Below follows an article from Joseph Glover, a graduate from The School of Medicine at The University of Manchester who also spent his intercalation year at The Humanitarianism & Conflict Response Institute (HCRI) at Manchester. He has been on a two month placement in Uganda as a part of the South Manchester-Gulu link.
My elective was carried out in Gulu, which is the the largest town in Nothern Uganda, working at the Gulu Regional Referral Hospital. The whole experience was fascinating and eye-opening, and I wish to reflect on just one of the many different experiences that made the trip so worthwhile, and really epitomised my stay in Uganda. This particular day was about half way through my elective block and consisted of joining 100 2nd, 3rd, 4th and 5th year medical students on a venture into the community in Northern Uganda, this particular one being in the extreme north near the Sudanese border. These types of community outreach projects are typically undertaken once a semester, and are sponsored by World Vision, who provides funding for every aspect of the complicated organisational task that is required when attempting to treat literally thousands of villagers in a single day.
When we arrived at the school where the event was to be held, the first thing that was apparent to me was the sheer scale of the faces staring at me. The number of people attending this particular day was over 2,000, all of whom had arrived before us, and were waiting in silent anticipation of our arrival. As soon as we arrived, however, the quiet, somewhat eerie atmosphere all but disappeared, and was replaced with a raucous maraud of hundreds of shouting and laughing children, equally matched by hundreds of shouting and laughing elderly ladies, all outdone by a blaring brass band in full attire, with a full complement of deafening instruments, and a bizarrely smart costume. The locals seemed to think it entirely normal when the brass band started marching up and down the central patch of grass playing very loud brass band tunes, right next to the clinic area where I was trying desperately to hear heartbeats and respiratory sounds of the ailing young and old alike. They would also intermittently play the Ugandan national anthem, unbeknownst to me, which would necessitate everybody jumping immediately to their feet for the entire duration of the song, and for an extended duration afterwards, until the very last ebb of the last bar had died away.
The sheer volume of patients really was staggering, with the out-patient marquee where I was, entirely surrounded by the crush of hundreds of people around the clinic desks and spilling out into the sunlight in their hundreds, staunch in their belief that the closer they could get to the doctor, the more swiftly they would be plucked out of the fray to be seen. This meant that I normally had four or five patients sitting opposite me on a bench made for two, and on my bench I inevitably had the usual quota of three small children next to me, and one cantankerous grandmother perched on the end, on a seat made for one. Needless to say this made examination of patients sitting opposite you difficult, since to gain access to them you first had to traverse a complicated landscape of babies, toddlers and elderly patients all sitting helpfully in the narrow aisles between the benches. The actual consultation was a further challenge, as virtually none of the patients spoke any English. Luckily this was remedied by a very friendly 2nd year medical student called Simon, who determinedly translated for me for 7 hours straight without any complaint.
Despite these difficulties we pressed on and after a relentless clinic lasting from 9:30 until 16:00 without any breaks, we finally stopped for lunch. It was only at this point that I was able to reflect on the unique and curious events of the day. The fact that a cohort of 100 medical students had been able to staff and run not only an outpatient clinic, but also a cervical screening marquee, a HIV and a malarial testing tent, a breast screening service, a nutritional centre, an ante-natal service, a family planning clinic, and lastly but probably most importantly a pharmacy with an inventory of 15 different drugs in large supply, all out of temporary marquee tents erected in scrub land near an isolated school, was nothing short of miraculous. Despite my doubts, all but a small handful of the 2,000 patients were seen and treated (only the cervical screening centre being oversubscribed and unable to see everyone), and, come 18:00 we were all packing up the temporary settlement ready for departure back to Gulu. As a thank you, all of the medical students were presented with a World Vision t-shirt, and a payment of 40,000 Ugandan shillings (roughly £10) for a hard but rewarding day’s work. I was exhausted by the end of the day, and we returned back on the rickety and heavily overloaded university bus, 30 of us standing for the full hour and half trip back down the only potholed and dusty road back to the city. The medical students, determinedly undeterred by the day’s events, spent the full hour and a half trip back jiving to blaring Ugandan pop songs, incorporating the sometimes agonising lurches of the vehicle into their complex and enthusiastic dance moves.
This day taught me an immeasurable amount about the provision of healthcare in a resource restricted environment. It also taught me that the care providers are never perturbed by the enormity of the task before them, be it seeing 2,000 patients in a single day (the population of a small GP practice), or treating patients in the hospital with no diagnostic services and no real idea of the specifics of their problems. In terms of an action plan, I can only say that I certainly have renewed gratitude for the privileged services of the NHS, which so many people take for granted in the UK. If only they could experience a day in a Ugandan hospital, and see how privileged they really are. Despite these overwhelming challenges, and the fact that an FY1 doctor in Uganda is paid only £200 per month and is expected to be in hospital or on call 7 days a week, 24h a day, the calibre of doctors produced is highly impressive, and my only lamentation is that the Ugandan government does not deem the service they provide important enough to merit a real salary, with more being spent on the Presidential budget than the entirety of the health budget.
This sad fact sees many Ugandan trained doctors leaving the country for greener pastures such as the UK and South Africa, depriving Uganda of their requisite personnel. Things are slowly improving however, which is evidenced by the steady increase in the number of doctors and nurses and the quality of service at the Gulu Regional Referral Hospital, where I spent two fascinating and inspiring months.