Arriving at Entebbe airport, Dr. Patrick Sekimpi was waiting for me as promised. We hoped into his Toyota Prado and made for the road to Kampala.
The roads:
There is a reason why Uganda has an ever-rowing number of road traffic accidents. At best, a highway might have two lanes in either direction, is paved and has a wide shoulder. Most city roads are two lanes with minimal shoulder, occasionally paved, and ridden with pot holes. The dirt roads have ruts and pot holes that make you wonder how sedans, matatus and boda-bodas survive it. Patrick says it's no problem so long as you replace your shocks frequently.
Boda-Bodas and Matatus:
Boda-Bodas are motorcycles or scooters. Although sometimes for personal use, boda-bodas are often taxis for up to three or four passengers, and large furniture or bundles of logs. They are great for bypassing traffic. Boda-bodas mostly drive on the shoulder or meander through cars. They share the shoulder however, with many pedestrians and cyclists. Intersections rarely have traffic signals, and stops signs are a mere suggestion. Crossing a junction reminds me of a game of Chicken. Needless to say, two of the three patients I interviewed this morning were admitted for fractures sustained when hit by a car while either driving or riding on a boda-boda. Helmets, though apparently mandatory, are rarely worn, and women passengers tend to ride "side-saddle" holding onto a handle, if present.
The matatus make driving even more exciting. These are the 14 passenger mini-buses which are the cheapest local public transport in town. They stop more or less anywhere along the road, are not terribly skilled at merging, and often drive in the oncoming lanes to avoid traffic.
Luckily for me, as of Saturday when I move to the Mulago Guest House, I will be on hospital property which is gated and has little traffic. The surrounding main roads are also blessed with side-walks. Small joys! Photos to come!
Mulago Hospital:
Mulago Hospital has a rather large campus. The "New Mulago Hospital" is a six story building which has an emergency room, a trauma OR for immediate emergencies which all specialties share, in-patient wards, and out-patient departments. Across the street is the medical school. Dispersed around the hospital, are 16 or so wards which are housed in small one-story buildings. Orthopaedic in-patients are in the Spine Ward and Ward 7 (Orthopaedic Trauma). Each ward has its own OR (1 in Spine, 2 in trauma). The surgeons' offices, resident teaching rooms, and library are in another building just up the hill.
Yesterday I planned on attending the trauma OR. Unfortunately, the OR had run out of oxygen the day before. By 1130am Thursday, the oxygen tank had been delivered to the main hospital. It was not transported to Ward 7 until 115pm. Once it arrived, 3 patients were rolled into the OR bay. It took another half an hour to find the right connection to hook up the tank to the anesthesia machine.
In the mean time I got a tour of the OR. The autoclave for sterilizing equipment has been broken for two years. Everything must get sent to the main hospital. Screws are low in stock, so rod cutters are used to cut them to the right size as needed. Creativity and resourcefulness are key in performing surgery here.
The first patient had a left mid-shaft femur fracture with an ipsi-lateral femoral neck fracture. As the anesthetist assumed cases would not go today, she was out of town. Her second year resident did the spinal. At home, an ideal way to fix these fractures would be a cephalomedullary nail (a rod that goes inside the bone and has a big screw at the top going into the head of the femur), however they do not have these here. As the patient was older, he got his femur plated and his hip replaced with a Moore's prosthesis. His outcome should still be good.
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| Cephalomedullary Nail |
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| Moore's Prosthesis |
Today, I waited to interview some patients at the residents' out-patient clinic. Imagine a ticket window at a tiny train station in a small town. Imagine the townspeople must all commute to work at 8am, but the window opens only at 7:55am. In the clinic's tiny waiting area, people in plaster casts rush the window to check in. They are in wheelchairs, lying on the ground, leaning on crutches or family members, or limping independently to the window trying to check in. The residents are 90 minutes late for clinic as they had a tutorial. It is hot, but a TV in the back plays CNN. No one seems angry or irritated. Everyone waits in line and shuffles along as instructed. By the time the residents arrived, it was too chaotic for them to give me a room for interviews.
I ended up speaking to a few patients on the ward. A brick layer fell off a ladder at work and broke his hip. He waited two days before going to the hospital hoping it would improve. Once here, he waited a month for surgery. His femoral head did not survive and so it was removed. He will unlikely be able to continue his profession. A 27 year old man in a small town was hit by a car while on his boda-boda. His right shoulder is dislocated and ulna fractured, and the entire arm is paralyzed due to a brachial plexus injury. He also has a femoral shaft fracture. The local hospital operated on his leg but didn't fix the fracture. No one understands why. They only put his arm in a sling. After being sent home for a week he went to a different local hospital. Here, they recognized his injuries and sent him to Mulago for treatment. Two and half months later, his leg is fixed appropriately. His arm will probably never recover but he sees the neurosurgeons tomorrow.
Tonight I will post some photos. Until then!
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