Goodbye Uganda, hello Tanzania!

Hello from Tanzania! We'd booked a direct flight from Entebbe to Kilimanjaro airport with Precision Air. Emma had warned me that her previous experience hadn't been good... We got a taxi to the airport and walked to departures to find a big crowd waiting outside and nobody allowed in. I still don't know why that was because I got slightly distracted by the departures board which didn't show any flights with Precision. Most of the flights it did show were cancelled! I left Emma with all the bags and went to find the airline offices, only to find Precision didn't have one! Eventually someone said to go to Air Uganda, who it turned out have taken over Precision's flights from Entebbe as they no longer fly that route. Not that we'd been told! Unfortunately, the bad news was that all Air Uganda's flights had been cancelled for a whole week. I begged and begged, and the staff were lovely and eventually found us two options. Both involved travelling with Kenyan Airways to Nairobi, then Nairobi to Dar es Salaam and then with Precision to Kili. The first option left in the evening and got into Kili the next morning, after our safari was meant to start. The second got in the same day but was fully booked so we had a very anxious wait to find out if anyone had cancelled. Eventually about 30 minutes before the flight we were told there was space so we ran through check-in and security! I have never known as many security gates as in Entebbe, I think I went through 5 metal detectors in total! Slightly stressful when you're running for a flight and have to take your walking boots on and off every time! Then suddenly we were on our way to Kenya!

After a very short flight on a very smart plane we arrived in Nairobi and waited in transit for our next flight. I got more and more stressed as our flight was half an hour late taking off and we only had 1 hour 5 minutes in Dar to change flighta. I spent the whole of the second flight bouncing up and down and willing the plane to fly quicker, as we really didn't want to spend a night in Dar! In the end we landed 30 minutes before our next flight. We ran through to immigration and pleaded for help. The visas took ages as they make it using the picture from your passport. We then had to queue again for passport control but a man took pity on us and waved us through! We then grabbed our bags and ran through a tiny corridor to departures which was totally empty. It was 10 minutes before our flight was meant to leave so obviously check-in had closed. We pleaded with some officials who phoned a lady who very reluctantly checked us in and then refused to give us our tickets until we gave her some money. We didn't really care at the time but are now feeling rather annoyed that we had to bribe her! We ran up the the gate to discover that, surprise surprise, they were running late and everyone was still waiting! Two men had been told to walk to the plane with our bags and we watched out the window to see if we could see them. Finally, 7 hours late, we arrived in Kili airport and were amazed and delighted to find our bags there waiting! Maybe bribery does help... So now we're in Tanzania! We stayed at an Ethiopian restaurant/guesthouse but arrived too late for food so we'll have to wait until after the safari. It was such a relief to have made it to Arusha, even if we did go a very long way round (have a look at a map to see how close Entebbe and Arusha are and how far away Dar is!) I love Africa but there are times that I'm glad that I'm European and don't have these problems every time I travel!

Entebbe and the Ssese Islands

We're on holiday! Our first stop was the town of Entebbe, near Kampala and on the banks of Lake Victoria. It used to be the capital and the airport's still there. It's joined to Kampala by a long road which is lined by a series of towns and villages so it feel like they merge into each other, but Entebbe is much smaller and quieter than Kampala, and in our opinion much nicer! When we were at the gorilla camp we got chatting to the boss who was visiting for a few days from their office in Entebbe. She said we should stay with her in Entebbe and we later found out she meant for free! It was so sweet of her and it was a lovely place to stay. In between her house and the company office there's a small annex with 2 bedrooms, a bathroom, kitchen and sitting room and we had it to ourselves the whole time. It even had a TV and games console and really comfy sofas and it felt so cosy and Western compared to our house in Kagando! The first night we stayed in the guesthouse and had a lovely meal cooked for us. We were very excited to discover BBC world and catch up on the world outside rural Uganda!

