hospital staff

So the work I do here will have to be spread out in many blogs, since there's so much to tell! I thought I’d try to explain the hospital a little bit today. The hospital is similar to ones I’ve seen in other parts of Africa. There are a series of interconnecting buildings for each ward; I spend most of my time in the female and male general wards, which consist of two rooms with two rows of about 25 beds in each row. There is an ICU of some sort which I haven’t found yet; and there are three small rooms where the new patients are admitted to the hospital before a bed assignment happens. There is about 1 nurse per ward, and I haven’t quite figured out what they do yet beside give some iv medicines, answer a few questions for the patients, and occasionally help us position a patient or organize a chart. I’m sure they do more but I’m not sure what. The families of the patients feed the patient, give oral meds, bathe the patient, and generally take care of them. They often just lie on a pallet on the floor in between each patient’s bed (about 2 feet of space!). Privacy for procedures only occurs when a small screen is dragged in.

The medical students really seem to be the main force behind patient care here. There are 30 of them on our wards at once. 30!! In Portland, there are 6 at most at any given time. They do EVERYTHING. They check vitals, give iv meds, draw blood, take urine samples, run slides to the labs, do biopsies, counsel the patients and their families, get patients to pay for laboratory tests in advance and then chase down the results of the labs and put them in the chart, start iv’s, start oxygen, etc. They actually even get to decide to admit patients themselves; they see them in the outpatient clinic and if they think a patient should be admitted, they walk them over to the general wards, put them into a small holding room, and write out this huge history and physical. They then present the patients to the attending and senior resident in post-take rounds and hope the attending agrees to admit the patient; I honestly don’t know what happens if the attending does not agree!

It’s hard to comprehend the differences in the role of the medical student here. It seems at times as if the medical student has too much responsibility and not enough supervision, but at the same time, I think we in the US often baby our medical students because we don’t want to offend patients. No one wants to be the first patient who a medical student tries an iv on, you know? And we are reluctant to ask. Plus, we are spoiled by having nurses who do everything in the US. I haven’t started an iv since medical school. Here, no one else will do it but the medical student, so there is no choice. In part, the residents and doctors are so busy, they don’t have time to help each of the students as much as they would like, so the student learn more independently than we do in the US. But in another part, I think there is simply the expectation that the medical students should be more independent, too. They do work really hard. The old British system seems to be a harsher system than we have in the US, and medical students are “pimped” (asked question upon question about a certain disease until no one knows any more answers) quite a bit more than I am used to. I think it generates more independent reading and memorization than I ever did. I am amazed at the amount of knowledge they retain. They have a much more formal relationship with their attendings than I am used to and sometimes I feel sorry for them as they seem a bit fearful of their attendings but it could also just be me not understanding the cultural deference that young people give to their elders here. They seem so eager to have any personal teaching time so I am happy to do that for them. I worry sometimes I may not have much to teach them but I’m trying to be confident that two years of residency DOES make a difference! They are all very polite and nice and I enjoy working with them. In fact, everyone I work with has been kind and fun and polite, which is what I had heard about Uganda. You do have to spend a lot of time greeting people before getting to anything else in the conversation but it does seem quite genuine, actually, not just a mumbled “how are you doing” without waiting for an answer but true concern for “how are you? How was your morning? How are your children?” etc, etc.

As for the residents, there are only 2 interns here and they have 12 hrs on, 12 hrs off EVERYDAY; no days off! During their 12 hrs, they do all new admissions and any cross-cover calls on all the patients with a little help from the senior on call (I think). After intern year, they do a year or two of research and clinical practice of some sort. Then they come back for 3 post graduate years. So I am the equivalent of a post graduate level 1 since I just finished my internship, but the level of proficiency is not the same; I think experience-wise I might be closer to a PG level 2. There are 3 residents in each PG level. I won’t even attempt to explain their convoluted schedule to you!

I haven't yet figured out how many attending physicians there are but I think there are about 8. A few of them are UK doctors who are just the brightest, funnest people and thanks to them, our white faces aren't too strange here so I don't get stared at quite as much as I thought I might. All of them seem to be incredibly devoted to constantly up-ping the standard of care in this hospital and I think it is just great.