Lyths in Uganda

Typhoid Epidemic

2010-12-22T05:16:00.000-08:00

Wambale is an 8 year-old boy, currently in our ward struck down by typhoid. His intestine perforated and he underwent surgical removal of a section of his gut. He needed re-operation twice, and is still discharging faeces. Typhoid fever is a bacterium that is transmitted by the faecal-oral route. It affects millions in the world today, particularly in poor areas with a high-density population

“These cases are the worst abdominal catastrophes that we ever encountered.” Are the words of three surgeons who worked in Kagando in decades past. But in those days it was perhaps 2 cases in a year. In the past 5 years there have been almost 500 cases (half children) operated on in Kagando, with about one in five dying. Many have endured months of suffering, with family, nurses and doctors doing their utmost before they died, as emaciated skeletons. Families have to sell their fields, their only financial asset to pay the hospital bills, causing further poverty and malnutrition.

Several volunteers, and one research group from Florida, USA worked on this outbreak. In the past 6 months a young American student, an Australian surgical trainee and myself formed a team that have got to the bottom of exactly ‘where’ and ‘why’ the disease is occurring. This week we start on ‘how many’ of the scores of patients with fever each week actually have typhoid, and not malaria. We then have an opportunity in March to present the work to Uganda’s Minister of Health, and to roll out the information to the community, with solutions on prevention.

For this we need about £500 for lab expenses (£3 per patient). If you would like to contribute, make a cheque to the ‘International Relief Fund’, marked Typhoid Research and send it to Vine Church, 131 Garvock Hill, Dunfermline. KY11 4JU, Scotland. Tel 01383-631001. (Gift Aid applies) Any excess money it will go to the ‘operating theatre extension’, which we are about to build in January, and for which we need funds.

Roof-raising in the mountains

2010-12-22T05:07:00.001-08:00

Yesterday were co guests-of-honour at a fundraising event, to build the roof of a Sunday school room (the children currently meet in the open). For our first time we drove round the south of the Ruwenzoris, and 15 miles up the other side. The route took us high into the hills, ½ mile from the Congo. The last half hour was on foot. We went with our good friend Rev Asa, who was born there, and used to walk 21 miles round trip to school each day, together with 1,000 ft down and up!

Most villagers have no cash, so buying roof materials money must be raised from the wealthier, or from visitors. After a traditional Anglican service the congregation brought in every kind of produce that grows there, and chickens, ducks, guinea pigs, and goats. In the next 2 hours everything was auctioned. Helen auctioned a goat! We bought pineapples and sugar cane to be divided amongst the 200 children, and we carried home 2 chickens, and a pile of other food!

At the end of the day £400 was raised, which was within range of the target, so everyone was delighted. We were exhausted after an 11 hour day!

A young Congolese saved

2010-11-16T05:26:00.000-08:00

Lafurva, from Eastern Congo was injured in a road accident 6 years ago at the age of 14. Because of temporary head injuries, the staff passed a catheter that sadly damaged his urethra. A second catheter was passed through the abdomen to his bladder. Infection set in, blockage, further operations and over the years he started to drip slowly from a hole in his abdomen. His kidneys were obstructed, and he got severe anaemia. He was dying.

In June this year Lafurva and a brother heard of a visiting urological surgeon hundreds of miles to the south. They went there, and an operation was done. Once again he could pass urine normally again. Wonderful! But it was to last only a few weeks. The new urethra narrowed down again, and he was back to dribbling, misery, and facing death.

Was there anywhere else they could try? Across the border in Uganda was a Christian hospital called Kagando. Could they help? The two men went, found the hospital, and wonders, a foreign specialist. Hope started again!

Dr David spoke to them each day in a mixture of French, Swahili, and Lukonzo. He arranged Xrays and scans, explained the problem, and how an opening could be made between Lafauva’s legs, which would bypass the obstruction, enable him to pass urine with a normal stream and be dry again. It wasn’t perfect, but the kidneys and his life could be saved. Three weeks later they were on their way back home, cheerful and thankful – for life, for Kagando, and the doctor and staff. Thank God.

Huts to university in 50 years!

2010-10-28T23:37:00.000-07:00

In 1964 Kagando Hospital began when expelled missionaries from Congo took over a disused leprosarium, consisting of a dozen asbestos Nissan huts, see picture.

Yesterday the Danish ambassador opened new accommodation and lecture rooms for the 260 strong nursing school, funded by the Danish government. This school is the basis of the anticipated Kagando Nursing Degree Course, which will be linked to the Christian University near Kampala. Wow!

These links help the peasant community here reach into the modern world. Thank God.

First school to receive books

2010-10-09T09:35:00.000-07:00

2 months ago Helen's teacher-colleague invited her to kindly visit the new primary school, which he had helped to start in his area in the hills. Although Helen had a painful ankle at the time she just managed the 20 minute walk up a hilly footpath.

Local parents had started a school with 100 pupils. They had rented 4 rooms, and hired 4 teachers, who taught 4 classes from nursery to P3, but but with no books or even teacher-guides. Imagine the response when Helen arrived a 2nd time, laden with books for all.

We now have received book money for 4 schools, but are still aiming for 10 (see blog 'Early Readers'). Would you like to help transform a school?

Surgeon Robert, answer to prayer

2010-09-27T05:34:00.000-07:00

From January this year Frank, our previous general surgeon and medical director for has been preparing to to leave for higher Urology training in Tanzania. Since then many have been praying fervently for his replacement.

Robert, the same age and surgical experience as Frank from a church hospital in the far East of Uganda arrived to fill the gap with a week to spare. Whew! His reasons for the choosing Kagando included "Dr Lyth" and "You do so much with so little.".

Robert is a warm sociable character, ex-boxer and rugby player, who will get on well here. However his wife and 5 young children remain the East 450 miles away, so they will need our prayers.

Silver Jubilee

2010-09-11T19:10:00.000-07:00

We were invited to speak on parenting to a thousand people at the celebrations of the Episcopal church of South Ruwenzori. Eight children helped us on stage with a play, contrasting two different families. After that we lead a session for hundreds of children on living a christian life.

The number of churches has quintupled in 25 years to 400, and the membership grown to 85,000! The church is also active in health care, education, water supply, agriculture, finance and other areas. Something to celebrate!

Early Reading Books

2010-08-28T18:48:00.001-07:00

John Kelly - 'Fistula Legend'

2010-08-27T20:41:00.000-07:00

As a young gynaecologist in1967 John volunteered to work for a year in a mission hospital in Nigeria. On the back of this 3 years later he agreed to go to the fistula hospital in Ethiopia to give holiday relief for the 2 doctors. Since then for 40 years he has never stopped doing short trips in scores of places all over Africa and S Asia, becoming easily the most experienced VVF surgeon in UK, with about 8,000 cases behind him.

Last week I had a call from Kitovu the largest VVF work in Uganda to help them with 40 patients remaining after a huge camp. Only one doctor remained, the 79 year-old JK. So I came, and shared a flat with him.

John is unpretentious, and humble about his extraordinary experience. He has a lovely smile and chuckles away with remarks on homespun philosophies. He still picks away at the toughest VVFs, reluctant to ever say that a case is inoperable. He has been retiring for many years, but next year may be the last. "I'm not improving much these days, David." he said.

Fistula camp

2010-08-14T20:37:00.000-07:00

Judith Goh was my first trainer in Sierra Leone, apart from Jerry, whom I took over from. She is of diminutive size, but great in terms of experience, dexterity, and speed. She came all the way from Australia for 2 weeks to help with the 53 fistula cases (included 13 obstetric tears) we had lined up. It was an excellent camp.

Most of the women were from the area I grew up in in S. Uganda, and some recalled my parents and grandparents! My boyhood Rukiga, Swahili, and now Lukonzo came in useful on ward rounds. Playing Scottish reels on my laptop further lightened the atmosphere in the recovery ward!

4 women, aged 18, 19, 20, and 30 have undergone 6 hour operations creating a new bladder from bowel (Mitoffanov for the technical) by Dr Frank and myself. Cecilia (photo) had hers 4 months ago, and Evas (photo), Judith and Grace this week

Pig roast at end of term

2010-08-14T15:54:00.000-07:00

The final year students at school have been boarding for 3 months, and have not eaten meat once. They also haven't had rice for 6 weeks- just bananas, beans and casava. Helen's idea of celebrating with roast pork and rice met with huge excitement.

The pig was one of three owned by a teacher who wants a video camera for his wedding photography business. Helen negotiated the pig in January in exchange for a 2nd hand video camera which we bought recently on e-bay in the UK.

The evening with 60 students and teachers was a riot of games, speeches, songs, and eating huge piles of rice and chunks of tasty tender fried pork. They will sleep well tonight before their mock exams tomorrow.