The next day was Emma's birthday. We walked into town, although every boda-boda (motorbike taxi) and matatu (minibus taxi) stopped by us asking if we wanted a lift. As usual when we are in a big town our first stop was a supermarket! We then went to the zoo, or offically the Ugandan Wildlife Education Centre. The animals there have all been rescued from poaching or other threats and they use it to educate people about the threats to wildlife in Uganda. It was really interesting and we saw lots of things that are hard to see in the wild like a leopard, white rhinos and chimpanzees. The chimpanzees were in a huge enclosure and we spent ages watching them climbing trees, play-fighting and swinging on the ropes. We met up with a friend from Liverpool, Jemma, who's been working on the paeds ward in Kagando's sister hospital further South. It was really fun to see her and exchange stories. I was a bit jealous as they had interns (first year doctors) and 2 consultants on paeds there and more resources. After the zoo the 3 of us went out for a birthday meal, its so nice to have a variety of food!

The next day was really hot so we met up with Jemma again and went to a posh hotel to spend the day by their pool. The pool was massive and had a 10 metre diving board. We spent a very lazy day reading books, swimming and sunbathing which was lovely. There were lots of tourists there, it's strange to see so many muzungus!

The next day we packed up and got the ferry to the Ssese Islands, which are in the North-West of Lake Victoria. The ferry took 3 hours. We splashed out on 'first class' (for £6 instead of £4) and were glad we did as it meant we had enough space to lie down on the sofas as the journey was very rough and we both felt very sea-sick! The Ssese islands used to be a popular tourist destination but the ferry stopped for a while and so people stopped going. Our hotel definitely felt rather derelict and past its hay-day! We'd paid for half-board which we later regretted as there was only one veggie option for Emma and the food wasn't great. The people were friendly though and the hotel was right on the beach with amazing views of the lake and other islands. The water level is much higher than it used to be and there was a jetty and a parasol about 20 metres out which used to be on the beach! At first we felt a bit deflated but it was nice to relax and have time to catch up on blogs and read. We stayed there 3 nights and then got the boat back. It was much less windy and a much nicer, less rough journey.

We had one more night back in our lovely accommodation in Entebbe before leaving Uganda. We had a fun day doing some shopping and eating nice food again! Our host Lydia, had had a baby in our absence which is exciting but she didn't manage to be discharged from hospital before we left so we left her a present in the house. Next stop Tanzania!

Lake bunyonyi

I've realised I haven't written about a trip we took ages ago, in May, to a place called Lake Bunyonyi. It's about a 6 hour drive from Kagando, quite near the border with Rwanda and the gorillas. There were 9 of us in total as 5 new medical student had arrived that week and Jess and Becky were still there. We left after ward round on the Friday and had a long and bumpy drive down on the nursing school minibus which we'd hired. The scenery was amazing though and we spent most of the journey gazing out the window. FIrst we went through Queen Elizabeth National Park, which is flat savannah. We then climbed up into some hills which were really green and lush, with lots of different plants growing. It was fun to see all the food we eat growing. Then we passed lots of tea plantations. Most of the road was paved but there was a stretch for about an hour which was really bumpy and dusty. Lake Bunyonyi is about 20 kilometres from Kabale but between them is a massive hill which the minibus struggled up and we saw lots of vehicles being pushed! We then went back down again with amazing views of the lake. It's said to be the most beautiful lake in Uganda and we were told that after you've seen it you realised God must exist. I'm still not sold but it was incredibly beautiful!

We were staying on an island so we got canoes there. It was pretty hard going against the wind and our group (3 girls and a guide) had only 2 pairs of oars so we were very slow. On the plus side we got to rest a lot whilst the others had to row the whole way! We passed lots of islands and eventually got to ours. We stayed in a place called Byoona Amagara which is an Eco Lodge. We stayed in their geodomes which were huts with open fronts with amazing views of the lake. The showers were heated by solar power and had amazing views too but the loos were compost toilets and less pleasant! They don't have a generator so all the power comes from solar panels. The lake it quite high (over 2000 metres) and it got pretty cold in the evenings.

