Experiencing Surgery in Uganda

Medicine in Africa: a cringe-inducing sentiment, evoking images of Ebola, malaria, malnutrition and overall misery. Upon telling people that I was going to the surgery ward, they winced and wished me luck. However, after spending two weeks in the surgery ward at the Gulu Regional Referral Hospital, all my initial expectations were blown away. While there certainly are some gruesome aspects and grave illnesses, the surgery ward is compassionate and optimistic.

Due to the lack of supplies, low funding and large volume of patients with severe conditions, I expected bedraggled and terse staff. Conversely, I was warmly welcomed into the hospital by some of the most compassionate and patient doctors, medical officers, and nurses I have ever met. They willingly explained their actions and decision making process when examining patients or performing surgery, allowing me to truly experience medicine. Moreover, they strive to deliver the highest level of care possible, and are delighted when a tibia is re-aligned perfectly, an infected wound finally turns around, and peoples' suffering slowly ebbs away. At the Gulu Regional Referral Hospital, in the surgery ward at least, the staff genuinely loves the process of healing others.

The level of care and sophistication of services floored me. I was told anesthesia was unavailable- "going under" is risky business in North America, never mind Africa. The doctors graciously permitted me to observe "theatre," and the experience was astounding and enlightening. Patients walk into the operating theatre if they are able, observing all the tools that will be used for their procedure. There is indeed anesthesia- Lidocaine is preferred for local anesthesia, spinal blocks for surgery below the waist, and general anesthesia if there is no alternative (eg. for a splenectomy). The surgical instruments are mostly manual, although enough machines (pulse oximiter, oxygen machine) require electricity to make the frequent power outages a serious problem. Improvisations must be made, but largely supplies are available. The surgeons know what they are doing, minimize bleeding and infection, and overall do an excellent job.

While the hospital is free, transport, food and time off work are not, so people put off hospitalization as long as possible. This means that fractures can be a few weeks old, severe burns infected, wounds exacerbated by flesh eating disease. While this complicates treatment significantly, the doctors still do their best to promote optimal recovery. Not everyone makes it, but the death rate is below 2% in the surgery ward and there is a constant effort to improve.

Ultimately I emerged with a completely different perspective than I approached medicine abroad with. The medical system is not in crisis, but in progress, and it still needs a lot of support. I will never forget the kindness of the patients and personnel at the hospital, generously helping me to learn and understand their medicine.