This summer I spent my medical elective in Kuluva Mission Hospital near Arua in Northern Uganda. After four flights, an overnight stopover in Dubai, and a weekend acclimatising in Kampala, the Ugandan capital, I arrived at the small airstrip in Arua.
I was picked up, and we stopped off in the town centre. My first clear memory of rural Uganda is of a man going into a shop and saying something to the shopkeeper. The shopkeeper rummaged behind some boxes near the counter, and brought out a live chicken. The man tied its feet together and slung it over the handlebars of his bike. He then cycled off, with the chicken pecking his leg as he went. I knew these 10 weeks were going to be a little different from what I was used to!
The hospital had one English doctor (who left shortly after I arrived, promising to return one day), two Germans, and three Ugandans (one of whom had trained and worked in Britain). The nurses and other hospital staff were largely Ugandan, but also included two Koreans, several more Germans and an American. The hospital itself perhaps had slightly better facilities than I was expecting for example there was an X-ray and an ultrasound machine. However I thought it was extremely poorly equipped compared to what I was used to. This was especially true of the children's ward, housed in a series of dilapidated buildings. The children (the majority of whom were under the age of one) were often two to a bed, their mothers sleeping on the floor between the beds. The laboratory was also quite limited, with little more than haemoglobin levels and microscopy available.
When arranging my elective, I applied to several grant-making trusts for help with funding. I pledged that half of any monies I raised would be donated to the hospital. I was delighted to be given a total of £600, and could therefore give £300 to the hospital when I arrived. They were extremely pleased, and immediately ordered a new fridge for the laboratory, to enable them to run cultures and check organism sensitivities to antibiotics. They had been unable to do this for over a year, since their old fridge broke down. I was asked to pass on their thanks to the trusts and organisations responsible.
The medical conditions I encountered varied enormously. Some patients used the hospital as we would use a GP surgery, for routine management of chronic conditions such as high blood pressure and diabetes. Others had fatal conditions in much more advanced stages than I had ever seen before. Some patients had travelled hundreds of miles, including from neighbouring Congo and Sudan, where the facilities are even less well developed. There were many infectious diseases rarely seen in the U.K. including malaria, tuberculosis, leprosy, dysentery, cholera and tetanus. I also saw many patients in the end stages of AIDS.
I was glad of the opportunity to pray with some of the patients I met. After a few initial nerves, and with some encouragement, I asked several patients if they would like me to pray with them - none of them ever said 'no'. For many, it was virtually all we had to offer. In these situations it felt good to be doing something practical, and whenever I spent even just a couple of minutes praying with someone it was always really appreciated. I wish there were more opportunity to do the same thing in the UK.
Communication was an interesting issue. The hospital staff all spoke excellent English, which is the language used in Ugandan schools. Like all the Ugandans I met, they were also fluent in several African languages. Many of the patients and relatives had not been to school, however, and so knew only the local languages. This was rarely a problem, as there was almost always someone around to translate who had a language in common with them, if not three or four. With only a rapidly fading knowledge of French, barely spoken since the 'A' Level Oral exam four years ago, I was easily the least linguistically talented person in the hospital.
The most fascinating aspect of my elective was finding out about the health beliefs of the people I met. Despite the increasing influence of western medicine, more traditional practices, involving witch doctors and natural remedies, still play a major part in people's lives.
The disease 'Lomara' for instance, which is characterised by symptoms including chest pain, difficulty breathing, cough and fever, corresponds well with what we would call pneumonia. During my time on the children's ward, I saw many such cases - one particularly stands out in my memory. A child of about one came in seriously ill. He had been taken to the witch doctor first, who had made six small cuts in the boy's chest. One of these was quite deep, going down into the subcutaneous fat. We were told that he had removed a strip of tissue and held it up to the parents, telling them that it was the worm that had been making their child ill. He then applied something caustic to the wounds, possibly paraffin.
By the time the child had been brought to the hospital, the pneumonia was extremely serious, the wounds were infected with a large area of blistering of the surrounding skin, and the child was in a lot of pain. When asked, the mother told us she hadn't wanted to take him to the witch doctor, but the grandmother and other senior members of the family had insisted. The child eventually recovered on antibiotics, although he was extremely lucky (providing he didn't contract HIV from the blade used). Another patient arrived with tetanus following similar 'local cuttings', and sadly was not so fortunate.
Also quite common is the removing of 'false' teeth in young children. These milk teeth are thought to be the cause of diarrhoea, and need to be removed for the child to recover. This is becoming very popular around Kuluva. During my stay one of the Ugandan doctors at the hospital began an education campaign, using churches, the primary health care team and the local Christian radio station, to try to reduce these sorts of traditional practices.
I had a fantastic time in Uganda. It was very hard work, and quite emotionally draining - for example seeing children die of conditions easily treatable in the West. However, it was also tremendously rewarding, and I would recommend a similar experience to any student planning their elective. I am hoping to go back to work in a mission hospital in Uganda or somewhere similar in the future, and I would love to go back to visit the friends I made at Kuluva.
