Sunday, June 6, 2010

Mulago....Mulago.....Mulago

It's not for the faint of heart that is for sure. It was with some trepidation that I arrived for my first shift at Mulago Accident and Emergency Department. In some strange twist of fate or lunacy it is a requirement of the Ugandan Nurses and Midwives Council that all foreign trained nurses should complete eight weeks of supervised practice at a major Kampala hospital in order to gain Ugandan Nurses Registration. Some aspects of this statement are a contradiction of terms of course. On my first day I didn't meet another nurse so I am not sure how the concept of 'supervised' practice is working here! In fact in the first month I have not seen the same nurse twice and if there is a nurse on duty she sometimes disappears for hours on end, after arriving somewhere between nine and ten for a shift that starts at eight!

About an hour into my first shift I was suturing someone's head. Not something that I have ever done before or not something that I had ever imagined doing. I felt pretty nervous about suturing and felt sorry for the man whose head I sutured. This feeling however was short lived as I saw other people suturing and their techniques and standards left alot to be desired. Of course there are some differences between suturing in Mulago and suturing in Australia. In Mulago there is no light, often no sterile field, rusty equipment which often doesn't work, you don't have to spend much time selecting the sutures you just use what is available and usually that is several years out of date and completely inappropriate for the job at hand. So since that tentative first day there has been much suturing and I have got quite good at it although I am really just making it up as I go along. I am also now very adept at shooing away flies before they land on the wound, although I don't think many clinicians worry too much about that here.

I have been working in the trauma room of the accident and emergency department. Most days are a blur of traffic accidents (mostly boda-boda or matatu), mob justice beatings, assaults, domestic violence, burns and bites (yes that is a combination of dog bites and strangely human bites). It is a strange world to exist in. The reality and prevalence of mob justice in Uganda has been a real eye opener. We all know it exists and I have seen it a few times in my neighborhood but to see the magnitude of it in society has been stunning to say the least. I am flabbergasted at the damage humans can do to another, and I am not sure if the punishment ever fits the crime. Mob justice seems to exist whether the crime is real or suspected and the victim has little or no chance to defend himself. Most mob justice victims are beaten with sticks, rocks, fists and feet and present covered in blood with multiple cuts, bruises and abraisions and usually some form of head trauma. More serious cases present with burns (ie beaten then set alight), fractures, sever head trauma, stabbings (eg cut throat) and the occasional gunshot wound. So I guess the motto is.....if your going to be a theif in Uganda make sure you are a really good one and never, never, ever get caught....

The Mulago emergency room lacks the frenzied activity of many emergency rooms back home. This took me a while to work out, then it seemed to become clearer that although there were horrific injuries most patients were relatively stable. After careful thought and consideration and some discussion with my colleagues I discovered that patients in more critical conditions didn't make it to hospital. Many accident and trauma victims that make it to hospital in a critical condition in Australian die at the scene in Uganda. There is no public ambulance service in Uganda, and if there was it would be pretty hard to get through the traffic and the potholes anyway. So patients receive little or no first aid at the scene. The issue of life and death is somewhat random. Many patients arrive in hospital in the back of a police pick up truck after being bundled in there at the accident or incident scene, no first aid has been administered until they arrive in hospital and if they are lucky they may get treatment once they arrive. So there it is if you can somehow get to a hospital you could have a chance of survival, if you can't get to a hospital you will just die on a roadside somewhere and hopefully people will step over you......

I am perplexed by the numbers of head injuries that present usually as a result of assault or traffic accident. Not once have I seen a patient properly assessed for neurological function or injury, occasionally patients are allocated a CT scan or Xray but many are sewn up, sent home without assessement or follow up. Next week I will start working on the Neuro ward so intend to follow up on these questions to find out just how brain injury is cared for in Uganda and what the impact is on the society. Of course the amount of brain injury here could potentially be reduced by the universal wearing of well fitting helmets by boda-boda drivers and passengers. The use of helmets is rare and most helmets are ill fitting.

