Last days & Returning Home

My last days at Salem were busy assisting the staff to produce workplans and aims and objectives for each of the departments. This had been one of the major projects in my objectives - for each department to develop a workplan and associated budget for 2011.

Some people had more experience of this type of project than others and so 1 -1s were put in place for those who needed a bit of extra help. We had 2 workshops; one for the heads of departments and the Board, and one a week later for the rest of the staff. The result of which was that 'workplans' were the buzzword at Salem for my final days as much effort was being put into preparing their departments contribution ready for sign off by the Board on 16 December.

I hope the workplans are followed up in 2011 and are a useful tool for taking the organisation forward to a new level, after all the effort that was put into developing them. 

At the all staff workshop I was very touched by how many people stood up at the end and thanked me for my contribution to Salem. It meant a lot to me and it was amazing that so many individuals felt they needed to stand up and publicly express their thanks. I have worked hard in many other organisations but I never felt that my efforts actually meant as much in the past. It is a very happy experience that will stay with me for a long time - hopefully forever.


I was lucky enough to share transport to Kampala on Friday as other staff from Salem also needed to go to Kampala.

On Saturday I was able to do some last minute shopping for gifts and Christmas presents to take back home. I was glad of the time to do this. it was strange to see the money dwindling down to my last few thousand Ugandan shillings.

My overnight flight home via Istanbul was largely uneventful although a bit bumpy in places and I managed to get a couple of hours sleep on the plane. The only thing with that is ending up all stiff from the odd postures you get into.

I was very pleased to see my husband and daughter waiting for me at Heathrow. They had brought me a warm jumper and boots to put on which were very welcome as the ground was still white in places from the snow. The temperature difference between Uganda and the UK was probably about 30 degrees.

We went straight home to a roast chicken dinner which was fab. When I weighed myself I was pleasantly surprised to see I had lost 1 1/2 stone from when I left. The diet of fresh fruit and veg (and rice and beans) obviously did me a lot of good. 

I have to say I was not a real fan of the matoke (bananas) or posha but the other food was very good and tasty and I wasn't ill at all while I was there.


I am hoping to link in with the PONT organisation in south Wales on my return and maybe it will be possible for me to go back to Uganda again at some stage in the future. I found the placement very fulfilling and would love to meet up with the people that I had the pleasure of working with and meeting.

I would recommend it to anyone who wants to see a different side of life and maybe appreciate what we have in the west a little more.

Climbing the ridge - one of my little walks!

Last Sunday a small group of us (Mike a volunteer from the Peace Corps , Misha a social worker from Germany, Carl-Heinz a visitor from Germany and I walked to the top of Wanale (pronounced Wanally) ridge. This is a ridge formed from the volcanic flow from Mount Elgon many years ago. It is about 2000m above sea level, so the climb was about 800m as Mbale is already just under 1200m above sea level. Our guide was Andrew - an 11 year old boy who is from the village at the top but who lives in the slum at the bottom of the ridge. On the day his father Steven decided that he would accompany us as well, to visit his family at the top.

We left Salem at 7am and started walking from the Mount Elgon Hotel at about 7.30 am. It was a long hard climb

and in several places we crossed waterfalls

and there were some very steep drops from the side of the path. There are no pictures of the really steep bits because we were concentrating very hard, but I think you can see from this how far we came up.

One of the things that surprised me was the bits of land on the side of very steep hills that were being cultivated for crops.

This is one of the waterfalls that can be see from about half way –

the next pictures are when we were standing on top of it. Looking over the top it was a VERY long way straight down.

The views from the top are stunning.

I was really surprised at the number of people living there. They seemed to have a reasonably good quality of life and be well fed.

Apparently it rains a lot up there so the crops are well watered. I was also surprised at the number of people who passed us on the steep path to the top. There were ladies with big piles of goods on their heads and with small children (about 3 years of age) in tow, who made the climb look very easy.

When we reached the top I was very glad as I don’t think I could have gone up much further.

Mike and our 2 guides were like mountain goats and were as spritely as ever. I had to bandage my foot as I had developed a very large blister on my left heel and all the skin had come off even though I put a plaster on it. My boots have not been worn that often and the constant rubbing from the upward climb really rubbed the back of my heel.

I really noticed the difference in the altitude whenever we hit an incline at the top and I could really feel that I was much more breathless that when we were at lower altitude, I expect it is partly because at home we live fairly close to sea level and so the difference is quite considerable. The air was also much cooler at the top which was really refreshing although it was a hot day.

