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

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.

Thomas a Becket, Michael Owen and other Mbarara Residents

Having been born in the early 1980's, we thought our chances of meeting Thomas a Becket would be slim, given that he was famously murdered in 1170 on the altar steps of Canterbury Cathedral.

Imagine our surprise, therefore, to be introduced to him by a colleague at a recent social event. Regrettably, as huge fans of beatified 12th Century martyrs, we were disappointed to hear that the man before us was born in northern Uganda in 1978 and was therefore almost certainly not the original version.

A contemporaneous photograph of Thomas Becket's murder.

It transpired that his parents were keen admirers of the deceased Archbishop and had decided to name their first-born son in his honour. This doesn't seem to be unusual practice in Uganda, where most people have entirely different forenames and surnames to their parents', opening up the possibility of becoming a namesake. As such, as well as Thomas a Becket, we've also met Michael Owen and Michael Jackson, which would make for an entertaining, if morbid, episode of Celebrity Come Dine With Me. 

Michael Owen - ex-footballer

To add to the variety, most people here tend to structure their names with a Ugandan-style name first, followed by a European-style name.

This also leads to confusion when we introduce ourselves, as people assume that our working, hospital names are Dr David and Dr Kim, but informally they will call us 'Riding' (pronounced 'Rayding', which I prefer) and 'MacLeod' (variations in pronunciation infinite, even in the UK).

The second names also tend to be very traditional, as this list of some of our hospital colleagues reveals:

Dr Mutiibwe David, Dr Kayondo Stanley, Dr Rwambuka Godfrey, Dr Kanyago Samuel, Dr Ngozi Joseph etc.

It's also usual to meet people called Herbert, Moses, Gerald, Ronald, Gertrude, Beatrice, Henry, Isaac, Ernest and Albert, names which somehow give immediate authority. This is in contrast to Kim's experience in Liverpool where Nevaeh is a popular girls name ('Heaven' spelt backwards), and Chantelle, Britney and Beyonce all keep the taste police busy. Worryingly, American colleagues confirm a rash of unfortunate children called 'Lady' in tribute to The Gaga.

Whether the Ugandan names provide inspiration for any possible future offspring is still under discussion, but don't be surprised if you are introduced to Master Riding Agamemnon at some point in the future.

Birdblog #2: Marabou Stork

The ugliest of all the birds, the Marabou Stork is a disgusting embodiment of how nature doesn't always produce sweet little Disney characters who charm and beguile. This grotesque abomination is notable for several physical features. One, its rigid, pointed beak, is rattled sombrely, and is usually to be found pecking at piles of rubbish in sub-Saharan towns and cities, including those at Mbarara Hospital.

Pendulous air sac

The storks also possess two pinkish-red air sacs which they inflate in a futile effort to appear attractive. The front sac hangs below its chin like the pendulous, excess skin of someone who has previously had gastric-band obesity surgery.

Marabou Stork nightmare

The photograph also suggests that the bird appears to have white legs, but this is not the case.

The defining symbol of the Marabou's rankness is that it can't even be bothered to defaecate with dignity - the colour comes from the constant torrent of excrement that spews forth from its horrid bowels.

If the Marabou Stork were a celebrity, it would be:
Jocelyn Wildenstein.

Sole Providers

‘How Can we be Lovers if we Can’t be Friends?’ sang Michael Bolton, addressing, yet again, one of the great existential dilemmas of our age. The Mbarara glitterati recently managed to overcome the complex philosophical issues that form the basis of his work by attending a surprise birthday party, themed in tribute to the man himself. The reason for this diversion from good taste was that Mark, the American infectious disease resident who has previously saved my life, shares his special day with Michael (in a similar fashion, plans are now afoot for Kim’s Bonnie Langford-themed party) and has long expressed an admiration for his works.

The Soren Kierkegaard of mediocre 80's balladry

Naturally, Kim’s first thoughts were of clothing, and so she set out to find an outfit composed of leather waistcoat, billowing white shirt and fake blonde hair. Surprisingly, the plan to discover retro-chic boutiques in a provincial town in sub-Saharan Africa was not immediately successful, and so ambitions were downgraded from Reiss, Whistles and Urban Outfitters to the local thrift market. Her description is below:

There was a general scene of chaos with piles and piles of clothing and, everywhere, an unbelievable number of shoppers. My favourite vendor would be the man who sold waist-high mounds of wedding dresses. If I could’ve thought of a use for one, or four, I’d have been sorely tempted. When I began to consider having one altered into a top I realised that I had to move on.

Mbarara Clothes Market

The next notable salesman would have to be the most enthusiastic guy I have ever met (apart from Dave, obviously). Never before have I met a man more excited about dresses than me (apart from Dave, obviously) but I felt I had met my match. This vendor had a random pile of dresses and enthusiastically repeated: ‘Wonderful dresses! Can you believe it? These are so wonderful!’ over and over again. No matter what your reply was to this apparent statement of fact it did not stop the repetition. However, it must have been a very convincing argument as we did buy three dresses (but still no leather waistcoats or billowing white shirts). 