Working in Mulago is like stepping through a hole in the Universe and arriving in a place like no other that bares no resemblance to anything you have ever known. I have seen some of the most appalling clinical practice that I could ever hope to see. I have see Doctors slap patients, nurses verbally abuse patients and degrade and humiliate them. I see poor practice in terms of infection control. The trauma room is covered in blood which seems to end up on door handles and walls and ceilings, I am not sure how! It is only ever cleaned with water, so I am not sure what microbes and things may be lurking around. Drugs are never checked and vials may be used for multiple patients are often accessed with a dirty needle then used for different patients. IV lines that have been on the floor are connected to patients.....there are too many things to mention.....but it is interesting that this time of practice is to get Ugandan registration and I have only seen bad practice. I am not sure what we are supposed to be learning.

Exsisting at Mulago makes you question the very core of health care and ever society here. It makes me question why I am here. I didn't come to Uganda to change the world (or Uganda) but I did hope to make some small amount of difference. Unfortunately it seems that a thousand lifetimes at Mulago may never make a difference. So the question extends, can I really make a difference when I return to my VSO assignment or should I just admit defeat and head home????? The answer of course isn't simple and perhaps doesn't exist yet. So what are aid workers and volunteers doing in Uganda? Can we help? Can we even comprehend what is going on here? Why in a country with 7% economic growth is there no money put into the health care system? Only questions I am afraid, I may attempt to answer them someday but at the moment I can only confuse myself (and probably you) with them.......

The Serengeti

They call it endless plains, a special sense of freedom that goes on forever,
Once you've found that place, your body may leave but your heart will never.
The wildebeest were migrating an incredible sight,
And the predators come alive in the pale, fading light.
A lioness carries her cub with tenderness and love,
Vultures and stalks survey the land from above.
The hyenas are hungry, they take what they can get,
While the leopard sleeps in the tree, he's not ready to get up just yet.
A cheetah mother is on guard, protecting her young,
We share special moments with her family in the midday sun.
Alive in the magic of the never ending plains in the soft morning light,
And transfixed by the wonder as day turns to night.
May the Serengeti live on, may the Universe protect her,
And may we always feel the magic, the freedom and the wonder.

The Wedding of the Century

An arrival from deepest, darkest Africa saw it all begin with a surprise,
The shock defied words, and brought tears to Michael's and Caroline's eyes.
But the weather man said grey clouds would gather in the Melbourne sky,
But we drank champagne and celebrated in brilliant sunshine, stories of rain were surely a lie.
The laughter was all around this was the time to rejoice and celebrate,
A family together, a journey of love, joy and fate.
The Universe agreed and decided to leave her stamp,
Everyone left smiling but feeling pretty damp.
A once in a lifetime storm, the city stood still,
But the party continued, such was the will.
It was the wedding of the century, it was always going to be,
An eternity of love and laughter is all the future can see.

Thursday, February 4, 2010

A journey into the badlands

We ventured way up north we had to cross the line,
Lost in the badlands, but the Kidepo valley looked fine.
We traveled for days on the road to nowhere,
Grimy and covered in red dust , but it was worth it I swear.
For Kidepo is wild, it is rugged and raw,
There's just savanna and mountains stretching wide and far.
We moved into our new home at Pride Rock,
I never wanted to leave, I came to love it a lot.
We ventured further north to the ostriches and the Sudan,
So the ostriches were OK but for the other there THE ban.
But sometimes you have to go where you're not supposed to be,
When your on safari in the badlands you become wild and free.
The creature of Kidepo are struggling to recover and survive,
They too have been victims of war, I hope someday they'll thrive.
The giraffes are endangered they cling to the earth,
Zebras are losing their manes, trying to shake the curse.
So there's peace in Uganda, will they get a chance to regenerate,
Oh but beware of the Sudan and other matters of state.
We had to leave Pride Rock, our wild Kidepo home,
We hold great hope for her creatures, they will never be alone.
For I left a part of myself behind on that day,
Sitting on Pride Rock, gazing over the savanna at play.
I hope to return to visit the badlands again one day,
To retrieve myself from Pride Rock, come what may.