Our general consensus on getting to the top was that we were not happy to go back down the same way and so we walked to join the road. It turned out that the road was 14 miles back to Mbale. We ate the snacks that we had brought with us and Steven also picked some passion fruits and showed how to open them by twisting them with your hands. Standing at the top slurping really fresh passion fruit out of their skins was a memorable experience -  don’t think they will ever taste any where near as good again.

It took a good while and Carl-Heinz and Mischa took a boda from near the top he was finding the distance a bit too much. We trudged down the road and I eventually got back to the Mount Elgon Hotel with weary feet by about 4pm. I left a bag there at the beginning of the day so that I could have a swim and shower after the walk. I needed at least 2 bottles of water and something good to eat (as well as a beer) before I felt human again.

This is the picture from the hotel and you can see the top of the ridge that we were on in the background - pretty impressive eh??

Then we had a taxi back to Salem. 

I thought my muscles would ache afterwards but they didn’t, I just felt very tired and needed early nights for the next 2 days. Then we had the objective setting workshops and lots of assistance was needed afterwards (hence the delay in the blog).

Riding the Rapids of the Nile

Well just got back today from a 2 night stay at Jinja. this is the centre for white water rafting on the the Nile. i decided that I need to do something a bit special before I go back home so I thought a bit of a trip down the Nile would be good.

Even though this is what I wanted to do I was feeling very nervous about it so I thought may be the 2 man kayak version would be better. At least then I can make decisions about my own journey. Also when I looked at my insurance I'm covered for canoeing but not the rafting.

So off I went on Thursday to Jinja, and on the advice of one of the staff here whose brother lives there- I ended up at Bujagali Falls in a place called Explorers. I booked in for rafting as a nervous person and was advised I would be looked after by Peter a very experienced river person. My intention was to do the kids version of the river!

On Friday morning we were loaded onto the bus and taken down to the centre and fitted with life jackets and helmets. As it turned out there were 28 other people so the plan was to go down the river as a group of 4 rafts and the 2 man kayak (me).

We started off with some practice capsizing - which was horrible - but had to be done, and then encountered some bubbling water and a Grade 2 rapid.

It was pretty scary but not too bad. I don't know why but I thought the kayak would be easier to take routes down the river that were less demanding.

Then we hit a Grade 4 and the first Grade 5 at Bujugali Falls. What I hadn't really bargained on was the fact that the rafts go over the waves but the kayak goes through it when you hit the wall of water. I think I must have drunk at least a gallon of Nile water - no option when you are absolutely hammered by the water.

- I swallowed and inhaled so much water I was coughing and spluttering all over the place.

 So when we hit the next grade 5 rapid called Silverback - I opted to sit in the safety boat. The young guys from the raft centre all called me chicken but I didn't care I decided it was too big for me in a kayak. Even in the safety boat it was a thrilling ride down and we almost tipped over.

My biggest dread was that we would capsize in the middle of a rapid. Peter kept warning me that this might happen and what to do. I admit I prayed that this would not happen - and he was brilliant because even though we nearly tipped a couple of times we did stay upright all the way.

We were out for the full day, and there were long periods floating down the Nile in our life jackets in the still but still quite fast flowing water. We had lunch of pineapple, biscuits and water on the move and it was a great day. 

I've got the DVD that I am sure I will show to everyone when I get back. I did a lot more than I intended to and was really scared in places - Pete thought it was hilarious that my knees were shaking as well.

All in all, I've decided - if I can do this - I can do anything!!!!

The Offcial Opening

It has been a busy and tiring week so I apologise for the shortage of entries.

On Wednesday 17^th November we had the official inauguration of facilities at the health centre by the German Ambassador for Uganda Mr Klaus Dieter Duxmann. There was lots of manic preparation leading up to this as when I first came here on placement it was only planned that he would officially open the operating theatre. I suggested that may be we could include the new path lab as well so the work to get this to the stage where it was ready for the ceremony was considerable.

This is what the lab looked like 6 weeks ago.

After much hard work –  it was starting to take shape.

The day before the ceremony student nurses from the nursing school on site were recruited to help with the cleanup operation. Needless to say there was much laughter and shrieking when a large group of young women, a group of builders and quantities of water became involved!!  I think they all enjoyed it although they did work very hard.

Official Opening of the Laboratory and the Operating Theatre

The Ambassador is new to Uganda having only commenced the post 2 months ago. We all had dinner together the evening before the ceremony and it was really pleasant to meet such nice people who were very easy going. It was such a nice change as the dining tables in the guest house were set out in the garden and well all sat under the stars to eat.

I was nominated to be master of ceremonies for the day. The main purpose of this being to keep to the planned schedule as the Ambassador is not allowed to travel after dark for security reasons; so he needed to leave on time to be back in Kampala (a 4 hour drive) by about 6.30 pm. We were due to start at 10am and by 11am we had still not started as some of the key quests had not arrived. However as some people did not turn up I was able to pull back the timings.

