So this is probably going to be my last entry on here whilst I'm in Uganda. I've printed out some of my boarding pass, though for some reason it wont let me check in my flight from Amsterdam to Liverpool. I think it might be because that flight isn't within the "30 ahead of me bit"yet. So I'll have to try and print that out tomorrow morning before I leave.


Buluba went really well. We didn't manage to get to Kumi in time, but that will have to wait until another visit in the future perhaps. Whilst in Buluba though, we did manage to re-organise some problems with running of vehicles and re-started an outreach program that failed some years ago. So all in all that trip, although extremely brief, was a success in many ways.

This is just a brief message to say that the trip is almost done, and there's only few remaining hours left before I'm on a flight home. I'm really excited to get back and see everyone again, and I'll post up here when I safely land.

Byeeee!!

Written on 22/10/10 (Last Friday I know, but not had a chance to get online since...)
What a day. I'm so pleased with how everything went! Ok, so we started off with a plan and timetable, but that pretty much went out of the window when the bus with all the students turned up late, and then the patient came even later. But after a bit of jiggerypokery, we were back on track and stayed within the time scale that we needed to in order to manufacture two limbs for demonstration purposes.

So we were originally going to have those two groups and have each of them produce a leg, but as saying above, time didn't allow us to do so. Instead it was just a demo, one produced by myself, Patrick and Frederick and then theirs that they made almost exclusively themselves. It was actually a really good exercise not only for themselves, but also for me. I've never really taught anyone anything before, and certainly not in a classroom environment like this. But whilst standing there in the limelight, students AND teachers watching me to see what I have to say and do, I realised that this kinda rocks! I'm seriously SO pleased with how the day went, and  I've never even considered teaching before until today. It's not as hard as I thought it would be, and I found that as long as I was confident in what I was doing and took control of the class, things went according to how I wanted them to. OK, I was nervous before they arrived, but once they were seated and I had them doing what I wanted (watching a DVD on Jaipur feet) I knew that the rest of the day would go well.


Basically I demonstrated the casting procedure for transtibial amputees - markings, hand positions and the reasons for each. Apparently they cast differently to the way I was taught in Uni', but I was stoked to see them wanting to try my method. They're so keen to learn new stuff here, and I was enjoying showing them. We then just went through the rest of the procedure for making a Jaipur limb (I'll write it up soon and post it on here if anyone's interested). The other technicians all helped out too (especially Patrick who's an absolute saint) and we managed to almost get 2 legs made in a day. I think in the future we'll skip out the idea for 3 legs and keep this template, perhaps reducing the class size to a more manageable 10.

Obviously the students massively benefited from the day too. With such constraints on material and resources that they have  in Mulago school (where they're all from) a day like this, where they get to actually make a leg is a huge bonus. I'm still not entirely sure how they selected the 15 out of the 74 to come though. When asking one of their teachers, he explained that he used their grades and experiences that they each have to allocate them a position.  They were a great bunch and it was a pleasure to teach them.
It's actually going to be the last time that I see them all on this trip and its quite sad to think of that. Originally I was here just to learn about the Jaipur foot and see a few clinics in Uganda, helping out along the way wherever I can, but it's been a lot more than that. So much more. Whilst I've been here I've met the most amazing, determined and dedicated people. Not only have I practiced and taught whilst being out here, I've also witnessed the opening of the 4th rehabilitation centre in the country, witnessed the signing of an agreement to bring students from Mulago school (the only one in Uganda) to the GLRC, been a guest speaker at the Rotary Club and passed on knowledge to technicians that I've worked alongside for the past month. I don't really want to start wrapping up this trip in this blog just yet, but somehow the experiences today have consolidated my thoughts on my visit so far and clarified what I've witnessed. The contract between school and GLRC is perhaps the most important out of that list, such that I hope that the GLRC will become a strong training centre, producing sound prosthetists to be distributed throughout Uganda. THAT is a massive step forward for the country, and hopefully the lead for the future.

