I feel incredibly fortunate to have spent 2 months in Kisiizi hospital in South-West Uganda over the summer. Having never been to Africa or travelled alone before I was very nervous and excited to discover what opportunities awaited me. The first time I saw the amazing rolling hills and banana plantations whilst driving from Rwanda to Uganda I fell in love with the ever-expanding beauty, and also became quickly acquainted with the African massage! Away from the bustle of the cities, the single dirt track to Kisiizi began to reveal pockets of villages and farming communities. I was immediately made to feel at home by the lovely guest house and hospital staff.

As this was my first experience working in a mission hospital, I was not sure what to expect. The team consists of Ugandan doctors, the majority of which are interns alongside a handful of medical officers and a couple of consultants. They work alongside nurses, midwives and pharmacists and a large cohort of nursing and midwifery students training in Kisiizi. There is a rehabilitation centre which is run by physiotherapists and physio assistants and a psychiatric unit run by nurses and a psychiatrist. There were several external professionals who had come to work at Kisiizi as well including some British doctors and Irish physiotherapists.

During my time in Kisiizi I rotated around all areas of the hospital including the paediatric, surgical, medical, obstetric, rehabilitation and psychiatric units. It was really interesting to see how each of these areas worked and be able to learn from each clinical member. I was involved in clerking patients as well as reviewing patients, taking histories with a translator (often a very helpful nursing student!) and examining them. I was encouraged to join in making a plan for the patients as well as writing prescriptions and discharges under supervision. During surgery I was encouraged to participate wherever I felt comfortable.

I was amazed by how adaptable the staff were when faced with challenging situations where the available medicines or investigations were limited. I improved my ‘end of the bed’ medical examinations and was amazed by how much information the staff could gather just from observing a patient for a minute. It quickly became clear that histories were often unreliable for the first few times of asking as patients or family members were afraid of getting into trouble or being accused of not taking good care of their relatives. Because of this, many of the staff put more focus on examinations and educated judgements when making decisions, particularly when the options of treatments were so limited.

Throughout my time at Kisiizi I was exposed to many diseases and infections that I had not frequently encountered in the UK including severe tuberculosis, cerebral malaria, yellow fever, osteomyelitis, atypical pneumonias and suspected haemorrhagic fever. The HIV clinic was very informative into the complications of being immunosuppressed and highlighted the complexity of revealing a diagnosis such as this to a society where there is still much fear and prejudice towards HIV. In Uganda calling someone ‘slim’ is one of the highest offences as it suggests they have HIV due to the rapid weight loss experienced by many patients with the condition. I found it fascinating to learn from the clinical staff about snake bites and other things rarely found in the UK and was taught how locals deal with them using white beans and black stones, with the village performing a man hunt to kill the snake, often leading to more than one person being bitten. I saw anti-venom being used and discovered through this how treatments are sometimes more dangerous than the initial condition. During my time I had to suck maggots out of a patient’s throat and witnessed worms being pulled out of a child’s nose- it was definitely a test to then eat lunch straight after!

It was interesting to see how much value was placed on surgery during my time in Uganda and this was reflected in how busy the surgical unit was. Many patients would request surgeries that were not necessary such as a TURP for elderly bedbound males and would happily pay beyond their means for surgical intervention. Family members would often ask if there was a surgical solution rather than having to pay for medicines, particularly for chronic conditions like diabetes where long-term medical regimes were seen as logistically challenging and expensive. Because of the preference towards surgery, the medical students and interns’ courses are heavily weighted for surgery as well. By their 3^rd or 4^th year of medical school all Ugandan student doctors are required to have performed their first c-section. It was therefore interesting to see how the life-saving nature of many surgeries like c-sections has become entwined into the society. Many of the surgeries are on patients who have had traumatic motorbike/road accidents or have been wounded by knives working in fields or following an attack over money etc. The surgeons are therefore very skilled general surgeries as well as being able to perform laparoscopic surgeries and being a centre for urological intervention.

I found my time in the maternity ward particularly challenging as Uganda has the highest rate of stillbirths in Africa. Many mothers were expectant and fearful of pregnancy complications, acting as though a miscarriage was inevitable or being reluctant to draw attachments to the foetus for fear they would have a stillbirth. This highlighted to me the deep shared trauma of many women in Uganda, with the expectation of death arising from the many stories shared through generations, friends, neighbours or personal experiences. There is also little faith in many of the health centres as they are often inadequately staffed and underfunded. This fear was reflected in the hospital c-section rates as over 50% of labouring women had a c-section. Despite these high rates of c-section, the rate of stillbirth in Uganda is roughly 8 times higher than that of higher income countries.

