Monday 16 April 2012

Glastonbury 2012 To Go Ahead After All



The similarities between the world's greatest music festival and a provincial Ugandan town don't seem to be immediately obvious, but here's ten reasons why they are more alike than you think:

1. The Weather
Despite Glastonbury falling around midsummer the weather always conspires to transform the entire site into a mudbath within 24 hours of the gates opening. You can enjoy similar scenes of rain-based chaos here in Mbarara, as epic thunderstorms turn the murram roads into boggy rivers. However, whereas 'revellers' in Somerset will stand in the pouring rain watching a barely audible Get Cape, Wear Cape, Fly set in stoic misery, the Ugandans head undercover and sensibly wait for the sun to re-emerge before continuing with the normal activities of daily life.
Party on!!!

2. The Food
Barbecued meat, warm flat beer, bread that tastes three days old and has bits of earth in it, melted chocolate and a reliance on bananas as the major energy source - again, the similarities are clear.

3. Music
Wherever you go, whatever time it is, whatever day it is, it will be unusual to enjoy silence in either place. In a similar way to Glastonbury, we often feel the music before we hear it (as I type this on a normal Monday lunchtime, a marching band is parading up and down the road, apropos of nothing). Young men set up enormous sound systems in the back of empty banana trucks, turn up the bass and turn down the treble, and then spend all day driving up and down Mbarara high street playing hip-hop at gut-rumbling volumes. Even the churches turn it up to 11, with one recent evangelical shindig keeping us awake until 4.30am on a Sunday morning.

4. Fires
Ugandans like to start fires. As you fly into Entebbe Airport, vast plumes of smoke can be seen all over the surrounding villages. We have twice been smoked out of our flat as a result of our neighbours deciding to burn their rubbish ten metres from our (glassless) windows. Like at Glastonbury, the smell of burning is constant and inescapable, and results in a permanent cough which only a rigorous course of physiotherapy will cure.

5. The Power Supply
It's usually around day 3 of the festival that iPhones and Blackberries start to run out of battery, and a general sense of panic begins to develop as access to Facebook and Words With Friends is rendered impossible. In a similar way the power supply here is often unreliable, though the consequences of this are perhaps more serious when it cuts out half way through a night-time emergency laparotomy. The blackouts are described euphemistically as periods of 'load shedding' which, to me, appears to imply that there is simply too much energy for the system to cope with, and it must be thrown overboard for the ship to remain afloat. The only benefit of the outages is the brief respite it can give from the nocturnal evangelists, as they scrabble in the dark for the key to their diesel generators.

6. The Toilets
There are public toilets in Mbarara, but they tend to be entrepreneurial ventures set up by individuals, who charge a 200 shilling fee (5p) for the opportunity to make a 'short call' or a 'long call' (you work it out). Anecdotal evidence from Ugandan colleagues at the hospital suggests that they are best avoided, and that pharmaceutical measures should be taken to avoid their emergency use. Anyone who has visited the pit latrines on day 5 of Glastonbury and regretted their failure to pack a box of Imodium tablets will sympathise.

7. The Hippy Vibe
The Mbararans are an extremely friendly people, and will take a keen interest in anything that you are doing. Thus mundane activities like opening a parcel in the post office, going for a run or performing an intimate examination on a patient will all draw a crowd keen to know exactly what is going on, and offering helpful comments on how you can do it better. You only realise how unsociable most British people are when Ugandans will approach you in the street and tell you their life story and demand you share yours with them. Similar behaviour in the UK would probably have you interred for harassing passers-by, except at Glastonbury where people rely on artificial stimulants to enable this social interaction with strangers. The average Mbarara resident needs no such device for their innate and routine friendliness.

A reveller.

8. Public Transport
Anyone who has spent an unpleasant 5 hours at Castle Cary railway station waiting to be herded back to their hometown will have some insight into Ugandan intercity travel. Recent experiences on a bus trip from Kampala to Mbarara (bus packed to the brim, no air conditioning, overpriced ticket, tyre blowout whilst doing 80mph on a bend, arriving two hours late) led to memories of cattle-class transport services away from the festival.

