It's not for the faint of heart that is for sure. It was with some trepidation that I arrived for my first shift at Mulago Accident and Emergency Department. In some strange twist of fate or lunacy it is a requirement of the Ugandan Nurses and Midwives Council that all foreign trained nurses should complete eight weeks of supervised practice at a major Kampala hospital in order to gain Ugandan Nurses Registration. Some aspects of this statement are a contradiction of terms of course. On my first day I didn't meet another nurse so I am not sure how the concept of 'supervised' practice is working here! In fact in the first month I have not seen the same nurse twice and if there is a nurse on duty she sometimes disappears for hours on end, after arriving somewhere between nine and ten for a shift that starts at eight!
About an hour into my first shift I was suturing someone's head. Not something that I have ever done before or not something that I had ever imagined doing. I felt pretty nervous about suturing and felt sorry for the man whose head I sutured. This feeling however was short lived as I saw other people suturing and their techniques and standards left alot to be desired. Of course there are some differences between suturing in Mulago and suturing in Australia. In Mulago there is no light, often no sterile field, rusty equipment which often doesn't work, you don't have to spend much time selecting the sutures you just use what is available and usually that is several years out of date and completely inappropriate for the job at hand. So since that tentative first day there has been much suturing and I have got quite good at it although I am really just making it up as I go along. I am also now very adept at shooing away flies before they land on the wound, although I don't think many clinicians worry too much about that here.
I have been working in the trauma room of the accident and emergency department. Most days are a blur of traffic accidents (mostly boda-boda or matatu), mob justice beatings, assaults, domestic violence, burns and bites (yes that is a combination of dog bites and strangely human bites). It is a strange world to exist in. The reality and prevalence of mob justice in Uganda has been a real eye opener. We all know it exists and I have seen it a few times in my neighborhood but to see the magnitude of it in society has been stunning to say the least. I am flabbergasted at the damage humans can do to another, and I am not sure if the punishment ever fits the crime. Mob justice seems to exist whether the crime is real or suspected and the victim has little or no chance to defend himself. Most mob justice victims are beaten with sticks, rocks, fists and feet and present covered in blood with multiple cuts, bruises and abraisions and usually some form of head trauma. More serious cases present with burns (ie beaten then set alight), fractures, sever head trauma, stabbings (eg cut throat) and the occasional gunshot wound. So I guess the motto is.....if your going to be a theif in Uganda make sure you are a really good one and never, never, ever get caught....
The Mulago emergency room lacks the frenzied activity of many emergency rooms back home. This took me a while to work out, then it seemed to become clearer that although there were horrific injuries most patients were relatively stable. After careful thought and consideration and some discussion with my colleagues I discovered that patients in more critical conditions didn't make it to hospital. Many accident and trauma victims that make it to hospital in a critical condition in Australian die at the scene in Uganda. There is no public ambulance service in Uganda, and if there was it would be pretty hard to get through the traffic and the potholes anyway. So patients receive little or no first aid at the scene. The issue of life and death is somewhat random. Many patients arrive in hospital in the back of a police pick up truck after being bundled in there at the accident or incident scene, no first aid has been administered until they arrive in hospital and if they are lucky they may get treatment once they arrive. So there it is if you can somehow get to a hospital you could have a chance of survival, if you can't get to a hospital you will just die on a roadside somewhere and hopefully people will step over you......
I am perplexed by the numbers of head injuries that present usually as a result of assault or traffic accident. Not once have I seen a patient properly assessed for neurological function or injury, occasionally patients are allocated a CT scan or Xray but many are sewn up, sent home without assessement or follow up. Next week I will start working on the Neuro ward so intend to follow up on these questions to find out just how brain injury is cared for in Uganda and what the impact is on the society. Of course the amount of brain injury here could potentially be reduced by the universal wearing of well fitting helmets by boda-boda drivers and passengers. The use of helmets is rare and most helmets are ill fitting.
Working in Mulago is like stepping through a hole in the Universe and arriving in a place like no other that bares no resemblance to anything you have ever known. I have seen some of the most appalling clinical practice that I could ever hope to see. I have see Doctors slap patients, nurses verbally abuse patients and degrade and humiliate them. I see poor practice in terms of infection control. The trauma room is covered in blood which seems to end up on door handles and walls and ceilings, I am not sure how! It is only ever cleaned with water, so I am not sure what microbes and things may be lurking around. Drugs are never checked and vials may be used for multiple patients are often accessed with a dirty needle then used for different patients. IV lines that have been on the floor are connected to patients.....there are too many things to mention.....but it is interesting that this time of practice is to get Ugandan registration and I have only seen bad practice. I am not sure what we are supposed to be learning.
Exsisting at Mulago makes you question the very core of health care and ever society here. It makes me question why I am here. I didn't come to Uganda to change the world (or Uganda) but I did hope to make some small amount of difference. Unfortunately it seems that a thousand lifetimes at Mulago may never make a difference. So the question extends, can I really make a difference when I return to my VSO assignment or should I just admit defeat and head home????? The answer of course isn't simple and perhaps doesn't exist yet. So what are aid workers and volunteers doing in Uganda? Can we help? Can we even comprehend what is going on here? Why in a country with 7% economic growth is there no money put into the health care system? Only questions I am afraid, I may attempt to answer them someday but at the moment I can only confuse myself (and probably you) with them.......
