My last link letter was written during the hot season, which prompted me to change my habit of going for a walk after work to going for a walk at first light in the morning, around 6.45am. The benefits are many: less heat, less dust and less unwanted attention for the “mzungu” (white person). It has also opened my eyes to what goes on in everyday life at that time of the morning. Just outside the gates of the hospital, the cooking pots are already steaming. I do not know how early those ladies start cooking but by the time I pass, food is ready to be bought by patients and their relatives. Patients do not receive food from the hospital, so it is up to relatives to provide for them, a perfect business opportunity for people just outside the hospital gates.
During my morning walk I meet many children on their way to school, the colours of their uniforms representing which school they attend. I do not know how many schools Kiwoko town has, but judging by the different outfits quite a few. It is very encouraging to see so many children attending school. The quality of teaching may vary, but there is hope that they learn at least to read and write. However, I also come across children – and adults – with hoes and spades making their way to the garden to attend the crops. I feel sorry for these children, that they have to work instead of attending lessons. Life is not easy for those families.
Food has been a bit scarce, so now that the rainy season has started it is important to make the most of it so that food can be produced in abundance. The maize in the fields is already coming on nicely, so we keep praying that the rains will not stop before harvest time. However, other regions in Uganda are not equally blessed with rain and the far north especially remains very dry. This is the region where many of the refugee camps for people from South Sudan are located, putting more pressure on the already scarce resources. In Kiwoko we do not notice any of the refugee issues. We are too far away from it. What news I get is from international websites.
In Kiwoko Hospital, life goes on. Increasingly, the hospital is building a good reputation far and wide, which creates more work and keeps us busy. In maternity over the past month we had 69 mothers referred to us from other health centres and hospitals. Our neighbouring hospitals seems to struggle with manpower (some of our referrals are because other hospitals have no doctor) or resources (referred to us because of a lack of materials at other hospitals). It puts more pressure on our medical team who nevertheless continue to work very hard and deliver a good standard of care.
Kiwoko Hospital is facing some big challenges itself. Our current medical director, Dr Rory Wilson, a CMS-Ireland mission partner, and his family are leaving Kiwoko this week to return to Northern Ireland. This leaves the post of medical director at Kiwoko vacant. So far the hospital has not been able to recruit a replacement. There are several reasons for that. Firstly, the job has become too big to be done by one person. So we are looking for a medical director as well as a business manager. However, the question is whether we should employ at least one expat for the roles, to make it more likely that our many donors will continue to support the hospital.
The other issue is financial. The hospital has no money to pay two large salaries. As soon as the dollar or the British pound drops a little, it has a major effect on overseas charities and organisations like Kiwoko Hospital. It means that we need to find someone who is well qualified but is willing to come to a rural area and be paid a salary way below what they could demand in Kampala.
While we pray and wait, for the time being one of our surgeons, Dr James Nyonyintono, is stepping up into the role until a new medical director can be found. This is a huge challenge for him personally, but also leaves the hospital short of surgeons. We only have two surgeons, who each do a week on call at night as it is, so taking Dr James into a directorate role on top of continuing a surgical practice is not going to be easy. So we are thinking that as part of the interim process, we will perhaps find another surgeon. This might be slightly easier than finding an administrator. As a Christian hospital we trust that God is in control of these events; he knows the needs that we have and we trust him for the way forward. Many prayers are going on and I would love you to join in those prayers.
In my last link letter, I wrote about the changes in my own work patterns. It has not completely turned out as I had hoped but at least the work has become more manageable. One of the aims was to get involved in the work of the ante-natal clinic; this clinic has always been run by midwives with no input from doctors. There are extensive guidelines from the ministry of health about what should be done in an ante-natal clinic, which involves keeping endless records – which the ministry demands – but which leaves very little time for the actual clinical assessment of the patients.
What is required is a change in mindset of those midwives working in the clinic. Up to now there has been a lot of resistance, partly due to the midwives working independently for so long, so when someone comes to challenge them it creates resistance. So we recently had conversations about attitude and time management before going on to discuss clinical practice. However, I am hopeful that with time the midwives will get used to the idea of having me around (some of the time at least!) and for them to improve their clinical skills.
In churches it is common practice to greet each other with words of peace – “Peace be with you” we say. These were the first words Jesus spoke to his disciples on the day he rose from the dead. Jesus came and stood amongst them and spoke those words. To him, as the risen son of God, those words were his first priority. Let us take encouragement from those words; Jesus comes into our situations and stands with us and offers us his peace.
Greetings from all at Kiwoko Hospital.