I’ve seen some pretty incredible things during my time in Uganda, but the most impressive has been watching the health workers here at Mengo Hospital. Frankly, they’re miracle workers. Given the resources that are available, the staff somehow manages more than 4,000 HIV/AIDS patients in addition to a couple thousand TB patients. They have extraordinary skills and superb teamwork –that includes the physicians, nurses, assistants, volunteers, managers, technicians, data keepers, and administrators.
A few members of the Mengo Dream Team
Dr. Paul and Dr. Vincent lightheartedly make remarks to me on a daily basis comparing what they do to how things “would be done in developed countries.” It’s true – the conditions are not completely ideal. The hospital sincerely tries its best to provide treatment at no cost, but some charges become unavoidable. Then the treatment or test all of a sudden is not feasible for the patients. Towards the end of the quarter, donor-allocated medications for HIV or TB or even antibiotics may have run out. When x-rays are needed, the machines can be broken. When blood transfusions are required for the severely anemic, the blood bank may not have any stores remaining. All the required instrumentation is not always available for surgery. But everyone tries their best and does absolutely everything they can given the circumstances.
VOlunteers
In fact, I’ve found the physicians here to be so versatile. Sometimes in the US, it feels that all the specialties and super-specialties preclude physicians from gaining knowledge of other fields. But here, the doctors can at any moment serve as the primary care giver, the radiologist, the dermatologist, the ENT, the pathologist, the surgeon, the pharmacist, and the ER physician. There are only an estimated 2000 doctors in Uganda, so sometimes they have no choice but to task-shift and take on other roles. They will read scans, do skin biopsies, administer chemotherapy, and deliver babies – both naturally and via Caesarean. Every Friday is circumcision day so we usually operate on 8-10 patients, including infants, adolescents, and adults (circumcision has been proven to significantly reduce HIV transmission, so many health centers are rolling out low-cost or no-cost circumcisions).
Saturday support groups
There are frustrations on all ends. The doctors work long hours, they’re paid little, and their job is emotionally and physically taxing. There are also risks, especially when working with HIV-infected blood. One of the doctors was pricked while doing an operation and had to take HIV post-exposure prophylaxis, which ended up giving him the side effect of Stevens-Johnson Syndrome that has scarred his body. For the patients, HIV drug adherence can be difficult, often complicated by some secondary infection, further complicated by their personal living situations. The prevalence of concurrent relationships (referred to as ‘side dishes’), multiple wives, discordant couples, and positive children can certainly make things challenging. As a result, the health workers also have to function as social workers and counselors for the patients, although there are great counselors on staff, as well. Every Saturday, a specific support group is held at the clinic – for children, for serodiscordants, etc. There are also HIV+ volunteers who do home visits and community-based DOTS to improve HIV and TB adherence. The clinic may not have everything, but what the staff is able to do is simply inspirational.