Sunday, June 6, 2010
The Serengeti
They call it endless plains, a special sense of freedom that goes on forever,
Once you've found that place, your body may leave but your heart will never.
The wildebeest were migrating an incredible sight,
And the predators come alive in the pale, fading light.
A lioness carries her cub with tenderness and love,
Vultures and stalks survey the land from above.
The hyenas are hungry, they take what they can get,
While the leopard sleeps in the tree, he's not ready to get up just yet.
A cheetah mother is on guard, protecting her young,
We share special moments with her family in the midday sun.
Alive in the magic of the never ending plains in the soft morning light,
And transfixed by the wonder as day turns to night.
May the Serengeti live on, may the Universe protect her,
And may we always feel the magic, the freedom and the wonder.
Once you've found that place, your body may leave but your heart will never.
The wildebeest were migrating an incredible sight,
And the predators come alive in the pale, fading light.
A lioness carries her cub with tenderness and love,
Vultures and stalks survey the land from above.
The hyenas are hungry, they take what they can get,
While the leopard sleeps in the tree, he's not ready to get up just yet.
A cheetah mother is on guard, protecting her young,
We share special moments with her family in the midday sun.
Alive in the magic of the never ending plains in the soft morning light,
And transfixed by the wonder as day turns to night.
May the Serengeti live on, may the Universe protect her,
And may we always feel the magic, the freedom and the wonder.
The Wedding of the Century
An arrival from deepest, darkest Africa saw it all begin with a surprise,
The shock defied words, and brought tears to Michael's and Caroline's eyes.
But the weather man said grey clouds would gather in the Melbourne sky,
But we drank champagne and celebrated in brilliant sunshine, stories of rain were surely a lie.
The laughter was all around this was the time to rejoice and celebrate,
A family together, a journey of love, joy and fate.
The Universe agreed and decided to leave her stamp,
Everyone left smiling but feeling pretty damp.
A once in a lifetime storm, the city stood still,
But the party continued, such was the will.
It was the wedding of the century, it was always going to be,
An eternity of love and laughter is all the future can see.
The shock defied words, and brought tears to Michael's and Caroline's eyes.
But the weather man said grey clouds would gather in the Melbourne sky,
But we drank champagne and celebrated in brilliant sunshine, stories of rain were surely a lie.
The laughter was all around this was the time to rejoice and celebrate,
A family together, a journey of love, joy and fate.
The Universe agreed and decided to leave her stamp,
Everyone left smiling but feeling pretty damp.
A once in a lifetime storm, the city stood still,
But the party continued, such was the will.
It was the wedding of the century, it was always going to be,
An eternity of love and laughter is all the future can see.
Thursday, February 4, 2010
A journey into the badlands
We ventured way up north we had to cross the line,
Lost in the badlands, but the Kidepo valley looked fine.
We traveled for days on the road to nowhere,
Grimy and covered in red dust , but it was worth it I swear.
For Kidepo is wild, it is rugged and raw,
There's just savanna and mountains stretching wide and far.
We moved into our new home at Pride Rock,
I never wanted to leave, I came to love it a lot.
We ventured further north to the ostriches and the Sudan,
So the ostriches were OK but for the other there THE ban.
But sometimes you have to go where you're not supposed to be,
When your on safari in the badlands you become wild and free.
The creature of Kidepo are struggling to recover and survive,
They too have been victims of war, I hope someday they'll thrive.
The giraffes are endangered they cling to the earth,
Zebras are losing their manes, trying to shake the curse.
So there's peace in Uganda, will they get a chance to regenerate,
Oh but beware of the Sudan and other matters of state.
We had to leave Pride Rock, our wild Kidepo home,
We hold great hope for her creatures, they will never be alone.
For I left a part of myself behind on that day,
Sitting on Pride Rock, gazing over the savanna at play.
I hope to return to visit the badlands again one day,
To retrieve myself from Pride Rock, come what may.
Lost in the badlands, but the Kidepo valley looked fine.
We traveled for days on the road to nowhere,
Grimy and covered in red dust , but it was worth it I swear.
For Kidepo is wild, it is rugged and raw,
There's just savanna and mountains stretching wide and far.
We moved into our new home at Pride Rock,
I never wanted to leave, I came to love it a lot.
We ventured further north to the ostriches and the Sudan,
So the ostriches were OK but for the other there THE ban.
But sometimes you have to go where you're not supposed to be,
When your on safari in the badlands you become wild and free.
The creature of Kidepo are struggling to recover and survive,
They too have been victims of war, I hope someday they'll thrive.
The giraffes are endangered they cling to the earth,
Zebras are losing their manes, trying to shake the curse.
So there's peace in Uganda, will they get a chance to regenerate,
Oh but beware of the Sudan and other matters of state.
We had to leave Pride Rock, our wild Kidepo home,
We hold great hope for her creatures, they will never be alone.