Welcome home, despite the dust and spiders

2010-07-29T08:21:00.000-07:00

We traveled safely and intact back to Kagando and found that the dry season had brought a layer of dust everywhere, and thousands of spiders and their webs in every possible space. The spinoff is that there are no mosquitoes or other flying creatures around. After a spring clean we feel ready to re-start.

We were both warmly welcomed, especially Dave, as the hospital is down to 5 doctors for the next month.

Six weeks in the UK

2010-07-29T08:16:00.000-07:00

We have just returned from a very refreshing time in the UK. We spent a wonderful last week with the family on the Isle of Arran off the West Coast of Scotland. This included climbing the 2,800 ft Goat Fell, some wild cycle rides, and getting to know our precious new granddaughter, who is 10 weeks old. She is lovely.

We also spent a week looking after Dave’s 90 year old Mum, who is quite frail, and looking forward to her heavenly home.

Donation launches New Theatre Extension

2010-05-23T13:35:00.001-07:00

Dave had 3 aims when we came to Kagando last August which are gradually being fulfilled.

1. Encourage the leadership team

2. Develop surgical training

3. Develop the operating theatre.

For years the twin operating theatres have been

· Poorly furnished and equipped, even by Ugandan standards

· Too small for the current work load of 3,000 cases a year

· The sterilizing room is needed by the adjacent maternity as a delivery room

The plans to extend the building by a major theatre and adjustments of the layout (– see draft drawings below) have remained a dream because the funds collected were insufficient. However 3 weeks ago the James Knott foundation added a vital donation, which will result in bricks and mortar within this year! Thank God.

Now that the building is going ahead others will want to contribute to furnish and equip it so it will better serve the surrounding half million population in the years to come. Will you?

Children’s week

2010-05-22T06:51:00.000-07:00

3 neighboring churches organized a children’s holiday week of teaching and activities, a first ever in the whole district. Helen and Dave were in on planning and leading many of the sessions for the 150 children.

One day the topic was Jesus’ parable of the talents. To illustrate this the children had a chance to try their talent at various activities including drama, doll making, clay modeling, catapult making, singing, art, football, netball…..They loved it.

Children’s work in churches is not at all developed (though half the population are under 15). Helen now has several invitations to coach Sunday school teachers!

Volleyball court completion

2010-05-22T06:46:00.000-07:00

Although the metal posts for the court await construction and installation by engineer James the volleyball court is already highly popular each evening.

Construction has not been easy, due to the heaviest April-May rains in living memory! (We nearly lost James in the river working on the dam yesterday). Dave flattened the murram using the land cruiser, and leveled it with 3 inverted beds (illustrated) with 4 men riding on them!

We are also working on the 2^nd badminton court, and a netball court is a possibility.

Ruwenzori

2010-04-20T04:58:00.001-07:00

2 days and a night in the Ruwenzori, Africa's greatest mountain range, this week-end fulfilled a long felt wish. For 7 hours each day we scrambled through bracken, bamboo, and deciduous forest, balancing on precipitous ridges and crossing rushing streams. We climbed from 1,600 meters to almost 3,000. Opposite our mountain hut we looked up at a 4,700 meter peak (6,000 ft above us), and in the morning it was bathed in sunlight.

The forest is an incubator of living things with no sign of humans, apart from a path. We oohed and aahed over so much – including 40 ft heather trees, whispy lichens 8 feet long, ferns 12 feet high, the cries of chimpanzees. At one time we were surrounded by a troupe of monkeys. The roar of thundering waterfalls was in our ears for most of the time, water that will flow 2,000 miles down the Nile to Egypt.

Thank God for good weather and Helen being fit for such a climb. A year ago her knees and spine would not have stood up to it. Back in Kagando Dave now takes over clinical seniority for the next six weeks, till we go on leave.

Support for volleyball court

2010-04-19T20:13:00.000-07:00

Under four mighty mvuli trees below the community hall a piece of land has been approved for a volleyball court. The court will be for the use of the 250 nursing students, and anyone in the community. It will be in constant use we are sure.

Charles and his team of 5 start work tomorrow with digging up the hard grass underneath, then covering it with 6 inches of black soil and six inches of red murram. The lower sides will be edged with large stones.

We have taken financial responsibility for the £400 budget, so if anyone would like to contribute towards it that would be a great help. Anything received beyond the needs of the court we will put to devveloping other sports facilities here. Make cheques to the ‘International Relief Fund’, marked volleyball court and send it to Vine Church, 131 Garvock Hill, Dunfermline. KY11 4JU. Tel 01383-631001.

School outing

2010-04-08T01:56:00.001-07:00

An outing nearby for the senior class Helen thought would be easy to organise and finance. She knew our hospital hydro-electric scheme would be interesting and relevant; and also a project where citronella perfume is distilled from the plant grown to prevent hillside erosion.

So Helen partook in meetings with staff x 3, headmistress x 2, manager of the project x 1, details submitted in writing, a personal reminder on day of outing…..but sadly the 40 children were still standing under a tree an hour after leaving time! However, Dave was available, and ran around chasing drivers, mechanics, extra vehicles x 2 and additional funds. We finally set off in high spirits at 3.30 pm, complete with crates of sodas. On days like this we wish we had an African sense of time instead of getting frustrated.

In the end the visits went well, and no one got hurt. Risk of injury was considerable, as inspecting the dam involved clambering slippery surfaces on a 3-meter dam wall, and balancing along a pipe 2 meters above a roaring stream. Thank God!

Ambulance can’t stop!

2010-04-08T01:53:00.000-07:00

A car bringing a sick patient to hospital couldn’t stop at the locked front gates of the hospital and flattened them. It then careered down the 100-yard steep and 3 yards wide covered walkway, miraculously missing the walkway supports, and a score of patients, staff and visitors. In the field below the car came to a stop and the patient and driver got out unharmed. Thank God!

Such love

2010-03-17T07:24:00.000-07:00

Dave is in Masaka, central Uganda for a two weeks fistula camp, replacing an American surgeon who had to cancel his appointment.

25 year-old Judith from a remote village 3 hours walk from a road near Lira was born with a rare bladder deformity that opened directly onto her abdomen with resulting constant wetness. Catholic priest, Father Opio Vallente in the photo made the double 12-hour rickety bus journey from here last week-end, partly at his expense to pick up two girls and their fathers so they could attend the camp. (click on this YouTube link for the story) What love!

At Kagando we could manage the very challenging surgery, but set against that are possible complications and worse. Also she would have to make a new home near a hospital in case of medical emergency. Her alternative would be to accept the disability and loss of marriage prospects, and make a life as a shop-keeper in her village. Judith decided on the latter.

Father Vallente knows a catechist (known as Ogena, meaning ‘trustworthy’) in Judith’s area who will handle the £300 we are giving him for the rent of a shop, and start-up capital for a 2nd hand clothes business. Ogena can also give her training and follow-up. Judith now has a future and a life. There is a new joy in her face.

Love is something if you give it away…

2010-03-03T19:29:00.000-08:00

‘Love is something if you give it away it ends up something more’…..runs the childhood ditty. Helen bought a £2 cake during a fund-raising service in January, and knowing how much Ugandans appreciate cake gave it to the man next to her, Jonah, the school bursar. Since then he has frequently thanked her for the public honour she gave him. Last week in return he gave her a whole stick of matoke bananas from his garden.

Not being able to eat them all ourselves Dave carried the matoke down to the fistula ward, where the diet is cassava root and beans. The 15 patients who love matoke were thrilled to bits!

More road accidents

2010-02-14T18:20:00.001-08:00

Uganda has the highest fatality rate in the world, 2nd only to Ethiopia. Sadly Bishop Patrick of Fort Portal (our adjoining diocese), a young leading and promising churchman died this week, avoiding a motor cyclist. On the same highway another senior clergyman was killed 4 months ago.

The seatbelt law, and tyre regulations seem to be universally ignored in Uganda. Enforcement might reduce some of our terrible injuries and losses.

PS Later: Two bishops from Eastern Uganda on the way to the funeral also had a car accident. They were both injured, and the wife of one of them was sadly killed.

Cars damage hospital

2010-02-08T19:23:00.000-08:00

Hospital property was hit by two cars this week. One passed between some trees somehow and hit the outpatients department. The other, at speed overtook a motor cycle on the main road that runs through the hospital, left the road and hit a tree 30 yards away. The unconscious driver was conveniently located for admission and suturing of his face.

Kagando’s first Surgical Trainee

2010-01-29T17:24:00.000-08:00

6 weeks ago Kagando was accredited as a training centre by the College of South, Central and East Africa (www.COSECSA.org). Last Saturday we enlisted our first candidate, David Mutiibwa for the 2-year course in basic, but very wide ranging surgery.

David is a voracious worker, who can do 5 caesarian sections during a night on-call, followed by a 3-hour ward round, several major and minor surgeries, interspersed with a dozen surgical outpatients without blinking. Back in September I found him tackling removal of a ruptured spleen, single-handed just a month after registering as a doctor!