I think many of the staff here were amazed that we finish only 20 minutes after the time on the programme. In Uganda presenters are well known for talking for long periods and for not starting on time. Meetings are often in ‘Uganda time’ which is at least 1 hour after the planned time. There is also a saying in Uganda that in “Europe they have clocks; but in Uganda they have time!”

I shared with the staff afterwards the event that the way I kept to time was to whisper to the presenters  how many minutes they were allocated as they came up to the microphone. They were all very good at roughly keeping to this. I was very touched at how many of the staff came up to me afterwards to thank me for helping with the preparations (even those I had to chase up) – it was quite humbling.  

One of the highlights of the day was the Mbale School Brass Band who played the national anthems for the ceremony.

They are a group of young musicians who have managed to get a collection of donated brass instruments and who practice whenever they can. They were absolutely fabulous in the atmosphere that they created. When the ceremony had finished they started playing some music with a really good beat, then they lined up and were directed and led by the security police towards the guest house where lunch had been prepared. The rest of the invited guests then fell in behind them dancing their way towards lunch – it was amazing and really made the day. 

The other highlight for me was the obvious delight of the staff in having the dignitaries to open the new facilities, they sang and danced and called out in true African style as they were walking around for the opening. 

Being a pateint in Salem

Receiving healthcare in Uganda

Having been around the health centre for a while I thought I would share with you a description of how it works here. I haven’t taken photographs of the wards and the people as it doesn't seem right to share their pictures especially in times when they are compromised with an unknown audience. Those pictures I do have – people are happy for me to share them.

If you are not an emergency you make you way to the health centre. This could be by walking, by bicycle boda or by motorcycle boda. Some people arrive in the afternoon having walked many miles within the region to get here.

At the reception you are checked in and waiting to see the doctor who will assess, possible refer for blood tests and then make a treatment plan.

Treatment is usually a course of tablets or may be an injection. Some people are admitted to hospital.

As it is a non government organisation the stock of drugs is usually pretty good. Some drugs supplied by the Ministry of Health are free – these include immunisations, Vitamin A, worm tablets, HIV treatment, Septrin (antibiotic). There is a small fee for family planning and anitmalarials. As a non government organisation the health centre is able to obtain stocks of drugs – but as these have to be paid for the charges have to be passed on to the patients.

If you arrive as an emergency you still have to make your own way. I have seen 2 people arrive as emergencies where they are not conscious and have been brought on the back of a motor cycle. This involves having a third person to sit behind the patient and hold the patient between themselves and the driver.

They patient will then be brought into the health centre on arrival where they will do what they can or they may be referred on to the district hospital if they cannot be treated effectively here. If the patient or their relatives have money for fuel then the ambulance may be used otherwise people re generally expected to make their own way.

If you are admitted to hospital you will be expected to have an attendant with you. This is generally a family member(s). Sometimes several members of the family and children are present. The attendant is expected to buy and prepare the food and feed the patient. They will also wash the patient and clean any soiled laundry or clothes. Soiled laundry is expected to be cleaned before it goes to the wash room on site where it is washed with other laundry. The attendant generally sits on the floor during the day or on the grass outside while the patient lies on the bed. At night the attendant sleeps on a rush mat on the floor beside/ underneath the bed.    

When people are discharged – again they make their own way home. After having a baby it is common to see the parents and newborn disappearing off on the back of the motorbike.

This is a picture of some of the midwives, in the post delivery room. Siter Loy (the tallest) says she has adopted me as one of her daughters :)

There is a security presence at the gate. This includes an armed guard. Part of their role is to check that patients have paid their bill from the health centre before they leave the premises. Although there are still runaways – people who cannot afford to pay.

Last week there was an elderly person in the hospital who was very worried that his son (his attendant) had run away. This meant that there was no one to provide him with food or to pay the bill. The patient in the next bed provided the food for this person and I believe some arrangement was made about payment of a small fee. The organisation tries to be as helpful as possible but at the end of the day it relies on donations to operate and only has a finite supply of money.

Disposal of hospital waste is on mu agenda for follow up. I have yet to see the placenta pit although I have heard a lot about this. It’s next to where the rest of the infected waste gets buried. That is for another day.

Bats & Mystery Object

Bats in the Night

My house mate Misha was away on Saturday evening to visit some friends in Jinja. I made a meal to share with Vanessa who is another long term volunteer from Australia, read my book and had an early night. As I was on my own in the house, I locked the front door but left my bedroom door open so that I could hear the rest of the house.

