CMS Ireland Rory Wilson

Superglue me.

2008-05-05T00:00:00Z

Most people are aware that haemophilia is an inherited disease where people bleed and don’t stop.

We had such a boy admitted to the ward last night. (His younger brother has already died of the condition.)

He bit his lip a week ago while playing football, and a stitch was put in the lower lip at a local health centre. However after 1 week it is still bleeding. Ten gauze pieces were soaked in blood that had oozed from the wound overnight. I missed staff worship as I tried to see what we could do for him. I put a new piece of gauze between the lower teeth and the lip, with part of it on the outside of the lip held in place with a piece of tape. After the doctor’s morning meeting 1 hour later it was evidently ineffective.

What to do?

I left Dr James holding some cotton soaked in adrenaline to try and temporarily close the capillaries while I went for help – in the form of superglue. (Don’t try this at home please – standard superglue contains cyanides, this was a slightly desperate measure.)

The treatment the boy needed was an injection of clotting agents his body is unable to adequately produce. Such an injection is practically and financially not possible for this boy.

Thus our superglue solution.

Under the spotlight (which having arrived in a recent container had been mounted in the ward treatment room) we carefully placed one drop of glue on the oozing area. Making sure the boy didn’t close his mouth we waited…and the glue set, the bleeding did not return, and the boy went home happy!

Perhaps not possible for all bleeding wounds in children with clotting disorders, but it’s probably saved this boy’s life. Dr James remembered a previous time trying to suture a bleeding would in this boy. Every time a stitch was placed, fresh bleeding would begin from the site of the suture needle’s entry point!

Practicing medicine in Kiwoko means you must be more reliant on your clinical skills than one’s colleagues who have the possibility of more investigations open to them. Frequently though a bit of improvisation is also required.

Teamwork and holistic care remain as our great strengths. As I write this I am just back from a round of the wards at 10pm. On the neonatal unit I had to wait for a minute before reviewing a baby, because Sister was leading the mothers in prayer, committing the babies and mum’s to a safe night. It is odd to be able to care for our patients and their carers so holistically on one hand as we can address spiritual issues in a way many clinicians in the UK would shy away from. (The only branch of UK medicine to pay more than very superficial notice of spiritual issues seems to be palliative care – sadly perhaps a little late in the day for many.) Yet it remains an odd dichotomy that many, such as our boy with haemophilia will never have access to treatment his counterparts in the ‘developed’ world often take for granted.

Bye for now

Rory

Thy kingdom come....

2008-04-21T00:00:00Z

I sometimes wonder what heaven will be like.

The Biblical writers have done their best to describe it, but words don’t seem to have been up to the task of conveying it to me with particular clarity.

A new earth without any sickness or suffering sounds like a good prospect to me as two 12 year old boys have died on the ward this week – one to a crisis of his sickle cell disease, and the other to a rampant viral infection affecting his whole body.

There are descriptions in the book of Revelation of a huge throne with all the nations before it worshiping their Lord. Such a picture probably is the dominant picture in the popular mind of what is in store for us. I think that I have had a little foretaste of it a few times in recent weeks. At the hospital we have daily worship for staff to start the day. A time of focusing together on why we are here, building us together as a team, and being empowered for the day ahead. The bulk of our worship usually takes place in English as it is our common tongue. However of late we have been having different parts of Uganda presenting every Friday. Uganda has many tribes and each has it’s own language. Differences, particularly tribal differences can be a source of great division, and attempts at comparison are often based around finding grounds for superiority of one’s own or diminution of they the other group. Evidence for the consequences of this are evident in the recent and ongoing chaos in Kenya, or modern Northern Irish history. However God has made us all different by design rather than accident. That is not just ok, that is good, indeed very good?

Standing in the midst of staff worshiping enthusiastically in Teso and Acholi (languages I don’t understand even one word of) and having a strong sense of God’s presence as these folk were praising their Lord with all their hearts is a powerful experience. Not understanding the exactitudes of the words isn’t necessary to appreciating the key import of the praise they were giving to their God. For a moment I caught a glimpse of the power of uncountable numbers of people from every nation before God’s throne worshiping from their hearts. Christianity is not a middle class white Western world social construct. This God we are worshiping is God over all the earth He has made. The reality of that can seem distant in our busy media full lives, but man, I have been struck forcefully (yet) again of who are God is, and indeed how blessed I am to know him and work with His people here.

May you know something of that afresh too.

