The Finale Finally

I'm not sure about reverse culture shock, but I feel I might be suffering from reverse climate frostbite. I left for Uganda at the end of January; a perfectly natural time for snow. As I drove South from Manchester to Herts the falling snow blurred past the car in white streaks, that the slightly more childish side of myself really enjoyed as it looked just like hyperspace (a Star Wars reference for those unenlightened)...sometimes the childish side is the dominant force, and I may or may not have made some sound effects to accompany it. Sufficed to say the snow was a few inches thick when I left. As I said: perfectly acceptable for January. The big shock was that after enjoying temperatures in the mid twenties to mid thirties I returned to find the weather in the UK almost unchanged. As though to spite my absence it had stubbornly kept the thermostat the same to punish me on return. This meant that despite a 2 month gap, both the trail South and the return journey North were snow covered affairs.
 This blog is intending to cover three weeks so brace yourselves: verbage is coming.

 I asked a Ugandan man how parents came up with the names for their children in their country. He responded, straight faced, that they look through the dictionary for words they like...then use them as names. If that is the case.... it definitely shows. This particular gent had named his eldest children Innocent (the guy of course) and Immaculate (the girl), which aren't exactly the easiest names to live up to, even with the best school record. His name selection isn't exceptional, I made good friends with at least two Innocents and an Immaculate in my time out there.
(As an aside -you must be getting used to my style by now right-  I could help but imagining a future court room scene involving one of these ambitiously named kids. Something along the lines of:
 Judge: So who is the accused
 Barrister: The accused is Innocent sir
 Judge: Are they now?
 Barrister: They are Innocent sir.
 Judge: I think we'll be the judge of that. The cheek of the man.
 Barrister: No sir I don't think you understand, Their name is innocent.
 Judge: Ah, I see. How do they plead
 Barrister: Innocent?
 Judge: Innocent is it? Even with all those witnesses. Very well.
 Barrister: No guilty
 Judge: Is that their middle name?....... )
Other names Include Blessing, Happy and Dopey (that one isn't true). There's also a great trend towards choosing names that would have been incredibly popular at the turn of the Century: Doris, Geoffrey, Edmund and Doreen to name but a few. I'm partly tempted to return to Uganda for the birth of my children call them Salacity, Plethora and Englebert (two girls and a boy if you're wondering, the second one had some weight issues) and watch them coast through school without even a moments bullying.
 In the Buconzu region there's a second part to the naming process where instead of having family name (there is no surname), your first name would be your position in the family i.e. 'firstborndaughter' and all the following children named in respect to their order of emergence from their mothers womb. There's also names specific to twins and the order that they make their escape. The honour associated with childbirth also bestows a new name on the mother of said twins, triplets gets you even more kudos...the more womb-mates, the more respect. (So Tom Breckers, your mother is a woman of great honour is seems)
 
 Once the Oxford lads had left there was a respite in comings and goings. A paediatric Intermediate life support (ILS) course took place over the next two days so we were busily distracted from the 'gaping hole' the boys had left (I'm only being mostly sarcastic R and K). So to a degree, I can now save the life of children....although with the over 5s I'm only used to resuscitating them if they are quadruple amputees and have permanently closed eyes (I'm referring to the slightly creepy 'little-annie' dolls that are used for resus training that in order to save material and space have nothing but the portions vital for practice. They also allow the over-zealous play-actor to shout 'Holy Cow! It's been a massacre in here, their arms and legs are gone!..I'm going to check breathing while you search for their limbs, they may still be viable' but who would be that absurd?)

 Friday afternoon I finally managed to visit the local market to pick up some local fruit and sugar cane. Trying to get the cane to give up it's sweet goods demonstrated why everyone over the age of 4 seems to walk around with a machete, my knife and fork skills were useless here.

 On friday evening before you could say 'ze Germans are coming' er...the Germans had come, four more. Two fourth year medical students there for a fortnight, a sixth year student on a 5 month elective (they have a lot of elective on the germanic degrees it seems) and a radiology assistant coming out for a year. All hope of a British majority being re-established were crushed a few days later. Before you could say 'Waffles, Ice tea and war memorials' four Belgian nursing students and their overseer had arrived.
 So I was finally a plucky Brit amongst Europeans and Ugandans.

Saturday evening was Dr Chris's leaving do. The best thing to do when confronted with grief and the impending departure of friends is to burn some animals (having killed them first) and then eat them. So this was done. Succulent pork and surprisingly tender goat supported the speeches and heartfelt goodbyes that evening as the sun set behind the Rwenzoris.

 The final week then went too quickly:
 On monday I taught a gathering of nations (Germany, Belgium, Britain, Ethiopia, Kenya and Uganda all represented) about the basic management of congenital malformations (having only read up on it that day).
 Tuesday we headed to the Congolese border for Epilepsy outreach clinics, we didn't cross into Congo; but we were situated on a hillside the river in the valley at the bottom of which marked the border and the hill rising up directly in front of us was Congo. It looked greener, but grass always does.
 Wednesday and Thurs were busy. The ILS course was being rerun again, and a lot of the paediatrics team teaching or learning on it, so I went ahead and looked after paediatrics (it wasn't actually just me...but it felt that way) and attempted to do some teaching in the process. Weirdly enough, I occasionally thought that the nurses calling me doctor was justified. Reality returned quite quickly however.
 Then all of a sudden It was the final fellowship with my international brothers and sisters on thursday evening. Then Friday morning arrived and I hit the road.

 My Travels from there in summary:
 Friday night: Kingfisher lodge, great food, swimming pool, pretty much abandoned except for my good self.
 Saturday: Traveled to Mbrara for debrief and to start the process of ranking 274 (that's right 274!!) jobs on FPAS.
 Sunday: Church at MUST (the university in Mbrara) and journeying to Kampala.
 Monday: 'Relaxing' by finishing FPAS ranking.....this took hours.
 Tues: White water rafting on the source of the nile in Jinja with Some Ozzies, Germans (these guys get literally everywhere) som czechs, british JWs, Japanese soldiers that spoke no english and some 'Gap-Yahr' students nursing hang-overs having 'experienced' some Ugandan culture last night.
 Weds: Traveled back to Kampala and watched Django Unchained in a Ugandan cinema as part of my world cinema tourism program.
 Thurs: Packed, actually relaxed....at last.
 Friday: 1am returned to the UK......followed by sleep.
 Sunday: Return to Manc.
 Monday: Placement re-commences....