At about 4.30 in the morning I heard a noise like an ornament falling over which work me up. As I was lying in the dark trying to think what had happened I heard a high pitch squeak above my head. I grabbed the torch from under my pillow and sat up in bed. I could see an animal about 4 inches long in the mosquito net right over my head. I leapt out of bed – I wasn’t going to sit underneath an unknown creature. When I looked in the mosquito net I could see it was a bat. My heart sank; I thought what on earth am I going to do with this? I didn’t really relish the idea of picking it up with my hands and what if it bites me – had it got rabies????

I looked out of the window to see if anyone else was up and about to help me – normally I would not be on my own but it had to be tonight. Obviously at 4 in the morning everyone else is fast asleep. I wondered about going up to the gate to get the security guard but felt it probably wasn’t a good idea in my pyjamas.

I decided the thickest cloth was the oven gloves – so I got them from the kitchen to try and pick it up to take it outside. The little bat held on for dear life to the mosquito net and wasn’t budging – then it decided to flap and fly away just over my head but it flew into the wall and landed stunned back on the mosquito net – not my favourite moment. When I tried to pick it up I didn’t really like the sensation of the small creature trembling in my hands and I was still afraid it might bite me.  

I wandered around the house for a few minutes looking for some inspiration and then spied the waste paper basket which is made from plastic with lots of holes up the side. I emptied the contents into a bowl and then got an old towel. I gradually managed to persuade the bat to inch forward into the bin and put the towel over the top to stop it from flying away.  Then I took it outside and managed to get it to crawl out onto a bush.

Just in case there are any sceptics amongst you I did get a photograph. (Yes that’s my socks hanging up to dry).

We have a lot of bats in the roof in the day time and they roost in the tree outside the front door at night. They are very noisy and fight a lot with each other, as we walk along the path they flap overhead, and don’t really seem to like it if you shine a torch up into the tree. I think they are fruit bats but not really sure.

Mystery object  

As you seem to have guessed the mystery object is a solar cooker. It works best when a pot with a black exterior is used as a silver exterior reflects the rays. It works best for dried beans (that need a lot of cooking) if the water is brought to the boil first; it then simmers away when the sun is out. It reaches quite a hot temperature – one of the previous volunteers tried to warm water in a plastic bowl but it melted a big hole in the side of the bowl.

Ants, concrete and wash days.

Ants Antics

For supper tonight I made spaghetti (which is cheap and plentiful here) with a sauce from aubergine, green pepper, onion, chili and tomato puree. It was very good with a bit of grated cheese that my Misha my German housemate bought from a store in Mbale called the Dutchman. I haven’t tried Ugandan cheese yet but from what I have heard it’s not quite the same as European cheese. As it is a warm evening we went for a walk down to the roadside and back up the lane. Its pitch black but this doesn’t stop the steady stream of people walking and bicycles passing on the way – how they see I really don’t know. It’s not too bad when the moon comes out and there are no trees but under the trees it seems completely black. One thing I saw tonight that I have never seen before were luminous insects, giving off a yellow/ green glow. At first we thought they were glow worms but on closer inspection they were little flying insects so I think they might be fire flies. It was great to walk along and see them glowing in the hedgerows.

We decided to clear up the kitchen when we got back. When we did we saw that the scout ants had been out and they were on the scavenge. I have never before seen 5 little ants carrying a piece of grated cheese. The ants here are much smaller than our ants at home, (although here are also some very big ones), but they are very strong!!

Its not the best photograph but you can probably just see the ants at the back of the sink with the piece of cheese.

Concrete delivery

A big lorry arrived this afternoon to deliver concrete as they are preparing the foundations for extra buildings for the School of Nursing. The lorry was too big for the drive way and was in danger of taking half of the trees down. We were quite a large crowd watching this spectacle but no one seemed to be doing anything and the driver seemed to be keen to push through so I took it upon myself to stand in front of the lorry and tell him he couldn’t go through and had to go back. I wasn’t really sure he would listen to me but I thought the locals would back me up. He did stop and reversed back a bit so that the concrete could be delivered behind the building rather than in front.

The delivery was for 200 bags of cement. At home this would probably involve a forklift or some kind of lifting gear on the back of the lorry. Here it means that about 10 men appear from the back of the lorry to do the unloading, it was amazing to watch them just keep appearing from the back.

One of the local ladies said that the men were complaining that they would not be able to produce (have children) because the Mzungu had made them work so hard and walk such a long way – it was only a little bit further. They were laughing as well but I don’t think I was very popular.

