Ed Jones

Three Months After our Return...

Ed Jones — Thu, 17 Sep 2009 11:39:39 GMT

Exactly 3 months ago, Kate and I woke up at the Airport Guesthouse in Entebbe and flew back to the UK at the end of our work in Uganda. In some ways, it doesn’t feel like that long. In others, it feels a lifetime ago.

Since our return we’ve been to two weddings, bought two cars, found somewhere to live, and visited friends and family in Cornwall, Devon, Somerset, Shropshire, Merseyside, Sussex, Derbyshire and the Isle of Man.

I’ve been kindly invited to return to Riverford Organic Vegetables where I’m working as a project manager. Sadly, Kate has not been able to start her job at Barnstaple hospital because she’s suffering from post-viral fatigue, precipitated by a virus she caught in Uganda at Easter. This is hugely frustrating for us both, and obviously makes us wonder what the future holds. However, the Liverpool School of Tropical Medicine have ruled out any lingering tropical diseases which is a good thing.

We keep in touch with our friends at Kisiizi Hospital. Their internet connection helps with that, of course. Amazingly, I’ve been able to help Edson diagnose and fix faults from the UK – I ensured before I left that I could connect to the Kisiizi network remotely.

Periodically we hear from other people at the hospital too: the new hydro generator is now running fulltime, we understand, and Edson and Charles have been learning how to install and manage the new prepaid electricity meters.

Our housekeeper and good friend Margaret wrote to us a few weeks ago. We hope she’s doing well. Sister Ann emails Kate with paeds-related things occasionally.

It’s true to say that the grass always looks greener on the other side of the metaphorical fence. While we were in Uganda there were many occasions when we longed to ‘go home’. Now we’re here, I find myself wondering if the relatively simple rhythm to life in rural Uganda might not be more appealing…

(On a practical note, I’m not planning to update this website much in the coming months. Life in the UK isn’t nearly as interesting to read about. Articles about our work in Uganda won’t be going anywhere, though.)

A spiritual reflection on our year

Ed Jones — Sat, 18 Jul 2009 15:45:11 GMT

Last weekend we presented a short talk at our church in Tavistock, TMC about our work at Kisiizi Hospital, which was great. It was a short description of some of the work we’ve been doing, and an exploration (in video form) of the bible verses we’ve found helpful during our time in Uganda.

We thought you might like to see it.

Planned Hiatus

Ed Jones — Sun, 28 Jun 2009 22:46:37 GMT

We’ve now been back in the UK for 10 days or so. We’re enjoying catching up with friends and family (and visiting our church) today. We’re also ensconced in the practical things required for a return from a year overseas: buying a car, finding somewhere to live, applying for jobs for me (Kate’s job starts at the beginning of September).

We’re travelling a lot for the next few weeks, so don’t expect much on the blog I’m afraid. We’ll be writing some ‘followup’ articles from our work at Kisiizi soon, though.

24 hours into life in the UK: it's odd what you notice...

Ed Jones — Thu, 18 Jun 2009 21:01:22 GMT

We got back to the UK safely yesterday, after an uneventful flight, although the BA staff in Entebbe were bizarrely draconian in their interpretation of the 23kg-per-bag rule – even when we were underweight in aggregate – which required some repacking at the airport. Grr.

After 9 months in Uganda and 24 hours in the UK, what are the differences which have struck me most? Not what you might expect. OK, the journey from Heathrow was idyllic, being on unbroken tarmac with not there merest hint of a pothole. But stranger things have struck me today:

Toilet roll in the UK is about 25 times the size of the stuff in Uganda. The photographic evidence accompanying this article should be proof enough, I hope.
When you overhear a conversation in the street, you understand what’s being said. Unless it’s a screaming child, in which case the accompanying gesticulation usually crosses linguistic barriers anyway.
All the cars are so posh! Even comparatively modest conveyances appear to the unaccustomed eye to be the epitome of luxurious transport. All of them have 2 headlights which work, a boot that closes and, it seems, very few of them belch acrid blue-black smoke. Hardly any have more than one occupant, and none more than 5, which seems very modest.

I wonder what I’ll be thinking at the 48-hour mark? I have yet to sample the delights of a town centre or supermarket…

Phone system complete!

Ed Jones — Tue, 09 Jun 2009 08:25:31 GMT

I’m pleased to say that we managed to finish the installation of the phone system before leaving for a (really wonderful) holiday in western Uganda with Kate’s parents.

There are now 49 extensions installed, and the logs show that lots of people are using the system which is great! The graph below shows the call volume over the last 4 days – 30 or so calls during peak hours is a fairly high volume really.

We’ve designed the system to be extensible, so if the hospital needs more phones in the future it’s a fairly small incremental cost for more Analogue Telephone Adaptors (or IP phones).

The only functionality we haven’t had time to get going before I leave is the connection to the MTN line. It’s not a big priority (people are perfectly OK with wandering to the admin block to make outgoing calls), and needs to be thought through properly before we install it. Still, all the equipment is here and installed to it’s a simple matter of configuration to get it working.