Part of my farewells involved food. Food is an important social occasion out here as it is in many cultures. There are two particularly distinctive foods that were staples for the nursing students. Posho and Bundu (TP will no doubt correct me on the spelling here). They are both dining experiences. Posho is a lump of maize flour (or something like it) that looks not unlike porridge that has been cooked and then abandoned in it's bowl overnight. Except that it doesn't have any of those distracting features of porridge...like flavour. Paul Shep would have it that it tastes like 'white' but I think that that does a disservice to white. Sugar, salt, icing, mayonnaise all are the flavour of white....this was more like the taste version of beige, it definitely has a flavour but it's one that makes very little effort and doesn't really care if you notice it or not. Either way, it's function is to leave you full and this it does quite well, as long as you load your fork with beans and sauce the lack of flavour isn't really an issue. The other is bundu. This one your not supposed to taste, and if you do your doing it wrong. A friend of mine when asked which was their favourite food said 'Bundu, because you don't have to chew it. It just goes down'. Just like an inexpensive, vegan friendly version of the oyster you just put it straight in; bypassing the mouth into the food pipe. Bundu is good, if you approach your food like a performance art or a sport..... and have no teeth. Again sauce is where you get the flavour from. You make a ball by rolling a chunk of bundu in you palm, you then plunge your thumb into it to make a hole scoop up some soup-sauce-stuff and throw back your head. Simple right. Don't make the mistake of chewing, then you'll find that it has the consistency of play-do and wants to cling to the roof of your mouth with the tenacity of an alien face-hugger.

 So I dined with my Ugandan friends and said my multitude of farewells. It seems like I was only arriving yesterday, but already the time had gone. Friendships between brothers are eternal however, and there is no such thing as a missed opportunity amoungst Christians as we will hang-out in eternity. As sad as parting may be, it will be the briefest of breaks in contact in the light of eternity. Maybe I will return there some day, there's still Murchison falls to visit and a number of things to do that an impoverished student couldn't afford. Who knows? the future is written but I will not be privy to it until I walk into it.
 I've had great times, made some fascinating friends from vastly different backgrounds, been pushed professionally and learnt much about myself, God and the nature of poverty. Will I work in Uganda in the future, maybe. Will I take this experience with me whatever the future holds: of course.


Prayer:
 -The Shepherds are still out there and on their final stretch. Pray for their work, health and walk with the LORD.
-Matt Craggs is out there now as the Manc representative on the ME program. He's not got quite the ego I do to keep a blog....but I promise he is there, but pray that it'll be a great experience for him.
-For my final two months or so in Manchester before I move on to the great unknown of a job in South England.

Thanks for reading this, the gramma and spelling must have been gruelling. But I appreciate the effort.

A Tale of Orphans and Kingfishers

'Well done Doctor'. I looked around for a moment before realising this was aimed at me.
'Er....thank you sister,' what had I done? granted I'd woken up, showered, dressed myself and fed myself all without much prompting which could all be perceived as quite impressive; but I wasn't sure which part of my morning routine had invited the adulation of the ward nurse. It took at least two further mornings to realise, that it was more of a welcome than a comment on my performance. But every ones confidence takes a nice boost when praised for turning up.
 This joins the list of the Ugandan turns of phrase that have in turn first bemused, then amused me before becoming part of my dialect (the ones that don't leave me feeling like a traitor to the English language that is).
 Here are a series of examples:
'Yes [insert name here]' -a common greeting. This one was relatively easy to understand.
'You are lost' - not a phrase used when I accidentally find myself in the women's bathroom because of being unable to interpret the symbols on the outside, but a phrase meaning 'I have not seen you for a while'.
 'They are more likely to WHAT?....to have an ectopic, which is WHAT?....life threatening, which is WHAT?....a very serious situation.' This is an example (loosely based on life) of Ugandan rhetoric, which is very confusing at first because you think that the speaker is shouting a question at you and before you can marshal your muddled thoughts they have answered their own question and may have moved onto another. Another WHAT?....another question. Rather than helping matters it tends to jar the old train of thought.
 'They have ever had vomiting' - This is not a claim to eternal vomiting that began when time was made or saying never but dropping the 'n' but in fact the positive form of never which can lead to such a situation:
 Doc 'Have they had vomiting'
 Brief discussion with patient...
 Nursing student 'They have ever had vomiting.'
 Doc 'So they have not vomited'
 Nursing student 'they have ever had vomiting'
 Doc 'They have never vomited then?'
 NS 'No, they have ever vomited'
 Doc 'Have they, or have they not had vomiting?'
 NS 'Yes'
 Doc 'Yes they have or yes they have never vomited?'
 NS 'Yes....they have ever vomited
 Doc 'Ah......'

There are a few others, many of which are more pronunciation based, that can't be done full justice here...

The rainy season has dutifully begun. It's timetabled to turn up in early March, and unlike many things working on Africa time, it has done exactly that. Rain has been pounding us in the morning for the last two days demonstrating one thing. Heavy rain is as much a nemesis of productivity (and life in general) in Uganda as Snow is in the UK. Like we look out the window, see a layer of white and start acting like it's a nuclear winter here they look out the window see rain and the walk from the nursing school accommodation to the chapel becomes untenable. Sufficed to say, yesterday there was hardly a soul in chapel and work only began once the rain had died back. Despite the deluge of rain, it switches back to blistering sunshine in the space of an hour and by the afternoon all signs of the rain have almost completely disappeared.

 On Thursday I strayed from the wards to a local school/orphanage combo. The place is run by a local man Isaac who has set up a number of such projects the school has a roughly 50% orphan student body whose fees are paid for via the fees of the children with means and from donations. The definition of orphan out here can mean someone with no parents at all (or a full orphan as one of the teachers described it) or someone who has lost there mother and their father can no longer care for them (a 'half orphan'). Here as part of the project they get both accommodation and schooling. 'Education' is definitely the big buzz word out here, and loaded with the promise of success and escape from poverty. Rita (the Maltese -or is it Malteser - nurse that is the driving force behind quite a number of community outreaches) has been a long term collaborator and supporter of the project and invited me along with her. It took some essentially off-road driving on tracks that weren't made with cars in mind to get there navigating some 45 degree inclines and pot holes that goats could comfortably shelter in. The school was in a isolated spot on the hillside across the valley and around the corner from Kegando. The drive when as smoothly as could be expected from the terrain (bar Rita forgetting to bring Isaac's sister with us) and we pulled up in the village 'high-street' to be greeted by a crowd of school children. There is detail if this scene that I have left out and will return to in a moment...
 The day proceeded with me and Rita sitting in on a school board meeting (my contribution was to smile an nod appropriately), visiting the site that was being prepared for the new classrooms; being welcomed at great-great-great length in front of the gathered school by various members of staff; making a speech myself...i made something up about the value of education (although the only applause I got was when I mentioned i was an arsenal fan); having the school choir sing some self composed songs for us (including the classic: 'Well-e-come, Well-e-com our vistas, well-e-com Thom-omu'); having photos with various people and finally having lunch with the Staff in which I had the distinct honour of eating the chickens stomach (which is preferable to kidney and having your eye removed with a spoon, but not quite as good as a drum-stick). It was an amazing and surreal day.