I stayed in a room with Jess and Emma which was fun. It was nice to have a big group and lots of different people to talk to. On the Saturday we went on a guided walk on the mainland. It was a really steep climb up but then we were rewarded with gorgeous views of the lake. Our guide told us stories about the islands. There's one tiny one which used to be used as a prison for girls who became pregnant out of wedlock. They were sent there with no food and it was too far to swim. Their only hope was to be rescued by a man who was too poor to afford to pay for a wife! Luckily that doesn't happen any more! When we got back we went for a swim in the lake. It's one of the only places in Uganda with no hippos or crocodiles and (probably) no schistosomiasis (bilharzia) so it's safe to swim. That evening we had a late meal (as the food arrives about 3 hours after you order it) and then the staff all came out and started dancing so we all joined in. It was very spontaneous and great fun.

We swam again the next day before opting for the lazy option and getting a motorized canoe back before our long journey home. It was a great weekend through and probably one of my favourite places in Uganda.

Malnutrition

One of the saddest conditions we see here is malnutrition and this year has apparently been unusually bad. There are two types of malnutrition, oedematous and non-oedematous (also known as Kwashiorkor and Marasmus). Nobody really knows why some children develop one and some the other, but the oedema seems to be due to protein-deficiency. It causes the children's feet, abdomens and sometimes faces to swell and they also develop skin changes, curly, light hair and they become sullen and apathetic. The other type is due to lack of calories full-stop, and they are usually lighter (less than 60% of the expected weight for their height). Both groups of children are at risk of serious infections and because of the malnutrition they don't always have fevers, raised white cell counts or positive malaria tests, so we treat them empirically with the strongest antibiotics and with antimalarials. Then are started on milk called F-75 which is then changed to F-100 when the swelling is gone and they are more lively and seem hungry. Sometimes they respond really fast, one day they'll be lying still looking miserable, the next day you might get a smile and the next day they're playing! The tiny babies seem to take longer to respond. Once they've put on weight and are doing well they are started on a peanut-based food called RUTF which they go home on. This and the F-75 and F-100 are free. The F-75 and F-100 are made from milk from the hospital's farm (which I didn't know existed until two Brits came over to work on it a couple of weeks ago). The remaining milk is used to make tea for the staff! Water, oil and sugar are added to the milk using a recipe from the WHO. The hospital are trying to get ready-made sachets of the milks though because these contain other things like vitamins and minerals which they can't get separately. If anyone knows how they can get the ready-made milk please let me know!

Malnutrition affects many of the children we see to some extent, and malaria and other serious illnesses can trigger it, so it becomes a vicious cycle. The other children who are at high risk are those with HIV. On the last ja-ja day I was talking to the nurse who organises it, Laheri. She was getting worried about a couple of the children because they were looking sad and not playing. This withdrawal is often a sign of malnutrition and she says that's how they often lose the children. Many of them are looked after by grandparents who struggle to find food for all their grandchildren. During each ja-ja day they have 2 meals- firstly porridge and then a lunch which they call 'balanced-diet food' as it contains matoke (a type of green banana, mashed), rice, beans, meat and cabbage. I've never seen plates piled so high and even the smallest children ate about 3 times as much as I could and took the left-overs home for later. For most of them it's a once a month treat as they can't afford to eat that well normally. Ja-ja day ran out of money last year and they had to stop for 6 months and apparently quite a few children died of malnutrition during that time. It's tragic that children with HIV are on free treatment and so don't die of AIDS but instead of hunger.

The crazy thing is that Uganda is really lush, green and fertile. It rains a lot and they can grow so many crops. The farmers I mentioned above have said that the farming here could easily be productive enough to feed the population and stop malnutrition but so far it's hasn't worked. I don't know enough about farming or economics to comment but there definitely seems to be lots of food around, it just doesn't get to the people who need it.

