Report from John Vernon who visited Kamuli Mission Hospital in March 2015
“I was the only medical student visiting Kamuli for the first two weeks, and was then joined by another Nottingham medic for the final month. There was plenty of opportunity to get involved. There are around 300 beds, with medical, surgical, maternity, and paediatric wards, and an outpatient department. During my time there were three full-time junior doctors (although one was away on leave), a medical superintendent (senior doctor), and a volunteer British GP trainee.
The resources at the hospital include a pharmacy stocked with basic medication, and a good supply of consumables such as sterile gloves and cannulas. Although there is a recently installed generator, it was not surprising when the lights went out in theatre for a short period of time (or perhaps worse, the fans!). There is a basic lab, and simple tests such as an FBC can be requested, as well as basic radiography, although this, as was the case with all investigations, had to be paid for by the patient. The wards are basic but perfectly adequate.
Inpatients have an attendant (usually a family member) who perform many of the tasks that might be performed by an HCA in UK, such as washing and (outside-long-drop) toileting, The nurses, supported by nursing students from the attached school of nursing and midwifery, perform many of basic practical jobs, such as cannulating and catheterising, in addition to doing drug rounds and observations.
Accommodation is currently being constructed for visitors, and will most likely be ready for future elective students. During my stay I spent a few nights in a private maternity room, before moving to a flat in a nearby technical college, which was the height of luxury, with cooking equipment, electricity, western toilets, and wifi! Kamuli is a small place, with some shops for the basics. There are a few restaurants, mainly serving the standard fare of goat meat with carbs, and transport around town involves jumping on a boda-boda (motorbike) with a few of your friends.
Prepare to be intimidated by the competency, skill, and confidence of the Ugandan doctors. Two juniors (F2 equivalent) managed all of the inpatients and did all of the operations while I was there, and not just minor operations either; they do major surgery including bowel resections, orthopaedics, gynae surgery… the works! They were incredibly friendly (as I found all Ugandans to be), very keen to teach, and also very keen to get me involved. They also understood that training in the UK does not afford the kind of opportunities to get hands-on as does training in Uganda, and didn’t hold it against me. Before graduating from medical school, Ugandan doctors are required to be competent to do caesarian sections and operations alone. The closest I got as an undergraduate was holding a retractor, so when asked if I wanted to do the next ‘caesar’, the doctors were not too surprised when I admitted I wasn’t quite ready…
Operations are performed using ketamine, with basic manoeuvres to maintain the airway, which meant I was able to practice my jaw thrust in theatre a few times. There is no HDU or ITU, limited options for antibiotic treatment, and often limited patient resources to pay for medication anyway. In one memorable case, a patient with an obvious post operative DVT could not afford heparin or warfarin, and so her treatment consisted or aspirin 300mg and prayer. It can be challenging to experience the reality of medicine in a developing country, and I felt sympathy for both the patients and their families, as well as the doctors who were trying their best in difficult circumstances.
The hospital is supported by the catholic church, with nuns working on the wards, and a priest providing spiritual support and performing the odd exorcism. However, there seemed to be no requirement for visitors to participate in worship.
Life in Uganda is very relaxed, and my timetable was flexible. Days generally involved joining one of the doctors for the morning ward round at 9, which continued until lunch. After lunch I usually spent my time in theatre, assisting with planned or emergency operations as required. I did the odd weekend shift, but had plenty of time to see some of Uganda in addition to spending time at the hospital. We were able to have a gander abound the local area, visit Jinja a few times (where amongst other things, world famous rafting can be enjoyed along the river Nile), see Kampala, Entebbe, and Mbale, and climb Mount Elgon (4321m). We chose to travel by matatu (public minibus), and had no problems. Both my fellow Nottingham student and I found Uganda to be one of the safest places in which we have travelled.
During my time at the hospital I was able to, amongst other things:
- participate in the daily ward rounds (on all wards), eventually feeling confident enough to, with my fellow Nottingham medic, review patients alone
- get involved in theatre, assisting with a huge variety of operations, including helping a visiting fistula surgery team
- carry out some basic operations such as incision and drainage, with supervision
- get much better at suturing
- do my first lumbar puncture
- do a lot of examinations of women in labour
- practice my jaw thrust
I am absolutely sure that I will spend more time working in Africa, and my career plans have been influenced by both my experiences in Uganda, as well as my desire to return with useful skills in the future. I hope that by training to be a surgeon, in the future I will be in a position to be useful in places such as Kamuli.
I would encourage any healthcare student or worker to spend time in Uganda, and Kamuli is the perfect place to visit; the people are amazing, and there are incredible opportunities to share ideas, learn, and make a difference. I was sad to be leaving, and look forward to a return visit soon.”