A relatively calm week in Kampala
on Random Uganda (Uganda), 29/Mar/2010 13:09, 34 days ago
Last week was a week of mourning for the Baganda (people of the kingdom of Buganda). Many of them wore a strip of bark cloth or olubugo tied around their waist or pinned to their clothing. The inner bark of the Mutuba tree (ficus natalensis) is harvested after the rainy season and then beaten with wooden mallets to make a suede-like, terra-cotta colored cloth that swaddled and draped the Buganda royalty. The bark cloth reportedly dates back some 600 years to the second Kabaka. In more ancient times, the cloth was used as a shroud for the dead. As such the cloth is a potent symbol of Buganda culture and a sign of mourning.The mourning Baganda also mounted photos of the Kabaka (Ronald Mutebi, king of Buganda) on their bicycles and motorcycles and matatus. The loss of the Kasubi tombs (see last week’s post) has hit the people hard. It is difficult for us to understand how people can mourn the loss of a tomb (the bodies of the four previous Kabakas, interred in the tombs, were undisturbed by the fire). In a way it seems odd to mourn for what has already been mourned for, but for the Baganda, fighting to maintain their culture in a rapidly changing world, it seems like the tombs were their link to the past glories of their kingdom. The tombs will be rebuilt. Maybe this time with better security, or wiring, but will they be the same?On my side of town, Prasandan and I taught an ACLS-type course to the medical staff at IHK. Prasandan is the cardiac anesthetist from Kerala who has landed the unenviable task of starting the new IHK Heart Centre (this morning I asked a medical officer what the EKG showed for a patient that had gone into shock—and was told that the hospital’s lone functioning EKG machine was broken). ACLS is Advanced Cardiac Life Support and is a copyright of the American Heart Association, and, as such, if we were to teach an ACLS course here we would have to have the blessings and sanctions of the AHA, which we did not, hence ‘ACLS-type.’ACLS mostly focuses on the skills and knowledge needed for resuscitation of people in cardiac arrest, although lately it gives some emphasis to the early treatment of heart attack and stroke as well. In a US hospital, the paramedics, most of the ER and critical care nurses, and many of the doctors would be certified in ACLS. Here in Uganda, where resuscitation is a new thing, the only people certified in ACLS are ex-pats or medical personnel that trained abroad. Given that IHK is about to become a‘Heart Centre,’ I thought it a good idea that we begin teaching our medical staff the basics of cardiac life support. Prasandan agreed.I will, up front, confess that my ACLS instructor certification expired during the Clinton administration. But I did manage to research the current ACLS curriculum and guidelines and put together an impressive array of shamelessly copied powerpoint slides. And our doctors stayed awake, for the most part, even after the traditional 1300hr bolus of matoke and gravy. Although they did seem amused by a few of the ACLS recommendations. For instance, the thought that you could get an EKG within five minutes of coming to the ER (at IHK, the EKG machine, when it works, is in cardiology, and you send the patient, without a monitor, to cardiology to get the EKG. The walk to cardiology alone would take up your 5 minutes). Or a head CT within 45 minutes (even if it worked, it would take that much time just to locate the key to the room). Too dang funny. What kind of stuff is the AHA smoking anyway?My evenings in the Casualty ward at Mulago were a little less didactic. At least this week no one was shot (or, if they were, they weren’t brought to Mulago while I was in attendance). But, at one point I was taking care of 3 patients with Glasgow Coma Scales of less than 8. (the Glasgow Coma Scale or GCS was, not surprisingly developed in Scotland as a prognosticator of head injuries, anything below 9 is considered a major headinjury) As is typical of my unflagging optimism, I tried to get some CT scans of my patients damaged brains. Unfortunately, the tech that runs the scanner had gone home and ‘couldn’t be called back in unless it was a true emergency…’I have decided that I really do not wish to be around Mulago when the‘true emergency’ comes through the doors.Fortunately I was not at Mulago on Friday when the Baganda mourning was brought to a close and the bark cloth was unknotted and the tears were dried. The Kabaka and the Nnabagereka (his queen) came to Kasubi to officially bring an end to the mourning period. The tens of thousands of people at the site pushed forward to see the Kabaka and between 150 and 250 people were injured and 2 people trampled to death.