Star Fishes

Prior to coming out here to Jinja, like any other trainee on their first volunteering mission abroad. I was full of doubts, hopes, worries and more worries. At the pre- assignment training my fear was ever so glaring on my face that it prompted a pet talk from Global links Manager about my options at which point the popular story about the young man throwing in the starfishes was discussed.  After 5 months in Jinja this story continues to hold true.

Here is a reminder of the story… Once upon a time, there was an old man who used to go to the ocean to do his writing. He had a habit of walking on the beach every morning before he began his work. Early one morning, he was walking along the shore after a big storm had passed and found the vast beach littered with starfish as far as the eye could see, stretching in both directions. 

Off in the distance, the old man noticed a small boy approaching.  As the boy walked, he paused every so often and as he grew closer, the man could see that he was occasionally bending down to pick up an object and throw it into the sea.  The boy came closer still and the man called out, “Good morning!  May I ask what it is that you are doing?”

The young boy paused, looked up, and replied “Throwing starfish into the ocean. The tide has washed them up onto the beach and they can’t return to the sea by themselves,” the youth replied. “When the sun gets high, they will die, unless I throw them back into the water.”

The old man replied, “But there must be tens of thousands of starfish on this beach. I’m afraid you won’t really be able to make much of a difference.”

The boy bent down, picked up yet another starfish and threw it as far as he could into the ocean. Then he turned, smiled and said, “It made a difference to that one!”

adapted from The Star Thrower, by Loren Eiseley (1907 – 1977)

I present to you some of my starfishes-

 M & M! These twins were born at 27 weeks gestation; they weighed 700grams and 800 grams.  All we could do was give them antibiotics keep them warm via KMC and use our homemade CPAP.  5 months on they are both 2.8 kg and 3.1 kg respectively. 

Baby N- brought to hospital with severe pneumonia from an orphanage by a kind lady.  Needed oxygen for a few days and is now a picture of health.

Baby S- Admitted with severe malnutrition in shock, and tuberculosis. Now gained a lot of weight (maybe too much!)

It thus make a difference to that one starfish thrown back in the ocean.

Reflections

I haven’t written in a while, not because nothing has happened but because I find myself getting use to the order of things. I no longer count the amount of deaths we have each week as I did in my earlier months, neither do I complain about the lack of resources. It is the order of the day and lamenting never helped anyone; one just has to make best with what we have here.  My time here is slowly drawing to an end and I find that I have become very reflective about what these few months have taught me.

 At first I was worried that I have become hardened to mortality and that scared me, but this isn’t true as one of my favorite patient “passed” last week whilst we were away and I find that I feel such a great loss on the passing of this lovely 2.5 year old boy who has been in Nalufenya for over 4 months. I realize that doctors working in these situations are not hardened to mortality; they have learnt a way to cope with it without burning out. One of the Ugandan doctors once told me that she hardly cries at the loss of a patient now because she did all her crying when she was a Medical student. I can relate to this in my time here.

Lunch with work colleagues

On a personal level, I am overwhelmed by how far I have come.  It really is true that you do not know what you are capable of until you are pushed. Jinja has taught me to be patience and tolerance, in truth my character and identity as a person has been greatly tested over the few months and I feel a better person for doing this. The challenges I anticipated ahead of this experience seem ever so trivial in comparison to what were truly my challenges. More than any fancy clinical skills, I find that in these situations your relationships with people matters as well.

Apparently this baby looks like me

Professionally I feel more focused than ever, this is what I like doing.  This experience has taught me to rely on my clinical skills more than any investigation; I have learnt to think outside the box and find alternative, simpler ways to treat our patients instead of worrying about what I do not have. I now realize how ambitious some of my aims and objectives were and although I haven’t achieved every single one of them, in here lies a lesson itself. Patience! Rome wasn’t built in a day. In the last 5 months I have done more teaching than I did at home and this has also opened up another interest of mine. People ask me if I think I am a better doctor for doing this. I hope I am! I feel so luck to be able to do this job. 

Working on the special care unit

Lastly I have come to appreciate my life even more, I feel incredibly blessed for the opportunities I have had thus far. To have such great mentors, friends and family both at home and amongst the expat community here is incredible. Thank you to you all once again.  Will I do this again? The answer is yes, in a heartbeat.

Perks of the Job - "Paediatric Safari"

This week a friend from the UK came to visit, luckily for me we have a couple of extra bank holidays in Uganda this month. So I decided to take some days off as annual leave and do some field research at a popular Safari destination. Here are some of the pictures from our Safari trip, it is "semi" paediatric themed. Unfortunately we did not see any lions, they were having a nap but there were some crocs. Enjoy!! You can click on each picture for a better view.

Sunrise 

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Giraffe family

Ze hippopotamus

Ugandan Kob breast feeding- Breast is best! 

Family of Warthogs on our camp site

Famous Acacia tree

Crocodile getting ready to hunt.

Walk in the park

Just chilling 

Strike a pose

'The Village'

It is still the rainy season here but thankfully most of the torrential downpours occur at night. The nights are much cooler however the days are still very hot! I thought I would’ve acclimatized by now but unfortunately I still walk around pouring in sweat much to the amusement of our Ugandan colleges. With the increased precipitation, there is a visible increase in the amount of mosquitos around, which as expected equates to an increasing number of children admitted with severe malaria despite the amount of preventative work going on all over Africa. As part of malaria prevention initiatives, most households in many countries in sub-Saharan Africa are given a number of free mosquito nets. This is especially valuable in rural areas where the incidence of malaria in children under 5 is particularly high. I can vouch that these initiatives do take place as several friends and family have been supplied with mosquito nets.

Hence my confusion at the incidence of severe/complicated malaria in the children we see at Jinja. A vast majority of them are from the rural areas which are the targeted areas, so most of them should have free nets. We often ask them about preventative methods and although the majority of them admit to receiving mosquito nets, whether they use these nets is another question. On a recent ward round, the issue of whether parents use mosquito nets or not created an interesting debate. Much to my disappointment I am informed by reliable sources that most of these families in ‘the village’ have found alternative, more lucrative uses for mosquito nets;

1. Making several vests for the men of the house to wear
2. Fishing
   
   
   
   
3. Collecting large numbers of plastic bottles to be recycled for a reward
4.  On a medical side, apparently even we doctors are using them. Mosquito nets are also very good for hernia repairs.

Aside from these profitable alternative uses for mosquito nets there are also several myths about nets (e.g. it is government propaganda to harm people, and that mosquito nets kill babies). I am not surprised about these myths; it wouldn’t truly be Africa if there were no myths (I’m allowed to say this, I’m African after all). I suppose that all of this suggests a new plan of attack for our malaria prevention strategies. We need to go to ‘the village’. Health education in these communities is just as important, if not more important than all the work we are doing in the hospital. The only problem is, after all the tales of cannibalism and kidnappings I have heard occur in ‘the village’, I am slightly scared.

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….