Health care in Uganda......

We recently took one of the school boys to a hospital and a recovery home in Kampala for orthopedic surgery. That was an eye opener, to say the least.... A lot like we have seen on TV and imaged it would be.

We started out with the recovery home, a home for children mainly, but adults too, with mostly ortho needs. The defect of Club foot has been a common occurrence, and this organization was initially started to address this problem, but they have branched out into other areas. This is an Italian run mission, Catholic, run by Nuns and various handicapped people. This is a great idea, to employ the handicap as it shows these children that no matter how severe their defect is there is hope for the future.

In Uganda, all hospitals and recovery houses require that you have a full time care giver with you. Their definition of nursing care is much different than ours and the duties of a nurse are restricted to only giving medicines and some hands on dressing changes if the care giver can not be trained to do them. All the care givers at the recovery home had duties or chores to do daily. Some mop the floors other get water, do KP in the kitchen, and everyone must wash their own sheets and other laundry, and not very often do they have the patient wear gowns, just their own clothing. Patients provide their own plates, cups, spoons, jerry can for water, basin for bathing, soap for laundry, sheets and blankets for the bed. They are given 3 meals a day, a bed and an extra mattress for the care giver, and all medical treatment, such as medicines, x-rays, and equipment. And surgery and hardware like outriggers and crutches or wheelchairs, all of this for 3500 shillings daily, or $2 a day. What a deal!!!!!

The boys were checked into the home on Tuesday afternoon, given a bed in a large dorm room, with mixed patients. Males and females, all ages and many different languages. Each dorm has a foreman who gives out duties. Wednesday is clinic day, starting about 10 AM, the Doctors and PT's come. Everyone lines up out side the PT room and sit on the ground or benches and wait their turn to be seen. In the large room there is an exam table, a few desks, a large file cabinet, and a white sheet hung from the ceiling for a background for pictures. Since most of the patients are ortho with mild to very severe problems, the Doctors take alot of pictures and video of patients, study their ability to walk or not, send some off to have x-rays and others for castings. After x-rays, they are seen again and procedure plans are made.

Most of the Doctors are Italian, and they have students with them from all over the world. They can see deformities first hand that most others only read about. These doctors are very gentle and can communicate very well with the many different languages that they encounter. They remembered our boys very well and spoke very fondly to them and really made them feel comfortable.

Surgery was planned for the next day, and later in the afternoon the ambulance transported both of them, along with all their things, to the Hospital. Because of the holiday season, only a few surgeries had been scheduled and surgery was done by mid afternoon. It only took an hour and half and the patient was back in the ward. Now that was the scary part. The ward was a very large, dark, dirty, smelly, paint peeling from the walls and ceiling, room. There were 4 bare bulbs hanging from the ceiling, only a few windows, no glass or screens on them, and the beds were about a foot apart. They were very old and rusty with cracked, plastic coated mattresses on the frames. It looked like a room from an old World War one movie. L had been out of surgery for about 45 minutes before we arrived to see him, and he hadn't been given any medication for pain yet. He said it didn't hurt very bad, but he had this large outrigger screwed into his upper leg and hip area. It looked very painful!!!! He looked like he was in pain, he couldn't get comfortable and kept moving around in the bed. His caregiver had to keep moving his leg for him, the care giver looked more worried about the patient than the patient looked about himself.

There were 4 other patients in the ward and one nurse. But she wasn't the nurse for L., his nurse was in another ward which was on the other end of this big building. When we found her to ask about the surgery and what was to happen next, she didn't really know who or what we were talking about. It had been 2-3 hours since surgery and she hadn't seen him yet or gotten any record of him. It was really hard to leave the boys there by themselves!!!

When we came back later that night, 6 PM, they have moved them to the other ward, a smaller room with 12 beds in it and one nurse for all these patients. Still no pain medicine and L had been up and out of bed and had been down for an x-ray. His care giver had to carry him to the building because the wheelchair was in use. He was still in pain but it was better. We went back in the morning and L was awake and looked alittle glassy-eyed. Finally they had given him pain meds!!!!!! He was a happy young man!!!!!! He had been given water and a bit of food, and even seen the Doctor that morning. But the nurse still didn't know anything about him or what was next!!!!! They spent the day there and the next morning they were loaded into the ambulance and returned to the recovery home. We were told that it would be at least four weeks before they could come home and that they would call us if anything came up, so we left for Karamoja on Saturday morning.

Wednesday afternoon of the following week, just six days after surgery, we got a phone call stating that they had been discharged!!!! We were in Karamoja, 7 hours away, and so we have to scramble to find a way to get these boys home. We called for a special hire transport and had them driven to Mbale where Pastor Dave lives and he brought them up the next day. Rough trip, in a old van on a very bumpy highway, in alot of pain. But he is doing well, dressing changes twice daily here at the clinic and on antibiotics and doing his exercises. He'll go back at the end of Jan. to have the outrigger removed and be on crutches for a few weeks....All of this for 32,000 USH or about $19 US.

In third world countries all the ortho devices that are used are cleaned and reused. You have to sign a will stating that if you ave an internal device implanted you will allow them to remove it after your death. That is how they keep the costs down!!!!!!!