23. An Emotional Day

Friday 23rd November 2012

 

The drum that calls people to prayer

Up early again today – the pressure is now on to try and catch up a bit with my blog otherwise I will be writing it when I get home. I’ve also got several things that I want to fit in to my last day here. I am meeting Doreen at 9.30am to see the Goat Project that she runs and definitely have to find a way to get my money exchanged. My skirt and dresses need collecting from the Sewing Room, a visit to IT is necessary to sort out sending my outstanding blogs and photos, plus I have to find time to call at the local shops to get some G nuts for Philip to roast for me to bring home. I have some clothes and cards that I want to drop into Night to give to the families I met last week and Tom has some other clothes for her to distribute generally to needy families in the local community. There is also a Management meeting I have been invited to at 4pm and I have to pack as well. It’s starting to feel like a busy day at The Countess!

 

I can hear the sound of the drum beating to call everyone to Chapel so I make haste. I don’t think I have mentioned the drum yet? It is tied to a tree opposite the Outpatients Dept and is used throughout the day as a method of signalling that things are about to start or finish. The banging of the drum announces the daily Chapel service, Banana break, start and finish, lunch break start and finish and at 5pm to let everybody know it is the official end to the working day for many workers, although not the nurses who work on shifts obviously. In Chapel after the initial hymn, names are called out as usual for the daily rota of staff members who have been nominated to lead prayers in each of the wards. Those named take their leave and the service continues with a bible reading followed by interpretation and translation of the passage, then prayers. During announcements Ian Spillman stands up and thanks the Countess team for all their hard work over the past 2 weeks and for the continuing partnership between the 2 hospitals which is helping to continue improving standards of care for patients. We each then have the opportunity to stand up and say a few words about what we have been doing during our time at Kisiizi, and everybody seems pleased to hear that today we will be ordering more than 100 replacement mattresses. Prayers are offered for our safe trip back to the UK the next day and then a hymn along the lines of “May God keep you safe until we meet again”, is sung with everybody waving farewell to us at each chorus. It is really quite moving.

 



Janet with Peter's goat (he's the one on the left!)

Angela arrives at Rose Cottage with Doreen at 9.30am as she is interested in learning more about the Goat project. We walk down the road, past the school and several little huts referred to as the local shops and on the right hand side of the road is a sign and an opening in a metal fence mesh fence through which we enter. The project was started in 2008 and Doreen liaises with the Children’s ward to identify families where children have been admitted suffering from malnutrition. The families are offered a goat which will provide milk as additional nutrition for the child or children. To ensure the project continues to develop and expand, some families are given both a male and female goat in the hope that they will ‘get together’ and produce one or more offspring. There are several mothers and kids in the pens tucking into some tasty looking greens that they have fill their feeding troughs. They all have really cute faces. I did indicate on a previous blog that I would probably be sponsoring a goat as part of Peter’s Christmas present. Well Peter I hope you didn’t think I was joking. I asked Doreen to take of photo of me with the goat that will soon be heading off to a local family to provide them with a constant supply of milk for their children, and I can’t think of a better pressie that I could have given you. I might also get you a little surprise to open on Christmas Day as well!

 

I am on my way to the IT Dept when a lady walks up the path towards the front door of Rose Cottage with a basket containing about 10 or 12 tomatoes. Philip is in the garden so I ask him to check if she is ok with me taking her photo. She agrees and I ask (through Philip, obviously as I am not yet fluent in Rukinga) whether she has been to the shops, but Philip explains she has come to the Guest House to try and sell the tomatoes. I ask how much they are and he says 3000 which he indicates is a good price (75p) so I offer to buy them for Phillip. Both he and the seller seem pleased. I probably paid a bit over the odds but does it matter? I don’t think so. I also give Philip 4000shillings (£1) to get a kilo of nuts from the market and he promises to roast them for me after lunch. I get to see Edson a bit later than planned but manage to send off my blog and photos which is a relief. Then it’s off to the Staff Room for Banana Break and Sam arrives a few minutes later armed with a bag full of sweets, including Haribos and chocolate treats that she puts out on all the tables for the staff to enjoy. It’s a lovely gesture and clearly appreciated by everybody there. A bowl is brought in so that some sweets can be given to the team in the Finance Dept, who by the way have sorted out my exchange of money so I can now pay everybody back what I owe them. After a couple of small bananas and a cup of peppermint tea I walk back to Rose Cottage to get the clothes and cards to take to Night’s office. She is most appreciative. I spend about half an hour time taking some last minute photographs around the hospital grounds. As I walk past the Outpatients Dept, there are still several benches full of people sitting there waiting to be seen. People start arriving from around 7.30am each morning without an appointment; it’s a bit like attending our A&E Dept I suppose, and then on the other side is a building where patients with prearranged appointments go.

 

Sarah, Sam, Tom and I have been invited to Ian and Hannah’s house for lunch at 1.30pm. The Pharmacy team were invited yesterday. We have a really delicious lunch of potatoes, chapattis, G nut sauce, cauliflower with tomato and onions, with a mixed salad, then slices of papaya for dessert.