Anyway, the trip isn't over just yet as I still have two working days left (Patrick and Fred are away for the weekend to visit family). I'm hoping that I'll get to travel up to Buluba clinic and then possibly to Kumi (North East) if we're in luck with time and get funding from a sponsor to service the pickup for a longer journey. It's a 6 hour drive though, so I'm not sure how practical it will be to get there and back in time for Wednesday for my flight back home. As much as I love it here, I'm excited to get back.

Not using my own computer this time, so no photos unfortunately, just a brief update on what's happened over the past two days. I've actually finished my time in Mulago School for Orthopaedic Technology, though not entirely with the students. I've been sitting in with the students in some of their lectures, buried in a crowd of 74 in that tiny room I posted a picture of the other day. It's pretty mental and everyone's all bunched up together somehow, most with seats... I got a chance to go around and talk to some of the students, and their knowledge is pretty fantastic on human anatomy and what's being taught and only a couple of lessons were literally "rained off" through thunderstorms. One of the students explained that usually if there's any sort of an excuse for a lecturer not to make it, then they'll usually fail to turn up (with the exception of Mr Kyondo) and one lecturer hasn't taught in over two months!

Yesterday, after classes here, Dr Wanume took me to the weekly meeting of the Rotary club of Kymbogo in Kampala. I didn't actually realise that I was going to be the guest speaker for the evening until half way through a mouthful of peanuts and beer, I was asked to come up and talk about the progress so far. I think I did pretty well considering it was improvised and answered a few interesting questions on the differences between Jaipur feet and more Western designs. I went on to explain that really, although the foot is very simple in nature, it IS it's simplicity that lends itself very well to certain situations. I feel so far that the jaipur limb should just be considered another tool in the prosthetists tool box. It doesn't necessarily need to be used, but it's good to know that it's there and can be prescribed for cases where poorer patients may not be able to afford or maintain a more expensive limb.

Anyway, 15 of the 74 3rd year students are coming to the great lakes rehabilitation centre (GLRC) tomorrow for training and education in the Jaipur limb, and I'll be demonstrating with the knowledge  that I've gained so far whilst being out here...how to manufacture it. I've got help from Patrick and Fred, but it's still going to be a tight schedule to squash the making of 3 legs from start to finish in in one day. To get an indication of how much time to allow for each stage, I asked one of the students how long it takes them to rectify a cast. They told me between 1 1/2 hours to 2. I've allowed them 30 mins. Should be interesting...

Written on 18/10/10
So following an awesome weekend in Jinja rafting, it was back to work again. Today I was taken into Mulago hospital where I was based for the day.

So a bit of background about the centre there:

As far as I've learnt, it was originally opened by a Shelly Cox from the University of Strathclyde back in 1992. She founded and laid the path for its progress, whereby the British Red Cross provided funding for the project and a period of time. After a few years, she left, only to be followed by a German filling her footprints. Then, in 1994, that guy left and a Jane Hunter joined for a year, leaving in 1995. At that time, the sponsorship from the British Red Cross ended, and gradually since then, funding has plummeted alongside their stock that they have here (but more on that later).

Classroom for 75 students

I travelled with Dr Wanume, meeting Patrick there (he lives in the area), though once I was introduced to Dr Mugisha and Mr Kayondo, he left to head back to his own clinic. Dr Mugisha is the president of 18 paramedical schools and was apparently extremely eager to meet me before I left. Mr Kayundo is the only full time staff member for the school here, with the others only being part time and frequently unable to attend. This guy has a mammoth job and I applaud the amount of work that he has to do every day. Today, an agreement and contract was signed between Mulago Hospital and the Great Lakes Rehabilitation Centre (where I'm working) to allow 15 students every 6 months to train at our centre. The reason being to allow the best of the students at the hospital to have further education and experience in manufacture and materials. The reason for this is explained below:

Originally the course was designed for 15 students to attend every year and to train for a period of three years with over 300 students that apply. However, with the increasing amount of pressure from the government and the ministry of education, from the year 2006 the class sizes have exponentially increased in size to a ridiculous total of 75 per year. That's an incredible percentage increase in such a short time.