As it turned out I did the right thing because the project coordinator (the boss at Salem) said there are pipes buried under the road and because the lorry was so big it could well have ruptured these. I wonder what the outcome would have been if I hadn’t said anything as nobody else seemed to have the confidence to say anything.

Doing the Washing

Very few people in Uganda have a washing machine or anything like that. If a family has bit more cash they tend to have a maid who will come in and sweep, clean and do the washing as well as looking after the little ones if the mother goes to work.

The mud here is very red and so clothes get covered in dust if is dry or mud of it has been raining. Or if I have been to visit the children’s home I just plain get dirty by the time they have finished climbing over me. The other aspect is the heat. When the work of a day involves moving around a lot - as I have been lately as I have been overseeing the building work at the lab – by the time 6 o’clock in the evening comes – there’s no escape I need a shower and my clothes need a good wash.

In the beginning I used to try to wash and scrub the clothes to get them clean, especially as we don’t have any hot water - but I am much wiser now. The washing powder here is really not bad and all it takes is planning to soak clothes in the bowl in the shower overnight and then wash out in the morning. I have also invested in a small scrubbing brush for stubborn stains. We usually get a thunder storm in the afternoon but as long as the washing is done and out on the line before work starts it’s mostly dry by lunchtime. The worst thing is – because our washing line is strung between two trees – there are some things in the trees that insist on using the washing for target practice so sometimes clothes have to be washed more than once. Such is life.

We don’t put underwear of any description out to dry on the washing line as this is simply not done in Uganda. If you are staying with a family then you will be allocated a discrete place where underwear can be dried as it should not be on display at any time. I tend to wring mine out in the towel when I have washed it and hang up on the end of my bed on the mosquito net support. It dries quite quickly really – socks seem to take the longest.

We do have the luxury of an iron here in the volunteer’s house as well, so as long as there is electricity I don’t look too badly dressed. Interestingly the locals tend to wear a lot of polyester clothes probably because they font need ironing and dry quickly. I don’t think I could cope with that I do prefer cotton and linen even if it takes more work.  

Guess What This Is?

I thought it might be time for something a little more interactive. I wonder how many of you out there know what this is. It is located next to our house and we use it as often as we can? The only clue I will give is - what we use with it has to be black and not silver.

I look forward to hearing your suggestions and guesses.  ...............  Answer next time.   

Views to date

Well folks I just had a look at the stats page on the blogger website and this is a summary of the page views by country to date. I have no idea who is looking at my blog across the world. The Uganda views are me I suspect when I check to see what it looks like. Many thanks for looking whoever you are, any comments gratefully received. Best wishes Helen  Pageviews by Countries United Kingdom 555 United States 27 Uganda 5 Canada 1 Slovenia 1 South Africa 1

Patient Satisfaction Survey & Ministry of Health

Patient Satisfaction Survey

As agreed, this took place at the health centre on Thursday. My team of community workers (volunteers) were very good although the 9 o’clock start sort of staggered its way from 9.30 to 11.15. The staff were a bit wary but I explained as well as I could before we started so that they knew what to expect.

The results were fascinating and some areas come up in the comments that had not occurred to me at all. The community workers were also very good at placing themselves so that they spoke to as many people as possible – we 48 interview in the end.  It was their suggestion to place some of them at the gate so that they could talk to people who were leaving who had completed the episode – my mindset was very much at the health centre.

I have completed the initial report and we have a meeting booked for Tuesday to discuss the findings. I’m sure there are some quick hits we can make that are almost cost neutral that will address several of the issues.  E.g. making information about charges on display so that users are aware of the financial commitment before treatment is commenced, and then having itemised receipts that show what people have paid for.  Where people have very limited amounts of disposable income or savings it must be quite worrying to enter into a transaction not knowing how much it will cost. Other issues need further consideration and prioritisation by the team - should be very interesting.

Kampala and the Ministry of Health

On Friday I took the Elgon Flyer from Mbale to Kampala. This is an express bus/coach that takes 4 hours and costs 10,000 Uganda shillings UGX (about £3). The coach seats approximately 50 people and provides comparative luxury travel for where we are. There is no air conditioning on the bus but the windows all open so it’s not too bad. AS we started off the conductor walked down the bus thanking people for using he service and hoping they enjoyed ‘flying with them today’. The seats were quite tightly packed as there is a 2 seat row and a 3 seat row on the other side to the bus and it gets a bit hot and sticky where bodies are pressed against each other – but at least each person gets a seat each.  The price of the bus is very good considering it cost me 50,000 UGX to get back from the hotel (15 minutes down the road) the other night when I was invited to meet some of the visitors from Wales. As the taxi had been booked for me I thought a price had also been agreed. Big mistake. It’s very difficult to argue about the price where you are at your destination and don’t have any change. A lesson not to be forgotten though – I’ll make sure of the price before I travel anywhere in future.

