10 days in and still standing

10 days so far in Uganda and I am still standing strong.  In this short while I have seen and learnt a lot, I could write pages but I do not want to bore you all. For this post,  I will update you about work first (since that is what I am here to do, after all); but I promise to write about my personal experiences so far in a later post. Before I proceed may I ask my UK readers, how is the weather in the UK? Is it raining? I weirdly miss the rain.  It has been scorching here, 31-33 degrees this week, I never thought I would pray for rain but that is exactly what I have done on my daily 20 minutes walk to and fro from work.

 Work started in full swing this Monday at Jinja Regional Referral Hospital. Prior to travelling to Jinja, we had a tour of the main teaching hospital in the capital Kampala; it is called Mulago Teaching hospital.  It can be compared to a UK tertiary hospital, for the non-medics reading this, think of Great Osmond Street or Royal Manchester Children’s as an equivalent. The paediatrics department is huge and incredibly busy but I left with a certain sense of disappointment.  

After seeing the hospital in Mulago, I set my expectations for Jinja a little lower and to my surprise so far Jinja has exceeded my expectations in many aspects. Don’t get me wrong it is nothing like any Hospital I have ever worked at but neither is it worse than any of the scary stories I have heard or read about pre arrival in Jinja. 

The hospital is one of the 3 paediatric regional hospitals in Uganda and is serves a large population of children, some travel as far as 5 hours to seek care.   Over the next 5months I will be spending 3 days a week on the paediatric side and 2 days on the neonatal side.  It is early days yet but each day so far this week has been filled with highs and lows.

The highs were,

1.     The warmth and welcoming nature of all the staff both on the Paediatric side and on the neonatal unit.

2.     Fantastic HIV Paediatrics service, on Monday we attended the HIV clinic and it was phenomenal. Jinja sees over 500 HIV exposed/positive children a year! The doctors saw approximately 30 patients and they were all incredibly well  and thriving.  We learnt a great deal about the management of HIV exposed/positive children. The clinic is organized, well staffed with an admin office, a counselor, as well as 2 doctors to see the patients.  There is also a separate adolescent clinic to give the young adults some privacy to discuss some of the more relevant social problems that a HIV positive teenager is likely to face.

Alfresco art work on the wall in the malnutrition unit

Wildlife mobile on the unit

Mosquito nets in the malnutrition unit

3.     Malnutrition unit- It is beautifully decorated alfresco African paintings and wildlife mobiles for the children, light and airy, child friendly and each bed had a mosquito net (Dr. O senior will be glad to hear)!!!

4.     What great work my predecessor Jess/Colin have done. There were laminated job aides all over the hospital made by these UK Global links volunteers, new protocols drawn out for managements of paediatrics/neonatal conditions common in Uganda. These doctors have done such great jobs and are spoken of fondly by all the staff; their achievements are encouraging but also makes me aware that I have such big boots to fill!

The lows are,

1.     The disparity between demand and supply, on arrival on Monday at 9.00 there was a sea of patients waiting to be seen in the triage department. Although there are more doctors in the paediatric department than the main hospital, the demand for care still outweighs the supply.

2.     Just like the UK there were the few worried well patients, however most of children present very late at which point they are incredibly unwell. Some have tried several care centers or non-medical solutions (herbal/religious) before presenting to a referral hospital.  (See Jess and Colin’s post about hierarchy of care)

3.     Glaring lack of resources, for instance this week we did not have any oxygen in the paediatrics department or the main hospital. Despite the fact that over 1/3^rd of the acute admission had respiratory distress with low oxygen saturations.  Some were low enough to get my pulse raising. It is incredibly hard to know what to do in these situations .

4.     High mortality- some of you might have read my Epic wobble post describing my doubts which was partly due to the high level of mortality seen in Uganda.  My predecessors from Global links Jess and Colin posted a great post about the difference. (Do click on their name to check out the post). To put it in clearer terms, in my 6 months in Blackpool I saw 2 childhood deaths, one had a malignancy and the other was a neonate with Fulminant Necrotising Enterocolitis (Gut infection). In 3 days in Jinja I have seen/heard of 4 deaths some of which I struggle to come to terms with, as they were due to the point I raised earlier, lack of resources and delayed presentation.

In summary in the short time I have spent here, I have been able to reflect on the things I can do to help.  GL (Global Links) aims to not only help with service provision but mainly to provide sustainable ways of improving health care with the ultimate goal of reducing childhood mortality.  For the next month I will be standing on one feet and writing down every idea I have.  It is important to not jump in all guns blazing to avoid making mistakes or alienate myself.

I will try to understand the rationale behind why things are done and work along side the other paediatricians to make sustainable health care improvement. The key word been sustainability, i.e. when all foreign aid and volunteers go, can the local staff continue to provide affordable care for the children. That is the task!