little villiage about an hour or two (depending on traffic) passed Jinja. They have been doing public health education from a clinic that was set up by the Ugandan High Commissioner for Australia. It was a pretty impressive clinic actually but again by what we are used to it was quite sparse. They are doing some great work there and the outlying community has good access to health care and education so that is fantastic.
The real highlight of the weekend as the hospitality of the residents of the village. We were welcomed with open arms and taken around all the houses. We had to do all the traditional Ugandan greetings at each house so it gave us a good chance to practice the language. We have learned some Luganda and although the language of this area is Lusogo there are lots of similarities and we seemed to get by OK. We were taken out to see all the crops and the brick making area. They also taught us how to hull maize (we call it corn), that they turn into posho. It is important to add here that posho is a thick white substance that looks like solidified clag glue and should be banned, I am not sure how you could get a thing as fine as a corn-cob to turn into posho!
Anyway just as we were saying our goodbyes - that take almost as long as the hellos - one of the grandmothers came along and had cooked us food. We ate cassava, and BBQ maize and jackfruit. Then we finally left laden down with paw-paws, eggs, mangos, cassava, popping corn and jackfruit. The village folk were so incredibly warm and welcoming it was really a magical experience. It is normal for Ugandans to be so hospitable and to give so readily to visitors. We also got to visit the village's chicken farm which was surprisingly interesting. I would also like to report that we found the best eggs in Uganda, I think they are doing something right as the eggs were fresh and yellow yolked. Most of the eggs here have a very strong flavour have yolks that are a pale lemon colour, I think it's because chickens often eat alot of rubbish and not much else. Some of the villiagers helped us carry the produce home and even returned Hazel's mobile phone that she had accidently misplaced earlier. This day was the very, very best that Uganda has to offer, but there is a flip side....
Social - the Worst
Yesterday after a quick change after work I left the house to head out to the movies. A few meters down the road a scuffle was taking place. The scuffle turned nasty and a man was kicking and punching a younger man who couldn't have been more than about 16 or 18 years of age. I had to actually walk around them giving them a wide berth. I knew not to stop and intervene as this was a scene to stay well away from. It was as if the street was suspended in stillness (expept for the beating) for a few minutes as bystanders watched and surveyed the scene. Suddenly the stillness was broken and men started running from all directions to join in the mellee. I could hear the punches and the kicks as I walked away but worst of all I would hear the screams of the boy who was being beaten. The whole situation made me feels quite sick and coming the day after we had seen such warmth and kindness from Ugandan's it was particularly hard to bear. I think there were tears in my eyes as I walked away and left the man to his fate... whatever that may be.
I have no idea what the issue was that precluded the beating but I know that 'mob-justice' is commonplace in Uganda. Recently I read that a man was beheaded by a mob for being suspected of stealing a chicken, not quite sure if the punishment fitted the crime there. So perhaps it was a domestic issue but more likely the boy was suspected of some wrong doing and had to endure the consequences. As a 'muzungu' or 'white person' you cannot become involved no matter how strongly you feel. Having to walk away and leave the boy to his fate was almost as sickening to me as having to witness the incident in the first place.
Ugandans are essentially good, kind, relaxed and warm people but every now and then something happens to make you question every expereince that you have had in this country so far.....
Work - the Best
The best would have to be the incredible warmth and welcoming I have received from my colleagues on Hope Ward as I continue my clinical time there. I have been struck by the resourcefulness and courage of the nurses that work there. I felt a bit like a fluffy pampered Persian kitten in with all the alley cats. They take life as it comes, they rarely complain and they make do with whatever they can find. We made a bucket of saline from scratch, that is boiling the tap water adding saline and waiting for it to cool and we made a soap and water enema (yes I know it is unheard of these days) using soap and lathering it in between the hands until the right consistency had been obtained. People keep telling me that Ugandan nurses don't care, well I am not sure I agree. I believe that they care but I think that the extreme conditions they work under grind them down and they 'appear' not to care. I think they care a great deal but there is little support and they are just doing the best they can.
Work- the Worst
The worst of nursing work in Uganda would have to be the poor resources available in the hospitals and the poor condition of some of the patients. Nurses work with nothing, something we just wouldn't accept in Australia but something Ugandan nurses have no choice about. The only dressing supply available is gauze and subsequently it is used for everything even though it is useless against some of the extraordinary wounds that you encounter here. They did have hydrogen peroxide however, which got poured over a patients fungating leg wound, doing little good except for causing the man extreme pain and possibly killing what precious little good skin remained (if anyone from Clark is reading this don't tell Nik!).