We get on well, and I greatly look forward to the next 2 years being one of his joint mentors.

Stop press our consultant paediatrician resigned suddenly, and we urgently need to recruit a replacement.

Fractured spine

2010-01-24T11:19:00.000-08:00

The day before yesterday 3 Belgian medical students who were working in Rwanda were visiting the local game park. Their careless driver reversed the vehicle on the edge of a volcanic crater and they rolled over 7 times. Due to the lack of seat belts the girls were thrown about, and two sustained neck injuries. One broke her neck, but despite an unstable fracture her spinal cord was intact. I was operating when one girl came in for suturing.

Kagando hospital has collars, so we could support the neck of the girl with a fracture. We put them up for the night in our home (2 of them on the floor), which eased their pain and shock. We received numerous international phone calls to arrange their care and travel. Next day we slowly drove 30 miles to the airstrip in Kasese, where a small plane came in and air-lifted them to Nairobi for X-ray scans and advice.

Hand grenade injury

2010-01-19T09:57:00.000-08:00

Sunday night at 9pm I received a call to say that an 18 year-old cattle herder had picked up a hand grenade (from Idid Amin days) which exploded. As well as loosing his hand, his legs were severely damaged, and he was unconscious when I reached him.

This was just the scenario I have been dreading since I came here. I have been in several war zones but have operated on few cases of bombs and bullets. However amazingly a plastics surgeon and his experienced trainee had just arrived for a 4-day ‘surgical camp’. Andrew Hodges was surgeon here in the civil war years, and had experience of over 60 landmine casualties! Who better in the world to cope with this situation? I thanked God so much.

We removed both legs rapidly, and tried to restore his blood pressure, but sadly he did not survive till morning. At a ‘post mortem’ meeting last night we recommended several important changes in our system for trauma, and also some staff training in the famed ‘Advanced Trauma Life Support (ATLS) course.

Photos not recommended for public viewing.

C.E.O.’s Graduation Party

2010-01-07T19:28:00.000-08:00

Canon Benson has been Chief Executive for 7 years and a steady helm on ‘KARUDEC’, the multifaceted development organization, of which Kagando hospital and primary school are parts. KARUDEC’s activity has doubled in this time, and its influence spread to tens of thousands. (See www.friendsofkagando.org.uk)

‘Benson’ was born a mile away. Initially a teacher, he joined the Church of Uganda after getting a B Div in Kampala. His new degree is an MA from the Uganda Christian University in Organisational Leadership and Management. He won a credit in a class where over half had failed. Word is out that he’s started a PhD by correspondence!

To celebrate, and bring in the new year Benson and Zerina arranged a thanksgiving service in the local church, followed by a party for 250 at their house. They invited a wide spread of academic and social friends, plus the extended family, and scores of neighbours. Traditional dancers were stunning, food was overflowing, and speeches brought tears to the eyes. Torrential rain interrupted events for an hour, but didn’t dampen spirits.

Christmas with Christa

2009-12-28T19:28:00.000-08:00

For 2 months we counted the days till our daughter Christa’s visit – together with 2 suitcases of important goods and letters. After picking her up we drove to SW Uganda, where Dave spent 6 years growing up as a teenager.

We spent two cold nights at 8,000 ft perched above a nearby lake, and one on an island, enjoying flowers, bird watching, and paddling dugout canoes.

Getting home involved 11 hours of rough twisty spectacular mountain roads, and a night in a game park. We saw rare birds (shoebilled stork), tree-climbing lions, and were seen off by elephants and hippos.

In Kagando there was a farewell service for 7 departing staff, that included carols and nativity drama, and gifts including 3 bicycles, a goat and a cow. The service ended with a meal in chapel for several hundred with a roast pig and a cow!

Christmas day we joined the chapel staff to take lunch to the local prison, and hold a service for them. In the evening we had a meal and games with neighbours. Boxing day we visited our language teacher’s mountainside home for lunch, and a lively service in his local church. See YouTube clip here.

Next morning we were off at sunrise on a 7 hours climb of the steep 2,500 ft Ruwenzori ridges that face us. Helen’s knee and Christa’s ankle coped with the steep inclines.

Kagando accredited to train junior surgeons

2009-12-09T19:24:00.000-08:00

10 years ago a college of surgeons was started in East, South, and Central Africa (COSESCA) that was not tied to the universities (A bit like the Royal Colleges of Surgeons of England, Edinburgh etc). At a ceremony last week Rwanda became a member country, and the president of the country was made an honorary Fellow, along with the most recent of the 45 graduates.

Yesterday the founding president of COSESCA (Prof Jamie James from Perth, Scotland) along with 2 other Ugandan surgeons inspected us, and gave verbal agreement for Kagando to become one of 10 hospitals in Uganda to train young doctors.

Afterwards hospital staff were thrilled to hear the news, especially the young doctors, who couldn’t believe it. Dave will be involved in mentoring 2 doctors for the 2 year course.

This step will raise the medical standards of Kagando, and help maintain staffing. Thank God!

Northern Uganda

2009-12-03T19:53:00.000-08:00

After Nairobi we met in Kampala, and we drove 450 km to Lira in Northern Uganda where old friends of ours are working in a smaller Church medical centre. We met some of the tall nilotic black tribesmen there, who live in small round houses, and women who ride bikes and enjoy tribal dancing!

We crossed the mighty Nile in flood at Karuma on its way to Murchison Falls where it passes through a 21 ft gap! We spent 5 bone-shaking and slippery hours on a 100 mile section of dirt roads, averaging 20 mph.

Dave addresses International Society of Fistula Surgeons

2009-12-03T19:23:00.000-08:00

250 delegates (including 60 surgeons) from Afghanistan, Pakistan, Bangladesh, and all over Africa assembled in Nairobi for the 2^nd annual meeting. Meeting with people from such different places was most interesting.

I gave two scientific papers from Sierra Leone on urological topics, (hence pouring weak tea from glass to glass!), and enjoyed talking with some of the best people in the field. We also looked at many other aspects of Fistula, and discovered many new things.

Christmas Chicken!

2009-12-03T18:57:00.000-08:00

Last week the school had their annual Christmas Carol service/fund raising event for the school and the church. All the children were issued with brown envelopes for donations. Contributions on the day included money, local produce and chickens. The photo shows one class’s effort. Produce was auctioned on the spot back to the congregation. Helen bid for and won this chicken, which caused great hilarity!

While on Christmas Carols, we recommend our son Dan’s Christmas music album just released. Click http://music.danlyth.com/album/the-fat-man-and-baby-boy?permalink&vis=equaliser3d

11 year-old Judith

2009-11-07T20:24:00.001-08:00

As well as the girl with the displaced ureter made dry another sad girl aged 11 came to the camp. She complained of daily unconscious leakage of faeces and frequent leakage of urine both day and night for 2 years. She was an outcast. After careful questioning and examination I felt she had a muscular inco-ordination (sphincter instability) which might respond to retraining of muscles. Judith’s T shirt caption reads ’Quick repairs 24 hours’, but it took 3 weeks of daily instruction and eventual co-operation before she became became completely dry. Big smiles!

Bean Feast

2009-11-07T20:01:00.000-08:00

Cassava and beans are the leading staple foods. They are often served for school lunch. Cassava is definitely an acquired taste!

We are in the middle of the bean harvest, and Helen has received baskets of beans (in their pods) from friends, who don’t want us to go short. In fact our fridge is half full of them, and after some weeks we have had enough!

The colourful beans are about 8 different types, each looking and tasting a little different. They are all planted and harvested together. If one type does badly that year, the others make up the loss. To store for next year’s harvest you dry the pods in the sun for a week, thresh them to get out the beans, keep them in the sun for further time (difficult in view of the daily heavy rain), then rub them with oil, and finally store them in earthenware. We consider ourselves semi-experts in beans!

Primary school leavers' party

2009-10-31T04:38:00.000-07:00

Helen proposed a celebration, and cooked cakes for the 45 school leavers (plus 18 teachers & a dozen others); a much appreciated first.

Only the 45 top students are admitted into year-7 from 100 year-6 pupils; improves school stats! They have taken and retaken mock exams endlessly (see pile of old papers) as you can only go to Secondary School if you pass the exams.

But school is not always serious; some Friends of Kagando sent some paint!

Local King recognized by Government

2009-10-19T11:42:00.001-07:00

I million Bukonzo, who are short, industrious, and hospitable live in the foothills of the mighty Ruwenzori range on its Ugandan side (5 million on the Congo side). Over the past century political and physical conflict with a neighbouring tribe, and the British and Ugandan governments disturbed the area, leading to suppression, restriction on development and resultant poverty. Interestingly we sat next to the son of one of the 13 rebels who began the uprising 45 years ago with the King’s father.