 The detail from our arrival at the school that I neglected to mention and it's later consequences can be told here almost in full with the aid of retrospect. When we drove into the town 'plaza' not all the children were on their feet waving or jumping to greet our arrival. In the crowd of kids scattered away from the approaching car to reveal what could have passed as a bundle of rags if it wasn't for the limbs sticking out from it. A child was lying in the road oblivious to what was happening around. As we passed the spot again on foot we were told that the child had just had an epileptic fit moments before our arrival. Children and adults were milling around, but no one had helped. There is a belief, it seems, that epilepsy is contagious (even to the degree that epilepsy that develops in someone after their marriage is immediately blamed on the family that they have married into and the social reprocussions can be severe). The child therefore had been left to fit and then lie in the blazing heat of the morning sun. Rita carried the boy inside to recover and gave hims some water and food. On our return from the school we checked up on him again and his father was found. He had suffered probable birth trauma as a child and had been suffering epilpesy ever since until this his 9th year of life. He was lucky to not have befallen any accidents, but a combination of the initial insult and multiple seizures had left him mentally slowed. It was locally believed that there is nothing that can be done for seizures and therefore nothing was done. The father was talked to and encouraged to seek medical help. It was an incredible joy to see him on monday attending the epilepsy clinic in kegando, where the consultation and medications are free. It may be overly melodramatic to say that this could turn his life around, but with the right management and and medications a degree of normality can be restored to his childhood and the social ostrosization may be removed. It is sheer providence of God that we arrived when we did to witness it.

Friday was a day off. The day off took us to a place called kindfisher lodge. The lodge is home to almost 'infinity pool' (would that be a billion pool?) that overlooks Queen Elizabeth national park from atop one of the neighbouring hills. You can swim with a vast expance of beautiful horizon stretching 180 degrees in front of you. This is added to by the great food they slap on your plate and fine cups of tea that the place in front of you.

Saturday took me to the Rwenzori high-school for focus fellowship, a scripture union event for teaching and outreach. The subject that was being covered was 'sex' rather suprisingly. It was a fun event to attend and definitly lent a lot of cultural insite as to how it was approached biblically. Not sure i agreed with -or in fact understood- everything said, but it was enjoyable none the less. Favourite quote: '10% of people are what is know as very sexy' after which the speaker wrote the words '10% -sexy' on the board (I gathered that he meant 10% of people have an  extremely high sex-drive not to do with how great a percent of the population he personally found attractive).

 Sunday afternoon Rob, Keelan, The two German electivites and I headed to the waterfall again. This time armed with swimming gear. We were originally going to head into the rewenzori mountains for trekking, but our guide pulled on us at the last minute....planning anything out here is a little foolish to attempt, but still us mzungus try. The swimming in the waterfall was a very good substitue, especially after discovering that you can swim around the back of the falling water throuch the channel of erroded rock, position yourself behind the thundering water and then throw yourself into it's stream. Having seen how forcefully it tried to relieve you of your swimming shorts, the girls descided (wisely) to pass up on the experience to avoid any wardrobe malfunctions.

 Monday and today were back to wards for malaria, malaria and a slice of prematurity.

 The medical elective scene is ever changing. Two German third years have arrived Mareika and julia, neither of which are Bayern Munich fans, so we can safely be friends for now. And who knows the entire situation may be redeemed next week if BM oblige and loose by say 4-0...that would be nice (and very realistic). A new American has arrived to inhabit the star-spangled (non-literally) American room at clay house in the form of a final year called Erin. Plus tomorrow morning the oxfordians are heading off to South Africa, so farewell to Keelan and Rob. The unfortunate fall out of this is that I will be the only Brit left on the medical elective program here...I hope to survive the assault of foreign cultures unperterbed.

 I could mention FPAS here, and the shambles that has been afflicting the medical students of the uK. But the only comment I'll make is....It looks like for now my future is again unknown in terms of location in the country. God has a plan however, he just has delayed the part where I discover what it is, which he has a perfect right to do.

Prayer points, for those that pray:

-For safe travel onwards for Rob and Keelan and protection from flying bullets and other mishaps in South Africa.
-For UK medical students as they await their results...again.
-That I will be able to make the most of my last week and a half in kegando
-As always for health
-For wisdom in care and descision making for me and the other doctors.

Yours faithfully Tom
 SDG

To Mbrara and Back Again. (Like the hobbit but with less dragons)

The two men strolled through the paediatric ward arms interlocked and laughing at each others little witticisms. They dropped their arms in unison to grasp others hands and jauntily walk outside together. This isn't one of Uganda's first bi-fathered family units visiting an ill child. One of them is married to a woman with a child nuzzled at her breast and the other is a close family friend. This is cultural. A culture that makes the average Brit a tad uneasy, at least at first (Paul shep tells a good tale of getting into the UG mindset so much that when he went home he tried to hold a mate's hand after greeting and got a less than warm reaction) and would have JM Dyer throwing a hissy-fit on the floor. (Iain MacIver on the other hand, these are your people, in terms of personal space, out here you can have the kind of man-man platonic friendship you've been dreaming of all these long years). If you are friends you shake one-anther's hands for an protracted amount of time letting the sweaty palms of mutual respect mingle and then if your walking in the same direction why not synchronise your arm-swing with your pal by staying interlocked. Another cultural difference that is blindingly obvious (literally in some fundamentalist doctrine) is that ladies will whip out their mammarys at a moments notice. This makes performing a full thoracic and abdo exam a little easier than normal as the are already 'adequately exposed'...if not a little too exposed. Breast feeding is also it seems meant as a spectator sport. Everyone on paediatrics is at. Even to the extent that you examine some of the kids still latched on. The only option is to choke down your western taboos and be thankful that it's this half of the patient that it is a cultural norm to reveal at moments notice.
 I spent a few more days in Paediatrics main; the largest single ward in the hospital with up to about 50 patients at a time. 6 on high-high care (as in very sick, not those palliated with mind altering substances) 10 in high care, 10 in medium care and the rest on the low care (being teed up for the booting out the door) and diarrhoea regions (which sounds like a really unattractive tourist destination). The patients are mainly two to a bed, with the family member looking after them sleeping on the floor, and siblings may accompany the kids (this occasionally leads to the thorough examination of a patient on a bed, finding there is nothing wrong with them...at all...and then once a nursing student translator discovering this is the second cousin of a patient that decided to take a kip.) I've moved on after two weeks on the kids-chaos zone (although I still join for the start of ward rounds and help with emergency admissions) to NICU the neonatal intensive care unite to those not acronymically gifted. Here is is calm and incredibly warm, as tiny little babies, cry with tiny voices while shedding tiny tears and spike tiny fevers. It's a game of 'when to feed that baby' (available from all good board game merchants) and 'slam that baby full of Abx' (not yet licenced as not everyone can agree on the rules). It's a fascinating branch of medicine but means starting again with a lot of concepts as 'little adults' these certainly aren't (as far as I can tell).
 Friday afternoon till Saturday evening i headed to Mbrara, it was the AIM social and prayer breakfast out there, which happened to coincide with James (aka Dr Lovely) leaving Kegando for the journey home (via white water rafting). The journey back was an opportunity to see all the country I'd admired on the way through in reverse through the national park, woods and tea+ Banana plantations. The heat was almost unbearable that day, although a breeze through the cab of the taxi gave some reprieve, I dropped a water bottle on the floor and only picked it up an hour later to find that the water inside had near-enough boiled. The heat was even more intense at two further points. The park authorities burn over the dried grass of the park and felled trees to make way for fresh growth. This was one of those days when the flames had been lit. as we drove down the near-straight road in the national park (it isn't a straight drive however due to the occasional swerve to avoid potholes or lorry drivers on mobile phones) out path was flanked by a wall of flame devouring the already crisp countryside and on the far side lay a charred wasteland. We drove through this for a few minuted before hitting a second wave of heat driving by the flames travelling in the opposite direction. The surprising part was how much was spared, green trees stood proudly in the midst of the ashes of less fortunate plants. On the reverse journey, fresh green shoots could be seen amongst the dead. For new growth, the old must die. (Budding sermon architects: You can make an analogy for humanity spiritually with that. We must die with Christ to live for Christ. Take it, it's a gift) The rest of the weekend was spent with a the rest of the AIM team, a meal on the Friday evening (burger and chips people!!!! mzungu food, sweet nectar of the Gods). I was hosted by a couple from the UK that have recently started teaching at MUST (Mbrara University of science and technology), Him: an A&E consultant and Her: a Molecular Biochemist. They had hot running water (a shower you can stand in...I'm not joking, you don't have to do the cold water hokey-kokey with this one) and real brown bread. Amazing. The Saturday was a great morning of prayer and encouragement and then a journey back in the car with the Team Shep. Beyond Dr Lovely, there have been a few further transfers.
 Ben has left as well, but the two open spaces have been filled by two new MEers. Possibly in some cruel way of twisting the knife marked 'Bayern Munich 3 Arsenal 1' they are both Germans. I've yet to ask them if they are Bayern fans....maybe some things are best left unsaid and unasked. In personal news, the FPAS (Foundation school applications to put it simpler or 'dem people wot tell me wot job i got next year' to put is even simpler still) results have come in. Looks like I'm of to South Thames. It's an occasion for Praise and sadness. I did put it first, and I do want to go on to this exciting new chapter (I had to slip in a cliche or two like that) of life; but I'm not looking forward to leaving all the great friends I've found in Manc behind. Who knows though, the Southern drift may bring you back to me again.
 For those that pray:
 -For health, it's been a but dodge here and there. Mine and the other MEs as well as Helen, who is frequently afflicted
-Ben and James as they head on home that they will be able to re-adjust to the West and contemplate all they have learnt spiritually and medically
-For the hospital administration and wisdom in all it does -For furthering of friendships with Ugandans -For wisdom in my choosing of jobs within the Foundation school (there's at least two more stages to complete...)

