Going on home visits with Hospice Africa Uganda

I have heard it said by the volunteers who come to work here that Uganda is ‘Africa light’. It is true that the climate is generally cooler and less humid than West Africa or coastal Kenya and the people are genuinely welcoming and friendly but the realities of life for most of the local people can still come as big culture shock to those of us used to being cosseted by the welfare state. Visiting the patients of Hospice Africa Uganda with their home visit team takes you to the heart of those realities.

Monday 6th February, Mark and I joined the team based on Uganda’s second city, Mbarara, on visits to four patients. Although a university town, Mbarara is a million miles away from the hustle and bustle, traffic and pollution of the capital Kampala. Set in rolling hills the area is known as ‘the land of milk and honey’ from its cattle ranches and the local beekeeping industry. Well maybe for some! It was cooler than the capital as it is some hundreds of metres higher in altitude and the first rain for some time had fallen.

The team was palliative care nurse Fransisca and driver Siraj. He loaded the big four- wheel drive vehicle with Francisca’s back pack and suitcase of medicines and equipment and we piled in. In front was young girl of 12 or so. She was the daughter of our first patient and had called in that morning, the first day of the new school term, to say that mum’s condition was worse and due to hospital expenses the family could not pay the school fees for the four girls so they could not go back to school.

We set out on the paved road west, towards Kibali and the crater lakes of the far west of the country. After ten minutes, we turned off onto dirt road and after twenty minutes of bouncing about on the well rutted track through banana plantations we turned again into a clearing containing a mud built four roomed house. There are several other houses in the surrounding banana plantation and the arrival of the big Hospice vehicle generated quite a lot of interest from children and adults.

We followed Fransisca into the house and through to the patient’s bedroom accompanied by the patient’s sister in law who was her carer. Fransisca opened the shutter to let some light in. She sat by the patient’s bed and Mark and I sat on the bed opposite which, as our eyes got used to the dark, we realised we shared with a chicken. Francesca explained our presence in the local language and we greeted the patient. There was a musty smell which Francesca explained was the patients unwashed condition as the children had not been to get water from the well. She has cervical cancer which has spread to the rectum. She was being provided with morphine by Hospice to stop the pain but this has caused constipation. To ease that she has been taking laxatives which have caused diarrhoea but has she has continued take the laxatives. Her discomfort from this caused the family to take her to Hospital which has incurred further expense. She is bedridden so has not worked the plantation. The husband is absent to find work.

Fransisca examined the patient. Looked at her medicines and advised her on which she should continue to take; refiled her morphine bottle and talked through her worries. We spent about 40 minutes with the patient.

Outside Fransisca explained that the patient and family had not yet accepted that she is dying and is looking for a cure which she will not find. The patients main worry is that the family cannot find money to pay this terms schooling costs for the four children. These are still in primary schooling although 3 out of four are older than we would expect in the West for primary school. They go to Government schools so there are no fees but there are costs for food, books and equipment etc. I casually remarked to Siraj that the place was surrounded by banana plants, no one would starve. He

told me how wrong I was. ‘Do you see any banana’s Jim, these people are starving’. He explained that with the surrounding houses there were too many people to be supported by the plantation and with the drought we have had for two months the crops were failing. Later I heard on the radio news that there are now 7m people on food aid in Uganda- up from 1m a month ago, and 80 people had died of hunger. Fransisca’s worry for the kids is that when the Mum dies the father may marry the older one off and abandon the rest. Hospice need to find where he is and provide the necessary support so that will not happen.

30 minutes of rough riding later we entered a beautiful valley to visit the next patient. I remarked on two very fine houses with satellite dishes despite being at the end of an increasingly narrow and rough track. Siraj explained that this valley could support bananas and coffee and the surrounding hillsides could be quarried for stone giving three sources of income. In fact, our patient lived in a comfortable brick built house with concrete floors surrounded by guava trees. She is an old lady suffering from rheumatoid arthritis. Her pain is controlled but she also suffers from constipation caused by the morphine. The driver was sent off to look for local weed which is a mild laxative. Mark and I were relieved to be asked to leave whilst a rectal examination was carried out.

In fact, for non-medic’s like us, it is important to stay for one full consultation with a patient to see the whole procedure but little is gained by seeing more. The interesting thing of staying with the team to the end is to see the different patients and how and in what circumstances they live. And to see what a day’s work entails for the team. Whilst outside this house we were joined by the husband ,and Siraj who could translate for us, and we had a lovely chat about hunting for game with a spear in the old days when things were better.

To get to patient three involved returning to the paved road and then enquiring with the locals which dirt road we should take to find him. Mark and I were just commenting on how comparatively smooth this track was when we came to a deeply rutted vertical side track. We gave each other a ‘we’re not going up that’ look when we did. At the top of the hill, in another banana plantation we found him. He is the widower of a patient of ours who died of cervical cancer and whose children are on the ‘give a chance’ programme for school fees. He looked quite elderly. On the way back to boarding school they called in at Hospice to say Daddy was ill and they feared he might die before they returned home. (Boarding school for children of even modest means is quite usual here and relatively cheap. I am told that results are better without the distractions of home.)

Once again, our arrival caused quite a stir and we were surrounded by the neighbours and their children. The patient, who was not on our programme, was taken into a neighbour’s house to be examined. Mark and I were given a couple of stools to sit on in the sun and be stared at. After a while we tired of looking at the stunning view and being stared at so we decided to entertain the kids. I cuddled the baby. Mark swapped hats with the oldest boy who seemed to consider the others to be his gang. We took photos and sang a song, showed them how I could touch my nose with my tongue which seemed to pass the time. After the examination Fransisca thought the patient probably had a benign prostate growth and advised him to get himself to hospital for examination.

And to the final patient. A little girl of ten or so who has Hodgkinson’s lymphoma. She is an orphan who lives with rich granny in a very posh house on a farm. Granny and two friend were eating lunch and watching TV when we arrived. The girl was called and I am pleased to report that Fransisca found her lymphoma dramatically reduced and she would return to school the next day.

We finally got back to Hospice for lunch and debriefing at 4pm having left at 10am.

Two beers at the Lake View hotel were very welcome.

The fertile valley

Our unintended audience.

Fransisca our nurse

Our driver