Emu, Biri, Satu, Nnya... (1,2,3,4...)

Week 4 already!

I’m not managing too well with the whole trying to learn Luganda, it’s difficult to pronounce the words right and I’m pretty forgetful as well, but counting is something I’m getting more confident at since we often get the patients to count as we do stretches and the younger ones like to count when they’re playing!

So it’s been a good week so far. It turned out that Monday wasn’t as busy as I was expecting at all. Most of the girls who had been admitted with the bus crash seemed to have been discharged at the weekend. Apparently most of them weren’t harmed too badly, just cuts and grazes and I think a few were transferred to hospitals nearer to where they live.

Tuesday was busy! We treated a few of our patients on the ward, then at half 11 I headed off to find the community health worker that I had arranged to join on his visits. So we headed off on his motorbike to visit various patients where they live around Kiwoko and in nearby villages just before 12. It was really good to see patients in their own homes and to get more of an idea of how they actually live.
We saw 11 patients altogether, most of them with some kind of physical disability. The community team are very busy with all they do and it was good to see they difference they have made. They do a lot of education about hygiene and safe drinking water etc and they try to think how they can help the patients to make their everyday living easier. One device they have come up with for people without running water is a wooden frame with two jerry cans attached for hand washing. The person presses a wooden leaver with their foot which then turns a bottle of soapy water downwards to wash their hands and then they do the same for a bottle without soap to rinse them. I saw this contraption at a few houses, so it’s good to see it’s being used. The community health workers are very good at thinking ‘outside the box’ as we’d say as they try to come up with ways to help people who either struggle to walk or carry out everyday tasks. When a patient is unable to walk independently, they often provide them with a suitable walking aid and for a few of the patients we visited they had built special toilets for them as they would normally have to squat, which can prove very difficult with one leg or if your leg muscles are very weak. For one of the patients we saw, they had made him some parallel bars out of wood so that he could practice standing and so he is able to spend some time out of his wheelchair (a plastic garden seat on wheels!). For some of them it was limited what they could do depending on the patient’s condition or sometimes they didn’t have enough money for equipment, although they do try to build with local materials to keep costs down. We saw a guy who was 19 and he had his own way of moving around by shuffling around on his bottom, so they just let him do that so he can at least move independently as he couldn’t use any walking aid because of his arms and he didn’t like the restriction of being in a wheelchair. He seemed to have a reasonable quality of life living with his family (alot of people live in their extended families) and he seemed very happy, so they check up on him every month or so.

We also visited the baby boy that we put plaster cast on his feet a few weeks ago to treat Club foot in the physio dept. So it was lovely to see him at home. I would say his feet aren’t really normal but they do look better than they did when we first saw him. They’ve now decided to get him to wear shoes on the wrong feet to help correct the positioning of his feet, but when we arrived we noticed he wasn’t actually wearing the shoes. (One of his siblings picked him up and took him inside when we arrived, then he reappeared with the shoes on!) So I think the health worker tried to tell them of the importance of wearing them, but I’m not sure if they will actually get him to wear them or not.

There’s so much more to say about the community visits, but I’ll maybe try and upload a couple of the photos which might give a better idea of what I saw. By the time I got back at about 3pm Moses had had a busy day with lots of Outpatients being sent our way aswell as the ones on the ward. He had already seen 4 and had another 2 waiting! So I was able to see a patient with back pain and one with knee pain before we both went to see the boy with the burns on his back and leg. I think they are going to have to do skin grafting, but he is improving – he was able to bend over and touch the ground which is a great improvement for him and he was able to hold his leg straight and fully weight bear on it too.

Wednesday we weren’t too busy, we managed to cover most of our patients in the morning and then I was able to read some of the physio books that have been left in the department by the physio that was here from the UK for a few years. We didn’t have any outpatients at all, it seems to be one extreme or the other!

I met up with one of the students that Sarah had introduced me to go to Nursing student’s bible study on Wednesday night.  The leader was very quiet and the discussion never really got going as they seemed to just ask question after question. I’m not sure if it’s just what they are used to learning but the leader just seemed to be quite happy to get the expected/right answer instead of questioning why or how it’s relevant to them or what they could do or change. So I’m not really sure how much anyone got out of it, but hopefully it was encouraging to meet up with other Christians and maybe it will spark some discussions among some of them later.

