Doctors and other elective students at Rushere

I spent four weeks in Rushere Hospital, Uganda during one summer at medical school. The weather in Uganda is hot, but not as hot as Singapore. Day temperatures average 25C and it is dry. At night it falls to about 16C. Because this is the dry season, it hardly rains.

Brief overview of the hospital

There are three main wards in Rushere; general (male and female), paediatric, and maternity. The whole hospital is run by 4 doctors. Medical director Bonnita and the superintendent and surgeon Enoch were the main players, but there were 2 additional junior doctors, Damasco and Deus. Since it was a district hospital, patient load was not very heavy and most admissions were due to malaria and pneumonias. Simple investigations are expensive and lacking. There were the most basic blood tests, an X-ray machine and an ECG.

A typical day begins at 0800 hrs with ward rounds. These typically last till at least lunch. After that either doctors may be called to new admissions or ER to handle other patients. We are all on call, so Csections which are required in the night means all the doctors get up to help. Since the doctors stayed in a house a stone's throw away from the guest house, it was easy to contact each other.

Only in Africa are there chickens in the wards
and cows just outside the window

Noteworthy happenings

A man came in having axed himself accidentally on the dorsum of his hand, severing all 4 tendons and fracturing some metacarpals. Instead of just presenting to hospital, he decided to first pack thewound with a whole bunch of dirty leaves. The surgeons decided not to operate immediately but to wait a day. I was initially frustrated at this, but perhaps it was to allow proper wash and antibiotics to work slightly on the dirty wound before thinking about repairing the tendons and fractures.

A drunk man was brought in by the police and left in the hospital, after he sustained a scalp laceration from blunt trauma. He was too drowsy to speak so no history could be taken. When we started suturing up his laceration, he started convulsing. He ended up on the floor in a tonic-clonic seizure that lasted about 1 minute. Post-ictally, we then had to do the suturing on the floor. So, setting up a curtain in the ward to cordon off the area from the other patients, I starteddebridement after local anaesthesia. Debridement was done with a razor blade (those used for shaving), since surgical blades were unavailable. Our main concern was the intoxication masking an intracranial bleed, which was the case a few days later when we found out he became hemiplegic. We had to send him to another hospital as they could not do decompression in Rushere. We are not sure if his friends actually took him there.

Final remarks

Uganda is a beautiful place. Accompanying the gorgeous rolling hills and greenery are some of the most lovely and hospitable people I've met in my life. They are friendly and genuine, and really take an interest in you. Relationships here really count and the people you meet here may become friends for life. While it doesn't have the wildlife that Tanzania boasts, nor the infrastructure within it's towns, it more than makes up for by the sheer lack of mzungus (white people), meaning that you really get to know the locals. You are easily and readily assimilated into local culture, and these people really let you into their lives (and houses too!). Obviously being a mzungu, bus operators and other store vendors still try to cheat you of money, but with a little bit of wisdom and caution, one can get by just like any of the locals, minus the language. After my time at Rushere I went white-water kayaking, went on safari, did a bungee jump and visited Kampala.