I have spent the last 6 weeks in Kisiizi Hospital, a small mission hospital located in rural South-West Uganda. The hospital was established in the 1950s when the Church of Uganda requested permission from the government to purchase an old flax factory to use as a mission hospital. Dr John Sharp was the hospital's first doctor and, by 1960, Kisiizi Hospital grew to include two wards, a labour suite, operating theatres, kitchens, laundry, and stores. Since then it has grown and developed to have nine fully functioning wards, four operating theatres, labs, radiology, pharmacy, and a busy outpatients department, including a small emergency department. Kisiizi Hospital now has an accompanying primary school, School of Nursing and Midwifery, and hydropower project, providing the hospital and over a thousand surrounding homes and businesses with electricity (most of the time). Kisiizi also has a big focus on sustainability and community outreach.

After spending a few days exploring busy central Uganda, I felt ready to base myself in a small village, nearly 2 hours drive from the nearest town. This quickly felt the case as, while still over an hours drive away, we turned off the last tarmac road and bumped along the last 29km. The setting of the hospital is stunning, located at the base of Kisiizi Falls, a popular tourist destination in the area. It is surrounded by green hills covered in banana and pineapple plantations.

The hospital itself is a 200-bed unit with a busy outpatients department alongside many inpatient wards including medical, surgical, paediatrics, maternity, special care baby unit, and psychiatry. The day begins at 8am with the daily chapel service, led by the chaplains and featuring short devotionals from different members of staff. Before you even arrive you hear the Rukiga hymns from the nursing students, accompanied by drums and clapping. This was a joyful way to begin each morning and allowed us to come together as a team to focus on God and centre our thoughts before the busy day ahead. This meeting was often followed by presentations or meetings, such as monthly audits for each department and teaching. Once these were done the day could begin.

I spent my first two weeks rotating through different departments to get a feel for how the hospital runs. These included the medical wards, surgical ward, theatre, and outpatients. Here I had some experiences I will never forget, operating by torchlight because the power went off, remodelling a young man's nose due to a human bite, and reviewing a man with a traction splint created by placing a pin through his tibia and attaching a paint bucket full of stones to a rope to hang off the bed (he says the femoral fracture felt much better but the pin was a bit sore!).

I then began working with the paediatrics team, knowing this is where my heart lies. This put me between the children's ward and SCBU, as well as frequent visits to the paediatric clinic once ward round was complete.

I also had the opportunity to join for outreach, which they do 5 times a month, to the peripheral clinics to provide antenatal clinics, paediatric immunisations, and malnutrition screening to communities that may struggle to access these services otherwise.

A core memory I will always treasure was when I was invited to join the nurse who led the malnutrition work for a home visit, "a short walk away". We met at 5pm and followed another nurse who lived near the patient and would show us the way. After twenty minutes of walking steeply uphill, on grassy paths through banana plantations, we stop to collect some guavas, knocking the out of the tree and eating as we go. Another ten minutes takes us to the nurses house where she offers us porridge. I soon discover this is a little different to the warm bowl of milky oats I was expecting! Porridge is a sour drink prepared by fermenting sogum and maize flour, it is certainly an acquired taste and I was informed I'd failed the community test. Assuming we were now close, we carried on climbing. Another twenty minutes later we seemed to have arrived. We sit in a field full of yellow flowers, watching the sunset over the surrounding hills, while we wait for our patient. The mother brings the baby out to meet us and we conduct the appointment right there. With lack of anything to hang the weighing scale from, the nurse just holds it up to weigh our baby. We were thrilled to see she was doing well so we left them there, as the moon and stars were starting to come out. Then begins the long walk home, completely in the dark. This features a stop to pick up a heavy bag of cassavas to take back and picking many herbs for treating their families ailments. My prayers were abundant to get us home safely, without slipping on the dusty track or getting hit by passing motorbikes! Nearly four hours after we set off, we return to Kisiizi, very tired and very hungry. A "home" visit unlike any others I've experienced!

A big focus of my time in Kisiizi was joining with the Empower programme. Empower was set up in 2017 by Heather Peace and Sister Monica. They both identified a lack of sanitary provisions leading to girls dropping out of school. With fewer girls attending school, the rates of teenage pregnancy and HIV increase. With children to look after, these girls are unable to gain qualifications to find jobs to financially support themselves and their family and thus begins a cycle of poverty and financial difficulties.

Heather and Monica saw a need for something to be done so began making reusable pads to distribute to these girls. They organise a team of tailors with the skills to make the pads, many of whom cannot work for other reasons including caring for children or having disabilities preventing them entering a workplace. Funding for Empower allows materials to be supplied for these tailors and for them to earn enough to support themselves. These pads are put in “pad packs”, a wet bag holding 4 reusable pads and one pair of knickers. Monica coordinates school visits to areas where the girls are unable to afford sanitary pads and gives the girls these packs for free. Alongside other members of the healthcare team joining her, she delivers teaching sessions on personal hygiene, adolescence, and the menstrual cycle. The girls have the opportunity to ask questions anonymously on pieces of paper which we try our best to answer.

I had the privilege to join Monica for three of these visits and during my time in Kisiizi I developed a leaflet summarising the information to be distributed alongside the pad packs. While I was there we gave out 300 leaflets in two schools, it was amazing to see their faces receiving the pad packs and watching them read through the leaflets provided a great sense of achievement.

The logistics of arranging so many leaflets certainly weren't easy! One evening, while trying to print 230 leaflets for a school visit, I jammed two of the three printers in the hospital, and made the poor IT man stay an hour after he tried to go home. The grace and patience of the staff was so evident in all these struggles. Another volunteer from the UK has offered to continue sorting the printing and I pray she has an easier time than I did!

If I had to sum up Kisiizi Hospital in one word it would be "welcoming". The culture in Uganda is so focussed on hospitality and I've seen that in so many ways. Every time I arrived on a new ward I was told, "you are welcome", a small phrase that means so much when I'm so far from home. One of the nurses on paediatrics, on the first day she met me, invited me to her house for Easter lunch. She had me round again, shortly before I left, a gesture I cannot underplay as with a nurse’s salary, with four kids to support, taking the time and money to feed visitors who cannot repay the favour, she really is an angel!

And I'll never forget my Ugandan Easter, no chocolate eggs but so much joy and celebration. The church had an Easter worship evening and it was two hours of praising and dancing and clapping, how else can we celebrate the resurrection!

My time in Kisiizi has been unforgettable and I couldn't have wished for anything more from my elective. Since I arrived I've been told that I'll come back, and with the way I've been welcomed and the friends I've made, I can absolutely see why so many people do! I've learned so much and been able to gain so much experience for which I am so grateful. Although the long path of medical training means it might be a while before I can return, I hope I can and I'll be praying for those I've met and the incredible work of the hospital as I come home.

Thank you to MMN for the funding that has made this elective possible and thank you for all the prayers and support encouraging me through the last two months.