January 2017 – Jim McWhirter’s visit

Those of you who have been reading these reports since 2009 will have noticed that they have changed significantly over time. Early reports were full of the emotional impact of seeing human suffering at first hand and the culture shock of coping with the very limited resources available to help.

Inevitably one becomes accustomed to seeing these things and latterly reports have concentrated on our efforts to make longterm improvements. Although improving the efficiency of hospitals is critical to saving the lives of mothers and babies, it doesn’t make such good reading as details of practical work on the hospital wards.

On this, my 15th visit, I have been deeply disturbed once more.
Uganda is a green and pleasant land thanks to two rainy seasons each year following the spring and autumn equinoxes.
Last year the September rains failed with severe consequences for rural subsistence farmers, the community that most of our patients come from and the bulk of the Ugandan population. There are food shortages, increased prices and many are down to one meal a day in the rural areas. In field after field the maize crop has died as shown in the pictures:

Hopefully the rains will come again this spring and set them on the road to recovery but if they don’t, it will be very serious. It is easy to overlook how vulnerable these poor countries south of the Sahara are to changes in climate and how we cannot take well established historical weather patterns for granted.

On the project front we are seeking to repeat the successful programme we implemented at Kamuli in a much poorer setting in Eastern Uganda. We hope to refurbish the maternity ward at Freda Carr Ngora Hospital (pictured above) and send a Vocational Training Team to boost education at the nurse training school, all with the help of a global grant from Rotary. We are receiving strong support from the Rotary Club of Kampala Central and the Uganda Protestant Medical Bureau.

One of the great joys of coming to Uganda is the opportunity to meet the most incredible people. I have previously mentioned the Kamuli anaesthetic officer who works literally 24 hours a day, 365 days a year and Dr Maura Lynch of Kitovu, a nun and surgeon who celebrates 50 years in Africa this year. Both of these are still working in their 70’s. On this trip I met an 80 yr old ophthalmologist who has been 52 yrs in Africa, still works full time and spends two weeks each month travelling all over Uganda taking his surgical skills to remote communities. His name is Keith Waddell of Ruharo hospital and he is photographed with his team on an outreach journey. Between them, these three remarkable people have 151 years of service. I feel I live an incredibly lazy and self indulgent existence!

July 2016 – Jim McWhirter’s visit

Visit report July 2016

Every visit to Uganda holds surprises, some pleasant, others less so.
The road network has improved dramatically over the past eight years but this is a mixed blessing. On the upside, travel is quicker and more comfortable with less dust and fewer bumps. On the downside, local drivers have a lot to learn about the hazards of high speed travel. IMG_7064When we found ourselves in a major traffic jam following an accident, we took to the side roads (!) to try and get by but unfortunately met others doing the same from the opposite direction! Fortunately my travels were otherwise uneventful apart from paying more for petrol post Brexit.

IMG_7169My first job was to welcome 20 Bristol University medical students and see them on their way to Kitovu and Villa Maria. These hospitals have hosted Bristol students for four years now, providing 50 in total with exceptional learning and unforgettable medial experiences. Next year we hope to extend this programme to Kamuli as well.

One of the main objectives of this visit was to complete the process of setting up the Medicaudit Foundation in Uganda as a fully fledged non-profit organisation. It will partner with Medicaudit Ltd in Uganda and Rotary Doctor Bank in UK and oversee the work of supporting rural hospitals which has been developing so successfully over the past four years. We now support 24 hospitals, 7 clinics and other sites including pharmacies and even a hospital farm!  Your generosity has secured the future of this work which goes from strength to strength.IMG_7119

 

The inaugural meeting was held by the founding members, somewhat informally, over dinner in a cafe in Kampala:

 

A critical element of the Foundation’s work is computer system support and as our network spreads further afield, we have developed ways of providing remote support over the internet to cut down on the need for staff to waste a lot of time travelling. It never ceases to amaze me how we are able to productively and cost effectively use up to the minute technical solutions in a low tech society. But it really does work and our hospitals are constantly improving the care they are able to give patients.
Medicaudit is sponsoring one of its employees, Nicholus Seguya, to undertake further training by doing an MSc in Public Health Informatics at Makerere University, Kampala.

