Nursing, traveling and dancing in Uganda - a whole new world
on Sam Elrick (Uganda), 07/Dec/2009 12:57, 34 days ago
Last week I had my first clinical shift in a Ugandan hospital. Until now I have been working a lot on planning clinical placements for students including developing practice portfolios and clinical guidelines. All that work needs to be done but it does get a bit boring after a while so I negotiated to work one day a week clinically. I am now working on Hope Ward each Wednesday. Hope Ward is the Charity Ward of the International Hospital Kampala (IHK). The University where I work is located on the third floor of the Hospital and while they are different organisations they have a close relationship both physically and financially. IHK is a private hospital and subsequently patients have to pay for their health care - there is insurance available. Of course not everyone in Uganda can afford it so that is where Hope Ward comes into it. Patient's on Hope Ward have come across hard times and their medical costs are covered.Although IHK is very well resourced by Ugandan standards it was still a bit of a shock to my system working there clinically. Stock levels are very low and sometimes the most basic of medications or supplys simply aren't available. The thing that struck me the most however was the suffering of the patients. The ward is a mixture of adults and children but it's pretty different to a hospital ward in Australia as the life expectancy here is around 50 years so you don't see many elderly people. The children I looked after were either at really advanced stages of illness or had shocking stories to tell. There was a twelve year old girl with advanced cancer and brain mets, so only palliative treatment was an option and a little fella of about five who had HIV/AIDS and was barely conscious, being tube fed and having almost continuous seizures. Then there was a young boy who had been tortured and kept in a cupboard by his father for three months and was suffering significant trauma as you can imagine. The adults weren't fairing much better, there was woman in her twenties with advance HIV/AIDS and a man who was about to lose his leg (I am not sure why).Half way through the day a young man of six came in for his first lot of chemo to treat his lymphoma. He looked very smart in his brown pin striped pants and waist coat and white shirt, his Grandma had dressed him up for his first trip to the city. But he was so lethargic he could hardly move and when the nurse put the IV in his hand he didn't even flich. I couldn't imagine that happening at home. In Uganda many cancers that we pick up early and that get treated and often cured in Australia present as advanced cancers. It really is heart breaking to see how much suffering people go through because health care is not available to them. Access to quality health care is something we just take for granted....There are many other things we take for granted, especially in a nursing context. I was interested to see that alcohol swabs don't exist here, you have to squirt 'surgical spirit' on a cotton ball and that does the trick. There is not nice clear occlusive dressing to cover the IV site its an abrasive tape - kind of like a cross between sleek and elastoplast. This even goes on the kids. When you was your hands when working you use a bar of soap (the same bar for everyone), and to dry them you have to go to secret cupboard quite a way away from the sink to get the paper towel which is in quite short supply. The discharge medications come up in plastic bags but there are no directions on it so sometimes the patients get confused and take them all at once! I am starting to see why people only live til they are 50.Despite the hardships they nurses were a pretty friendly and resourceful lot. They don't get much ancillary help so they have to do alot of errands and cleaning and there was very little engagement with the patients. That is the challenge infront of me - to find a way to turn that around. Easier said than done but we will see what happens. The workload of IHK was pretty good - about 6:1 but it goes up to about 6:1 when the ward is full. I recently heard about a hospital up-country in Lira where the ratio of patient to nurse is 250:1!!!!!! That is not a mistake. It is something we can't even imagine and that was in a children's area. If you have oxygen you get cared for inside the walls of the hospital but if not you are generally outside on the lawn if there is one. This story was from Northern Uganda which is just coming out of decades of war, bloodshed and misery. I think there is alot of work to be done there. So next time you go to work and there is someone off sick and you're a bit short staffed spare a thought for your colleagues in Lira - it suddenly wont seem so bad!Other than work there was a trip to Jinja for the day. Oh a road trip is always a fine adventure in Uganda. The trip there was entertaining, highlighted by a thousand stops to try to pick up passengers even if they didn't want to go where we were headed and a change of matatu mid way to one with heavy plastic covered seats. Generally though the trip there, although slow, was relatively painless. Coming back! Now that is a whole new story. I have never seen so many trucks. Trucks that were often coming towards me in the same lane - until the last minute when they turn away somehow. There was much overtaking in all directions and many, many, many near death experiences. I have now come to understand why the best road in Uganda is also the deadliest. I have to travel that road again at the weekend so if you never see me again.....oh you'll know what happened.There was working.....there was travelling......oh that's right and then there was dancing.......................By far a highlight (although a reluctant one) was our dancing performance at the VSO BBQ. Our friend committed our services without much consultation so as it turned out it was one in all in...We had been taking Ugandan dancing lessons and were only up to lesson number three so as you can imagine we were pretty bad. We had a percussion band and singer and we were dressed in African costumes complete with wiggley, hairy skin thingy tied on the bottom. We really looked a treat. There were four of us Gosia, Saskia, Hazel and I and when we went on stage the crowd were cheering wildly. It was great fun and I think the furry bottoms were our salvation. I wonder if anyone has it on video.............