During our four-week stay in Rugazi we spend the mornings in the health centre and the afternoons working on our community based projects. For the clinic work we were able to make our own rotation schedules. Each nutrition student ended up being grouped with two nursing students; I’m with Dayna and Britany. Having just finished third year, I have yet to complete a rotation in a hospital or clinic. Having my first clinical experience in Uganda definitely had the potential to be highly overwhelming! I’m so thankful to have other nutrition students to talk to and to have the nursing students take charge on all the cases we see. Seeing Britany and Dayna in action each day makes me realize that I will be in good hands should I fall ill! There is not as much work for the nutrition students because Rugazi HC IV does not offer much for nutrition services. All of our malnutrition cases so far have been referred to Kampala International University. I expect to gain more hands on nutrition experience during my clinical placement in Mbarara. For that six week period, I have chosen to work for three weeks each in pediatrics and with malnutrition cases
The first week at Rugazi HC IV, we helped to see patients in the outpatient department. I mostly watched, but Britany and Dayna did assessments of the patients that came in. Usually the clinical officer or other medical students could speak the same language as the patient, and would translate the symptoms for our benefit. With the help of the medical students, we were able to see two patients at a time. Patients check in at a desk on the sheltered deck that makes up the waiting area. The room where patients are seen is inside, just around the corner of a hallway where people wait to go into the lab. If more than one patient was being seen, it was always in the same room, with little regard for privacy. The room is small and cluttered in one corner. It’s cramped at times (when 10 people are in it), but there are large windows that face the back of the clinic and let in enough light, even when the power is out.
The second week we worked on the wards. There is a pediatric ward and then a male ward and a female ward. We saw
a variety of clients throughout the week. There were many cases of malaria in both children and adults. There were also several cases of sickle cell disease in children. These patients often experience flare ups in the rainy seasons when it is colder. Sickle cell disease affects the shape of the red blood cells. The coldness can cause flare ups because blood is coagulating more, leading to blockages and pain.
I've also seen a large abscess in the upper arm, pneumonia, sciatic nerve pain and measles, I've also seen several patients (mostly children) who are malnourished. When these patients come in, they are referred to KIU (Kampala International University). Many of the malnourished children I have seen are admitted at Rugazi for other acute illnesses. They are only mildly malnourished and often this could be party due to their illness. I have been able to talk (through translation) to a few patients about what to feed their children or about their current breastfeeding practices. It's strange to rely so much on others to not only interpret what the patient is saying, but help to further educate me on available foods and cultural practices at the same time. Sadly, I
also spoke to a few families who were referred to other nutrition clinics. Not everyone can afford to travel to and buy food in a far center. Although many patients would say they were going to go, I always worried that they would not make it.
There are a great many differences between Ugandan and Canadian health care practices. The patients here are responsible for their own medical record. They carry with them a small notebook, like the ones that are used in grade school. This holds all of the notes from their recent medical visits, as well as any prescriptions they have been written. There are no electronic records or charting here. Some people told stories of losing their books, or accidentally using them to start fires. Most of the books only had a few pages filled out. This doesn't make for a very comprehensive health history so we need to rely on the patient to fill in any missing information from memory. In the inpatient wards, the nurses or doctors keep the books with them and reference them when doing rounds or giving out medication. In the outpatient department, the patient books with lab results are returned
to the clinical officer and we call the patients name out the window. They come pick up their results and either come inside to see the doctor again, or take their prescription to the pharmacy.
Supplies in the clinic are scarce. We bring our own gloves and hand sanitizer as these items are rare. The Ugandan students were smart enough to bring their own thermometers and we could only find one other thermometer (both baby thermometers) in the whole clinic. The days that thermometers cannot be found, the clinical officer feels for fever just through touch. The Ugandan government supplies the clinic with drugs and some supplies at regular intervals, everything runs out before the next delivery. If drugs are available, they are free, but if they are not available, patients must walk to the pharmacy and pay for them, with no reimbursement. Patients also must go to the pharmacy to secure supplies for any procedures they need. Gloves, IV tubing, iodine, bandages, basically everything must be purchased from outside the clinics. Even expectant mothers must arrive to the clinic with a kit of supplies including a plastic sheet to deliver on and gloves for the midwife.
do not receive hospital gowns, they are also responsible for their own bedding and food. Some people lay in their beds wrapped in a small blanket, but others bring a full set of bedding. Parents stay overnight on the same beds as their children. So far I have seen most people eating, usually out of pots that a family member brought from home. I’m still sure that some patients go a day or two without eating or even being able to access clean water. It sounds like this is the case in most of the public clinics and hospitals in Uganda. There are private clinics and hospitals where those who are better off or have good insurance can go, and these may have food provided. What I am seeing in Rugazi is very different from the nutrition outlook in Canada. In Candian hosptials, food is provided according to diet orders that are meant to enhance patient health. Patients are still free to eat outside foods if they prefer and can access them. In Canadian hospitals each meal presents an opportunity to nourish and heal the body and spirit. In Uganda, access to food while staying in the clinic is a
bit of a luxury.
Still complaining about your hospital food in Canada?
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