IMG_6525An exciting new project is helping the Rotary Club of Thanet, UK, with their project to improve water supply and sanitation at Soroti Regional Referral Hospital. I visited this incredibly hardworking hospital again and look forward to developments in the coming year

 

imageWhile in the east I visited the Medicaudit project at Ngora. This hospital was a leader in many spheres a long time ago but after a period of decline it is heartwarming to see it recovering. There is huge scope for useful projects here and Medicaudit is closely involved.
Jim McWhirter, July 2016

January 2016 – Jim McWhirter

Visit to Uganda January 2016

I’m not superstitious but I did have my laptop stolen on my 13th trip to Uganda, just concluded. The interesting aspect of the story is that when thieves broke into my colleague, Rogers’, home when we were upcountry visiting hospitals, they stole an ipad I had passed on to him a couple of years ago. Although we were a six hour drive away, he was able to track the movement of the ipad on the internet which enabled the police to make an arrest and recover it.

Africa is a fascinating mix of old and new. The heartwarming part of the story is the way the family rallied round. Brothers came round to stay with his wife and children, assisted with clearing up the mess and running around informing the police and providing the information to catch the thieves. This enabled Rogers and me to continue our work for another 24 hours, keeping in touch by phone.

IMG_6542-1024x768The extra time the family support gave us allowed me to attend meetings in Soroti to help move a water project forward for the Regional Referral Hospital. It serves a very large, poor rural area. At any one time there are about 3,500 people on the site and they have to do everything with a water supply which is usually only available for 4 hours each day. Unimaginable! The picture shows part of the 9 am daily outpatient queue and there were a further 100 patients waiting for the surgeon.

While in the area we had visited two of the hospitals using our Medicaudit management system.
I was at Kumi 18 months ago helping to install Medicaudit. They have worked very hard and have doubled hospital income without increasing patient fees. Similar results are achieved at many of our hospitals allowing them to increase expenditure on staff and equipment and so improve patient care with the result of saving of more lives.
Ngora has only recently started with Medicaudit but is making great progress from a very low base.
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Nearby there are some fascinating cave paintings which are over 3,500 years old.

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We have made great progress over the past two years and are now supporting 20 mission hospitals, 2 private hospitals, 7 mission health clinics, 3 private health clinics, a mission wholesale pharmacy and a mission hospital farm! We have one hospital in Kenya and strong interest from Malawi. We are working on a plan for further steady development.

IMG_6428-1024x768On this trip I visited three more of our hospitals. The highlight was a return to Kamuli where my Ugandan career began. The hospital’s only anaesthetist, Sebastian, works day and night, 365 days a year. He began work in 1968 and started giving anaesthetics in 1972 and is still the single most important person in the hospital at the age of 70. It is impossible to even guess the number of lives he has saved. It is seeing dedication like this that makes it impossible to to walk away from helping.
It was therefore a special pleasure and privilege for me to present him with a Rotary award for outstanding service (a Paul Harris Fellowship) on behalf of Rotary Doctor Bank GB&I. He is pictured with his wife.

As always, your continued support is what keeps it all going and I hope you can share with me a sense of pride in what we have achieved and excitement about what is yet to come.
Jim McWhirter, January 2016

July 2015 – Jim McWhirter

This was my twelfth visit since beginning work here for Rotary Doctor Bank in 2009.
IMG_5754It was the first opportunity to see for myself the completed major hospital refurbishment project at Kamuli. Everyone who has donated should feel a great sense of pride at having contributed to an effort which is transforming the physical fabric of this hospital which serves one of the poorer areas of rural Uganda.

IMG_0309 - from GP 28Sep14On my first there were only two buildings less than 10 years old and most were over 50 years old. Now the new buildings outnumber the old ones and the whole place has a completely different feel.

A Rotary Global Grant funded the refurbishment and extension of  the maternity ward and the refurbishment and major extension of a derelict building wh
ich had p
reviously been the operating theatre and is now used as a ward for VVF surgery. This work is carried out by the Uganda Childbirth Injuries Fund which makes an almost immeasurable difference by improving the quality of life for women injured in childbirth. It is hoped that the improved facilities will make possible a significant increase in this work.

