Here a cell phone, there a cell phone everywhere a cell phone…..

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The world is an amazing place and here in Kibaale there is no exception…..I was truly surprised to discover that there is a cell phone in almost everyone’s pocket….. each of the clinic staff as well as many of the village folks have a cell phone. There are no land lines….. this infrastructure does not exist. Just like in Canada and in the United States, there are many companies each wanting your business….. unfortunately, Kibaale is only serviced by one company at this time and that is Uganda Airtel. I have no contract with this company…. no bills come to my door…..they do not have my credit card number and therefore can not bill me…. It is very different from how I did it in Canada. What I do is buy the amount of air time I want when I want it. First of all you buy your own phone…. all the companies will sell you a phone and for a good price starting from about 35,000 shillings ($14 US) upwards. Just behind the battery in the back of the cell phone is a spot to put in a very tiny chip you obtain from the company you will be using. Then you buy the amount of airtime you wish…. it is a small card like a lottery card which you then scratch and see if you win…no, in Uganda you scratch and then input the 15 to 20 digit number into your phone which then gives you the amount of airtime you bought. It is truly an inspiring idea… no bills and you pay as you go with no complications …. a very simple process and it works. Most of the Ugandans I know buy between 1,000 and 5,000 shillings of airtime…. I buy between 10,000 and 30,000 shillings. The reason I buy large amounts is because I have discovered that I can call Canada and speak for about 45 minutes for 10,000 to 15,000 shillings ($4 – $6 US)…. I have been told that that is very expensive but to me the cost to hear the voice of a friend or a family member is priceless…. I just have to remember to check the clock and count backwards 7 or 10 hours depending on where I am calling.

In Kibaale, there is still no electricity…. unless you have a generator like the centre has. When you go into Kibaale town you will see small notices letting you know you can have your cell phone charged for only 500 shillings or 20 cents US. BUT the clinic staff get their cell phones charged free….. when the generator goes on to provide the clinic with power each day from about 9:30 to 1:30 the staff find a outlet and plug in their cell phone. I will find a cell phone being charged in the pharmacy, and another one or two or even three being charged in the laboratory and then another in the triage room, the consultation room and at the reception desk and sometimes in my office. You see the clinic has 12 employees and they all want to have their cell phone charged when they are at work…. BUT what amuses me that most is that with all these cells phones everywhere in the clinic… only a few of them will have any air time. What they do have is music…. there must have hours and hours of music on each one of the phones…..I get to enjoy the various genre of Christian music depending who is working in the pharmacy or who is helping in the Lab.

I had no idea how valuable this resource would be in the middle of Africa…. a cell phone in the pocket of everyone I need to speak with. What a simple, quick and easy solution to contacting someone….. I will never have a land line again waiting by the phone for a call…..

I love this idea and carry my phone with me everywhere I go….not like when I lived in Canada and forgot it much of the time….but like everything there are times when the network is down… for minutes, hours and occasionally days… but then this is Africa.

Witch doctors……..

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There is a small mountain or a large hill just behind Kibaale Community Centre….. on top of which is a large hollow tree. I have heard that this tree was used by witch doctors. Over the years, many people have climbed this mountain or hill and prayed for the land and the people…. now the tree is old and there are no longer any gifts or sacrifices left in the hollow of the tree.

So, somehow I thought that witch doctors were of the past and not of the present. The story I am about to tell you was told to me by three of the clinic staff… each one of them at a different time. It is about an employee of Kibaale Community Centre, a driver. That he was bewitched by his wife because he took her cell phone away. This employee came to the clinic last week with abdominal pain. The medical officer and the triage nurse assessed the man and had him transferred to the nearest hospital, Rakai. I was not in Kibaale on this day…. but the next evening I was asked for financial support to transfer him from Rakai to the referring hospital in Masaka. He was transferred but died in the night. I was told he had been healthy up until that day. His brothers speak about how they believe his wife went and found a witch doctor and had a spell on him…….

