Leprosarium – not a word you often come across in England. In fact, I don’t think I’d ever heard the word before, and yet I was heading towards one for a three month stay. ‘St Francis of Buluba’, as the hospital is now more attractively known, began life on the shores of Lake Victoria in the 1930s as a centre specialising in the treatment of leprosy. Due to the decreasing incidence of this most curable disease the hospital has now taken to covering many other specialities including general medicine, surgery, maternity and paediatrics. There is also an outpatients department with regular visits from specialists in ophthalmology and dermatology, as well as specialised HIV, TB and antenatal clinics.
The hospital itself comprises a collection of small buildings set amongst hospital owned farmland which contain the various wards, the laboratory, the physiotherapy block, the theatre and also an administration office and canteen. The majority of these buildings are set behind a high fence with two security gates designed to stop people sneaking in, but interestingly also to stop people sneaking out. Buluba hospital is not-for-profit and gains significant financial support from various groups including USAID and the German Leprosy Foundation, but sometimes even the small fee requested cannot be reached by various patients, and a number are kept in (albeit quite amicably) until they can find the money to cover the services they have received.
After the grand tour of the hospital and following introductions to extremely welcoming members of staff, my first week began on maternity with a doctor of a similar age who is soon hoping to specialise in obstetrics. The ‘labour suite’ has four delivery beds each intimidatingly upholstered with a section of disposable tarpaulin and arranged in a somewhat awkward fashion directly opposite each other. The morning I arrived there was one lady present in the full throws of labour who had been transferred from the care of a traditional birth attendant as she had still not delivered after a long time pushing. One significant problem with healthcare in Uganda is the poor access to medical services. There are many causes for a lack of access – it could be a relative absence of the healthcare facilities themselves, or it could be poverty that prevents local populations from affording the services or simply transport limitations. Due to all these issues of access it is quite common for pregnant mothers to instead seek the help of traditional birth attendants, or TBAs. They are cheaper, more numerous and often more culturally accepted, though they are completely untrained. This lady in question had sought the care of a TBA. She did not have her obstructed labour identified promptly, was transferred late and eventually delivered a birth asphyxiated baby that required resuscitation. She also went on to bleed heavily following her delivery and required two additional surgical procedures to stop her bleeding. This lady’s case was unfortunately not unique. Throughout the week it was common to see patients presenting later in their pathology, and therefore sicker, as they were unable, for whatever reason to access the facility sooner. Buluba runs regular antenatal clinics to identify mothers who are at risk of complications in labour, carry out vaccinations and general health checks and advise the mothers to deliver with a skilled midwife either at the hospital or at a registered local health post. To attempt to overcome the problem with access a free weekly outreach service visits local villages to gain contact with the mothers who cannot attend the hospital.
The accommodation provided at Buluba is a very reasonable guesthouse set amongst the farm land and usually houses two people, though just me for now. This special plot of farmland boasts the loudest cow in Uganda, who runs the risk, if he chooses to persist in his 3am foghorn impression, of being transformed from his current self into a stack of deliciously silent beef burgers. Despite this occasional mooing, the accommodation is a comfortable place to return to after work and apart from the gangs of flying insects that gather for the nightly ‘Fiesta del Lightbulb’, no other unwanted house dwelling creatures have yet been spotted.