A proposal to VSO

I shall start by proclaiming 'Dear VSO',
I have to confess I traveled overland to Kidepo.
There's work to be done in the National Park way up there,
We need to make more tracks so we can go everywhere.
My friends and I would be up for the task,
If you let us do this project we'll do anything you ask.
We promise to be good, all your rules we will obey,
We will return to Kidepo and there we will stay.
Because as well as the tracks there are creatures to save,
If you let us help the Zebra and Giraffe we will surely behave.
We promise to stay out of the Sudan,
Because of course we know all about the ban.
We will wear a helmet and wont catch a boda-boda at night,
We will be good, we have seen the light.
Dear VSO please grant our request,
And help us to make Kidepo the best.

The nature walk

The day was hot and the grass oh so long,
They called it a nature walk but something seemed slightly wrong.
The grass hit me in the face and tickled my arms,
Suddenly walking in the wilds of Kidepo had lost all its charm.
Oh why were we walking through this crazy long grass,
If there was something to see then we would surely walk past.
But the buffalo wasn't stupid he heard us amble on by,
He huffed and snorted as he charged and I wondered why.
Why were in walking in long grass that rendered animals invisible,
We were trapped in a bizarre nature walk, I was feeling quite miserable.
Could it be that the ranger really didn't have a clue,
Or perhaps he'd just gone stark raving mad, that could also be true.
I started to dawdle behind, I'd lost the will to go on,
Surely it would be over soon, we'd been walking so long.
Finally it was over and we could go for a beer,
There's nothing like a Club to restore a little cheer.
So if your ever in Kidepo remember not to go nature walking with the ranger,
You'll be smothered by the long grass within which lay many a hidden danger.

Oh how they love me

I traversed Uganda through formerly troubled towns,
And found a place called Kidepo where insects abound.
At first they didn't really bother me much,
But then I got bitten, the bites were red, swollen and hot to touch,
Why do they choose me over all of my friends,
I'd like them to share the love around, I don't want to offend.
There are very many flies both tsetse and regular,
And some other flying insects that look really quite bizarre.
Then there are ants and mosquitoes that are only too happy to bite you,
The insects of Kidepo lie in wait when you head to the loo.
Oh how I wish they would all go away,
And leave me to get on with my day.
But I should stop moaning I've no right to complain,
As Kidepo has lion, leopard and cheetah and all sorts of other game.
As I sit in the paradise that is our campsite home,
I watch the creatures of the savanna that are wild and free to roam.
So I forgive you Kidepo for every pesky and biting insect,
Because in so many other ways you are close to perfect.

Wednesday, January 6, 2010

A Ugandan Christmas Safari

Looking back on my Christmas safari around Uganda it is hard to know how to describe it properly or where to begin. So I'll just start at the beginning and hope that I can do it justice.

It all started with a death defying drive to Lake Mburo (thanks Wayne). I particularly enjoyed the near misses, the sudden braking and hurtling along the shoulder of the road hoping to avoid a number of large heavy vehicles without slowing down. Although it looked unlikely at times, we arrived safely at Lake Mburo and set up camp under the watchful gaze of a spectacular sunset. We set off the next morning on a game drive on an ever disappearing road which was eventful and time-consuming. We saw many of the creatures that Lake Mburo is known for - zebra, impala, warthogs, topi, birds too numerous to mention, monkeys, warthogs, bush pigs, buffalo, hippos oh and did I mention warthogs. No rare red tree climbing warthogs, still looking for them!