Cheers for now,

Rory

John goes home laughing

2008-04-12T00:00:00Z

John is an eight year old lad from a village about 20 miles from Kiwoko. On Thursday he was at school and on the way home was well enough to climb a tree to get some mangoes to eat with his friends. On Friday he was not able to wake up properly. His mother knew something was wrong, but hoped that everything would be ok. When he still could not talk or sit on Saturday she became concerned. On Sunday she thought that she must get to hospital. The costs of travelling with her son and other 3 month old daughter, as well as being away from being able to plant in the family garden at a time of year when the rains have started, had discouraged her from going any sooner, but now she had no choice. It was Monday when she arrived on the ward. John was deeply unconscious. His only response was to squeal in pain if his neck was moved at all. The neck was stretched back as if looking at the ceiling to minimize stretching the spinal nerves. He seemed to have meningitis, and a test of fluid from his back rapidly confirmed it. We started him on treatment for his meningitis, and also his pneumonia. He had obtained the pneumonia from his mother trying to feed him over the weekend when he was deeply unconscious, so he had ended up with some of the food in his lungs.

After some days, the pain seemed to be well settled. Then he opened his eyes, and then weakly tried to respond to my greetings.

Being poor is a curse in so many ways. This boy would have been brought to us much sooner if his mother had not been concerned about the financial consequences of spending time at hospital. She thus very nearly lost her son. John walked out of the ward with the carefree gait which an 8 year old should have without any obvious problems remaining from is infection. It is a miracle indeed that he has not been severely brain damaged by the infection. Such occurrences are a testament to the commitment and skills of our nursing staff, and are the reason why patients sometimes come from such long distances seeking care at Kiwoko. It is great to be able to see such patients improve, though the underlying social ills caused by such poverty are even harder to treat.

Yet the contentment most folk have with their life remains a profound lesson for those of us with greater material wealth. I was driving through our local swamp recently to be surprised as two fish flew through the air just missing the windscreen. I stopped in time to avoid hitting the two young lads chasing the fish. Then we saw the dozen youngsters up to their middle in the swamp catching fish with their bare hands and tossing them onto the road. They were going to feast well that night, and were having a ball meanwhile! Finding pleasure in the simple things in life is something many of us have lost – I suspect that I have much to learn from such children.

The Rains Are Here!

2008-02-16T00:00:00Z

Greetings from a rainy Kiwoko!

They’ve come at last. I got soaked last night when out on my bicycle – sort of not good as I was wet and muddy, but sort of fantastic as we now have some water in the hospital water tanks.

Our container also arrived last weekend. Brian Dorman and some friends had garnered up some fantastic equipment from various hospitals and friends. The container got stuck in Kenya in the middle of all the strife there. Amazingly it arrived on Saturday afternoon, when as circumstances would have it, Brian was visiting Kiwoko. What had taken him weeks to prepare, and a day with a forklift truck to pack, our men unloaded by hand (with the aid of 2 ropes and 3 planks) in 1.5 hours.

It is a fantastic hoard of surgical instruments, neonatal incubators, ultrasound and radiography equipment, sterilising equipment, and also a box of books, tools, and even a few biscuits and a bicycle!

Thanks to everyone who has been praying for rain, and thanks also to those who have supported this container – by donations of items, money, time, prayer.

Our plans for maternity are developing apace. It was also great to have our ISIS donors with us last week. They are a whirlwind of enthusiasm and encouragement. We should be building before the end of the year a fit for purpose maternity and neonatal unit. Our goal is then to attract more of our mothers to deliver at hospital – where we can intervene at an appropriately early time rather than dealing with the consequences of the huge delays in referral to us, which we too often see.

The hospital hasn’t been too busy of late – awaiting the upsurge of disease which will follow a few weeks behind the rains which have now started – but my night on call this week was my busiest for many weeks – I got into bed at 7am and mitched staff morning worship for the sake of a quick nap. The need for our new maternity, and connected community maternal education was obvious again – 4 caesarean sections, one for a lady with a ruptured uterus (burst womb – and so dead baby,) and another required stitches to the cervix (neck of the womb) after bad care in a smaller health unit initially.

Schools have restarted again after the Christmas/ new year break (we more or less follow the Southern Hemisphere school year here.) The children of our staff kids now have more to keep them amused so hopefully they’ll spend less time stealing my unripe mangos.