 Yours In Christ. Tom
  SDG

Baracas, Bacon and Borborygm

There is a whole lot of nature out here. It's hard for a day to pass without a number of different species vying for your attention/wonder/irritation. As I've already mentioned the night is a shrill chorus of bug-orchestra, it has now of late been intermingled with the odd sounds of scuffling that sound like a rodent lodger skimping on paying his way. As you walk through long grass crickets spring from your legs like you're wading in a green ocean; ants join you in most rooms making diligent trails of workers; fire-ants carve roads through the terrain, boring holes through raised ground or using each others bodies as bridges (and punishing anyone who absentmindedly steps on their road by promptly clambering up their leg to the thigh and making their presence known with formidable jaws); the wards are diligently visited by concerned cockroaches checking up on ill humans; and the odd rat puts in some voluntary time in the sluice room (where equipment is cleaned); chickens and goats roam freely (a little close to exposed laundry one might say) and geckos and colourful lizards defy gravity on almost every surface.
 Chris, one of the more senior (in rank, not advancing years before you picture a liver-spotted grandad figure) doctors managed a three day stint of nature spotting with a black mamba joining him in his kitchen, a tarantula having a tet-a-tet with his kittens and an assortment of feathers and animal parts being left as gifts by said kittens in his living room. Generous. Sadly there have been no mamba callers in Clay House (the name of my current accommodation block)
 This is the everyday on site fauna however, last Wednesday we took a trip in search of the slightly more exotic. Elizabeth national park, so named after the queen payed a royal visit to roll her wrist in the regal equivalent of a wave and gaze with mild fascination at the animals, is one of the biggest nature reserves in Uganda and not to far away. We -that is Chris, Ben, James, Keelan, Rob and I- piled into the back of Dave the stalwart land rover that creaks and complains, but has of yet not failed. Yet. We took a morning game drive after paying our dues for park entry. The early morning fair was mostly numerous herbivores, dead-eyed buffalo and jumpy Cog were the first species to grace our path. Plenty of meat...this was good, if we were going to see the main attraction. The morning trail held no predators however and so we went on to do the substitute for hunting that the modern man performs which involves the skillful removing of a sausage and bacon from a serving tray onto an awaiting plate, which is deftly counterbalance by the breakfast seeker to receive the new weight. Live animals were not the only reason we were there. Mweya lodge is a secluded mzungu resort in the middle of the park where you can 'do Africa' with out all the inconvenience of Africa itself. The mzungu breakfast however is fantastic. What is called for want of a better name 'toast' has been our staple and Ugandan tea with powdered milk has accompanied it. Here in the 'I-could-live-in-Uganda-for-a-month-with-that' pounds per night price lodge they serve up a splendid English and Continental breakfast. We dined like kings. Granted the hash-browns were a miss-step and there wasn't a black pudding in sight. But real milk, fresh fruit, fibre-filled cereal and familiar meats.....they were most welcome.
 After some misunderstandings over bookings of a river tour we managed to get ourselves a place on one that afternoon. Although mysteriously we discovered that the name that it had been booked under -Pocock- had somehow trans mutated in its passage down the phone line in a game commonly called 'Ugandan whispers' to become the rather dashing sounding 'Mr Lovely'. What may have come about something like this.

Ugandan clerk 1: 'Good news we have space for 3 o'clock, group of five?'
James: Lovely. We get breakfast now.
Clerk picks up phone
Ugandan at booking office {after 1/2 hour greeting courtesies}.: 'what is name for party?'
Ugandan Clerk 1: Ah party of 5, he says Mr er Lovely.

So Mr lovely (soon to be Dr Lovely, watch out ladies) and his group jumped on the boat at 3 with the company 3 rough groups of foreigners. The first consisting of young honeymooners who had forgotten a camera because the only lenses they needed to stare at were those in each others eyes (or something sickening like that....and in Spanish from the sounds of it), the second group were the leather skinned Europeans who could do with getting sponsored by a sun-protection company as the 'warning' photo so at least they'd make some money out of the experience the final group were the paler and much better equipped bird fanciers. Uganda is seems has a reputation (just asked Paul Shep if you want to know more about it and brace yourself with a fixed object so you don't get swept away in a wave of enthusiasm) for being one of the best spots to find the wing'ed blighters. There were alot of overblown lenses on display and a few high-tec high-def high-price cameras. But one man put them all to shame (from a certain point of view). He was a head and shoulders above the rest, metaphorically, in reality his head ended in a wisp of thinning hair at the height where most men's nipples lay. His lens was gargantuan however and the stoop in his back was likely to be the sign of years of camera weight gently curling him into a ball. His bazooka-like, Duchess-bothering proportions lens was -it must be logically deduced- to add to his collection of images of animal nostrils close up. Flocks of birds swirled, buffaloes bathed in mud and hippos peered from below the surface along the bank. We spied a monitor lizard and at least two crocs out in the afternoon sun and further on Elephants frolicked by the shore.
 We took an evening trail to try and find the crowning glory of the safari park. Finally, when hope was packing up her bags and saying her goodbyes, we heard a rumour from another car about a lion. We raced back, and there she lay....granted it was a football-pitch-length away and looked like a rock with ears. But rocks don't move, this one did (don't you dare say it was an expectation induced illusion). So we returned satisfied.