The patients that you see here are very challenging in so many ways. The average age is much, much, much younger than what you would find in Australian hospitals and because of the lack of preventative health you see people presenting with end stage conditions which can only get palliative care as the condition is so advanced. This includes things such as cancers that are detected late to HIV/AIDS that is ignored due to the perisisting social stigma until it is way too late. It is a challenge for Ugandan nurses to be confronted with this every day. They are smart and knowledgable and they are caring for people with advanced conditions that could be cured if they were detected early. Breast cancer is a significant issue here but unfortunately there are not many survivors as early detection is an extremely new and misunderstood concept. As a result there are alot of fungating breast cancers that can only be treated palliatively. Now back to the good things...
Social - the Best
My friend Hazel and I went to stay with some other friends who have been working for three months in a little villiage about an hour or two (depending on traffic) passed Jinja. They have been doing public health education from a clinic that was set up by the Ugandan High Commissioner for Australia. It was a pretty impressive clinic actually but again by what we are used to it was quite sparse. They are doing some great work there and the outlying community has good access to health care and education so that is fantastic.
The real highlight of the weekend as the hospitality of the residents of the village. We were welcomed with open arms and taken around all the houses. We had to do all the traditional Ugandan greetings at each house so it gave us a good chance to practice the language. We have learned some Luganda and although the language of this area is Lusogo there are lots of similarities and we seemed to get by OK. We were taken out to see all the crops and the brick making area. They also taught us how to hull maize (we call it corn), that they turn into posho. It is important to add here that posho is a thick white substance that looks like solidified clag glue and should be banned, I am not sure how you could get a thing as fine as a corn-cob to turn into posho!
Anyway just as we were saying our goodbyes - that take almost as long as the hellos - one of the grandmothers came along and had cooked us food. We ate cassava, and BBQ maize and jackfruit. Then we finally left laden down with paw-paws, eggs, mangos, cassava, popping corn and jackfruit. The village folk were so incredibly warm and welcoming it was really a magical experience. It is normal for Ugandans to be so hospitable and to give so readily to visitors. We also got to visit the village's chicken farm which was surprisingly interesting. I would also like to report that we found the best eggs in Uganda, I think they are doing something right as the eggs were fresh and yellow yolked. Most of the eggs here have a very strong flavour have yolks that are a pale lemon colour, I think it's because chickens often eat alot of rubbish and not much else. Some of the villiagers helped us carry the produce home and even returned Hazel's mobile phone that she had accidently misplaced earlier. This day was the very, very best that Uganda has to offer, but there is a flip side....
Social - the Worst
Yesterday after a quick change after work I left the house to head out to the movies. A few meters down the road a scuffle was taking place. The scuffle turned nasty and a man was kicking and punching a younger man who couldn't have been more than about 16 or 18 years of age. I had to actually walk around them giving them a wide berth. I knew not to stop and intervene as this was a scene to stay well away from. It was as if the street was suspended in stillness (expept for the beating) for a few minutes as bystanders watched and surveyed the scene. Suddenly the stillness was broken and men started running from all directions to join in the mellee. I could hear the punches and the kicks as I walked away but worst of all I would hear the screams of the boy who was being beaten. The whole situation made me feels quite sick and coming the day after we had seen such warmth and kindness from Ugandan's it was particularly hard to bear. I think there were tears in my eyes as I walked away and left the man to his fate... whatever that may be.
I have no idea what the issue was that precluded the beating but I know that 'mob-justice' is commonplace in Uganda. Recently I read that a man was beheaded by a mob for being suspected of stealing a chicken, not quite sure if the punishment fitted the crime there. So perhaps it was a domestic issue but more likely the boy was suspected of some wrong doing and had to endure the consequences. As a 'muzungu' or 'white person' you cannot become involved no matter how strongly you feel. Having to walk away and leave the boy to his fate was almost as sickening to me as having to witness the incident in the first place.
Ugandans are essentially good, kind, relaxed and warm people but every now and then something happens to make you question every expereince that you have had in this country so far.....
