David's last post from Uganda
on Hoggs in Uganda (Uganda), 24/Jun/2010 20:44, 34 days ago
David:I've been back in the UK now for almost a fortnight. Time sure flies by. However, I had one last post to share, and have only managed to complete it now...11/6/10Today I am to meet with Alison Cowan, a GP from England who has been working at the International Hospital, Kampala (IHK) for the last year. She has very kindly offered to show me her work for the day, and so at 8.15am I find myself on the front terrace of the hospital. It's peaceful until the piercing cry of an inpatient child breaks the ambience.Alison arrives in a whirlwind. Very quickly I realise that she has an amazing passion for setting up decent sexual health services for the community around the hospital. She makes me feel very welcome, and soon I'm observing, even making contributions to, a meeting with some clinicians involved with the community project, on developing a validated screening tool which can be used for chlamydia and other STI testing. Currently patient concern centres on syphilis, and patients' understanding is subject to signfiicant myths so that even minor itches and other completely unrelated symptoms can instigate a strong belief in patients that they have the condition.So many factors contribute to the awesome task of trying to improve sexual health. Condom use is still heavily influenced by religious belief, social propaganda and myths which are regularly upheld by local - and widely-received - media. The double-whammy of trying to offer effective family planning with STI protection is no easy task. The additional task of tackling cervical cancer is yet another strand to this neglected component of community health care.But Alison and her team have taken this challenge head-on. With impressive support from her friends at home, she has managed to find funding and enthuse local clinicians in developing the services that they can offer. Collaboration has been set up with UK experts, and a heavily evidence-based approach has been taken to target the service effectively to local people.The meeting is productive, and at the end we have a plan on how to take forward the next stage of the project. I am sorely tempted to cancel my flight back on Sunday so that I can stay and get involved - however stronger factors, mainly getting back to my fiancée Kelli, prevent any calls to KLM!I sit in the STI clinic, again gaining more understanding of the scale of HIV/STI problems in Africa. Patients and staff very helpfully conduct some consultations in English, purely for my own benefit.We then go to a school which Alison's husband, Alan, has been supporting in one of the slum areas of Kampala. Their offer of running a meeting with parents of the schoolchildren, to teach on various aspects of health education, has been welcomed by the teachers, and today Alison and Alan are to explain more about what they intend to do. For them it is an important step in building on the rapport they have with the teachers. For me it is yet more proof that myths and beliefs regarding healthcare continue to present the biggest challenge in providing decent access to services, and an indication of just how important it is to engage local community leaders with any planning. And the appetite for such information is there.Later we return to IHK, and Alison gives me a tour of its facilities. IHK is the international hospital, a rare opportunity in Uganda for modern medicine to be practised with the adequate backup and support. A philanthropic strand means that some profits from paying patients are reinvested in health services for the local community. There are still some interesting differences however, such as when blood is required for transfusion. When this happens, a call is made on the tannoy and staff are requested to donate. Apparently there is never a shortage of volunteers, from all levels of the hospital workforce, andchecks on HIV and hepatitis status are carried out before its timely infusion next door to the labs, in the emergency department or ICU.Our tour continues through medical, surgical, obstetrics and paediatric wards, and I am grateful for the time that Alison takes to show me the facilities. Once again, as hinted at in previous posts, I feel a sense of futility - I really am a doctor-tourist with little to contribute - but I hope that in some way this insight might be applied in whichever future healthcare setting I find myself in. The scale of what IHK achieves is impressive. The frustration is that so few Ugandans can expect healthcare to this level.Alison and Alan have embarked on an impressive challenge, and now that they've been here for over a year, they've built up an interesting account of their experience - at their bloghttp://thecowansinkampala.blogspot.com.