 The return to Paediatrics wasn't a terribly easy one. Although I have learnt the mysterious cause of all the B.A. Baracus mo-hawks being sported by the kids. I thought that it was some strange trend in infant-fashion that had spread through the region. In fact the explanation is far more practical (and will get on a plane), all infants receiving oxygen have their temples shaved in order to stick down the tubes on either side. So O2 not the A-team.
 In more serious news I was involved in my second cardio-resp arrest. This time a 9 year old. It doesn't get any easier.
 I was however getting the hang of admitting, treating and punting (metaphorically) kids out the door. This was until the day of the sickness....but we'll get back to that.

 Friday morning we -the MEers, the 3 Norwegian nurses, 2 Norwegian friends visiting them and Uli the German orthopod- trekked to the MTN tower again, this time before the sun had slipped above the hills. We arrived as the sky reddened and the clouds looked to be glowing like fresh embers. With a hot choc and a smattering of glucose biscuits. Munching and slurping as light crept across the valley and the sun rapidly lunged skywards. Another one of Africa's beautiful sites. Friday night was film night again This time 'King Solomon' an epic charting his life. It was my first experience of dubbing in Lugandan (another language that not everyone speaks). Dubbing doesn't quite do it justice. It's like watching a film with a friend, you know that irritating one who insists on quoting the film as you go along despite your never having seen it before, and in case you blink for too long and miss any details he insist on describing the film to you too. It's like that but the guy is partially deaf- so shouts- and on top of all this cannot speak a word of English. Put that all together and you get the style of film.
 A classic scene would be:
  REALLY LOUD LUGANDAN BLAH BLAH BLAH- serene pause witha hint of music- BLAH BLAH BLAH BLAH SOLOOOMONNE BLAH-DE-BLAH- one word of English and a sigh- MORE SHOUTING...... you get the gist.
 The highlight was a tremendous flash storm that rattled the chapel and sprinkled us with rain watter through the slats in the windows. Lighting flashed and thunder rumbled...and you couldn't here the voice over. Amazing.
 Saturday was a half day working and a relaxing afternoon. In the evening we said farewell to the Norwegians and their unusual painfully salty liquorish disks. They departed the following day. The first group that will disappear in my time here. Ben and James have only a week or so to go.
 Sunday was the day of the sickness. I'm not blaming the Norwegians -some have- and I can't bring myself to blame Mweya -it would be blasphemy to talk against bacon in such a way- and the pattern of people getting ill in my wake made it hard to see any common factor...other than we were all in Africa. For those of a more gentle disposition I won't describe my symptoms exactly (no bleeding from the eyes for those fearing Ebola, or body fluids similar to rice water for the cholera-phobes...fear not) but in summary I was out of action until today. First through acute illness, and secondarily through the inability of my gut to deal without fibre in the presence of Ugandan foods. Sufficed to say my daily routine wasn't even a weekly one anymore...decode that if you will. So If turned to chemical solutions. Ask me in person if you want the full details, you weirdos.

 I'm much improved however and over half way through. By the next blog I will have been out here for a month and will know where my job is next year. So: big week.
 God bless.

For those that pray:

-For a return to regular health (I have Weetabix and coffee in my armoury...it should submit to my superior firepower)
-For the others in the hospital who have fallen ill.
-For the paediatric staff who have just lost a patient that they have known and helped for many months. See will be missed.
-For the transition and the welcoming of the new elective students (they are German, so this could be interesting....especially if they are Bayern fans)

SDG

Gospel Chiors and the Jail-house Rock

Warning: post contains needles and medical speak!!

