Greetings From Uganda
Greetings from Mbale, Uganda.
TIA stand for "This is Africa." I've been in Uganda for 7
days and will be here for the rest of September on a global health rotation. I
have spent four days in Ugandan healthcare facilities, a Mzungo (white person).
It is difficult to call them "hospitals" because of the
conditions. Take any perceptions you have from reading about third-world
healthcare and its impoverished conditions and multiply it times 10 and you get
Ugandan public health. Dirty, squalid, outdated, no medications, smelly and no
modern equipment are just a few adequate words.
Here is a day in the life from this week:
The nine PA students and I arrived at the hospital a bit
earlier and Margaret, my buddy for the day, and I waited for our attending
doctor to arrive -- Dr. Assem, a beautiful 24-year-old intern who knows more
than I ever will about internal medicine.
She was late, so instead we began rounding with Dr. Boddy
O. (pronounced "bod-dee" I think). He
was 24 as well and a "walking Harrison's" (the famous medical text book). We
rounded the whole morning, going from bed to bed deciding what to do to manage
these very sick patients with so little options.
It would go something like this: Dr. B. would walk up to
the bed and one of the young nursing students (complete with small white caps
pinned to their cropped hair) would hand him a "chart." It had maybe the
results of a CBC or ultrasound (read by a radiology student) and a flimsy
He would tell me a little bit about the patient, "Carol,
this is a 30-year-old with ISS who had been vomiting and having diarrhea for 2
months. Here is his CBC." I would see he was severely anemic. I would
listen to the patient and do as much of a physical as I could, usually find
about five things very wrong and then we'd make a plan.
The problem at Mbale is they have no medicine, no imaging,
no specialist surgeons and the patients can barely pay for food. It limits your
options. We'd mainly give antibiotics or fluids. We couldn't check electrolytes
or most other common labs.
Common conditions today included: pneumonia, TB, PCP,
heart failure, renal failure, hydronephrosis, stroke, paraplegia and probably
about 100 things we missed because we have no diagnostic tools except chest
X-ray and ultrasound. There is one CT machine in the entire country and it
costs hundreds of dollars in a place where most people live on a dollar a day.
The doctor kept asking questions about what we see in
America & if we had TB. I explained it was very rare. He wanted to
take me to the TB ward but thought better since they all have MDR TB (drug resistant)
and I don't really want to get that.
I learned so much from Dr. B's bedside lectures! He
was so kind and gracious and very kind to the patients and their families (at
least compared to a few other docs here). The nursing students followed us
around and I joked with Rose and Rashika.
They seemed so sad and unexcited but I got them to smile
a few times. Dr B wanted a blood pressure and I ran off to grab one, "Rose,
I beat you! You lost the race! Haha." She smiled! Victory, in a place that
contains so little joy.
There was one patient I can't forget. Dr. B said she
should be in an ICU. She was 30 years old, breathing 40 times per minute, ISS
positive, multiple bouts of pneumonia, diarrhea for days, wasted, in
respiratory failure, and probably other things I missed. She couldn't much
respond but she looked like she would die soon and her mother was by the bed. I
used Rose to translate to her mother
"Are you her mother?"
Got a yes.
"What order is she in the family?"
attempts from Rose, I gathered she was sixth born out of nine brothers and
sisters. I then found out mother was also sixth in her family. The conversation
ended. I took the patient's blood pressure: 95/44.
Later on rounds I looked over and saw other female
members around the bed. Sad eyes. Everyone in the ward has sad eyes. There
is little joy when there is little hope, I think.
Dr. B let us go to lunch around 1 after seeing at least
25 patients that morning.
There was little to do in the afternoon. Margaret got a
photo of her patient with shingles and we consulted a woman who is now probably
dead from respiratory failure secondary to fluid overload. Her family couldn't
get her medicine and she was in the fetal position in the bed gasping, in awful
This is Africa's internal medicine. So few options, yet
patients still come. They must be desperate. And if I spent a whole month
with Dr. B and Dr. Assem I would be an American infectious disease expert.
Many questions and few answers arise in a week of
medicine like this and I don't have to answer the problem of pain in one blog
post. Instead I will learn and see and be thankful to be in a place so few
Americans will ever have a chance to touch.