Today the ‘cultural’ King of the Bakonzo was recognized for the first time by the President of Uganda, witnessed by 50,000 Bakonzo, who had walked in from miles around for the exciting event. Torrential rain predictably interrupted the proceedings half way through, but spirits weren’t dampened.

Fistula Camp

2009-10-17T11:07:00.000-07:00

Fistula surgery here is headed by Frank (centre), who is a busy general surgeon. So to get a large number of cases done, train other Ugandan surgeons (2 on this occasion), and also to deal with very difficult cases Frank invites an expert (Tom Rassen) to come for 2 weeks. Frank also puts out advertisement on the radio to invite masses of patients.

85 ladies with injuries from obstructed labour came during the 2 weeks. We five doctors spent a day and a half examining them, and then 9 days operating successfully on well over 50 of them from morning till up to 9 at night!

Special memories for Dave were the patient, on whose birthday he did a special sling operating that he learnt in Sheffield one time. Another was a 12 year old, born with a displaced ureter that had leaked since her birth, which caused her to miss school (memories of the girl, Sara in Sierra Leone).

Another spin-off was that the theatre underwent a massive spring clean beforehand, and rain leaks, rat cupboards, and wobbly operating tables got sorted. We did have electricity and water cuts, which the visitor from Nairobi found disconcerting! Head torches and antiseptics made do. Generally it was a huge success. Thank God!

A hot cup of coffee

2009-09-28T19:19:00.000-07:00

Coffee grows in the gardens round here, and up the hillsides to 6,000 ft, as in this photo. When the berries turn ripe they are hand –picked, and dried out in the sun in front of the house. The beans are then husked by hand, and sold to our village agent at £1 per kilo. At the factory they are roasted, blended, and packaged to sell at £4 per kilo – a great cup of coffee!

Water-supply-project handover ceremony

2009-09-14T09:06:00.000-07:00

All day yesterday Helen and I stood in as co-representing the US, Dutch and British sponsors of two multi-thousand-$ 3-year projects, providing clean mountain water to 5,000 people in our region. Kagando hospital’s rural-development-wing made the pipelines 18 and 31km in length, with a tap provided every km.

There was tremendous appreciation shown at each of the 3 locations we stopped at, with speeches, dancing, drama, presentation of certificates, prizes, and gifts (3 goats changed hands), and finally a meal for 500 people. The excitement level was greatly enhanced by the presence of the Ugandan Minister of Defense (with almost no security, despite current disturbances in Kampala). A great day was had by all!

Lukonzo & moving in

2009-09-07T12:53:00.000-07:00

Lukonzo language has lots of ‘mawanasueruhoro’ sort of sounds in it with a lot of rules on everything agreeing together (not as bad as Arabic), so we are thankful for our good language helper John, the electrician, and our dictaphone and notebook. With these and many hours spent this week with stallkeepers and villagers we have become conversant with 30 phrases of greetings and basic questions. We hope to continue intense study for another 5 weeks.

Prior to moving into our attractive but partly furnished semi-detached 2-bed bungalow we visited Kasese 40km away to buy a few basics to cook with (also bought a 4kg pawpaw for 60p). On entry yesterday we found that full furnishings had all been boxed away out of sight, and we didn’t need anything! Wonderful.

Rough and smooth landing in Uganda 21st August

2009-08-26T12:04:00.001-07:00

This is the police report of the theft of important documents from our car in a shopping mall under the nose of a security guard. Passports, driving licenses; credit cards; and Dave’s original medical certificates, and a few others things were taken.

After the initial shock and self pity, we realized that everything is replaceable, except for the certificates, and that really we should be more careful in a 20 years old car with wobbly locks. We were also reminded of the forces of evil that turn a fine person into a wicked cruel one.,

The smooth landing is the many delightful gracious Ugandans who have helped us in our difficulties. Also we are thrilled with the fine Toyota Landcruiser we have been loaned. Tomorrow we drive the 300 miles from Kampala to the Western border of Uganda.

Flashback to car slogans in Sierra Leone

2009-08-12T21:19:00.000-07:00

Some of these brought a smile or chuckle as they drove past (or didn’t!)

CHAPTER 2 IN WESTERN UGANDA

2009-08-09T22:05:00.001-07:00

Lyths in Uganda

Thank you for your interest in this blog (nearly 1,000 hits in the last 2 years), which gave an insight into West Africa. The story continues, but with some changes:

New location: A 250 bed general hospital in a very rural (Kagando not on google maps) and poor area of Western Uganda, 10 miles north of the equator and 5 miles from the Congo border.

New purpose: In Sierra Leone we supported the vision of Mercy Ships under Western management; in Uganda we will support local African leadership, under the Episcopalian Church of Uganda, whose vision is ‘To Demonstrate and Promote Christian Love through Holistic Care and Development of the rural population of Kasese District’.

New roles: Dave, under the leadership of General Surgeon and Medical Director of Frank Asiimwe will:
Share in the Fistula work that treated 150 patients last year.
Train Frank as a Urologist.
Train junior doctors and nurses.
Assist with the service of emergency general surgery.

Helen will advise on ‘learning difficulties’ in the linked Kagando Primary School, with 700 pupils and other educational needs that arise.

UNCHANGED
Love of Africa.
Love for the young, the sick, and the poor.

Needs for the Lyths
Prayer for our arrival (21st August) and settling in our small cottage.
Making friends (no other Westerners after September).
Intensive language study (Lukonzo- a tough one) for 6 weeks.
Feeling our way into new roles.

The Encouragement of supporters.
Your prayers make the difference to what happens.
Your financial support goes a long, long way in Africa.

How?
Email us for a copy of our letter ‘Africa – Chapter 2’ (dave.lyth@gmail.com
and helen.lyth@gmail.com).
Introduce yourself. We can alert you every time we publish a new blog.
Become a "Friend of Kagando". See www.friendsofkagando

“LETS DO IT FOR THE YOUNG, THE SICK AND THE POOR IN WESTERN UGANDA AND EASTERN CONGO!”

Leaving Sierra Leone

2009-05-31T08:28:00.001-07:00

Yes, we left at the end of April, two years after arriving, and 3 years earlier than expected. We thank God for much satisfying work, (Dave did 365 fistula repairs, with a 90% closure rate) and we had rich experiences with so many people that we had no idea were in store.

Why move on? Latterly the number of patients did not warrant 2 full time surgeons, so it was best for Dr Lewis, Dave’s Sierra Leonean work colleague surgeon to take over from him.

Farewells; We had a series of fond farewells; a hospital staff beach-party; food, drink and songs for 60 children at the street school; warm farewells from church members and leaders; Spurs United football team arranged a gathering of 500 members of the community beside the new football pitch; the Freetown soroptomists; Scottish dancing group; patients; Mercy Ships international staff; and many, many individuals. We felt well thanked and sent off

What next? From Freetown we visited to view potential new locations in Uganda for 3 weeks, and 3 days for Dave in Ethiopia. Both are strong possibilities, but we are going to Addis for two weeks in the 2nd half of June for both of us to have a better look. Please pray for guidance to the right place. Thank you!

Thank you too for your interest in these blogs and in the great people of West Africa whom we have come to love in these short 2 years.

“Gladdi day” Celebrating going home dry

2009-04-08T07:31:00.001-07:00

Pictures of this morning’s gladdi show women, who 3 weeks ago were at the lowest level of humanity – smelly, isolated, usually small, childless, uneducated and impoverished…and hopeless. Surgery, loving care, and a daily message of hope has transformed their lives. Now they are celebrating with singing, clapping, and dancing wearing their new outfits, first in devotions, and then around the courtyard. No one is dry eyed.

Joy Lyth against England

2009-03-29T23:15:00.000-07:00

Joy played in all but one of the 6-nation women’s rugby tournament matches this season. The last was against England when she played from the start. She was said to be “the best of the ‘front five’ in the first half” by a coach. Here we see her effective jumping for the ball in the line-out. “Go it Joy!” The main coach said “Joy is a very positive person and a great addition to the team. She’s a very effective lineout jumper and is very mobile around the park”

Football pitch week 4, heavy work

2009-03-29T14:42:00.000-07:00

The mechanical digger was cancelled because of budget miscalculations (we need all our funds for the actual materials). So all earth moving is by hand. Last Saturday we had 50 people on site, this Saturday 30 (half children).

It’s heavy work and the 25 ft cliff of the last corner was not shifted. There were injuries; a head had to be sutured, and several finger and foot wounds (many come in flip flops and don’t wear gloves). .

The largest rocks (5 tons and above) are broken by lighting a fire on them. Smaller ones are broken with a sledge hammer and chisel. Heavy granite boulders are rolled.

Wedding disaster

2009-03-23T09:55:00.000-07:00

Another staff wedding was planned for last Sunday. Mohammed, one of our manual workers met formally with his girl friend’s family the previous week-end to arrange their engagement. “No need for that,” they said, “just marry her. And the dowry will be £60”. (Mohammed earns about that in a month) So he with about 10 mates from work got on the ferry Sunday morning to cross over to her home town, just by our international airport.

