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.

KMH mat  constr


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.


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.



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


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.


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

Jan 2009 – Jim McWhirter

Kamuli Hospital, Uganda, arrival and initial impressions

P1020079-768x1024I set off on Thursday 8 January 2009 with Dr. Tim Jenkinson and his wife Gill who have visited many times before. The flight was uneventful and we touched down to hot English summer weather beside Lake Victoria.

We were met by Andrew Mutengu, a delightful Kampala Rotarian and he drove us into Kampala where we met Sr Gilder and Moses who drove us to the Hospital, 160 km away.

On Saturday we explored the hospital and met the medical director, Alphonsus Matovu, who is one of only two doctors staffing the entire hospital.  He begins work with a ward round at 6.00 AM covering paediatrics and surgery and then proceeds to an operating list in theatre!  It has been impossible to recruit more doctors recently as many leave for easier work with the government or NGO’s or are paid two to three times as much by governments in neighbouring countries. He has had no holiday for 7 years!

The hospital has a nominal 160 beds with wards for surgery, general medicine, TB, isolation, maternity, children, and also has departments for the treatment of outpatients (which doubles as a 24 hr emergency department), Aids and antenatal.  Measuring the size of the hospital by the number of beds is a little meaningless; for example the childrens’ ward recently had 80 patients who are accommodated on the floor at night and outside during the day. When a patient is admitted to hospital, the family come and cook and care for them.

The first day of work – Monday.  I say work, but it will be at least a week before I am in any way productive and am simply going round with the doctors climbing a very steep learning curve!

The paediatric ward round began at 6.00 AM and we saw 36 patients, most of whom had life threatening conditions.­ It was mostly cerebral malaria but with plenty of pneumonia and two cases of tetanus, one of whom had been in under heavy sedation since the middle of December. We then proceeded to the surgical ward round and then to Minor Surgery following a brief brunch.  “Minor surgery” consisted of 17 cases which were self referrals sent across from outpatients.  All of them were dealt with on the spot or booked for surgery within a week. The elective surgical list for the afternoon was supplemented by a strangulated hernia and we then proceeded to complete the minor surgery cases.  The day was rounded off reviewing a couple of paediatric cases although the medical director had reviewed the obstetric patients while I had a bite to eat!

Tuesday morning began again on the paediatric ward at 6.00 AM.  One of our children had died in the night and the obstetric wards had also lost a patient.  Neither would have died in the UK.  Sadly, these are such commonplace events here that they were not the subject of particular comment.

Today, Wednesday, I explored the obstetric ward and was particularly struck by the lack of continuity of care and social support for mothers in labour, the virtual absence of pain relief, lack of facilities for the newborn and frequent loss of life more often of infants than mothers.

I have tried to give a brief flavour of conditions here.  Initially I was very shell shocked but am beginning to think that I may be of some use in what is a completely different world.

Kamuli Hospital – the first 10 days                           Wednesday, 21 January 2009

I thought I would put together a few thoughts after my first 10 days here. After 3 ½ days working with the doctor running the paediatric ward, I took over responsibility for it and did my last day’s work there today.  Tomorrow I start a 2 day hand over on the obstetric ward where I will spend 4 weeks working from next Monday.

I must confess that I did not really enjoy the paediatric work.  I was looking after an average of 50 patients.  Most of the patients had malaria and quite a few had pneumonia and some had both.  On average one child dies each day.  Most distressing were the cases of tetanus, not least because this is a completely preventable disease through immunisation but also a very unpleasant way to die.  During my brief time there we had five cases, three of whom died.  Two of these were only a week or two old and at least one had had cow dung applied to the umbilical cord in the traditional manner.  It is hard to accept that in the face of repeated national publicity campaigns and widespread availability of the vaccine, there is not a better uptake of immunisation although we all know how false beliefs (eg the MMR controversy in UK) can easily spread, even in a sophisticated society such as our own.  They did have a very successful measles immunisation campaign here but this only requires one dose to be effective whereas tetanus requires at least three and preferably five doses over a significant period.