9. Bono

10. The Inevitable Return
Every year, 160,000 physically exhausted, emotionally demoralised people flee from Pilton vowing never to put themselves through such a period of intense sensory overload ever again, yet every year they block phone lines and websites in their desperation to get a ticket for the next festival. Likewise, although Uganda can be equally as frustrating, noisy, challenging, smelly, hot and wet as Glastonbury, it's hard not to love it, and to want to spend more time here, bathed in mud, listening to evangelical rock at 4am, drunk on warm lager and ready to do it all over again.

Wednesday 4 April 2012

Birdblog #3: Grey crowned crane



Grey crowned crane - featuring reverse knees.
This young punk is the national bird of Uganda, though it appears more often on coins and flags (and as the door handles of the Ugandan Embassy in Trafalgar Square) than in real life.

There is a family of three that we've spotted over the hill from our flat, but when I went for a run yesterday one of them was lying dead in a farmer's field whilst the other two conducted a rudimentary post-mortem.

Grey crowned crane door handles - just visible behind ardent fans of The Seahorses


No-one seems sure why it was chosen as the national bird, but it definitely is one of the more spectacular species, particularly with its red wattle that has evolved to resemble a mad, screaming, bloodied mouth.

When a few of them get together they sound a bit like the Scousers from the Fast Show - the third sample down via this link gives the best example.

If the Grey crowned crane were a celebrity it would be: Johnny Rotten


Monday 2 April 2012

The Great Partogram Robbery

We thought we’d better provide a hospital update, if only to reassure you that we are doing some work amongst the Michael Bolton tribute parties, clothes shopping and birdwatching.

Things are going well at the obstetric unit; I’ve acclimatized to the mayhem and even managed to reduce it (sort of) by introducing whiteboards outlining the essential details of all the labouring patients. This is designed to improve the organisation of the ward and to make sure everyone is aware of the patients who need particular attention.  I will admit that there was initial resistance, and for the first 2 weeks there was only me and one of the fourteen residents updating it regularly, however it is now up and running successfully!  I even had a resident come up to me after his weekend shift to apologise for sticking paper on the board after the marker pen ran out.  We now have more marker pens, unfortunately they still need to be tied to the wall to stop people ‘borrowing’ them but small steps are being taken in a (generally) forward direction.

In a similar vein, it is amazing what people ‘borrow’ if they find it lying around the ward. My favourite thing to go missing so far has to be a massive (3ft by 5ft!)  laminated partogram (in this case, by ‘left lying around’ I mean ‘stuck so firmly to the wall that its removal has left the wall paintless’).  On a positive note it gave me the opportunity to discuss why the use of a partogram was so important in the morning meetings and we’ve now organised a partogram teaching session, so every cloud…

Another reason for my work-related blog is to post some of my favourite theatre photos, when things are going less-than-swimmingly in the operating theatre, you just need to walk into the recovery area to find instant amusement.  We have ‘The Dangerous Drug Cupboard’, which I think has a much better ring to it than ‘Controlled Drugs Cupboard’.

The Dangerous Drugs Cupboard


There is also the store of endotracheal tubes with the mysterious empty box – if like me you thought there must be something secret and wonderful inside that is kept safe from all the staff, you may be a little disappointed but I was still amused that it was actually an empty box (modelled by Julia one of the UCLA residents who came over for a recent 3-week placement).
Julia - with empty box



Is it really an empty box?












Also, if you are looking for another way to use tape, here’s your answer.  There is no end to the ingenuity; some of you may have noticed the lack of a cord clamp replaced by the sleeve of a disposable glove which works surprisingly well.
Babies

On a more serious note, our projects are going well, and with the collaboration of my Ugandan colleagues I have managed to pilot a cervical cancer screening project for our HIV-positive patients using visual inspection with acetic acid.  I am also starting a quality improvement project aimed at reducing the very high rate of stillbirth here, so I’ll let you know how that goes.  We are also planning to introduce improved infection control measures, focussing on hand hygiene. This has been proven to reduce rates of sepsis in other Ugandan hospitals, and we’re hopeful that similar results can be achieved in Mbarara.