I was aware that Kisiizi Hospital would be small and rural, but I was not expecting the single dirt track running past the main gate and the surrounding villages sprawling out into the rolling green hills and banana plantations. Kisiizi Hospital in south-west Uganda would be the hospital and community which two close friends from medical school and I would call home for five weeks during our medical elective; my first experience of African culture and working in a Christian mission hospital.
The current superintendent of Kisiizi is Dr Ian Spillman, a paediatrician, who has worked at the hospital alongside his wife Hanna, a midwife, for many years, initially working with Tearfund. Ian and Hanna, inspiring in their faith to follow God’s calling and in their trust and reliance on His provision for the hospital, welcomed us from the evening we arrived and were a huge encouragement to us throughout our time there.
The healthcare at Kisiizi is provided by a small team of Ugandan doctors and surgeons including interns, consultants, nurses, the many nursing students based at the attached nursing school, pharmacists and a physiotherapist. Throughout our time at Kisiizi, we were also privileged to meet and learn from various clinicians from around the world, serving at the hospital for different periods of time.
As elective students, our role was mainly to work alongside the interns, supporting them on ward rounds, examining patients, taking histories in clinic, discussing and suggesting management plans and undertaking jobs such as chasing results and performing electro-cardiograms. Towards the end of our time, the nursing students left the wards to begin their revision period and we were also able to support by performing the routine observations of patients.
I spent the majority of my time on the paediatrics ward and in the general paediatrics outpatient clinic, but also had opportunity to experience general adult medicine, attend a maternity outreach clinic (taking so many manual blood pressures that my ears began to ache!) and be part of an ‘International Fistula Day’. The latter occurred during a week-long fistula surgery camp held at Kisiizi and was a day aimed at raising awareness of available surgery for women with obstetric fistulas, giving hope to the many suffering tirelessly from the physical and emotional consequences. We certainly hadn’t anticipated being part of the group performing the ‘fistula dance’ in front of hundreds of people from the local communities until our last minute call up!
Kisiizi was my first experience of medicine in such a resource poor setting and it was incredibly eye-opening seeing how the care of patients was significantly compromised by a lack of resources. The paediatric ward had only three oxygen saturation monitors, only one of which consistently worked; the children received oxygen from shared concentrators via multiple long plastic tubes which were draped along the floor and frequently stood upon. There were frequent shortages of blood; transfusions meant that the generosity of staff with compatible blood groups was often called upon and the only electrolyte panel test was broken for a whole week. These and other examples posed challenges both in treating individual patients and in the various decisions of resource allocation which had to be made. Despite these difficulties, I was amazed at how the hospital staff continually adapted under the circumstances and strived to maintain a high quality of care.
During my time, I was exposed to a variety of often interesting medical conditions which I had not previously seen, including fungal meningitis and other HIV complications, frequent cases of malaria, including cerebral infections, and the tragic consequences of often extremely harmful traditional therapies, such as the cutting of the chest for children with pneumonia named ‘Millet extraction’. I was also able to develop my understanding of how children presenting with severe acute malnutrition are diagnosed and managed at Kisiizi, and compare this to evidence-based guidelines for my medical school report.
As I think and pray through the potential of future overseas medical mission I realise my time at Kisiizi was invaluable in gaining an insight into what this might entail, helping me to start thinking through some important questions and teaching me more about a God who is sovereign over all nations.
Living at Kisiizi challenged my prior expectations about the sort of opportunities I would have to share the gospel, and how this would compare with working in the UK. I had assumed that having the freedom to do so openly, I would have more opportunities to tell people about Jesus’ love for them and in some ways, this was true. Staff and patients were generally very open about their faith, patients would often join together in sung praise and prayer on the wards, and each day began with a time of chapel to seek God through His word and commit the day to Him. But there were some challenges to talking about faith, some of which I expected whilst others I didn’t. My own lack of courage to initiate a conversation was often a barrier, just as it is often the biggest barrier to talking with friends in the UK. Even though I now had more freedom to do so at Kisiizi, it was still not easy and I am challenged to be praying more regularly wherever I am, for more boldness and wisdom in how to share the Gospel in these conversations.
Understandably, the different language was a barrier to discussing faith with patients and this highlighted the value of thorough language learning. Kisiizi is based in a very Christian community, and we praise God for the many staff and patients who are followers of Jesus there. This has challenged me as I think about the number of people who don’t know Him on wards in the UK hospitals where I currently spend each day, and areas in the world where gospel workers are few, compared to somewhere like Kisiizi.
One of the hardest questions to work through from my experience at Kisiizi has been the reality of tragic death, particularly of children, which I encountered. I was involved in the care of a child who was seriously unwell and who had been subjected to a harmful traditional therapy. After the ward-round one morning, the child received his nutritional feed from his parents through an unchecked nasogastric tube and suddenly aspirated and died. I remember praying as attempts at resuscitation began, that God would heal the little boy at that moment, but He didn’t. I felt helpless and confused at what felt like the injustice of it all, knowing that the little child may have survived if he had been treated in a different context.
This experience has caused me to seek to pray these issues through and God is teaching me through studies into His word and discussions with friends and mentors. I have been struck by God’s sovereignty and power which is far greater than we can understand, and which leads us to a humble reliance on His wisdom and plan. I have been challenged by what it means to trust in God regardless of how He answers our prayers as Daniel’s friends state before Nebuchadnezzar: ‘the God we serve is able to deliver us…but even if he does not…we will not serve your gods’ (paraphrased Daniel 3: 17-18). I have been moved by Jesus’ understanding of the grief we feel and His compassion, but also the beauty of His ultimate victory over death. Jesus is the only reason we can sing for joy and be glad all our days, despite all of the suffering in this world. Clearly, this is an area I will continue to pray and work through with God.
One of the overriding themes in people’s prayers living at Kisiizi was an attitude of thankfulness for all of God’s blessings and provision in the everyday, not just His answers to prayers. I am challenged to cultivate such an attitude in my own prayer life in the UK, where it can be so easy to not rely on God for the everyday.
Kisiizi Hospital is a special community and a testament to God’s provision and blessing. My time there has challenged me and excited me in my journey of faith and my path to becoming a future Christian doctor.