A patient tried to bite me yesterday. It's not a question of poor bedside manner, nor have I been moved to a psych department to administer the happy pills. No; it was my first day on paediatrics. Granted it wasn't unprovolked. If I had the reasoning skills of a three year old and two giants roused me from my feverish sleep to pin me down while a third attempted to stick me full of holes with a giant needle...maybe I might try and make use of my mil teeth as an offensive weapon. Kids are cute, sick kids are a challenge. The world of paeds seems like a possible horizon for me, so I have to see if I have the stomach o torture kids in thier best interests. I didn't get the cannula in, kids are lined by a layer of heathy chub that makes the whole thing a little harder (fortunately the veteran nurses on the ward here hardier and more skilled than me). The rest of the day was good, as I tried to immerse into a completely different set of patients that are maths problems as much as medical ones (drug dosing in kids is by age and/or weight in most cases) and managed to get my first paeds cannula (needle for medications into the veins) into a 12 yr old.
 I've just finished a week under the close eye of another aplty named Dr Shepherd -Helen this time- on female medical ward. For every two great responses to treatment (cue fist-pumping cellebration...internally anyway) there is one frustration, either longing for an investigation that isn't available or a treatment that isn't on hand when needed. The second victim of the blood shortage that I was directy involved in the care of died on my first day of paeds. Their major problem at that momment being a lack of red blood cells, everything else would have been treatable...
 Mecinine out here -from what i've experienced- is a blend of medical accumen and hedging your bets. The leading thoughts being is this malaria or typoid? lets send of tests (that might tak 12hrs at best or completely evaporate -metaphorically- between the patient and the lab at worst) and then treat for both. You've got to roll with the punches (eg. your slightly traumatic tap of an LP* being mistaken for and being tested as blood). Your mind may then wander onto TB and HIV, although we get our fair share of heart failure and diabetes out here. So medical school has at least partially equipped me for this.
 I'm sorry if this reads too much like a portfolio piece so far, the medical refereces are likely to remain limited for the rest of this post.
 This week was the first relatively ordinary week in terms of eveing activity. If such a thing as normal really exists. Friday night is film night in the chapel, which is hilairious. The previous offerings have apparently included the classic hollywood epic 'the ten commandments' partially 'dubbed' into the local language. I say dubbed, the original soundtrack isn't removed, so the actor will start speaking in English, then a few seconds later some one will shout the equivalent in lhukonzo over the top. It's apparently quite disconserting. This week there was no dubbing however. The film was a tour de force of filmaking that was outragously snubbed by the oscars a few years ago. A whistful few know it only as 'the masterpiece', the humble name it goes by otherwise is 'Jouney 2: The Mysterious Island' How Dwayne 'the Rock' Johnson missed out on the best actor nod and his pecks were denied best special effects is a mystery to us all. Okay, so the film wasn't a good one, a half hearted Disney 3D cash in, but the audience made the film. The film was projeted onto the wall in the chapel and the sound piped throught the chapels speakers. The audience was made up of the students of the school of nursing and midwifery and a number of us electivites. The reactions of the students were incredible, wailing with fear as the giant CGI lizard (that was about as convincing a an appology from Lance armstrong) snapped at our irratingly shallow characters, gasping as our lead female fell from a giant bee and reeling with laughter at the capering of the comic relief. The film even got an ovation at the end. This is why cinema is great and will always have a place in this era of home entertainment. Even a dudd like the mysterious island can be redeemed by good company.
 Saturday we climbed up to the MTN and Orange mobile towers, the trio of spires that thrust from the hilltop above kegando. The view of the compound and hospital puts it into better contex and the 360 views of the surrounding valleys is an experience in beholding the beautiful (but oddly, James lacked any mobile reception from orange and missed an incoming call as a result...while almost litterally sitting ontop of the tower). Later that night with little else to do, we were encouraged by the Norwegian nurses (still only my joint second favourite Norwegians you will be glad to know Mrs Brekwoldt) to head down to the chapel to watch chior practice. It was enjoyable to sit and drink in the intersting takes on some modern (and not so modern) songs sung by a chior and played on only a bass and keybord. The rythme section was always the samba metronome on the keyboard (which sometimes comicaly interupts deep, reflective prayers with its jaunty clicking) and the keys tend to be programmed to heavy synths (think the killers or the Chris Stratta version of all songs), the fast songs always seem to be fast and the fast songs slow. (Try 'I wan to see jesus lifed high at funeral pace and you'll get a taste) That said it is never less that earnest. We began as observers. It didn't end that way however. Rob and Keelan (the oxfordians I introduced last time) accidentally joined the chior by entering the wrong door, and when it came to practicing the dance number (there is regularly a Lhukonzo song repleat with a jaunty dance) we joined in too. Unfortunately we impressed them a little too much and we were asked to join the chior, and before we had a chance to really examine the offer it was anounced as official that we were going to perform in the service tomorrow.
 So when the chior (named Echoes of victory) stepped out, so did the mzungus. If hips don't lie as the sagacious Shakera once prophesied, then ours were saying 'we have know idea what we were doing'. One thing can be said, the congregation did wake up when we arrived on the dance floor. We were inundated with congratulations on our skills afterwards, strangely they always laughed when they did. No idea why. Although our dancing remains questionable at best, I for one hope to take up the offer of membership to the gospel chior. This adds two rehearsals to my weekly diary. Should be fun. Maybe I'll pick up some African rhythm.
 The rest of Sunday wasn't uneventful. I discovered the Ugandan way of doing things when I went to visit the prison for part of the prison ministry. As we sat on the bench of the prison that is perched on a hillock that sticks out of the valley floor with the greenery of the valley falling away on shallow slopes in three of four directions, Sam (a fantastic nurse who is also a lay reader at the church) turned to me and asked me to say a few words for the prisoners two. Over the next 2 minutes, i first panicked, gathered my wits together and then tried to mentally hobble together a gospel message. I had two things on my side, the first was the two other talks I've done on Phillipians and Mark (so guess which bits of scripture I quoted, no prizes) the second was that i was being translated. This means that while your words are put into Lhukonzo you can smile and desperately formulate the next part. I think i managed to outline the gospel, touch on original sin and say something about sanctification (the process by which the holy spirit makes us more like JC) which goes to show how scattershot some of it was. However it's the spirit that turns hearts not man, and he used my meagre efforts and a talk that Sam delivered to bring some of the prisoners to faith. 25 men put up their hands when Sam asked who wanted to become a Christian my the end. For those that pray, please pray that they stick to their new proffession and they find a church to learn more)
 Today (skipping monday, which I've outlined above) I headed out on womens health outreach up into the hills of the Rwenzori. The temperatures were hitting the low 30s and I probably reached the top a few stone lighter with the water that was fleeing my body. The clime was worth it for the majestic surroundings, Coffee, Bannanas, Papayas and vanilla pods all in the foreground along our path. The rich lush landscape infront of us, stretching out to the horizon of smoothly curving hills and jagged mountains. This is a country with a weath of natural resources and fertility. The talk was on VVF (birth trauma related complications) and parasitic worms (yeah I know I promised that the medical talk was at an end, and I should have put 'Worms!!' in the title). It was a good hour and a half on the asscent and hour on the descent, my legs were worn and my cheeks were covered by a lingering warmth that I hoped was the feelig of a job well done and not the first warnings of sun-burn...we shall see. So all in all an eventful week. Tomorrow, it's safari and slap up breakfast time on my day off (saturday and sunday are half days of ward work so I haven't had an official one since last monday). Here's to elephants and gorging yourself on western food.


*for the non-medical: LP= lumbar puncture, a sample of the fluid around your spine and a traumatic tap is when you hit some blood vessels on the way. Which is harmless to the patient btw.

Prayer points (for those that pray)
-For the prisoners, that they would come to know the living God and put their faith in Christ.
-For the imminent announcment of my foundation school allocation, that I would put it fully in the Lords hands and be confident that he works all things to my good, not necessarily to my preferece.
-For friendships and relationships with both ugandans and ex-pats.
-For the morale of the medical staff as patients die from preventable causes due to lack of resources or late presentations.

SDG

The End of a Week + the End of a Year of Life....

