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.