IMG_5727The work at Kamuli is being carried forward by Dr Philip Unwin of Henley and his niece Dr Alice Unwin. Alice first went there five years ago as a medical stude
nt on an elective. They have made a massive contribution by building a guesthouse for visiting volunteers and accommodation for the staff.
All these initiatives and improvements have led to a reduction in staff turnover which is one  of the major problems in these rural hospitals.

Kamuli-VTT-leaving-Heathrow-17April15Of course it is the quality of care within the buildings this is actually the most important thing. I am delighted to say that Rotary in the Thames Valley is addressing this. Part of the Global Grant project was a team of midwives and doctors who visited twice to teach essential life-saving skills. Following on from this the Rotary District (1090) has undertaken to fund twice yearly visits to reinforce and continue this work for mothers and babies. This is also supported by Rotary Doctor Bank and the Unwins’ charity “Kamuli Friends”.

IMG_5625This is the third year that Bristol University has sent fourth year medical students to Uganda. This year nine students went to  Kitovu and Villa Maria hospitals. They were very happy when they heard that they had passed the exams they had sat just before leaving.

On a more serious note, they all had a profound and fascinating experience which will contribute significantly to their personal and professional development.

I was able to review the work of Medicaudit which is making good progress helping rural mission hospitals improve their efficiency and the quality of care they give patients. We are now working with 18 hospitals and 7 health centres, most of whom are seeing significant improvements in their income as a result. The project is on target to become self-sustaining by 2018.

IMG_5620Rotary Doctor Bank has been very active this year sending out many volunteers. I visited Buluba, the hospital which will have received four RDB volunteer doctors this year, providing virtually continuous cover for the whole year. For the first time RDB sent out a radiographer volunteer who had a very successful time at Villa Maria installing donated equipment, instructing local staff and dramatically improving the quality of x-ray films.

As always, I owe a huge debt of gratitude to all of you for giving such great support to this project over the last six years.

July 2015

June 2014 – Jim McWhirter

 

In this report I want let you know what I am doing and how Rotary Doctor Bank is spending your donations in Uganda.

The objective  – to save lives, especially those of mothers, their babies and children  – remains the same. But over the five years I have been coming here, the method has changed significantly.

Being a doctor, my first inclination was to work on the maternity ward which I did at Kamuli for six months spread over my first three years. This undoubtedly saved some lives and was personally rewarding. However, between visits nothing changed and staying in Uganda long term was not an option for me. So I was wondering where to go next….

IMG_0389At this point, by happy coincidence, I met a Ugandan doctor who was addressing many of the problems that troubled me in my work here. Lack of essential supplies was a constant frustration, but trying to discover how much of this was lack of resources and how much was inefficiency, was beyond me. The lack of resources was unquestionably very real but so was the inefficiency. And if you have few resources it is even more important that you avoid waste and manage them efficiently.

Fortunately my new found Ugandan doctor friend, Rogers, had the answer. He previously had been in charge of a rural mission hospital and had written his own computer programme to help him in his work.

Further development of the programme and trials in a few hospitals had led to a working management tool which increased hospital income and efficiency without increasing the fees charged to the poor rural populations these hospitals serve.

Good news spreads fast and I met Rogers just at the time when demand for his system (Medicaudit) was rising but hospitals could ill afford the upfront computer costs to get it started.

And this is where you come in! Funds donated through Rotary Doctor Bank paid the modest £1,500 start up costs for each hospital, after which they required no more funding as they saw their incomes increase.

Only one problem remained. Until this year Medicaudit was a one man band with Rogers providing installation, training and support to a dozen far flung rural hospitals from his base in Kampala. Medicaudit had to expand or grind to a halt.

A five year plan to develop Medicaudit leading to a self sustaining non-profit organisation was drawn up. A generous private donor offered full matching for funds raised by Rotary Doctor Bank for this work. So now they have a staff of four and rapid expansion well ahead of the original plan of six new hospitals a year starting in 2015.

Laying cable for the computer network
Laying cable for the computer network

On this trip we visited six hospitals in the first week to review progress and problems. In the second week I went with Rogers and new team member, Nicholus, to observe (and occasionally help) as they installed the system and trained the staff at Kumi hospital in Northern Uganda.