On one particular day there were three deaths all of which I witnessed personally.  This would have been difficult under any circumstances but with no experience of the cultural norms in bereavement here and no knowledge of the language, it was particularly hard. Furthermore, the staff felt impelled to continue resuscitation to the bitter end in the face of inevitable failure and this was done in the room which simultaneously acted as treatment room, office and the location for my ward round which was only briefly interrupted during the early stages of resuscitation. Even more distressing was how it underlined poverty as one of the deaths (meningitis) was at least partly contributed to by the parents’ difficulty in finding £4 a day for one of the antibiotics which is considered particularly expensive here (unskilled pay rates are 15p per hour and that is if you are lucky enough to get any work).  You might think, not unreasonably, that I could easily have paid for the treatment myself. That would be true but the issue arises many times each day and once having started, one would not know where to stop.  It is easy to justify what I have done (or not done) but that does not make it any easier to bear.

The same issue of my personal wealth verses their poverty arose in another context.  I was approached by a member of staff to sponsor the education of his child.  I had been warned that this would happen and had again made a policy decision not to get involved in an open ended situation where drawing any lines would be completely arbitrary.

On a happier note, everyone is very welcoming and friendly and grateful that I am here.  I am really looking forward to working on the maternity ward and have already done a couple of caesarean sections without mishap (my hopes for an easy first one were answered and I am most grateful to all those who trained me!).  Unfortunately the working conditions are primitive and unhygienic which means that a lot of patients get infections.  The maternity unit has about 3,500 admissions a year (which includes 700 gynaecology cases) and delivers over 2000 babies, all with staffing of one registered midwife, 8 enrolled midwives, a number of student midwives and usually half a doctor (duties shared with the medical ward).  Again, the cultural differences are huge and not easy to adapt to.  There is virtually no pain relief in labour.  A woman who is making a lot of noise will be told very firmly to be quiet, especially if her distress is disturbing the doctor’s ward round!  Even if the doctor is inflicting significant pain on the poor woman (and many procedures here are done without analgesia or aesthetic), she will be told very firmly not to protest or vent her feelings.  Again, the need to communicate with the patient via an interpreter (nurse) whose culture, agenda and mastery of the English language is quite different to one’s own, is not easy.  Interestingly one sometimes needs two interpreters as some of the staff come from other parts of Uganda and do not have complete mastery of the local language. Also, there is little or no social support for a labouring mother; the father is not normally allowed on the ward and female relatives are rarely present during labour and there are not enough staff to assign one to each labouring mother.  However, at least live births significantly outnumber stillbirths and neonatal deaths and so this is a much more cheerful place to work.  Large families are still the norm and many mothers have had between 5 and 10 children.  I asked the staff when the Ugandan mothers stopped having children and the answer was “never!”.

Shortages of basic things are a normal part of the working day – the electricity supply goes off at least once a day on average for a totally unpredictable period – there is a back up generator but the high cost of diesel means that this is only started if an emergency operation is needed so other routine functions like laboratory tests and oxygen supply to the wards are interrupted. Drugs are not infrequently out of stock; today the laboratory ran out of reagents to do blood counts; sterile gloves were in short supply; stocks of anaesthetic agents are perilously low; etc, etc.  On such a brief visit it is difficult to work out how many of these problems are caused by inefficiency and how much by lack of resources but the latter is obviously a very significant factor.

On the social front, I attended an “introduction” which is a traditional Ugandan wedding.  It was a very jolly, if rather long drawn out, ceremony that was a rather beautiful acting out of the bride leaving her own family and joining her future husband’s family in the presence of both extended families and most of the village.  I have been told that it is only legal if the groom has a letter from the bride’s parents confirming their consent!  Getting there and back was interesting!  The local equivalent of a taxi service is a seat on the back of a bicycle or motorcycle.  I have used the bicycle version into the local town which is less than a kilometre away but this time we had to go five kilometres along a deeply rutted and potholed mud track, so opted for the motorcycle.  The driver of my motorcycle had the rather unendearing habit of hanging his crash helmet over his rear view mirror for most of the journey and then reaching out and putting it on as a car approached from the opposite direction only to replace it on the mirror as soon as the hazard had passed!  However, as you are reading this email you will conclude that I survived!!  Unfortunately we missed the meal at the end of the “introduction” as we did not fancy the journey home after dark.