A relatively uneventful drive delivered us the breathtakingly spectacular Lake Bunyoni. In the misty morning light we took a very special boat ride around the various islands of the lake and soaked up the atmosphere and the surroundings. Then it was off to Bwindi with great anticipation for the mountain gorillas. Of course '.. it wasn't the road that Anthony took...'. Yeah, yeah I think that there was a reason for that - it wasn't the road to Bwindi!!! After a three hour detour and another wrong turn we were actually on the road to Bwindi passed the placenta pit and the dodgy road works that you had to pay to go through. Finally there we were in the Impenetrable Forest home to 320 of the last remaining 750 mountain gorillas.

Ah it was all about the GORILLAS. There was a great deal of exitement and anticipation as we set out on the trek of a lifetime. The gorilla permit costs $500 each so it is something one would only really do once in one's life so I was planning to enjoy every minute. The Universe didn't fail to deliver here either, after a ten minute trek (some people trek for up to six hours) we were in the company of about 18 mountain gorillas of all ages and sizes. We were only allowed to spend one hour with them and although when we were with them time seemed to stand still, when it was over it felt like the quickest hour of my life. Words don't really do justice to the experience, it was very special and humbling and magical all at the same time. We spent the afternoon walking in the forest to a series of waterfalls which was pretty spectacular. Bwindi Impenetrable Forest if you ever get the chance go there you will never regret it and never forget it.

Leaving Bwindi and her mountain gorillas behind we headed off to Ishasha. Ishasha there it is again, I just love that word - ISHASHA. Ah yet again she didn't disappoint, Christmas eve saw two lions in a tree and hopes were high for Christmas day. I had earlier asked Santa for two lions in a tree and a leopard for Christmas and I had also drunk some South African wine with the picture of a leopard on the label to give me good leopard karma. Things went a little wrong when we got stuck in a bog for six hours and we had to dig and jack and search for big logs while everyone at home was indulging in turkey, ham, raspberries, pudding with brandy sauce and chocolate covered almonds among other things. We ran out of water and had no lunch but thankfully after alot of hard work we exited the bog at around five thirty! Apparently as it turns out good things happen to those who wallow in mud for six hours. On the way back to our camp Santa, who had had his laugh for the day, delivered up a spectacular leopard in a tree. We were blessed to be able to spend about half an hour with the leopard (we named him Santa) as he did leopard things. He got out of the tree, he sat in the grass, he walked about, he flicked his beautiful tail, he sat on a rock, he marked his territory, he climbed another tree, he surveyed the savana to check for prey and finally he walked away. Magic is the only way to describe it, and for days later I kept checking my camera to confirm that we did actually see a leopard.

We headed to the northern section of QENP and saw two more tree climbing lions. What do lions eat again - people I think if they get out of the vehicle. We stayed at the spectacular campsite number two by the channel but there was tension brewing in the camp. The next day after confirming with google what a rainforest was, luckily Wayne was right all along, we arrived in the foothills of the Rwenzori where we had a spectacular trek in the forest for three hours. Tensions boiled over in the camp over a two second tent. Its a long story but the next day we said goodbye to one of our group and headed off the Murchison Falls, never looking back really.

Murchison Falls were as spectacular as ever and we had a fabulous experience trekking the chimpanzees. At one stage we were surrounded by chimps they were mostly above us and occasionally the odd leaf or branch came down on our heads. One of the lady chimps was on heat and a rather raucous fight ensued which was a little scarey to say the least. But all was forgiven and there was even some chimp mating going on, I had to avert my eyes for a while, well only for a few seconds really because it didn't take too long!

We had a fine time in camp in Murchison as our guide passed out by ten pm, not sure why, but anyway we painted his toe and finger nails and generally took advantage of him while he was sleeping. It wasn't my idea of course and I would like to absolve myself of any responsibility. He spoke of revenge, but it never eventuated which I was thankful for.