For I left a part of myself behind on that day,
Sitting on Pride Rock, gazing over the savanna at play.
I hope to return to visit the badlands again one day,
To retrieve myself from Pride Rock, come what may.
A proposal to VSO
I shall start by proclaiming 'Dear VSO',
I have to confess I traveled overland to Kidepo.
There's work to be done in the National Park way up there,
We need to make more tracks so we can go everywhere.
My friends and I would be up for the task,
If you let us do this project we'll do anything you ask.
We promise to be good, all your rules we will obey,
We will return to Kidepo and there we will stay.
Because as well as the tracks there are creatures to save,
If you let us help the Zebra and Giraffe we will surely behave.
We promise to stay out of the Sudan,
Because of course we know all about the ban.
We will wear a helmet and wont catch a boda-boda at night,
We will be good, we have seen the light.
Dear VSO please grant our request,
And help us to make Kidepo the best.
I have to confess I traveled overland to Kidepo.
There's work to be done in the National Park way up there,
We need to make more tracks so we can go everywhere.
My friends and I would be up for the task,
If you let us do this project we'll do anything you ask.
We promise to be good, all your rules we will obey,
We will return to Kidepo and there we will stay.
Because as well as the tracks there are creatures to save,
If you let us help the Zebra and Giraffe we will surely behave.
We promise to stay out of the Sudan,
Because of course we know all about the ban.
We will wear a helmet and wont catch a boda-boda at night,
We will be good, we have seen the light.
Dear VSO please grant our request,
And help us to make Kidepo the best.
The nature walk
The day was hot and the grass oh so long,
They called it a nature walk but something seemed slightly wrong.
The grass hit me in the face and tickled my arms,
Suddenly walking in the wilds of Kidepo had lost all its charm.
Oh why were we walking through this crazy long grass,
If there was something to see then we would surely walk past.
But the buffalo wasn't stupid he heard us amble on by,
He huffed and snorted as he charged and I wondered why.
Why were in walking in long grass that rendered animals invisible,
We were trapped in a bizarre nature walk, I was feeling quite miserable.
Could it be that the ranger really didn't have a clue,
Or perhaps he'd just gone stark raving mad, that could also be true.
I started to dawdle behind, I'd lost the will to go on,
Surely it would be over soon, we'd been walking so long.
Finally it was over and we could go for a beer,
There's nothing like a Club to restore a little cheer.
So if your ever in Kidepo remember not to go nature walking with the ranger,
You'll be smothered by the long grass within which lay many a hidden danger.
They called it a nature walk but something seemed slightly wrong.
The grass hit me in the face and tickled my arms,
Suddenly walking in the wilds of Kidepo had lost all its charm.
Oh why were we walking through this crazy long grass,
If there was something to see then we would surely walk past.
But the buffalo wasn't stupid he heard us amble on by,
He huffed and snorted as he charged and I wondered why.
Why were in walking in long grass that rendered animals invisible,
We were trapped in a bizarre nature walk, I was feeling quite miserable.
Could it be that the ranger really didn't have a clue,
Or perhaps he'd just gone stark raving mad, that could also be true.
I started to dawdle behind, I'd lost the will to go on,
Surely it would be over soon, we'd been walking so long.
Finally it was over and we could go for a beer,
There's nothing like a Club to restore a little cheer.
So if your ever in Kidepo remember not to go nature walking with the ranger,
You'll be smothered by the long grass within which lay many a hidden danger.
Oh how they love me
I traversed Uganda through formerly troubled towns,
And found a place called Kidepo where insects abound.
At first they didn't really bother me much,
But then I got bitten, the bites were red, swollen and hot to touch,
Why do they choose me over all of my friends,
I'd like them to share the love around, I don't want to offend.
There are very many flies both tsetse and regular,
And some other flying insects that look really quite bizarre.
Then there are ants and mosquitoes that are only too happy to bite you,
The insects of Kidepo lie in wait when you head to the loo.
Oh how I wish they would all go away,
And leave me to get on with my day.
But I should stop moaning I've no right to complain,
As Kidepo has lion, leopard and cheetah and all sorts of other game.
As I sit in the paradise that is our campsite home,
I watch the creatures of the savanna that are wild and free to roam.
So I forgive you Kidepo for every pesky and biting insect,
Because in so many other ways you are close to perfect.
And found a place called Kidepo where insects abound.
At first they didn't really bother me much,
But then I got bitten, the bites were red, swollen and hot to touch,
Why do they choose me over all of my friends,
I'd like them to share the love around, I don't want to offend.
There are very many flies both tsetse and regular,
And some other flying insects that look really quite bizarre.
Then there are ants and mosquitoes that are only too happy to bite you,
The insects of Kidepo lie in wait when you head to the loo.
Oh how I wish they would all go away,
And leave me to get on with my day.
But I should stop moaning I've no right to complain,
As Kidepo has lion, leopard and cheetah and all sorts of other game.
As I sit in the paradise that is our campsite home,
I watch the creatures of the savanna that are wild and free to roam.
So I forgive you Kidepo for every pesky and biting insect,
Because in so many other ways you are close to perfect.
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