Then today we had the kids club for kids with HIV. It seemed to go pretty well. It’s all just so much more relaxed than working with children at home! We stuck roughly to our plan time wise, although a lot of it did seem to be a bit last minute!
Once the kids were registered we played lots of games outside which was good fun, they were all so full of energy! Then we had a tea break before starting with the story and puppets. It was pretty much all in Luganda, so I have to say I didn’t understand too much at this point, but they all listened really well. There was a slight change in the plan, so I was given the task of doing an ‘energiser’ (which is just a few minutes of getting them moving around and making noise to keep them awake!) before they did the memory verse and then got into their groups for discussions and crafts. We ended up doing colouring in for the younger group which I was in. One of the other leaders came up with a craft for the ones aged 8-12 which involved them making a little fence out of wooden sticks, decorating it with sheep on it ...and then after they had made them, they had to swap and destroy what each other had made! Apparently the aim was to see how they reacted to loosing something they had made and for them to learn from Job’s example when he lost his flocks! Certainly an interesting idea, I can’t really imagine it working at home! I wasn’t with those groups to see the reactions, but they all seemed very happy when they came back to join us in the room inside! I think they quite enjoyed it all!
They then had a wee quiz, sang a few songs and finished up about 2pm and we managed to get some lunch and see a couple of patients before the end of the day. I think the kids did take in a lot of what they were being taught, so please pray that they will take that away with them and that they might come to know God for themselves and to learn to trust him like Job did even when they don’t know why they are in the circumstances that they find themselves in.

Because we didn’t see all our patients today, we’ll make sure they are all seen tomorrow. We were able to ask the attendants of the ones we didn’t see to help them with exercises and where possible to get them walking outside, so we’ll have to check up if they did or not!

A fairly busy week...

Well the week has just whizzed by! There seems to have been a lot going on.

On Tuesday night I had one of the most bizarre experiences! A group of guys from Northern Ireland have been visiting and were staying in the training centre accommodation while they visited various schools in the area before they headed of to Jinja to do some mission work with YWAM. They had organised a film evening where all the staff and students at Kiwoko were invited to come up to the HIV shelter to watch a film together. The HIV shelter is basically a building with no walls which is used for clinics a couple of times a week. It seemed a bit strange heading out once it was dark but we made sure we covered up and were all stinking of the mosquito spray!! So we all headed up there from the guesthouse and as expected nobody had really turned up yet (It can be difficult to decide whether to go African time or Muzungu time as sometimes you are caught off guard when people actually mean the time they say!!) Someone was selling pop corn, so we got some to eat as we were sitting on the concrete floor starting to watch Indiana Jones which was projected up onto the wall. It must only have been a few minutes into the film when the whole sky around us light up! We realised after this happening a few times that it was lightening and we thought it might pass soon. But it continued for the whole film with thunder adding to the excitement in parts! So here we were watching Indiana Jones in the middle of a thunderstorm sitting on a mat on concrete floor under a roof while bats flew over our heads and lizards were casually running up and down the wall beside the film! It was a really good night, although the rain seemed to hold out until the film finished, so we had to run back to the guesthouse in the dark getting a bit wet. By this point the power had gone and the generator was off, so it was reading by candle light before bed!

On Wednesday the Male ward was moved back into their original building which has just been renovated and extended slightly. I only realised how cramped the ward they had been in was when I saw the space there was in the new ward! (Though even in the new ward the beds are a lot closer together than wards at home!) It seems really spacious and is lovely and bright having been newly painted. One side is for surgical cases and one is for Medical and they have isolated rooms for each side now as well as a separate part on the end for highly infectious diseases. It all went really smoothly and everything including patients seemed to be moved within a few hours! It did take a wee bit longer to locate our patients but other than that I was just amazed at how quickly it all happened with everyone just mucking in!

