Working in the Hospital

Kisoro Disctrict Hospital: The hospital is set amongst some of the most beautiful scenery. It consists of a pediatrics ward, surgery ward, female ward, make ward and labor ward. Each ward is one large room with about 30 beds. The patients must bring with them sheets, blankets and basic necessities to clean and eat for the time there. Each patient must have an “attendent”, someone responsible for feeding them, cleaning them and buying them various medicines when necessary to be admitted. When there are more than 30 patients (which there always are), patients sit on straw mats on the floor, a mat which they must provide.
The women’s ward is usually busier than the male’s, so we have one resident and 3 medical students on the female ward, and one resident and 2 medical students on the male ward. Dr. Paccione oversees all wards.

We arrive at the hospital at 8am, and begin “rounding” individually on our patients. We each have about 10-15 patients and see them between 8-10am. At 10:30am, one of us goes to clinic (we go to clinic every other day), and then the others start admitting new patients, We admit on average about 15 patients a day. We take lunch from 1-2, and then have teaching rounds with Dr. Paccione from 2-4:30pm. Then from 4:30pm – about 7pm we admit more patients and finish all our work for our patients. Then, we go home, eat dinner, drink a few beers and go to bed. This weekend we worked both days! On Saturday, we finished early enough to finally check out the town. Everyone stares at us since we stand out like a sore thumb. As the only white people in town, its hard to blend in.

Since I work on the female ward, I have only female patients ranging from 15 – 75 years in age. Since I am going into OB, I get all the pregnant women. You only go to the labor ward when in labor, so all pregnant women who get sick, just go to the female ward. And, considering the average women in Uganda has 9 children, you can play the odds that the majority of women between 18-39 that come will be pregnant! For the medical people reading, the main things I have seen are malaria, malaria and malaria! Malaria is endemic to the region, so anybody with a fever ets started on malaria medicines. They do not do smears to officially diagnose malaria, so we never know if they get better from the malaria meds or they had a viral illness and improve due to time! Other ailments include UTI, pyelo, congestive heart failure (in young women from endocardial myofibrosis, thought to be due to parasitic eosinophilic process), endometritis, dysentery, peptic ulcer disease, arrythmias (paroxysmal SVT), TB, HIV, asthma, pneumonia, IUFD, miscarriages (missed AB), hookworm, migraines, and osteomyelitis. We see lots of pneumonia; the number one presentation of HIV is community acquired pneumonia in a young person. So we test all young people with pneumonia for HIV, and the majority turn out to be positive. HIV, regardless of its prevalence, is still very taboo to talk about. It has only been in the past few years that medicines have been made available in Uganda, so for the past 20 years a diagnosis of HIV was a death sentence. Its lack of a treatment deterred people from getting tested. Even now that there are medications available; there are only enough for 10% of the people who need it. So, diagnosing HIV is not all that easy, emotionally or socially, to do.

So far, the learning curve has been tremendous. You really get god at your physical exam skills when you have no technology or labs to help you. (lab services available are: CBC, ESR, UA, B-HCG, blood smear, AFB smear and HIV). Ironically, its quicker to get HIV results than CBC results here due to the strong funding for HIV.

So far it is exhausting and amazing!!! I will write more soon!

Our Group

Our group: There are 5 students, 2 third-year residents and Gerry, our attending.

Babak: 4th year medical student, originally in my class, but took a year off to study in Israel, he will be doing internal medicine next year at Montefiore.

Katrina: 4th year medical student from upstate NY specializing in pediatrics and will stay in the Bronx at Jacobi for Pediatrics.

Dan Bourque: 4th year medical student who was also in my class, but spent a year working in Peru doing research on Leptospirosis (an infectious disease). He will be doing internal medicine at UCSD.

Michael: 4th year medical student from NY; he will be doing emergency medicine at NYU. His wife is Anya, one of the third year residents.

Ania: 3rd year internal medicine resident at Montefiore (married to Michael) went to medical school at Mount Sinai.

Aaron Fox: 3rd year internal medicine resident at Montefiore and went to Einstein for medical school. I worked with him at the free clinic as a 1st year and 2nd year.

Dr. Gerald (Gerry) Paccione: An internal medicine attending from Montefiore. He works with Doctors for Global Health (DGH) and has been coming to Uganda now for 10 years.

We arrived!!!!

Miracle of all miracles, we made it out of New York’s storm and made it safely to Uganda, bags and all. We were met at the Entebbe airport by Babak, one if the other students who had come a few days earlier, and a car from the hotel. We celebrated with a few beers and hit the hay, it was midnight here and after > 30 hours of travel we were exhausted. We woke up early ready to make the 12-hour trek to Kisoro, in the southern end of the country. Luckily we did it in style in a private van. And had an amazing trip, we stopped at the equator monument (I have now been to two parts of the equator). We saw lake Victoria, Lake Biyurin and all its beautiful glory; we passed magnificent scenery. On the way we stopped in Embarara to visit the main teaching hospital of Uganda. Einstein used to send residents to this hospital, but with the help of the British faculty, we were no longer needed. After all my work in third world countries, I was still shocked at the condition of the hospital. Each ward was one large room packed with beds with no sheets, no curtains, reeking of infection and death. Families were camped out all around the perimeter of the hospital making food and caring for their afflicted family member. We finally arrived to Kisoro at 7pm. We met the head doctor and then went to unpack and make our house home.

The house: The house is much better than Limon standards but still slightly roughing it. It is four bedrooms each with a single bed, so we each have our own room, with a single bed, gracefully draped with a mosquito net. There is a kitchen with a portable gas stove and fridge. There is an indoor toilet and bathroom, just no hot water. So far we have been taking bucket showers with heated water. I guess some habits die hard.


We will be staffing the “internal medicine” service. There is a men and women’s ward each with about 30 beds, with the women’s side usually being overcrowded.

A Little Bit About Kisoro

The district of Kisoro is located in the far south-western corner of Uganda, a few miles from both Rwanda to the south and the Congo to the east. It is a poor, remote and beautifully rugged land of sharp hills, towering volcanoes and serpentine lakes. It is accessible only after hours of winding dirt roads. The district is over-populated, meaning the land is over-farmed and the hospitals overcrowded.

The Kisoro District Hospital, where we will be working, is the only public hospital in the district. (There is a private catholic hospital nearby, better equipped, but costs money). The hospital is very underfunded, meaning few doctors, no specialists and very limited resources. Doctors earn less than $4000/ year with little potential for extra income. In the cities, doctors earn twice that amount, deterring physicians from staying in the rural areas of Africa where they are greatly needed. At last count, there were three physicans caring for 150 beds comprising Medicine, Surgery, Pediatrics, and Obstetrics/Gynecology wards plus the bustling HIV clinics. The nursing staff is at 60% capacity and there are 2 lab technicians. Needless to say, there will be plenty of work to go around for our team.

A few statistics about Uganda:
Population 28.8 million
38% of the population live below the national poverty line
87% of the population live in rural areas
Life expectancy: 49 years
Infant mortalilty rate: 80/1000 births (compared to 6.43/1000 births in the US)
23% of children are malnourished
6.8% of the population is infected with HIV