Adam Brown - University of Newcastle-upon-Tyne
I was picked up, and we stopped off in the town centre. My first clear memory of rural Uganda is of a man going into a shop and saying something to the shopkeeper. The shopkeeper rummaged behind some boxes near the counter, and brought out a live chicken. The man tied its feet together and slung it over the handlebars of his bike. He then cycled off, with the chicken pecking his leg as he went. I knew these 10 weeks were going to be a little different from what I was used to!
The hospital had one English doctor (who left shortly after I arrived, promising to return one day), two Germans, and three Ugandans (one of whom had trained and worked in Britain). The nurses and other hospital staff were largely Ugandan, but also included two Koreans, several more Germans and an American. The hospital itself perhaps had slightly better facilities than I was expecting for example there was an X-ray and an ultrasound machine. However I thought it was extremely poorly equipped compared to what I was used to. This was especially true of the children's ward, housed in a series of dilapidated buildings. The children (the majority of whom were under the age of one) were often two to a bed, their mothers sleeping on the floor between the beds. The laboratory was also quite limited, with little more than haemoglobin levels and microscopy available.
When arranging my elective, I applied to several grant-making trusts for help with funding. I pledged that half of any monies I raised would be donated to the hospital. I was delighted to be given a total of £600, and could therefore give £300 to the hospital when I arrived. They were extremely pleased, and immediately ordered a new fridge for the laboratory, to enable them to run cultures and check organism sensitivities to antibiotics. They had been unable to do this for over a year, since their old fridge broke down. I was asked to pass on their thanks to the trusts and organisations responsible.
The medical conditions I encountered varied enormously. Some patients used the hospital as we would use a GP surgery, for routine management of chronic conditions such as high blood pressure and diabetes. Others had fatal conditions in much more advanced stages than I had ever seen before. Some patients had travelled hundreds of miles, including from neighbouring Congo and Sudan, where the facilities are even less well developed. There were many infectious diseases rarely seen in the U.K. including malaria, tuberculosis, leprosy, dysentery, cholera and tetanus. I also saw many patients in the end stages of AIDS.
I was glad of the opportunity to pray with some of the patients I met. After a few initial nerves, and with some encouragement, I asked several patients if they would like me to pray with them - none of them ever said 'no'. For many, it was virtually all we had to offer. In these situations it felt good to be doing something practical, and whenever I spent even just a couple of minutes praying with someone it was always really appreciated. I wish there were more opportunity to do the same thing in the UK.
Communication was an interesting issue. The hospital staff all spoke excellent English, which is the language used in Ugandan schools. Like all the Ugandans I met, they were also fluent in several African languages. Many of the patients and relatives had not been to school, however, and so knew only the local languages. This was rarely a problem, as there was almost always someone around to translate who had a language in common with them, if not three or four. With only a rapidly fading knowledge of French, barely spoken since the 'A' Level Oral exam four years ago, I was easily the least linguistically talented person in the hospital.
The most fascinating aspect of my elective was finding out about the health beliefs of the people I met. Despite the increasing influence of western medicine, more traditional practices, involving witch doctors and natural remedies, still play a major part in people's lives.
The disease 'Lomara' for instance, which is characterised by symptoms including chest pain, difficulty breathing, cough and fever, corresponds well with what we would call pneumonia. During my time on the children's ward, I saw many such cases - one particularly stands out in my memory. A child of about one came in seriously ill. He had been taken to the witch doctor first, who had made six small cuts in the boy's chest. One of these was quite deep, going down into the subcutaneous fat. We were told that he had removed a strip of tissue and held it up to the parents, telling them that it was the worm that had been making their child ill. He then applied something caustic to the wounds, possibly paraffin.
By the time the child had been brought to the hospital, the pneumonia was extremely serious, the wounds were infected with a large area of blistering of the surrounding skin, and the child was in a lot of pain. When asked, the mother told us she hadn't wanted to take him to the witch doctor, but the grandmother and other senior members of the family had insisted. The child eventually recovered on antibiotics, although he was extremely lucky (providing he didn't contract HIV from the blade used). Another patient arrived with tetanus following similar 'local cuttings', and sadly was not so fortunate.
Also quite common is the removing of 'false' teeth in young children. These milk teeth are thought to be the cause of diarrhoea, and need to be removed for the child to recover. This is becoming very popular around Kuluva. During my stay one of the Ugandan doctors at the hospital began an education campaign, using churches, the primary health care team and the local Christian radio station, to try to reduce these sorts of traditional practices.
I had a fantastic time in Uganda. It was very hard work, and quite emotionally draining - for example seeing children die of conditions easily treatable in the West. However, it was also tremendously rewarding, and I would recommend a similar experience to any student planning their elective. I am hoping to go back to work in a mission hospital in Uganda or somewhere similar in the future, and I would love to go back to visit the friends I made at Kuluva.
Adam Brown - University of Newcastle-upon-Tyne