Julius was a boy of 8. He presented with classical signs of Tetanus. He required very strong sedation, and for a week the outlook was very poor. He started to improve, but for some days I stopped myself from getting too optimistic – our last two lads with the same condition had deteriorated and died after a similar mild improvement. After a few days of improvement I came into his room while doing the ward round to find him singing for me! He then asked me to tell his mum that he would need to eat some pancakes to aid his recovery (he likes pancakes, and had figured that his mother might listen to me more than to him!) After being unconscious and immobile for several weeks he had to relearn how to walk – it is good to have such an excellent physiotherapy dept! It was wonderful on his day of discharge to watch him walk out of the ward with his mother. A boy who had been very close to death, now alive and well because of the team work and care of the staff at Kiwoko hospital.

So that’s all for now.

My computer has been a bit sick so is off to hospital in the UK for a few weeks – but as my blogging has been intermittent of late, I’m not sure you’ll notice the difference – I promise to reappear on her return!

Toodle pip

Rory

Happy Christmas to All Our Readers

2007-12-22T00:00:00Z

Yesterday was the Kiwoko hospital Christmas party.

With singing, sketches, food, speeches it was an excellent afternoon. Students, staff and children presented, and unlike last year the rain stayed away and let us eat the roasted bull in peace. In a few weeks the health care at Kiwoko will be twenty years old. January 1998 saw Ian Clarke and his family move to Kiwoko and the first provision of health care locally for many years. From what was then a community based health project, patient needs have driven us to become the hospital that we are today. Our roots remain very much in the community and preventative community based education a priority. At the party it was good to be able to celebrate the handful of “historicals” remaining who were part of the original team in those early days. We also reflected with gratefulness the support of many far away (that means you) who support us in prayer, practical means and with finance –as you weren’t there to hear it yesterday let me say it again – thank you. It was also good to be able to celebrate a year almost passed. A year with plenty of challenges, but as a team, in God’s strength we seem to have met those challenges and are more than ever focussed on our goals of serving all those in need and spreading the Gospel of Jesus Christ.

We have many challenges for the year ahead.

Developing our middle and senior management team is a crucial, though slow process. We hope that one of the benefits with our link with the South East Trust in Northern Ireland (roughly = Ulster +Lisburn Hospitals and the community trusts connected with them,) will be further development of these staff. Though our financial position is better than one year ago, we will need to further increase some salaries in the next financial year and continue to increase and improve upon our standard of housing to attract and maintain good staff.

We still have a few key gaps needing filled in senior positions both on the clinical and administration sides.

The main theme for the end of the year in Kiwoko in thankfulness:

Please thank God for his faithfulness over 20 years.

Thank him for the provision of staff and finance such that we are in a better position today than we were a year ago.

Thank Him for those who in the midst of suffering have found healing here, particularly those who have also committed their lives to follow Jesus themselves.

Thank him for the many donors and supporters within and without Uganda who enable us to continue the work we do every day.

And finally…

Thank you for reading. Happy Christmas to you and your family. I’ll be working over the new year so don’t call over…but if you’re passing by sometime next year do call in for a cup of tea.

Cheers,

Rory

Dancing Bishops

2007-11-19T00:00:00Z

Yesterday morning (Sunday) I found myself at the Tenth anniversary celebrations of Mukono University. Previously (for almost 100 years) it was a theological college (named after Bishop Tucker). Then ten years ago it became the first private university to be given its charter when the Ugandan government deregulated tertiary education. Also known as UCU (Uganda Christian University) it seems to be doing a good job preparing students in various different disciplines for roles of leadership in their country. They’re hosting the East African inter-varsity sports next month which will certainly be a big event.

It was refreshing to be at an event taking place at what is still a theological college, and find vibrant African praise. Shortly before Communion, the Canon who was leading the service went down to dance with the youth choir because he couldn’t resist the beat + Spirit. Perhaps Trinity College should link with these guys – I think both sides would learn a lot! Seriously if you’re a professional with a bent for teaching you could consider joining them for a few years to help build capacity – Accountancy, Law, science etc…. all very welcome.

The hospital Board meeting will be on Thursday 29th. One thing particularly we will be considering is our hospital policies. A visiting Australian Lawyer (Abbie) helped rewrite all our policies in a more legally robust fashion. The board will now review them to see if we can agree to ratify them. Of particular relevance is the hospital marriage policy. Having clarity on what standards of behaviour we should expect from our staff is important. This is particularly so in a society that has various traditional and religious wedding ceremonies, and where polygamous marriage is still very common. Do please pray for wisdom that we reach the right conclusions.

