John Ross's Ugandan Diary
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1 John Ross's Ugandan Diary The experiences of a Canadian Doctor helping to establish post-graduate medical training programmes. For readers wishing to print this Diary it consists of 176 US Letter Sized pages made up of 168 text pages followed by 8 pages of colour photographs. ©John Ross, St. John's 1994 2 CONTENTS Preface and Portrait..............................................................................................3 Eulogy .................................................................................................................8 Foreword............................................................................................................10 Map of Uganda .................................................................................................12 Acknowledgements............................................................................................13 Diary Part 1:. February, 1990 - July 16th 1990 ..................................................14 Diary Part 2: September 3rd, 1990 - June 1st, 1991 ............................................45 Diary Part 3: October 17th, 1991 - July 16th, 1992............................................67 Diary Part 4: August 24th, 1992 - June 23rd, 1993 .............................................98 Diary Part 5: August 4th, 1993 - March 16th, 1994 ..........................................141 Plate 1 –Colour photographs – Tororo hospital views.......................................169 Plate 2 – Colour photographs – Residents and surgery at Tororo ......................170 Plate 3 –Colour photographs - Tororo people ..................................................171 Plate 4 –Colour photographs – Local scenes and people...................................172 Plate 5 –Colour photographs – Kitovu staff, Mulago Hospital and bicycles ......173 Plate 6 –Colour photographs – An incomplete Siamese twin, herpes in AIDS ..174 Plate 7 –Colour photographs – Animal scenes..................................................175 Plate 8 –Colour photographs – Spousal care and the tragedy of AIDS ..............176 3 John Munro Ross 1928 - 1999 Preface A brief account of the career of John Munro Ross is of interest as it will give a better understanding of his work during the period covered by the Diary. He was born at Kisumu, in Kenya, in 1928, the son of a Scottish doctor in the Colonial Health Service and an Australian missionary mother. His initial primary education took place at Kenton College in Kenya, and subsequently at Prince of Wales School, in Kenya, and Scotch College in Melbourne, Australia, where he had relatives. He later studied medicine at the University of Aberdeen, graduating in 1953. Initially he considered a career in surgery and his early appointments in the UK were in this field, with a view towards obtaining his surgical Fellowship. This initial career period was interrupted by National Service in the Royal Army Medical Corps where, in view of his knowledge of the language and the 4 country he expected to be posted to somewhere in Africa - naturally he was posted to Germany! Eventually he did get a little closer to Africa by being transferred to Jordan. Following this service in the R.A.M.C. he gained further surgical training in the U.K., but decided that perhaps full-time surgery was not really his first choice of a career. Thus in 1957 he came to work in the cottage hospital system in Newfoundland. For the first year this was at Channel Cottage Hospital in Port aux Basques in south-western Newfoundland. It was during his first term of duty there that he met the lady that was the following year to become his wife. In 1957 Doreen Janes, a British trained SRN and midwife, was the Nurse in Charge at Channel Hospital. The following year John was appointed as Senior Medical Officer at Bonne Bay Cottage Hospital and it was during that time that John and Doreen were married. Throughout John’s career Doreen has been a very important partner as will be appreciated from the Diary. For a further year (1959 - 1960) John Ross returned to the Channel Hospital. Then in 1960 John was appointed to Placentia Cottage Hospital in the south east of Newfoundland, here he spent a further ten years in the Cottage Hospital system. He still remains in the fond memory of the many patients he cared for and delivered during that time. In those days as well as obstetrics the work in the Cottage Hospitals often included a significant surgical load. During this period he also took time off for a further surgical rotation in St. John’s to update both his surgical and medical skills. Between 1963 and 1965 in addition to his clinical work-load he served as the President of the Newfoundland Chapter of the Canadian College of Family Physicians. Although he returned for a further year to the Channel Hospital it was no surprise that the new medical school being established at Memorial University in St. John’s sought him out and recruited him in 1971 as the first Chairman of the Family Practice unit of the Medical School. He stepped down from this position as Chairman of Family Practice in 1973, handing over an already well organised and enthusiastic department to Dr. Keith Hodgkin. During John Ross’s time as Chairman, and subsequently as an active professor in the unit, he continued to help establish a strong program for developing community health services. In 1972 he was awarded the Fellowship in the Canadian College of Family Physicians. Further community involvement included periods when he served as Vice-President of the Planned Parenthood Federation, and President of the Physicians for Social Responsibility. In 1985 in association with a programme to assist in developing medical services in Uganda being spear-headed by Dr. Donald Hillman, the then Chairman of Paediatrics at Memorial, John visited Uganda and spent three months reviewing the situation. He returned to Uganda in 1989 to devise a training programme for primary physicians in and for that country. This led to the period covered by the Diary (1990 - 1994) when he was actively participating in that programme. Each year John would send back a “floppy” computer disc containing his diary entries for the year. These were then printed and circulated to a dozen or so of his many friends in St. John’s. 5 The possibility of making an account of his experiences during this period available to a wider readership was considered on his return. He had hoped that it would help other physicians, particularly young ones in other parts of the world, to become more aware of the many difficulties they would have to face should they be interested in serving in some way in the Third World. Although it is now some eight or nine years after the period covered in the Diary and changes may well have occurred in Uganda the problems encountered will still be common in many parts of Africa. As will be seen from the Diary not only are the medical conditions they would have to face be very different from those they may have encountered during their training in the Western world but so also would be the political, social and cultural differences they would encounter and have to deal with. The problem of AIDS for example is, growing more serious all the time. In the belief that his, and Doreen’s, experiences, recounted here, will be of wider interest, and also be of use to others planning to serve in third-world countries, his Diary entries have been put into this format. For his many services to the people of Canada John Ross was made an Officer of the Order of Canada in 1994. After returning from Uganda and retiring from the University, John Ross maintained his interest in clinical work, firstly by spending a year as a locum for various practices in a number of Australian states. More recently he had been active in helping to develop a teaching programme for nurse-practitioners in the Province. In 1998 when I at last managed to convince him that his memoirs would be of great interest to very many others he agreed that they should be put together in a more standardised format than was on the original “floppies”. His original text and style has not been altered significantly and we met regularly while this was being done by me. We had long been good friends and one day he called to see me and told me that he had an inoperable cancer of the large bowel. He had decided, no matter what the course his condition might take that he had no intention of undergoing any surgical procedures to alleviate any complications in the hope of prolonging his demise, he had no illusions about the likely progress of the disease. He planned to stay at home receiving only such medications that would control pain and dehydration. We continued to meet up until a few days before his death on the 2nd of December 1999. As will be appreciated from various entries in the Diary, John Ross had always been a keen salmon fisherman, as well as a great hiker and incidentally as a poet. A founder member of the East Coast Trail Association in Newfoundland, John had also spent his retirement years helping to blaze new hiking trails around the east coast of the Avalon Peninsula so that others may also enjoy our beautiful scenery. He was loved and respected by numerous friends as well as all his old patients. I find it difficult to describe him, apart from being a great friend I always thought of him as “a doctor’s doctor”, someone we might all aspire to be. 6 The reason behind my encouragement to John Ross to prepare his Diary for a wider readership was primarily to recognise at least one part of his life’s contribution to humanity and his day to day experiences and thoughts during this particular period. As such, it was not meant to be a detailed study of primary care services in Uganda at that time, though obviously much comment is made on that subject. For a more formal presentation of the training programme that John was involved in the reader is referred to two articles by him which appeared in the Canadian Family Physician, soon after his return to Canada and which were published in the Canadian Family Physician in 1996 (General Practice Training in Uganda Part 1, 42, 213-216, and Part 2, 42, 226-228.