Fort Portal follow ups

Once again we set out from Mbarara this time heading north to past Queen Elizabeth National Park to Fort Portal a town sat at the edge of Kibale National Park. The route of Mbarara is particularly scenic. Not long after leaving the town we are driving past farmland, standing out of the usual fields of maize or millet is a small piece of land dedicated to lemongrass. A funded farming project that unfortunately came to no fruition when it was deemed to be economically unviable, however there it remains, now a field of wild lemongrass. A short drive later our eyes are drawn to a large cement memorial on the road side. Our driver explains that this was the sight of a schoolbus accident many years ago. All the children, 70 from the same village, died. This sobering sight on our latest adventure reminded us of the perils faced on the roads here and the tragedies many of the familes have known.

Soon the regular fields give way to the banana plantations that populate much of the country. Bananas in their various species and guises form a large part of the local diet here. There are bananas for cooking (matoke), bananas as we know them, including the tiny really sweet ones and even bananas for beer and whiskey brewing (not gone down that road yet)! We can see the fruits of their labours piled onto the back of pick up trucks to an unimaginable height, and just when you thought no more could be put on you notice the people sat on top of this precarious pile.

As we continue north the land becomes increasingly hilly and much of our journey is framed be the domineering presence of the Rwenzori’s. This large mountain range borders Uganda with the DRC and also helped form the landscape of our destination – the crater lakes. By know we are looking out over a bright green felt, carpeted landscape. The region is famous for its tea plantations and was a popular retirement area for a few of the past British commissioners during Uganda’s time as a protectorate. A quick look at the map told us we could short cut our journey and have a chance to drive through the crater lakes – however this meant forsaking the comfort of a tarmac road and hitting the dirt track once again. A few quick enquiries later established that the road should be drivable and off we set.

In between the tea leaves and banana trees we could catch glimpses at first of the lakes. Soon we were spoilt with stunning views of deep blue lakes surrounded by cliff edges, a result of the massive volcanic activity that helped form this land. Oded, our driver, had never been here before and was wide eyed with the view as well. “Surely these people are blessed with the lakes they have been given” he exclaimed. While I have to agree they do live in a beautiful part of Uganda and have a supply of water from the lakes there are no fish in them and they create an existence through some back breaking work.

This brings us back to our follow up. Our next stop on the SAFE follow up was KIU (Kampala International University) hospital. This relatively newly build hospital sprawls across the hillside looking down over Ishaka town. The hospital attracts students from across Uganada and neighbouring countries. The impressive building supports an A&E department with two ambulances waiting outside. This made it all the more curious that as we entered the main door and approached the receptionist there was no one to be seen. Something else bothered our subconscious but it took a while to place it – it was the abscence of sound. The hospital had patients, indeed the person we had come to meet was currently in theatre but for a building of its size it was eerily quiet.

After a short wait we were enthusiastically greeted by the anaesthetic officer. She quickly ushered us across the compound, threw some theatre greens at us and before we knew it we were in theatre with an emergency caesarean section on the table. The spinal had just been sited and the staff were waiting for the surgeons to arrive. We were impressed with the standard of theatres. A huge room housed 2 operating theatres each overseen by an anaesthetic machine with a reasonably equipped anaesthetic trolley next to it. The hospital had power and a back up generator (which we had the joy to see in action when the power went part way through) and prior to surgery the WHO safe surgical checklist was completed. Accurate records and full observations were taken. With all this it still seemed strange that the entire hospital, including ICU and theatres, had one saturation probe – the one we were looking at on the patient’s finger. Issues between clinicians and managers exist here to when it comes to deciding where the money goes to. For the record the mother and baby did very well and as always there was an inner sigh of relief when the little boy let us know of his arrival into the world with a full set of lungs.

Kitagata town

It took us a while to work out where all the patients were. After all here is a brand new big hospital near a pretty sizeable town with easy road access. The answer lay not far down the road. 

Kitagata springs - with the locals

After leaving Ishaka we reached a fork in the red dirt road; left to Kitagata and right to Mitooma and between the two all the patients we expected to see in KIU. Kitagata (literally hot springs, they have natural hot pools here with proposed medicinal purposes) serves as the larger of the 2 hospitals with an impressive theatre record book of cases. Mitooma is a health care 4 centre. It is served by one dedicated anaesthetic officer who comissioned, designed, oversaw the building of and runs theatres. This means personal care and stock taking of all the equipment, drugs, water and power supply. Ingeniously a solar power back up system, on top of the back-up generator, has been installed providing light to theatres at all times. Feeling slightly foolish we hadn't thought of this before, we wonder why more places don't have this.

Stella and her equipment

Vaccination day at Mitooma

Mitooma is a basic health centre from a surgical/anaesthetic point of view. All we could do is take our hat off to Stella the anaesthetic officer for putting it all in place. She works here on her own and has spent years bringing people back from the private clinics in town (private means expensive but not necesarily better) to her theatre complex. The downside is that if she ever tries to have a day off, attend a course or go on annual leave she is surrounded by angry villagers demanding she works. An sort of training involves slipping away unnoticed - and we thought getting leave at home was difficult! The bottom line is that no one trusts the big new place and want to continue to use the place they know. Also as ever KIU might be quite a journey for the villagers and this is expensive. Far better and cheaper to stay close to home.

Circumstances put a few of our plans on hold and stalled us from visiting some of the other units. However we managed to conduct  rewarding telephone interviews in their place and gleamed a lot of useful information and feedback. I’m sure you’re getting the picture but when we asked one officer about the main issues he faces at work he declared there are just 3 “lack of equipment, lack of drugs (including oxygen at times) and lack of power” oh well just those then we thought!

Back at our new base camp, the beautiful Chimpanzee Guest House, we had been greeted by extremely friendly staff and just to ensure we would completely fall in love with the place a fire had been lit to heat the water tank to our room...yes this potentially would mean a truely hot shower. Having had a few disappointments along the way and having spent the last week washing out of a bucket in our bath we didn’t get our hopes up to high. We are not ashamed to admit however that it was amazing to stand under running, hot water and properly wash. We spoilt ourselves at dinner with a cold beer (Hugo found another new Ugandan brand-Moonberg) and meat- chicken stew and roast goat.