Ayilo

Week 2

The pictures are the hospital in Ayilo 1 refugee camp where I spend most of my time.  First is the female ward and second the pediatric.  It gets pretty crowded as although every patient is supposed to only have one caretaker often more family wants to stay or other young children have to stay with the mother.  We also have kids bringing kids for treatment and will admit them without any adult in sight. Yesterday I admitted a baby with severe malaria and the mother had 4 other children with her all of whom had malaria.  The older ones were not sick enough to be admitted but all stayed.  We managed to find 2 beds for the 6 of them and the nurses helped the Mom give medicine to everyone.  Patients and one caretaker get lunch and dinner from us.  The caretaker has to provide any juice or other food. They also have to provide any sheets and the bathroom is a pit toilet outside.  One thing I find hard is seeing feverish kids on plastic mattresses with no sheets. We did get a shipment of blankets this week and were able to hand them out so at least there was something over the mattress. There are no diapers so Mom’s are often outside washing sheets or clothes and I have picked up more than one soaking baby. Had a patient tell me today she couldn’t be discharged as her laundry was still drying. 

One of the advantages of this type of construction is ease of modifications. Yesterday I asked for a window near where we sit and write and today a couple of men came over and made it. No glass or screens on any of the windows but they do have a closing door.

All of October is “child health day”  (yes I know that doesn’t make sense) meaning that any child seen by any health care provider is supposed to get a dose of Vitamin A (to prevent blindness) and worming medicine. Since at least half are being seen for a fever many get malaria screening as well.  While of course I have read about the toll that malaria takes on children it is quite eye opening to actually see the hundreds of sick children. The outpatient department treats 100-150 kids a day for malaria and we usually have a few admitted with severe malaria.  The ones that are not sick enough to get admitted are cured by 3 days of medicine but of course often get infected again. Most do not have mosquito nets.

I have a lot of trouble understanding the Ugandan accent (British influence but definitely different), which causes my clinical officers (CO’s) a lot of amusement. The problem is even when I understand the words I’m not always sure what they are talking about. During morning rounds we got to an empty bed and I asked where the patient was. The exchange went something like this:

CO: “lonca” 

Me: “what?” 

CO: “lonca”

Me: “what”

CO: (very slowly) “long call”

Me: “what’s that”

CO: (laughing) “toilet, long call or short call”

Another one I liked

CO: “Mamma you must wash and smear this baby”   (smear=lotion)

A hospital worker in Kampala died from Marburg fever a couple of weeks ago.  Marburg is a hemorrhagic fever similar to Ebola. MSF is in charge if there is an outbreak around here and is helping with preparations/isolation in Kampala. We have kits with full protective gear and instructions on what to do if a case turns up.  There hasn’t been a second case yet but everyone is holding their breath for another few days. A couple of MSF staff on this mission will be going on a 6 week Ebola mission in West Africa after a rest at home.

If the refugee population stabilizes MSF will eventually hand over the health center where I am working to the Ministry of Health and they will run it.  Right now there is concern that the refugee population may swell in the coming months due to the possibility of famine in South Sudan.  Although the fighting seems to have calmed down it disrupted the normal farming that would have been done. The other concern is the possible outbreak of epidemics. MSF has just finished a huge door-to-door effort to get all children under two in this district vaccinated.  Usually the limit in Uganda, set by the Ministry of Health, is age 1 for vaccines (i.e. if you don’t finish your vaccines by age one you don’t get them) but they extended it to two for this effort among the refugees. The exception is all women of childbearing age get tetanus to try and prevent neonatal tetanus and all refugees get measles as outbreaks in refugee camps are common and severe.

This project now has a staff of15 expats and 145 nationals. The expats are from Somalia, South Korea, Nigeria, France, Kenya, Czechoslovakia, Italy, New Caledonia and Liberia and the US(only me).  It is a very nice group of folks and it is fun getting to know them.  My favorite though has to be a Kenyan woman who is the nurse manager and reminds me of Mma Ramotswe from the The No. 1 Ladies Detective Agency.  She has an infectious laugh and helps me out all the time at work with understanding how to get things done. Being on our own for entertainment we have designated Tuesday as movie night and Friday night as team meeting, games and dancing.  Trying to play charades with an international crowd is interesting.

I miss swimming and water polo but have started playing a little badminton in the evenings right before dark when it gets cool. Have also started going for walks outside the compound with a couple of new friends.  We walk on the main dirt road but traffic is infrequent and it is pretty.  As we were walking yesterday someone yelled out “hello Dr. Megan” which is what everyone here calls me. Turned out to be one of my CO’s that lives close to the compound.

Working 6 days a week and being on call 24/7 is tiring but so far I'm doing well.  The call part has been fairly minimal.  I’m doing a lot of pediatrics, which I love because most of the patients get dramatically better with treatment.  I also get to do things I would not in the US.  Yesterday the midwives asked me to consult on a young woman 32 weeks pregnant with malaria, a kidney infection and very anemic (hemoglobin of 6.1).  Besides figuring out what drugs to use I got to type and cross match the blood myself for a transfusion and retest it for HIV, syphilis, Hepatitis B and C and malaria.

Thats some of the news from Uganda and probably more than enough for most of you!