Depleted stocks

Empty shelves

And the teaching isn't the only problem. Since the centre was originally designed for 15 students, that means the amount of equipment, tools, materials and classroom sizes are also all designed for that size. There's one lecture room for all those students and it's nowhere near big enough.  Even the equipment that they do have is very limited. At a glance it doesn't look too bad, but it is. Two of the three routing machines that they have are broken and the oven has been out of order for five years. Materials that were originally available for the 15 students are almost exhausted, resulting in students unable to complete much of their coursework until further supplies arrive and having to work in large groups to keep costs at a minimum. With lecturers almost entirely part time, many are late for lessons or cannot attend. However, even with all those complications, drop out numbers from the course are at a minimum and they all attend with impressive enthusiasm to work, attending smartly dressed in shirts and ties. It really is inspiring the spirit that they show to learn, it's just such a shame that they can't be provided with better resources. It really does make me feel incredibly grateful that I was able to receive such great education with apparent ease. There is SO much that needs to be done and improved here. That's why that contract that was signed today is hopefully going to be the beginning of a step forward.

Patrick with a students cast

Today was mostly about me meeting those listed earlier and for me to meet some of the students. Fortunately (for myself), not all 75 of the second years turned up, and I was able to chat to as many of them as possible before the day was over. They were all really keen to hear about the course in the UK, similarities and differences, but had so many questions about jobs at the end of the degree. In Uganda, only 10 of the 75 will get jobs in the public health sector, a  few will work for private companies, with the rest going into the "army"  trying to get another job and pass time until they can be absorbed into the system.

Tomorrow I'm attending the school again and I'm hoping to continue a list of possible improvements and guidance that can be established in the near future. I think the plan is for me to stay there until Thursday, with Friday being the day on which the first select few students will attend the GLRC here.

So after a solid two weeks of working in the Great Lakes Rehabilitation Centre, treating patients, giving some guidance and advice to the technicians here, traveling to Kabale to open a new prosthetic centre and gaining an insight and understudying in the Jaipur limb, I took a weekend off to free my mind a bit. I headed out to Jinja, the source of the Nile for some white water rafting. There's no way I could travel all the way out to Uganda and not see some of the countryside for a few days. Jinja is about a two hour drive outside of Kampala (if you're lucky with traffic jams) and in an easterly direction.

Got up early and arrived there via the companies bus for about 10, where we got a free breakfast and were kitted out with helmets and lifejackets. We were all paired up into groups of 7 and then driven down to the river. There was an insane number of us who were going, and I think it was more than normal. Actually, there were about 13 boats on the water, whereas they normal have about 3? Anyway, we were all given safety instructions and training on how to paddle, the commands for forwards, backwards, stop, and GET DOWN. Following that we all set off down the river and towards the rapids. Not done it before, but I'm SO glad that I did, its AWESOME!

There are actually seven main rapids that you go down, each totally different from the other and the hardest being a grade 5 (which out of 6 is pretty damn high). We managed to make it all the way down to the bottom without capsizing, though I'm not entirely sure how, since on a couple of occasions we were either going backwards or on our side at the brink of falling out. Once, a guy in another boat flew out and broke his arm by smashing it on a rock and I think a girl either sprained or tore something in her ankle. Nice! About 3/4 of the way through the trip, and whilst we were in a calm section where you just have to paddle for about an hour until you reach the next bit, we were chatting to our Austrian guide and found out that this was actually the very first time that he had rafted down the Nile! Turns out it was fine though because he had Kayaked down it "a few times" and rafted for a company back home. Great. But nobody died, so that's ok then!

On the Sunday I hired a bike too, and was just given a map and sent on my merry way on my own. I cycled down a load of dirt paths and through villages, when all the little kids run out shouting "Muzungu" (white person) and "Give me money". There are some amazing views along side the river and I took a load of photographs. But once again, photos never do it justice...

Back to work tomorrow, and serious work. I'm working in a school of prosthetics and orthotics with huge class sizes.

