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!