Neonates

I promised ages ago to write about the neonatal ward and never did, so here goes. The ward is next to the main paeds ward and has two sections- the main room with cots, a resuscitaire (used in the UK to resuscitate babies but here as another incubator) and a few incubators, of which only one works. There's also a bed so one Mum can be there with her baby. The other room has 7 beds and is used for the stable babies on antibiotics to be with their Mums and also the preterm babies receiving Kangaroo care. The number of babies varies from about 3 to about 25, but there are usually 10-15. The unit looks after babies from birth to 1 month of age. Most come in straight from maternity or from the community on day 1 or 2 of life. Some have fevers or other signs of sepsis and are treated on a cocktail of antibiotics for 5-10 days. These babies usually do well. Another set of babies are suffering from birth asphyxia (basically lack of oxygen either because of a problem during the pregnancy, during labour or straight after labour). This is a lot more common here than back home, mostly I think because most births are in the community and problems aren't recognised until very late. Giving birth in hospital is expensive. The caesarian rate here is really high because only the most complicated cases come. These babies are often quite unwell and can have lots of seizures. Sometimes they respond well and recover quickly but others don't and you can tell from quite early on that they are likely to develop cerebral palsy or other long-term problems. It's really sad because if they survive they are much more likely to end up malnourished when they are older and are less likely to survive to adulthood.

There are also lots of premature babies. We don't usually know exactly how premature they are because most women aren't sure when they are due but some are very small. When they are first born they are put in the incubators if available and given oxygen and intravenous fluids. We use aminophylline to help prevent apnoeas (stopping breathing suddenly due to the immaturity of the brain). In the UK we use caffeine which is apparently a metabolite of aminophylline. They also all have antibiotics. Once their breathing settles they are started on feeds of expressed breast milk given via a naso-gastric tube. At this point they can usually start Kangaroo care. This is a great system that was started in Colombia and involves postioning the naked baby next to its Mum's bare chest and then wrapping them both in lots of layers. It's basically using the Mum as an incubator and is used a lot now in low-resource settings. The babies are discharged home once they have reached 1.5kg and continue Kangaroo at home. At this stage they are still too small and immature to breast-feed so the Mums continue nasogastric feeding or give them expressed milk using a spoon.

There are also a few babies with other problems, such as congenital problems or babies who came in from the community. One baby I saw had been burnt really badly because her older siblings had been playing with a candle near her. In the UK, a story like that would trigger at least a discussion with social services but here there's no child protection set-up. Another baby that stands out was a tiny little thing who was brought in at 2 weeks because she hadn't been feeding or crying. It was immediately obvious that she was very premature which was probably why she couldn't feed. She'd been born in a rural village and been taken to a traditional healer. She was extremely malnourished and really unwell. It broke my heart because she'd probably have done ok if she'd been brought in a birth but as it was we never managed to get her any stronger and she died after a couple of weeks. There are so many factors involved and it's stories like that that make you realised the importance of education, community health programmes and working with traditional healers to teach them how to recognise their limitations and when to refer to a hospital.

In my second week here I was by myself (except for a very helpful and very good medical student) and I was petrified at the idea of having to do the neonatal ward round. The ward was really busy and lots of the babies were very sick. I was right to be worried, and I almost left at the end of the week! There was a pair of twins, one of whom was very poorly but there was nothing else to do for her. She was on antibiotics and fluids and although she was jaundiced the only treatment for that here is sunbathing (!) and she wasn't stable enough for that. I worried about her all night and the next day saw her first on the ward round. I was just about to examine her when I realised she wasn't breathing. Luckily Emma was there and Jess, the student and together we started to resuscitate her. I'd never been at a full-blown neonatal resuscitation before and was very grateful I'd done the course as otherwise I'd have been totally overwhelmed. Even then though it was pretty stressful. We tried everything but never got a heart rate so after 25 minutes I decided we should stop. I spoke to the Dad (one of very few people in Kagando who spoke good English) and explained what had happened. It was awful, but it got worse because I suddenly realised the nurse had restarted resuscitating her, saying she thought she had a heartbeat. The Dad looked hopeful for a bit but we went over and listened and there wasn't one so I put my foot down and said we had to stop. I think the nurse was quite inexperienced but so am I and the whole situation was so awful. Thankfully the other twin did really well and the parents were so sweet and so in love with her! I really didn't want to go back the next day but I had to, because there was nobody else. A couple of days later we had another resuscitation of a very premature baby who'd come in after being born at home. Her twin had already died. Unfortunately the outcome was the same, but the nurses were much more helpful and supportive and it helped so much. I don't really feel ready to be making decisions about stopping resuscitation but here even the nurses sometimes have to, as there are so few doctors. Luckily it will be years before I'm in a similar position at home.

