First Impressions

Dear Internet,

I have arrived safely in the pearl of Africa, Uganda! I flew into Entebbe airport on Sunday/Monday, arriving at around 5AM (which actually looks remarkably like the last scene in the Last King of Scotland now that I think about it)... The first nice surprise was the fact that everyone else in the passport queue had to pay $50 for a visa, but I didn’t because there’s no visa charge for the Irish, thanks to all the foreign aid we give every year! So nobody has any excuse not to visit me really.

I was picked up by a lovely 24 year old Ugandan who brought me to Lacor House in Kampala where I stayed overnight. I was awoken at 10AM with the plan to leave at 11AM – properly African-time-shtyle we didn’t end up hitting the road until 5PM. And hitting the road is rather literal – serious potholes up the north of Uganda, mostly a dirt road, but I had great company with an American clinical officer, two Italian technicians who have come to set up a new XRay machine, a Ugandan XRay technician and our driver. The landscape was a lot greener than I had imagined it to be, we had several drive-thrus (ie. where traders approach with pineapples and bananas on their heads when you’re stopped in traffic), which had a plentiful supply of fruit and nuts. I also crossed both the equator and the Nile, but it was too dark to see anything so I'll keep my eyes peeled the next time I head to Kampala!

I arrived in Gulu at 1AM. Managed to terrorise some poor English volunteer in the hospital guesthouse by barging accidentally into his room in the middle of the night, but managed to get a few hours sleep before waking to the sound of a cock crowing. Incessantly. At the crack of dawn.

There are such stark contrasts between the hospital here and what I’m used to at home, I’m not sure where to even start.

Firstly, the heat. It is like 27 degrees or more everyday, with no air conditioning or fans. The hospital itself has almost 500 beds, split into medical, surgical, obstetrics, gynaecology and paediatric wards, as well as a 10 bed ICU and the capacity for six operating theatres. So there is a huge number of staff, all of whom so far have been so friendly to me. People tend to stare and children shout ‘Muzungu’ (which means white person) when they see me and my pashty complexion, but it’s very inoffensive and I’ve been told the best thing to do is wave and say hello. So I more or less feel like somewhat of a celebrity.

Bottle of local brew, 5.9%. Yeoooow.

I’ve spent my first four days in operating theatre. It is totally different to home. As there is a shortage of doctors in general in Uganda and a large requirement for trained anaesthetists, they run a two-year anaesthesia training programme for non-physicians (ie. Nurses or clinical officers). After this they are fully trained in anaesthesia and intensive care and may end up as the only anaesthetist in a rural hospital. As far as I know, the medically trained anaesthetists are known as anaesthesiologists. It does make me feel like a bit of a shmuck embarking on a six year training programme... They actually have something similar for medical doctors here too – called a ‘medical officer’ or ‘clinical officer’ where they don’t have a medical degree but can perform most of the duties of the doctor.  With such a large population and so few trained doctors it seems to be the only and best solution here. There is also extremely limited radiology – only XRay and ultrasound (and occasionally a small bit of fluoroscopy). There is no CT or MRI.

Most of the operations I’ve seen are general surgery and obstetrics/gynaecology. For almost all procedures (90% according to the anaesthesiologists) they do not use general anaesthesia, opting instead for spinal blocks. This seemed absolutely bizarre to me initially, to have women fully awake during a hysterectomy or a toe amputation it works very well as there is a shorter recovery time and less requirement for intubation and ventilation (there are only 3 ventilators available). What I’m beginning to understand about working with limited resources is that you reuse and recycle as much as possible without endangering the patient. A spinal only needs a few syringes and needles, but general anesthesia requires a sterilized laryngoscope, an endotracheal tube, possibly a sterile mask, a ventilator, oxygen and an inhalational agent (normally halothane) which are both very limited. There is no waste here – all drapes, gowns, hats, masks, tubing, and all equipment are sterilized and reused as much as possible. Sure half the time, instead of using a blanket for the patient going to recovery, the surgeon will give you his gown to cover the patient. And here there is nothing wrong with that!

I’m living with the nicest Ugandan woman across the road from the hospital and really enjoying it so far. Her sister had a baby the other day by C-section and I was there with her for the procedure so it’s a very exciting time and there’s loads of their family about. I’m loving the African food and learning a few odd phrases of the tribal Acholi language but mostly everyone speaks a bit of English. I actually cannot even begin to explain how friendly everyone here is, every five seconds someone welcomes me and shakes my hand! 

Final tot from the fundraising was €3750 – half of which will go to St Judes and half toward medical supplies for St Mary’s Hospital. Thank you all so much for your generosity, it will really go far here!

 

I’m a bit overwhelmed at the moment and there is so much to say about this place but I’ll continue to update the blog when I’ve access to wifi and/or when I’ve formulated some coherent thoughts about life here!

Wee shnake on the road to Gulu today (Friday)... It might have been dead but I didn't get too close to check..!