Night-time is a chorus of noise. If anything the nights here are more filled with noise than the days. Various different insects – enboldened by the darkness that lies smothers the district at night- fill the air with their calls. Some like over-enthusiastic members of a mariachi band with a new set of maracas, others chirping like they are trying to add sound effects to the twinkling of the stars to try and make Disney depictions of the heavenly bodies seem more realistic. When the rains fall at night, the frogs and toads like tone deaf cousins of the crickets join their voice to the soothing cacophony. There is even one irritating -as yet unidentified- critter that lets of a sound just like my phone alarm and had me waking in cold sweats the other night, just to realise that it was 3am and some pretender was waking me. I have since changed to a tune that I doubt they have the musical ear to mimic. We shall see.
 On the topic of rainfall -I never even mentioned it I hear you say- almost every day since I arrived had a shower, which makes them calling this the dry season a little suspect ( just like us calling that time of year without snow and with leaves on the trees summer). At first I thought I had brought the British weather in my wake and was somehow to blame for the sudden downfalls. This however is the South Rwenzori and a reliable source (if you can't trust David Attenborogh, then there is no hope for humanity) informs me that is comes from one of the local dialect meaning 'The rainmaker' the tall peaks force the water laiden clouds upwards, forcing them to shed their watery load on the land below. This happens with minimal warning, in the middle of searingly hot days. This range is an unpredictale mistress. (as JM if you want a more accurate account of clouds and rainfall, I'm sure he'll oblige)
 My twenty sixth year began here in these humble trappings.I took a day of to celebrate my quater century (a relatively good innings, but I'm hoping for a few more God willing). After the previous blog entry I had another day with only Dr Hassan as cover, then a day with Helen Shepherd at the end of the phone. Which is fortunate due to an acutely unwell HIV (or ISS, as its PC/cover up name is out here) patient landing in my semi-capable hands. So after a minor moment of inward panic, I did what any sensible foundation doctor should do I followed guidelines and when I found myself at the end of any written commands....called a senior. Helen approved of what I had done (she had written said guidelines, so she may have been a tad biased) and the panic was able to pass. Although he improved over the next few days, he was the first of what may be many patients to suffer under the fact that western Uganda (this is only slight hyperbole) is entirely of blood (outside of peoples bodies in bags that is, not in it's other forms). Sadly he badly needed blood and he died two nights after I left the ward. It is a hard thing working within the confines of restricted resources. This wasn't the first death of a patient in y care I've come across (cue serious section) a young girl who had been recovering otherwise stopped breathing and the doctors began trying to resuscitate  my first experience with real life CPR- but despite our best efforts she was beyond our help, with the facilities she had. She was only 13. If you pray, then pray for her family.
 Paul Shep was back in town in time for the weekend. It's a working weekend, even though they are only half days. The major aim of the weekend ward-rounds is explained in the pithy tag line 'keep them alive till Monday'....so not unlike the UK.
 Sunday held my first church service in which worship was led by a local choir  The liturgy of the service was far more high Anglican than I am used to, which -given the trappings- was rather surreal. It seems once I'm done here I will have 'the grace' down to a tee. The service was a long one as it was a thanksgiving for the school: multiple speeches that you can barely hear (they speak incredibly softly here, as it's deemed rude to raise your voice, and as a Brit I feel it's rude to get people to repeat themselves too many times...which can lead to a bit of a cultural impasse) which was longer got far more laughs when translated into the local language. This was followed by a fundraiser to buy the choir a guitar. Which involved dragging a goat and some chickens into the church (for a moment I thought they were going to surpass high Anglicanism and get all old testament on us) these were to be sold to the highest bidder. Following Lunch i headed for a hike to the dam in the nearby hillside with Ben (the Yank) Oolie (the German othopod, her name is unlikely to be spelt that way and when he reads this, Paul Shep is likely to insult my ear for new words...bring it Shep, i'm ready) and the two new Oxbridgers (Rob and Keelan from Oxford, this makes me the only one fying the PBL flag out here....wish me luck). The dam wasn't particularly beautiful, but the waterfall and the climb to it was brilliant.
 I spent my birthday on the road for the greater part, heading to Fort Portal on the way to the Bigodi wetlands. Our driver didn't know the way and -even armed with a map- it turned out nor did we, and when I say we....I mean Ben. We got gloriously lost and in the process of re-finding ourselves we went through a back-road right through the dazzling greenery of the tea plantations, tea bushes rustling like a vast ocean that would taste good with a dousing of hot water and a spot of milk. And the smell....don't get me started on the smell.
 We eventually arrived in the wetlands and toured in the midday sun (there were no mad-dogs, but there were Englishmen , the baboons and monkeys were out in force with more birds than we could number. Lunch was held back in Fort Portal, a restaurant called 'the Dutchess' founded by some Italians (not a cockney as the name may suggest) so a wonderful calzone graced my plate. Fortunately I had still maintained my mzungo capacity of stomach and downed the whole thing (we had to go full sized, the 'baby' size would have been an insult to my masculinity). It was fantastic, better than pizza express hands down.
 On the topic of Mzungus, this is the call that goes out from the sides of the road as we pass. Small children gather, as though a local celebrity is in town hollering 'mzungu' and when you reply something terrifying like 'hello' the scatter like dandelion seeds under a heavy blow howling with laughter. Mzungu means 'white man' roughly translated. It isn't racist -i'm reasured- it's just like shouting 'fatty' to an individual who in the words of Bill Shakespear 'hath most certainly consumed the totality of the meat containing pastries . Which again isn't insulting, but descriptive....especially as a bit of chub is seen as an attractive feature of wealth amongst the more traditional parts of society. Which is fortunate with all these carbs I'm loading, as though there is a marathon that I am never going to run.
 From now on updates are like to be weekly. We'll see if I manage that.

Prayer points (for those that pray):

> For continued health and improving language skills (I can say hello and goodbye....vital skills)
> For the staff out here, we've lost a number of young patients  which is never easy especially as you feel they may have lived if resources were more available.
>For the women's and family health outreach programs to local villages that happen weekly. That they bear fruit.
>That I won't start feeling the effects of old age too soon.

Travel #2: Orientation, orientetation, orientation....

 Breakfast is a feast of beauty. Not because the food is exquisite –I don’t know many people who get giddy with excitement at the thought of toast- neither is that a comment on the visual appearance of my fellow medical elective students (I choose not to make a comment either way when it comes to Ben and James); but it’s in reference to the view. My uphill stroll that takes me to the guest house –and takes the wind out of me, I’m embarrassed to add- ends with a view across the valley to the foothills in the distance. A stunning display of rich shades of green and brown reaching skywards, peppered by trees and small houses. It makes the climb worthwhile in a way that the brown slabs masquerading as toast don’t. The view at nightfall is even more dramatic as the sun begins to hide itself behind the horizon making the areas not covered in cloud light up with the colours of fire. We’ve yet to see the full display due to the pillars of cloud that obscure it, but I suppose I have another 7 weeks of dinners to witness that. The view on the way to chapel at 8:30 – which is attended by all the staff and students of the nursing and midwifery school- is equally arresting, a lack of tree cover giving you a panorama as you descend. The kasesse foothills are an impressive work of the creator and his nifty tectonics.

 Since I dispatched my last blog a few things have happened (which is fortunate otherwise this would be a short or excruciatingly dull read…you may be the judge as to whether this is still the case). I left the AIM guesthouse on the outskirts of Kampala early Saturday morning. Hitching a ride with an American couple missionaries who were just about to leave the mission field and were heading down to mbarara to pick up their possessions to return to the states. They were making the journey (providentially enough) on the same day I needed to go. We made the trip through the back streets of Kampala to avoid the inevitable grid-lock in the city centre and soon managed to drive beyond the city limits, which gets more and more ram-shackled the further you leave. Urban migration with the phantom promise of work and prosperity that the capital represents to those in the country side leads many to make the journey on the last of their finances and discover having arrived at the mirage they cannot leave. It’s estimated by the WHO that the ‘homeless’ in Kampala are set to double in number over the next decade with estimates reaching into the millions. I met some rural workers on my travels pursuing this dream across the country hoping for construction work, I couldn’t bring myself to try and dissuade them but instead wished them luck. Maybe they will be some of the lucky ones. Maybe.

We stopped for lunch in a town called Musaka (but no, they didn’t serve any musaka, or have an awareness of what it was) I had my first taste of Ugandan food on Ugandan soil. Metoki (spelt something like that and made of mashed plantain), potatoes (confusingly called Irishes) sweet potatoes (noticing a carb theme here? I reckon that Hulme hall had its Carbs, carbs with a side of carbs diet inspired by Uganda) chicken stew, baby egg plants (I thought they were peas and eagerly took a mouthful….turns out they have all the sweetness of lemons and the charm of road-kill) and beans in sauce (I’m going to have to get used to beans, they occur so much in my diet now I’m surprised not to find them on my toast in the morning). We casually dined with such light topics as infant baptism and communion and the ‘new perspective’ on Paul. (It makes more sense if you realise that the missionary in question also teaches seminary classes and is returning to the US to be a pastor). We arrived in Mbarara later that afternoon and I said my farewell to my Yankecano friends and met the Joel the regional co-ordinator for the region (he has a wonderfully alliterative –not illiterate, that’s something different- family Joel and Joy with their children, Dara and Dane).