We had a meeting that morning with some of the workers from the HIV department about the kids club that they run once a month for kids with HIV. They call the club ‘Afaayo’ which means He cares. In this case they are meaning God cares and the aim of the club is for the kids to realise that God cares for them. So they pick a theme each month and have stories/dramas, games and discussions to help them decide for themselves what they believe as they learn about God. It think they usually just meet the week before to organise it, to me it seemed very African, where the meeting went on for quite a while and at the end I was wondering what had actually been decided! I then realised that I was signed up for thinking of a craft that can be done for each age group keeping in mind the theme for this month is Job! So yeah, hopefully it’ll all work out ok on Thursday! They do it every month, so I assume it’s slightly more organised than it seems!!

Physio wise we’ve been continuing with mobilising a few fracture patients using crutches and walking frames, playing with the malnourished kids and we’ve managed to get our burns patients walking a bit, weight bearing on each leg and even squatting down, so they are progressing well. However they definitely don’t get as much painkillers here as they would at home and sometimes it’s just awful to hear them crying out in pain. But the people here do have a much higher pain threshold and I think culturally they are expected to just get on with it and I suppose painkillers are pretty expensive too.

A lot of people do travel quite far to get here for treatment. We had a lady come in the other day carrying her 12 year old daughter on her back. Apparently she was born healthy and grew well and was walking and talking until the age of 4 when she came down with a flu and fever. They then realised she had epilepsy and by the time she was 6 she no longer talked and by age 8 she could no longer walk. But they had never actually visited the hospital until now! From what I could gather I think she had come a long way, so maybe that had something to do with it. From assessing her she appeared to be malnourished and the physio diagnosed some form of Cerebral Palsy. She could only really lie on her back, unable to sit independently. I just couldn’t believe that she hadn’t been seen for the past 8 years since she was first unwell. I think this kind of thing can be quite common though, and if people don’t come for help, you have no idea that they need it.

I met one of the health workers who does community visits this week, so I’ve arranged to head out with him on Tuesday to go and see what the health care is like in the community. It should be really interesting to see even more rural areas than we already are and to see what work is being done. I’ve heard from Sarah and quite a few of the medical students about clinics which run under mango trees, using the branches to hang babies off of to weigh them etc, so certainly sounds like you certainly have to be thinking outside of the box anyway!

It’s not been too busy this week patient wise, but on Friday female ward was extremely busy when we went to see one of our patients in the afternoon .Unfortunately it turns out that a bus full of school girls had came in after their bus had been turned upside down in an accident. I think about 20 were admitted and 10 were operated on during the day, so I there are plenty fracture patients for us to see next week. It was all a bit hectic on Friday with lots of people everywhere, but we’ll find out more about the situation on Monday morning.

Week 3 already!

So today was the start of my third week! I can hardly believe it. Although I’ve certainly managed to fit a lot in since I got here, including whitewater rafting down the Nile and a wee bungee jump this last weekend! The rafting was such fun, and it was just beautiful between the falls when we got to swim for a bit and see all the birds and scenery about us. The bungee jump was pretty terrifying but I loved it all the same!! All 5 of us from the guesthouse headed to Jinja together for the weekend then 4 of us headed back to the hospital on the Sunday as Sarah is now staying there to work in an orphanage for two weeks.

Today was good, we had plenty patients to see so there certainly wasn’t a dull moment. The lady with burns that I saw on my first day is really coming on, her wounds are healing well with a lot of the skin growing back and she’s managing to bend and straighten her arms and legs herself now with just a little assistance from us to get full range. The next patient we saw was a lady who had fractured her femur, and we were trying to get her up to walk but her other leg is so weak after being in hospital for a while. We did some strengthening exercises in bed and got her standing with a walking frame. It was really frustrating though because I could easily have treated her myself if either I could speak fluent Luganda or if she could speak English! I have a few words I know for treatment, but if they speak back I have no idea what they mean!! I feel like I should be doing more by my third week but I have to have one of the other physios there to translate to do anything. I find they often speak with the patient for ages, then translate a few words for me which is also a wee bit frustating!! However, after that we headed back to the Nutrition group with three little ones and I was able to do an assessment of the new patient with Solomon translating for me which was good. One of the Mums is really nice and although she dosn’t know much English, she always talks with me and tries to teach me more Luganda! We also saw the daughter of the lady who was burnt badly. The baby is healing really well and if finding moving a lot easier than her Mum who saved her from the house fire. We then saw a few more patients on Male ward before lunch, including the boy who was burnt by his Father. He is still in a lot of pain, but he is now able to straighten his leg when he stands. And we’ve managed to get him to bend over to lean on the bed, our plan is to gradually lower that until he is able to bend right down to touch his toes.