On one occasion I was talking with a woman who had been transferred across from a local health centre. She had had a seemingly normal pregnancy and labour until she had an obstructed labour and was taken for a c-section. Unfortunately, the baby died as no one had prepared the equipment for neonatal resuscitation. The response of the staff was ‘that’s Africa for you’ highlighting to me the expectancy and hopelessness of even the midwives for the ‘African system’ to fail their women. But the more striking feature for me, was the lack of grief support for the women and families outside of places like Kisiizi. The patient was left devastated and unsure how she was going to explain her supposed failure as a mother to her home village when she returned. She explained that she would receive judgement and blame for the death, with many querying whether she had liaised with spirits. Alongside these burdens were the fear that her husband was going to leave her because of her supposedly lacking fertility and mothering instincts.

Death is a frequent outcome in Kisiizi as many families cannot afford to bring their relatives until they are extremely unwell or cannot afford the treatments required. On the one hand I was struck by the longing for a relative’s death by many family members who found looking after very sick relatives for extensive periods of time wearisome in a society where working the fields is often the only way to make money. I found it challenging when I saw parents reluctant to pay for their child’s treatment when they knew they had many other children to provide for at home, with many being forced to reject life saving treatment in order to do so. The pain and struggle on the parents’ faces will stay with me forever. But on the other hand, there was more joy and celebration at death then in the UK with the heavenly promises rejoiced at. When a patient is dying, all of the attendees in the ward, even if they don’t know the patient, gather around and clap and sing until the patient has passed. They often have the chaplain praying over the patient in and amongst the singing and this was a blessing to witness on many occasions.

Traditional healers and practices are still very prevalent with many patients requiring attention following the intervention in the community. Many children were brought in after having their chest cut open to various degrees to ‘extract millet’ in order to cure pneumonia. Many told stories of child sacrifice required by ‘witch-doctors’ and the fear this brought. Herbs are also frequently used and so patients often came in with liver failure as a result of herbs. What was described as ‘traditional Chinese medicine vans’ toured round the villages and patients spend their entire fortunes on the treatments offered. One patient died due to a spirulina overdose from pills suggested to her to cure tiredness.

I found the prevalence of blame on witchcraft and dark spiritual forces to be much greater than I’d expected. For example, the cause of cerebral palsy is explained as the mother liaising with demons during pregnancy. Children with cerebral palsy are therefore kept in separate rooms and often houses to other children in case they ‘infect’ them with the presence of demonic beings. This was heartbreaking to see and so I was amazed at the work being done by the rehabilitation outreach to educate communities and parents on the condition.

During my time in Kisiizi I went on many community outreach days and clinics which allowed me to get a sense for how life is lived outside of the Kisiizi community. I also participated in a period project which involved us going into schools and educating girls on menstrual health and reproduction. We provided them with reusable pads as many girls drop out of education and miss school because they have no way of managing periods beside putting ash in their underwear. I was able to go into the local primary school and help the Irish physiotherapy students put on a sports day for the children which was amazing fun to see their competitive spirits!

Although there were many challenges during this time, I feel incredibly blessed and looked after by God. I found so many conversations with staff and patients to be a reminder of how good God is and how there is always hope with Christ. Even though western eyes may look on the lives of many in Uganda as sad and hopeless, the joy experienced by so many was uplifting. God was so evident in so many conversations. I was amazed to see the doctors pray with every patient before they had surgery, and this encouraged me to think about my practice in the future and exploring ways to be brave with my faith. The role of the chaplains was so vital as they faithfully prayed with every patient possible and ensured a blessing on each ward and the staff during chapel in the morning.

I had so much fun exploring the area and learning more about the culture. I thoroughly enjoyed getting stuck in with traditional Ugandan dancing and was overwhelmed by the amazing culture of celebrating people and life woven into the hardships of life. It is a truly beautiful country filled with loving people who were so kind in sharing their lives and culture with me.

God looked after me every day I was there, and the experience has encouraged me to seek the joys of each morning and never to take people for granted. I was reminded that God is above all things and his power and authority over all nations are endless. Whenever situations were challenging, I was reminded to lean on him for support and peace. I pray that the nation of Uganda will continue to seek the Lord and that he will bless the people and the work of the hospital. Please continue to pray for the resources and continued faithfulness of the staff in the hospital as they work to love their community and honour Christ with their actions.

I’d like to say a big thank you to MMN for the generosity and kindness that has allowed me to have this incredible experience. I am also very grateful for the thoughts and prayers during this time. Although the imperfections of this world lead to many struggles and seemingly unanswered prayers, Uganda has reminded me that God is sovereign and will faithfully end suffering and complete his salvation plan through the new heavens and earth.