The trip to Kampala was partly to accompany Vanessa one of the volunteers as she had to go to the dentist – and I thought I would take the opportunity to go to the Ministry of Health to see if I could get copies of the standards and guidelines for health centres so that we can start to put mechanisms in place to show that these are being met.  As I had a chance meeting with someone from the Ministry of Health during the previous week I was directed to the Central Pubic Health Laboratory. I found this quite easily and asked to see the person whose name I had been given. When I got there e she spoke to her boss who said that copies of guidelines were kept at the serology office up the road and I was directed up there. I eventually found it after getting a bit lost, so I arrived hot and a bit sweaty having walked nearly 3km in the afternoon sun. When I got to the office it was mostly deserted but I managed to find someone who said they did not really keep any publication there – they were mostly at the public health lab. So – off I walked all the way back again, with the name of a public health doctor to ask for. When I got back to the office I was directed to a person to help who said that they did not keep anything there. After some discussion he said that the clinical guidelines for most services had just been updated and printed and copies of these were available at the main office for the Ministry of Health (close to where I had just walked from). He telephoned and spoke to someone and I heard him agree that I could have 2 copies of this document. As it is a newly updated document that is quite a large book I though great – success at last. It was 4pm by this time so he said I needed to hurry as people would be going home soon, and he told me which office to ask for (who shall remain nameless for the purposes of this blog).  So off I walked again trying to go as quickly as possible and wishing I could take a boda.   When I arrived I was directed to the appropriate office of a senior person. I explained what I had come for but he was adamant that I could not have any copies of documents. He gave me lots of stories about the documents ending up in Sudan, Kenya and neighbouring countries and the cost that all this incurs. On discussion and reflection on my return I think I missed here that maybe he was asking for money – but not being used to this type of discussion I missed the cues. I explained that the purpose in asking for the document was to work with the organisation I am placed with to help put systems in place to meet the standards – as it is difficult to do this if the standards and guidelines arte not known. He said that they had the documents and were planning to start distribution on Monday. Again I asked if it were possible to have just one copy but he looked me in the eye and flatly refused even though it has been agreed on the telephone that at least one would be available. At this point I had to remind myself that as a representative of another country I needed to put my diplomatic head on, but this took a lot of effort. I was very complimentary about the content of the guidance etc etc as they are good documents – but completely wasted if no one sees them. He admitted that the web page for the ministry is not that good and he said that there internet providers were poor but it didn’t seem to be anyone’s responsibility to do any about this.  I left feeling quite frustrated and deflated. Having to walk all the way back into town to meet Vanessa – by now it was nearly 5 pm. I calculated I walked about 15km that day, and the temperature was about 28C.

I confess I cursed to myself as I walked back up the road again but by the time I got back to town I had walked it off. I think it has made me realise that when I get back to my job in Wales I need to be mindful that we do not create these types of situations for people who need information to try to be able to deliver good quality services.     

The hotel we stayed in is very popular with backpackers and volunteers travelling through. It was by no means luxurious but is was clean and felt quite safe. We had a family room with 3 beds and use of a shared shower and facilities which cost 45,000 UGX (about £15). When we got back to the hotel there was an event going on across the road.  As our room had access to a veranda above the shop fronts http://www.pbase.com/bmcmorrow/image/63364464 we went out to look and had a good view of the African drummers and dancers – it was loud but very good. Thankfully they packed up at 11pm.  We were afraid ait was going to go on all night. I tried to take some photos but it was too dark.

We had a good look around the craft stalls on Saturday morning, I have some good ides now for Christmas presents to bring back, but I think it will be better to get these on a stopover on the way back to the airport when I leave.

We got the 12 o’clock bus back which left at 11.45. Apparently once they have sold enough tickets for the bus to leave it just goes.  The bus makes a couple of very quick stops on the journey back. Forget MacDonald’s as fast food. The stops are at pre arranged places and the locals rush up to the windows to compete to sell chicken on sticks, chicken kebabs, roasted banana, and water or fanta.

Then the conductor on the bus comes around with napkins and a rubbish bag. It’s a shame but most of the local people throw their rubbish out of the windows of the bus and don’t make use of the rubbish bag.

There is also a stop for a ‘short call’ – This is along a deserted strip of road with high buses and tall grass – almost everyone piles ff the bush and disappears into the buses etc reappearing a few minutes later. I didn’t partake but apparently it is agreed that the men go one way and the women go the other. As we stopped a bus stopped on the other side of the road as well. I have to say the men were particularly bothered that they were in full view of the bus on the other side of the road!

