This week my exposure to orthopaedics has been extremes. On Tuesday, I attended Patrick's out patient clinic in the morning in his Mulago office. Some of them were post operative patients, some referrals from the ER, and many others were just passersby looking for a doctor with his door open who could help. A positive was learning that physiotherapy is covered by the government here in the public hospital system!
We then attended departmental rounds. This is when all the surgeons, the residents, medical students, nurses, orthopaedic officers and others I didn't recognize, get together to discuss the happenings of the past week. The chief resident listed the number of admissions, discharges (significantly smaller than the number of admissions), operations (again, significantly less than the number of admissions), and deaths. The problems encountered throughout the week were highlighted: no oxygen in the operating room, no saws or drills in the casualty theater, no beds for admission... the list went on. There was next a large discussion about the UBC group that arrives tonight. There is a group of orthopaedic surgeons who come to Uganda once a year, stocked with implants and tools, to do a straight two weeks of collecting the injured patients as they arrive in the ER and operating on them within 24 hours. The head nurse of the ward however, was concerned. How could they accommodate such a large volume of post-op patients when the ward is currently full with people waiting on surgery. The point was well taken, but it was never decided how they would find the additional bed space.
That afternoon I followed Patrick to one of the many private hospitals in Kampala, the International Kampala Hospital, started by an Irishman. Here we did another outpatient clinic. What a difference! The hospital for one, was as beautiful if not nicer than ours.
The clinic room was well furnished, clean, sunny and had a balcony. There was a nurse just for Dr. Sekimpi who helped run his clinic and handled the fees patients had to pay. Patients got same-day Xrays and OR the following day if needed. Follow-up appointments were no longer than a week away. Patients did not wait more than an hour to be seen. If only we could accomplish that!
On our way back into town, we stopped in the true downtown of Kampala to buy weed killer for Patrick's farm. We got stuck in one of Kampala's notorious traffic jams. One hour to move maybe 400meters! I can't believe I didn't see an accident! It seems the jams are more frequent these days because campaigning is going on for the 2011 presidential elections. Trucks with loudspeakers crowd the streets and prevent traffic flow. There are two short videos on my the web album (link in previous blog), but I thought only to take them once we started moving so they are not a great example of the madness.
Yesterday, I went back to the Orthopaedic OR at Mulago. Although there was oxygen today, there was no anesthetist until 10am. Drills did not work. The drilling for screws was done by hand. A one hour case turned into a two and half hour case. Again, the theater list was littered with injuries that were months old. It seems the pattern is that patients spend the first month hoping they will get better on their own or with a traditional healer. When they fail to improve or their function worsens, they come to hospital. It takes one month for them to get to the OR. The first two cases of the day were a man with a 3 month long dislocated elbow, and a women with a 3 month old broken femur. Xrays below. Both have been treated, but the lack of tools and inappropriately sized implants do not promise favourable long term outcomes. In the meantime, I will keep my fingers crossed for them.
Until next time, Namaste.
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