The interns were welcoming as was the sister and we arrived as their rounds were taking place. There are about 40 children under the age of 5 and more children are on general wards and several arrived while I was there. There is ONE nurse taking care of all of these children who are very ill, there were two students, one was looking through charts and the other was running errands. The interns were seeing an endless line up of children waiting in their mothers arms. Some things that surprised me was that no vital signs are taken and recorded and that the doctorgot up at one point and weighed a child. I suppose with only one nurse who was at that time drawing blood, that's the way it is. The first few children were very sick and I saw several with sickle cell, one who had been in the hospital a few weeks ago and was discharged but then ended up back having had no treatment at all since he was discharged. He is a beautiful little two year old and you could almost feel how painful it was when the physician moved his swollen limbs. What was a bit more painful is that he kept moving them to show me how painful it was for the child. Ouch! My goal is to study far more tonight about SC as I haven't exactly lived in places where we see an abundance of it and suddenly there were textbook examples right before my eyes. The next three children were suffering from malaria and so ill. Fevers, pain, anorexia, and so the list went. For the doctors it was an almost endless line and stretched across the ward as one tired mother after another carried her child up to them. I was looking at the mothers faces and thinking that I would have no idea at all how old they are. None. For the most part they looked too old to have a child to me. After some time a boy of about 7 was carried in by his mother and grandmother. He was limp and the intern who had spent the most time talking with me jumped up and ran to a cot to examine him before I realized what was actually happening. He was coming in from the out-patient department. He was unresponsive and three staff members tried to get blood from him until at last one was successful, I am sure that on top of all else he was dehydrated as they simply could not get the vein, one doctor ended up poking his own self and had to wash up and take anti-HIV medication while others continued to work on the boy, they finally got blood through the femoral artery as best I could tell and the child cried out in a very hoarse voice, to be honest I was happy to hear at least a sound from him. Although I would still classify him as "unresponsive" throughout the rest of the time I saw him. The mother and grandmother appeared to be almost numb and said that he had only been sick since last night which might not be possible. I wonder what kind of obstacles this family faced trying to bring little Steven in, transportation, arrangements for children at home, and of course money even though the treatment at the hospital is free no doubt there are many expenses involved. The doctor did not even have a guess to what was going on but the blood work came back very fast and they was some rushing about and exclaiming over the results. I got a fast enough glance at the lab paper before it was whisked away to say that I have never seen blood work that was this out of whack. WBC was three times above normal, his platelets were so low that a student nurse was rushed out to go get blood so they could start it immediately. Then the bad news, No blood at all in the blood bank. The boy was moved to a bed, the doctors went back to other patients, they had a few laughs and discussed some other items and the child and his family seemed to have been left behind in the thought process. The most that I could glean without being intrusive, as I was only there as an observer, was that they were going to try to transfer him to another hospital, and whether or not he could even survive a transfer remained a question to me. And what hospital? We were at the Regional Referral. In all it looked catastrophic and for an older child who appears to have been a healthy child with adequate nutrition prior to this event I think I could venture a guess what will happen but I might not be told immediately. I said good bye to the staff shortly thereafter and wrote down his name as I want to follow up on him when I return from Kampala. There are so many like him who I didn't truly see the other day and it all became more real for me as I saw him come in, for the rest they are just lying in their cots in the heat and with family members caring for them. It was all there, I just didn't really see it until I came to know the children's names and saw their mothers faces. That poor, poor, family. There are tough days ahead. There is no chance that I can imagine that this child will survive the event and I feel frustrated, tired, and ready to get to work.
I had some mixed news from one of the nurses who I had met in the Neonatal until. The little 1 kg baby did not survive, I didn't honestly think he would but had hoped, he died not long after we left and the mother is doing a bit better and has been released and the malaria is stable. When the nurse came up to me she spoke in Lango and I answered and for some reason at least 5 words came rolling out of my mouth, which is sort of the beginning and end of my Lango so far but it was nice to at least be able to speak and to see that this helped bring at least a few smiles to some faces.
