Dr. Kisige's Gulu

My past four nights and 3 days in Gulu have been filled with complex, long-neglected orthopaedic cases, 30-degree operating rooms, election campaign rallies sung to the sound of World Cup-reminiscent vuvuzelas, and thunderstorms clanging for an hour or two a day which invariably cut the power to nearly the entire town for hours at a time.

That said, this might have been some of my favourite days so far.

Dr. Kisige is the head orthopaedic surgeon here. He purposefully started his practice here as he wanted to create a new department on his own terms. His experience, like mine, at Mulago taught him a lot about the do’s and don’ts of running an orthopaedic service. Gulu Regional Referral Hospital, where he works, is a 350 bed hospital with a growing orthopaedic department, and affiliation to the Gulu University medical school.

Dr. Kisige and his staff welcomed me warmly to their town and hospital. Wednesday was spent doing ward rounds and some interviews. Ward rounds was of the entire surgical ward. We visited each patient one by one as a team of medical students, interns, orthopaedic officers, nurses, surgeons and visiting doctor. It was sad to see how many patients delay coming to the hospital who are now faced with permanent complications. I don’t know how many cases of osteomyelitis of gangrene we saw that had been festering for years. It’s the opposite of home where it seems a clean cut barely needed a stitch necessitates an ER visit. There were also many burns, from babes to the elderly.

Dr. Kisige and his medical students on rounds with a patient in arm traction

A neglected open tibia fractures

An 18 months old with 2nd degree burns

Thursday I was in the operating room with Dr. Kisige. As per usual, the cases didn’t start until 10am. Our first patient was a 35 year old school teacher who was hit by a car while on a boda-boda last April. He was treated near home for his open segmental femur fracture in traction and then a hip-spica cast for 5 months. When healing hadn’t occurred they re-xrayed him and finally noticed his hip dislocation. By the time he reached Gulu, where the nearest orthopaedic surgeon was, it had been 8 months that he had been living with a broken, non-united femur and dislocated hip. We managed to fix the femur, but we couldn’t get the hip in. He will have to return for more surgery once the femur heals. Luckily being a teacher is a government job and it seems he is being paid on sick leave, but who knows how long that will last. Maybe because it is election time, he’ll get compensated until at least the elections in January.

Right segmental proximal femur fracture with right hip dislocation, the school teacher

Friday was clinic. It’s amazing the severity of the cases we saw. Lots of bone infections, even more neglected fractures and dislocations, I have certainly learned a lot the past few days. The saddest thing about yesterday was the story of this man and his three sons. In July, the boys had been riding on a boda-boda when they were hit by a car. The man who hit them was rich. He paid for them to be transferred to a hospital, as they were all severely injured. The family didn’t know they had been brought to a private hospital, Gulu Independent Hospital, where Dr. Kisige works on a consultation basis. After multiple surgeries and recovery, the bill was 2 million Ugandan Shillings, about 8700$. The father is unable to pay this of course, and the driver has denied responsibility as well. He has already apparently bribed the police to change the police report on the accident to absolve him of fault. Even if Dr. Kisige were to give his services for free, they are still left with a 14million dollar bill. Until they pay, these boys are bound to the hospital. They have spent a healthy 4 months there now. We are hoping they can appeal to the district commissioner for help, as it’s election time, maybe they will get some sympathy. But corruption in Uganda is high. There is little hope. It breaks my heart. Part of me wants to raise the money, but the other part says, if I do this now, when will the government ever realise how much crap goes on in their country.

The private hospital's OR. Despite newer construction and some amenities, they are still poorly stocked of instruments unless a patient buys and they order them in.

If only our hospitals promised to see us in 30 minutes!

There was a joke on the news last night, which I saw while at Dr. Kisige's for dinner (his wife, beautiful 6 year old daughter, Nambi Anne, and niece welcomed me with great warmth and yummy food!). A politician was saying how the Muzungo developed a machine for detecting corruption during elections. They used it in Nigeria and it caught 7000 people. They used it in Kenya and it caught 3500 people. They used it in Uganda, but someone stole the machine.

Somehow, despite the fictional nature of the story, this rings so true.

On that note, I leave Gulu today for my little trip with a few other backpackers to Murchison Falls. I will write you again soon with lots of wildlife and scenery pictures.

Happy American Thanksgiving.

Maryse