The rains are very much still here – the authorities are disappointed that after all their preparations for the Queen’s visit next week the roads are getting washed away most days by what is, even by Ugandan standards, excessive rainfall. For myself I’m fairly happy as my Bananas, sugar cane + pineapples seem to be loving their regular watering. Sadly my chrysanthemums seem somewhat dilapidated this morning after a severe hosing (including hail!!) yesterday afternoon.

Bye for now,

Rory

Blood

2007-10-29T00:00:00Z

Greetings from Kiwoko.

We’ve had a busy week entertaining some visitors from the Ulster hospital. It has been good to have them – they were involved with helping optimise the pictures produced by our x-ray equipment; train our ward sisters; judge our inter-ward competition; visit patients in the community; share at morning worship; provide physio on the wards when our physio Alison was busy with the HIV +ve children; and generally encourage staff by their presence.

It was also great to receive some finance they had raised which will help subsidize costs for treatment provided on paediatric ward and also send a nurse for further training.

They are part of a project to build links with the Ulster hospital which seems to be a most worthwhile endeavour so far!

On Monday evening as our visitors arrived I was on call. We had a very sick young girl admitted with severe malaria and anaemia. She needed blood at once or she would die. Unable to find a vein quickly enough we used a bone in her leg to get her some sugar and then blood until we improved her circulation enough to get a canula inserted in to a scalp vein. By the time I had finished all that the visitors were in bed so I met them at breakfast on Tuesday instead. The little girl has done well – only alive because of the skilled staff and rapid attention which we were able to provide. It is fortunate that she had not presented the previous evening when the hospital did not have any blood for transfusing.

The Ugandan national blood bank in Kampala still runs out of blood intermittently. Sadly a mother who was referred to us the previous day after the placenta did not deliver with her baby died earlier the same evening. She had been severely anaemic, but the family would neither take her to Kampala or donate blood for her themselves. Tragically the blood had arrived from Kampala, been cross matched and started to run into her needy body, but it was too late and she died before much had been administered.

Some people suggest that the Gospel of Jesus is just a cultural imposition from the West, and that in countries such as Uganda we should let people worship the God they see fit.

It was wonderful last night to be with a family of Ugandans as they heated the drums by the fire before having a time of praise together – led by voice + drums – an entirely appropriate Ugandan expression of praise to our God. It is exactly how people here have sung and danced for centuries, so how natural to use it as the medium for praising God. I was honoured to share the time with them, and humbled by their sincere devotion and genuine enthusiasm.

The rains continue most days. As I planted two banana plants last week, and some sugar cane, I am pleased. I even weeded my pineapples today after a nurse told me that the weeds close to them were the reason for the leaves turning yellow, (because unlike for you folk living further North than me, it’s not Autumn here.)

Better go – the generator will be switched off in a few minutes, and the battery for my solar lights has stopped working. My solar lights now work well during the day, but sadly not at all during the hours of darkness. I’m sure there was a joke like that about an Irish solar torch some years ago…. Well I am that person!

Thanks for reading
Rory

Good to be Home

2007-10-15T00:00:00Z

Better late than never they say….. well late I am, but it is good to be blogging again at last.

I’m back in Uganda after a few weeks in the UK. It was great to see some folk, attend the CMSI mBrace conference, meet some hospital supporters, swim in the sea, walk in Cairn wood, organise some equipment to be brought out, have a fish supper with Granny, get some bits for the bike and house……

Sorry if you are one of the people whom I was sitting in Heathrow lamenting our lack of having met up – hopefully next time we will succeed.

And I have been a bit too busy for blogging for far too long– hopefully no longer so.

But to be honest it is now good to be home. While saying goodbye to my friends and family in Ireland is always hard (not least this time with the lovely Denise) it has been good to get back to Kiwoko.

There are so many good people here, and while our resources in both finance and skilled personnel are always so lacking, it is amazing how much we achieve with the little we possess.

Ugandans are such an encouragement to meet up with. You would imagine I had been away for months with the level of effusive greetings I have received. I was spied across the bush on my bicycle last night and a lad sprinted the half mile to me laughing with glee the whole way.

I left two very sick boys on the ward when I returned to the UK. Dr Mary (a Scottish GP with us for several months) has looked after them well in my absence and I was delighted to find them greatly improved. The 6 year old with renal failure and blood pressure so high he was convulsing 3 weeks ago will go home tomorrow. The 9 ear old boy with meningitis will also go home this week. Sadly the meningitis has left him unable to speak and with significant weakness in his right arm and leg.

