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Published: January 19th 2013
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Main corridor in clinic
Where people wait for hours for services! There are no appointments! 1/14/12
I spend the day in the local health clinic today. As I write this, I am sitting on a cold concrete bench, where the patients usually wait hours to be seen by the nurse or the medical officer (a person with 3 years of medical training, I’d say roughly the equivalent of a PA in the US.) A doctor comes here roughly once every 4 months, and nurses here diagnose and prescribe medications.
Today, the other health worker didn’t show up, so it was just me, the nurse, and her husband who is the dentist, owns the local pub, and taxis people at night. So we began our day alone. I weighed all the patients, and the nurse began to see them. After I was done, I joined her. We saw people with malaria, pneumonia, urinary tract infections, respiratory tract infections, sexually transmitted infections, and peptic ulcer disease. The nurse palpated one woman’s pulse, but outside of that her diagnosing was solely based on what the patients told her was the problem. Their diagnostic equipment is basically nonexistent anyway. The nurse wrote in what is basically a blue book used take tests in college- little lined
notebooks with a blue paper covering. Many were cut in half so two people could use the same one. This is a patient’s medical record, and they bring it each time they come to the clinic. So, the diagnosing person writes what prescriptions they want in the book, and the books are given to the pharmacy. The nurses usually work in the pharmacy if the pharmacist is not available. Since there was no one else today, the nurse and I saw roughly 8 people, then went to the pharmacy to fill their medications, and repeated the process. The medications are free, paid for by the government. If the pharmacy is out, however, the patient must try to go to the drug store and buy them, though many can’t afford to do so.
The first nurses’ shift ended at 1 pm, so she left and the second was supposed to come on at 2 pm. It’s 3:10, and she has not shown up yet. She is responsible for the women’s and men’s inpatient buildings, as well as the outpatient department. This is the same situation for the morning nurse. Hopefully no one is too sick in the inpatient
buildings….
*Quick note. I also worked with a midwife the other day palpating the fundus’s… fundi? of pregnant women. It was fun because I haven’t done that since nursing school. It was in a small, cramped, dirty room, with a filing cabinet that was open and its contents were spilling over. The most interesting thing was the device used to listen to fetal heart rates. It was essentially a metal stethoscope but I’ve never seen anything like it- see the picture!
1/16/13
Today was so miserably sad. I worked at the healthcare clinic, and the morning was fine, I just packed medicines for patients. The afternoon was horrible. One of the nurses asked me to start an IV on a patient, and asked a nursing student who has been in school for 6 months to show me the supplies. We went to a dimly lit, dirty room, with a small cloth cot for patients. The IV catheters are very different than those in the US, so the nursing student started the first one just to demonstrate their equipment. He did fine, but then tried to start another one on the next patient in
a vein that was way to small. I told him that and we ended up finding a better one but it just shows his lack of experience and the fact that his level of confidence exceeded it. The next patient, a 20 something year old guy, needed stitches for a large cut between his eyebrows and the nursing student put them in. First problem: he never washed his hands between patients. Next, he did an awful job with injecting the lidocaine and was pulling the guy’s skin really badly while injecting it because he couldn’t get the needle in properly. He said it was because the patient’s skin was tough- I believe it, after working hard in the sun all day. As I result, I do not think he was properly numbed. Then, he used a huge needle to stitch because the clinic was out of smaller ones. The student was just yanking at the patient’s face. I went to try to find a smaller needle but was told again that there were none, so I just stood there rubbing the patient’s back. He was trying to be manly and not show signs of pain so he was just shaking
Ripped posters cover the walls.
They're in English, which most people can't read. They taped using bandages usually. and it was absolutely miserable to watch. Then a 4 year old girl in a pink sparkly princess dress needed stitches because she was playing with another kid and he cut her on the head with a knife. I was going to flip out if the nursing student tried to do the sutures again, but a nurse did them. This poor little baby was crying her eyes out and her mother was just standing around and telling her not to cry and not providing any sort of comfort. Instead, she was smiling and joking around with another nursing student. I think it’s a cultural thing because they like their kids tough. They had little tiny suture kits with absorbable sutures and the big ones they used on the previous patient only. They tried the little ones on her first, decided they didn't want the absorbable and so they used the huge needle, then decided it was too big so used the small one in the end. It was just absolutely miserable. They put her on a dirty table, and used a metal pan that had been rinsed with water after the previous patients to hold the suture needle and the
Public health campaign for HIV prevention
The nurse told me they target 15-45 year old men. They had a 2 day circumcision blitz and circumcised 268 men! They are currently out of kits, however. Also, here they put babies under general anesthesia to circumcise them. Quite different from the sugar water used to pacify babies at home! pieces of cotton soaked with blood. They held her down on the table, I was rubbing her legs to try to calm her down, and her mom was just chatting. She was a bit scared of me initially because a lot of the kids have never seen white people (muzungus) before. After a bit I literally pushed her mom towards her and immediately the girl calmed down a bit when her mom was touching her. It was just sad and horrible and I almost cried so many times. When it was over I was standing at the edge of the table and she sat up and tried to jump into my arms. I wanted to hold her but she was covered in blood and in Uganda especially you have to be careful. I passed her along to her mom. Less than minute later Amos, one of the locals that works for Big Beyond, knocked on the door to tell me he was going to buy potatoes and would come get me in an hour. I was never so happy to see him, my knight in shining armor. I told him that he was not leaving me so we hopped on
the boda and rode off into the sunset along the crappy muddy rode to buy potatoes.
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