I’ve been struck again this week at just how much poverty affects people in Africa. I know that I live and work in a rural area of Uganda – Kiwoko Hospital is in the Luwero Triangle, the area previously torn apart by the civil war twenty years ago. That’s the reason the hospital is here – An Irish GP came here just after the war finished, when there was no healthcare available for the people living here, and started seeing patients using the shade of a tree as his clinic! Its testament to God’s grace and provision that in merely 20 years the place has progressed to a 250 bed hospital offering some of the best healthcare in the country.
Its very difficult to see patients on the ward who can’t afford the cost of a matatu (public transport, and very cheap really) to get to Kampala, let alone the £15 that a proper Ultrasound scan or Contrast X-ray would cost. We end up providing care based purely on the clinical skills of the doctors with a few limited laboratory tests that may not be particularly reliable. We often even have patients’ attendants asking for money to provide food for themselves and their patient (basic personal care and food is provided by relatives who stay with the patient, often sleeping underneath their bed at night). We are able to help in a number of cases, due to our Good Samaritan Fund, money kindly donated from overseas, which should mean that no-one is turned away from the hospital because of lack of money.
However, Muzungus (white people) are seen as having lots of money… I guess, compared with the local people, we are pretty well off. I’m fortunate enough to be supported while I’m working here by Skillshare International, who give me a small monthly allowance – which in UK terms is next to nothing, but compared with salaries here is possibly four times as much as our nurses get paid each month. The perception is that we have much more, and earlier this week I was asked by one of our students if I could help sponsor her studies. Tuition Fees are about £400 a year, which includes accommodation and food as well as the studies. Often women in this culture take second place to men, and this particular student is facing not being able to complete her course because her brother has now got a place at university, and the family only have money for one child to be able to study. Somehow, the ability to buy CDs and DVDs each month back home seems less important in comparison to helping someone train to get a good job and help to support a family in the future. In one way, its difficult to help one person, rather than all the others who are often in similar circumstances, but at the same time every little helps.
Meanwhile, Surgery here at Kiwoko hasn’t got any quieter. I was on-call this weekend again, and ended up performing 17 operations in addition to reviewing all the medical and surgical patients each day (fortunately someone else saw the paediatric and neonatal patients), and seeing the new admissions. I’d thought that Saturday was busy enough, but Sunday was again the busier day, and I was up from 0345 operating on two emergency Caesarean Sections. Then later in the day, another emergency section – this time the baby unfortunately didn’t survive due to the length of time it had taken for the woman to get to hospital, and in the evening four more operations including two laparotomies for peritonitis and another section. Not such dramatic pathology as the previous weekend, but still quite a variety – draining bones for osteomyelitis, opening abdomens to remove appendices and wash out pelvic abscesses, along with delivering babies with varying degrees of difficulty. I was again completely exhausted on Monday and was fortunately allowed the afternoon off to rest!
Somehow the workload, although tiring, doesn’t seem so much of a trauma as busy weeks back in the UK. Being on your own, making important decisions at all times of the day or night, performing surgery without trained assistants, should make things much harder than back home where there are always other people around to help share the work. However, when you recognise that you are doing what you love doing (Surgery rocks!), for a people who really need your help, and when there’s nobody else to do it, small things like being barely able to stand up due to exhaustion don’t matter so much! It’s going to be difficult to leave at the end of the year!
Hopefully things will be a little easier soon. There’s a doctor from Edinburgh coming out to help for a couple of weeks, who could make my workload easier for the next time I’m on call for the week! Also I have a holiday to look forward to at the beginning of July. The plan is for a bit of a safari in the North west of the country, followed by a bit of white water rafting on the Nile, and a few days of rest and relaxation. It’ll be good to recharge the batteries!
I hope that you are able to see yourself making a difference in the lives of others wherever you are just now too.
Steve
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