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.