...is a well-known Ugandan saying – often heard if visiting somewhere to get something done such as collect a repair, prospectively view a purchase, visit an official, etc. Usually there is only one key for the room/building you are trying to enter, and invariably that key is with someone who is not there. Ugandans are fairly laid back about this sort of thing – why get upset or annoyed when you can’t do anything about it? Muzungus on the other hand tend to get very frustrated by not being able to get something done in a hurry! “The Man With The Key Is Gone” is also the title of a book by Dr Ian Clarke telling the story of how Kiwoko Hospital, where I work, came to exist.
I found myself in the unusually position yesterday of being that Man With The Key! I had been doing some photocopying the previous evening, and had forgotten that I had the key to the room in my pocket… Of course Ugandans are far too polite to interrupt our doctors meeting, so they waited an hour until they could speak to me to get the key back! No hassle, no pressure or attempts to make me feel guilty – its just how life is here! I’m really going to miss it once I return to Edinburgh in a few weeks time.
Another thing I’m going to miss is the huge variety of the medical work here, although I’ll not miss busy nights on-call like last night – I’ve been unlucky to only get a couple of hours sleep on my last couple of calls. After a good surgical afternoon – a gastroscopy, a large abscess and a partially amputated finger to sort out – I started my call at 5pm, and had seen eight admissions before 7pm!
To give an example of the variety of work not normally seen by a General Surgeon, last night I saw: A man with a huge swelling in his armpit, likely to be an abscess or TB; A 13 yr old with severe heart failure who had come to Kiwoko because the treatment prescribed by the Kampala referral hospital wasn’t working and he was seriously ill; A man with HIV on antiretroviral medications who had developed a second bout of TB within a few months of completing treatment, likely therefore to be drug resistant; A child with severe malaria and secondary anaemia who died within minutes of arriving in hospital; Two babies with dehydration after two days of vomiting and diarrhoea; A young child with severe malnutrition secondary to Cerebral Palsy and poor home circumstances; Another baby with a distended abdomen, not moving it's bowels; Three triplets, five days old, delivered at a local health centre, one of whom was dehydrated, wasn’t feeding and had unrecordably low blood sugars; A postmenopausal woman with sudden onset of significant vaginal bleeding; A girl who was unconscious after being knocked off her bicycle by a car and sustaining a head injury with probably basal skull fracture; A young woman who had sepsis following an attempted abortion (illegal here in Uganda); A seriously ill pregnant mother with meningitis and a cerebral abscess who died later in the night; a second trimester mother with lower abdominal pain who may have appendicitis; Another young woman with end stage HIV, cerebral toxoplasmosis and giardia who also died through the night; and finally at 4am a mother with deep transverse arrest in second stage of labour requiring a difficult emergency Caesarean Section. I got to my bed at 5.30am!
Not every night is so busy, but when on-call I do cover seven wards with about 250 beds, as the only doctor available! In Edinburgh, that number of patients overnight would be a busy night – but I’d have a team of four or five junior doctors to help me look after half as many patients. Also all the patients would be likely to have similar conditions – various different types of abdominal pathology – with better facilities for investigation. My girl with the head injury, for example, would have gone straight to CT scanning, and probably rapidly onwards to specialist neurosurgeons, if not to ICU. Here I was examining her by paraffin lamp (no electricity overnight), was preparing to take to emergency theatre for blind burr holes to drain a blood clot, if she deteriorated, and today will just observe and support her as the family cannot afford to take her to Kampala for a CT scan costing only £15!
However, I’ve just over three weeks to go, and am starting to realise that I’ll be leaving soon. So many people have been very kind in their disappointment that I’m going away, all of them making me promise to visit again, and sincerely wanting me to come back and work here for longer. I’m committed to another three years of specialist surgical training in Edinburgh, but only God knows what I’ll be doing after that. Africa certainly has a very strong appeal!!!
Anyway, have a very Happy Christmas whether its in somewhere hot and sunny like Uganda, or dark, cold and wet like Scotland… In case you’re wondering, the picture is of a typical Ugandan meal – Matoke, groundnut sauce, Irish potatoes, eggplant and cabbage! Enjoy your own Christmas meal!
God bless,
Steve
