Grania: First week at work

Well it’s a rainy Sunday afternoon in Kampala so I’ve got plenty of time to update you on our exploits. I have now completed my first week of work although they have been very nice and given me a two week “induction” period so it’s not been as bad as it could have been.

I am working the first half of the week in ReachOut, a clinic attached to Our Lady Parish of Africa Church in Mbuya. It seems to be really forward thinking in its ideas. It believes in complete care of people with HIV so although the medical aspect is important, they also realise that there is a lot more involved such as finance, food, capacity building and education.

Monday, was as every first day of a new job is, wandering around lost and feeling pretty useless. I was being introduced to lots of people, struggling to remember anyone’s name but everyone was very friendly. The afternoon I sat in on the clinic which will be mostly what I will be doing. Everyone here is so sick and so young. I keep being told that once I’ve been here for a while I’ll see people improve on ARV’s (Anti-Retro Virals, i.e. treatment for AIDS) but it is horrible to see 18yr olds newly diagnosed, with CD4 counts of less than 50 (severe advanced AIDS) cradling a 2 month old baby who looks sick as well. By the end of the clinic I realised that I am going to have to turn everything I know on its head – we had a young girl who was very unwell, HIV +ve, CD4 count of 10! She had a 18cm palpable spleen, 8cm liver and widespread oedema (sorry to all non medics out there, you can skip to next paragraph!) My usual lists of diagnoses were all useless but at least now I have seen my first tropical spleen – essentially very severe malaria (blackwater fever) in someone with no immunity.

Tuesday I was joined by Mark, who was the volunteer doing this job before me and fundamental to setting up the other main aspect of my job – the TB project. He is trying to set up and run a low cost, rapid TB diagnostic test. The test has been shown to work in Peru but not much work has been done in Africa. By the end of the year we are aiming to have it up and running as a useful test and possibly even start getting an idea if there is any drug resistant TB out here. As with all new things there is an awful lot of politics surrounding it and that was what Mark had come out for a few days to help me start to understand. I met some of the people who want to make this work and had a tour round the fancy new lab to run the project out of. For this side of the work I will be based out of IHK, which is a part private, part public hospital, set up and run by a Northern Irish doctor who has been out here for ages. (Proves the point that people from N.I get everywhere!) As well as the TB work I will be doing a ward round on the public ward (Hope ward) and starting the very first Chest clinic. I think this will become my refuge, a place of safety where for a brief period of time I will be doing stuff that I know about! The hospital itself looks very smart and clean but apparently although it looks fully up to date there are definite elements that are still in the developing world!

The rest of the week has mainly been spent at Reach Out seeing the other aspects of their care – The pre-test counselling which was excellent, in fact even better than some of the counselling I’ve seen back home. I found out about their CATTS service, who are community based workers (many of whom are HIV/AIDS patients themselves) who go and see everyone on treatment, ensure they are taking their treatment properly but also keep an eye out on the other social problems that may interfere with their health.

I did another clinic and my job title of “doctor with special interest in TB” ensured that everyone I saw had TB. This however is nothing like the TB I do back home. A gentleman with most likely drug resistant TB (but as we don’t test for it we don’t know) who has been thrown out of his house by his family, lives in the back of his sisters house surviving on a small bowl of rice a day and the last time he was strong enough to stand unaided on the scales weighed just over 5 stone. Back home I would have admitted the man immediately but here that costs money, doesn’t always guarantee treatment so instead I get to prescribe emergency food rations. There was also another little girl, only 13 with abdominal TB, who has jaundice from a reaction to all the drugs she was taking and again underweight. She is the main carer for her Granny, both her parents dead and we have to try and manage her problem from home. She was so very sweet and helped me between patients practice my Luganda (the local language) and all she wants to do is get better enough to pass her exams to get into secondary school….

I hope this isn’t sounding too depressing as although there is A LOT of sickness here and the age of the patients involved is so young, there is also a lot of hope and good work being done to help the problem, and most encouragingly the majority of work is being done by the Ugandans themselves. As they say in Reach Out, Live positively!

4 Responses to “Grania: First week at work”

  • Hi Grania
    Just to let you know we have (finally) got access. I will be watching progress with interest. Great work. Keep it up, and remember we are here if you need a chat. D

  • Mum says! great to hear that all is going well and you seem to be coping really well–Independence Day reminded me of Jomo Kenyatta’s garden parties with goat butties and coca cola! Enjoy! –

  • Good To hear about you…. And your exploits. Best Wishes.
    Keep up the good work. Love from both of us.

  • Well done Grania! We are all very proud of you indeed. We think you are just pure fabby dosey! Will keep looking at the site for more progress reports!

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