Last night another driver died. He had been on a number of medications for his high blood pressure. His blood pressure was not improving and he was encouraged to seek additional medical help in Masaka…..

This afternoon, I heard some of the clinic staff and some of the patients discussing witch doctors and the deaths of these two drivers. If I thought witch doctors were of the past I was wrong. There is still an underlying fear of witchcraft and the witch doctor.

On Jan 7, 2010, there was an article by the BBC about witch doctors in Uganda… that witchcraft was on the increase because of development and prosperity. There is a belief that witchcraft can help people get rich quickly.

From what I have been told these two men were believers in Jesus Christ and somehow witch doctors and witchcraft is being discussed about their deaths. I am hoping that with the passing of time, these two men lives will no longer be part of any discussion on witchcraft or witch doctors but on who they were as a brother, husband, father and trusted employee.

Why are they carrying their shoes?

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Today, May 16 is the third day we have had thunder and lightening rains… the rain has come down from the heavens as if to provide everyone with a bucket shower…. the skies are grey like those in Vancouver in November or early March but the temperature is over 70 degrees…. In spite of this warm temperature, I am cold. I feel the coolness right through to my bones….. I am wearing a sweater and a light jacket all the day long…. and this evening I have socks on for the first time since arriving in Kibaale….

But the question is why are they carrying their shoes?

There are no paved roads or sidewalks in Kibaale and today, the red dirt is covered with hundreds and thousands of small, medium and large puddles of bright terracotta water. This morning when the rain has started to let up, I slowly walked towards the clinic, trying very hard to step between the puddles but I nearly slipped and fell a few times. The ground was very soft and soggy. At one point, I stopped to plan my next few steps and looked back to see each of my footsteps in the mud. The last hundred yards to the clinic were the most challenging…. I was focused on watching each of my steps…. it was when I got to the entrance to the clinic that I looked up and saw many students arriving late for class… but most of them were carrying their shoes. I looked down at my shoes and they were covered in mud…. and since I was wearing crocs, the mud had oozed through the holes and my feet were covered in mud. I thought that maybe the idea of walking to the clinic in bare feet may have been a great idea… I would have good traction and this way my crocs would be clean. All I had to do was wash my feet. I may still try walking in the mud in my bare feet and see if there is truly some good traction……..

But that was not why the students were carrying their shoes…. they were protecting their shoes from getting wet…. and in fact many would rather go barefoot then wear shoes…. could it be that they do not have the same opportunity to have shoes properly fitted like we have in Canada and in the USA. In this part of Uganda, there are no shoes stores…. on Market Mondays, a traveling sales man comes with sacks and sacks of shoes and that is how they are bought.

I can not forget the picture I saw this morning the very young and slightly older students walking bare foot through the mud in the pouring rain carrying their shoes to school. As much as I wanted to laugh…. I also wanted to cry.

It is midnight in Kibaale and I can not sleep……

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Today, May 3 was the second of a two day workshop put on for the Kibaale Community Clinic staff…..

I really do not know where to start but at the beginning….. the second day of my work in the clinic, I was shanghaied into a meeting with 6 of the 11 clinic staff…. they informed me that there were two problems which needed to be resolved immediately. The first was the fact, the nursing staff were not being paid the same salary as the nurses in the nearest hospital, Rakai. The second issue was that the PHC fund was not suppose to go through the accountant but go directly to them and avoiding the money being double taxed. Well, only one of the 6 was a nurse.

Over the next few weeks, I had one nurse do all the research…. he was given money and time to find out the truth. He was able to obtain a copy of a Rakai employed nurse’s pay stub. He thought it showed the fact the staff were not being paid the correct amount BUT Master Peter, Kibaale Community Centre director and Madame Samalie, the clinic administrator corrected the miss information and showed them that they were paid the appropriate amount. What a surprise!!!!!!!