“The dowry is £1,000. Take it or leave it’” her family announced when Mohammed and friends arrived. “What?” he said, “No way I can find that kind of money.” So they all got back on the ferry crestfallen
This story, including the fact that the bride had two children by different men (and therefore had low dowry value!) was passed round the 400 people on the ferry in no time, and many came over to sympathise, including a bunch of the President’s followers (he had been on a flight that day). They said they would go back to that family and give them a hard time for such behaviour!

Kids can help too!

2009-03-15T10:19:00.001-07:00

Due partly to the Liverpool / M United match yesterday we only had 15 men working. The number was replaced, however by a gang of children who loaded and emptied the pickup all day with rocks, some of which weighed 20 kg. The men had fun bringing down 5 ton rocks and breaking them up. Thank God there were no injuries.

Don’t exclude people who keep things moving!

2009-03-15T10:16:00.000-07:00

Football pitch development: two weeks later

2009-03-10T14:49:00.000-07:00

Coach and project director, Sahr James after 10 days on the project said, “Dave we must rent a mechanical digger, or the earth-moving will never get done.” “It costs £800 a day, and may increase the budget.” Dave replied “Let’s have a volunteers work-day on Saturday, and see what we can manage by hand.”

‘Incentive’ is a key word here. We came up with:
• An Argentine football shirt (from Ruwi in Garvock Hotel), which I hung in the goal mouth for the ‘hardest worker of the day’. In fact the 35 men and youths all worked like Trojans, practically non stop. (they are all superb athletes in the peak of training).
• Periodic snacks of peanut cakes, fried dough balls, bananas, helped, but they worked in the blazing sun without a break right through to 5 pm when there was a big bowl of tasty bean sauce and rice for the thirty workers, who continued through to the end.
• A pair of football socks (from Dunfermline Athletic) for everyone
• Everyone got paid 75p (up from 50p because of complaints!)

“We have never seen anyone work like this before!” said the team of four, running the project. The whole day cost £50. The guys will remember the day for the rest of their lives.

Our plan is to have another big work-day this Saturday, and then get the digger in next week for the 30 ft cliff where there are rocks the weight of motor cars.

8 hours of working in the tropical heat left me exhausted and blistered (my hands gave out after an hour, and I had to buy gloves), but the day went very well. I have to say I felt that God’s hand was over the whole thing.

Update on Sara

2009-02-27T21:40:00.000-08:00

Sara was admitted last week at the government hospital for observation and tests. On closer questioning her mum, Haja, said that she had actually been wet for only two years. We did two dye tests, a bladder one where we looked for bladder leaks, and an intravenous one, where we looked for abnormal openings of the uretur (pipe from the kidney). Both were negative, so the abnormal uretur, we saw on Xray was misleading, and her wetness is due to an abnormal function of the urethra (final urine exit pipe). We treated this with tablets, pelvic floor exercises and bladder training, without any success initially. However Sara and Haja are deeply grateful for all those who have helped her, and been so kind.

Incidentally, at the government (teaching hospital) there is no regular electricity supply, and water is available only one day a week. On other days you have to go into town at 4 am to queue at a tap with a bucket. Drugs you have to purchase yourself at an outside pharmacy.

‘Never give up’

2009-02-25T12:23:00.000-08:00

Remember Salimatu from December 13^th blog, the girl who asked Helen for a helping arm to walk? She has recovered her strength and nerve function, and is walking normally. She has now had her surgery done. See the radiant look on her face. ‘Never give up.’

Press Release: Football mini-pitch development

2009-02-20T21:30:00.000-08:00

Yesterday 50 gathered (the press never showed, despite offers of payment!) to announce the 2 month work project, starting Monday. The local chief and other dignitaries were there, and 7 speeches were given.

The almost triangular, irregular and uneven pitch serving immensely athletic sportsmen, who train 5 nights a week has been a source of irritation to Dave for the last 2 years. The ground also serves a primary school of 200 (behind the chief’s head), and many local events. Friends in Dunfermline, and the Athletic (football) Club have given money to help.

The plan includes 20 ft concrete walls etc, which local engineer Sami Sesse relishes building. Pray that there are no injuries or burst underground pipes! E-mail us for further details.

School Sports day at ‘Number Nine’

2009-02-16T06:40:00.001-08:00

West Africans generally have a very athletic physique, and they love football, running and all sports.

Friday’s 6-hour school sports day was attended by an enthusiastic crowd of over 500. The participation and cheering was wild. See the lady hit the dust in the video of the ‘Mothers race’. Helen was asked to give out the prizes at the end.

Watch this space next week for development of the sports field.

2009-02-16T06:40:00.000-08:00

Update on Sara

2009-02-01T00:55:00.000-08:00

A couple of problems have arisen regarding the definite diagnosis. One is that her symptoms, on closer questioning probably started only 2 years ago, which you wouldn't expect in a congenital condition. The second is that though she leaks unconsciously often in the 24 hours, it doesn't seem to be continuously, as you would expect in the misplaced ureter condition. I carried out one of dye the tests, showing a normal bladder but was unable to complete the IV one.

As Dr Kamara is away for 2 weeks Sara and her mum, Haja have now gone back home and will be admitted at the government hospital on 16th Feb. It will be up to Dr Kamara to observe her, do the IV dye test and decide whether we should go ahead with surgery or not on 23rd Feb.

Sara, girl with a rare congenital abnormality

2009-01-27T21:59:00.000-08:00

7 year-old, Sara, has been wet with urine continuously since birth, which has deeply affected her whole family. Her enterprising mother brought her 217 miles to Freetown, and attended various clinics. Twice she waited in the queue for our paediatric clinic, but because of numbers they weren’t seen, and they went back home, bitterly disappointed. On hearing on the radio about our visit to Koinadugu she came to see us. I saw her and suspected a congenital fistula of her urinary system. An IVU X-ray this morning in a private hospital confirmed my suspicion of a ureter that bipasses the bladder. I have contacted the other urologist in Sierra Leone and we plan to operate on her next week at the government hospital – paid for by our supporters. Here is Sara eating an ice cream in Freetown.

Health care in Koinadugu District

2009-01-27T21:56:00.000-08:00

Shown is one of 12 health centres in the district, where there is a clinical health officer (known locally as a doctor), and a maternity health nurse. This centre, which serves 50 villages with a population of 10,000 is very poorly equipped. It does however have a solar powered fridge for vaccines. A 'vaccinator' tours the area

Search and bring

2009-01-27T21:49:00.000-08:00

Last week we went on a 4-day trip with the nurse and driver who go to outlying areas to search and bring back patients suitable for fistula surgery. Our destination was Koinadugu district, the poorest, and most remote of 12 in Sierra Leone. ‘Main roads’ are dusty, steep, tracks, some with broken bridges. We stopped in 25 villages to ask if anyone had fistula symptoms. We picked up one woman but 4 other patients reported were too remote for us to access; for example “5 miles down that rough track, and then 4 miles walk. But she may be in her fields harvesting.” We went to the radio station on a nearby hilltop and asked the man to transmit a personal message (cost £1.50) to ask the women to come in during the next day or two. Sadly our efforts failed.

Joy Lyth capped for Scotland

2009-01-17T22:13:00.000-08:00

Yes, the day before we left Scotland on our home leave we had the thrill of watching Joy in action for the national team against Sweden. They played at a high level, as you can see in the video (if you install 'flash 9' on your computer - try google) and won 32-0. Joy captains her Lismore (Edinburgh) team and trains several times a week. Well done!

Never give up

2008-12-13T22:34:00.000-08:00

Salimatu, though she is partly paralysed feels she must walk or die. She said to Helen, “If you just sit, you will not walk again. Please, please help me walk.” So Helen took her arm and they walked round and round the courtyard. But that wasn’t enough, she also had to walk round the outside courtyard several times, three times the size.

Salimatu, like one in four other fistula patients developed paralysis of her lower leg muscles because of the squatting position during delivery that lasts several days, and needs support to walk properly (if at all). On top of this she had severe anaemia, her blood being 1/3 of normal (4.5 Gm%). She also has an undiagnosed fever each day, that makers her feel very unwell. But she never gives up.

So close!

2008-12-07T22:33:00.000-08:00

Dave watched ‘Services Junior Secondary’ going down 3-0 in their final match to a much more experienced team. They played to their best however, and are greatly honoured to have done so well.

Dunfermline Athletic club strips bring glory

2008-12-03T23:25:00.000-08:00

‘Services’ Junior Secondary School team donned DAC strips this week and won successive matches Monday and Wednesday that puts them in position to win the League Cup for schools of the whole city (pop. 1.3 million) this Friday. Some team members were too exhausted to play in the tropical jungle heat yesterday because of the fierce battle in Monday’s game when they won by a slim penalty. They are now gearing up for a death-or-glory match on grass at the national stadium (in photo background) this Friday. Watch out for the blog!

