Resident Travel Blog September 18, 2013

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

September 18, 2013 by Brigette Gleason

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There isn't a general medicine ward at Mulago Hospital; the ID ward mainly fills that role. It has a reputation for being a difficult ward, whether playing the role of patient or provider. The patients are often quite sick, but the diagnostic capacity is limited such that diagnoses rarely are confirmed by data. Most patients cannot afford a blood culture, so antibiotics are chosen and changed based largely on clinical presentation. It seems that most physicians know what needs to be done, but it isn't always possible to carry out the plan.

One patient on the ID service had the unfortunate combination of jiggers and tetanus. Both of those infections, at least, are easily identified without blood work. Patients present with tetanus nearly every day: the vaccine is available, but most people don't get it. Pregnant women routinely are vaccinated for tetanus if they go to a health facility during their pregnancy (less than half do). The fertility rate in Uganda is 6.9 babies per woman; family planning is not practiced widely. Although barrier contraceptives aren't commonly used, there has been recent acceptance of circumcision as a way to reduce transmission of HIV.

Recently, the prevalence of HIV in Uganda has been on the rise again. According to the lab director at Mulago, about 80% of patients admitted have HIV. While antiretroviral therapy is free, there isn't enough for all those that qualify. It's one of the many barriers to receiving adequate treatment. About half of meningitis cases at Mulago are due to cryptococcus in HIV-infected patients, which has a local mortality rate of about 50%.

Being on the wards at Mulago has been an overwhelming experience, but it also has highlighted the systemic issues that have created such conditions. It reminds me why I want to be involved with public health. Trying to address these issues one patient at a time—after much of the damage has been done—just isn’t enough. Focusing on preventive tactics like immunization promotion and health literacy, and enhancing allocation of resources and health-care accessibility, is essential—but easier said than done. Ultimately, the key remains eradicating the cyclical poverty trap. Any suggestions?

Outside the hospital, I was able to play soccer with "Team USA" in a local adult league last weekend, which was great! I'm happy to report that we beat Denmark and Italy. I also enjoyed a cooking-lesson exchange with a Ugandan friend. She taught me to make chapati (wheat flatbread), and I showed her how to make chocolate-chip cookies. She'd never had a warm cookie straight from the oven, so she asked me why it was soft!

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It's hard to believe I'll be back in the U.S. in less than a week. I'm feeling pressured to take more pictures, get more sun, eat more avocados and rolexes, drink more Stoney (a bold and delicious ginger ale), and dance to more reggae. Thank you to everyone who made this trip possible and supported me along the way! I'll see you soon!

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