Saturday, March 21, 2009
Uganda - Clinic #1
Our first clinic in Uganda was in a Kampala Slum. Kampala is the capital of Uganda (see map). There are about 30 million people in Uganda; about 1.5 million live in Kampala. I'm not sure exactly where we were in relation to the rest of the city, but we turned off the main (paved) road down into a dirt road. All around the mini-bus we saw little stands set up. People were selling tomatoes, potatoes, bananas, shoes, etc. Children were running around and people walked, shopping for goods.
We travelled a bit down the main dirt road (which was only wide enough for the mini-bus), when all of the sudden the driver stopped. Apparently we had arrived. The building was made of concrete and, like most things in Uganda, adopted the red hue of the dirt. We piled out and went in. Inside the main room (which stood about 50x30ft), approximately 25 people sat on plastic patio chairs. There were 2 tables in front and some chairs up there. We had carried in the 7 suitcases that contained our "pharmacy" -- medications purchased both in the States and in Uganda that morning.
We were ushered to sit in front of everyone, behind the tables. We introduced ourselves, and Seggy (our Ugandan partner) told everyone in their native Luganda language that we were from the US and here to provide medical care.
We went back to the "treatment rooms." We discovered that this building was probably a type of hostel or dorm. The rooms were small -- about 10x6ft -- with barely enough room for a twin bed. Myself and the PA (who also saw adults) took one room. The two pediatric NPs took the other room. Across the hall from our rooms was a slightly bigger room -- about 15x15ft, with a queen bed. We unloaded the drugs on to the bed and left a 3rd NP and a lawyer to figure out the pharmacy.
The 4 providers looked at each other and got to work. We had enough Purell for a small country, and we used a ton that day. After a few patients, the PA felt comfortable enough to look for another room. Having 4 adults in that tiny space was too much. Thankfully, she found another room down the hall.
We had some translators bouncing between rooms to help with the people who didn't speak English. School is taught in English, so anyone who spent any significant amount of time in a classroom spoke fairly good English. However, most of the people who we saw didn't have much of an education.
The saddest case I saw was Ronald. He is 26, and his English was amazing. He had served in the Ugandan Army and was stationed in Iraq. He sustained an injury to his left eye in 2003 and was sent back to Uganda. He was discharged from the military, but his vision continued to decline. He came to me with a letter from a Ugandan ophthalmologist. She described his eye and the growing pressure that was occurring. She had performed a few drainage procedures, but the fluid kept returning; he needed a definitive procedure if he had any hope of saving his vision. As it stood, he could see light and dark and basic shapes on my exam. He couldn't count fingers in that eye.
The letter went on to explain that there were no doctors in Uganda who could perform the procedure. They hadn't been trained to do it. She asked for help so that this young man could get a place that might be able to help him. My guess is that the closest facility would be in Nairobi.
I introduced him to Julie Clark, the leader for doma. We had travelled to Uganda with doma so Julie could try and figure out how doma could best partner with orphanages and community groups to provide medical care to orphans and vulnerable families. Julie took down his name and contact information, and her hope is that we can raise money to get him to Nairobi for further care. He was very thankful, and he came back to my room twice to express his gratitude. He was hopefully that we might be able to provide some way for him to save his sight.
We saw just over 200 people in 5 hours. We had to turn about 30 people away because it was getting dark, and we needed to be on the road before it got too late. There was such a need for basic primary care -- blood pressure monitoring, nutrition counselling for new mothers, STD testing and treatment -- we probably could've spent all week there and barely made a dent in the population that lives in the slum.
However, we had 3 more locations to visit before our trip was done. Next up: Seeta.
Posted by Just a Doc at 2:58 PM