 
IMG_2817The challenge of establishing working computer stations at reception, cashier, patient billing and accounts departments over a local network with many staff using computers for the very first time, should not be underestimated – and all in three and a half days followed by a seven hour drive back to Kampala.

You would naturally conclude that this could not possibly achieve anything useful but you would be wrong. Experience has proved the method in 15 hospitals so far and there is every reason to believe that the 16th will not be an exception. A follow up visit in a month or so will consolidate progress, continue training and encourage gradual extension of the system. Hospital motivation develops rapidly as they see cash income rise as the computer tracks all transactions and identifies problems to be addressed.

So, by helping to make hospitals more efficient and self sustaining, mothers and their children, as well as other patients, will benefit and more lives will be saved.

As always, thanks to one and all for your support as this project moves forward to a very exciting future!

Jim McWhirter

June 2014.

 

 

 

 

 

 

 

 

 

 

 

 

 

April 2014 – Jim McWhirter

This visit was a very rewarding trip as the patience, hard work and generosity of so many of you is now bearing real fruit on the ground.

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The maternity ward and the old operating theatre at Kamuli are both being refurbished and extended.photo

This has been made possible with the support of many individuals and Rotary Clubs, a large private donation, the Uganda Childbirth Injuries Fund, Rotary Doctor Bank, fundraising by Dr Philip Unwin of Henley, and a Rotary Global Grant.

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At the same time a Rotary Vocational Training Team was teaching lifesaving skills at the School of Nursing and Midwifery.

 

After Kamuli I visited ten other hospitals, being driven 1350 miles by my Ugandan friend and colleague, Dr Rogers Kabuye of Medicaudit.

Some of these are hospitals which have been using the Medicaudit management system for some time and where it has produced very real financial benefits.
We were seeing other hospitals to assess their suitability for using the system.
By increasing management efficiency and use of resources, Medicaudit increases hospital income without the need to increase patient fees which is very important as most patients are poor subsistence farmers.
We have embarked on a programme to install Medicaudit in 30 – 40 hospitals over the next few years. The team has been expanded to cope with the extra work and the whole project will be self funding in five years time as hospitals pay a fee for ongoing maintenance and support. In the meantime your donations will support this critical work which is enabling hospitals to save lives by working more effectively with extra funds for staff, equipment and buildings. For the next two years all donations to this work will be matched fully by a very generous private donor up to a maximum of £20,000.

Examples of benefits from using Medicaudit that we saw are are shown below and were both purchased from their own savings and without donor help.

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New staff quarters at Villa Maria.

image  A new X-ray at Nkozi

IMG_1979You may recall that Kilembe Hospital lost all their staff quarters in a flood in May last year. It was very gratifying to see how we had refurbished a previously burnt out house to provide accommodation for four nurses.

 

Thanks to all of you who have helped to make all this possible.

To make a donation which will attract gift aid and a full matching increase, follow this link to Virgin Money Giving by clicking here

Many thanks!

Jim McWhirter April 2014

2013 Tim & Gill Jenkinson

UGANDA EPILOGUE

As we come to the end of our work in Uganda, we would like to say a big thank you to everyone who has helped us over the years in sponsoring young people in education and training. We thought that you might like to know what has happened to some of the students we first sponsored over ten years ago. We are proud to say that they have qualified as: a vet, two medical clinical officers, 14 nurses, 9 teachers, an accountant, an electrical engineer, a mechanical engineer, a Catholic priest ( and one in training), a scientist in the Ministry of Fisheries, 2 builders, 2 catering officers, 2 secretaries, a driver, a travel agent and a computer technician. There are many others with whom we have lost touch and do not know what happened to them after they left school, including six blind children. Well done to all of you (and to them)!

Two of the medics, Richard and his partner Salaama, who were both in Gill’s  first form when we first went to Kamuli, have plans to start a clinic in their home village. Salaama is a Muslim and would have been forced to leave school at 15 to be married, if it wasn’t for your sponsorship.

The beehive enterprise to help AIDS orphans is continuing successfully and is helping an ever increasing number of children (over a hundred now). We hope to stay involved with this project.

                                         Tim and Gill Jenkinson, 2013

July 2013 – Jim McWhirter

What an exciting visit – a new roof on the maternity ward at Kamuli, a miraculous recovery from a flood at Kilembe, hospitals turning round their financial situation with our computers, an Australian volunteer and Bristol University sends eight students to learn.

