Friday, January 11Part 1

Hello from Uganda!

The nurses trekked west to Bushenyi yesterday for a return visit to St. Daniel Comboni Hospital. We were housed at a combination priests’ retreat house/woodshop/vehicle storage facility, which may sound odd to you at home, but is totally ordinary in Uganda. And we had hot water, which was a real treat.

After the formal welcome we get everywhere, Matt and Dr. Hunter went to the pediatric ward, Robin to the outpatient department, Dave to the HIV clinic, Kathy to maternity and Joanne to post-surgery. Matt and Dr. Hunter made the rounds of the peds patients doing assessments, and later meeting with Dr. Moses to discuss treatment plans. Both reported that they were quite impressed with the currency of Dr. Moses medical knowledge, especially of HIV and malaria patients. The Ugandan Health Ministry reports that 20% of all hospital admissions in Uganda are for malaria, but that percentage is much higher among children because of their unique vulnerability to malaria and its complications.

Malaria symptoms include high fever, chills, sweats, loss of appetite, nausea, vomiting and diarrhea. For children, the dehydration that goes along with these symptoms is a much more serious matter than it is for adults. Thus they can die of dehydration much more quickly. Not surprisingly, malaria also suppresses the immune system (normally not fully mature in babies anyway), making an HIV-positive child more likely to develop full-blown AIDS.

Anemia is another complication of malaria and, again, children are much more vulnerable to it. The malaria-causing parasite attacks oxygen-carrying red blood cells causing hemolysis, and invades the liver. Where an adult with malaria may feel like she has the flu and generally weak, a small child will die. The Ugandan government has numerous programs to fight malaria and teach how to recognize and treat its symptoms, but Dr. Moses said that it still makes up more than 70 percent of pediatric admissions to Comboni Hospital.

When we reconvened for lunch, Robin reported her surprise that Comboni’s outpatient department operates very much like an urgent care clinic in the US. Patients sign in, take a number, see a “clinical officer” (equivalent to nurse practitioner or physician’s assistant in America), have lab tests, receive a treatment plan and any medications they need. Dave reported similar efficiency in the HIV clinic, as did Joanne for the post-surgical patients, most of whom were being treated for the same ailments that affect Americans: hernias, abdominal adhesions, abdominal and lung cancer.

Kathy, our neonatal nurse, was partnering with a midwife, and they found a mother in the late stages of labor. Although they were hopeful that the mom would deliver to allow Kathy a chance to use her skills, baby was not yet ready for her debut.

St. Daniel Comboni Hospital faces the same problems that all health care facilities do in Uganda -- shortages of money and supplies, power outages, patients who wait too long for care. Yet we were impressed by the spirit and professionalism we saw there, probably owing in large part to Dr. Thompson, Comboni’s medical director, and Sister Gertrude, the chief nursing officer.

We rejoined the sisters for dinner after an afternoon break . It was dark, and since streetlights don’t exist in rural Uganda, we donned our headlights for the 200 yard walk over uneven ground. This delighted the locals, who live in a small collection of homes outside the hospital gate. Buzungu, they call us, which we used to think meant “crazy white people,” but now we think it means “person who has traveled to different places.” We’re hoping it’s the latter, but to their eyes that evening, it was probably the former. We also had a hard time convincing the night watchman that we were legitimate hospital visitors, what with the headlights and all. But Dr. Hunter started dropping names of the hospital’s bigwigs , which impressed him enough to unlock the gate. A wonderful Ugandan dinner awaited us, followed by a colossal evening of brightest stars any of us had seen in a long time.

The business and chemistry students joined us the next morning for their first up-close look at a Ugandan hospital. After a tour, they scored a major coup by securing from Comboni’s business director and staff a very complete set of the hospital’s financials. This is critical information for us, as it is our only guide to how much Holy Innocents and its supporters will have to raise. They learned, for example, that more than half the hospital’s operating income last year came from donors (Catholic Relief Services being the biggest), and one-third from patient fees. If you are bringing in a sick child, you will pay a flat fee of 3,000 Ugandan shillings, or $1.75, for your child’s stay. And if you’re an expectant mother, expect to pay 10,000 Ugandan shillings, or about $6, for an uncomplicated delivery. Your family will bring all your food and do your daily non-medical care while you are there.

After a bus ride back to Mbarara, we lunched at the Agip Hotel, recommended to us by some Peace Corps volunteers we’ve met. We feasted on pizza, Indian food and club sandwiches. As good as the Ugandan food is, we were glad to get it. There were lots of Buzungu there too. Then a few of us took off in the tropical sun for a walk back to Monfort House. We knew it was a ways away, but 1 hour and 45 minutes later, hot, tired and thirsty, we trudged in.

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