Resident Travel Blog August 26, 2013

This blog documents the medical experiences of our residents as they travel abroad and experience healthcare in different parts of the world.

August 26, 2013 by Brigette Gleason

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So my RHD research has come to a close for now, and I've transitioned to clinical medicine at Mulago Hospital. There are 1300 beds, but likely twice that many patients. There aren’t enough doctors to see all of the patients everyday, and often the only doctor that does see a patient is an intern. There may be as many as 60 very sick patients that are assigned to a largely unsupervised intern, who also has the role of drawing blood and starting IVs because there aren’t enough nurses either. The medical education/training system here consists of 5 years of medical school after high school, then an intern year which involves rotating through the specialties (surgery, peds, OB, etc) for a couple months each. After that, you can start working as a generalist or you can go back to do residency at some point, in internal medicine for example, which is 3 years that you have to pay for.

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Patients rely on their families for providing bedding, clothing, food, and retrieval of medications. Many of the basic medications and tests are free, although not always in stock. There is a CT machine (costing the patient ~$100 per scan), but no PET scanner or MRI. The lab results usually take a couple of days to return. I spent 1 morning rounding with the endocrine team, which mainly consisted of patients with complications of diabetes. There is no long-acting insulin available in Uganda, patients don’t have the means to check their sugars at home, and HA1c is too expensive to be used. Patients had overwhelming infections, were awaiting amputations, and you can imagine that DKA isn’t as easy to treat without an insulin drip. The next day I rounded with the hematology team, which mainly consists of anemic patients of various etiologies. Anemia is considered severe if the conjunctiva is as white as the sclera. Rounding is very thoughtful, but there is a different way of thinking when there aren’t as many tests to rely on and when the interventions are based on what is available. I’m also learning about some illness that occur here but not in the US such as Tropical Splenomegaly Syndrome and Endomyocardial Fibrosis. I've already seen Kaposi's Sarcoma and Burkitt lymphoma, as well as many other diseases that are much more common here. Mulago is a very busy referral center, so it's hard to imagine how the even more resource-strained health centers in the smaller towns and villages are providing for their patients.

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The MUYU program that organized this part of my trip is very invested in giving the participants a well-rounded glimpse of life in Uganda. The program includes lectures on sociopolitical, historical, and cultural topics as well as excursions around the city. There are so many factors contributing to health outcomes in any nation, so I'm glad to have the opportunity for such a broad exposure while I'm here. I now have a new set of roommates who are also eager to explore other aspects of Ugandan life in our free time. We have been frequent visitors of the weekly free music scene at the National Theater as well as frequent consumers of the famous rolex (essentially street food version of an egg burrito made with chipatti flat bread). I also was able to travel to the southwest of the country a couple of weekends ago for a short trip to Lake Bunyoni. It seems to be a popular destination for those looking to be immersed in nature and focused on relaxation. The scenery was beautiful, the food delicious, the water refreshing (and reportedly schisto-free), so it was very rejuvenating overall!

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