IMG_0034At last the projects you have supported for so long are bearing real fruit. The first visit was to Kamuli to see the new roof on the Maternity Ward.
The roof is great but, perhaps unsurprisingly, this work has revealed a large number of other problems with the structure. Happily our other reason for visiting Kamuli was to plan the next phase of improvements. We agreed to modify the programme to put full refurbishment of maternity as the first priority.

Unhelpfully Rotary International changed the grant rules without warning on 1st July meaning that they will no longer do extension work. This would undermine our planning over the past six months so we are appealing for an exemption but if unsuccessful, will improve things with refurbishment using Rotary grant funds and use other sources for extension work.

Many miracles at Kilembe.

On 1st May 2013 a flash flood swept away all the staff houses at Kilembe Mines Hospital, Uganda in a mere 3 hours. It also destroyed the hospital kitchen and filled most of the buildings with silt and stones.

IMG_0035The picture shows the remnants of one of the staff houses  – most disappeared altogether.

The first miracle was that it occurred during the working day. The surgeon, like the captain of a sinking ship, kept operating until rising water forced him out of the theatre! As the full magnitude of the situation became clear, all 192 patients and all staff and their families were evacuated to safety without a single life lost.  Had it occurred at night most of the staff and their families would have been swept away and many patients would also have died.
The next miracle relates to the tree in the picture. A member of staff trapped in his house by the flood climbed onto the roof. As the water completely destroyed his house, he climbed into the tree. The flood destroyed many larger trees but this one, and the man, survived.

Three Government Ministers have visited the scene but so far have not given one penny to help.

The greatest miracle of all is the spirit and resilience of the community. Outraged at the loss of their beloved and life-saving hospital, they insisted on coming and clearing the site. Silt and stones were removed, septic tanks dug out and wards cleaned.   Within an incredible five weeks the outpatient department had re-opened staffed by those who had lost all their possessions and are living in temporary rented accommodation some distance away. Just one week later the wards opened and when I visited, eight weeks after the flood, the wards were overflowing as usual  – with patients!!

It was a deeply moving experience to see and I am proud to say that Rotary Doctor Bank was the first to send humanitarian aid to the homeless staff within days of the tragedy. We are planning further help with the hospital’s recovery now.

The work of Medicaudit

Over the past two years we have been supporting the work of Medicaudit which helps hospitals make the best use of their very limited resources. The system is now installed in 14 hospitals and 11 are already showing improvement in their finances.

Image 1Villa Maria has even generated enough surplus income to commence construction of the new staff quarters shown in the picture.

 

 

DSC09796Villa Maria is also hosting eight fourth year medical students from Bristol University who are spending three weeks there in July carrying out projects as part of their course. They were originally scheduled to go to Kilembe but the flood put an end to that. Villa Maria kindly stepped in at the last minute and has made them very welcome. Bristol is making a generous donation and part will go to their hosts but the rest will help Kilembe rebuild.

IMG_0730Nearby Nkozi hospital is hosting an Australian paediatrician, Dr Theresa Pitts, who is doing a great job working there as a volunteer for three months.

So, very many thanks are due to all of you for your support and generous donations which have made all of this possible. Please continue to make it all happen!

Jim McWhirter, July 2013

Nov 2012 – Jim McWhirter

My eighth visit to Uganda has been exciting, busy and successful. I was based in Kampala with Dr Rogers as last time. The main purpose of this trip was to lay secure foundations for a major building refurbishment programme at Kamuli which is planned to take place next year with the help of a Rotary Grant which will boost the funds that many of you have so generously donated.

But life is never straightforward! Just before my visit the roof of the Maternity Ward at Kamuli was declared unsafe with termite damage to the timbers, missing tiles and water damage to the ceiling. Clearly this required immediate action. The Hospital had already constituted a building committee in preparation for the Grant application. Working with them over the past fortnight we have had the situation assessed by an expert, had plans drawn up, met with potential contractors and finally authorised the Hospital Board to engage contractors and get the necessary work done immediately at a cost of £25,000.

I hope you will feel real satisfaction that your donations through Rotary Doctor Bank have enabled this essential work on what is the busiest ward in the Hospital.

