Tuesday, 18 March 2014

Nicola Credland's Uganda diary - entry 1

Uganda Diary

18th March 2014

After a mammoth five hour drive from Entebbe I have finally arrived. AGIP hotel is great (much better that the flight hotel I stopped in at the airport!). The drive from Entebbe to Mburara was amazing. Loads of tiny children (3-4 years old) running around naked and with stocking feet. Fantastic scenery and a running commentary from a brilliant taxi driver (Moses). Literally checked in and then decided to walk to the university to meet Mary Sebert, a Lecturer in Nursing at MUST (Mburara University of Science and Technology) . Uphill, in 28C heat and about a mile away so not the easiest start to my visit! Seemed to make quite a stir as not seen another white woman since I got off the plane.

Mary is fantastic and we hit it off straight away. First things first, a tour of the hospital. I had tears in my eyes on numerous occasions. The general wards have one nurse to approx 50 patients. Nurses 
have little time to do anything other than dispense medication. The families wash, feed and care for the patients - none of this is provided by the hospital. The interns do vital signs but again this is spasmodic due to lack of equipment and lack of available treatment. Very little documentation is done - none at all by nursing staff. Patients simply do not get treated if they have no money to pay. There is limited access to medication (metronidazole is the only antibiotic) and they are prohibitively expensive (most families cannot afford even a single dose). Patients even have to provide their own oxygen. There are adults and children alike dying of completely treatable diseases. There is no s cardiac arrest team or trauma team and little understanding of the importance of recognition and rescue of the deteriorating patient (patients and their relatives simply cannot afford that level of care and the equipment and medication is not available). The “intensive care unit” is a world away from what I am used to. They have two ventilators and all the beds have cardiac monitoring; however, the staff do not know how to use them. They rarely ventilate patients (again down to cost) and when they do, rarely have oxygen. One suction catheter has to last 24 hours. The electricity fails between Friday and Sunday on a weekly basis and there is no back up generator - the relatives have to hand ventilate with an ambubag. The NICU has no ability to ventilate babies. I saw a man in A&E in partial airway obstruction - the family could not afford treatment so we had to walk past. This is probably one of the hardest things I have ever had to do in my whole career. A five year old had a perforated bowel due to typhoid - the family could not afford the operation and after care costs - andthe child was left to die. According to Mary these are everyday dilemmas.

However, the student nurses that I met are passionate, enthusiastic and are so excited to learn. They are like sponges mopping up every little bit of information I could give to them. They are so excited about being taught by a nurse 'from England'. This is both invigorating and humbling to the same degree. I wish I could bottle 'it' and bring it home. The NHS could learn a lot from these nurses.

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