Reflecting on my Community Placement in Rugazi

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Africa » Uganda
July 16th 2019
Published: July 18th 2019
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I have spent the past week reflecting on my time in Rugazi. We lived in Rugazi for a month and it was filled with many opportunities. There were many firsts for me: observing and providing health care in a third world country with limited supplies and lack of diagnostics, lack of running water and using pit latrines rather than toilets. But there were so many positives in Rugazi, I learned so many things, and gained so many new perspectives.

In regards to the health center, I witnessed for the first time patients having to go without medications due to lack of resources. I saw newborns go without vitamin k injections due to lack of syringes. I observed midwives having to prioritize the care of newborns due to only one warmer and one oxygen machine. The laboring mothers and babies that are born here are the most resilient human beings I’ve ever seen. I saw mothers labor all alone with no support person, no epidural, no other form of pain medication. Most mothers had an attendant nearby who had all the supplies for the mother's experience. The attendant is responsible for all the food, bedding, personal care, medication fetching, and anything else the patient may require other than medical attention. The midwives are incredibly hard-working and deliver many babies daily, however, their approach is very different than in Canada. Patient-centered care and confidentiality are very different here. I saw midwives become frustrated with laboring mothers when their labor was not progressing or their second stage of labor was longer than what they had in mind. The treatment towards laboring mothers is vastly different than in Canada and there were times it was hard to observe, however, this is their healthcare system and it is not up to me to place judgment.

Another learning curve for me in Uganda has been empirical/prophylactic treatment plans. In Canada, we almost never treat empirically/prophylactically as we have the tools for diagnostics, but here it is different. Their assessment skills are more efficient and holistic than ours in Canada as we rely so heavily on technology and they do not. At the health center, their CBC machine was down for a few weeks and that was hard as that machine is a significant tool for them. Therefore, during our time there if patients presented with symptoms of an infection they were automatically given antibiotics. I also became very familiar with using a fetoscope. Women rarely go for ultrasounds, therefore palpation and using fetoscopes were the essential tools used for diagnostics unless a complication was suspected in the assessment.

We lived on-site at the health center which gave us many opportunities to be in the clinic. However, this meant when we had no water in our dorm, the hospital also had no water. It’s hard to imagine running a health center with no running water, and this is their normal. After the Ebola scare, three or four handwashing stations were set up around the health center which consisted of a jug filled with water and bleach. In Canada, hand hygiene is HUGE, we know it’s the number one practice in prevention of spreading infections and diseases but it is hard in these conditions to wash their hands continuously. They are not provided with alcohol to wash their hands either. It is not that the healthcare providers are not compliant, rather they do not have the necessary resources.

I have taken so many resources we have in Canada in health care for granted that Uganda does not readily have access to. Blunt fill filter needles, alcohol swabs, endless supplies of fluids, syringes, medications, hospital clothing and bedding. In Uganda, each patient has an attendant who is responsible for providing all bedding, clothing, and food for the patient.

Bathroom practices in the community varied, but most people use a pit Latrine or bucket to go to the bathroom. We had toilets in our dorm but without running water the toilets were not a realistic option so we quickly became comfortable with pit latrines. Within a week or two, the pit Latrine was normal for us. Not only did this become our normal but so did our basin showers and our constant filling of jerry cans when the water would sporadically turn on.

Despite some of these challenges we faced, Rugazi was truly an amazing experience and the positives as well as the people and relationships I built strongly outweighed the challenges. I gained a new perspective and appreciation for healthcare in a third world country. Reflecting on my practice in Canada I hate to think of how much supplies are wasted without a second thought. It is truly amazing to watch healthcare providers in Uganda and their constant improvisation. I will miss Rugazi and working at the health center but I will take away many lessons learned and amazing experiences from my time there.


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