We had a fine boat trip up the Nile to Lake Albert passed numerous hippos, huge crocodiles and a fleeting sighting of the very rare shoebill bird. We then spent the night in Ziwa Rhino Sanctuary and had the pleasure of walking with their newest arrival Augustu and his mum Bella and her new boyfriend. There was a bit of tension in the rhino camp and Bella got grumpy with the boyfriend and they both started running towards us. But after goillas, leopard, lions, chimps and all the other creatures the rhino incident hardly even registered with us. Looking back now we were pretty lucky to see the baby who was only born in October and even luckier to see the rhinos so fired up and active.

So it was back to Jinja, although we nearly didn't make it after a very close encounter with a truck exiting a petrol station but I think that we came off better than the matoke that the innocent bystander was carrying!

Then it was New Year's Eve and it was perhaps the most bizzare nye yet, highlighted by a facinating fireworks display. The fireworks didn't really go very high into the air so you felt like you were being shot everytime one went off, there was much screaming in the audience. Of course not all the fireworks seemed to go off and there was alot of smoke filling the venue which luckily was open air. We were a bit worried about surrounding thatched roofs though. Somehow tragedy was averted and we live to tell another story.

So that was it then, the Ugandan Christmas Safari over and done with. Now its back in Kampala and I have discovered a new disease called PSMD. It is also known as Post Safari Mood Disorder and it is affecting many who were out and about in Uganda over Christmas. I think I have a serious case of PSMD but I am hoping to cure it with a trip to Sipi Falls this weekend and a safari in Kidepo national park in a couple of weeks.

Until then I will always be on safari in my mind.........

Endangered but Cherished

They said '...be prepared you may have to trek all day',
But ten minutes was all it took, we hardly went out of our way.
And then there he was lounging up against a tree,
The silverback relaxed right in front of me.
I caught my breath at the sight of this spectacular creature,
His shimmering silver torso was his finest feature.
His ladies were foraging in the trees up high,
He was waiting for them to come down so he could move on by.
We went deeper into the forest hoping for more of his family to meet,
Gradually the gorillas surrounded us, it was truly a treat.
The tiny baby clung tightly to her mum,
Others were tumbling and playing, having lots of fun.
Only 750 mountain gorillas remain on this earth,
The joy and happiness they bring, proves their true worth.
On a very special day they welcomed me into their home,
May they always be with us, free to forage and roam.

Monday, January 4, 2010

Christmas Cats

In December 2009 I sat on Santa's knee,
And I asked for a leopard as well as two lions in a tree.
I assured him that I'd been a very good girl,
It would be a fine way to end a year that flew by in a whirl.
Christmas eve he delivered a tree with two lions lounging within,
What a magical way for Christmas to begin.
Now Santa for the leopard, it's a simple request,
For Christmas in Ishasha you should bring out the best.
But Santa's got a dark side, he likes to have a bit of fun,
So he sent us six hours stuck in a bog in the sun.
We were covered in mud, hungry, thirsty and tired,
This was a pretty strange Christmas, I could have broken down and cried.
Then suddenly in the distance there was a cat in a tree,
Stop! Back up! There's a lion up there, cried Nathalie.
But no lion exists with such a curl in his tail,
This was a Christmas leopard, I knew Santa wouldn't fail.
The next thirty minutes were spent in the leopard's company,
It was a magical Christmas for the wild and the free.
So thank you to Santa and every large predatory cat,
I'd like a cheetah in 2010 if you can arrange that

Ode to Wayne

In the wilds of Uganda, he's not sure what's a road and what's not,
What once was a road seemed to disappear quite a lot.
He can sniff out a gorilla where it's not supposed to be,
Perhaps they are kindred spirits both wandering and free.
He's fun to spend Christmas with, six hours stuck in a bog,
And a never ending quest to find a big log.
All was forgiven with a leopard and a smile,
A day to remember for quite a while.
The champagne brought him undone, down and out by ten,
He awoke with black and gold nails, how could that happen.
Wayne is so brave, in the frontline of the fireworks display,
He protected me from so many dangers that day.
Sometimes he is naughty and sometimes he is nice,
But if he passes out before midnight, he's gonna pay the price.