…… what I do in the clinic?

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This is Africa and I am stilling trying to comprehend two things…. one is the length of time it takes to get anything done….. it still surprised me the amount of time and energy it takes to find an answer to a problem. What appears to be a simple problem often turns out to be more complicated that I would have imagined. The second thing is that there is always crisis which somehow I am expected to resolve. 

The clinic is open Monday to Friday from  8 am to 5 pm and on Saturdays from 8 am to 12 noon…. So I  usually arrive at the clinic around 8 am Monday through Saturday and I leave anytime after 5:30 once the clinic is closed…. except Saturday which is a half day and I leave around 1 pm.

Each morning, I am expected to go around and greet each of the staff….. and hear their news. There are 14 staff working in the clinic: three nurses, three assistant nurses, two laboratory techs, two house cleaners, one receptionist, one health and safety coordinator, one comprehensive nurse who can diagnosis, treat and prescribe, and a part time medical officer who works Monday, Tuesday and Wednesday. This little clinic sees  between 1,600 and 2,000 patients monthly…. that includes students, staff and members of the community. All this information has been kept on pieces of paper which  I am now attempting to find and put on an excel spread sheet…. It is huge learning curve for me as to what data is available, obtain it and then input it….. but it is coming together slowly. I am collecting data on who comes to the clinic each day: the number of students, the number of staff members, the number family of staff, and the number of community members plus the daily clinic receipts…… as well as our expenditures like cost of medications, salary for the medical officer, fuel and transportation costs for referrals and transfers to another facility for continued care.  

I work in my small office answering emails, preparing medications orders, input any new data and attempt to put order to the clinic….. it seems that the staff have gone many months without proper supplies and they have learned to live with less…… or learned to go without………. like proper mugs for tea and dish soap for washing up, towels, laundry soap, uniforms, boots, buckets and many more things I would consider an essential which they did not think to ask for.

Each morning the clinic needs power to function…. light to assess a patient, or insert an intravenous catheter or for the lab to process blood work…. power is essential. When we do not have power….. it becomes a crisis and now my responsibility to discover the reason….. for the past few months there have been numerous reasons why there has been no generator power….. from there is no fuel, the operator slept in, they cannot find the operator,  there is water in the fuel, someone is going to Kyotera a 90 minute round trip for fuel, and the breakers for the clinic have somehow been switched off. Searching for power can take me at little as  30 minutes but more likely most of a morning……….. 

Our receptionist daily needs change even though she has been told to keep 20,000 shillings in small bills in the safe……she comes asking advice for each patient who comes with no money or some money and need to be helped even though she knows what to do…… Just for your information, every person who comes to the clinic is served whether they have funds to pay or not.

The pharmacy staff come frequently throughout the day requesting one item at a time which they somehow cannot find in the pharmacy in spite of me stocking it well weekly…..even though each medication is in alphabetical order as per their decision, and labelled…… it seems that if the packaging is changed in anyway they cannot see it and therefore, assume that they do not have it. It is taking time … and they are learning to look for the label and check the designated spot but when the clinic gets busy and the work load increases the old habits pop back up.

After working in the clinic for almost 6 months, I am still amazed that I have not discovered every medication or medical supply required…… just this week, one of the nurse ask me if I had Vitamin K in my store room……… I was stunned, all I could think to say was that if I had it then you would have it.  Later this week,  I was told we were out of surgical blades. I did not know we used blades. A few months ago, I found scalpel handles in one of the store rooms and asked if these were ever used and did we need blades to go with the handles and was told “NO”….. it seems that at that time we had many blades and I misunderstood the answer. Now, Vitamin K and blades on my list of clinic needs and purchases.   

It has been come clear that there are times in the school year when many of the students are stressed over exams and getting good marks… their stress comes out in many forms from headaches, to upset stomachs and nausea and vomiting and as a result they arrive in the clinic…..  these symptoms are treated but the real cause also needs to be addressed…. the stress. The staff work hard to support their needs, talking to them, praying for them and now we have pastoral care once a week in the clinic for these types of issues both for the students as well as everyone else.