The ladies, Rose and Skovia, who work at the guesthouse really look after us well, so we had a lovely lunch ready for us. (They also do our clothes washing all by hand, which is amazing! Although I have to say I am missing the luxury of a washing machine as we have to hand wash our underwear ourselves!!)

Just when I feel I’m getting used to the way things work here, I’ve just had an afternoon where the lack of resources seems to have be so noticeable in comparison to home. After lunch we had a mother bring in her baby who is 1 ½ with Cerebral Palsy. We assessed him and were able to give her advice about the condition and what she could do. It seemed to be down to the physios to tell her about the condition, all she seemed to have been told so far was that something was wrong with his back and head. We gave her advise on different ways to encourage his development and we recommended she got a seat made that would help him to sit up. It really made me think how different it is in our country where so much can be done and there would be all sorts of equipment provided, whereas here it felt like they were just left to get on with it really! They are going to come back to see the physios in 3 months though, so there is a follow up, and I think they seemed to be able to either buy or make a chair which should help him to at least sit up. Then the lady we saw earlier with the fracture was getting discharged. Our plan was to work with her for a few days so that she could then move around on crutches, but as she was getting discharged today the family requested that they could take home a frame with them. In the UK, that wouldn’t really be a problem, there is usually enough, but here we spent nearly an hour trying to find one that she could take home for a few weeks. There were only about 5 or so in the whole hospital with most being used and shared between patients already. And there was only one without wheels which had a stopper missing off the bottom. So eventually we got her sorted with a slightly rusty old frame to take home until she is able to stand and walk without it!

I don’t want to give a really negative impression, it’s only me comparing. The people here don’t think in comparison to the UK hospitals, they just get on with what they have here and are thankful for it! There really is so much good work that is done by this hospital for the patients and it’s great that the physios are able to see such a variety of patients. Many people from around Kiwoko are saved from travelling far on dusty, bumpy roads to get to a hospital.

It really is a beautiful place here, I far prefer it to the busy city of Kampala! After work today, once it had cooled down a bit, I was able to go for a lovely walk around Kiwoko. It can actually be quite busy with people travelling by on bikes (I'm still amazed at how much can be piled on an bicycle!), people working on their land and cattle being herded along the road! The people do so much physical work here that they think it is funny that we choose to go out for walks!! There is always lots of different plants and wildlife to see around and the large red sun was turning the sky most gorgeous orange colour before it started to set! I’m definitely realising there are some things you just can’t capture by camera!

Muzungu! Muzungu!

There is so much I feel I havn’t communicated on here at all!

I don’t think I’ve even mentioned things like how we get our milk delivered to the door fresh from a farm nearby, then we have to boil it and pour it through a sieve to pasteurise it our selves before we can drink it. Or the fact that the toilet is a pit latrine outside the guesthouse (and when we used public toilets last weekend we had to take a tub of water in with us to use as a flush! Not what you call the most pleasant experience but memorable none the less!!) And how everywhere we walk little kids shout out “Muzungu” (which literally means ‘white person’ in Luganda) and they wave madly until you wave back! ...To begin with you feel a bit like a celebrity and now it feels totally normal!

Physio wise, I’m getting into the swing of the normal routine and I’m starting to be able pick up on the odd word the physios say when speaking to the patients! It is a lot more relaxed than home time-wise with a few hours chat after lunch most days! I am learning lots, the physios are very knowledgable about a lot of the conditions that they see, although there are some dodgy ideas here too - such as treating a patient with abdominal pain with ice, that was interesting! When I asked about it the physio just said it may have been some kind of muscle spasm which ice would help!! Anyway, here’s a couple of examples of patients I’m seeing everyday at the moment.