After the overwhelming sensory assault of the wonderful dresses we went for lunch, inevitably picking up a pair of shoes on the way. Unfortunately, or fortunately, we were still no closer to looking like Michael Bolton. Things took a turn for the worse when one of my fellow shoppers decided what we really needed was chest hair, something I never thought I would want, let alone need.  After a quick subject change I hoped the chest hair was forgotten and I continued my week’s work, waiting for the highly-anticipated party, feeling safe in the knowledge that I could look normal in jeans and a top.

Unbeknown to most of the group, our friend Helen had managed to find a hairdresser selling fake hair. I’m pleased to report it was synthetic and plentiful, and so a carrier bag full of blond acrylic hair was brought to the party, different than the usual token bottle of wine but one which actually went down very well.  Prior to the birthday boy attending there was a mad dash whilst Wazungu and Africans alike donned themselves with fake blonde chest and head hair in a desperate attempt to look like Michael Bolton. I’ve never seen Dave look so good.

The party was a great success and we danced into the small hours, fortunately by that time having moved from the Michael Bolton-playing initial venue to an African club with great music. Just a routine night in Mbarara – don’t you wish you were here?

Birdblog #1: Hadada Ibis

Uganda has an unbelievable 1061 recognised species of bird (compared to the UK which has 596, and has a similar surface area) and so we thought we'd use the blog to reveal a few of our favourites (i.e. the ones we've managed to catch on camera).

Hadada Ibis

The first is the Hadada Ibis, which announced itself to us on our very first morning in Mbarara. The bird has an extremely loud call (you can hear it here) which was impossible to ignore, even in our comatose jet-lagged state. Since then we've grown used to seeing them foraging for nest-building materials in the grassy areas around our flat, and waking us at 5am with their alarming squawk.

I was sure I'd heard their piercing racket somewhere before, but couldn't work it out until I stumbled on an old YouTube video...

If the Hadada Ibis were a celebrity, it would be Ricky Gervais.

Obstetrics, Ugandan style...

Time for some obstetrics! I am working at Mbarara National Referral Hospital in south-western Uganda. The 600-bed facility is one of four teaching hospitals nationwide and is affiliated to the Mbarara University of Science and Technology. It has a large obstetrics and gynaecology department with 24 doctors and 20 midwives, and is the first place I've worked where the former outnumber the latter. The hospital has approximately 8000 births a year (a similar number to Liverpool Women’s Hospital, my former workplace) but has only three beds on the ‘labour ward’. The literacy rate in Uganda is improving at 73%, but for the less fortunate there is a handy clue at the entrance to the department that they are heading in the right direction for their obstetric and gynaecological services (see photo below).

Dr Kim outside the Obs and Gynae ward

The first few days were certainly eye-opening. There is a general air of chaos on the wards which takes a little getting used to, but I’m beginning to acclimatise to the mayhem. I delivered someone at the foot of a tree on the way to work one morning which is not something I’d experienced in the UK! Quite why the patient was not occupying their bed that was only 50 yards away is anyone’s guess, but I have never left the house without a pair of latex gloves since that occasion.

The staff are incredibly friendly and helpful and I’m getting used to ‘Ugandan Time’. If you add at least an hour to the length of time within which something might be expected to occur, then you’ll be well on your way to getting to grips with the local timekeeping. Unfortunately ‘Ugandan Time' also applies to emergency situations, which has led to some hairy moments. 

The patients themselves tend to be extremely appreciative of any treatment provided, however minor, although this sometimes becomes embarrassing as they try to give you money following their Caesarean section.

 

I’m beginning to formulate tentative plans of what I’m hoping to achieve here. It remains a challenge to work in a clinical environment devoid of guidelines and information whiteboards so I’m hoping to be able to introduce these soon.  The Royal College of Obstetrics and Gynaecology in London have raised charitable donations for Mbarara which I am helping to allocate, so I’m hopeful that basic facilities can be improved. I’m hoping to install curtains around the beds on the antenatal ward to give the women some much needed privacy.  We also need a better way of transferring patients from the operating table to the trolley following surgery as a patient recently fell after her Caesarean section. We use PatSlides routinely in UK and they could be something we could consider introducing here.

Outside of the hospital I’m pleased to report I’ve just attended my first Ugandan aerobics class, which takes place in a nightclub, bizarrely. My anxiety levels were raised as we assembled in the middle of a male sauna, prior to the session, but fortunately this was the place of payment rather than exercise and we were soon able to flee to the dance floor for the exercises to begin. Working out beside fridges full of beer and with people playing pool in the background may seem distracting but it was most enjoyable and I’m guessing this will turn into a regular Wednesday night trip, though whether Dave decides to dig out his sweatbands remains a moot point.