A Day of Transformations!

We got to go to beautiful Ssanga for clinic today - photo below stolen from Peter Gregson's wonderful blog (https://petergregsonblog.wordpress.com/). Please see his and Tony's (https://disboblog.wordpress.com/2019/01/31/sleeping-babies-at-ssanga/) fantastic blogs for brilliant and clear descriptions of our day).

Ssanga is a lovely place to work, nestled amongst the trees and in the countryside, with patients sat outside on the grass, under trees, waiting for us. Unfortunately, the church there is a little small for such a large medical team so we did feel a little cramped. The other problem with the location (or perhaps more my choice of clothing) was the toilets.... You begin to get used to having to squat over a hole in the ground after you've been in rural Uganda for a while. What you don't get used to however is the number of flies that fly up at you and then the rising damp travelling up your baggy trousers when you wade through a small flood created from other's struggles with aiming.... I don't think I have ever been so happy to change my clothes when I returned to the hotel!

Just before we had a break for lunch, Dr. Mike Wong appeared after his 36 hour journey from the UK! Unfortunately, his flight had been delayed due to snow in Manchester. Despite journeying for so long, Mike was so dedicated to the work that he came straight to the clinic and began seeing people! It is very hard to comprehend that it is so cold in England when it is sweltering hot here in Uganda. Together, the team worked our hardest, brushing sweat off our brows and saw another diverse range of fascinating and resilient people, along with a few familiar faces, which made my day!

• A young gentleman required a home visit as he had been paralysed from the waist down due to being shot in the spine in September. This was due to someone trying to steal his motorbike. Unfortunately, this man is now incontinent and so gets too embarrassed to leave his home. We are considering how we can refer him to the spinal specialist unit in Mulago.

• One little 4 year old girl was seen who had sickle cell anaemia. She had been so used to having infusions in hospital that she was scarily compliant with examination and investigations - especially compared to her screaming peers.

• There were many people who had been in the army and fought in the Ugandan wars. One such gentleman who was in his 60s, was very talkative, describing how he jumped out of planes!

• One lady came to clinic with an exercise book filled with her scrawled medical notes from a mental health review clinic. She had been diagnosed with Bipolar Affective Disorder around 55 years ago. She was on Chlorpromazine, Carbamazepine and Trihexyphenidyl. Simon, our orthopaedic specialist, was able to inject her arthritic knee for her after I spent a while educating her on how her arthritis was not in fact a side effect of the medication and explaining to her about what her illness was as it seemed like this had never been explained before. It was interesting to compare her psychiatric notes to ours, with some mental state exams stating "she looked nice" only!

• I met a 90 year old lady with a very sad story. She had bilateral cataracts and had been completely blind for almost a year. She lives with her 2 elder sons but they "are drunkards" (according to her) and would leave her on her own for 2-3 days, unable to cook for herself. The church had been helping out as much they could however. This lady did not have any shoes and appeared depressed. She was however doing very well for her age! We are working out what we can do to best support her at present.

• The first familiar face that I saw was Maria! The incredible lady that I met in the Summer who has withstood a huge amount of domestic violence from her husband towards her and her children. We diagnosed her with HIV and TB in the Summer. I am so pleased to say that today, Maria looked fantastic - what an improvement! She has transformed from a depressed, reticent, emaciated, abused wife who cried every day, into a ray of sunshine, who had put on a little weight and couldn't stop smiling! She has now completed her TB medication and has been discharged. She is on antiretroviral medication and feels well. Her husband stays elsewhere most of the time, visiting only rarely. She states that she does not worry about him anymore and there has been no further domestic violence towards her or her children. She gets food parcels for the family every month and we are trying to find sponsors for her 3 children (as her ex-husband is now looking after her eldest son). We did have to treat her youngest child who had malaria with a temperature of 39.6 however!

• I was also delighted to see Belinda, who has now renamed herself Bridget, who I met in 2015 and diagnosed with psychosis. I spent a great deal of time with her and her family, educating them about mental health at this time as the community used to tie her to trees due to her responses to hallucinations and delusions! She was assaulted due to being so vulnerable and thus had a young son from this attack, along with developing syphillis, which we treated. Now, she is on medication prescribed by Butabika Hospital and she looks so content, happy and settled. She came to clinic today in a red dress, with braids, greeting me with a very large grin and hug - another transformation! Unfortunately, she did not bring her medication so she is coming back to our follow up clinic and I will review her medication then however her mental state seemed stable.

Although we meet people in awful circumstances doing this work, it is very affirming to see the transformations that can happen when the social support, medication (where needed) and education about the illness is provided. I have witnessed so many transformations during my time with Children of Hope and I hope to witness and help to bring about many many more.

We had a team debriefing this evening, going over patients who we wish to follow up and who we feel need more support. It is our first follow up clinic tomorrow and it is at Bombo. We aim to see patients in the morning, returning from the clinic on Monday. In the afternoon, we have designed teaching sessions on women's health and mental health, referring appropriate people to them from the clinics, and the news has also been spread around the community.

Tomorrow night, we have 4 of the brilliant translators staying with us and I have the stunning Christine staying with me in my room! I will try to blog but may not have time! To be continued...!!!