This last week we’ve been seeing a guy who is about 16 years old who is in hospital because his Father burnt him as a result of him being accused of stealing. I’ve no idea whether he did steal or not, but he has been burnt all down his back as well as the side and back of his left leg leaving raw flesh. To begin with he was kept at home with no treatment until his wounds went septic and he was taken to hospital. You just can’t imagine it happening in our country but apparently this kind of story is quite common here, where people take things such as stealing into their own hands. The boy only really has one position he is comfortable in which is lying on his front leaning slightly to the left with his left leg bent so his open wounds arn’t touching the bed. Unfortunately our job is to try and get his joints moving to prevent contractures which is very painful for him. Today I had to bend his leg and straighten it while he was crying out in pain but I know that it was for his own good.

Another patient I have seen everyday since I’ve been here is Isaac. Isaac is a five year old boy who has been in hospital for three weeks but they have actually just discharged him without really knowing what was wrong with him. It’s such a shame as he really is pretty ill. I think he came to see the physios originally because had fluid building up in his stomach which was pushing the diaphragm up and causing him to have trouble breathing. He couldn’t actually lie flat to sleep as he was having so much trouble breathing. So we had him blowing bubbles etc to try and get him doing deep breathing exercises. In the last week we’ve really just been playing with him to engage him in something as he’s been stuck in hospital for so long. He always looks so serious, like a wee old man! More recently the doctors have discovered some sort of mass on his liver but the family doesn’t have enough money to find out what it is or to spend anymore time in hospital and I think it would be too major an operation to carry out here to remove it. In the last few days after he was discharged and waiting for transport home, we took him through to the rehab department while we had the nutrition group in and we got him playing with a football so that he was moving around. I’ll miss seeing him everyday, we had good fun together, he’s helped me learn to count to 10 in Luganda with some of the games and puzzles we were doing!


I find it really hard to age people here, I would’ve said Isaac was about 3 and the boy who got the really bad burns about 12 but I discovered their real ages with the notes! And one of the nutrition kids who come along most days I thought was about 1 and a half and it turns out they are actually 3!


Oh and exciting news! For those of you who know I booked an extra week by accident... I’m so glad I did!!
It turns out that on my very last weekend here there is a childrens club for kids age 5-12 which Kiwoko Hospital runs from the Fri to the Sun. Both the physios are involved in it, so they asked if I would like to join the team! It’s called ‘Ekisa’ which means ‘Grace’ in Luganda and it sounds like we are basically going to have lots of fun playing games, doing crafts, drama and singing songs to teach the kids about the gospel. I think that they used to have teams of people coming over from the UK to run it but this year the Ugandans are running it and there are only 3 ‘Muzungu’ helpers. So, I’ve just been to our first team meeting tonight which is very exciting! I’ll be on the team which has 5-7 year olds which I’m sure will be good fun! The majority of it seems to be pretty well organised with the schedule all planned by the two main leaders already, then I think we'll have more to plan in the next month within the smaller groups.

Prayer wise it would be really good if you could just pray for wisdom for how to encourage the Christians I meet here. There is a lot of superficial Christianity around (like when you go through towns and see buses with ‘God is Good’ and ‘Hosanna shopping centre’) And because it’s a Christian hospital which was started up by a missionary, then there are a lot of the people and students we are working with here have basic understanding of Christianity and often know right things to say, but it can be hard to tell sometimes whether they really are committed Christians. The two physios are Christians and I’ve had some good chats with them which has been good!
And more practically, just for the physio aspect that I’d have the confidence to use and share the knowledge I have to treat/help patients, and also that I’d be able to take on lots of new stuff that I’ve not learnt about at Uni really.

Off to Jinja this weekend to go whitewater rafting with other students at the guesthouse and to say Cheerio to Sarah as she moves on to work in an orphanage there for a few weeks, can’t believe how quick the two weeks we’ve had together has gone!

Adjusting to life at Kiwoko!

Sorry if anyone has been wondering what I’ve been up to since my first day, we’ve had problems with the internet and getting our time onto our dongle, so we’ve not had internet since Tuesday! (Also to save internet I’m not on facebook too much other than to check messages as it uses up a fair bit of our package – so feel free to email or f.b message as I have a system of copy and pasting onto word to reply so I don’t use up lots of time!)