There was a young 7 year old student who presented herself to the clinic staff everyday for almost two weeks with various complaints……. all examinations, and lab tests were negative and this had the clinic staff wondering what was wrong. Finally, the family were called in…….. the staff were wondering if she was mistreated at home but the parents showed love and compassion for their child. They stated that she did not want to go to school……. after much discussion with the girl and her family it became clear that she did not like school and especially her teacher. The parents were told to bring their daughter back to the clinic the next day by which time, I was expected to have discussed this issue with the administer of her grade. The rest of that day, I spent  finding out who was responsible for the student/ who was the principal for her grade, discussed what we discovered in the clinic and ask if this student could be moved to a different class. Once the information was presented, the administer was very willing to move the student…..a week later, I checked up to learn that the girl was busy catching up on her homework, happy and making friends. 

My job takes me all over the compound and I get to speak with many interesting and caring teachers, administers, and staff ……each want only the best for the students.

Some told me that my life and job in Kibaale was a soap opera…. unfortunately, the stories are not the imagination of a writer but real………. real lives are touched each day by the clinic staff….. they do an amazing job with the little they have….. 

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…..the bodaboda

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In Uganda, the motorcycle is known by the name bodaboda. I have not yet discovered the meaning of the word but maybe with time.

The bodaboda is the basic means of transportation throughout Uganda. Even in the small village of Kibaale there are many….. I think of it as a simple effective taxi. It can travel the main paved highways, on the red dirt roads or along the narrow footpaths…. it can go anywhere for a inexpensive price. A litre of fuel is around 3,500 shillings which is more than $1.25 US.

As I travel back and forth from Kibaale to Masaka I see many of them stationed at certain crossroads along the way from the big town to the small villages ready in a second to carry one, two, three or maybe four passengers to their village. Yes…. these motorcycles are the basic ones found in most parts of Canada and the USA, nothing fancy but they are used everywhere for transporting many people at a time short or long distances. I rarely see anyone wearing a helmet.

Some drivers own the bodaboda while other rent them….. but it is a job. Whatever there is a town, village or city….there is a spot where the bodabodas congregate for conversation, repairs and washing…. the driver work hard to keep the motorcycle functioning and sparking clean.

When I say is it the basic mode of transportation it is not just for people but everything else. I have seen 30 or more pineapples tied to the back of a bodaboda hanging down like tails or the double bed balance on the back so wide that I cannot see the driver, or numerous jerry cans for water bounding around like a yellow flower in bloom. The motorcycle carries luggage, large bags full of roasted coffee, stocks of matoki, cases of pop, lumber, bricks, wooden crates of fruits and vegetables, book shelves, and anything that needs to be transported including the body of a loved one who has passed away. I think I have seen almost everything somehow tied down, balanced on the back and transported on the main road to the narrow paths. It is amazing what the motorcycle can carry.

BUT….. they are very scary. I have not yet had a ride on one but they can get you from one place to other in Kampala faster than a car….. the congestion in many parts of Kampala is just as bad as the gridlocks in Vancouver during rush-hour. So, many business men in their suits and ties use the bodaboda as a means of quick transportation from one appointment to another.

BUT for me…. they are scary on the roads. They dart in and out between the trucks, cars and bikes as if they have the right of way. I have seen a mother carrying a new baby on the back between two other people, or a father driving his four children to school or an elderly couple holding tightly to numerous heavy bags of who knows what. It looks like it is a fine balancing act which goes well most of the time and then…… there are the time when things fall apart. Like the other day, when a bodaboda carrying three men plus the driver passed me on the wrong side, darted out in front of me as I was going up a steep hill on the dirt road into Kibaale. All of a sudden the last man of the bike falls off…. I almost ran over him. This is just of the many times I have watched the bodaboda a few feet in front of me drop off the last passenger. I watch to make sure the person is O.K….. but wonder if the person gets their ride free.

Bodabodas are a good thing but I wonder how many people are seriously hurt when the driver makes a mistake turning, passing or traveling up a hill and someone or all fall off. I watch these drivers and ponder the value of life….he is balancing the making of a few shillings with the health and well being of his passengers.

…….. yes, I finally got a flat tire

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It is Sunday evening and I am still in Masaka. I normally leave for Kibaale around 4:30 Sunday afternoon so that I can get home before dark. It is also I very beautiful time of the day traveling from Ssanje (sand-gee) to Kibaale on the dark red dirt road. The hundreds or thousands of colours of green vegetation, the cool evening air with its freshness and the quiet peacefulness of the numerous people slowly walking or riding on the road gives this part of Uganda a welcoming invitation. I always feel like I am entering into a precious and amazing world separated from the loud, noisy and busy world like Masaka and Kampala. But tonight, I am stuck in Masaka…..

