I've only been working in the hospital for two days now, in the pulmonary department, because I took the opportunity to go to Murchison Falls National Park from Thursday to Saturday with a group of fellow American medical trainees. I'll try to post some pictures of Murchison Falls in the next post. Uploading pictures to Blogger is a little slow here so the posts might be a little light on images but I know I can't use that as an excuse for not writing about the trip so here's an update.
On my first Monday, Stella, a second year medical student at Mulago Hospital took me around Mulago Hospital and the neighborhoods surrounding Makarere University and Mulago. Here are some pictures of some of the halls in the hospital. I was actually trying to capture the view of the city, which clearly didn't quite happen, but you can see that the halls are open air.
It's actually kind of nice to get to walk around in the open air when you're moving from place to place. I'll get some pictures of the the front of the hospital later, but I'll describe the wards to give you a sense of what it's like to be a patient here.
The patients are all in their own beds that, estimating from the paucity of paint and abundant rust, are probably decades old and are paired with matching mattresses. These beds are arranged one next to the other, with just enough space for a family member or 'attendant' to place a mat and belongings on the floor. Patients with HIV and low CD4 counts (one patient I saw had 6, normal is 500-1000 cells/ul) are right next to patients with tuberculosis.
Some of the beds are capable of raising the patient's head with the turn of a crank. One patient last week was having trouble breathing when lying flat (orthopnea) so we moved her to one where we could keep her head raised. You might assume that there's someone with the specialized task of moving the patient from one bed to another. Actually it was her husband, dressed in a worn suit jacket, and me who pulled the sheets (sheets that patients provide) off her bed and moved them over to the other bed. Most patients have one to one personalized attention from at least one family member or friend. These are referred to as 'attendants'. The attendants don't just provide emotional support, encouragement and someone with whom to spend the time. They actually play an essential role by being the ones who physically push the patient's bed to get the required studies. If an X-ray is ordered, the husband, wife or friend pushes the bed out of the ward and to the appropriate destination and then brings them back, with an envelope containing the requested study. Which in the case of an X-ray is often extremely underpenetrated, but I suppose adequate enough to tell if there an obvious pneumonia or effusion or cavitation. Or at least adequate enough to forgo the ordeal of getting another X-ray that will take a few hours and be equally underpenetrated. The attendants also go to the pharmacy themselves to purchase the prescribed medications. And they bring them food, which actually might be the envy of our system because some of the food smells delicious.
It's actually moving to see how people spend their time caring for their loved one in the hospital. When I helped the patient's husband move the bed sheets and belongings to a new bed as the patient stood by, disabled by her lung disease and severe osteoarthritis of the hips and without a place to sit, it seemed to me that the man, dressed in a worn (to put it mildly) suit jacket, attended to his wife's needs with only worry on his face when others might reasonably feel some burden.
As for medical 'records', the patients are the sole possessors of all of their medical records. Any past medical records are brought by the patient or their family or they're just not available. And all of the medical records, past or current, including imaging studies, are 'stored' on the patients' beds.
All of this is happening is a room where the walls are made from 'bricks' that form a repeating pattern of shapes where those shapes provide clear views of the outside. This keeps the ward fully exposed to any breeze from outside, which is actually the cheap version of a negative flow room because it keeps the air fresh and flushes out germs (like tuberculosis) that would otherwise spread better in an enclosed area with poor circulation.
One thing you might have read about in the news is the Marburg virus outbreak here. I knew that there were some cases in the west of the country, but I found out that there are 2 cases here at Mulago, which is a, or the, major referral hospital in Uganda. I found out when I noticed for the first time a box of latex glove on one patient's bed. I thought maybe this patient had something particularly contagious or the patient brought the gloves with them. I asked the the senior house officer (or 'SHO', who are the people who really run the service, with minimal oversight from the attending physician or 'consultant', which is a more apt term because they really don't play as much of a role as attendings in the US) if this patient had something contagious and he responded, "We have a visitor to Mulago. A visitor named Marburg (Mahbeg as it's pronounced here). Have you heard of him?"
Just so no one is too freaked out, I've been wearing an N95 mask everywhere on the wards and I bought a box of gloves and I have hand-sanitizer I use everywhere. And more importantly, the suspected cases of Marburg are sent to an isolation area and from what I've read in the news the CDC and other agencies are coming and they are going to start using a new test that can rule out Marburg in 3 days instead of a week or so.
So that's the update so far. This week I'm going to try to work in the pediatric infectious disease department. I haven't seen any cases of malaria, which is one of the main reasons I made this trip, and the pediatric ID department is the place that likely has the highest amount of malaria.
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