Our first day.

Background: We were both slightly anxious. Despite a decent UK education and a good amount of NHS service between us, we’ve never really seen much tropical medicine, and we are both quite use to senior supervision and back up from nurses and other parts of the hospital. We were also unsure about cultural differences, the ability to offend, the inability to help and the risk of picking up diseases. We’d had lots of reassurance and we’d been told that as long as we were sensible, we could always ask for help and stick together

We arrived on the medical unit and found two doctors struggling around two wards and introduced ourselves. They seem bemused but pleased to see us. Mattea immediately abandoned me and suggested we take one Ugandan doctor each and split the wards. Off I went with a Ugandan intern called George.

We enquired as to whether or not others would be joining – but apparently, someone had decided that today should be a bank holiday and announced it on the radio THIS morning! Consequently, most of the staff were not coming to work today (including the senior surgeon with an expectant list of patients!)

I thought I’d start as I meant to go on, and as we reached the first patient, I asked if there were any gloves. Sorry – we’ve run out. Never mind, I’ll wash my hands, Sorry we’ve no water. Ok.

Things we don’t have:

Ø  Gloves

Ø  Water (intermittent)

Ø  Electricity (intermittent – and rarely on a night shift!)

Ø  Blood sugar machines

Ø  X-ray (‘its broken’)

Ø  U&e machine (its broken)

Ø  ECG machine

Ø  Thermometer (the intern had bought his own)

Ø  Sheets

Ø  Curtains

Ø  Any drugs I’d heard of

Things we had plenty of:

ü  Patients

ü  Insects

ü  Chickens

ü  Human Immuno-deficiency Virus

We do have access to a full blood count and a malaria screen – but the doctors don’t trust the results so generally don’t bother ordering them.

Despite our somewhat limited resources, we ploughed on with the ward round. Gradually I realised that I wasn’t the only one that didn’t know what was going on. The poor interns (first year doctors, equivalent of FY1s/house officers) were doing their first medical job and were only slightly less clueless than we were. Mattea and I bumbled our way around the expectant queue of patients and then re-convened for lunch.

Quite weary by our mornings efforts, we were invited to lunch by one of the nurses. She lives on site in a small but lovely house and cooked us some traditional Ugandan food. We spent a good hour sat on her sofa eating Ugandan cuisine and watching a ludicrously bad dubbed Spanish version of coronation street! The NHS could learn a thing or two about how to do lunch breaks.

Post-lunch, we weren’t sure what to do. The medical ward was deserted of staff but a helpful medical student told us that the intern might be in A&E. We set off to find him. He wasn’t there but they did have a smallish room with 7 beds packed together. Six of them had patients on, All of them looked half-dead.

Shortly after, another patient arrived. We did our best to ignore her screaming and pretended we were busy with important ‘English doctor work’. Now that the seventh bed was occupied, the senior nurse closed the barred doors and proceeded to bolt them together. Brilliant – no more patients (Andrew Lansley watch and learn!) But I’m not sure how we get out…

Eventually, our in-activity became embarrassing and we offered to see a patient. The nurses, looked bemused but suggested we see the new patient. We strode over to bed one and introduced ourselves to the young naked girl and a lady we assume was her mother and another who was probably her grand-mother. We were met with a stony silence.

What is her name? I asked politely

‘Allo’ she replied

Hello. What is her name? I replied again in slightly louder and slower voice

‘Allo’ her grandmother said.

Hmm – without a translator  - this was going to be difficult. The nurses had all disappeared and I glanced around the room of half-dead people unsure how to proceed. Luckily, a family member of another patient interjected and offered to translate.

‘Please can you ask her what her name is’ I asked the kindly translator

(In Ugandan) ‘What is her name’

‘Allo’ her mother replied…

Allo was a 12 year old girl with an ear infection. The initial antibiotics had not worked and now she had an invasive meningitis (infection of her brain). In the UK, we’d sedate her, give her intra-venous antibiotics, CT her brain, send off all the investigations we can think of and send her off to a specialist paediatric intensive care unit. In Gulu, I enquired if they had cannula.

After our first day, we felt quietly pleased with ourselves. We had sort of integrated ourselves into the system and feel more confident about what we might be doing tomorrow and for the next few weeks. We are still very doubtful about our ability to make much difference. We don’t really know what diseases anyone has, because we have never seen them before. We have nearly no tests to help and the limited drugs we have at our disposal don’t seem to be distributed anyway. However, all hospitals must start somewhere and I’m sure the UK hospital wards used to be filled with chickens, insects and bereft of any useful equipment – so the only way is forward and I doubt we can do much harm.