DAC donated strips from last season via the Vine Church’s representative in Freetown ‘Dr Dave’. Dr Dave’s neighbouring carpenter friend’s son, Sam Tommy, is centre back for the team. Sam came with a pal to Dave’s room Sunday night to select their dream shirts, shorts and socks. Next day these were laid out beside the pitch and donned for the match.

Cow transport in Freetown

2008-11-28T23:15:00.000-08:00

This week a taxi like this stopped at the hospital, blocking our entrance. Four men got out, came to the back of the car where hooves were sticking out, and pulled a fully grown cow (like the bovine in the photo) out of the boot. Without a glance back at us they all walked off together!

Large tumour taken from patient's abdomen?

2008-11-28T23:00:00.000-08:00

No this yam (incomplete) and these chickens were 'gifts in kind' from patients who came back to say 'thank you'. One patient travelled three days from neighbouring Guinea to say thanks.

Village Chief and local midwife undergoes fistula repair

2008-11-16T08:13:00.000-08:00

Sally Jusu (centre)aged 50 was forced to get into a Mercy Ships vehicle and come to Freetown for surgery by her children, the only ones aware of her problem. Two weeks later she phoned them to say “You can tell everyone I am well now, I not ashamed anymore.”

For 25 years gracious, dignified Sally had managed to conceal her fistula problem and remain village chief. She used to fast from water on official meeting days, and would keep meetings short, so she wouldn’t have to leave and change herself!

After recovering from her surgery she agreed to speak about her experience on 17th November at a conference on maternal health for chiefs from all over Sierra Leone. She met the wife of the president!

Krio “small, small”

2008-11-09T13:33:00.000-08:00

Helen has been asked to preach in church in February on the ‘Women’s ministry’ day.
Through constant daily use in her work she has gone way ahead of Dave in the language.

Krio has a lot of words that are now outdated in modern English, such as: make haste; yonder; cutlass; gentry (wealthy); copper (cash); tote (carry).

Krio is easier to understand than to speak, as you may appreciate in the following phrases taken from the Gospels: una for wideawake (be alert); oneword (unity); Jizos en in lanin boy den (Jesus and his disciples); den aks Jizos bot di day for pray en blow (they ask Jesus a question about the Sabbath); di married uman we den ketch pan fri life (the woman caught in adultery); Jizos tel di breeze en di swelin for steady (Jesus stilled the storm); Jizos swe one fig tik (Jesus cursed a fig tree).

Management takeover by ‘Freedom from Fistula’

2008-11-02T00:45:00.000-07:00

Ann Gloag’s (Scottish businesswoman and philanthropist) organisation (www.freedomfromfistula.org.uk/), which does similar work elsewhere in Africa has just publicised their takeover of our centre from a management point of view at the end of this year.

Our fistula and paediatric clinic work is more of a long term service, which has a very different emphasis from the urgent relief work that Mercy ships focuses on. Mercy Ships will however still be directly involved in supplies and other ways. It would be nice keep the Mercy Ships name, which has a hugely positive image in this country.

We will be sorry to lose some of the spiritual heritage of Mercy Ships, and the centre in Texas, and the many fine people who support and visit here, but we do see the benefit for the women and children of ‘Salone’ of management that is focussed on the medical work.

Please pray for those making decisions, and may our centre bring honour to God. The physical rehabilitation centre ‘New Steps’ has not yet found a parent to take them over.

Ministries of tourism and land clears ‘congestion’ in Aberdeen

2008-10-16T14:39:00.000-07:00

We normally take a relaxing drink on Friday after work at this beach bar, but all 15 bars on the 3 mile beach has been cleared in the last two days. The beach is now more lonely and less safe.

We have more sympathy for pavement shops opposite our hospital in Aberdeen built, by entrepreneurs trying to make a living. Shopkeepers (who helped us with learning Krio) have nowhere to go but the roadside. Dave runs out between surgeries and gives a hand moving the shoemaker’s kiosk to a side street.

Bible School marches in Lumley’s ‘Number 9’ area

2008-10-15T15:04:00.000-07:00

At a 6½ hour ceremony 120 children received their awards for attending the weekly Bible school that ‘Pastor Samura’ runs. This school is run in conjunction with the street school that Helen supports (due to re-start next week). Together they really impact the community.

Note the ‘Frenzy’ T-shirts from the Vine church.

National workshop on educational materials for prevention of fistula

2008-10-05T22:32:00.000-07:00

2 weeks ago Helen participated in this 3 day workshop held at our centre. Staff from the ministry of health attended, from the deputy minister downwards. Also the national broadcasting service attended, and several NGOs (non governmental organizations). She was impressed by everyone’s enthusiasm and teamwork.

The result was: 2 radio advertisements and a song, 3 informational posters, and a flipchart for use as a teaching tool. We will show you the photos once they are available.

Africana - celebrate the different tribes

2008-10-01T00:39:00.000-07:00

This month our church focused on the differences between the tribes, with much rehearsing for a 4½ hour service on Sunday. We learned new things about the culture, history, agriculture, dances,…… of nine tribes. One of them was Scotland!

Helen cooked flapjacks and shortbread, and Dave reminded them in a Scottish accent of the many streets in Freetown with Scottish names. We heard a greeting from our pastor in Dunfermline, and then had Auld lang syne, and the Eightsome reel. ……300 goggle eyed people watched with mouths hanging open!

Kumba petrified by fear of death

2008-09-21T00:01:00.000-07:00

Kumba is a 17 year-old girl, who said she was a Christian, last year delivered a still-born child after a long hard labour. Afterwards she leaked urine from a fistula, so in misery she went to the village medicine man. He, after tying herbs round her feet said that sand would pass into her feet and would rise through her body and cure the problem. If it reached her head, however she would certainly die.

Suddenly a Mercy Ships vehicle appeared in her area, offering surgery in Freetown. She climbed aboard, and soon found herself facing a white doctor offering an operation to cure her. She thought of the death-warning on her and was terrified. She asked repeatedly to be taken home to have the curse dealt with. At last after days of reassurance and teaching from Florence our counsellor and others she agreed to surgery. Two weeks later, cured but still anxious about the 'sand', here she is after her ‘gladi gladi’ going home.

Rugiatu - deadly complications

2008-09-14T01:14:00.000-07:00

A 26 year old woman from Bo district is the head of the ‘bundu’ society in her village. Bundo is the W Africa wide practice that initiates virtually all girls around or before the age of puberty. Typically it is a 6 week period of training in all sorts of female roles in society, some healthy and some very frankly occult. The course ends with genital mutilation (called ‘female circumcision’ see www.wikipedia.org), which renders the girl ‘clean’ and fit for marriage.

Rugiatu developed a fistula from bearing a child and came to us for surgery. Her smouldering introspective manner indicated an occult involvement. Her operation was difficult but no problems were expected. Suddenly on the third day however she became feverish and developed pain in her upper abdomen. I felt a bubbling crackling sensation under the skin, and instantly knew that she had ‘gas gangrene’, a condition with a 50% mortality in the West. I injected antibiotics and transferred her to an emergency hospital where large incisions were made to drain off the infection. She survived. After 48 hours she underwent further surgery and 2 weeks later came back to us, her fistula re-opened. She is still spitting fire and venom at me in particular. She is going home tomorrow and will return in 3 months for further surgery.

Pray for a turnaround for this woman, and for protection for our staff.

Faithful staff

2008-09-14T00:38:00.000-07:00

Thursday afternoon this week the heavens opened and on our way home we had to cross a river 150 yards wide with hundreds struggling to cross on foot (see video below). The back of our pickup filled to bursting with grateful passengers wanting to avoid and soaking and possible injury.

Freetown came to a standstill and most of our staff took hours (some as much as four) to walk home where there is no means to dry clothes. But next morning they were all back to work on time, bright and cheerful. We sang at devotions ‘Send us more rain……..!’

One member of staff’s relative is a little boy aged 3 who among others was drowned when several houses were washed away. A local newspaper wrote, ‘Freetown is congested with one third (not true) of the country’s population this could be evident by…. the illegal occupation of the dangerous and sloppy hills in Freetown by the downtrodden.’

Let it rain!

2008-09-07T01:24:00.000-07:00

Clothed in brilliant green tropical plants West Africa looks so beautiful at the end of the rains. The view from our balcony has changed from the dry dust of February with a few scrubby plants to an eight foot wall of ochre plants and other edibles. The video taken outside Helen's office shows what causes the change.