The crew - Dr Kale Wanume, myself, Patrick, Frederick and the driver

Written on14/10/10
So, at 6 am on Tuesday, we set off to Kabale to launch the new rehabilitation centre that has recently been refurbished and equipped as best as possible to treat patients and manufacture limbs for those in the South West region of Uganda. Kabale is right down there in the bottom left of the country, bordering the Congo, Rwanda and Tanzania (Rwanda being the closest at just 20km away from this town). Therefore the drive there took a good 7 hours (plus toilet breaks) and we got there for about 2pm. But the journey there itself is just as amazing as the destination. After just over an hour to get through the regular Kampala traffic jams and get out of the city, houses quite quickly fell behind, thinning out as we entered the countryside, and what a countryside. Perhaps it was being used to the hustle and bustle, dust and smog of the city, or perhaps it was through brute ignorance, but I had absolutely no idea just how green this country is (and I don't mean in terms of recycling).

Equator!

Once we were only into a fraction of our journey, landscapes literally changed before my eyes. Scanning my eyes out of the car window as we moved along, all I could see was a sea of green and lush vegetation, carpeting the ground and meeting mountains in the horizon, broken only by the occasional cluster of houses denoting small villages. Small street sellers stood every few miles at the side of the road with their stalls selling various fruits and vegetables - bananas and tomatoes being the most common. In fact, I've actually never eaten so many bananas in my life before this journey. In fact, we had to stop twice to re-fill our stocks. I must have eaten at least 10 there and more than that on the way back again. I tried taking a couple of photos of the scenery and everything, but they really don't do it justice. Its hard to capture a jungle of Mahtokee spanning into the distance with a camera. We didn't need any radio or any entertainment since the views were enough to keep us occupied. That and my introduction of how to play I-spy with them.

Markets at the side of the road

On our way down there we also passed the equator! Got a couple of photos of us all standing there together on the line between the southern and northern hemispheres, though Fred isn't the best photographer and he missed out the N/S sign. Anyways, after the long trip with 5 of us squashed in that little pickup truck, we eventually arrived at Kabale. By now the temperature had dropped significantly due to our altitude  driving up into the mountains, and we had to wear jumpers or a coat to stay warm - quite different from the capital. We basically just ate and had a quick tour of the centre prior to everyone arriving tomorrow, though it was apparent that there was a lot of work and cleaning to be done before then. The prostheses that were to be worn by amputees as a demo were also in need of looking at, since trim lines of the sockets were way too high and the overall appliances weren't that great. So a couple of us set some time aside to cast a patient, rectify some casts and sort out the existing problems. Following all that, we just went to bed for the night and figured that we'd sort the rest out the next day. Dr. Wanume put us all up for the night in a hotel, and was relieved that we weren't sleeping in the plaster room like he had suggested.

Dr Kale Wanume, Caleb, myself, Frederick, Patrick and the centre's new manager

The next day, we were all due to wake up at 7:30 and then meet up some time after that for breakfast and assemble some sort of plan for the day. But
 Dr. Wanume decided that he'd do the honour of waking me up at 6:45, so that was nice. Anyway, we all ate breakfast, comprising bananas (again), potato, beans and everything else that sounds like it should be eaten for lunch or dinner. Tea was suspiciously milky, in fact, I think it was milk, but all in all it was very tasty and a good start to the day. In the prosthetic centre, we prepared everything else that needed to be done for the day, like finishing some rectification, and preparing speeches for when everyone arrived. People began to turn up at about 3, and talks were well underway for the opening ceremony by 5. With some delay due to some key people breaking down on their way in their cars, we were a little behind schedule, but it still ran pretty smoothly. The vice chairman for the local rotary club, politicians and other guests other than myself gave speeches. I said a few words about being over here and visiting the centre to help out, congratulating the club for finishing the centre and wishing them the best of luck for the future. A tour was given to the people that turned up, and Patrick, Fred and I gave a live demonstration on how to drape a Jaipur limb to them all. The rest of the day was left for people to walk round and discuss things, followed by dinner. It was all very impressive and everything went pretty smoothly (with the exception of the cow that wandered onto the field where the speeches were being given).


So I'm actually back in Kampala again. We travelled back earlier yesterday and had that same long seven hour trip back, past all the greenery. I thought I saw an elephant at one point, but after closer inspection, it was just an overly large rock. It's been a mammoth journey for just 3 days, and I wish that I could have stayed longer. I'll just have to return at some point in the future to see all the things that I missed.