Monday, December 7, 2009
Nursing, traveling and dancing in Uganda - a whole new world
Last week I had my first clinical shift in a Ugandan hospital. Until now I have been working a lot on planning clinical placements for students including developing practice portfolios and clinical guidelines. All that work needs to be done but it does get a bit boring after a while so I negotiated to work one day a week clinically. I am now working on Hope Ward each Wednesday. Hope Ward is the Charity Ward of the International Hospital Kampala (IHK). The University where I work is located on the third floor of the Hospital and while they are different organisations they have a close relationship both physically and financially. IHK is a private hospital and subsequently patients have to pay for their health care - there is insurance available. Of course not everyone in Uganda can afford it so that is where Hope Ward comes into it. Patient's on Hope Ward have come across hard times and their medical costs are covered.
Although IHK is very well resourced by Ugandan standards it was still a bit of a shock to my system working there clinically. Stock levels are very low and sometimes the most basic of medications or supplys simply aren't available. The thing that struck me the most however was the suffering of the patients. The ward is a mixture of adults and children but it's pretty different to a hospital ward in Australia as the life expectancy here is around 50 years so you don't see many elderly people. The children I looked after were either at really advanced stages of illness or had shocking stories to tell. There was a twelve year old girl with advanced cancer and brain mets, so only palliative treatment was an option and a little fella of about five who had HIV/AIDS and was barely conscious, being tube fed and having almost continuous seizures. Then there was a young boy who had been tortured and kept in a cupboard by his father for three months and was suffering significant trauma as you can imagine. The adults weren't fairing much better, there was woman in her twenties with advance HIV/AIDS and a man who was about to lose his leg (I am not sure why).
Half way through the day a young man of six came in for his first lot of chemo to treat his lymphoma. He looked very smart in his brown pin striped pants and waist coat and white shirt, his Grandma had dressed him up for his first trip to the city. But he was so lethargic he could hardly move and when the nurse put the IV in his hand he didn't even flich. I couldn't imagine that happening at home. In Uganda many cancers that we pick up early and that get treated and often cured in Australia present as advanced cancers. It really is heart breaking to see how much suffering people go through because health care is not available to them. Access to quality health care is something we just take for granted....
There are many other things we take for granted, especially in a nursing context. I was interested to see that alcohol swabs don't exist here, you have to squirt 'surgical spirit' on a cotton ball and that does the trick. There is not nice clear occlusive dressing to cover the IV site its an abrasive tape - kind of like a cross between sleek and elastoplast. This even goes on the kids. When you was your hands when working you use a bar of soap (the same bar for everyone), and to dry them you have to go to secret cupboard quite a way away from the sink to get the paper towel which is in quite short supply. The discharge medications come up in plastic bags but there are no directions on it so sometimes the patients get confused and take them all at once! I am starting to see why people only live til they are 50.
Despite the hardships they nurses were a pretty friendly and resourceful lot. They don't get much ancillary help so they have to do alot of errands and cleaning and there was very little engagement with the patients. That is the challenge infront of me - to find a way to turn that around. Easier said than done but we will see what happens. The workload of IHK was pretty good - about 6:1 but it goes up to about 6:1 when the ward is full. I recently heard about a hospital up-country in Lira where the ratio of patient to nurse is 250:1!!!!!! That is not a mistake. It is something we can't even imagine and that was in a children's area. If you have oxygen you get cared for inside the walls of the hospital but if not you are generally outside on the lawn if there is one. This story was from Northern Uganda which is just coming out of decades of war, bloodshed and misery. I think there is alot of work to be done there. So next time you go to work and there is someone off sick and you're a bit short staffed spare a thought for your colleagues in Lira - it suddenly wont seem so bad!
Other than work there was a trip to Jinja for the day. Oh a road trip is always a fine adventure in Uganda. The trip there was entertaining, highlighted by a thousand stops to try to pick up passengers even if they didn't want to go where we were headed and a change of matatu mid way to one with heavy plastic covered seats. Generally though the trip there, although slow, was relatively painless. Coming back! Now that is a whole new story. I have never seen so many trucks. Trucks that were often coming towards me in the same lane - until the last minute when they turn away somehow. There was much overtaking in all directions and many, many, many near death experiences. I have now come to understand why the best road in Uganda is also the deadliest. I have to travel that road again at the weekend so if you never see me again.....oh you'll know what happened.
There was working.....there was travelling......oh that's right and then there was dancing.......................By far a highlight (although a reluctant one) was our dancing performance at the VSO BBQ. Our friend committed our services without much consultation so as it turned out it was one in all in...We had been taking Ugandan dancing lessons and were only up to lesson number three so as you can imagine we were pretty bad. We had a percussion band and singer and we were dressed in African costumes complete with wiggley, hairy skin thingy tied on the bottom. We really looked a treat. There were four of us Gosia, Saskia, Hazel and I and when we went on stage the crowd were cheering wildly. It was great fun and I think the furry bottoms were our salvation. I wonder if anyone has it on video.............
