Confession: I can really be a slacker sometimes! But when things really need to get done, I’m your girl. I’ve been living life, finishing residency and trying to figure out my next moves in life. This blog post has been written forever but somehow I never actually posted it.
So today, I’m copying and pasting it for those that have kept up with my musings and for me when I want to go back and reminisce and reflect on times gone by....
November 2019:
Being back in Nakaseke, Uganda was like I was just there although it’s been exactly 3 years. When I arrived, I was welcomed with open arms by Winnie, Ronald & “Driver” Salongo—Deo. We stopped in Kampala to see my girl Roona who didn’t remember me bc she was so young last time I was here...then on to the village. There have been so many positive changes & some things that were nice and familiar including some of the staff on campus (including Masereka who happened to stop by) and at the hospital. They’ve not only built a hospital on the ACCESS campus but guest housing now includes hot showers, a microwave, and internet!!
My first day at Nakaseke Hospital I assisted in a C-Section and hernia repair and then was given the scalpel to be the primary surgeon for a C-Section of a twin delivery. Pretty crazy and pretty awesome at the same time!!!
The first time I was in Uganda was Sept-Oct 2016 as a 4th year Medical Student. After living in St. Maarten, the UK and traveling the world since I was a child, I was no stranger to experiencing different cultures; in fact, I welcomed it. Visiting Uganda for 6 weeks during my Med School rotation was definitely an eye opening experience. I talked about it extensively and chronicled my experience during that time on my blog. Seeing how the people lived in both Kampala and Nakaseke was something I would never forget. Spending time with the staff at ACCESS and Nakaseke Hospital gave me a new appreciation for “working with what you have.” This area is resource limited compared to the USA when it comes to healthcare spending allocation and per capita income. Many families in Nakaseke are surviving on less than $1 per day. These are families of 4-10+ people. The hospital is run mostly with government funding and they don’t have half of the bells and whistles compared to what many Westernized Countries are used to however they have the necessities and they make it work.
The Physicians are extremely well trained and their clinical skills are outstanding. They have to be when the hospital doesn’t have the same diagnostic equipment or lab tests available that many who adopted Western medicine rely so heavily upon. Not only does the hospital not have expensive equipment like CT scanners or MRI, the entire country only has a few CT scanners. Even when the tests and technology are available, they are so cost prohibitive that the patients that need them most likely can’t afford them. And when I talk about cost, I’m talking about $10-100, for potentially life saving evaluations. So what do we do here? The physicians rely almost exclusively on their history taking, clinical exam & prevalence of diseases in the area to determine what illness their patients are most likely suffering with and then they treat accordingly.
As a Medical Student, our focus was tropical medicine and getting a broad overview of culture & medicine here in Uganda. This second time around as a 3rd Year Family Medicine Resident interested in Women’s Health and Obstetrics, I elected to predominately focus on these two areas.
ACCESS spearheaded a huge program targeting Family Planning in Nakaseke which has grown even bigger since my last visit. Many families have a lot of children and women often have short inter-pregnancy intervals which isn’t as healthy for moms. Having children in a short space of time can also put a big financial strain on families. Supporting a large family is the primary issue but a secondary issue is if a woman starts having children very young, she’s less likely to complete schooling or pursue higher education. This further reduces a woman’s ability to be more self sufficient and contribute financially to the household.
During my first week, a woman delivered her fourth or fifth child. This isn’t unusual in an of itself. The day after the delivery, mom was not producing any milk which is a major problem for the baby since the primary means of infant nutrition is breast feeding. I didn’t see anyone using a bottle the entire time I was in Uganda. After discussing what the problem was and what should be done, the Medical Officer stated the reason she wasn’t lactating was because of inadequate nutrition in mom. She hadn’t had anything to eat in 2 days. Her husband was responsible for providing food and drink as well as paying her hospital bill. Dad was there for a short period of time and left but never returned with food. The next day, he came again without food and in fact brought raw milk (which hadn’t yet been boiled to kill any bacteria)—mom definitely couldn’t drink this. This woman was at the mercy of her husband who smelled of alcohol and didn’t bring food for his wife who just delivered their latest child. I had plenty of food prepared for me so I shared with the young mother. She started producing milk and she was able to feed her new baby which no longer required IV fluids. She was later discharged home and her baby was feeding well.
I couldn’t imagine being in that situation with no one to help. Being a Physician isn’t always about knowing every disease process, medication or treatment option, it’s recognizing all of the abilities you have and choosing to use them for the good of humankind.
Overall, my return trip to Uganda was wonderful. Most days were spent in the hospital doing C-Sections and other surgeries with the Nakaseke Doctors. Other time was spent involved with one of the many ACCESS Programs: at the clinic placing IUD’s, birth control implants, administering childhood vaccines, and seeing other ill patients with the Medical Officers; meeting with participants of the Dream Girls Program which provides vocational skills training (tailoring and hair dressing) to young girls who have left school due to various circumstances; spent time with the crew at ACCESS and one weekend we celebrated Dr. Robert’s son’s birthday at their home in Kampala. There was even time to re-connect with Dr. Henry Sembatiya! He taught me so much the first go around and had so much confidence in my abilities. We had a great reunion at Cafe’ Java’s, one my & Kendal’s favorite places during our first visit. The pizza there is reaaaally good.
Quite a bit was squeezed into my 2.5 week trip and I’m very thankful that my Residency program supported my dream to continue to pursue Global Health experiences! Note to my future employers: continuing these types of opportunities are paramount and will be near the top of my request list please & thank you 😁😁!!!
This is what the ACCESS campus looks like now! That's the new hospital on the left and the clinic annex on the right.
New Women's Hospital
Holding all these Shillings made me look wealthy, but the experiences gained and lifelong connections I've made is what actually make me rich!
ACCESS is making a huge impact in Nakaseke with a variety of health, education and social support programs. If you are inclined to support any of the wonderful programs, here’s a link to their website to make a donation: ACCESS Uganda.
Until next time...