Written on 9/10/10
So, the power went off this morning but its back on again. It only stopped us manufacturing a limb for an hour or so. The transtibial amputee came later, and we fitter her with her first leg. She walks really well but it's going to take some time for her to get used to the new limb that she's been given - she's not walked in over a year and a half. Overall, we were very satisfied with her progress in just one day and we'll have her back in a week for some more gait training on it. Hopefully she can be fully discharged within about 2 weeks (latest). Generally the main trouble is followup appointments here, but she seems pretty proactive, so I doubt that will be a problem.

The rain has finally stopped, and the sunshine is back out again. It's actually really good that we can work under a roof and in some shade. Working in a full lab coat in this temperature would reduce me to tears if we didn't have that relief. We're all going to Kabale on Monday (takes a whole day to get there). It's a four of five hour drive, but we're going up to launch a new rehabilitation centre; therefore I'm not sure when I'll next be online to update this blog. I'll update it once I'm back here in Kampala though. Fortunately the weather has cheered up again, the sun is out and everyone is rejoicing. For some reason we have both electricity and water at the same time (they must have fired the guy in charge), and I finally caught that gecko - though once I had it, I realised that I had absolutely no idea of what my intentions were to do with it.

Written on 8/10/10
The weather has cooled down here a lot now and we had our first rain in nearly two weeks today, HEAVY rain. Makes a refreshing change and kinda settles most of the dust that rises off the beaten pot-holed roads. I went on my first bodaboda yesterday (motorbike which you ride on the back of and generally helmetless). It's kinda risky but soooo much fun. In some cases they're much better than a car because traffic jams build up regularly and the bikes can just nip in and out the cars quite easily. Wouldn't want to make a habit of using them though, especially since most of the patients that we get at the clinic are due to road traffic accidents…. Still, I couldn't leave here without having gone one one since they're absolutely everywhere.

We were mainly finishing of prostheses today - one transtibial for a lady who's due to arrive tomorrow morning, and one for that transfemoral amputee who may attend in the afternoon. It's Uganda's independence day tomorrow though, so I'm not sure if that plan will stick at all just yet. I'm also planning to meet the chairman for the Rotary club of Kyamboko in the afternoon (the area that manages the funds for this district), and perhaps if I get time, I'll be able to see the international trade fair thats setting up for the next 4/5 days here. Everything is made so much more simply here. For instance, chipping out plaster from a socket isn't done with a hammer and chisel, it's done by smashing the socket against a brick. Smoothing trim lines and edges isn't done by using the soft mop on the routing machine, it's done by running a broken piece of glass around the surfaces. And attaching the foot to the shin isn't done by means of a bonding agent or central pylon, its done by screwing four regular screws through the plastic shin and into the foot.

Following the completion of the leg, Alex took me to the British Embassy where I'm supposed to let them know my whereabouts and the fact that I'll be travelling around and in different cities of Uganda. Wasn't very successful though, since after queuing for nearly an hour, I was told that they don't do it in the office any more, but instead on the internet, handing me a link to it online….  Never mind, it gives me an excuse to get online and update this now. We also visited a young guy who had lost his leg in another road traffic accident. He served in the fire brigade, but when his fire truck overturned on a sharp corner, he lost his leg below his knee, becoming a knee disartic patient. Unfortunately though, the scar tissue hadn't formed well and since it was still poorly healed, it's going to be at least a month, perhaps two until he can be treated at the centre.

Back at the GLRC, the three of us (Patrick, Fred and myself) got back to work on the remaining transfemoral limbs - mainly the elderly unilateral guy since he was most needy. After much rectification, extension buildups to the knee centre, some guess work, a power cut and a lost hammer, we managed to get it complete in time for him to arrive tomorrow for a trial fit. Patrick also showed me a KAFO that he's recently finished by using the same draping of the plastic pipe method. It's amazing what they can make here, pretty awesome. The rest of the day was pretty slow, spent talking, reading, and I passed some time trying to catch a gecko.

Written on 06/10/10

Practice at transtibial rectification

Another proactive day today. A transtibial lady arrived for casting and measures to be taken for her first Jaipur limb, although she had her amputation over a year ago (last July). Very nice lady, and this was an opportunity to compare my technique for casting a transtibial socket against the way they currently do it here. To be honest, from the way Patrick best explained, it didn't sound too dissimilar, although there were a few extra anatomical landmarks that I use and they said that they hadn't. I've not yet seen the way they cast, so next time, I'll ask to see their methods.