There are lots of neonatal deaths here, and I imagine we are only seeing the tip of the iceberg as many probably don't make it to hospital. It's really sad but it's also sad to see the ones who survive but you know will have developmental and health problems long term. On the other hand most get better and it's lovely when you see the premature babies coming back for review and they've put on loads of weight and are doing well. The 'kangaroo' room is also always really sociable and happy as all the women chat and help each other. If a mother's too ill to care for her baby or if she dies in labour everyone else works together to help and the babies are usually looked after by relatives or neighbours. Ugandans are such warm friendly people, almost always smiling!

Soon I'll be working in a big tertiary Neonatal Intensive Care Unit in the UK. It will be interesting to compare it to Kagando's NICU!

The last week

I wanted to write a bit about my last week in Kagando as I think it sums up a lot of aspects of hospital life. They've employed a new medical officer on paeds and it was his first week. A medical officer is similar to an SHO in the UK. When Ugandan doctors leave medical school they become an intern for one year, during which they rotate around medicine, surgery, paeds and obs and gynae. They then work as a medical officer for a few years after which they can do a masters to become a specialist. It's crazy though because they're not paid during their masters so they have to study fulltime and work in the evenings to earn money. Unless they are very well-off they also need to find a sponsor to pay their tuition fees. The masters take about 3 years and then they can work as a specialist. The new medical officer has just finised his intern year so is quite inexperienced. However he's expected to do ward-rounds by himself and learn on the job. I tried to teach him as much as I could before I left and I think he'll do well but it's definitely a lot of responsibility. I can't wait to be back in a team of doctors and have lots of people with more experience to ask for help!

It was a frustrating week as the machine to do CBCs (full blood counts, including a haemoglobin, white cell count and platelet count) was broken and, for 2 days, so was the other machine that only does haemoglobins. As so many of our patients are anaemic this meant we couldn't quantify the degree of anaemia so we had to just decide clinically whether to give them blood transfusions and how many. Some of the sickest children need lots of transfusions as the malaria breaks down their red blood cells. Luckily the blood here is all screened for diseases like HIV and hepatitis so it's relatively safe but we quite often ran out of some blood groups. We also couldn't test blood glucose as they'd run out of the test strips. This was difficult because we had 3 unconcious children who were having seizures. Low blood sugar levels can be the cause of seizures and they can also be the result of being very unwell and not having any nutrition other than intravenous fluids. I therefore decided to give a couple of the children intravenous glucose empirically just to be safe.

Two children died one night and both had been in for a couple of days on treatment so it was really upsetting and frustrating that we hadn't managed to save them. We don't even know what was wrong with them because we couldn't do many tests, but neither had clear-cut malaria. They both deteriorated during the night and the nurses resuscitated them without any doctors there so we couldn't even get a clear picture of what happened. Normally the children who die do so in the first few hours in hospital before the treatment's had time to work. It still seems crazy to me that a child can die without a doctor being called and without knowing what the cause was. In the UK it's such a rare event now that there's an investigation into every child death and it's just so sad to think that here and in so many places it happens so often. 

