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)