Using that cast we went through rectification and I think that this served more as a reminder or revision on the topic. They said that they attended a training programme in Kabale (a city about an hours drive north east from here) a few years ago, and an American supposedly showed them the same concepts as I demonstrated to them today. We just discussed various areas for removal and addition of plaster and the reasons why. We also had enough time to rectify the transfemoral casts that we took yesterday, and Patrick copied the way I showed him on his own cast. Working up until about six pm, we draped the casts in pelite (a softish foam liner to go in the socket next to the skin within the prosthesis), and tomorrow we're going to attempt to complete as many of the three limbs as we can. Although it's Uganda's independence day on Saturday, we'll try to complete hers by that morning.

I was supposed to attend a Rotary club meeting this evening with Dr. Wanume, but he travelled to another rehabilitation centre further north from Kabale, in an area called Buluba today, and he was late getting back. Therefore, we're delaying that meeting and we're going to go on another day. Shame really, it would have been nice to attend that.

In other news, we still don't have running water here (hasn't been running since I got here), and the storage container is now empty. I hope they fix that pipe that burst sometime soon, because a shower (all be it a weak cold one) would be nice one day. Also tried a load of mad fruit, like this orangey/red banada called Matokay, and a big apple type thing with loads of really hard seeds in it designed to make it exceedingly difficult to eat.

Guavas from a tree in the garden in the GLRC

Written on 5/10/10

Bilateral transtibial/transfemoral patient

Ok, so I've just finished my first real day of work. We had a bilateral patient, though he turned up really late, like 3 hours late, but that's fine. Transport isn't exactly the easiest thing to get by with here. So he came with two prostheses that had been sent over from a western country, and then had a socket made here for him to fit (this was all in another centre elsewhere in Uganda). When he arrived, his transfemoral leg had his toes pointing about 45 degrees inwards which looked really uncosmetic. The aim for today was to basically fit two new legs that had been made for him, but it became apparent that when we tried them on, whoever had made them had made the left about 6 cm too long. The socket was also a really loose fit, so he moved around in it. Therefore the idea was put forward to re-cast him properly. The only problem was that if we made him  new legs, then the ones that we would be giving him would be a far more basic ones than he currently has. I suggested that we just fix the toe problem that he has at the moment so that he can keep what he's used to, rather than moving him in a backwards direction to a cheaper leg made of drainpipes. (The transfemoral side was made of carbon fibre!). We casted him anyways as a pure training session for the two prosthetists here, and I demonstrated the way were taught in Uni'.

BUT, it wasn't all as simple as that. Once again, poverty raised its ugly head, and we soon realised that in order to rotate that foot outwards and back to its normal looking position, we would need a ring spanner.  After looking in the only tool box, we found that we didn't have one. We tried turning the bolt with a pair of pliers, but after 15 mins, our efforts were fruitless. We were almost ready to give in, when before I knew it, we were dismantling a huge drill and crushing a pipe in a vice around a similar sized nut to create our own spanner. Amazingly, this industrious idea seemed to work and we were able to remove the bolt, rotate the foot and then re-position it back in place with it tightened as best as possible. The patient seemed happy with the results and he went on his merry way. The creativity here with what they have is excellent, though we would have saved an easy hour if we just had that simple spanner - something that we take so much for granted in workshops back home. On another note, I was amazed how well the patient walked, especially considering that he was bilateral transfemoral/transtibial and walked with a locked knee joint.

New transfemoral patient

Another patient arrived today that Dr. Wanume had brought back from his clinic. He was an elderly bi-lateral amputee, losing his leg due to gunshot. He had never had a prosthesis in over 6 years (when he sustained his injuries), so Patrick and Fred showed me their version of casting, which doesn't seem all that dissimilar to my method. We also spent a few hours going over some basic transfemoral revision of suspension techniques, socket designs and concepts and touching upon some upper limb theory - though they don't see any upper limb patients here.