I traveled from Kibaale yesterday morning before the heat of the day….. arriving in Masaka with plenty of time to shop for medications and other supplies for the clinic, do some grocery shopping as I was out of coffee before going to a birthday party. It was Alex 16th birthday and his family put on an amazing pool party with lots of homemade Greek food. Of course, it had to be home made because you can not buy anything like pita bread, or the various Greek sauces in Uganda. I was transported back to Canada to my favourite Greek restaurants but nothing compare with this delicious food. You could say that the food was good because I have not had any Greek food for over 6 months but you would be wrong…. the food was an gastronomic delight because it was made with lots and lots of love…….

I parked my large land cruiser inside the gates of the Danish compound beside the pool for safety. I did not want to leave it on the street with all the medications inside. The land cruiser did not appear to have any problems as I drove to the Timothy Centre but this Sunday morning…. one of the workers spotted the flat. On examination, the tire had a very large slash in it which cannot be fixed. There is no place in Masaka to buy tires. Someone has to go to travel three hours to Kampala for a new tire for the land cruiser….. It is not just the trip to Kampala that takes the time but will the shops be open and will they have the right size tire for the vehicle. I have no idea when I will be able to leave but I am in Masaka until it is fixed.

I am so thankful that the flat did not happened on my trip into Masaka or on my trip long the dirt road into Kibaale ….. in fact no time is a good time to have a flat tire. BUT I have to say, this has to be the best flat tire I have ever had. I am safe and everything is being taken care of by someone other than me. All I have to do is wait. This is Africa.

I am going to take this flat as a gift so that I can be still and relax…. caught up on my blogging, emails and sleep…….. I can not nothing to change the situation so I might as well enjoy the opportunity given me.

………..a disco came to Kibaale this week

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On Wednesday evening of this week, Kibaale had an outdoor disco, we might have called it a music festival. A truck with a loud speaker had been traveling up and down the roads around Kibaale announcing the disco. The cost was only 5,000 shillings or about $2 US. Not much but when you think that many folks in the area live off the crops they grow this was a lot of money. I asked the clinic staff if anyone was going to attend and was told by most that it was for the young. BUT how can the youth afford to attend. I guess just like in Canada, parent want to provide opportunities for their teenagers….. as there is nothing or no place for the youth to “hang out”. Yes, they have their chores of collecting water and helping in the garden but life in rural Uganda is changing…… 

The outdoor disco was about 1/4 mile down the road from the entrance to Kibaale Community Centre on a very large grassy field used for soccer matches….. an enclosure was created by a 6 foot material fence held up by metal poles…….. I watched the enclosure go up from the front of the clinic.

There was excitement in the air and the little town of Kibaale was alive with people…. everywhere. Everyone was dressed up in their finest…….. the town was filled with also of small “entrepreneurs” from the young boy selling soda (pop) and water  to the lady cooking some sort of hot meals, and then there were the vendors who wanted to sell blankets, dresses and shoes….. it was an interesting scene.  I kept thinking that this was like a old country western town where the rodeo came to town…..

The music started around 7 pm and it played until close to 1:45 am. The music was a mixture of classical, jazz, vocal, instrumental, country and western and a little rock and roll…… I enjoyed the various genre but the only problem was the volume…. it was loud. I think everyone for at least “10 miles” could easily hear the music…. so why buy an entrance ticket. I enjoyed the music for free…… but then I did not get to sleep until the wee hours of the morning.

By the time I arrived at work, 8 am…. the tenting or fencing was down and the only things left were the hundreds or thousands of bottles, bags, pieces of paper left covering the field…. it looks like a hurricane came through and this is what is left behind….. who knows when this will all be cleaned up. I guess the next time someone wants to use the field for a soccer match.

I spoke to many of the students, and patients in the clinic the next day but no one admitted to attending……  can this be rural Uganda?

Who knows what is coming to this peaceful valley next?

….it is only a short distance.

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Last Saturday afternoon I was planning on walking into Kibaale Village to buy some airtime so I could call Canada and the USA. I was going to walk with Namuliika, (nam-oo-leak-a) the comprehensive nurse I hired a few months ago. It would give me an opportunity to talk with her about various things happening in the clinic…..

