Greetings my friends!
Greetings from wet Uganda. The weather here is variable with some heavy thunder and lightning storms followed by warmer weather. The rains have been slow to arrive and consequently some areas are still experiencing drought. The water shortage means long queues for water at springs and bore holes.
I try to collect my water early before the hospital truck comes to fill 1000 litre containers for the wards. It seems a real shame that although there are taps and sinks in the wards they are non-functioning and we improvise with a plastic container with a fitted tap.
The main focus of this link letter is the maternity unit at Kuluva, which I hope will give you an insight into the daily experiences. For the past three weeks, I have been busy with a short-term maternity mission project, seizing upon the availability of two Australian doctors, one Australian midwife and a U.S. nurse.
We were able to focus on teaching, in particular trying to prevent avoidable maternal and neonatal deaths by undertaking monitoring in labour, vital observations for women post caesarean section and observation for babies with infections.
It has been quite a challenge but there is evidence of learning which is encouraging. The mission has highlighted that the maternity unit lacks sufficient numbers of qualified midwifery staff; often there is only one midwife on per shift, who is required to cover the labour ward, which has four beds, and the maternity ward which has 21 beds.
Further to that, when the maternity ward is full, additional women are located on the nutrition ward. Women in labour should be monitored ideally every half an hour; however, when the unit is busy, this is unachievable.
The midwives are being asked to do the impossible, rather like the Israelites being asked to produce more bricks but not being given the straw (Exodus 5: 6-8). During the month of June, the majority of students were on leave and it quickly became apparent how much the students contribute to supporting the running of the hospital. Inevitably, this staff shortage means some basic care gets compromised or omitted as midwives constantly have to reprioritise their work load.
In addition, recruiting staff is not easy, as NGOs pay a much higher wage, hence Kuluva and the Ugandan public hospitals have a constant battle in retaining staff. Currently our staff receive payment at a lower rate than the public hospitals but the good news is that this is about to change.
The maternity unit needs a designated, dedicated doctor. Currently the doctors rotate throughout the hospital and have to be able to undertake medicine, paediatrics, general surgery as well as maternity. Undertaking specialisation occurs mainly in Kampala or in government referral hospitals. The Regional Referral Hospital in Arua, 11km from Kuluva, has one consultant obstetrician and gynaecologist. This is a real blessing as one woman who gave birth to her third child at Kuluva was able to be referred to Arua as she had a rectovaginal fistula from her first birth and had been incontinent ever since. It was amazing that she had medical care for this birth, where her condition was recognised and the necessary referral and transfer made giving her hope for the future.
The other issue is the availability of equipment. Last year, one of my link churches donated a sonicaid for maternity to help with monitoring the heartbeat of babies in labour. This equipment was a requirement for the hospital in order to obtain funding from the Belgian government. However, this one piece of equipment also gets used in the medical ward to ascertain the blood flow in the legs of diabetic patients. This is just one example of the shortage of equipment. I am truly thankful to support from the UK in investing in the hospital and the school.
I have been very blessed to have the opportunity to distribute financial gifts to the school staff donated by a friend. It is a wonderful to have the privilege of seeing such joy in the faces of the staff. I was particularly touched by one of the cooks who was so excited and praising God, it was a delight to see. This same cook, Margaret, borrowed 125,000 Ugandan Shillings (£30) from me for school fees for her son Joseph. Normally, when people “borrow” money, they do not intend to return it – borrowing is like asking for a gift. Therefore, I was surprised when she came to see me, on my return to Kuluva, and asked if she could pay back in instalments.
It was a real encouragement, just like the one leper who returned to Jesus to say thank you. I was really humbled by her amazing response. Margaret is a widow, living on hospital land previously set aside for patients with leprosy (her father had leprosy). Margaret lives simply, mainly working as a subsistence farmer supplementing her income as a cook. She is struggling to find the finances to send her youngest child, 19-year-old Joseph, to vocational college so that he can learn a trade.
Another delightful story is that of Annet. Annet is one of the six children of the assistant chaplain. She is 13 years old and has one more year (P6) to complete her primary schooling. She was struggling at the local school where she was not achieving, although her position in the class was 30 out of a class of 60. The family could not afford to send her to the same school as her siblings and her brothers had priority. Praise God then that with the help of UK friends, Annet is now at the same school as her brothers and is now achieving, passing her beginning of term exams. Her father was proudly telling me of her progress, with a wonderful smile. Hopefully when she completes P7, she will be able to do vocational training, finance permitting, and will be able to generate an income. This story highlights the continued difference between the opportunities for boys and girls, especially in poor families when they have to choose which child will go to the better school.
In my fifth link letter I mentioned the story of Josephine, the subsistence farmer who remained thankful despite her circumstances. I included a photograph of her with her husband Shadrach and her son Emmanuel. Shadrach is quite poorly with a progressive heart condition which means he gets quite breathless, particularly at night which is frightening. I know the family would appreciate your prayers at this time.
Whilst I was in the UK there were some significant changes in the school. There was an official handover to the new principal, Monica Efia. She heads up a newly formed team, with three new appointments last autumn and now two more staff recruited (but who have yet to start) including a midwife tutor. In addition, later this month one of the staff who has undertaken further training will return as a qualified midwifery tutor. It is encouraging to see the development of the school with well qualified staff. A new cohort of 12 diploma students also started in May. These students are enrolled nurses, undertaking an 18 month course in order to become registered nurses. This is the group I have been teaching since my return in addition to the ward midwives. They are a good group, eager to learn and participate in my teaching activities.
I would like to thank you for all your recent prayer support when I was back in the UK for health reasons. It was a challenging time as my return to Kuluva was delayed three times. Nevertheless, I did appreciate all the luxuries which I take for granted at home, like a hot shower, water in the tap and being able to flush the toilet without the use of a bucket. I also enjoyed a range of food, luxuries such as nice bread, cheese, butter and meat (sorry my vegetarian friends). When I arrived back in Kuluva, it was commented on how I had become fat! They did not mean it as an offence (I hope) but they did think that I was healthier and stronger, though I have to confess I do weigh more now than when I left!
My continued thanks for your support. I do hope you have an enjoyable summer.
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