Learning from Emergency Room Experts in Uganda

Published 11/04/2022 in Scholar Travel Stipend

Written by Nhi Ho | 11/04/2022

In February 2020, I participated in a month long global health rotation in Kampala, Uganda in order to learn how medicine is practiced in an under-resourced setting. Little did I know, the United States would also suffer from shortage of resources soon thereafter

Here are two valuable lessons from Ugandan medical providers that I believe are crucial for any medical providers on the front line of COVID-19: be flexible and be resilient.

the last few days, the rates of new coronavirus cases in the United States increased at an alarming rate. Across the nation, schools, conferences, and businesses closed and states implemented various versions of shelter-in-place. This is all in an effort to “flatten the curve” in order to alleviate the strain on the medical system. The scary truth is that we are already experiencing shortages, from swabs to ventilators and personal protective equipment (PPEs).

While this is new to the United States, this was every day life at Mulago Hospital, the national hospital and tertiary referral center of Uganda. Mulago Hospital cares for over 700,00 inpatients; 60,000 emergencies; and 40,000 deliveries each year. Despite this high volume, health spending in Uganda is only at 1/3 of what the country needs at $14 per capita.

In this setting, medical providers were required to be flexible. It was not possible to follow regimented routines and guidelines. For example, by midday, the Mulago emergency department would run out of gloves and masks. To accommodate, students and residents quickly learned the importance of bringing their own gloves and hand sanitizers. Instead of plaster casts, we made casts from cardboard. This may seem strange to someone who has only been in the healthcare system in the United States (before February 2020), and it was definitely alien to me when I first started working abroad. But it was necessary to for providers and the hospital system in Uganda to improvise on a daily basis in order to provide the much-needed care for patients. Change is now the new normal for hospitals in the United States as they have to adjust to deal with the exponentially increasing coronavirus caseload. Frontline medical providers will have to be flexible and think outside the box. After all, a cardboard cast is better than no cast at all.

I also learned no matter how no tired, dejected, and hopeless I may feel as a provider in such a limited resource setting, framing the situation to be about doing the best for my patients will always help me return to work the following day. The emergency “department” is actually a 30ft x 30ft room with beds flushed against each other and patients lying on the floor and hallway. On my second day of service, I found myself caring for a 30-year-old man who had a motorcycle accident and brain bleed who laid unconscious with a GCS of 3 and an oxygen mask. At midday, the oxygen tank had ran out and the patient lost his pulse. We started the resuscitation efforts and after 10 minutes he did regain a weak pulse. But there was not much else we could do…there were no beds in the intensive care units…there were not even a working ventilator in the emergency room to help breath for him. He soon expired, and we decided to let him go.

I became nauseous and initially did not want to ever return to the ED again. Despite the intense care and hard work that the residents, nurses, attendings, and medical students put in to resuscitate the patient, the institutional limitations prevented us from continuing care. We were helpless. I took it personally and felt like I had failed the patient and his family.

That afternoon, Dr. Gisha, an intern and aspiring ED doc, noticed my ashen face. I asked Dr. Gisha, “Why, despite the particular challenges and stress with the current situation in the ED, does she still want to be an ED physician?” Dr. Gisha shares that because of the high mortality rates and lack of resources in Kampala, there is a general acceptance amongst the people and staff that death is a common part of life. But Dr. Gisha believes that it is her role to always fight and do what is best for her patients. This mission drives her every day, no matter how challenging that day may be.

I returned to the ED the next day, and the rest of the week. I focused on doing what was best for the patients, and less on what I could not do. I did more dressing changes and gave more stitches to many more patients on this 1 week ED than during my 4 week ED rotation in San Francisco. I cleaned patients with full body burns, helped a woman who only spoke Lugandan call her mother, and not only placed my first IV but also taught other western medical students how to do so.

In just three months, I will become an intern myself at USC-LAC County Hospital. COVID-19 and a nationally strained medical system will undoubtedly make internship a wilder ride. The lessons that I learned and my time in Uganda will help me persevere and focus on providing competent care for my patients.