In September 2015 I travelled to Kitovu Hospital, to spend two weeks as visiting physician at the medical ward, thanks to the support of Rotary Doctor Bank. It was my third time there, so fitting in the dynamics of the ward was relatively easy. I certainly felt welcomed. Some diagnostic facilities have improved since my first visit: the quality of X-ray films is much better and also the ultrasonographic reports, thanks to a new technician. Laboratory facilities are basic. However diagnostic means are limited as many patients cannot afford them or you can order them just on admission, so you have to get the most out of clinical history and physical examination. That determines that ward rounds are long, due to the need of translation into English and the need of performing a thorough physcial examination every day; sometimes we started at 8am and finished at 4pm, non stop. I tried to help widen some differencial diagnoses and emphasizing the need for clinical reasoning in the context of the practice of medicine in a limited-resource setting.

As in every previous year, we had some very challenging patients, and I am always shocked when I get there because of the severity of the HIV/AIDS epidemic, with 100,000 new cases during 2014, less than the previous year but still with an incidence over 7%. Many patients were very young and got to the hospital with very advanced diseases, so sometimes it was too late to try any effective treatment. Some deaths are still an avoidable tragedy. The AIDS clinic does a very good job, but it has a daunting task.

 The medical officer and the two interns were new, that is one of the challenges of the hospital: doctors and nurses work a lot if they want to, and salaries at the governement hospitals are higher, so the turnover of health personnel is high, once they have been trained they leave, so every year the training process starts almost from scratch.

 For the first time in my three visits I looked after patients with spinal cord injury, my current field in Spain. Probably in any resource-limited country that medical problem is almost impossible to treat, as it was in Europe before 1944, when Stoke Mandeville, the first hospital entirely devoted to those patients, was opened. Doctors were interested in this topic, so I managed to deliver a brief update in the context of their continuing medical education (CME) sessions.

The country seems to be improving, albeit little my little: the road from Kampala to Masaka is now completely tarmaced and there seems to be more foreign investment (mostly Chinese and North American). During my two weeks, there were no power or water cuts. People are expectant about next year general elections, even though any meaningful political change seems unlikely. Luckily, violence seems also unlikely and the country seems to be stable.

 I´d like to be able to continue with my visits during next years as I think I can still be of certain help. I certainly keep learning from my visits. 

 Angel García-Forcada MD

Toledo, Spain