Hello everyone,
I just thought I would send an update of today's activities. The students have been struggling with writing their essays given the frequent powercuts, so today most of them went to a cafe in Masaka with free wifi. This left Gemma, Rachel and I at Villa Maria! This morning Gemma was sadly feeling unwell so stayed here to rest. Rachel went to an outpatient clinic with Dr Alfred, and I went to the antiretroviral therapy (ART) clinic to spend some time with one of the counsellors.
I had a fascinating morning. The counselling support for patients with HIV here is tremendous and the counsellor I was with (James) spoke excellent English and kindly translated for me throughout. Each time a patient comes to the clinic, they see a doctor, a nurse to dispense their medications, and the counsellor. There were a number of complex and troubling issues faced by the patients I saw today. One of the patients was a young girl whose mother had died from AIDS so was being looked after by her father. He has to work as a fisherman to provide for them, but consequently there are problems with the child taking the correct medications at the correct times (which is crucial for someone with HIV). We saw a woman with HIV on ART whose husband refused to be tested; this is a common problem here. The team run outreach education programmes but still there are those who prefer not to be tested to avoid the stigma of being diagnosed with HIV.
Another important role of the counsellors is to explain which medications to take, how to take them, when to take them and why they are important. This ensures that the patients obtain the maximal benefit from the ARVs. James discussed clean water safety with each patient, and distributed water purification tablets. Although these do not produce entirely 'safe' water, many patients only have access to contaminated water from lakes and streams, so it is better than nothing... He also discussed malaria prevention with many of the patients. One woman told us that she did not like to sleep under a net because she felt hot and claustrophobic, even though she understood the risks. This is a common view here.
During the clinic, James and I had an interesting conversation about the social, economic and political situation in our respective countries which was very enlightening. He actually trained as a social worker, and we were discussing the differences in social support between the UK and Uganda. My sister Lucy is a social worker so we had a good chat about the services available here and in the UK. They have a large proportion of social workers for 'OVC' - orphans and vulnerable children, but there doesn't seem to be a formal infrastructure for adoption or fostering. They have some social workers for patients with mental health problems, but mainly in the cities. He said that the provision for people with disabilities is poor, and there are only a few social workers for those with physical disabilities. They have some social workers for older adults, but their average life expectancy here is 64 (compared to 81 in the UK). He was astonished to hear that I am interested in care of the elderly, or even that it exists as a speciality!
I explained about the free healthcare provided by the NHS and that education is free up to the age of 18 and left the clinic feeling very fortunate indeed. James was asking about the prevalence of HIV in the UK and why I thought it was so much lower at home than in Uganda. He also asked about which diseases were common in the UK. I explained that many of our diseases are caused by smoking, alcohol and obesity. I said that I had only seen one person smoking since I've been here, but he said that smoking is a problem, particularly in the big cities. Advertising of cigarettes is still allowed and they are very cheap to buy. I wasn't able to quote the price of a packet of cigarettes in England but explained that they are very expensive! Apparently, alcohol excess is becoming increasingly problematic here as beer and spirits are cheap. I wondered whether the strong influence of the Church in Uganda had any impact on reducing alcohol intake, but he didn't seem to think so.
This afternoon, Gemma and I went to the maternity unit, and she undertook some qualitative research with the midwives relating to her project which was really interesting to observe. She was asking them about the importance of ante-natal care in preventing neonatal sepsis, and the barriers to accessing ante-natal care here.
The weather remains warm and sunny here as it seems to be at home too - I can't believe the heatwave is still continuing! The news of the royal baby has even reached us here - one of the teachers at the school yesterday asked me 'how is Kate?' and it took me a few moments to work out who he was talking about!
The students are all working hard on their projects ready to submit them this weekend. The incentive is that we can all go to the beach on Saturday if they are complete!
Tomorrow I am planning to go back to the ART clinic to spend some time with one of the doctors there (they have a special day for adolescents with HIV tomorrow). I will also be doing a video interview with Dr Moses (the medical superintendent) - I have my list of questions prepared! I am putting together a video diary of the trip so am making sure I have all the footage I need this week. I did an interview with our new friend Jacintah who works in medical records today (she is also joining the netball team for Thursday!).
More to follow in the next day or so,
Amy
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