A few days ago I got an email from a friend who read my blog and he (or she) said "This place sounds scary and without your descriptions almost unimaginable coming from where we come from." This got me thinking about a few things that are either directly related or tangential to his (or her) comment.
I definitely agree that most of the stories I have written about are scary. I would be scared to be a patient at the hospital where I have been working. Just to be clear though, I certainly don't want my stories to be an indictment of the people who work there. There are many interns, residents, and some visiting expats who do amazing things with the resources that are available. And of course, like everywhere, including back home, there are people who under-perform and consequently make a negative impact on patient care.
On the pediatric oncology ward I've spent some time with a peds resident from Europe. She works from 7 AM to 1 AM and essential splits the ward of 30 patients with a medical officer (the term for someone who has finished internship but hasn't done residency), who is also very dedicated and talented. It's really amazing to see the dedication she has to her patients and to watch her advocate for her patients in a system where it's easier to just let things slide. Of course, often the battles are lost, but she keeps fighting when most people (myself included) would probably give in. Part of her work here involves trying to improve the organization and recording methods in the ward. She's made spreadsheets to make it easier to record chemotherapy doses and and other medications. Apparently it's quite popular among most people in the ward because it makes records much easier to decipher, but one of the directors has expressed some fairly strong disapproval, preferring to use the older system. Like everywhere, there are people who are constructive and those who aren't.
Which brings me the point I've wanted to make about how, from what I've seen, the students, interns, residents, and consultants (attendings) have been overwhelmingly welcoming of visitors. The team often asks the visiting residents what they think and, save for the example I mentioned in the previous paragraph, I really have only seen constructive camaraderie between the Ugandan team members and visitors. I would have expected at least some occasional hint of resentment or defensiveness on the part of the locals, but they really value and appreciate the help and input from the visiting residents I've worked with. The only hierarchical interaction I've seen is in the interaction between attending and resident or resident and student, but that's just normal for medical training.
Going back to my friend's comment, I should also point out that this blog reflects my experiences with a government-supported tertiary care hospital in a very poor country. Two nights ago a group of us talked about how our perspective of Uganda would be different if we had come here strictly for vacation. We probably would have spent a few total nights in hotels here in Kampala, but most of the time would be spent away from the city, on safari in the amazing national parks and seeing all of the wildlife and natural beauty this place has to offer. And we would have met the friendly, welcoming Ugandans as well as the few who aren't so nice. If we had gotten sick, we would have gone to the nice hospitals. I hear the International Hospital is quite upscale. All in all, it would be a great place to vacation. Certainly further from the comfort zone than more familiar vacation destinations, but it could be quite comfortable nonetheless.
In contrast, being in Mulago Hospital means we have a front and center view of the consequences of limited resources (eg clean water, vaccinations etc), and the political failures that lead to sub-maximal utilization of the limited resources. All of the human suffering that happens is concentrated in one place, providing no shortage of examples of the shortcomings of the system.
So, to wrap up, I would emphasize that the stories I mention here only describe one small part of Uganda. It's certainly an important part, but it doesn't reflect what it would be like to visit as a tourist. Imagine, if someone went to Chicago and worked on the Cook County trauma team, their blog might give on the impression of a society where violent crime is rampant.
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