 I’d love to fill you in with absolutely everything but it’s just impossible to fit it all into a blog! No one would like to read an essay everyday...and I don’t suppose I’d find the time to do that either!!

So, last week was really good, I spent most of the time observing everything the physios were doing. There is so much to take in! As the week went on I was able to assist with treatment, so things like getting patients mobilised, passive stretching for the burns patients and measuring crutches for the many fracture patients. There’s not so much of the health and safety where the physios would decide if it was safe for the patients to walk with assistance of a nurse etc, it’s more like ‘here’s some crutches, off you go’! The patients do like to get outside as Ugandans do spend a lot of their time outside, so usually in the afternoons the majority of patients are outside in the space between the wards. I was also able to help put on plaster of paris on a wee baby who is 3 months old which was tricky!! We decided to put plaster on both legs to try and get their feet in the right position, as they were both turned in so the soles were nearly facing each other. It seems to be pretty common here for babies be born with this condition, they call it ‘Crab feet’. The plaster will hopefully be able to correct this as he’s still pretty young. We had a 13/14 year old boy in the day before but he was never treated while he was young, so his feet were still turned side on and he’d obviously found his own way to get around using a stick and carrying his things with him in a carry bag around his head. His feet were all swollen, but all we could do for him was order a proper pair of crutches.

We really don’t realise how fortunate we are at home with the treatment we get. With so many fractures here, they only have a Orthotic Surgeon who comes once a month (and it can vary slightly to be even longer). So one of the patients we went to see last week was a young boy who had been run over when he was on his bicycle, breaking both his Tibia and Fibia on both legs as well as his collar bone, and he has been stuck in bed unable to do anything for weeks until the surgeon came! All we could do was a couple of bed exercises to keep other muscles moving and working. The surgeon was here on Friday though, and when I walked by the male ward just before tea tonight I saw him with both his legs in plaster sticking out in front of him as he was wheeling himself about outside in a wheelchair with a massive grin on his face! So he must be chuffed to be able to move where he wants and have a change of scenery for the first time in weeks!!

I’ve been trying to learn useful words that I’ll be able to use when treating patients, like ‘bend’ & ‘straighten’ and useful things like numbers. It’s really good because there is a lot of contact with kids, so numbers and colours can be picked up pretty quickly and the physios are keen to try and teach me. However, one problem is that it’s not just people who speak Luganda who come here for treatment! Apparently most patients speak a bit, but there are many different dilects/languages and sometimes the staff who are local can struggle to communicate! So, we’ll see how my few words work!! I can't really imagine being able to treat patients myself here yet, especially with the whole language barrier, but we'll take it one day at a time and see how it all goes!

Since I only overlap a couple of weekends here with my friend Sarah, we’ve decided to make the most of it! So I’m just back from a weekend Safari at Murchison Falls!

No idea where to start describing that other than Amazing!! (My photos I’ve taken just don’t do it justice at all! ) A definite highlight was the boat ride up the Nile seeing Hippos really close; the giraffe’s were a personal favourite and one of the most amazing things I’ve ever seen was watching two lionesses stalking a massive herd of the Ugandan Kobs (which is the Ugandan national animal – it was some kind of antelope looking thing) ...So it’s been an amazing weekend, four of us went from the guesthouse at Kiwoko and in our minibus we were joined by two guys who were both travelling, but we’re all feeling pretty knackerd now!  It takes a fair bit of travelling to get anywhere from Kiwoko as it’s pretty rural, so that is pretty tiring in itself on the bumpy roads. And I also realised going to a touristy part of Uganda just how different it is to how Ugandans really live, so it’s been good to see the contrast. But there isn’t much time to write anymore just now, aiming for a fairly early night in order ready to start week two at the hospital! J

First Day in the Hospital

Really enjoyed my first day following the physios round, they are both lovely and took time to explain everything to me! We also had great fun as they tried to teach me some Luganda and I answered all their questions - they were very inquisitive about the UK and Scotland and how we do things there! All the people are so lovely here! We’ve just had a couple of the trainee Ugandan doctors pop round this evening to play badminton with us J

You almost just can’t compare what goes on at a hospital here to home. We went round all the different wards to check if we had any new patients that had come over the weekend and wrote down the ones that were still there from Friday, so that we had a list of what to cover through the day.  Apparently I am to expect a lot of patients with burns, trauma and who are weakened by diseases such as Malaria, HIV/Aids etc.

