Dave and Mattea Abroad: October 2011

As you may know, I (Mattea) didn’t really enjoy working as a doctor in the UK (hence my future career choice for non-clinical medicine). A big part of that is a fear of getting it wrong, of not meeting expectations, and what the result of that could be. I often came home feeling like I’d been chasing some impossibly high standard of care, never quite reaching it. I never thought I’d miss that.

We’re now into our 6^th week working at the hospital and are definitely starting to feel like we belong, almost too much, since in a month’s time we’ll be gone. We’ve taken the doctor count from two 1^st year interns who are on the ward three days a week (the other two days they run outpatient clinics, usually with no senior support what-so-ever); to two interns plus four full-time doctors with impractically-high expectations. Patients now get reviewed at least every other day, mostly every day, instead of once or twice a week. While this means a better level of service for the patients, it places that same impossibly-high expectation on the hospital staff. And actually, raising expectations is part of what we’re here to do. But getting the balance right can be hard. We’ve done a few audits since being here to look at where the biggest needs for change are. For example, drug charts exist, but are barely used. Depending on the ward, the doctor, and the mood of the doctor, drugs may or may not be prescribed. If they’re not prescribed, they are written in the notes and there is an assumption that somehow, they will be given. If they are prescribed, they are almost never prescribed legibly or correctly. And if they are prescribed, they may or may not be given, depending on whether the drugs are available, whether the patient has an iv line, whether the patient is present on the ward during the drug round, whether the nurse can find the notes/prescription chart before doing the ward round, whether the nurse thinks the patient needs the medication, and definitely not if the night nurse calls in sick – as we found out today. Yesterday, we heard that one of the best nurses on the ward, who is new to the hospital and in fact new to Gulu, was found crying after a night shift. It turns out that since starting work at the hospital (3 months ago), she’s not been paid, some mix up at payroll. She doesn’t have enough money to buy food, and however quickly payroll sort it out, she will almost certainly never get the money for the past 3 months! It’s no wonder she didn’t turn up for her shift, I certainly wouldn’t have.

For the past 2 weeks, a short-term team of doctors and nurses from Wythensahwe have been out here running some training courses for some of the students and staff at the hospital. A few of them have been out here before, one was here almost exactly 2 years ago, for an 8-month stint. After lots of discussions about ‘our ideas for improving the hostpital’, it’s become clear that they are the same ideas that others have had and tried to implement many times before. There are so many reasons for the lack of change, half of which we will probably never know. Money and gross staff shortages are certainly two of them, but there’s a huge cultural influence too.

Maybe it’s because death is so common, and because we can offer patients so little. Whatever the reason, there doesn’t seem to be the same feeling of responsibility for patients that we have back home. And that’s probably the biggest barrier we face when trying to impose our standards and ideas for changes in the hospital.

As a little break, we took a long weekend last weekend and went down to Murchinson Falls National Park. We ran over a python in our car, watched a lioness and meet up with her three cubs and wander off for a cat nap, got absolutely savaged by tsetse flies when stopping to look at the rotting python on our way home, and got our car completely stuck in the mud, and thankfully were rescued by a 4x4 and a tow rope.

Life in Gulu is an adventure.