Props to Eddie, the IT guy here; and Kenneth (pictured above), a guy who’s here on an industrial placement – they’ve been working with me to make this happen before I leave. It’s been a busy few weeks but it’s nice to have completed it…

My favourite roofspace

Ed Jones — Wed, 20 May 2009 20:05:52 GMT

The last two weeks has been a marathon of ladder-climbing, wire-pulling and telephone-installing, and it’s not over yet. In the process, I’ve become well-acquainted with the roofs of Kisiizi Hospital while pulling telephone cables and connecting sockets. I’ve clambered through medical, maternity, surgery and mental health wards; the outpatients department (linking to the pharmacy); the electricians workshop; the admin block; Dr Francis’ house; Dr Robert’s house; and the primary and nursing schools.

I’m pleased to announce that so far, my favourite roofspace is Surgical ward (which, for those of you who know Kisiizi, might come as something of a surprise given the limited delights of the ward itself).

It’s got a tiled roof (far cooler in sunshine than the almost-ubiquitous corrugated iron sheet), standing height headroom, and a magnificent array of wooden beams upon which to clamber, perch or loiter as you wish. It’s also got a surprising amount of access to the outside world through – intentional or otherwise – big holes under the eaves, giving plenty of light and a gentle breeze.

If you’re wondering, my least favourite so far is, I’m sorry to say, Dr Francis’ house (through no fault of his). He is playing unwitting host to a selection of yellow-tummied bats (what are their real names?), along with their guano. Not pleasant to hang around in. A runner-up for worst is the 50-year-old mental health ward (it was originally medical ward). Huge distances of unsafe ceiling between joists, very dark and housing enough spiders’ webs to furnish a fairground ghost train.

The new VOIP (Voice over IP) server tells me that there are 34 extensions online, and the phone list shows 49, so we have some way to go. I hope we can finish it all before we depart…

VOIP in Rural Uganda

Ed Jones — Sun, 03 May 2009 11:53:53 GMT

It’s been nearly a month since we last posted on the blog. Sorry.

I’ve managed to escape the ‘flu-like lurgy which has been floating around, and have been working on my next communications-related project at Kisiizi: a new telephone system.

I blogged several months ago about a phone system. At the time, I had hoped that the system donated a few years ago (and 20 years old) would do well. I’m not a believer in ‘modern for the sake of it’, but I do think it’s sometimes worth making a decision not to install gear if it isn’t viable in the long-term. I’m afraid the Mitel telephone system has fallen into this category: too old; one broken line already; not sure about the quality of the Chinese cabling bought in Kampala.

Mulling options other than this unit, I started to think about Voice over IP as a possible solution. The network here now reaches pretty-much anywhere we need a phone, and with Asterisk as an exchange, we can have an expandable system which relies on commodity hardware we can buy in Kampala (namely, a Dell Optiplex) in case disaster strikes.

So, after some thought and the construction of a test system, we’ve bought the following gear:

1 Dell Optiplex desktop machine as the server
12 2-port Grandstream HT502 analogue telephone adaptors (these allow you to plug in a normal phone, but send the data across the network)
14 1-port Sparklan wireless ATAs (as above, but they connect to the wireless network for locations without a wired segment: mostly staff housing)
1 8-port Grandstream GXW4008 ATA for the admin block

The software we’re using is an open-source Linux distribution called Trixbox. I’m really impressed. It’s basically a conglomeration of Asterisk and FreePBX, a web front-end for Asterisk, with a few extra bits included. But it just works. An hour after sticking the CD in the drive, we had a working telephone system, with voicemail, menu systems, conferencing, queues, everything you could possibly want (and lots we’ll never use!).

The suppliers of the ATAs, a UK company called OxfordTEC also kindly donated some gear for us, which includes 2 VOIP phones, which plug straight into the computer network, and two wireless IP phones. I’ve been corresponding with Chris at OxfordTEC for the last few weeks, and they’ve been really helpful in getting stuff sorted out for us. Some electrical engineers visiting Kisiizi have kindly brought all the gear out.

It’s early days yet, but Edson and I have spent the week configuring the ATAs, and we’ve put a few phones around the site. So far, everything seems to be working nicely.

Updates to follow (hopefully in less than a month!).

Bubble CPAP in Resource-Poor Settings

Ed Jones — Wed, 08 Apr 2009 17:11:43 GMT

Kate writes:

Before I left the UK to start work in Kisiizi, I had some very interesting conversations with a Rima Vaitkute (consultant neonatologist in Plymouth). Rima trained in Lithuania, and told me how to construct a simple ‘bubble CPAP’ (Continuous Positive Airway Pressure) circuit. The ‘how-to’ diagram was duly packed along with all of the other things that might be useful when working in a resource-poor setting.

We now use the CPAP on children’s ward and special care at least fortnightly. It has been useful in preterm babies with RDS, neonatal pneumonia and infants with severe pneumonia or bronchiolitis. It has literally saved lives in some cases, and has significantly improved care in others.