The Calabash tree, one of the earliest cultivated plants in the world

2008-08-31T00:17:00.000-07:00

Attending the funeral of another young women in childbirth this week we noticed a tree in the cemetry which had large green balls hanging from it. “Has someone tied balloons to that tree?” Helen asked. However when she approached the men sitting under the tree she was told, “No this is a calabash tree.” and they cut one down for her. Afterwards I sawed it open and scraped out the inner soft pulp (a culinary delicacy in some countries). You can see how useful it would be for containing fluids of any kind.

Amazing success rate

2008-08-27T14:41:00.000-07:00

On three occasions my leave has been covered by a Scottish gynaecologist who spent almost all her working life in Pakistan and Africa, concentrating for many years on obstetric fistula. She has a remarkably successful technique that I have not come across from my other trainers for repairing the common injury where the bladder and urethra have been severed into two. I am now practicing on this and finding it quicker and easier. Thank you Fiona!

Share physical possessions, but not metaphysical ones

2008-08-27T14:36:00.001-07:00

A predictable thing happened as I snapped this new sculpture of restaurant advertisement. Shouts went up and men hurried towards me from all directions. “Don’t ‘snap’ the sculpture.” “It belongs to the artist.”

The amazing generosity of Africans does not include sharing intellectual property. Photography, especially by a white man is seen as thieving the man’s work and using it for his own ends.

I escaped by saying I would phone the artist (“I de call am.”), whose name and number was on the sculpture, and “I able for bring mi padi den to dis restaurant de for eat dis chicken.”

Second Fistula Surgeon – their loss our gain

2008-08-25T10:38:00.000-07:00

In January 2006 when we first visited the Mercy ships in Texas we asked for a 2^nd surgeon to help Dave with on call and working together. This was turned down initially, but is now going to be fulfilled on 1^st September, by a national, which is a double privilege.

Alyona Lewis, a national of Sierra Leonean and Russian birth, has repaired 600 fistulas in 4 years at another charity hospital that closed three months ago. We know her quite well (and had a good chat on our flight last week!) and will give her a warm welcome.

Pray for good working and personal relationships.

8th August: 3 weeks in the UK

2008-08-24T02:29:00.000-07:00

We are sitting in the departure lounge at Heathrow waiting for the flight back to Sierra Leone for another six months there. We have spent great times with family and friends in the UK. Of special note:

Christa graduated as a primary school teacher
Stayed in a cottage for a week in the Highlands with our wonderful family
Enjoyed our very special grandson

We are prayerful for Stanley to overcome a fatigue problem which has been worse in the last 6 months

3 weeks’ course in Texas at Mercy Ships HQ

2008-07-24T22:37:00.000-07:00

We have just returned from an orientation course for longer term personnel, which we found a real blessing.

The centre with about 100 staff is located on a 250 acre cattle and forest ranch in deep countryside. There are deer, beaver, racoons, snakes (far more than Africa!), birds of many and beautiful varieties….

In was great to meet with people at the HQ, and understand each other better, and we got a better grasp of this great movement and its vision and values.

We enjoyed the teaching facilities and the visiting speakers for the course, which occupied 40 hours each week. We had time to reflect on our 15 months in Africa, and find some answers to our many questions. For example we learnt about ‘worldview’, the spectacles through which a person views and judges everything. Worldviews can be secular, god centred, or animistic (include the African traditional religion’s view of the universe).

We also learnt helpful things about our own personal development, and thought deeply about our relationship with God, and about changes we would like to make in our lives. We learnt about relationships with team colleagues and with the poor we meet in Sierra Leone.

There was also fun time visiting friends (see rose garden) and a trip to the rodeo (click the arrow on the photo to start the video).

Baby Sao

2008-06-30T17:35:00.000-07:00

In early May Helen (and Dave) received an urgent phone call. “’Ellen you mus’ ‘ep me! I go for die. Las week di police tek me to Kenema. Den say if I no pay de money for me operation dis Friday I go prison. DO YA please ‘ep me. I go DIE!”

Baby Sao is an intelligent woman of about 35 with six children. At the end of last year her seventh delivery went on for days, ending with a rush to hospital 30 miles away to save her life. Her elderly widowed father (as her husband is demented and she had no siblings) organised transport, blood donors and borrowed £140 (half an annual working wage) for the Caesarean section.

The operation saved the life of Baby Sao and her baby, but there was no money for drugs and her abdominal wound became terribly infected. After several weeks she was taken home to die, leaking urine from a wound the size of a plate.

At just that time the Mercy Ships 12-seater vehicle that drives round the country picking up patients stopped in her village. Tom French, the nurse looked at her and he and Francis, the driver put her in the truck, and brought her to Freetown. Dr Dave found her desperately ill. Her abdomen was widely open and he could pass a probe ten inches inside her. He prescribed strong antibiotics and changes of dressings three times a day. Over the next six weeks in the hospital her wound gradually closed and wonderfully, the urine flow ceased. She was back from death a second time.

The baby became the darling of the hospital. In time Baby Sao got involved in the patient rehab activities which Helen helps run. As she had learnt simple reading and numbers from her school-going children Helen trained her to operate a telephone business from her home. At last she was discharged, taking her baby, a large black phone and a charger.

Five months later the man who had financed her operation came up and said. “You are making big money from that telephone, so you can pay back your loan.” She replied, “But I have only earned a small amount (£30), and I am feeding 9 people.” He said, “Pay me in full or I will ask the police to charge you.” The man was within his rights to ask for the money back, but didn’t understand the circumstances. The police came and said, “You have four days to pay the full amount. If not you go to jail.”

So Baby Sao called and told us the news. Helen then told Florence (see lady in blue), the hospital counsellor, with whom she works closely. Florence said “My sister is the senior officer at that same police centre!” She called her sister and had the whole story confirmed; also that if the man pressed charges Baby Sao would be in prison indefinitely. She would have no one to feed her and might die and orphan her 7 children.

Dave & Helen had funds from UK to pay the bill, but how to transport it safely to Kenema 300 miles away? Florence offered, and that week-end spent 20 hours in a rickety minibus on bumpy roads to deliver the money to the creditor. Baby Sao’s life was saved for the third time!

More ‘Crossing the River’ (see article in April)

2008-06-15T22:36:00.000-07:00

Over the last 6 months your chance of crossing the river from the national airport to Freetown without incident was less than 50% in our experience.

This week some friends arrived in the evening from UK on the BMI flight. They took a taxi two miles and boarded the 500 man ferry. They waited over two hours and then the captain announced that there were still spaces for 15 cars in the ferry, and so “it would not leave till the next morning…..unless someone was willing to pay the fares of the empty spaces!” Indeed there was someone with the money and a sick child who couldn’t wait, so my friend was spared the night on a ferry seat.

Two weeks ago other friends who were travelling on to USA, one of them to his wedding in 7 days’ time. They bought tickets for the hovercraft and waited 3 hours to board. After 3 hours, under pressure from 20 passengers the captain announced that “the hovercraft had been damaged in a collision and would not be going.”

So the 20 got into taxis and crossed Freetown to the ferry port. At the port they heard that a president had chartered the ferry. No motor boats were available that night and the only remaining way was a large canoe with an outboard. The waves were rough and it was late, so they came back home. They waited two more days with us until the next available flight.

Fatmata

2008-06-10T00:04:00.000-07:00

Fatmata has an amazing story of suffering and of God’s help and healing spanning the last four years. She gave birth to a stillborn child in June 2004, after several days in labour. Immediately after the birth she could no longer walk because of damage to the nerves in her leg. Worse still she found she no longer had control of either her faeces or urine which passed from her uncontrollably. Her husband didn’t want a woman in that condition and returned Fatmata to her family where her aunt took her in with her three children. Gradually she recovered her control of faeces. Her leg however was still not functioning well and the family decided to take her to the local ‘medicine man’. He proceeded to make cuts in her leg and pour medicine in, to restore her strength. She still has visible scars.

After two years of misery someone from a local church told her to go to Freetown to the Mercy Ships Clinic. She made the six hours journey, and was admitted for surgery, which was partially successful. Over the next two and half years she has been admitted four times having for different procedures to put her right. At the same time the physiotherapist worked on her weak leg and she is now able to walk perfectly.

On each visit she would attend the hospital devotions and listen to the stories of Jesus that the counsellor told. She also observed the staff praying with each patient, encouraging them to believe and pray to Jesus who is the only healer. At the time of her final surgery she felt she needed to cry to this Jesus and ask him to heal her, which he did. Since then despite her family’s opposition she has made friends with the pastor and his wife of ‘Deeper Life Church’ and attends regularly. She has declared that she will never ever forsake Jesus.

Do’s and don’ts’ at the port

2008-06-09T22:37:00.000-07:00

The engines in two of our vehicles were wrecked after only 30 thousand miles thanks to the extremely steep and rough hill outside our house. A benefactor arranged for replacement reconditioned engines to be shipped, and also for a mechanic to fly out when they arrived and put them in the vehicles.

