Kate is our link missionary in Uganda. Here is her latest news:
Greeting my friends from Kuluva.
Leaving the UK
Before I left, I had a commissioning service at my home church. It was a wonderful occasion being with friends and family and was good to have a focal point and celebration before embarking on this new venture with God. It reminded me of what Elisha did before he followed Elijah; he killed his cattle, which he then cooked and shared with the people (1 Kings 19: 20-21). It was lovely to share time and food with people, especially cheese and chocolate cake!
Arriving in Uganda
I arrived safely in Uganda on 26 January, so have now been here for over 14 weeks. I stayed for a week in Kampala to receive my air freight and visit the Nursing and Midwifery Council (NMC) to try to arrange registration as a midwife here in Uganda. The visit with the NMC required two visits with the second one being an interview with a five-person panel. The outcome of the process was that I was required to undertake a clinical placement in Arua Hospital for eight weeks; this is a normal procedure for Uganda for foreign registered nurses and midwives.
Arua hospital is 11km from Kuluva where I am staying. It is a regional referral hospital, so patients and pregnant woman come from the surrounding areas including South Sudan and the Democratic Republic of Congo. As you can imagine, language is an issue; the local language is Lugbara but there is also another local language, Alur, and Sudanese women speak Arabic and women from the DRC either speak a local language, Swahili or French. Therefore, caring for pregnant women is quite a challenge when you cannot be sure the information you want to share is translated accurately. I completed four weeks on the labour ward, participating in care and seeing some of the frustrations of trying to deliver effective midwifery care. If you read any literature about what contributes to poor maternity outcomes in low income countries such as Uganda, the evidence talks about delay in recognising a problem and delay in accessing maternity care and delay in the right care being provided. Regrettably, I saw the consequences of all three types of delay: stillbirths, neonatal deaths as well of hearing of maternal deaths. However, I saw some really amazing situations, for example undiagnosed triplets who were all born normally without the need for resuscitation and I had the joy of helping new life into the world. The placement was a mixture of blessing and heartache. As one of my friends said, I saw more in four weeks than our student midwives in the UK see in the whole of their three-year degree course.
I then completed two weeks in antenatal clinic and two weeks in a young child clinic. Of course, the priorities in these clinics are very different to home as a result of tropical diseases and malnutrition. For example, in Uganda malaria affects 80 per cent of pregnant women so they give preventative treatment. The challenge in these clinics is the unpredictability in attendance as there is no appointment system, which is quite a different cultural experience.
As you can imagine the placement reiterated what I already knew, that poverty, lack of understanding and a lack of resources including staff, all contribute to overwhelming poor outcomes for mothers and babies, which is heart-breaking. The difference in being on placement is that it is just not reading and knowing about it, it is seeing the faces, touching real people.
Please pray for pregnant women in Uganda, particularly those who are poor with minimal education, as they have no voice, few opportunities and suffer the most. Please also pray for those in the Ministry of Health who allocate resources.
What about Kuluva?
Many people were waiting for my arrival for some time, so it was disappointing for it then to be further delayed by an eight-week placement in Arua. It has been difficult not to get started with the job I came for and I think my settling in process was delayed as a result. However, in the midst of this, God has reminded me of the story when Jesus at the age of 12 wanted to be about his father’s business, only to have it delayed until he was 30, so I guess eight weeks does not compare with 18 years!
The School of Nursing and Midwifery at Kuluva Hospital currently has 223 students in total, 95 of whom are midwifery students. Although I had been introduced to the students when I first arrived I have only recently met students on the wards following my placement in Arua; I immediately took the opportunity to commence some ad hoc clinical teaching. My first formal classroom based teaching was on Friday 22 April; it was great to get started, doing what I came to do!
Kuluva Hospital is a Church of Uganda Mission Hospital. It is a private, not for profit hospital so patients have to pay for their care, which is a challenge for local people. However, even in the state hospital patients have to contribute to the cost of their care. It was really exciting when the hospital passed an assessment for the opportunity for funding from the Belgium government. However, the funding is performance based so now the hard work begins as staff have to ensure that all documentation is complete for all aspects of care as proof of the work undertaken.
As well as the maternity unit the hospital has a theatre, medical, surgical, paediatric and malnutrition ward as well as outpatient facilities. There is also a dental clinic and opticians so the hospital does have many facilities but some resources are basic and need refurbishment. The hospital has its own electricity supply produced from water from the reservoir, hydroelectricity. The dry season has resulted in a depletion of water in the reservoir, which has meant several long episodes of no electricity to the hospital compound. At this time the theatre at the hospital is prioritised whilst the houses on the compound are switched off.
