Steve's Blog

It’s been far too long since I last posted, but this blog was really supposed to be a record of what I was up to in 2007 when I was working as a Surgeon in Kiwoko Hospital, Uganda. I returned for a visit recently, and realised just how much I missed working there, and just how unsatisfying I am finding my current UK life. I think there are a number of reasons for this, and I probably need to sort out a few of my issues here in Scotland before making definite plans to return long-term – although this is a definite possibility!

Tell Him your plans! At least that was what my former minister said (Rev Dennis Lennon, who sadly died recently). I sometimes feel that God’s been able to laugh at me a lot. It’s now over three months since I returned to Scotland from Uganda, and I’m still finding it difficult to settle, workwise. Surgery at the Royal Infirmary Of Edinburgh is a very different work environment from surgery at Kiwoko Hospital in Uganda, but I think it’s more the type of surgery that I’m doing that is causing me difficulties.

I’ve been having a fairly depressing time since returning to Scotland from Uganda – the weather in January was miserable, it’s been a little overwhelming to reacquaint myself with old friends, life is very over-regulated, and returning to work in the NHS hasn’t been easy. However, on Saturday I found myself saying, for the first time in six weeks, “I’m glad to be here today!”

… and back home in Edinburgh! My year’s adventure in Uganda has come to an end, and I have safely returned, although I’m aware that a large part of me has been left behind and is still in Kiwoko Hospital. In many ways it’s a miracle to have made it home (there seemed to be a conspiracy to keep me at the hospital!). First off was the planned UK airports strikes, cunningly designed to impact my planned date of flying! These were fortunately called off well in advance.

 
… is only a little surreal! Here at Kiwoko Hospital in Uganda we had our Christmas Party yesterday. For someone coming from Scotland, its very difficult to get used to a mid-winter festival taking place in 28 degree heat, with burning sunshine, no rain or snow, and 12 hour days. Nevertheless, there are some wonderful aspects to a Ugandan Christmas – not least the fact that there is none of the commercialism that is seen in the UK anytime from August onwards!

  
is a well-known Ugandan saying – often heard if visiting somewhere to get something done such as collect a repair, prospectively view a purchase, visit an official, etc. Usually there is only one key for the room/building you are trying to enter, and invariably that key is with someone who is not there. Ugandans are fairly laid back about this sort of thing – why get upset or annoyed when you can’t do anything about it? Muzungus on the other hand tend to get very frustrated by not being able to get something done in a hurry! “The Man With The Key Is Gone” is also the title of a book by Dr Ian Clarke telling the story of how Kiwoko Hospital, where I work, came to exist.

For the last two weeks my brother and sister-in-law have been visiting me here in Kiwoko Hospital, Uganda. They’re probably the last people I’ll have coming to stay, as I now have less than seven weeks until I’m back in the UK. Before heading on another grand tour of Uganda, we spent some time at the hospital – the first and probably the last time that Alan and I have worked together as doctors. It was actually quite fun: we were able to operate on a couple of patients together, and helped each other out doing an orthopaedic clinic when our visiting specialist failed to turn up. I introduced him to some of the more tropical aspects of orthopaedics, and he was able to help with some of our more complicated patients.

here in Kiwoko Hospital, Uganda. Some visitors from Northern Ireland arrived today bringing with them three more endoscopes for us to use, including one designed for Gastroscopy. If you’ve been following my efforts this year, either through this blog or by newsletter, you’ll know that one of my projects has been to introduce endoscopy services to the hospital – the facility to examine the inside of the stomach or bowel using a flexible telescope.

…is sometimes what practicing surgery in Kiwoko Hospital feels like. For someone brought up in the UK healthcare system, where almost any investigation can be carried out (albeit sometimes with a long wait – oh dear, I’m getting political!), the lack of facilities here in rural Uganda makes treating patients fairly interesting.
 
We can do basic laboratory investigations on blood, but each test costs the equivalent of £1 or $2 – which starts becoming unaffordable for our population if you suggest too many. So rather than getting routine haematology and biochemistry on every admission, we may request a Haemaglobin level to check for anaemia, a white cell count (done manually by microscope), to look for signs of infection and likely type of causative organism, and sometimes a Potassium level or renal function tests.

 
I was especially struck by this amazing fact earlier this week. At the beginning of last week, I was on-call for Kiwoko Hospital, here in Uganda, covering all seven wards rather than just the surgical wards that I work on day-to-day. At 6am a small child was admitted, very sick, with a fever and difficulty breathing. The diagnosis of chest infection was fairly straightforward, and the treatment we are able to give, namely oxygen and intravenous antibiotics, was started immediately. Something about this six-month old made me wait to ensure that he responded – and five minutes later she stopped breathing completely.