Running in Circles

Earlier this week, I had another typical day of getting a patient admitted to the hospital in Kampala (otherwise known as malalu). Of course, it is not all that different back in the States. Rarely can someone walk into a big hospital and get admitted to see a specialist unless he or she has been referred by another physician or walk through the ER and be willing to pay loads of money for the “simple” process of admissions.

Anyway, the day was spent on tour of the Kampala hospitals. First, we went to IHK (International Hospital Kampala) but of course, we were shooed away from the private hospital and sent to Mulago Hospital, instead. Supposedly, IHK does not have an urologist. As we kept walking around in circles of hospitals and wards, I tried to keep myself amused even though our patient is a 3 1/2 year-old boy diagnosed with nephroblastoma 2 days ago. It is all fun and games until it is not. I was very appreciative to have the driver with me because he has connections at Mulago after his own 3 year-old twins were both diagnosed with tuberculosis.

We finally got our patient admitted to the hospital by going through the casualty ward. He was not really a casualty patient, but it was our only option at that point, and luckily, we managed to pull it off but still with the hopes he will see an urologist and oncologist in the next few days. I have been on quite a few trips to IHK, but never have I seen as much as I did in the casualty ward of Mulago. It is so easy to forget the poor: IHK is private and will outright refuse patients, whereas Mulago is sponsored by the government and all the healthcare is supposed to be free; however, who knows if it actually works out that way when the funding comes from the Ugandan government. I also have my doubts of our patient getting good treatment or even seeing an oncologist after initial care.

I have truly enjoyed working at our rural clinic here in Kyabirwa village, but being at Mulago Hospital made me witness the true shortage of medical staff. Maybe it was the fact that the casualty ward was full of trauma and emergency medicine patients and I sat and watched the ambulances coming in and out as we waited. After spending an intense month in Wilderness EMT school, it would be nice to try to use those skills more while I am here. Sometimes the afternoons in the clinic are painfully slow and I wonder if I could be more productive or helpful elsewhere. However, working in rural and 3rd world medicine sure increases my scope of practice; I may not feel as qualified as I should be, but sometimes I just get thrown in and go with the flow.

I have been asked so many times that the questions barely register anymore: “Are you a doctor? A nurse?” Well, not really. “Are you a social worker?” Umm…sure, sounds great. However, no matter what my background is, I still find myself getting much more experience here than I could back in the States. It could be starting an IV, distributing drugs in the pharmacy, removing stitches at the NRE bar with scissors, tweezers, and a headlamp, or walking home from the clinic and getting pulled into a family’s hut to see a 6 year-old girl crying and screaming while itching head to toe from ant bites. Ah hah! So what’s next in my life? Only time will tell.