In five week’s time, and save for disasters, I will be with my family, somewhere in the skies above Europe, heading towards Uganda. I am about to spend the next several months there, working as a doctor in a hospital in the remote, rural South West corner of that country, close to the border with Congo and with Rwanda. I am going with Brian, my ever-supportive husband, and my two wonderful daughters, Miss A who is 7, and Little Roo who is 4.
Five weeks – quite a long time to get ready? It really doesn’t feel like that. Between now and then there are still so many things left to sort out, from antimalarials to mail-forwarding to work meetings to birthday parties. Oh yes, and a new opthalmoscope, and reading books for the children who won’t be in school for a year, and where will I buy shampoo – do we need to bring enough for 10 months? And then there is a house to de-clutter before our tennant arrives …..
Somewhere amongst all this busyness I am trying to reflect on what it is we are about to embark upon.
Here are the facts:
I am a GP Partner (that means I am responsible for a general practice surgery as a business as well as for the patients.) I have been given the most generous opportunity by my colleagues – they are allowing me time away, up to a year away, to do something that feels like it matters. That thing for me, is to be with my family, working in Africa. I have worked in Southern and Eastern/Central Africa before, but never with children. Brian has too, but before the girls and I were part of his life. For both of us, the experiences were formative. We want to be open to being changed again, and for our girls to have that opportunity too.
We will be living at, and I will be working in Bwindi Community Hospital. The hospital was established only 15 years ago as an outreach clinic to meet the needs of a disadvantaged community who had been displaced in that area after the opening of the national Park, the Bwindi Impenetrable Forest. The services expanded, and now there is a fully established, and very well regarded hospital which has been innovative in many of the services it offers. The hospital is part of a network of hospitals run by the Uganda Protestant Medical Board. There is an equivalent Catholic hopistals board, and a Muslim medical board that supplement the State provision of health services. All of these are not-for-profit and need to generate income to run their services. The income comes from private donors, NGOs, the state, and there is a tiny contribution from user fees. BCH has been at the forefront of creative solutions to funding services. The hospital has developed a health insurance scheme that allows even the poorest families to access services even if they are expensive, and so enable people to take up preventative services as well as ones aimed at curing disease.
I will be working in the Adult In Patient ward for three days a week, and I will be involved in Quality Improvment projects for another three days.
We will all live on the hospital site. Brian is going to home-school the girls, and put energy into being part of the community. We will all take as much advantage as possible of the fact that we will be living on the edge of one of the most biologically diverse areas of the world, the forest home to half of the world’s population of mountain gorillas.
Here are the feelings:
There is excitement, of course, but at this stage, the dominant feeling is actually one of doubt. Here are some of them.
How can a GP like me, settled into the ways of primary care in the UK, make any sort of meaningful contribution in a setting so unfamiliar to me, when I will be there for such a short time?
After 15 years in General Practice, will I still be able to deal with people who are seriously unwell? Will I be of any use putting in a cannula, setting up a drip, putting in a chest drain, doing a lumbar puncture? I did all these things when I was younger, but will I remember how? Will my fingers remember the technical stuff? Will my presence on the ward be useful?
Do I have the stamina to see people die so frequently and in ways that would be unthinkable back in the UK? How will I respond?
How can I understand what will be useful for the services in terms of quality improvment, and find a way to make a difference?
Will I be able to spend the time with my family that we will all need? After all, part of the point of the whole undertaking is to spend more time together than we do when we are in our busy lives at home. Will I really be able to stop working all evening (or is that just me) ?!
Will I be thrown off course by things that previously I took in my stride, like bad roads and dodgy public transport?
Will the children find the newness of it all too much of a challenge? Will they settle?
Will Brian and the girls have enough to do each day so as not to resent the whole project?
Is it really fair for me to leave my colleague to manage the practice without me and carry the responsibility for so long whilst I swan off indulging my whims in this way?
Is it right to leave our extended family?
So many questions, and so many doubts. We can only trust that the answers will show themselves with time.
Dr Margaret's diary 