Disclaimer: The views expressed on this website are entirely my own and do not reflect any position of the U.S. Government or the Peace Corps.
Yesterday I was invited to travel with 2 other teachers to community sites where some of the students will be staying for 1 month. What an adventure! We had 4 health centers to visit and it took us about 7 ½ hours. First of all allow me to explain the health center divisions we have here. They start with VHTs – these are Village Health teams which consist of village members who have one day of training and who visit the sick, assist the sick to hospitals, and other lite duties. Then there is the Health Center I – this is basically a clinic which provides basic first aid with only minimal to no medication dispensing. The Health Center II is a clinic which provides more extensive care and medication dispensing without maternity or surgical care. Health Center III treats many illnesses and has maternity/labor and delivery services. Health Center IV has all the previous and includes a “theater” or surgical room. The next step up is the hospital. So, the students will be practicing in the Health Center IIIs and IVs. They get a lot of experience in these facilities, along with public health and family planning. So, the first facility took us about 1 ½ hours to get to. It was the only Health Center IV that we visited and they did not have a surgeon on the premises so the surgical unit was not fully developed. This is true of most of Uganda. The second and third facilities were close to each other and took another hour to reach. One of these Health Center IIIs had Cholera tents out back. As you might note, the ambulances were in disrepair and the staff told me that most facilities only have one ambulance (hopefully) that is in working order. Want a ride? (See picture) The last facility we visited took another 2 hours to travel out to rural “Tim-Buck-Too”. So, you live out this road 4 hours from nearest hospital. You are in labor and the baby is having problems or the placenta is rupturing. There is no surgery at this site. It is raining......You can take it from there - truly sad conditions. The road was rutted and at points we were driving on the shoulder or down the middle with large holes on either side. Oh, and remember, there are no speed limits so everyone drives way too fast. So, we are cruising up a hill in the middle of the road, ruts on either side of us, at about 45 mph, and you can’t see what is coming up the other side of the hill, or the next hole that is in the middle of the road at the top. Suffice it to say, they use their brakes rather quickly. At one point on the way home (after the rain) we started sliding. It was very flat and luckily not a concern about getting stuck in a rut right there. It surprised me and was kind of like a roller coaster (I was not scared though) so I let out a squeal and that got everyone laughing. They were joking about things like doing the twist on the way home, not needing a massage because the bumpy road was doing plenty of massaging, and making milkshakes of our lunches. I think it made them happy to see I wasn’t worried and believe me, I kept them well entertained!
Today was Global Handwashing Day. Today was my first day in the hospital. I went through a quarter bottle of hand sanitizer. Despite the lack of running water, I think I contributed to the support of clean hands. For the most part, the students did well with what they had available. It is challenging trying to keep track of 114 students who I don’t know throughout 18 different units spread out over 14 different buildings. Were they "dodging" me, sneaking out of the hospital, or just going to another unit because they were not busy? I wonder how long it will take me to learn all the students??? I was able to get masks for the students in the TB ward – not the good ones, but they are better than nothing. My biggest challenge was medication pass on the medical unit. When I entered I found 8 students gathered around the medication cart with disappointing looks. When I asked they said, “Oh, sister. The nurse is not here and the medications are not there.” Two wards with no nurse (maybe 20 patients), students who are brand new hanging IVs and giving injections. To try to make a long story short, 8 students passing meds without supervision, blocked IVs, missing medications, no place to chart which meds were given, restarting IVs, blood dripping, no gauze, no gloves, no pads to keep the blood off the beds, things falling on the floor, needles on the bed without caps, no handwashing, etc, etc. Yeah, you get the picture. Some of the students got smart and went to another unit for gloves. We commandeered the physician on the unit for help restarting IVs if the students could not access them. We are learning how to mix drugs into an IV bottle, break an ampule that is not scored (they are really hard to break with jagged edges everywhere and they use their bare hands), how and where to chart, and how to choose the right sized catheter for the patient’s vein. Hence, I loved it! It was great to be on the floor – stressed out and all! And for those of you concerned….I refused to touch a patient’s IV until I had gloves on. So, another day tomorrow, I am sure there will be many more stories to tell.