During that same time….. I learned that PHC fund, Primary Health Care fund is a set amount of money given to the clinic by the Government of Uganda for outreach…. vaccinations and immunizations. For some reason… the past few cheques have been given to our accountant, Mark, who deposits them and then hands out the money accordingly along with removing the required taxes. But after much discussion and lots of confusing information…. I traveled to Rakai along with a nurse and Madame Samalie to discover the truth…. we were told what the money can be used for, how much each person is to be paid and that when the money runs out… it is up to the clinic as to where the employees get paid for any additional work. Somehow, the nurses expected to be paid the amount required through the PHC fund for all out research. So, 4, 5 and 6 people would go out expecting to be paid the PCH fund requirement. The fund now comes through me as of the first of April and there is a limit to how many can go out.

Theses were the issues most urgent to the staff…. money.

The second Friday, I was in Kibaale…. at 3:30, I was given a two page list of medications and told I must go immediately to Kampala and buy these medications. It was a demand, I was confronted by the three nurses and told that these medications were needed urgently. I was told I had to go right then and there to Kampala….as they were pushing me out the door. I was confused…. a list that long was required immediately. Nothing in me said I needed to go…. but what was going on. I took a big step into the Pharmacy to discover the room was a mess… boxes atop boxes, there was no order and with that I was convinced that I needed to clean up the room and put it into some order before we could possibly know what medications were needed…… as I was walking slowly out the door…. I remember the receptionist opening the store room door for some cannulas (IV catheters). So, I asked for the key… and waited and waited. Finally, I opened the door to discover the room was filled to the ceiling with unopened boxes of medications.

The only help I received was from Madame Samalie who kindly offered a few of the senior students to help me take apart the Pharmacy and Store room…. open up more than 150 boxes of medications and put them in alphabetical order. All the medications were counted and recorded….. I now count or do an inventory of each medication weekly. I would love to give this job to one of the nurses but….. the four days I was gone to Queen Elizabeth Park…. I returned to discover a large number of the IV antibiotics missing…I put someone in charge but she got very busy and passed the keys off to the other nurses…. I was told the clinic was extremely busy BUT the records do not support that fact.

I discovered the receptionist (with no medical experience) was giving the vaccinations during one of the outings while the two nurses sat and did the paper work. I also discovered the same receptionist taking blood in the lab while the techs watched. No one thought any of her actions were wrong….. she was fired.

IV catheters or cannulas are put in by nurses without cleaning the skin nor washing their hands…. in fact patients are discharged into the community with cannulas still in place…. taped over to keep them closed. Everyone tells me that this is wrong but it continues…. why? I do not know. WE DISCUSS, IN FACT THEY TELL ME ALL THE REASONS IT IS WRONG…. BUT THERE IS NO CHANGE.

Nurses tell me one thing and do the opposite. I stop them and ask them why and I can a variety of answers…. but mostly it is easier to do the same… it will be very upsetting to the patients.

There is so much more than can be said…. but each time I think about them my blood boils…… I get so upset that these nurses who are trained refuse to follow the guidelines and principles of nursing practice. They say one thing and go on doing what they want.

So…. back to the two day workshop….. May 2 and 3. The first day was for Master Peter, the director, who spoke about the mission statement for Kibaale Community Centre and clinic….. it is to do excellence….that each of us must be a Christian first and do what is right before God and man…. to show love, and caring and compassion.

The second morning was for Pastor Eric, the chaplain, who spoke about vocation (God’s calling on your life) versus a career (self directed work)…. and teamwork. It was powerful. The afternoon was for Medical Officer,Ronald…. he is a graduate of Kibaale Community Centre and he is working his way through medical school. He had a month off from school so came and worked in the clinic 3 or 4 days a week. He is known to all the clinic staff so was a good person to discuss medical ethics…… what are the rights of the patient, the expectation of the patient and what we as nurses are expected to do.

Right now…. the students, employees and community are not getting quality care…. I would question if they are even getting any care at all. I am sad….. my heart hurts… why do these nurses do what they know is wrong.

I and many of you…. have prayed for this workshop to have some affect on the hearts and minds of each and everyone of clinic staff….