While swimming last night in a dam for cattle a few miles from the hospital (most refreshing) I noticed a young lad in trouble. Fortunately I was only a few strokes from him, and was easily able to stop his imminent drowning. I seem to be more upset by the experience than him. Life is fragile for us all, but here in rural Uganda it is harder to hide from such realities. While in the UK I was struck afresh by how much effort people invest in worthless activities and priorities. Caring for family and friends, having a relationship with Jesus, and saving children from dying needlessly seem to me good things to invest effort in, so thanks for playing your part in helping me do that.

I’ll upload this while I’m here. Do call back soon, as the 4 month blog famine is hopefully now over!

Bye for now

Rory

Decisions

2007-09-15T00:00:00Z

In some ways decisions about life are simper in rural Uganda – no worries about which TV programme to watch, which washing powder to use or where one should eat out tonight.

In some ways however significant decisions lurk at every corner. When out in the bush on my bicycle on Wednesday evening I stopped with a local family briefly. The three year old son was most unwell with pneumonia. As a GP in Ballyholme I would have phoned for an ambulance. After examination conducted with only my eyes and hands, and discussion with the family I left him in a mud hut without any treatment. The balance of allowing people to be responsible for themselves, and intervening in their lives is an unscripted path. Thankfully the boy has recovered.

My cradle to grave care this week took on new proportions:

- On Friday night I performed four caesarean sections (on average we do one per night.) All mothers and babies are alive and well.

- On Wednesday I found myself helping a family measure the body of their deceased brother (acute renal failure – on presentation to hospital had no appreciable renal function,) for his coffin. He was a lad of 32 and was previously well. I did laugh out loud afterwards at the ridiculousness of using my Bangor supply company tape measure for such a purpose.

Had some tasty goat’s liver for lunch yesterday washed down with some locally made yoghurt.

The rains have come at last – the road was so submerged in one of the swamp areas this week that the water was above my pedals as I tried to cycle through.

The wards are starting to get much busier. Most of our patients are very sick, and we have had several children this week who have did shortly after admission with severe pneumonia and anaemia.

Our HR manager Dennis has moved to a job in Kampala. He has been a strong member of the management team and will be greatly missed. Please pray that the right replacement is found. This post is one of great influence, and impacts greatly upon the extra work that Ken + I have to do – and as such is of great importance.

No more snake stories this time I’m afraid.

Cheers for now,

Rory

Snakes and ladders

2007-05-27T00:00:00Z

I know that repeating my previous topic is a bit inappropriate for maintaining interest from anyone calling by to see whats going on, but An 8 foot python is a story. See the photograph.

Im afraid that I wasnt there when it was killed, but called today to visit some guys in a local homestead, and they wanted to show me the snake that had eaten one of their calves the day before – they’d kept it to show me. They were then amused by the efforts of myself and Dr Steve at joining in their traditional dancing, and then tried to marry me off to one of their sisters but thats another story.

The rains havent really got started properly even yet which is a bit worrying as everyone here is a subsistence farmer. Even our nurses rely on their gardens to feed their children, so if we dont get rain soon, many will be hungry in the coming months.

The next few weeks here see a flurry of excitement as the various committees meet in anticipation of the hospital board which meets next week. Please do pray for these meetings which make decisions influencing the ongoing work of the hospital.

We have had quite a few cases of meningitis in the last month. Some very sick folk have got completely better, but sadly about 30% of people with such a condition die.

I had my 36th birthday this week, and it was a good one. Some of the team came round and we had a great cake. My presents included a watering can, bottle opener, and blue-peter style robot courtesy of Dr Rauls sons now proudly on top of my radio. I was discussing a book by John Piper this week with a visiting pastor from Vancouver called ‘Don’t waste your life’. What a privilege to be able to spend some years here at Kiwoko. The 36 that have passed have been good, but wont come back, and how many more hopefully lots, but however many, I certainly want to make the most of them. Not everyone has the freedom to choose to do what I have been able to do, but I have no regrets that I decided to leave Ballyholme General Practice two years ago. Let me encourage you to be bold enough to consider taking risky decisions to make the most of the life you have too.

Oh, and our two Ugandan doctors confirmed that they will be staying with us for the next few months at least just fantastic!

Thanks for reading. Bye for now Rory