To clear goods for Mercy Ships at the port we usually pay an agent a very generous fee, which provides an efficient service, and things can be delivered the day after unloading. On this occasion in the name of economy we chose ‘cheaper’ agent.

6 weeks later, and innumerable phone calls, many emails, and a yet to be finalised increased price the engines arrived at the hospital. The visiting mechanic was already well into his week’s visit and it was only through several direct face-to-face meetings that the strings of promises turned into reality.

Remember:
1. Penny pinching is not always an economy
2. Africans prefer the face-to-face approach

Relief and celebration is shown on the faces!

Mango season

2008-06-08T00:22:00.000-07:00

For four months in West Africa it’s mango season. Ripe mangos can be knocked off the plentiful large trees and eaten for free by anyone. And are they delicious, sticky and mouth-watering? And are there over 14 varieties of size, colour and flavour. One’s called the paraffin mango! And can they be made into jam, chutney ice cream, crumble………., not to mention fruit salad every evening?!

2008-05-31T15:33:00.001-07:00

Esther

2008-05-17T13:06:00.000-07:00

Esther is a 25 year-old likeable girl with a thoughtful personality. She has emerged a whole person despite some awful experiences in the last 7 years.

In 2000 she had an unplanned pregnancy when she was a 17 year–old school-girl. The labour took place behind her house with a ‘birthing attendant’ from the neighbourhood. It went on and on for 3 days and nights. Eventually her family collected a lot of money and 2 blood donors and she was hurried to a mission hospital in Mattru her nearest town, where they carried out a caesarean section. The baby was dead, as they expected, but some awful injuries to her bladder and rectum had also occurred. Afterwards her urine and faeces started to leak uncontrollably. She was also limping badly because her right leg had been injured by squatting for long hours during the delivery. At a stroke her whole life completely fell apart. There was nothing to look forward to.

Five long years passed until she heard that ‘Mercy Ships’ had opened a hospital in Freetown to help women with her sort of problem. A special clinic at the mission hospital was arranged for these women. Her hopes rose, but they were soon dashed when she was told by the nurse from Mercy Ships, “I am very sorry, your injuries are too great for us to deal with at present. But come back in 3 months, and maybe we can help you.” She came back, but the answer was the same. On the third occasion, however she was taken by the nurse to a mission hospital near Freetown where a big abdominal operation was carried out. She bled afterwards and needed blood transfusions. The rectal problem was cured, but she was still leaking urine.

Two years later Esther was taken again to Freetown, this time to the Mercy Ships hospital in Aberdeen, a place by the sea she came to love. Everyone was so kind. A very experienced fistula surgeon was visiting, and she managed to close the big scarred hole in Esther’s bladder. She went home dry at night, but still leaking when she walked about.

In May 2008 she came again, her sixth trip. Dr Dave was there, who said he could possibly make her dry by stitching some tissue from her abdominal wall under the mouth of her bladder. The operation was a success. She was dry. She could now walk about freely with no fear of smell or wetness.

Dr Dave’s wife Helen was there too, who always had a smile on her face. Esther learnt some basic craft skills from her during previous visits and she made and sold a variety of items. She went to a craft school in her town and learnt to make other things. During Esther’s final visit Helen chose her to learn to run a telephone business. As she left she happily took a big black telephone with her. Now people in her village will come to her and make phone calls, and charge up their mobiles! It’s taken time, but Esther’s life and hope has been restored.

Wedding of the Street-school headmaster, Pastor Samura

2008-05-10T23:17:00.000-07:00

Yesterday we took part in our friend’s wedding (Helen gave one of the 10 speeches) . He is also head security guard at the British Consulate, and so the British Consul was thre as well.

Six reverends and three pastors officiated (not an unusual line up) and a bishop was there and preached very well. About 500 attended for the meal and speeches.

Note the woollen 3-piece suit that about ten men are expected to kit up in in 80% humidity; also the travel arrangements for the bridal party, and a 1 mile walk through a market and up a steep hill for the guests. Our contribution went towards the fancy cake!

Award Ceremony singing competition

2008-05-10T22:47:00.000-07:00

Last Saturday we attended this 4-hour event at the national stadium put on by Maada, who also put on the 'Bowl of Praise' event at the stadium. (see blog Feb). We were asked to give ou the awards.

Supporters stormed the podium when the female vocalist winner was announced!

Note the Frenzy ’07 T-shirts worn by Maada’s ‘Springs of Joy’ group.

Death of a fistula patient

2008-05-03T22:59:00.000-07:00

On top of Kadi's death the same week we sadly lost a fistula patient to infection, the first in several hundred operated patients this year. She had a bad fistula and the reconstruction part of the operation could not be completed at the time of the dissection. A virulent bacteria got in during the intervening days which festered and didn’t respond to antibiotics. I was very glad that on site we had an unprecedented 3 experienced surgeons, an experienced resuscitation doctor, and also an exceptionally good ward sister. Usually I am on my own with the sister.

Death in Sierra Leone

2008-05-03T22:50:00.001-07:00

If a family member dies you must have a large, expensive public ‘bury’ to avoid disgrace, which can cost you more than a marriage. A Christian bury will go on for over a week; Muslim funerals are quick and the body is in the ground by sundown wrapped in a sheet, but the public ceremonies go on for days, weeks and the year.

Kadi, our very popular seamstress, who is very good at leading worship at hospital prayers had a big wedding last summer which we all attended. The hospital was rocked three weeks ago when she lost a baby at seven months. Then 36 hours later she died for no obvious reason. We feel like a piece of our lives has fallen out. (the mortality rate in that ward is said to be an incredible 1 in 3, and 4 died during that shift. The lifetime risk of a woman dying due to childbirth in Sierra Leone remains the highest in the world at one in six).

Perhaps 1,500 people attended the funeral, all dressed in white. Helen spent seven hours non-stop that day attending the open laying out of the body in two homes, 3 processions, a three hour funeral, and a graveside ceremony. Whew! (felt dead at the end)

Gift with a sting in the tail

2008-04-29T08:39:00.000-07:00

We were sorting cartons of food in a shipment from the USA this week when this scorpion appeared. Apparently the yellow fat tailed scorpion has the venom to kill up to five people! (but death is uncommon) It probably crept in after the container had been opened.

Life is easy sometimes

2008-04-22T01:45:00.000-07:00

A surgeon is currently staying who can cover Dave at week-ends. Since it was Helen’s birthday we decided, along with two other British doctors who work in the clinic to take a taxi for 1½ hours to ‘Kent beach’, and board a motor canoe to cross over to the 7 mile tropical paradise island, known as Banana, because of its shape. We spent a night (full moon) there in a small resort, swam, wandered through the jungle full of birds, and through little villages hundreds of years old, and enjoyed lobsters (for the first time) straight out of the sea at £6 a plate!

Anna was nearly hit by a falling mango during breakfast, so she took the hint and ate it! The previous afternoon while she was reading in a hammock a big black snake fell out of a palm tree beside her! (True)

“Fire! Fire! Pour on water! Pour on water!”

2008-04-18T23:34:00.000-07:00

The home (two rooms) of Jeremiah, one of our drivers burned, along with six others this week. He is a widower with two young children, and is a member of our church. The good news was that the Aberdeen Fire station with 5 five trucks was located less than 50 yards away (just across the road from the hospital). The bad news was that none of them had any water! A fire truck had to come from the other side of Freetown.

Actually there is good news that he has been offered free land to re-build on. Bad news is that this may cost about £1,000.

Local government

2008-04-13T00:22:00.001-07:00

Helen's pain is improving, and this afternoon she managed to clamber through a warren of rocky alleyways to reach the local chief’s house. It is two tiny rooms, part of a complex of rooms where the extended family also lives. He makes a living as a cook in the International Court. A year ago he was elected by 500 votes to be chief for life for this area of several thousand people. Every Sunday afternoon he hears disputes in the veranda shown, with a policeman in attendance. In a month’s time we are to be invited to attend (and contribute handsomely to!) his coronation ceremony, after which he expects to be paid for his work.

Before we left we raised three issues of public concern with him:
1. Huge pile of garbage just below the children’s home where the street school is
2. Lack of a street standpipe for the many scores of children who draw water daily from a leaking pipe in a back yard
3. Increasingly loud, and sleep-preventing weekly all night prayer meetings broadcast by 3 members of a nearby church

As he walked us back to our house he raised the topics with about 20 people we met, and came to an agreement on each of them. On each issue he also appointed someone to take some action on the matter. It was fascinating to watch African consensus government, not democracy taking place.

Pain

2008-04-04T20:41:00.000-07:00

At this swimming pool just a week ago Helen slipped on some wet stairs and winded herself very badly and hasn’t been free of pain since. She did it once before when her Mum had to come and look after the family for two weeks.

Thankfully no bones were broken and she is steadily improving. She came to work each day this week, but spent several hours asleep on a mattress. Pray for a complete recovery.