A little tipple

When I was looking around the supermarket in Kampala on Friday I saw a little carton of whiskey made in India – the kind of carton that kids have for fruit juice – certainly not what we see at home.

It was 200,000 UGX (about 60p) for 180ml, so I thought I would try a drop.  I tried it tonight and just noticed it says  75º proof on it! It smells a bit ‘spirity’ but tastes quite soft, with a sort of caramel aftertaste something like the flavour of brandy. Maybe I’ll put a few in my case when I come home for folks to try over Christmas.

Patient Satisfaction Surveys and VIP visitors

Ground breaking developments

I’m quite excited today (sad I know, but it’s still good). Tomorrow we will be undertaking a patient satisfaction survey at the health centre. I happened to be talking to someone from the Ministry of Health this afternoon and asked him if he knew of any other patient satisfaction surveys in Uganda. He said that he only knew of one that took place in a leading hospital in Kampala that is led by an Irishman. So we may not be the very first in Uganda but I think we are still on the cutting edge.

I have developed a template of questions to be asked. This has been derived from some of the Ministry of Health documentation and some are a common sense approach to the quality of healthcare, - information for patients & checking they have understood, privacy, infection control, cleanliness etc etc. The team that will be asking the questions are community healthcare workers attached to Salem. If I asked any questions I’m sure I would frighten everyone away.

 These workers are also used to giving health promotion talks and using drama to covey important health messages in the community.  I did some training with them this morning; it was so refreshing that the areas that I said I wanted to cover were areas that they also thought were important. I could really see a spark of enthusiasm in their eyes. The enthusiasm and obvious understanding for what we are trying to achieve also came through in their questions and comments on some of the questions. They will be talking to as many people as possible tomorrow using a conversation approach to try to ascertain their views on the experience of using the service. Once we have all the information I will produce a report for the project coordinator and the Board. One of the health workers also suggested we ask similar questions to the staff so that we gain their feelings on the quality of the service. May be this will be stage 2.  

I hope it all goes as I expect it to and we don’t hit any unforeseen snags.

More later......

Feet feast

I think I have recovered from having my feet eaten. Thank God for antihistamine tablets. I only brought 2 with me – so I took one on Monday and the relief was amazing I suppose I wonder why I didn’t take one before. I used antihistamine and hydrocortisone cream but they didn’t really do much. It’s amazing how much better you feel when you haven’t got burning itches.

Ambassador visit 17^th November.

The pathology laboratory is coming on well. It has been all hands on deck for the past week or so. I think we are on track for completion by next week when the German Ambassador to Uganda comes for the official opening, although there is still a lot to do.

I have some photos but will post later (they take ages to upload about 5 mins each).

We have agreed a programme for the day and I have been nominated to be Master of Ceremonies!!! This is a real honour – from what I gather the main challenge is to keep people to time on the programme – in Uganda that is no small feat. The programme is not at all as it would be in the UK it goes something like this: (I’m not completely sure of all the titles and roles by it goes in ascending order and it is very important not to leave anyone out who should be present)

1.       Tour of facilities

2.       National anthems

3.       Address by Local Commissioner 1 – village level commissioner.

4.       Address by Salem Project Coordinator / Medical Director.

5.       Address by Salem Board Chairman

6.       Address by representatives of funders

7.       Address by District Health Officer

8.       Address by Chief Administrative Officer – head of district council

9.       Address by Local Commissioner 5 – representative of the Ministry at district level

10.   Address by Regional District Commissioner

11.   Address & opening by the Ambassador.

We need to cover all of this in less than 3 hours, so I shall have to think of some careful strategies for moving people on, as some of these people are well known for their love of public speaking. I’m looking forward to the challenge J.

Climate change and experiences to make you think

Tree Planting and Climate Change

On Thursday I went to the official launch of the project for tree planting as part of the measures to address climate change. The project is part funded by Wales and so John Griffiths AM (Counsel General) was there to represent the First Minister, there were also lots of dignitaries and representatives of the tree planting groups from Uganda. The project has given a commitment to plant a million trees over the next years of the project. One of the things that has surprised me in hearing the discussions around this topic is how many examples the local farmers can give without any prompting that changes are occurring to the seasons and the climate on the equator. There used to be very clear and predictable wet and dry seasons. At the end of October we should be entering the dry seasons and it should quite hot and dry. Since I have been here it has rained every day to a greater or lesser extent. On Friday night I found it quite cold in bed because it had been cloudy for 2 days and so there had not been any sun to warm the ground and the air (although compared to back home its probably still very warm).