Kamuli Hospital visit progress report – third installment           Friday, 30 January 2009

This is the halfway point of my assignment having completed three weeks here.  I have just finished the first week on the maternity ward.  It has not been easy.

I had been lulled into a false sense of security by a few straightforward caesarean sections.  This week the complicated cases began!  In spite of the best efforts of those who trained me, I was well aware that there were a large number of situations of which I had had no direct experience.  Out here it is not uncommon for women to labour for a long time at home in the village before coming to hospital and only then doing so when the baby has got completely stuck.  If the baby is too large to allow a forceps delivery, then one has to do a caesarean section which is not technically easy.  I came unstuck on the first one I did and had to call for assistance.  The mother lost a lot of blood and I was very afraid that she would die.  There was no blood available for transfusion in our hospital, nor in the government hospital in town, nor in Jinja, 60 kilometres away.  In the past, we would have taken donations from friends or relatives or even staff but this is now prohibited at national level because of the prevalence of blood contaminated by HIV, etc. I was rather frustrated that they would not accept a donation from me as I knew my blood was safe as a regular UK donor, but it seems that bureaucracies can overrule common sense everywhere. Had my patient died, I would have been largely responsible.  As you can imagine, this significantly undermined my confidence and I seriously considered not doing any more surgery in order to protect the patients.

Fortunately, both the local doctors were very supportive and I have made sure that one of them is either with me or very close at hand during subsequent operations.  My confidence has grown again, not least in parallel with the recovery of the difficult case! This week has been character building and I have been grateful for the tradition of the stiff upper lip.  I have not had to work outside my comfort zone for longer than I can remember.  Perhaps it is a bit late in life to start character building, but hopefully some good will come of it!

However, it has not all been work.  Last Saturday we went to Jinja by bus (entertaining) and had local fish for lunch by the source of the Nile.  That evening the Sisters in the convent (it is a mission hospital run by a nursing order of nuns) entertained us to dinner followed by television news which was the first I have seen since arriving here.  On Sunday, the hospital transport took us to Kampala where we said goodbye to Tim and Gill who have been working with me for the last fortnight.

On the way to Kampala we visited a very inspiring project run by a Polish Salesian priest.  He runs a hostel for street children from Kampala and cares for 172 children aged 7 to 16 with a permanent staff of five and intermittent volunteers.  They have dormitories, playing fields and a small farm.  It is a wonderfully caring community which transforms the lives of those fortunate enough to go there.  The only qualification for remaining there are a commitment to study and learn seriously at school and to fit in – the older ones ensure that newcomers get the message!  After completing primary and secondary education they can go on to a technical college in Kamuli run by the same order.

Before I left UK, it was put to me that Africa was a lost cause and that we should put a fence round it and forget it.  I was told that the Chinese take a different view.  They carry out infrastructure projects here at no cost to Uganda. In return, they are gaining access to raw materials at minimal cost.  It seems to me that everyone is self interested in their approach to Africa but the Chinese appear to be rather more enlightened in their self interest than the West!

Talking of the Chinese, many of their manufactured products are on sale here and I bought two of their rat traps as my house is regularly visited by these dear little creatures.  So far, I have caught two and I appear to be winning the war but not before they had destroyed several of my socks and handkerchiefs trying to make a nest!

Now that Tim has gone, I have inherited the radio and so get the BBC World Service news.  There has been some reporting of the credit crunch, but from a different perspective.  The third world finds it difficult to understand how the rich countries can find such huge sums of money so readily for their own problems but have been consistently unable to reach the very modest longstanding target of 0.7 per cent of GDP for aid.  In the present context, the West appears to be completely ignoring the very real problems which the current financial turbulence is causing in the third world. A simple example is the cost of fuel – price rises may mean a few less luxuries for us but devastating here where unskilled labour rates are 1/30 of ours and most people are subsistence farmers or can only get occasional casual paid work. A staff nurse earns £85 per month for a 40 hour week after tax and social security payments. From this she must live, support a number of extended family members, pay school fees for younger siblings, etc, etc.

