DISPATCHES FROM UGANDA

Today it’s somebody else’s voice I would like to offer you. A more sobering tone than mine…

Jill is a friend, a bookworm like me and, above all, a doctor who practices emergency medicine in the Pacific Northwest. When she can, she volunteers her time with different NGOs, flying to remote locations where medical aid is desperately needed. Her last three weeks have been spent in a refugee camp in Uganda and her periodic dispatches to friends and other doctors have been pretty heartbreaking. I have combined a couple here, with her permission, for all of you to read. Names have been changed to protect privacy. I also omitted the wonderful pictures she sent – some upon her request, to protect the privacy of her patients but, even those of little kids encountered on the road, felt like a violation and I decided not to share them. I omitted the most intricate medical details that might be too convoluted for the untrained reader. Otherwise, this is what is going on on the other side of the world.

 

Have you ever wondered about what stroke of fate allowed you to be born into privilege and opportunity?  I do think about it quite often back home…but here, I think about it all the time. In fact, if one is occupied in Africa in some  capacity other than Tourist, one can’t help being impressed by the huge disparity between the abjectly poor and disenfranchised refugees or nationals and the wealthy practically anywhere else.  Starting with the basics…not just potable, but ANY water that doesn’t need to be carried in jerry cans plugged by a banana or an eggplant so the water doesn’t slosh out, electricity, food, mosquito nets, medicines, school, opportunity for university, permanent housing…

Take my translator, D.  He’s been in the camp for 15 years…fled war in the Congo at age 7 with his five siblings and parents…two siblings were shot and killed as they fled.  He is so bright and such a motivated, hard worker…and yet not allowed to have an education beyond high school and can never hope for a house other than mud and sticks (because the UN policy is to disallow tin roofs or cement floors or walls as that would constitute “permanency” and then the refugees wouldn’t want to leave their “nice” houses to return to their countries). D may not be able to save up for a dowry to get married for years on his translator salary…he banks by saving to buy chickens.  Ugandans and Ex-Pats query me, “Are they still there?  Why don’t they go home?”  That question belies a blindness or ignorance of the political and economic realities affecting this region.  Although 81,600 refugees from 8 countries are in Nakivale, my Health Center primarily sees Congolese, Rwandans and Burundi.  The Congolese flee war, the Rwandans have shifted…many Tutsis returned to their country to find that Hutus took their place.  I had a really weird encounter with one man who initially pretended that he didn’t know much French and claimed to be Burundi, but then it turned out he’d been covering up…probably a Hutu who’d perpetrated unmentionable atrocities in hiding.  When someone recognizes the bad guys, they go hide out in another village in a camp where no one knows them.

Mondays and Fridays are the heaviest days…we see 400 patients.  Other days 200-350. And they’re sick.  Presently the bottleneck is Lab .  But that’s because one of the two techs had a baby a week ago. J gamely does all the tests himself.  We have a Catch 22…the Rapid Diagnostic Test for malaria is expensive and so is Coartem, the best anti-malarial, but Blood smears are labor intensive.  So we let J decide which test he’ll do as we don’t want to use expensive meds without sure dx.  We use 50 adult packs of Coartem per day and at least that many pediatric.  If we are caught up with patients, but waiting for labs, we screen patients for glaucoma using the Tonometer Avia that was loaned to me.  Have trained 6 people to do it.  Problem is…glaucoma meds are not on the priority list of the Ugandan Ministry of Health.

I had a 40-year-old hemorrhaging today from what felt like a huge calcified fibroma extruding from her ovaries versus a tumor. It took awhile to convince other staff that it was not a miscarriage and that she needed to go to Med school hospital for emergent hysterectomy and transfusion. It is quite distressing for me to practice with such limited diagnostics.  Yesterday I had a deeply jaundiced 2-year-old, febrile, negative for malaria, hep b.  Can’t get liver functions…will have to do nothing (ie treat as infectious hepatitis and hope for the best).

There are moments of small triumphs…take for instance the mentally ill (schizophrenic?) Congolese woman who was noted by another villager to carry her infant around on her back, but never to be nursing it.  She just ran all over the place, trying to find men to sleep with her.  Her 6 month baby was malnourished at 5kg, but responsively smiles and lapped up a cup of nutritional supplement.  But that wasn’t the best part…I promised the mom a “sweet” if she’d let us put an Implanon in her arm…and she did it on the spot.  No more babies she can’t take care of!

Knowing our presence makes a difference to the refugees and the national staff makes the horrid 1.5 hour increasingly dusty and bumpy trip to and from camp tolerable.  Now that we’re in the dry season, the road disappears completely in red dust when another vehicle passes.  Any MD, PA or Nurse Practitioner would be most appreciated here.  One month is all I can handle…I don’t know how the dedicated national staff do it…they have to live on site without running water or electricity.  We volunteers with MTI (Medical Teams International) are driven to a guest house with a cook/housekeeper.

I do hope I find the fortitude to keep on working here and elsewhere.

 

 

 

 

 

 

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