This time last year my family and I were working in Bwindi Community Hospital, experiencing the challenges of living and working in a remote corner of East Africa and Coronavirus was as yet only a distant threat.  I recorded some early reflections:

“Drums call me to work. Singing heralds the beginning of our working day. An appreciation of the life we have, of the day ahead. Death is all too frequent here; a newborn baby, brought too late to the hospital following a traumatic birth in a far flung village. Like a tiny bird, her chest fluttered leaving life behind before it had even begun. An elderly patient on the ward reported to have had seven children, none of whom survived her. This is not uncommon and the visceral pain I experience on hearing this is just another sign of my own privilege. 

Two kilometres away over the mountain lies the Border of the Democratic Republic of Congo. After years of conflict, Ebola, fuelled by fear and mistrust sweeps through like a forest fire, a blanket of loss in its wake. 

It was many hours drive to reach here. We passed through dense mountain jungle falling away from the dirt road into a sea of mist. Villages teetered on high mountain slopes among fields of tea. A lone gorilla stopped to stare at us. A wildlife photographer once said that if you look into the eyes of a mountain gorilla your life will be changed forever. I can not validate this but I suspect that our year here will perhaps change how we view our lives, how we value life.

My sickest patients can’t afford to stay in hospital so they go home. A boy with poorly controlled epilepsy comes in with severe burns, his arm just dead flesh and bone. How much do we take for granted in our lives? Access to healthcare, medicines, food, clean water? The chance to live in freedom and safety in a world where there are 70 million refugees. We spend so much time thinking about tomorrow, how much money we might make, the new things we want to buy, the ‘civilised’ world pushing us to consume and compete. What if we pause and find that this day is an opportunity. What if we reach out to others and share our world. What if we place value on small acts of kindness. What if we are still and remember that we are alive.”

Reading over my thoughts from then I realise Coronavirus has since made many of us pause and reflect on our own health and well-being and the things we have taken for granted. 

Of course, the pandemic has only made the challenges greater at BCH. Tests are still being sent to Kampala and it takes a long time (two weeks) for them to be processed. There have been some community cases of Covid and a few amongst BCH staff. All are now well and back at work. Two in-patients had tested positive but had died before the results came back. Critically ill and positive patients are referred to the local Covid centre in Kanungu. Suspected patients are treated in the premium ward where they can be more easily isolated. There are staff shortages because of isolation and quarantine with a lot of pressure on the staff who are working. 

Costs of PPE are still high. A box of masks that would have costed 18000 Ug$ (£3.50) pre covid, now costs 60 000 Ug$ (£12), down from a peak 100 000 Ug$. There has been a change in policy from using cloth masks. Now, staff in clinical areas are prioritised to wear disposable masks. If each uses 1-2 masks /day, this costs £40/day. There are few tourists so limited opportunities for fundraising.

Community staff from BCH have been working hard to continue health education in the community on preventing the spread of Covid. However, with the elections on January 14^th, political rallies were happening throughout early January, making social distancing difficult.

Despite these challenges there are many positives. The Intensive Care Unit is nearing completion as is the accommodation for midwives. Thirty-two new clinical officers are due to start their courses now the election is over, with another eight returning to continue their studies. The nursing school skills lab has been completed with state of the art equipment, provided with support from the Rotary club. New eye and dental clinics are also being planned for when funding allows. 

As always, we value your support. Stay safe.