After what was a very small amount of sleep for most of the group due to the heat and how late we got back last night, we all arose bleary eyed, and took the long and bumpy journey to Nakaseke. Thankfully, today was a slightly shorter day but we still saw 192 people and got back to the Hotel at a similar time due to traffic.
Every time I go to Nakaseke, I am shocked at how difficult life seems to be for most residents. Nakaseke was at the heart of the Guerilla warfare and the poverty levels of those left behind and their new families are terrifyingly high. Even so, all those who come to clinic dress in their very best smart clothes and it is only when you acquire a social history that you begin to realise how much they are struggling. Many are immaculately turned out despite this and I even saw one girl called Immaculate! The majority of the people that I saw in clinic work as, what the Ugandans call, "peasant farmers", which means they spend most of their days digging and carrying very heavy loads up until they are too frail to do this. I saw a 78 year old woman who dug for 12 hours a day! Understandably, she had a sore knee! Pauline saw an 84 year old farmer with no shoes or socks. She was able to find some shoes for him and give him painkillers for his arthritis. It was wonderful to see lots of elderly people attend the clinic, as around 50% of Ugandans are under the age of 16 so elderly people are rare sadly.
In addition to the elderly, we saw all sorts of incredible people today including:
A whole family with hyperkeratosis, a genetic condition which causes skin to become very thick, similar to that of a crocodile's. Tony has photos of this on his blog (https://disboblog.wordpress.com/). Thankfully, the skin did not look like it was infected so they were given Vaseline to moisturise the skin and some education about the illness.
A terribly suffering teenager who I diagnosed with endometriosis. She was bed bound for 6 days of the month for 2 years, unable to study (she was at boarding school) or work due to the pain. She was also bleeding a large amount. I was able to give her strong anti-inflammatory pain killers and iron tablets. Kirsten is a GP with a specialist interest in gynaecology and she is going to lead a women's health education session at Nakaseke next Wednesday (and Bombo this Friday). I explained about her diagnosis and advised this poor girl to come to Kirsten's session to find out about contraception but advised her also to go to a family planning clinic to obtain free contraception (preferably the coil) as soon as possible.
Kirsten was able to see multiple ladies with significant gynaecological problems and had to treat multiple patients for pelvic inflammatory disease. We keep encouraging the use of condoms and will continue to do so in the women's health sessions however condoms carry a huge stigma with them in Uganda as, if someone uses one, people believe they have HIV.
We had a few ladies with very high blood pressures - up to 220/130mmHg - and were able to treat them.
Simon was able to give steroid injections to multiple painful knees
I saw a 10 year old boy who had moved from Jinja (near Lake Victoria) to Nakaseke 4 years ago, when his father died in a truck accident and his mother could no longer afford the house. She now works as a "peasant farmer" and very much struggles to make ends meet. The boy began to complain of pain when he urinates for the last few years. He had a scan 2 years ago which showed "bacteria or virus eating away at his bladder" but his mother could not afford the treatment so she left it. He has blood in his urine so I wonder if this is Schistosomiasis. We are bringing him back to the follow up clinic on Wednesday to treat him, as we will have to order medicine, and to get the Pastor to find out more about the family's social circumstances in order to work out how we can best support them. We gave the family biscuits and mosquito nets.
It was very positive for the team to review a lady who has been seen repeatedly in clinics previously and who is HIV positive. She has Kaposi's sarcoma on her foot, which has healed wonderfully with chemotherapy, multiple dressings from our clinical team, and aided greatly by Children of Hope building her a house (as she could never keep her foot clean in her previous shack). We were able to give her an orthopaedic boot with a built up area, along with some wedges that took her other foot to the same height and fit her perfectly! She was delighted with this.
Another lady had some rare and painful HIV associated tumours, which she was treated for.
My most memorable patient of the clinic was a 38 year old who had learning disabilities, psychosis, which appears to be currently in remission and epilepsy (with previous tonic clonic seizures). This poor woman had been severely emotionally abused and neglected by her step-mother all her life. Her step-mother would not let her eat, would insult her, got witch doctors to curse her and even cast her out of her own home. This left my very vulnerable and (then) psychotic lady without a home and she was sexually assaulted. From this, she contracted HIV and had a miscarriage. She has no chlidren. Thankfully, her biological mother returned when her father died (as they had separated) a year ago. Her mother took her to Butabika Hospital where she was treated and the psychosis and seizures are now almost completely under control! This woman had attended the clinic with her mother as they could not afford to either buy the medication from a pharmacist or travel to Butabika Hospital. She is returning next week with her medication and records so I can work out what she is taking and see how best and possible to help her. She was remarkably resilient and, although she had a stammer, possible echolalia and slight pressured speech (very difficult to tell through an interpreter), she and her mother denied any signs of depression, anxiety or psychosis saying that, now she lives with Mum "[she] ha[s] a life of peace". This did not stop both my wonderful translator, Fresera. and I welling up with tears when she described her traumas however.
Interestingly, out of the 9 malaria tests done today, no-one tested positive, whereas yesterday we had multiple positives! We had HIV tests today as they were delivered last night. We did 2 tests which were both negative thankfully and 1/3 pregnancy tests were positive.
The day was very tiring, especially due to the heat - around 30 degrees! Even the Ugandans were struggling so a tarpaulin was put up to create shade for those waiting. This is a rather disparate snowy Northern England, but I feel that some of us are longing for that right now - she says, dripping with sweat sat by a fan in her room!
We have a day off tomorrow, to sort through our medications, clinic notes and for some to go on a Walking Tour of Uganda. Goodnight!