It's been a great experience and the patients have been so refreshingly thankful and pleased to receive any sort of treatment. I'm really beginning to enjoy myself here, and everyone is so friendly, especially here in the centre. The other prosthetists (or technologists as they prefer to be called) have been teaching me little bits of Swahili and Ugandan, though I'm pretty rubbish. They keep reminding me of the different name of fruit, plants and trees that grow here in the garden, and names are gradually beginning to sink in a bit. The food is pretty tasty too, though I must admit that it's a first for me to have both spaghetti, rice and mashed potato all sitting next to each other on my dinner plate. They tend to cook a lot of different stews, beef and fish being the most common, with maize and a fruit called Matokay (not sure how to spell that) from the banana family that's heated and mashed up. Its all good stuff and I've not had any     *ahem*    traveller's troubles as of yet….

Managed to get back to the internet cafe again today, so thought I'd take the opportunity to explain a bit more about the centre that I'm in and more about the Jaipur limb….

Basically, disabled persons constitute an alarmingly high percentage of the disabled population in developing countries, especially in the Great Lakes area of Africa (which is where I am). This area includes Uganda, Sudan, Kenya, Tanzania, Rwanda, Burundi and the Democratic Republic of Congo.

Generally, whenever disability strikes a person here, they re-locate to rural villages since they can no longer sustain themselves in cities and towns. Here, they either depend upon support from enlarged families, lead a very different solo village life, or perhaps the more industrious ones will make themselves walking sticks, home made crutches or prostheses.. Naturally, this makes it difficult for these disabled persons to access and receive suitable rehabilitation services and help.

There is an estimate of 40,000 amputees in the Great Lakes area, with 400,000 individuals affected by polio. Currently, services provide cover for less than 20%, with the remaining 80% unable to receive treatment.

Located in the suburbs of the capital city of Uganda, Kampala, the Great Lakes Rehabilitation Centre (GLRC) has been established in order to help effectively train staff to manufacture basic low cost limbs that can be provided free of charge to some of these patients (where I am right now). The challenge that the centre faces is being able to improve accessibility to orthopaedic appliances, aids and assistive devices in a way that is both affordable and sustainable.


So what are these legs that the centre is providing?

The prostheses that are currently being provided are called “Jaipur limbs”, which were specifically developed in India in the 1970’s. Jaipur limbs were designed to be cheap, durable and affordable in order to allow patients to walk barefoot and over rough ground without the need for continual maintenance that a more western limb would require. These have allowed the amputees to return to work and given back freedom and the ability to care for themselves.

Damaged Jaipur foot

New foot made of tough rubber and wood - will last for a year

So, landed safely in Uganda after the long flight over. The journey was pretty uneventful, though I stupidly bought suncream in Liverpool airport once I was through their security. Once I arrived in Amsterdam at my transfer, I realised that I wasn't going to be able to take it through their security since it wasn't sealed. When probing the security guy for some sort of direction or advice, he sincerely suggested  to "wear it all at once". Great… wearing two whole bottles of suncream on a 7 hour flight, only to land in a country in darkness for the next 12 hours. Those crazy Dutch… But apart from that, everything went fine, and Dr. Kale Wanume was waiting at the airport to greet me with two other guys from the centre. After a brief hour of getting out of the airport, some random guy deciding that he wanted to get in the car and drive it for a bit, and dodging potholes and craters on the roads, we arrived at the Great Lakes Rehabilitation Centre. Unfortunately the area had been plunged into darkness due to an electrical blackout (in order to alternate different parts of the city to ensure that they get equal fair amounts of power since there isn't enough to feed the whole city), so I couldnt get a good look at the place until the next day.

However, once I did get to look around, it's a great place. Big security doors seal it off from the nearby roads passing along side it and there's a large garden, rehab rooms, rooms for guests to stay if they have travelled a long distance, and a workshop alongside the accommodation that Dr. Wanume Kale (Alex) stays at. There's also a parrot and a dog, though neither have names. So I took it upon myself to name them both. Parrot - Charlie and Dog - Bert. Sorted.