Listening to the presentations by the groups involved in the project I can now see the importance of planting trees (although I confess before I came to Uganda I could not really see the immediate relevance).

At the beginning of this year in the Bududa district (in the hills not far from here) there was a large landslide and there were many fatalities and loss of homes. This happened because people had relocated themselves and built their houses on the hillside and in doing so had removed quite large areas of forestation. It had been predicted that a landslide would occur but as ever no one really thinks it will happen to them. The displace families have been living in tents in a refugee camp since the landslide. The Ugandan Government are trying to relocate people to other less densely populated parts of Uganda but this is met with some resistance because the people to not have any support networks, family history or other links to  these areas. It also doesn’t seem to be helped by the fact that they are relocated to the new area in a tent and provided with a small amount of money to start building a house. One of the discussions I overheard was that it would seem better for the Government to commence a building programme and provide basic housing in preparation for the relocation so that at least they have some kind of basic permanent structure with which to commence their new lives (also the tents they are providing to live in are not cheap tents so there is a double expenditure).

It was also reported that the mud slides are continuing to happen although on a much smaller scale and there had been 2 this week.

The Teacher/ Student group from Wales that visited this week visited the refugee camp and seemed to be stunned by what they found. The people at the camp said that they had not had any food for the past 3 days and they were not expecting to have any until abut 6 days. They has despatched whoever they could off to the neighbouring villages to try to get some food, and some had returned with rice and beans. However each of these is not much good without firewood, as the main method of cooking is a charcoal burner – and they did not have any firewood.  Hence the need for the trees.

On another visit where there was an established tree planting project in the village, the locals reported that their crops of vegetable such as aubergines were doing very well as they were growing in the shade/ shelter of the trees. Without this shelter the sun is too fierce and the smaller plants just do not survive.   

The main problem now for the locals growing crops is the unpredictability of the weather, they are finding it wet when it should be dry, the dry seasons are also longer leading some drought conditions. So the need for our combined efforts to address climate change is clearly much more urgent.

Nose and Feet

My nose has stopped running for the past two days although I still feel a bit under the weather.  It’s only a cold but interestingly here it is most definitely ‘flu’. When talking to people no one talks about not feeling very well or anything like that – the language is very much 'are you sick’? People also turn up for work and say ‘I have malaria today’ and then disappear off to the health centre for medication. I was surprised to learn that the common course of treatment is tablets morning and evening for 3 days. I thought it would be for much longer.

My feet seem to have been a feast for something over the past 2 days and I am covered in bites which really really itch. I haven’t worked out yet if the DEET spray makes them itch more or whether there is something around that is not affected by the spray. When the weather is a warmer as it has been today it’s a nightmare to walk anywhere as the shoes/sandals rub the bites. I have got cream which helps a bit but I need to work this one out fairly quickly as I can’t do this for very long!

Experiences to make you think.

I had one of my first experiences that really shook me on Thursday evening. It was just about getting dark when a motorbike pulled up outside the health centre with 3 young men on the back. The one at the back got off and then I could clearly see that the one in the middle was supported by the body of one who was driving the bike. He was literally draped across his back with the side of his head resting on the nape of the driver’s neck. His nose was bleeding and he had quite bad facial injures. He also had a rough bandage on his left foot – both feet were just dangling as he was astride the motor bike. He was barely conscious and could not raise his head. The friends explained that he had come of a motorbike. The staff at the health centre explained that he required investigations that could not be provided here and they needed to go to the district hospital in Mbale. I could not understand the conversation and don’t know what was said but it seemed to take an eternity (about 15 – 20 minutes) before they could persuade the 3rd young man to get back on the bike to drive to Mbale. I asked whether the ambulance at Salem could be used to take him to the hospital, but the staff said this could only be done if he could pay for the petrol.

It wasn’t until much later that it occurred to me that I could have volunteered to pay for the petrol, it just didn’t think of it at the time and then felt quite guilty. The main thing is this is not just a single occurrence as these things happen every day here. It seems so hard to turn people away but they were absolutely right as he seemed to have serious inquires and they also don’t have the right drugs here for a head injury. We take so much for granted at home.

On a lighter note the group from Wales invited me to join them for dinner at the local hotel for their last night. It was a pleasant and there were people from PONT and the schools with which the Welsh schools are partnered. The minibus on the way back was the venue for some lusty singing of dubious quality. It was great.  It was a very clear night last night and we stopped along the lane where it’s dark just before the entrance to the compound to have a look at the stars. This was one of the very few times that I have seen many many more stars than I can see at home. It made me want to learn them all or have an ‘app’ to recognise them – it really was stunning.

They have all gone home today – best wishes to any of them who might read this – we might meet again soon.