One of the biggest challenges here has been working with the staff and trying to get the right balance between being assertive but also not feeling like the Western doctor coming in and telling them what to do. I have met some amazing and very dedicated nurses who have taught me so much and made my job so much easier and more fun. Unfortunately there were also some who were less good and I can't remember how many times I stamped my foot because none of the children had had any observations done! In the UK every patient has a heart rate, respiratory rate, oxygen saturations and temperature at least twice a day and sometimes up to every 30 minutes or hour if they need it. If anything changes they call the doctor on-call. We'd be lucky to get one temperature measured a day, even on the children in high-care. I tried everything I could think of to persuade them to do more observations but it never seemed to make any difference. There was a particular low point when I'd been away for a weekend and on the ward round on Monday noticed that hardly any children had had their medications over the weekend. Often this means the parents had taken their children outside so weren't there during the drug rounds but this time it included some of the really ill children who couldn't have gone outside. You realise how well the drugs work when you see how ill the children are without them! Luckily none had died but it meant lots of children had to stay in longer which increased the cost for their parents. I've never been so cross at work but the senior nurses (who don't work weekends) were great and got really cross too. The next day things weren't much better but the following day they'd really improved and they never got so bad again. I think the senior nurses threatened to take the money it would cost the patients to stay longer out of the pay of the nurses who'd been at work!

It feels strange to have left Kagando. By the end I was starting to feel quite confident with most things I was doing, although I still much preferred the days when my consultant was there than when I was alone and had nobody to ask for advice. I've looked after lots of very sick children and almost all of them have got better which is great. I've done ward rounds of sometimes 60-70 children and neonates and had to decide what treatment they need and way up the benefits of investigations and treatments against the cost to the families. It's hard not knowing what you are treating always or if you are doing the right thing but I think my clinical skills and decision making have improved massively. I do feel that I've helped and made some difference but with that comes a feeling of guilt for having left, especially as we're now having a holiday before we go back. However it's been hard work and emotionally draining and we both feel we need a break. I'm really excited about working in a lovely NHS hospital again with lots of nurses and doctors and never needing to worry about running out of drugs or not being able to do the investigations the patient needs. I hope to come back though, with a bit more experience under my belt!

Our little house

I wrote this blog about 2 weeks ago but my (usually very good and user-friendly) blogger app had a bit of a strop and it’s stuck in the process of publishing it, so I’ve had to re-write it. Now I back everything up before I press ‘publish’!

I feel it’s about time I described where we live a bit better. We are staying in a big compound across the road from the hospital. The compound is massive and we’ve only seen a tiny bit of it. It houses the nursing school and their accommodation and also most of the staff of the hospital and their families. It’s on a hill so the walk to work is downhill all the way but it’s a very steep trudge back home! The compound has locked gates with a security guard. Apparently there’s a curfew in this part of the country of 10 o’clock and I met a student who’d got back from playing badminton too late and spent the night in a police cell! It’s strange because we’re basically in the middle of nowhere apart from one village so it doesn’t feel very dangerous but I guess it’s nice to know we’re safe.

They gave us a choice of living in the doctor’s guesthouse or a house. It’s so nice to have a house. It’s basically a bungalow in a little garden just off the main path through the compound. Rita’s house is next door. There’s a concrete area between the 2 houses and the side doors come off this so there’s about 2 metres between our door and Rita’s. The main door is round the front with a covered porch. The garden has a few plants, a hedge, a lawn and a big coconut tree, as well as a washing line. We used to have 2 but random people have been chopping down one of our trees for wood and they broke one. We don’t really sit outside much because the lawn is on a steep slope and there are lots of things that bite in the grass!