Only one nurse on duty in the children's ward seems so impossible because these children are all so very, very sick. Another nurse came in for a few minutes but was dispatched off to somewhere else and the two student nurses were busy with their own tasks, one is training in public health and recording something in a book which is no doubt important statistical data. We are going out to another hospital tomorrow which I understand will be smaller and maybe with "less" resources.
Agnes and I had a long chat after we finished on the ward and I was able to get a better idea on what I will be doing, in addition to teaching I will also have about 5 students with me on this Pediatric ward at least one day a week. It would be helpful to have a few more hands around I am sure but I need to keep our nurses on track as to what they are there to learn and best practices in that environment. I came home eager to start doing more research on malaria in children. I knew that this is the way it would be on an intellectual level but most certainly was not prepared for the strong emotional reaction I saw these children, these aren't tiny babies, these are real kids who were learning their first words, toddling about and laughing and playing perhaps just a few days ago. It would have been a stretch to imagine the hospital before I got here, no matter what I had heard. I can't even totally grasp what it is like to work with with no blood, and children lying about without intervention and with one nurse. I am sure that there is much more going on then what is visible with my limited knowledge of the language or the care which they are trying to provide but it isn't going to be easy.
I had a very positive glimpse of what USAID is providing to the people here through the website "Sustain Uganda" when I got home as I wanted to read more about the hospital and ended up writing my therapeutic journal/blog. The boy in our home seems to have broken his thumb playing ball at school today. He is about 12 and they had no tylenol or aspirin for him and seemed to be upset about the fact he would have a hard time writing his exams, meanwhile the boy was tearing up and trying to be brave. I feel like I am at the bottom of a great big hill looking upward and wondering how on earth I can make a difference in the lives that touched me so profoundly today. I can't change anything today, or tomorrow but I most certainly am going to be doing my very best to help train some nurses to relieve Susan's duties as she had her hands full. Time to study Lango so I can actually develop more sentences. Feeling a bit deflated and overwhelmed but also feeling like I still have a great deal that I can contribute, and will.
In the meantime I found this article from a local newspaper on line which probably sums up much of what I am trying to say far better than I ever could. It is from 2012 and I hope that things have improved since that time, I haven't been in the hospital on a weekend so time will tell.
"Lira Regional Referral Hospital is facing a crisis as it has only nine doctors offering medical care to more than 500 patients per day. According to the principal administrator, Mr Henry Lwigale, the hospital requires 39 doctors. “It means that we cannot provide some specialised services because the clinicians are not there,” Mr Lwigale said on Wednesday.
Being one of the only two regional referral hospital in northern Uganda, many patients are stranded at the hospital. Some are forced to travel several kilometres to Gulu Referral Hospital for specialised treatment. “That situation has made service delivery a bit difficult because some health facilities are overworked while others are redundant,” he said.
The District Health Committee chairperson, Mr Moses Ogwang Adonyo, said due to the shortage of health professionals, sometimes patients are not attended to on weekends.
“They (health workers) work only on week days; when a patient reaches the health facility you have to wait up to Monday but it is not even guaranteed that when it reopens on Monday, you will get help,” Mr Ogwang said.
“They (health workers) work only on week days; when a patient reaches the health facility you have to wait up to Monday but it is not even guaranteed that when it reopens on Monday, you will get help,” Mr Ogwang said.
“The few doctors cannot do much to help us in case of an emergency. I took my wife to the hospital in September last year but unfortunately she died before seeing a doctor since it was a weekend,” said Mr Denis Obang, a resident of Adyel Kisubi, Lira Municipality.
Lira Resident District Commissioner Susan Akany confirmed the challenges the hospital is grappling with.
Ms Akany said recently she got information that some babies died at the hospital shortly after they were borne. She blamed the incident on the crippled healthcare system. “Power went off all of a sudden and by the time they could start a generator, the babies were already dead,” the RDC said, without offering details of date of the incident and the exact figure of the victims."