At 3pm I go the Sewing room as arranged to meet Joselyne but she explains she has not quite finished but will have them ready later and will drop them to into me at the Guest House. I suggest I pay her now as I am not sure what time the Management meeting with finish. She has made a skirt for me and three pinafore dresses for my three grandchildren and only charges about £9 but I give her more. I check whether she has been able to make skirts for Shivau and Precious. Because the piece of material I had bought last week was fairly large I suggested to Joselyne that she could make a couple of simple skirts with elasticated waists for them. I don’t have their measurements but show her photos and she estimates the size. She hasn’t been able to finish these in time but promises she will make them next week and drop into Night’s office. I ask her how much I owe for these two but she says she doesn’t want any payment, she knows they are for orphans and she is happy to make them for no payment. She explains that she looks after two orphans as well – I think when her sister died she took her nephew and niece in to live with her. I am really humbled by this gesture. She has very little money herself but she has such a kind heart that she wants to do this. I don’t see her later when she drops the finished dresses off as I am still in the meeting but when I open the parcel she has also made little shoulder bag to match the dress for Heidi – without me asking, and for no extra payment. This is so typical of the generous nature of the Ugandan people.

It’s now 4pm and time for the meeting in the staff room. The seven of us are there and apart from me everybody has prepared reports to be presented to the group. Ian and Hannah are joined by Moses and Father Patrick and we are advised that Sister Anne may join us later but she is currently busy in the Paediatric department. The purpose of the meeting is to feedback what has been achieved during our visit and to report on any challenges that are still being faced. Suggestions will be offered for different ways of working that may improve outcomes based on experience of working practices at The Countess, but our teams never go over to Kisiizi with the intention of forcing or imposing our ideas. This is a partnership and for it to work effectively, each hospital has to be able to see things from the other’s viewpoint and respect the fact that may be genuine reasons why sometimes things can’t be achieved as quickly as anticipated, and that equally there are times when indications are given that things will change but when this doesn’t happen, it can be very frustrating.

 

Haley and Beccy present the pharmacists report and confirm that the audit that have undertaken on the Prescribing Standards show improved results. As discussed at the D&T meeting this morning there are still some improvements that need to be made. The girls have prepared written reports which they will leave with Ian and have put together an audit toolkit so that audits can continue in the department after they have left so that the progress can be monitored on a regular basis. The ARV reporting shows a considerable difference in what is being reported compared to what is moving from the shelves which would explain the variance on stock levels. Carolyn confirms that further improvements will be seen once the new IT system is up and running and the overnight cupboard and emergency boxes on wards will also help. The storages shelves have been re-organised and re-labelled. The Pharmacy Dept is now making strenuous efforts to capture data correctly. It was also acknowledged that there is a need for a second check to be introduced on student nurses when they are dispensing. It was agreed that the new IT system would be set up to be ready for the new calendar year at midnight on 31st December. It was suggested that it would be beneficial for Carolyn to perhaps come back in February/March to see how the system is operating.

 

Sam gave an overview of the APPS Programme confirming that the four key areas were : Hand Hygiene; Waste Management; Safe prescribing; Safe Surgery Checklist (WHO). She had undertaken a review of systems and procedures in all areas and confirmed that policy documents were now available on all wards. There was a bit of an issue regarding Hand Gel in that on the day she and Sarah undertook an audit there was no hand gel in Outpatients. It was agreed that this would be looked into. The need for accurate discharge information to be recorded was discussed and it was agreed that this was a challenge – not just here in Uganda but in the UK as well. Various recommendations were made regarding the Waste Compound but it was agreed that massive improvements had been made in this area since the last visit. Standardising the colours of the waste bins to red and black was agreed in principle but cost implications would need to be looked at.

 

Tom gave the result of his audit on the WHO checklist which indicated that only 18% of the forms had been fully completed. Ian asked that we ensure the stats distinguish between elective and emergency surgery. It was agreed that there is a need to educate and train the staff as to the importance and the benefits of completing the checklist before all operations.

 

Ian thanked everybody for their input and Sarah suggested that although officially the three year partnership would be coming to an end around February 2013, and no further funding had been offered from the British Council to continue the three programmes, she hoped that this would not signal the end of the partnership. She would like to feel that there could be a way we could continue to support Kisiizi Hospital and reiterated what I have heard several times during my visit here; this is a two way partnership where Countess staff members are learning from working with the Kisiizi teams as well as us them learning from us. It was time to say goodbye which was quite emotional, but everybody agreed that we would find ways of making sure the links, professional relationships and friendships that have been made, will continue.

 

It was now after 6pm, very warm and most of the team wanted to get a shower before dinner so we went our separate ways and met up again at 7.30pm for a farewell meal of beef stew, beans and potatoes followed by rhubarb crumble and custard. We said goodbye to Peter and Angus but David said he was coming at 8am in the morning to wave us off. After that we headed back to the Round House to have another round of Bananagrams and to finish the wine off. I don’t stay too late as I still have my packing to do and my Wednesday blog to finish.

 

This will be my last night sleeping in Rose Cottage and as I settle under the duvet I think back to the first night I arrived and how, in my naivety I found the facilities very basic. Having now seen first hand the very sparse conditions that many Ugandans live in, I realise that what I have here is palatial in comparison to what they have. The furnishings may have seen better days and the concrete floor and outdoor shower may have taken some getting used to, but actually how important are these I ask myself? The warm welcome, genuine friendship and hospitality that I have been shown during the past two weeks have made a far greater impact on me that had I been staying in a four star tourist hotel, in relative luxury but where the front of house staff demonstrate little or no interest in you as a person. This has been my first experience of Africa and my first experience of visiting a country in a capacity other than as a tourist, and I can definitely recommend both.