My house is under construction and Dominic came to the clinic to ask for my keys……. he had taken down a half wall which had no purpose to made more space. He wanted to look at the hole and measure for new tiles…. So, we walked to my house, I dropped off my clinic keys and handed over my house keys…. I was off to town and would be back in 30 to 60 minutes.

The clinic closes at noon but we usually have a few patients whose treatment take them past noon and maybe up to 2 pm. The staff take turns staying behind and “keeping the guard” as I think of it. Susanne was suppose to “keep the guard” but she had made plans and asked Namuliika to stay…. So I decided to stay and talk with Namuliika. The first hour was busy as 5 of the 7 patients were quickly ready for discharged. There was a little girl of about 5 or 6 years of age and a beautiful pregnant lady both finishing the treatment for Malaria. We were talking when the father informed us his daughter was ready…… I thought the little girl still look very weak…… but the father insisted she was fine. That left the lovely lady…. she was only a few weeks pregnant and had Malaria as well. Her Quinine treatment was almost finished……… We were sitting waiting outside the front of the building when the young girl and her father left…..they had not even reached the clinic gate when the father was screaming something and running back…. his daughter was having a seizure. WHY??????? Namuliika nor I could understand the rationale….. but we had our own problems. The keys to the pharmacy went home with one nurse and the keys to the treatment room went home with another nurse….. I have not been aware of this being a problem in the past but it was a BIG PROBLEM today. I grabbed for my keys only to remember they were at home….. as I ran quickly across the field I saw my door was closed and wonder where Dominic was…… as I approached the door calling out his name, Dominic came around the corner.

With clinic keys in hand…. I ran back across the field and into the clinic…. the only keys I had were to the store room and we were hoping that the supplies we needed were available… and everything was there.

After a few minutes, the seizures stopped but her temperature was rising…. so further medications were needed….. as the race from the store room to the child’s bedside continued, the pregnant lady called out to let us know her drip was completed. I took out her intervenous…. and she told Namuliika her husband would be coming soon and she would wait for him at the gate….

We watched her leave and as she reached the clinic gate she fainted…. I looked at Namuliika and she looked at me and we both said…. what is happening? These two patients kept us busy for the rest of the afternoon….

At 4:45 we were discussing the fact that neither one of these patients could travel home safely….. they were both very weak and would need more time to recover but it was going to get dark soon. Namuliika spoke with the lady and the father about this problem….. unfortunately, they lived in opposite directions. Regardless of the situation……. I went for the land cruiser and by the time I returned, the husband had arrived and was ready to take his wife home.

There was no way the little girl could possibly sit on the back of a motorcycle. The father informed Namuliika that they only lived a short distance away………. so at 5:15 with Namuliika sitting in the back seat holding the young sleepy girl we departed following the father’s motorcycle. As we passed the only gas station in town, I commented that I had less that a 1/4 tank left but Namuliika stated…. “he told us it was only a short distance…” we followed the motorcycle up and down some good, bad and terrible roads and finally at 6 pm… we stopped. We had not yet reached his house but the road in front of me was not wide enough for my vehicle….it was truly a foot path. We could go no further…. the place where we stopped had a few people and they knew the father. So we felt O.K. to leave them there.

On our travels up and down the mountain roads…. we passed Asaph (Ass-off), one of the nurses enjoying the afternoon on his motorcycle…. his home town was somewhere on this road. It was after 6:30 when we reached Kibaale and saw Asaph walking towards us with a small bottle of fuel. We stopped and asked him where his bike was and he told us ……..” it was only a short distance up the road…..only a couple of kilometers.” I believed him and once again I traveled back up and down the mountains roads for more than ten kilometers before arriving at his bike……

Namuliika and I were hungry…. our stomachs were growling. We had not eaten since tea at 10 am… and it was after 7 pm. There is no McDonald’s, Burger King, Wendy’s or White Spot in Kibaale……we went to the only acceptable restaurant, to be told that their food was over….. it was all gone……. there was no matooke, no posho, no potatoes, no pumpkin, only some rice ……one piece of chicken and one piece of fish. The food was ready and the price was right…. only $3.50 for all the rice and chicken we could eat.

……. it was only a short distance home and this time it truly was.