I am writing this in the afternoon a few days after the start of the year. I hope I am not too late to wish you all a blessed year.
This year the dry season, and the heat that goes with it, has started a month earlier than in other years. Temperatures are daily reaching 35°C and above. The grass has withered, gardens where food is grown have run dry and the maize has turned to dry leaves only. It is widely expected that some regions of Uganda will have food shortages, which will increase the prices in the markets. The Kiwoko region is not usually the worst affected, but northern Uganda and South Sudan are already suffering and rains are not expected now until well into March.
Working in this heat has its own challenges, especially when working in the operating theatre. We do not have air-conditioning or even fans (because of infection controls). Whilst doing an operation I have to wear a plastic apron and a thick cotton gown over the top as well as a hat and two pairs of latex gloves and it is quite sweltering. I am going through a lot of bottles of water!
The last few months of 2016 saw Kiwoko Hospital in party mood with the major celebrations around its 25th anniversary. The hospital had started as a clinic at the end of the civil war in Uganda (as one speaker put it, “it was founded on the bones of the victims of the war”). As it grew as a health centre, it was officially registered as a hospital in 1991. Much has changed since the early days and the hospital has expanded – and is still expanding. The number of services provided are still increasing and the hospital now employs more than 450 people. However, we have some staff members who have been here for the entire 25 years. In October and November we heard many stories from those who knew Kiwoko Hospital as it was then. Those staff members are known as the “historicals” and many of them were invited for a commemorative dinner which was well attended.
The motto for the anniversary was “Thanking God for the past, trusting Him for the future”. A big banner with these words is still present at the entrance of the hospital. In the last week of November there was an official event held, with many dignitaries attending.
The day started with a march through Kiwoko town, followed by the opening of the latest building at Kiwoko Hospital. That was followed by a huge gathering in the grounds of the nursing school with many speeches and presentations. One of the guests was Dr Ian Clarke, the founder of the hospital (you can read his story in the book “The man with the key has gone”). No celebration is complete without food and two cows were slaughtered to feed the many attendees, and a good time was had by all.
The celebrations hardly finished when we headed into the Christmas season, with once again many dinners and a big hospital Christmas party where many of the staff were invited to do a “piece” to entertain each other. The doctors had also prepared something, but I was unable to join them as I was sweltering in theatre – the work always goes on and labouring mothers don’t wait for any parties.
Some of you may remember that I used to work with Dr Mushin, who is now training to be a gynaecologist. He is expected to finish in September. However, in mid-November the government of Uganda closed the university to investigate certain financial irregularities, leaving all the pre- and post-graduate students stranded. The whole process was expected to take three months before they would be opening the university again. Students have to pay school fees to study, a significant amount each trimester, but despite the lack of tuition no school fees will be re-funded.
So Dr Mushin decided to come back to Kiwoko to help us with work whilst waiting for his course to continue. He was with us for the whole of December and was a great help to me. However, the situation left the teaching hospitals of Kampala without junior doctors, which not surprisingly created a big crisis in healthcare provision within the capital. In maternity wards mothers died through an absence of doctors and we had some patients coming to Kiwoko for their operations because theatres were closed in the main national hospital. The whole situation would be unimaginable in Europe. The government was therefore forced to re-open the universities ahead of schedule, so after the New Year all students had to report back to their posts. So as much as it was nice to have Mushin around, I am glad the universities reopened and healthcare and training could continue as before. It is not yet clear if this is going to delay the timing of graduations but we shall see.
The end of the year also gave me the opportunity to review my work timetable. Up to now I have been working Monday to Fridays 7.30am-5pm, 45+ hours per week. As I am getting a little older this has become more difficult, which has prompted the review. This means that two afternoons per week I will not be working (or instead able to write newsletters as I am doing now!) and two afternoons I will be concentrating on antenatal care rather than acute labour ward care. This will keep me out of the operating theatre in the afternoons, which will be a great help with tiredness levels. Other doctors will have to cover for this, which is not easy as they have their own work as well. Thankfully I have been allocated a junior doctor once again (which of late has not happened consistently).
The antenatal clinic normally operates without the involvement of doctors and even though this will remain the case, I want to bring more structure into the work that the midwives do in that clinic. My aim is to develop the skills of the midwives rather than seeing patients myself.
As I end this letter, I want to encourage you to adopt the motto from Kiwoko Hospital, as it can apply to all of our lives: Thanking God for the past, trusting Him for the future! My prayer for myself, and for all of you, are the words from Romans 15:13: “May the God of hope fill you with all joy and peace as you trust in him, so that you may overflow with hope by the power of the Holy Spirit.”