St Francis Hospital, Buluba, Uganda.
St. Francis Hospital Buluba, during the rainy season in Uganda, is not the busiest but when the medical staff is depleted by 75% as it was for part of my stay, it becomes interesting.
Setting the scene briefly. I retired from General Medical Practice in the UK three years ago. I had harboured the desire one day to volunteer for the Rotary Doctor Bank; and now seemed the right time.
The Rotary Doctor Bank sends health professional volunteers to Mission Hospitals in Uganda for varying periods, ranging from a few weeks to several months. St Francis Hospital is one of their fairly regular recipients. The hospital, unlike the government run establishments, depends on outside charity/donor funding and some income generation in the form of patient fees and the hospital farm.
Established on the shores of Lake Victoria earlier last century by a German Leprosy relief foundation and the Uganda Catholic Church, the hospital now serves the local, largely impoverished peasant population as a fee-paying general hospital. As well as the district maternity centre, it still maintains its specialist bias with all leprosy, tuberculosis and HIV patients receiving free treatment, supported by various outside funding foundations.
After a seven hour journey by car from Entebbe airport, via Kampala and Jinja, I arrived at my basic but adequate accommodation in the pitch dark tropical night.
Next morning, following prayers, I attending the weekly clinical officers’ meeting, I was immediately confronted with an account of a sadly not too uncommon tragedy. 350 out of every 100,000 births in Uganda ends in maternal death. This fate had befallen a patient the night before. The usual story, one of neglect by outside health workers and traditional birthing attendants, was behind this tragedy, compounded by the lack of blood for transfusion. At Buluba the Caesarian rate, one in three deliveries, is well above average as it is recognised in the district as providing top notch care for obstetric problems. Unfortunately it also has to pick up the pieces created by poor care in the community.
Three year diploma trained Clinical Officers support the normal establishment of four doctors, one of whom performs administrative duties as the Medical Superintendent. He was due for his annual four week leave so my presence immediately seemed to gain more validity; though of course I harboured no illusions of being any form of real substitute. Not having done any significant clinical work for a few years and no tropical medicine for 40 odd I really did feel like I felt the first day on the wards as a newly qualified houseman more years ago than I like to remember. When Dr “JB” went on study leave followed by sickness absence, it was four down to two plus me! Dr Patrick’s short term sickness created a few palpitations but fortunately the “last man standing” was actually an extremely competent unflappable lady obstetrician. It helped that this, the rainy season, was one of the quietest time for the hospital, as the population concentrate on their gardens in preference to their health.
As time went on I found a niche when Dr JB, who usually oversaw the paediatric ward, went on study leave then sick leave.From the various manuals and aide memoirs available somewhat randomly on the ward, I was able to learn along with the nurses, all about the management of malnutrition. I think I have been able to give a significant but limited contribution in this respect; as I was able to enthuse the nurses who joined me on my steep learning curve. Even if all they do now is weigh and measure accurately every child who is admitted, I feel some small measure of success and contribution has been achieved.
The hospital buildings are reasonably well maintained with significant improvements to the Staff Canteen and Pharmacy as the previous “Dr.Tim” will be pleased to note.
My usual routine was a ‘’ward round” on the childrens’; then dipping into the adult ward if required; followed by a stint in the doctors’ Out Patients’. Here, my help was a little limited by the availability of a nurse to translate.
I managed to purloin a sit-up-and-beg bicycle which facilitated my journeys from my accommodation, by the lake, to the hospital twice a day.
Although the guest house provided for my nutrition and rest there were shortcomings in the form of variety and creature comforts. I think these issues can be addressed for the benefit of future volunteers.
My five weeks passed quickly and despite initial misgivings about my usefulness, I felt that my presence contributed positively especially in the paediatric malnutrition area. Being an extra pair of hands to fill in on the wards covering for short term absence was also a positive help.
I accepted that my contribution to patient management with unfamiliar diseases was usually limited but aided by the invaluable “Uganda Clinical Guidelines” pdf on my iPad.
Because of the relatively isolated rural location of the hospital opportunities for recreation were scant. I spent a weekend in Jinja, paddle boarding minor rapids on the Nile and visiting the famous source of that river. Another interesting experience, through a friendly member of the cleaning staff,was a trip to commemorate the murder in 1865 of Bishop Hannington. I also managed a visit to the Source of the Nile Rotary Club of Jinja on my return journey to Entebbe.
It was during a visit to the nearby village, I identified a possible project for funding either by Rotary or my own village. The community have established a primary school but lack substantial buildings. They have started to build a permanent structure but need funds to complete the project.
My five week stay was altogether, a “mind broadening” experience, combined with support for a very disadvantaged corner of the world, made this an invaluable time for me.
Thank you to The Rotary Doctor Bank, for facilitating it, and my family for enthusiastic encouragement.