I am feeling much happier and more confident than I was earlier in the week and hope that for the next three weeks I will significantly lighten the medical load on the two resident doctors.                                                 Jim. Saturday, 31 January 2009

Kamuli Hospital visit progress report – fourth instalment Friday, 7 February 2009

Quite a lot of water has flowed under the bridge since I recorded my thoughts a week ago and I am delighted to say that I am feeling much better than I was then. This is partly because I have regained some surgical confidence (with much support from colleagues here) but most importantly I am beginning to work out what I am able to do and when I need to call for assistance. With new work it takes a little while to get to know what you are capable of and where your limitations lie.

On a short visit one has to be very realistic about what can be achieved in terms of changing things or improving practice and also very humble in the face of staff dedication which is quite amazing. The difficulties of attracting doctors and nurses to a relatively isolated rural situation are bad enough but then add poor pay and an incredible workload and you have a problem!

For myself, the process of adjusting to local conditions continues. So far no mother has died under my care. Following an extensive review of the world literature on maternal mortality and a detailed statistical analysis of my own cases, I have reached the conclusion that the most important factors are (a) my clinical and surgical skills (5pc), (b) good luck (10pc), (c) the extraordinary innate healing power of the human body and the incredible tenacity of the human spirit to survive and overcome whatever insults and abuses are heaped upon it (85pc). Unfortunately the babies are not so robust and most days see one or more stillbirths or deaths soon after birth. To reach adulthood in Uganda is no mean achievement. Malaria kills many babies both before and after they are born. Pregnancy and birth are hazardous where only 40 per cent of the population receive any antenatal care and speedy access to modern medical facilities for complications of labour are only available to a tiny minority. Even if a mother reaches hospital needing an urgent caesarean section which could be organised in minutes in the UK, she will be very lucky to wait less than one hour here and much more likely a good number of hours in most places if things go well. If they survive all that, then the motor car and another accidents are just waiting for them.

The concept of patient consent here is slightly different to the UK. Recently we had a case of suspected meningitis complicating AIDS and wished to do a lumbar puncture. Before the patient was approached, there were consultations with her sister, who had recently been her main carer, her husband and finally it was stated that only her mother could give full consent for the procedure. Fortunately all these people were in the hospital area as they were looking after her. Only after mother had agreed was the procedure explained to the patient and her views taken into account! This case brought home to me the serious limitations of not knowing the local language. I would have had great difficulty getting an adequate medical history and negotiating the consents using translation by the nurses. Fortunately I had summoned one of the local doctors to help me and it was fascinating to watch him at work. The local people are delightfully softly spoken and mutually respectful. This is in stark contrast to the harsh reality of many aspects of the lives they have to lead.

I am typing this at 34,000 feet over the Mediterranean! I have just had a very self indulgent week on safari with my son Chris who joined me 2 weeks ago. We saw a lot of Uganda, a great deal of wildlife and had a fun time.

So, how to draw it all together?

I believe Kamuli Hospital is providing a very valuable service to a relatively isolated rural population who would otherwise receive very little modern medical care.

The local staff were all keen that I should return as soon as possible, so my work must have been of some value and the doctors certainly appreciated some temporary lightening of their burden.

I feel that I could possibly make several future contributions:

Simply going for a period of work such as I have just done is of value. I plan to improve my clinical skills by further training in Uganda and Dr Maura Lynch has kindly agreed to help at Kitovu.

Their work is constantly frustrated by lack of equipment and resources. The latest problem is that their 20 year old X-ray machine broke down 3 weeks ago and is now probably beyond economic repair. Patients have to go into the town when X-ray is needed. I plan to investigate obtaining a replacement machine in the UK (hopefully one no longer needed in the NHS) and then working out how to get it out there. Other needs include a replacement ultrasound machine and equipment to enable the taking of blood donations.

The problems of organising healthcare with limited resources and all the other problems the hospital faces are considerable and I am putting out feelers to explore ways in which I might provide administrative support.

I plan to talk to as many groups as possible in order to raise the profile of the work done by Rotary Doctor Bank (who have sponsored and helped organise my trip) and to raise funds. That little lot should keep me out of mischief for the foreseeable future and provide a focus for my retirement. Trying to establish how to use my newfound leisure was, after all, was one of the main reasons for undertaking this little expedition!

So, all in all, I feel it has been a success and would like to say to each and every one of you how much I have appreciated your support which has been given in so many different ways.

Jim McWhirter, 27 February, 2009