Please pray for the staff at Kuluva as they try to develop and improve their services. Please also pray that there is more rain to refill the reservoir.
My house is situated in a nice location, at the top of a small hill within the hospital compound, so I have a lovely view from the lounge window. The hospital compound is located in a forested area which is inhabited by Vervet monkeys who roam freely. They jump on the roofs of all the houses dislodging tiles, which means that roofs leak when it rains. They also start running around at day break, so no chance for a long sleep as they are very noisy! Saturday is my only chance for a slower start to the day, as the English Church Service starts at 8am on Sunday and during the week devotions start at 7:45am.
The facilities in the house are basic; there is no running water, so all my water is collected in jerry cans either from a borehole or protected spring. Unfortunately, the toilet within the house is a flush toilet which means manually flushing the toilet which now leaks due to over use following an upset gut! This is a far cry from my UK home and so I especially appreciated my trip to a Kampala guest house/hotel for a warm shower and a flushing toilet (in April). Whilst in Kuluva, I have resorted to taking a swim at the local hotel, so that I can have a regular shower although the shower is very cold, colder than the swimming pool, so that warm shower in Kampala was very appealing!
The water supply is a challenge which I share with the majority of people in the surrounding areas who also only have access to water by using jerry cans and bowls. In fact, I am blessed as I don’t have to do significant carrying; I can hardly lift a full jerry can (20L), yet women in rural villages carry full jerry cans several kilometres. Currently, water remains in short supply, as the dry season has lasted longer than usual; some areas have now limited families to two jerry cans per family. I’m always encouraged when I hear of projects that provide clean water for villages and schools as it is such an essential basic need.
Shower of blessings
In the church services here, the song “Shower of Blessing” is one of the favourites, frequently sung at every opportunity. It seems appropriate as I have been showered with many blessings as since I have arrived friends and family have been faithful in sending me emails and WhatsApp messages. It is amazing how social media helps to stay in touch with people; this is so encouraging, particularly as I live on my own in Kuluva. Skype has been another amazing tool, especially as I am quite a visual person, so I appreciate seeing people’s faces. Technology makes a real difference and a mobile modem for Wi-Fi is amazing but sadly I have to limit my use of Skype, as it eats up my monthly Wi-Fi allowance.
I was also blessed by a visit by my friend Maggie Clark, who came for two weeks in April. I was showered with cards and gifts which was humbling and wonderful. One church house group sent a shoebox of gifts which was amazing and now I know the delight that the children feel at Christmas when they receive a shoebox of unexpected gifts. Maggie and I were able to have a few days’ holiday, another gift for me. I feel overwhelmed by kindness so thank you so much for your love and support.
As a result of the blessings I received, I was able to participate in blessing others too. I was able to employ some local people to help with changes in the house and both money and work are in short supply. One couple helped a bright student to pay a significant part of his school feels. He would not be allowed to sit his final exam unless the debt was paid, so you can imagine his delight to be debt free! Another friend sent money so students could have meat in one of their meals (sorry vegetarians!). The students only get meat once a month which is a highlight of their diet. Normally their usual daily diet is posho (maize flour porridge) and beans, with posho being replaced by rice on Sunday.
I went to the Nursing and Midwifery Council in Kampala in April to take the reports of my placement in Arua and to get registration. However, there was a complication with registration due to different terminology as the UK Nursing and Midwifery Council records teachers as lecturers/education practitioners whilst the wording in Uganda is midwifery tutor. Consequently, the decision has been referred back to the panel for foreign registered nurses and midwives, although there is no date set for the next panel. However, I have been granted permission to start teaching as I successfully completed the placement and had all my original qualification documents with me. Please pray that I obtain midwifery tutor registration as Kuluva needs a tutor with that registration.
I am looking forward to the visit this month of a small team from one of my link churches, St Mary’s, Princes Risborough. They have a long established link with the diocese of Madi West Nile and the hospital in Kuluva, and undertake several projects to support the diocese. It will be good to see them and the work they are supporting.
Thank you for reading my link letter, I hope it gives you a taste of living in Uganda. Please pray for the poor and vulnerable people of Uganda who struggle with every day basic needs. Pray also that the rain comes to replenish water supplies. The lack of rain is delaying the planting of crops which also hinders the diet for the poor subsistence farmers.