The Home Stretch

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Hi All,

I have spent the last two weeks in Mbarara volunteering in the emergency department at the government-run Mbarara Regional Referral Hospital. I was fortunate enough to experience such a breadth of cases in such a short time. I saw all kinds of emergencies and realized that, although tropical diseases can be so different from western ones, the types of cases that present in the emergency department are very similar. There was a lot of trauma (mostly from boda boda accidents or mob justice), overdose, burns, stroke, hypertensive crisis, and the like. I felt comfortable and useful in surgical emergency because it was highly procedure-based. While speaking very minimal Runyankole, I am able to perform procedures but taking a history or constructing a differential diagnosis with physicians proved difficult due to the language barrier. I was able to work night shifts and day shifts, both of which presented unique challenges.

My two weeks in emergency were especially emotionally taxing because I bore witness to a dramatically higher mortality rate than I am accustomed to. It was difficult to come to terms with holding patients while they died because the hospital lacked the resources to save them. The doctors were incredible and so knowledgeable, but there were not enough doctors or nurses and little to no medical resources. Many patients cannot afford diagnostics (lab, scans, x-ray, etc. all come at a cost) medications, or supplies. If the hospital does not have a certain supply (everything from IV tubing to life-saving drugs) the patient's attendants (family members) had to go and buy it from the pharmacy and bring it back to the hospital before treatment could really get underway. Treatment would nearly come to a halt if patients came in alone and did not have attendants to buy their supplies, tend to their personal care, or feed them. I predisposed myself to emotional burnout by taking a personal interest in each of these abandoned patients and trying to make something out of nothing for them. Of course I could not ethically pay for my patients' treatment, but I was able to check on them more frequently and attempt to find them something resembling the resources they needed. It was very difficult for me when some of them died or deteriorated despite my efforts. It's not that the health care staff ignored these patients, but they simply did not have the time or resources to give them the little bit of extra care they needed due to their vulnerability.

Emotional hardship aside, I felt like I could really contribute to the health care team at MRRH in emergency and learned so much about emergency medicine. The patients and health care workers that I met were incredible and impacted my life and medical career invaluably. We are now taking off on safari and I will miss Mbarara a great deal. I have a strong feeling I will be back.

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