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Her main input was to increase the efficiency of care


delivery and staff motivation. “The care that was being given was excellent – it was how they were being led. A lot of the problems were to do with finance, staff, wastage. So I kind of tipped it all round – when I got there there were 15 widows using this 100-bed hospice and when I left nine months later, 70 widows were able to use it for pretty much the same money.”


African Prisons Project She still wasn’t ready to go back to medicine and during a trip to the capital, Kampala – her reputation evidently preceding her – she was offered a job by another charity, the African Prisons Project (APP), as its administrative director. Coincidentally, the APP had been set up by a fellow


student at Nottingham, Alexander McLean, at the breathtakingly young age of 18, after coming face-to-face with awful scenes of deprivation, brutality and ill health in Kampala’s Luzira Prison during his gap year. Hannah and Alexander have since married but they barely knew each other at the time. “I had met him once at Nottingham. I knew he was in Uganda and he knew I was in Uganda but we hadn’t met during the year.” The scenes that had driven Alexander, now a barrister,


to set up APP in the first place were truly shocking, she says. “I had spent a year in Uganda and I’d seen a lot of horrendous things and I didn’t think I could see anything worse. I then happened upon this project working in prisons and I found worse.” The overcrowding was grave and people were dying, she


says, from “the most ridiculous conditions”, including dysentery, malaria, diabetes and high blood pressure, which simply weren’t being treated. “Hygiene is a massive thing. Many of the diseases are passed around by not washing hands and the most simple things – in fact, there’s faeces everywhere, as they still have the bucket system.” AIDS was rife, as was tuberculosis, cholera and typhoid,


and terminally ill prisoners faced a largely unsupervised and painful slide towards death. “My interest at that point was end-of-life care and I’ve seen people with cancer and end-stage diseases die in prison the most awful deaths.” She spent around six months in Kampala on that


occasion, helping to advance the charity’s immediate aims of improving the welfare of prisoners and its longer-term aims of putting in place an infrastructure offering better access to healthcare, education and legal representation. By the end of that period, APP had built a health centre and a welfare centre and developed a library in Kampala’s remand prison. They were also making plans to build a health centre in Gulu, one of the country’s poorest areas, to benefit not just prisoners, but also prison staff and the wider community.


Back to the books Hannah had also come to a realisation. To do the best she could for the organisation, she would have to return to the UK to finish her degree. “I recognised that I could stay in Uganda and I could be a leader and a manager, but I wouldn’t be able to go and train and spend more time really helping, hands-on, on the more medical issues without completing


my medical training.” There was also a question of credibility and authority,


not least because she was a woman – and a young one at that. “A medical degree affords you a status in that environment, which I struggled to get. You have to work and work and work to prove that you’re on the level to have a conversation at the table.” Back at medical school, her outlook had changed


completely. “The faff and the stress just went away, because I had so much more perspective. After I came back, I think I did about a tenth of the work but in a far more focused way and my results went up significantly.” She continued to work with APP, becoming less hands-on and more strategic – though she admits: “I spent a lot more time than I should have in Africa when I was doing my exams. I wasn’t the most popular medical student. I’d work very hard for a couple of weeks and then head off for a bit.”


That was two years ago, and since then she’s continued


in her role as APP’s strategy and healthcare adviser while completing her F1 year at the Royal Derby Hospital – including running a GP clinic in a British prison – and embarking on her F2 training in Mansfield. And if life could not be any more busy she and Alexander have just had their first child. She is currently on maternity leave and planning another trip to Africa. “We’re going to take our son to Uganda in April and spend a couple of months there before I go back to work in August.” Hannah has been working two jobs for so long that the


busy-ness doesn’t seem to ruffle her feathers one bit. It is a sign of the drive and dedication that brought her the BMJ nominations in the first place and, though she didn’t win either, she’s more than happy for the publicity they have brought to the charity. “I’m very passionate about the work we’ve been doing in


Africa and it’s nice for the project, and what it’s achieved, to be acknowledged.” For more information on the African Prisons Project, visit www.africanprisons.org


Adam Campbell is a freelance writer and regular contributor to MDDUS publications


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