Report from Buluba Hospital – Dr. G. Kenzo Saito.
I am a Canadian emergency physician and family physician who recently had the opportunity to volunteer for a month at Buluba Hospital in Uganda. I was excited to follow in the footsteps of other Rotary Doctor Bank volunteers and am very grateful to the organization for making this experience possible.
Buluba Hospital is a community hospital serving the Mayuge District. Founded originally to treat leprosy patients, the facility has evolved into a more comprehensive general rural hospital providing outpatient and inpatient services for both adults and children. The hospital still remains one of the country’s major centres for newly diagnosed leprosy patients as well as those experiencing complications post leprosy treatment (e.g. leprosy reactions). Clearly, there is a lot of history associated with this place. The hospital is a non-profit organization that receives funding from the Ugandan government as well as international organizations, including USAID and the German Leprosy Relief Organization. Patients pay a small fee to cover hospital expenses and this helps to ensure that the hospital continues to function in a sustainable way.
I was quite impressed with the ability of the hospital to serve a large rural population and take care of a wide variety of medical and surgical conditions in a low resource tropical setting. The laboratory is able to test for many common conditions important to the region, including GeneXpert testing for tuberculosis, blood/stool/urine testing for common parasites, malaria blood smears and rapid diagnostic tests, HIV testing, CSF anaylsis, etc. Certain tests such as renal function tests, liver function tests, and biopsies are sent out to other facilities for analysis. The diagnostic imaging department includes both x-ray (daily) as well as ultrasound services (twice weekly). Not surprisingly, a substantial proportion of patients are seen for common tropical infectious diseases, including malaria, tuberculosis, as well as complications of HIV.
Similar to other countries in East Africa, many regions of Uganda are also experiencing an increased burden of non-communicable diseases. This is the result of increased life expectancy, lifestyle factors, as well as increased rates of case finding. During my time here a number of patients were seen with complications of hypertension and diabetes. For example, congestive cardiac failure exacerbations and diabetic foot ulcers were not uncommon. Another challenge of this setting relates to patients often presenting in the late stages of their disease and often after visiting traditional healers in their village. When cancer was diagnosed or suspected, unfortunately patients had often presented quite late in the disease course. Despite these challenges, it was very impressive to see the strategies used by healthcare workers here to maximize outcomes in the face of resource limitations.
Overall, my experience here at Buluba Hospital was quite memorable. Working alongside the other medical doctors was truly inspiring. Generalists in Uganda have to be very skilled in adult inpatient medicine, paediatrics, obstetrics, as well as common major surgical operations. Caesarian sections and hernia repairs were routine and frequent. I also took part in several outreaches and saw firsthand how Buluba Hospital serves the surrounding isolated rural villages and provides care to those that have difficulty travelling to the hospital. Travelling in the hospital’s Land Rover, over some incredibly bumpy roads and sometimes through heavy rain, I saw how the team of healthcare workers visited the neighbouring communities of Lwanika, Nakalanga, Walumbe, and Ntokolo on a weekly basis. The team provides point of care rapid HIV testing and distribution of antiretroviral medications, vaccinations of children, and medical assessments. The outreaches provide these communities with frontline care and help to identify sick patients who need further inpatient treatment or specialized care.
It was fantastic to get to know some of the hospital staff during my stay here. Everyone was extremely friendly and always willing to help out when I had questions or needed assistance, especially with translation of Lusoga (the language common in this region of the country) when talking to patients. Outside of the hospital highlights included having an incredible fried tilapia dinner with an amazing view of Lake Victoria, tasting the delicious local mangos, and going for jogs through the villages and countryside near the hospital. Although I am sad to leave Uganda, I am excited about the possibility to return again in the future.
30 May 2017.