Sunday, August 5, 2012

Gulu Hospital

While being in Uganda, I have seen, heard, learned, and even smelled things that I never had before. From the performance by the Mizizi Ensemble to the astonishing sight of the Nile River. From the intense classes at IPSS and writing papers to balancing time between my internship and meeting new friends. From exploring the smoggy roads of Gulu to walking through the pungent fish stands in the market. Through all these experiences, I will leave (sadly in only five days) knowing more about global issues, peace building, sustainability, and the Acholi culture of dance, cuisine, and language.

One thing that has taught me substantially is interning at the Gulu Regional Referral Hospital. I have worked in the Infectious Disease Clinic (IDC) (which has a main focus on HIV/AIDS), the Surgical Theatre, the Laboratory, and during free time I wonder through different wards meeting and talking with patients. My time at GRRH has brought about sadness, frustration, excitement and, more importantly, hope.

Sadness struck me from the babies, young people, mothers, and elders strewn out across the ground because so many come daily for HIV testing or checking their progression of AIDS not knowing whether or not the nurses will even get a chance to see them. About 5 of 20 tests we conducted came out positive and was a startling realization. I was happy to see that 15 people were in the clear and coming in and being proactive, but that is still 25% of people being tested becoming infected each day. On most days, the majority of patients were mothers with young children who were afraid of passing the virus to her child. Mother-to-child transfer (MTCT) to a child 15 years or younger accounts for 10% of all new HIV cases. According to the WHO, there were 3.4 million children infected at the end of 2011, and a large majority infected through MTCT. No one can help but be upset by these figures.

Frustration came from experiencing the lack of motivation of some of the staff (as Kaitlin discusses below in Follow Up to "Getting Sick in Gulu."). I was told by one of the nurses that they used to test and treat up to 200 patients daily. Today, after getting to a slow start around 9:30am, around 20 patients are seen before lunch break at around noon. After lunch, another 30 patients are seen before the day ends at around 4pm. "The goal is to see 50 patients each day" I was told by a nurse. The demand is made clear by the amount of people arriving each morning, yet the care given is not equivalent because of understaffing and the pay for the staff is unreliable at times. Another thing to get used to is the seeming insensitivity and carelessness. When a patient flinches while giving blood, the nurse straightens his/her arm, aggressively says something in Acholi, and the patients immediately has to straighten up and allow the nurse to finish. This follows suit with the culture here of being very short and blunt. So much so that it can strike as being rude sometimes. For example, there is no translation for the word please. Everything is short and direct. I asked someone how to ask "May I have water" and he told me "A mito pii." I asked the translation and he told me it meant "I want water." This would seem rude if I asked a server for water this way in the US, but here this is how it is done and does not come off as rude. This is a struggle for me to grasp in the hospital, because I've always been taught in Bioethics classes to establish rapport with people and develop trust. Being in healthcare is more than just diagnosing and treating, it's being a counselor, caring for the person's well-being, and even being a friend to a sick person. I understand that this may be impossible in this environment, because there is a plethora of patients and few staff. Yet the empathetic being within me is exposed and allows me to become angry at the situation. I want to hold the hand of every elderly lady who is in pain because the nurse is attempting again and again to get a needle in her wilted veins, or the still-teething baby that has its heel stabbed with a needle to do an HIV test, or the young man covered in lesions who can barely make it over the step into the nurse's office because syphilis has completely deteriorated his body. To see these people in these situations be handled in such a way is disheartening.

Excitement (along with a few other emotions at some parts) arose because of the time spent observing surgeries in the theatre. Patients were only partially anesthetized from an epidural and were awake and talking the entire time. I sat in on a hernia getting repaired, a club foot being corrected, a skin graft, and an elderly lady getting a broken femur repaired. Watching what few could probably stomach was thrilling for me. It is a reward in itself watching this young lady smile when seeing her foot in a cast pointing the correct way after having her club foot corrected. In about six months this lady will be walking correctly for the first time in her life, and the feeling I get picturing this is event is unexplainable with words.

Lastly, I have hope, hope that things will be better in the future. As a whole, the rate of HIV infection is rising in this country, but I feel that the GRRH is doing great things to improve the issue. In the laboratory, there are high-class machines and educated staff doing extensive blood tests to better assist doctors in prescribing patients the correct dosage of medications. There are community outreach programs that go out to communities and conduct HIV tests, collect blood samples and deliver the medications to people unable to travel to the hospital. These programs not only treat, they go out into villages to inform and educate people about how to prevent the spread of this virus. This is a crucial program I believe, and as Hillary Clinton said just a few days ago in Uganda, "I am hoping that together, we can work on making prevention the focus again and making sure that the rate of HIV infection goes down."

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