another trip to gulu
on Random Uganda (Uganda), 11/Dec/2009 12:13, 34 days ago
December 6thAmbulance ride to Gulu, and back.My second trip to Gulu (a month or two back I flew on the helicopter) and I stayed for even fewer minutes than the first.Friday morning, the sounds of the Soroti brass band still ringing in my ears, I show up at IHK. As it typical, whenever I have been gone for more than 15 or 20 minutes, Justine (senior sister in OPD) greets me with a smile and,‘doctor, you’ve been lost.’‘Yes, Justine, you have no idea how lost I’ve been….’Technically, I am still excused from work by VSO for conclusion of the IVD (International volunteer day) festivities: a cocktail party at the Imperial Royale Hotel and the Volunteer of the Year Awards (VOYA). Surprisingly enough, I won’t be getting the VOYA this year. It will be going to an UNDP volunteer who goes by the moniker of ‘the Bushman’ who managed to design mud huts using nothing but a laptop and Microsoft excel! (A feat which, apparently, has brought the mud hut into the 21st century. I don’t know why they didn’t think of using an excel spreadsheet before.)I pop my head in the ambulance/transport office to talk to Tom about a series of ambulance protocols we’ve been trying to put in place. Emma, one of my doctors is on the phone. With Gulu Independent Hospital. They have young man who crashed his motorcycle the night before. They want him to come down to IHK for a CT scan. He’s ‘stable.’ Glasgow coma scale of 13. Sure, we agree, send anambulance with a nurse. I set a meeting with Tom and go on with my day.A couple hours later I run into Tom again, talking nervously with Moses, one of the drivers. Apparently Gulu just called. The patient is getting worse. GCS 10. Gulu Independent is going to put him in their ambulance and head south to meet our ambulance heading north. I think out loud,‘well, if our rig left 2 hours ago, they should be half way to Gulu now…’ Tom and Moses smile and nod, our ambulance is still in the driveway…A few minutes later, I’m strapped into the front seat and we are driving like bats out of hell across town to the Gulu Road north. Flopping about the back of the rig, trying to take a nap, is another OPD nurse named Justine.The ride to Gulu was 3 hours and 45 minutes of adrenaline rush and the metal on metal smell of disk brakes on their last legs. Naturally we did not see the Gulu Independent ambulance on the road. When I was finally able to locate the physician caring for the patient (who had been left in the ICU with 20 family members but no medical personnel to speak of), I was told that the patient‘was too unstable to transport in an ambulance.’ Well thank goodness I had been planning on teleporting him back to Kampala.GCS 3. (the Glasgow Coma Scale is a 15 point scale developed in Scotland as a predictor of morbidity in head injury based on a few simple brain function—you get 3 points just for showing up…)As horrifying as the ride up to Gulu was(and as horrifying as was the reception at Gulu Indepenent), the ride home was exponentially more frightening. For one thing, I did much of it riding backwards attending to the last rites of my patient, while being thrown side to side like the scarecrow and the flying monkeys. When I did force myself to look forward (in a desperate effort not to hurl), what I saw through the doorway into the drivers’ compartment looked like a video game based on Death Race 2000:Winding red-brown road threading its potholed surface through electric green foliage to the sound track of warbling siren and blaring horns. Occasionally the foliage would disappear and roadside trading centers garishly painted in the puce of Zain or the yellowgold of MTN or the sky blue of Uganda Telecom would flash by. The back ends (and occasionally the front grills) of buses and trucks and matatus would loom large and deadly on the view screen and then disappear. Targets would fly by on the periphery: motorcycles carrying 30 live chickens, tall thin men on tall thin black bicycles, women carrying jerry cans on their head, children carrying jerry cans on their heads, women carrying children and jerry cans, a baboon, (a baboon? Sitting on a guardrail), a baboon carrying a baby, two men pushing a bicycle with a coffin balanced atop, matatus disgorging floods of people, six foot high bags of charcoal on the side of the road...The boy’s auntie rode with us, holding his hand. I had told her we would be very lucky if the patient was alive when we reached Kampala. He made it to Kampala. And got his CT scan. He was declared brain dead and taken off life support 2 days later.