Further Impressions of Mulago, Part 1
on Random Uganda (Uganda), 05/Apr/2010 06:57, 34 days ago
A small boy walks tentatively into Casualty. In his left hand he clutches a fiber-plastic sack of clothes, in his right, a sheaf of rain and mud speckled papers. It’s about 5pm and all four stretchers are occupied by young men either coming to grips with their newly crippled status or completely oblivious of the fact due to the severity of their head injuries. Since you seem to be only one in the crowded room who will meet the occasional upward flicker of his sunken eyes, the boy shuffles over within reach. His scalp is a flaking field of scabs. He is dirty, dehydrated, and underfed. When he raises his right hand to offer you his paperwork, the minimal weight of his hand and its contents causes his forearm to droop like Harry Potter’s after Gilderoy Lockhart accidentally removed the bones.The papers suggest that he is twelve years old, but to your eyes he’s an eight year old boy with eighty year old eyes. He has been abused by his father and step-mother. The police intervened and he was removed from the home and placed with, well, placed in the care of the state. In a country where the state has a lot more to worry about than the well-being andwhereabouts of a lone 12 year old boy.You examine his injured right arm. Both of the bones—the radius and the ulna—have been snapped in half. Then you notice that the arm holding the bag sways unnaturally as well. Both of his arms have been broken and untreated, from the dates on the papers, for at least 10 days.You walk the boy over to the cast room and introduce him to the orthopedic house officer. Best as you can tell from the conversation, the house officer bawls the boy out for not coming sooner—now he’ll need surgery to fix the arms.Later you find the boy on the crowded surgical holding ward. The boy now has plaster casts on both arms to above his elbows. His look of desperation grabs you by the trachea. You go to the canteen and buy a Fanta orange and a plate of chicken and chips and bring it back to the ward, feeling guilty as you walk by nine or ten other equally hungry patients. The boy looks at the food, and then to his hands—neither of which can now even begin to approach his mouth.To the best of your ability, you feed the boy the greasy chicken and fries. You wipe the chicken fat and dirt from the boy’s mouth with a waxy napkin. You’ve heard, but never witnessed, that you can offer the nurses a little something to get them to actually pay attention to a patient, so, even though you have sworn to yourself that you would never do this, you go looking for a nurse. But 8pm is rapidly approaching and the nurses are making an exodus. At 8pm the ward will be down to night staffing: one nurse, one intern, 30 or 40 patients.The night nurse and intern are nowhere to be found. You understand that the intern is probably in the process of barricading himself inside his call room. Much as you wish to help the boy, you have experienced what it is like to be the lone person in a white coat on a ward full of injured and dying patients (and their families) where you don’t speak the languages and you have nothing to offer more than another bottle of normal saline (if the IV fluids have been restocked today) and a helpless facial expression. You slink out the door behind the nurses.The next afternoon you try to track the boy to the orthopedic ward and can find no evidence that he was ever in the hospital.