Makerere University, Kampala (Uganda)
Impressions of Uganda
Aruna Shivam - medical student from Sydney Medical School, undertook an Elective with Makerere University in 201213
"My 20122013 elective placement was based in Kampala, Uganda. Mulago hospital is the largest national referral hospital in Uganda and is associated with the Makerere University School of Medicine. The hospital sees a phenomenal number of referrals from regional and remote hospitals up to 14 hours away from the capital daily and it is common to step into a very full and noisy emergency department. I found standing in the waiting room and looking around at the presenting cases was in itself a learning experience. I was predominantly placed in the Emergency department but spent some time in Infectious Diseases and Haematology as well.
Mulago hospital is significantly under-resourced to serve the number of patients it receives daily. It often lacks simple and basic equipment including ECG machines and blood pressure cuffs. Unfortunately while the hospital may have been an ideal facility in the early stages of its growth, the demand for health services in developing countries is ever increasing and recent budget cuts to the health sector have had significant impact. While it sounds deficient, the setting makes for a rich learning environment. The cases that present are varied and very interesting.
While on the infectious diseases ward, I got the opportunity to see many conditions which are often not commonly seen in Australia. These included Tetanus, Cryptococcal Meningitis, Typhoid, Malaria and Stevens Johnsons syndrome. Watching the deftness with which local doctors are trained in managing these often fatal diseases is incredible. In addition to that, complications of HIV and AIDS are often more serious in Uganda due to poorer living conditions including hygiene and nutrition.
The emergency department was just as fascinating. Common presentations in the ED included ascites, cardiac failure, malaria, severe anaemia and trauma from motor vehicle accidents and Mob justice type situations. In the emergency department, I was vigorously trained in resuscitation, patient assessment and stabilisation and got to learn a range of very useful practical skills including suturing.
While I didn’t spend much time in Haematology, I found the ward fascinating with several sickle cell anaemia patients presenting in crisis. I believe this would be a most valuable medical experience should time permit as well.
I thoroughly loved my placement at Mulago where I was able to spend lots of time learning new skills and procedures on the wards. I enjoyed working with doctors who were so knowledgeable in a range of diseases and conditions that we would be very unlikely see at home. But most of all, I was inspired by the patients who are strong and brave and handle such chronic illnesses in an environment that denies them basic necessities like food, water and shelter. My heart stays in Uganda and I am certain I will return someday.