Although IHK is very well resourced by Ugandan standards it was still a bit of a shock to my system working there clinically. Stock levels are very low and sometimes the most basic of medications or supplys simply aren't available. The thing that struck me the most however was the suffering of the patients. The ward is a mixture of adults and children but it's pretty different to a hospital ward in Australia as the life expectancy here is around 50 years so you don't see many elderly people. The children I looked after were either at really advanced stages of illness or had shocking stories to tell. There was a twelve year old girl with advanced cancer and brain mets, so only palliative treatment was an option and a little fella of about five who had HIV/AIDS and was barely conscious, being tube fed and having almost continuous seizures. Then there was a young boy who had been tortured and kept in a cupboard by his father for three months and was suffering significant trauma as you can imagine. The adults weren't fairing much better, there was woman in her twenties with advance HIV/AIDS and a man who was about to lose his leg (I am not sure why).
Half way through the day a young man of six came in for his first lot of chemo to treat his lymphoma. He looked very smart in his brown pin striped pants and waist coat and white shirt, his Grandma had dressed him up for his first trip to the city. But he was so lethargic he could hardly move and when the nurse put the IV in his hand he didn't even flich. I couldn't imagine that happening at home. In Uganda many cancers that we pick up early and that get treated and often cured in Australia present as advanced cancers. It really is heart breaking to see how much suffering people go through because health care is not available to them. Access to quality health care is something we just take for granted....
There are many other things we take for granted, especially in a nursing context. I was interested to see that alcohol swabs don't exist here, you have to squirt 'surgical spirit' on a cotton ball and that does the trick. There is not nice clear occlusive dressing to cover the IV site its an abrasive tape - kind of like a cross between sleek and elastoplast. This even goes on the kids. When you was your hands when working you use a bar of soap (the same bar for everyone), and to dry them you have to go to secret cupboard quite a way away from the sink to get the paper towel which is in quite short supply. The discharge medications come up in plastic bags but there are no directions on it so sometimes the patients get confused and take them all at once! I am starting to see why people only live til they are 50.
Despite the hardships they nurses were a pretty friendly and resourceful lot. They don't get much ancillary help so they have to do alot of errands and cleaning and there was very little engagement with the patients. That is the challenge infront of me - to find a way to turn that around. Easier said than done but we will see what happens. The workload of IHK was pretty good - about 6:1 but it goes up to about 6:1 when the ward is full. I recently heard about a hospital up-country in Lira where the ratio of patient to nurse is 250:1!!!!!! That is not a mistake. It is something we can't even imagine and that was in a children's area. If you have oxygen you get cared for inside the walls of the hospital but if not you are generally outside on the lawn if there is one. This story was from Northern Uganda which is just coming out of decades of war, bloodshed and misery. I think there is alot of work to be done there. So next time you go to work and there is someone off sick and you're a bit short staffed spare a thought for your colleagues in Lira - it suddenly wont seem so bad!
Other than work there was a trip to Jinja for the day. Oh a road trip is always a fine adventure in Uganda. The trip there was entertaining, highlighted by a thousand stops to try to pick up passengers even if they didn't want to go where we were headed and a change of matatu mid way to one with heavy plastic covered seats. Generally though the trip there, although slow, was relatively painless. Coming back! Now that is a whole new story. I have never seen so many trucks. Trucks that were often coming towards me in the same lane - until the last minute when they turn away somehow. There was much overtaking in all directions and many, many, many near death experiences. I have now come to understand why the best road in Uganda is also the deadliest. I have to travel that road again at the weekend so if you never see me again.....oh you'll know what happened.
There was working.....there was travelling......oh that's right and then there was dancing.......................By far a highlight (although a reluctant one) was our dancing performance at the VSO BBQ. Our friend committed our services without much consultation so as it turned out it was one in all in...We had been taking Ugandan dancing lessons and were only up to lesson number three so as you can imagine we were pretty bad. We had a percussion band and singer and we were dressed in African costumes complete with wiggley, hairy skin thingy tied on the bottom. We really looked a treat. There were four of us Gosia, Saskia, Hazel and I and when we went on stage the crowd were cheering wildly. It was great fun and I think the furry bottoms were our salvation. I wonder if anyone has it on video.............
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