Less dramatically, but no less importantly, the work of supporting hospitals with their administrative computer systems, described in my last report, continues. I visited six of the eleven hospitals we are now supporting. It was very encouraging to hear reports of improved management being reflected in improved income and reduction of debt in these hospitals that constantly struggle to make ends meet.

The website continues to attract high quality volunteers who are supported in their service by Rotary Doctor Bank. Recent visits include a Spanish physician, a British physician and a GP. Next year we are planning for extended visits by a British surgeon, a New Zealand GP Obstetrician and an Australian paediatrician.  

As I reflect on the past four years I notice how my reports have evolved. At first they were very long and full of shock and raw emotion. Now they are relatively brief and factual. The daily tragedies that blight the life of poor rural Ugandans have not changed significantly, so what has?

Thanks to the support of Rotary and the kindness and generosity of so many of you, I am no longer a relatively helpless spectator. Using the funds you have donated and with the invaluable help of my Ugandan colleague, Dr Rogers Kabuye, we are now able to do something to make a long-term difference.

It gives me great pleasure to sincerely thank you all.

Below is the architect’s drawing of the new roof on the maternity ward. My next report will include pictures of the new roof and news of the on-going efforts to improve the rest of the hospital.

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April 2012 – Jim McWhirter

This is my seventh visit since I began volunteering for Rotary Doctor Bank in 2009 and it has proved a very worthwhile adventure!

Previous visits have been spent working on the maternity ward at Kamuli which was a challenging but rewarding experience.

On my last two visits I met a local doctor (Dr Rogers Kabuye) who now spends his time helping mission hospitals cope with the multitude of problems that beset them.
I decided to devote this trip to visiting eight of these hospitals to see the problems at first hand and try to work out what we can do to help. Dr Rogers was my guide, mentor, companion and driver.
We covered 1400 miles in two weeks on roads ranging from first class to ghastly. We did two 10 hour bus trips and Dr Rogers drove the rest in his car. His driving skill was tested when he faced an imminent head on crash with an overtaking vehicle. His timely swerve not only avoided the two oncoming cars but also an innocent cyclist on the roadside!

These hospitals face common problems:
Remote location
Poor rural subsistence farming catchment areas
Very limited financial resources with diminishing Government grants and limited ability and willingness of patients to pay user fees
Problems attracting and retaining staff
Inconsistent donor support for capital projects and very rarely any donor support for recurrent expenses

So how can they begin to cope?

A difficult truth is that the fewer resources you have, the more efficiently you must use them to perform effectively. Unfortunately those with the least resources are rarely the most efficient!
Dr Rogers has produced his own locally developed, computer based management system. He provides hardware, software, installation, training and support. This provides the data necessary for the hospitals to understand how they are performing. Armed with this knowledge and his guidance, they are able to implement systems and procedures to increase income and limit expenses. In this way they can achieve stability on a day-to-day basis. Dr Rogers is a real modern day Robin Hood. As well as helping rural hospitals which are his first love, he supplies businesses in Kampala with management systems. This allows him to subsidise the service he gives hospitals which are similar to the one he worked in at the start of his career.

So how can we help?

Even hospitals that are managing to cope financially day-to-day have great difficulty saving anything for capital or unexpected costs. Those that are just beginning to realise that they need to improve in order to cope, often cannot get started without a bit of help.

Dr Rogers helps those hospitals which show their willingness to recognise their need for change by approaching him to install his system. He does not need to advertise – good news spreads fast. Last year we funded this system for Kamuli at their request and it is beginning to bear fruit as I saw on this visit. I have agreed that we will fund the supply of hardware to a further seven hospitals who are all keen to get started on the road to improvement and self-sufficiency. All this will cost about £7,000. The hospitals will show motivation by paying for the software and Dr Rogers will provide free on-going support. Thus a small investment will, in time, produce a real improvement in patient care.

Last, but not least, the relationships built up will develop as time goes on with visits from volunteers and capital donations into a fuller continuing collaboration.

I miss the challenge of hands on care for patients at Kamuli and the friends I have made there, but I believe we can save more lives in the long run by concentrating on helping all these hospitals to become self-reliant.

Thank you all for your care, concern and support.

Jim McWhirter
May 2012