Just a brief outline of the day:

8.15ish – Morning devotions with other staff where we sang a few songs, someone talked through a passage from Genesis and there was time for announcements where anyone can say anything, I had to introduce myself to everyone as it was my first day

9ish – I headed to Rehab department, which is just one room on the end of the Paediatric ward, however the physios weren’t there yet, and I was reminded that we are in Africa!! They did come after a wee while and they inducted me about the place. We then slowly made our way to find patients as the whole place is in a bit of a muddle on a Mon morning as that is when every ward gets a deep clean, so everyone heads outside while that’s done. The wards are pretty hot and cramped with hardly any room between beds and every patient has an attendant (a family member) who washes and feeds them and sleeps on a mat beside there bed.

We started with a patient who had superficial burns on all her limbs as she had been saving her little baby girl from a fire one morning last week. I had never seen burns so bad but they seemed really relaxed about it all and said she would recover well, so I’m guessing I will see worse while I am here. They managed to do Range of Movement ex’s with her and got her standing for a few minutes, but it really took it out of her. Then we saw a lady with two broken elbows before heading back to the Rehab dept for the class for Malnourished kids. They were so cute! But they were just tiny (the three year old barely looked older than one) they were really quite underdeveloped. We played with them, trying to encourage them to sit up/play with toys and one of them was able to walk a little and kick a football and then we sang with/for them before they left!

1pm – Lunchtime (funnily enough lunchtime dosn’t seem to be late, which suits me perfect!!) The ladies at the guesthouse make us lunch during the week and we had a lovely shepherds pie today! They seemed to add a few different vegetables and more flavour which was nice.

2.15ish – back to rehab dept. We had a long conversation where more questions were asked about where I’m from – Do you have monkeys? Gorrillas? How about Crocodiles? No lions?! Then we decided to go see the rest of the patients which ended up being a wee boy who seems pretty unwell with a very swollen belly because of fluid in his abdomen, fluid in his lungs and many other complications, so we were encouraging him to play games with us, go up and down steps and blow bubbles. Then we got a man who had fractured his femur and needed a few pins to fix it, using a walking frame and then crutches. And we were done about 4.30ish.

They seemed to have a reasonable amount of toys for the kids but some of the equipment like walking aids are very old and I noticed the kid size walking frame only had one wheel that turned around, and it was pretty stiff as well.

There was so much I didn’t have time to write about last time! Just the simple things that I’ve actually got fairly used to in the last few days; like the unreliable electricity, the fact you have to boil the water and filter it before you use it even for your teeth and that you shouldn’t really use the inside toilet and if you do, only flush it once a day between everyone in the guesthouse!

I was starting to think there wasn’t even much point in using the shower as only a trickle (and I mean trickle!) of cold water came out of it, but thankfully I discovered tonight that the upstairs shower in the Guesthouse feels like a power shower in comparison, well, that’s maybe an exaggeration... but I do feel clean after it which is a bonus!

Oh, and I am loving the African transport! Muttattu’s with 20 odd people squished in, and Bodas (Motorbikes with a driver that fits two extra people on) to take you to church 5km away!

I feel I have so much to learn here which is very exciting, I’m loving it so far and feel like I’m settling in. We’ve just had another medical student arrive today so there are now 5 of us in the guesthouse which is lovely, we all try and make tea together every night and it’s good to chat over everyone’s day together. I also realise that it’s not going to be easy though. Death is so common at this hospital and it is really difficult to see some patients so ill. I’m certainly learning to trust God but also learning to appreciate more of his creation in this beautiful country and with these people that he made and loves (which I will remind myself of many times I’m sure when there are misunderstandings and culture clashes)!