Rounds at Mulago Hospital

Just back from doing rounds in the cardiac/pulmonary unit at the Mulago Hospital with an internist who is here from Boston. I had the time, as I am waiting to hear later today from the faculty reviewing the Psychiatric Healthcare Masters Program I have developed for them.

About the Hospital – wards are simply large rooms with as many beds crowded in as possible. Patients have no privacy – not even a curtain is pulled when doctors and residents round. They do at least separate the men from the women in terms of wards. However, men are in the women’s ward, as family members caring for their relatives. There are a few nurses around, but they don’t seem to do anything. Basically, family and doctors tend to the patients. The doctors even take the vital signs.

The patients are critically ill and would be in an ICU in the States, but that doesn’t exist here. Patients and their families have to buy any medication the doctor prescribes and pay for any lab tests or x-rays, etc. Most can’t afford this, so they die. This explains the average lifespan of early 50’s. For the few who can afford to pay, the medications are nowhere near the gold standard in the US. They use ones that have been around many years and are cheap. Lab tests are not very accurate, nor are procedures. However, they do the best they can with what they’ve got.

There is no hand washing or use of Purcell or an equivalent when moving from one patient to the next. Anesthesia is often ether in the outlying areas or some other outdated one by our standards. There are something like 11 Anesthesiologists in the entire country, so RNs often give it during a procedure.

The man whose jaw was crushed, his lower lip severed and his hard palate split in two as a result of an elephant attack, finally had a six hours surgery yesterday after waiting a week. He had to wait because he could not afford the operation. An NGO outside the capital where this happened, got wind of this and wrote an article in the paper pointing out the government’s neglect in treating someone in such desperate shape. Embarrassed by the negative publicity, the man got his operation. I may have photos for Ralph and Marie when I return, as it’s not for the faint hearted. One of the dental volunteers here photographed the entire operation. Apparently, any of us could have stood around the operating table and observed the entire procedure.

The patients I saw this morning had uncontrolled hypertension, HIV, chronic heart failures, arrhythmias, pneumonia, diabetes and strokes. Most have 5 out of the 7 mentioned. Co-morbidities are commonplace. It was truly a heartbreaking experience, so I left before rounds ended.

I interviewed a nurse who was from Lira in the North where the Lord’s Resistance rebels were. She did a research project last year, interviewing survivors of torture. The detention camps are gone, but she was able to go into peoples’ homes since she was from the area. She spoke with many young women who were kidnapped and raped by the rebels when they were in their early teens. They were held captive by the soldiers and mutilated if they did not respond to questions posed by their captors. If they were accused of not listening, their ears were cutoff. If they gave a wrong answer or no answer at all, their lips were either severed or clamped shut. In spite of reconstructive surgery, they are still very disfigured and consequently isolated. They have no chance to ever marry or lead a somewhat normal life.

The child soldiers either fled into the bush after the head of the rebels was driven out of Uganda into a neighboring country (most likely Sudan or the Congo) or sought help in an effort to reconcile to themselves what they had done with the help of counseling. Most were kidnapped by the rebels when they were 8 to 10 yrs. old and brainwashed and drugged regularly until they were ready to be given a rifle and join the raiding parties. Their initiation usually involved murdering their parents and eating human flesh. Consequently, you can imagine how difficult, if not impossible, it is for these young men to return to “normal.”

Since the detention camps have been closed and the victims dispersed, I won’t be able to interview any of them. However, I am still hoping to go to the Acid Burn Foundation run by another NGO to visit the women there. A few do come into the Mulago Hospital, so I may also have an opportunity to see them here. Since my time is so short, I probably won’t be able to do any kind of therapy. I was hoping to do Narrative Exposure Therapy which is short term, but I would still need several weeks. Not really sure how effective NET would be, since these women are not only scarred on the inside but are disfigured for life. I think group therapy with other burned women would be the most helpful.

Well ,enough for today. This gives you an idea of conditions here. Please keep in mind that Uganda’s medical facilities are considered some of the best in all of Africa.