We have the benefit of a very stable electricity supply at Kisiizi, and use oxygen concentrators to provide oxygen. The concentrators have a water reservoir through which the oxygen is passed before going to the patient. If you are using piped oxygen or cylinders, a further reservoir is needed.

What you need:

Oxygen supply (we use oxygen concentrators)
Oxygen tubing
Nasal cannulas (large, long, flexible ones are best to give a good seal)
Tape to attach the tubing
Glass bottle with tight-fitting rubber bung (we use our IV fluids bottles), filled with distilled water.
2 large gauge needles (white or needle from grey IV cannula is ideal)

The nasal cannula tubing is attached to the oxygen concentrator as usual, with a flow rate of 2L/min. Where the tubing splits into two before reaching the patient, one end is cut, and the short end sealed to prevent leakage. The long end is attached to another piece of oxygen tubing (ensuring no leak) and is connected to a needle, the end of which is under the water in the sealed glass bottle. A further needle (this time above the water) allows the oxygen to escape. The number of centimetres that the 1st needle is below the water gives you the cm H₂O CPAP pressure (although in practice, we’ve found that it is ‘on’ or ‘off’).

Large, long, flexible nasal prongs are the most effective, as they provide a good seal and therefore good CPAP. If the prongs are much smaller than the baby’s nostrils, a better seal can be achieved by folding a piece of gauze and making 2 holes for the prongs to pass through into the baby’s nostrils.

Check that the circuit is working by occluding the nasal prongs: you should see bubbles coming from the needle into the water. When attached to the baby, you may not see bubbles in the water, but the baby blowing ‘CPAP bubbles’ and an improvement in oxygen saturation (if you can measure this!) should confirm that it is effective.

The staff and patients at Kisiizi are grateful for the advice given by Rima for this CPAP circuit!

Kisiizi Golden Jubilee Highlights Video (finally!)

Ed Jones — Wed, 25 Mar 2009 13:04:16 GMT

After reviewing hours of footage (mostly, I have to say, speeches!) and several attempts at uploading this over Kisiizi’s satellite internet connection, here’s a video of the highlights of the hospital’s golden jubilee weekend in November 2008.

If you’ve got a Vimeo account (free), you can download this ‘for web’ version. If you’d like higher quality, I’ve obviously mastered a DVD of it too – let me know if you’d like a copy and I’ll arrange for one to be sent to you (not promising when, though!). Hope you like it. It’s been a bit of a marathon.

What have I been working on recently?

Ed Jones — Tue, 24 Mar 2009 06:43:07 GMT

At the end of February, we completed the installation of the three wireless network masts. I’ve added a fourth, too, to account for a ‘dead spot’ around some of the doctors’ accomodation.

Since then, Edson and I have been working on ‘phase 2’ of the IT project: moving all of the equipment into a purpose-built cupboard, and installing the linux server. That involved a lot of scrambling about in roofspaces, pulling network cables from various offices to our new cupboard in the staffroom. Previously, the routers and satellite modems were shoved in the corner of the Medical Superintendent’s office: Dr Tonny didn’t fancy the idea of the server being in there too.

The server is actually a high-end Dell PC, running Ubuntu Linux. When we were looking at installing it, we quickly realised that running Windows Server—while being arguably easier to install and operate—would be far too expensive for the hospital, with its onerous per-user (or per-computer) licencing. With linux, we are able to build a really robust machine which fulfils all the functions of a Windows server (and more!) for merely the price of the hardware.

This is new stuff for the hospital. Up to now, the IT has been a piecemeal arrangement of computers, with data stored locally and backed up—if at all—on USB memory sticks. Not great. Now, everyone will have their own username and password, their own personal storage space, department drives for shared documents, and an email address if they want it, too.

In summary, here’s what the server does:

File and print server (and domain controller for the network)
Time server, to keep computers synchronised to the right time
Authentication server (using LDAP), to allow users to have one username and password to access things on the network
Web proxy, to ‘cache’ information downloaded from the internet. With so many people using the internet at the same time, many internet requests are the same. We can save a lot of bandwidth if common requests (e.g. website logos etc.) can be delivered from the server. We’re blocking adverts too.
Email server to allow email address for those who need them
Virus scanning
DNS
DHCP
Monitoring various things on the network and presenting nice graphs
A web-based admin interface to control everything

I’m sure there are more things I’ve forgotten, too. With all of these services being in the control of a single computer, we’re obviously being careful to back it up regularly. It’s got two hard disks which are ‘mirrored’ (RAID1 in the jargon) to provide a safety-net in case one fails. The server will carry on running and we’ll get an email. Much nicer than a horrid crash and huge data loss!

Of course, Kate and I are only here for a few more months, so the central point of this exercise is to hand over to Edson. He’s grasped the challenge and is already happy configuring things, adding users and machines and troubleshooting. Fortuitously, I’ve discovered that it will be possible to help him from the UK by connecting to the server remotely, too. Marvellous.