 I continued to ride the orientation express (which ironically when combined with a slice of sleep deprivation proves to be very disorientating), completing my second day of three consecutive days of travel and orientation getting more narrow in it’s scope each time. First Uganda, then the region, then the hospital. I was then taken to the house of Seb, a British short termer working in schools out here. As soon as I arrived I was on the move again ( I say straight away…… there is always time for a cup of tea) to head into town for my last taste of western style food at a local restaurant with the other single missionaries (does this ring of SBS tactics to anyone). It was a good evening, two yanks, two brits and an ozzie enjoying fish (from either lake Victoria or George, I believe) and chips. I was also take to see the latest attraction in the town,  a multistory supermarket that boasted the only escalator I the west of Uganda (that had the young girls riding it so terrified that they had to jump the last foot to avoid being dragged under) and a furniture department with one singularly hideous number a round leather bead that had speakers and a stereo build into its headboard and glittery studs in its mattress. Classy.

 The following day was not preceded by a sound nights sleep due to the neighbours sound system and the local wild dogs on heat taking it in turns to compete for the title of ‘most irritatingly loud noise’ in the ‘late night’ category. With another refreshing 5 hours slumber ‘rejuvenating’ me I was taken to the taxi rank to take my next step on the journey to Kegando. I say taxi rank, but ‘rank’ suggests troops orderly lined up so smacks as a bit inappropriate description. The white vans congregate in an ad hoc clustering underneath signs to their destination. The Mbarara taxi station was tiny in comparison to the one I visited two days previously in Kampala. The Kampala station looked like a watering hole for a species of white four-wheeled beasts who gathered in the clearing as big as two football pitches in amongst the ‘forest’ of Kampala’s buildings.

 I didn’t leave the taxi station straight away, they have to fill up to capacity first. This process –rather confusingly- involved driving out the other side of Mbrara to pick up further punters. Before turning 180 degrees and heading back to the station, switching driver and setting off towards the open roads that led to Kegando.

  The countryside rapidly changed around me. The buildings of Mbarara gave way to country side that was soon littered by banana plantations, these were soon joined by the tea planations that hatched the hill-side with orderly, light green lines. Seated in the passenger seat of the minibus I had a privileged view of the country outside. At approximately the half way mark we entered national park territory, first the dense dusky-green forests of *(&)(*&& (find the name later) reserve, which bordered onto the planes of the Victoria national park. Animal sightings started becoming common place; I saw hawks wheeling overhead, storks (I think that was what they were) strutted awkwardly around, and a solitary bull elephant greeted me into the park.

 I was accompanied by a friendly driver called Solli (or something like that) and a mother with a babe in arms who sat up front with me (was our insurance voided by that?...is insurance something they do out here). We got talking and managed to surprise eachother with our cultural norms. She was 41 and the child she cradled was her 13^th, the driver had 6 of his own and his dad was 1 of 36 children (he reassured me that his granddad had 3 wives…but even so that’s a rapid infant turn-over rate from all of them). They were surprised to find I was only one of three and felt it was even more absurd that the norm in the UK was more like 2 children.

 I was dropped off at a crossroad in Kikorongo before being picked up by Helen Shepherd (33% of team Shepherd, with whom I co-led bible studies at Holy Trinity Platt. The other two being Paul and Esmi….that said I don’t remember Esmi pulling her wait in terms of preparing studies) and the other two Medical elective students.

 After a brief and comfortable journey –comparatively- I was at the termination of my travels. Kegando hospital. The site is split in two by the road we drove up on; downhill lies the hospital equipped with two medical wards of approx. 16 beds each, a Paediatric ward (including neonates), a surgical ward, and obstetrics and gynaecology. The site also features a leprosy ward (which is currently uninhabited) and a vesicovaginal fistula ward (for women being treated for labour trauma complications). There are also a cluster of outpatient clinics. Out front and centre- almost as a statement of intent- is the chapel. On the uphill side of the road lies the accommodation complex, including my current lodgings, the clay house. The other international residents include The Shepherds (a family of three, not woolly mammal farmers), Chris (Paediatric and all round brain-box doctor extraordinaire, I am given to believe), Ben and James the other med students, The Three Norwegian nurses (Ida, Synna and Ingrid) a German Orthopedic surgeon and out Maltese nurse and professional enthusiast Rita. The site also contains the halls for the nursing and midwifery school and the accommodation for the hospital Dr’s and administrators.

 My first afternoon in Kegando took us to the Queens Pavilion to get a stunning 360 degree panoramic of the Victoria national park and the lakes that are found at its edges. We accompanied Helen, Esme and Helen’s parents and sister (the Reids) who are currently paying the Sheps a visit. During our time at the pavilion, a warthog even turned up to pay its respects, but oddly fled when we started singing ‘when I was a young warthog’. Strange. From the looks of the national park we won’t have a choice but come back for a proper tour of the place.

 I’m now at the end of my second day of ward work. The first day I was accompanied by the Essex born James who’s a product of UCL. I did my best to be of some help, whilst trying to rap my mind around a system where malaria and typhoid are in the differential for almost any symptom and a lot of our diagnostic technique is treating the usual suspects and watching for improvement. Throw drugs at the problem and see what sticks (this may be a slight overstatement). The second day was supposed to be like the first, but our good friend Mr Traveller’s Diarrhoea decided to promote me from assistant to junior doctor, so I tackled the ward without James who was alternating between bed and his porcelain throne. I wasn’t without support, there was a more senior Dr on the ward, but he stayed all of 30 mins to do a ward round, when it had taken my 45mins to see my first few patients. After that he practically evaporated, not to be seen for the rest of the day. Fortunately I’ve been blessed with mostly discharges and stable patients, so I wasn’t terrified entirely out of my mind today. The step up in responsibility is a bit of a shock to the system however.

 Taking histories from patients is an interesting ordeal for two reasons, one the patients often don’t speak English so I need a translator (normally one of the first year student nurses) and secondly the usual bank of questions that I use for histories get blank stares from the students. For instant hurt (as used in the common phrase ‘where does it hurt’) has to be replaced with ‘pain’ and often ‘very painful’ has to be substituted by ‘pain-pain’. This is going to be a challenge, and possibly starts to explain why my ward rounds last a little longer than my Ugandan colleague’s.

 That roughly brings us up to date. Back to being called Dr….that still hasn’t got normal yet.

Prayer points, (for those that pray):

·         That God would grant me the knowledge and understanding to carry out my role on the wards (I’ve been reading Daniel 1+2 where it’s made clear that these things are from the Lord)

·         For health and the rapid recovery of James, the Norwegians have also all had some issues along similar lines.

·         For Paul’s return Journey to Kegando

·         For relationships with the nurses and doctors, and opportunities for discipleship and growth

·         For patience with the limitations in communication and the occasional obstructive nature of some of the staff. The ability to object graciously. To be firm but loving.

·         That I’d be able to pick up the basics of the language. (It’s great to see people’s faces light up when you great them in their mother tongue)