Not got around to doing too much work yet, since Saturday was more about getting used to the centre, looking around and having a chat. Today has been fairly quiet since it's a Sunday, though it's quite common for people to work 6 days a week and sometimes even 7. The patients that I'll be seeing will begin to arrive tomorrow, so I'll get a chance to see if/where I can help out with from that point onwards. I've also been given the task to create a document to list the history of the centre and all the others that have been established in different cities around Uganda. It's a huge job really, but I recon if I split it up and do it in stages, then it should be manageable. At least I have a month to get a good start on it.

Above are two photos of the centre, the second is a view from the gate and into the complex. My room I'm staying in is further down on the right, past the door that's open and on the end. Past that path down the centre is the main house.

The third image is of the rehabilitation section, without the wide open door, being the entrance to the workshop where technicians can rectify casts and assemble the limbs for patients. That runway or "parallel bars" is space in which patients can begin their practice and gait training, using their new limbs. When patients begin to arrive, I'll upload more of their progress, but for now, this is all I have.

I'm in an internet cafe writing this since the centre has no internet, so I'm not sure how frequent these post will be, but I'll update whenever I can.

Managed to sort my malarial tablets out now. I ended up going for Malarone, and following some advice, got it from Superdrug for near trade price. Buying it from the Liverpool Institute for tropical medicine would have cost £160 odd quid, but instead, got it for £70. I'm all set now. Armed with a mosquito net, repellant, and a laptop, I leave early Friday morning for Amsterdam and then onto Entebbe. One last day in the UK!

Well, sat my last exam yesterday and passed all the stations with no bother. I guess thats that then! The end of student life and the start to the big wide world. It's mad to think that four years have gone by so quickly.

Another jab today, Rabies. In my right arm again. Damn, any more of these and it's gonna render them useless. I'll not be able to use them when I get there! Still trying to decide which malaria tablets to get, its either Malarone or Doxycycline. Malarone costs a bomb, and Doxycyclines cheap as chips. Ive got until the 27th when I'm getting I'm second rabies jab to decide though, decisions.....

Got my Hep A and Typhoid vaccinations today. One in the right arm, one in the left. Was hoping that I would get my malaria prescription too, but since the appointment was so late, the nurse said that the pharmacy would be closed by the time it was all written out. Gotta go to the Liverpool institute for tropical medicine tomorrow morning instead now, and just beg that they give me a slot to get them. If they turn me away, then I'll have to get them in Glasgow some time before or after my exam.. don't really want to have to do that. Still, at least I can discuss if I need Cholera and Rabies with them then.

My visa came back today too! All printed, and everythings fine. Oooooonly thing is, when I opened my passport to see it, some random lady's photograph fell out! I dunno who she is, but when I tried to call the embassy to let them know, they'd all gone home. Mrs X will have to wait 'til monday when there back in office before she can be returned. Otherwise I might just take here with me. She can be my accomplice!

Just been to the clinic today to get my yellow fever vaccination. Such a small needle! I was expecting something more dramatic than that. I guess I'll find out later on or tomorrow if its going to put me out for a bit, although I feel fine just now. Whats all the fuss about? I got a bunch of info on the different malarial tablets you can take too, so need to give that a read.

I've also got an appointment on friday to sort out any other jabs like Hep A, Typhoid etc... Although, I'm pretty sure that I had those last year when traveling to China. I phoned up my GP in Glasgow but they were pretty disorganised, and couldnt find most of the vaccinations that I'd had. Still, better safe than sorry I guess, and I'm sure the doctors here will put the record straight.

My visa is being processed today too apparently (phoned them up to see whats taking so long). According to them I should have it and my passport back by the end of the week. After that, I'm pretty much good to go! Only the mosquito net and repellant to get now!

So, a little update so far...

This week I've finished my second placement, studying prosthetics in Fazakerley hospital. It seems pretty crazy that this year is almost over and that it's nearly time for the very final exam on Sept 15th. Its been great fun at the prosthetics centre and the final night out was brilliant, with a meal at the top of the West Tower in the panoramic restaurant. Steve's jacket was pretty mental.

Ive also met up with a family friend - Helen Jordan, who works for the Teso Educational Support Scheme (TESS) in Uganda. She's given me plenty of advice on how to get around and places to see. Overall it was great to get a feel of what it might be like, and I'm really looking forward to the trip now.
26 days to go!