June 19, 2014
I haven’t posted in a couple days because there really hasn’t been much exciting to report, just work at the clinic every day, and occasionally seminars in the afternoons. We’ve finally settled into a familiar routine, with breakfast, rounds, clinic hours, lunch, and seminars, as well as free time. We had a few interesting cases this week, so I’ll probably talk a little bit about them, and we’ve gotten to know Allen, the medical officer at the clinic, quite well over the past few days.
One of the most common things we test for at the clinic is malaria, and I’ve gotten to know the symptoms quite well in just the short time we’ve been working here, because we’ve had several cases of severe malaria already. Many of these cases we admit to the clinic for treatment, because we need to give IV meds and fluids. We also see a lot of bronchitis and pneumonia, which is probably one of the most surprising things I’ve found in the clinic work.
Waiting room at the general clinic, and some of the patient rooms
We’ve also seen some really interesting cases, particularly this week, several of which are cases that I will probably never see in practice back home in the US. During morning clinic yesterday, we had a 52-year-old woman present with generalized abdominal pain and general weakness, but not much else. When we examined her abdomen, she had what we at first thought was a mass on the left side, but turned out to be her very enlarged spleen. Unfortunately, she was very poor and was unable to afford most of the tests we needed, so we had to settle for just an ultrasound and limited blood tests.
It turned out that her spleen was so enlarged that it crossed over her abdomen to the right side as well as down almost to her pelvis, and she was HIV+. Many people who contract HIV here either don’t come for testing, or can’t afford testing and care, and she had been sick for several years before the pain finally got to be too unbearable and she couldn’t lie on her left side due to the splenomegaly. We have seen several severely immunocompromised HIV+ patients at the clinic, with varying degrees of opportunistic infections and illnesses; her splenomegaly turned out to be a result of her HIV infection, something which only really happens with advanced HIV.
Another view of the inside of the clinic
It’s been a really difficult experience at times, especially when we hear that testing and medications can be around 25,000 Ugandan shillings-the equivalent of ten US dollars. Here in Kabale, though, that is a very large sum, and most people don’t make enough money to pay fees like that, or for school fees. We’ve learned a lot about the villages and local communities, and the economy here is not a cash-based economy, which makes it very hard for people to find money to pay for things like medicine and school fees. Many people farm, and eat the crops that they farm, so subsistence farming is much more common than commerce farming.
A little girl who came to the clinic for treatment-with the balloon friend Marni made for her!
Some of our group has also been doing village outreaches to conduct nutrition and maternal health surveys with members of the Rubira community; sometime next week we should have the data they collected so that we can come together and discuss the biggest challenges the women in Rubira face, and what strategies KIHEFO can use to help them. I think this is my favorite part of working with KIHEFO, because they want to implement “local solutions to local problems,” in Dr. Anguyo’s words. They pay very close attention to the communities they serve, and they seek to aid those communities in measures they already use.
Other than clinic every day, there isn’t too much to report, sadly. Tomorrow morning at 5:45 AM we leave for safari, and we’ll be gone until Sunday evening. Next week is filled with community and HIV outreaches, so I should have a lot to talk about then!
Until next time,