Day two! We started with an intro to health and security in Uganda, where we were advised not to touch dead people or the body fluids of anyone with Ebola - there was a confirmed case in Uganda a few weeks ago, but not in a district anywhere near here. As is true anywhere, staying safe here is mostly about common sense.
In Kampala, security has remained high since the terrorist attacks last year, and especially since the recent protests and political opposition to Museveni. As I mentioned, police checkpoints along the road are frequent sights, and as vehicles pull into the mall parking lot, guards check under each one with a mirror. Even going to dinner can be a little like going through airport security, with armed guards, bag checks or metal detectors on the way in. But it's not like the whole city is on edge - it's more a part of the daily routine.
We drove out to Makerere University, which partners with the Rakai program and has been coordinating a lot of this week's activities for us.
The drive through the hilly suburbs of Kampala was beautiful. Some of the houses in these neighborhoods are huge, modern, and wouldn't look out of place in California.
We toured the Makerere School of Public Health and met the dean of the school.
Views from the top floor of the school.
I'm used to seeing ARV drug charts on the walls at work...
but not for pediatric dosage levels.
We also got to tour Mulago Teaching Hospital, which is on Makerere's campus and is the referral site for cases from many surrounding district health centers.
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| via Oh MG |
Our tour was led by a senior nurse named Christine, who had been working there for 30 years, and took us right into the wards.
I'm not sure what I was expecting to see. The hospital is huge, but it is severely overcrowded and understaffed. The first ward we visited was maternity. All along the hallways, people - mostly families, but some patients - were camped out, some sleeping on mats on the floor, others sitting around talking or eating. A very pregnant woman was on her hands and knees on the floor. The wards were large rooms full of beds, one right next to the other, and all were occupied. The beds were metal cots with thin mattresses; many didn't have sheets. Christine told us that due to overcrowding, if a woman in labor comes in, she will be sent home to deliver unless it's apparent that she's having some type of complication.
The scene was the same in most of the units we saw. Some people looked very, very sick - skin and bones. There were puddles of standing water (at least, I hope it was water) on the floor in a few of the wards. In Emergency, a man who the police had brought in from the street lay on a metal stretcher in the middle of the room, clothes covered in dirt and lying very still. But he had been triaged, and apparently was alive and stable even though it didn't look like it.
Towards the end of the tour, we learned that the hospital has separate, private wards for paying patients, which we were not able to see. All of the patients we had seen were actually receiving free care.
Mulago Hospital is supposed to provide care for patients in one district, but people come from the surrounding four because there aren't quality health care facilities available in those areas. The nurses and doctors here work incredibly hard to care for all of them. Christine told us that if she had one wish, it would be the ability to follow patients and care for them through the entirety of their stay. Instead, she has time to see each patient for only a few minutes before it's on to the next, and she may not see them again.
After the hospital, we drove out into the country to tour an annex site which will soon house part of the public health school. We also got to visit District Health Center 4.
Part of the site, which is government property, is currently being used by the military, because Besigye, the opposition leader, is staying nearby. Outside a building, many small black tents were set up in rows. Men in uniform stood around with serious-looking guns, and - this is the strange part - a large group of children was running around in the yard playing. We weren't able to get a clear answer about what the kids were doing there. Communication here can be interesting; I'll write more about that later.
Simon, a university administrator, showed us around the site.
One of the buildings being renovated at the annex site.
District Health Center 4
This sign at the district health center surprised me - but apparently this is the current recommendation according to recent findings.
At the district health center, separate small buildings housed each ward. We visited maternity, where the scene was much quieter than in the hospital. We asked the nurses if any babies had been born today, and they enthusiastically told us yes and led us into a room with three beds where mothers were resting with their incredibly tiny newborn babies. Because we are being treated as important guests here (an interesting/slightly uncomfortable first for me), and we had asked to see the babies, the nurses started to try to wake them up and take them from their mothers so we could see! We quickly told them not to bother - we got a glimpse of the babies and they stayed (mostly) asleep.
Just a reminder. Avoid contact with dead bodies.
And here's a video of the drive back:
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