The main room at the front has a sofa, 2 armchairs and a rocking chair and some pretty hangings on the walls. We spend almost all our time in here, reading books, sewing, writing blogs etc. I don’t think either of us have read so many books in such a short time before, I must be on over 30! Off the sitting room is a dining area and then off this to the right is the kitchen. We have a fridge-freezer, 2 hobs, a sink and a big dresser. The kitchen’s very well-equipped thanks to the many people who have lived here over the years. The bathroom’s small. We’re meant to have hot water but it’s broken and it’s hard enough to get the engineers to sort out the big problems so we’ve decided it’s not a battle worth fighting! In a country where lots of people walk for miles to collect water, our running water is enough of a luxury. After a big rainstorm the water sometimes turns a nasty brown colour because it picks up mud. It’s ok to shower in but slightly disconcerting for washing clothes or when we boil it for drinking water! Emma’s bedroom is off the same corridor and mine is off the sitting room. I have a queen-size bed which is nice but the mattress is broken down the middle so I have to sleep diagonally. My room has a washing line too so we can dry our clothes there when it rains. I often have puddles on the concrete floor afterwards and you can see which way it slopes!

The ‘rubbish bin’ is a hole in the ground just up the path from our garden. Apparently they burn the rubbish when it gets full but it never seems to get any fuller because the birds and animals get in and spread the rubbish around. It definitely doesn’t feel like the tidiest or most hygienic solution but I guess it’s hard without rubbish collectors. People burn stuff a lot here on bonfires. They always smell awful and we can’t close our windows so the smoke sometimes gets in  the house.

Our electricity comes from a company in Kasese and we have a card which we have to top up in town and then we put into a little box outside our house to get more power. It’s usually pretty cheap but we’ve had a problem with ours and it uses way more than normal (like 5 times more). We think it’s either the fridge or a loose connection but the electricians came and didn’t get anywhere. It’s still only about £5 a week but it does mean we have to plan ahead so we don’t run out! We have a lot of power-cuts here, at the moment there seems to be about one a day. There’s a generator we can use when the power goes off. We turn a handle in our house and then wait until the generator has been started. It runs on oil and apparently once during an operation there was a power-cut and they were out of oil so they had to send someone to buy some whilst keeping the patient breathing manually without the usual machines! Sometimes it takes a while for the generator to be turned on so candles and head-torches come in useful. Because of our electricity problems though we quite like being on the generator because it’s free. We also have a special box which we use to charge tablets and laptops so they don’t get fried by the power surge when the electricity comes back on!

As I mentioned before, most of our cooking is done on gas and a few weeks ago we ran out and had a tough couple of days before we got more. All these things make you realise how easy life is back home, although we’re very aware that our lives here are much easier than most people’s in Africa. Our house definitely has its quirks though. The other day after a power-cut, the power came on but not enough for any of the lights except the bathroom light. Now they’re all working again but the bathroom light has stopped working, so we have to shower by the light of a head-torch!

We’ve had various house-guests/pets whilst we’ve been here. We always have a few geckoes, 3 of whom we named Tom, Dick and Harry but we’ve forgotten which ones they were! For a while we had a praying mantus who lived on our door called Rupert but he’s long gone. One night when I was ill Emma woke me up asking for help because she’d seen the biggest spider. It was literally the size of our fists and was very hairy. We’d heard strange noises earlier in the evening and I’d searched my room before I went to bed thinking it was coming from there. I definitely think an added bonus of a mosquito net is to keep out other bigger wildlife too! Emma tried to pick the spider up using a cup but it reared up at her so she swept it out with the broom. We’ve also had to sweep out frogs, cockroaches, loads of beetles and worms and other creepy-crawlies we can’t identify! The most dangerous animal in Africa is definitely the mosquito and all our windows are covered in netting so most of the time they don’t get into the house. Lots of people keep chickens and goats in the compound and there are quite a few cats that wander around and fight at night. In the evening the crickets all come out and make a racket so all in all it can get quite noisy! The other day there was a swarm of grasshoppers that arrived in a rather biblical fashion overnight and the next day all the Ugandans were frying and eating them. Apparently they’re a delicacy and normally quite expensive but I chickened out of trying one.

We’ve been very lucky to have had such a nice place to live and I’ll definitely miss it. However I don’t think I could live in a compound like this for a long time and daily life is definitely easier (and quieter) in the UK.