Report on my stay at Kitovu Hospital Medical Ward, September 2018
As in four previous times, I have volunteered as visiting physician in the medical ward at Kitovu Mission Hospital, Masaka, Uganda. This time I travelled with a Spanish resident of family medicine. Before travelling I wondered what I would find given the fact that Dr. Martin Opio, the former physician and medical doctor, had left the hospital since my last visit. At the same time, Dr. Sr. Maura Lynch, the last of the Medical Missionaries of Mary, would not be there as she died in November 2017. She is sorely missed.
I met Dr. Mary Rimbi, an Irish visiting physician from Edinburgh, who was volunteering at KH. I think it will be very interesting to get her impressions once she is back at home.
During my two weeks I attended the morning meetings and led the ward round. The ward is currently looked after by a medical officer but he was on holiday during my stay. I also met two physicians that have been hired by the hospital to fill the place of Dr. Opio. They devote their time to the outpatient department (OPD).
Thus, I have to say that, at least during my stay, the MW was run by Dr. Rimbi and the three interns, and probably just by the interns in her absence. Having far less diagnostic means that we are used to in western hospitals, you have to hone clinical skills and reasoning in order to perform the best possible medicine in that setting, which I have to recognize is sometimes frustrating as patients go to the hospital with advanced clinical pictures and many times the diagnosis is impossible to achieve. As is usually the case, the interns I met this year were friendly, cooperative and showed interest in learning and widening their diagnostic skills, I was very pleased to be able to help them in the short time that I was there.
Another problem that had also been present in previous visits, but seems to be on the rise, was the progressive worsening of nursing care, because of staff shortages. Sr. Pauline is now in charge who seems to be quite worthy and responsible, but I did not see much of her at the MW as she was attending a course in town, so most days nurses came and went and it was difficult to know who was really responsible of the patients. Tests were ordered but not performed and life-saving drugs were prescribed but some times not administered.
The new private wing is now in use and patients are being admitted, which bring extra income to the hospital. There is a doctor and nurse entirely devoted to this wing which is spacious and each room is self-contained. It will take time for this facility to become established but during my time there it was not fully occupied.
The surgeon, Dr. Luciene, a Congolese doctor who specialized in Nsambya hospital in Kampala and was hired following Dr. Lynch´s advice, is very reliable, how long he will stay is an open question as he has part of his family still in Congo and his current salary of about 800USD/month is scarce. He seems to have a clear idea about how the hospital should work, is aware of the fact that it is a teaching hospital and devotes time and some resources training interns and junior doctors. He has been aware of the poor current functioning of the MW for some time and he discussed it with me, so it is possible to conclude that it is not something isolated and experienced by myself during those two weeks, but something that has been going on since Dr. Opio left, one year ago.
The current situation at KH it is probably shared by other missionary hospitals: it is understandable that they have to charge the patients, but it is obvious that poor people, the kind of population originally looked after at those hospitals, cannot attend, which is in my opinion sad. I do not have an answer to this conundrum, perhaps if the UCMB could reach some sort of agreement with the government to take care of some segment of the population in exchange for some money things would improve, I do not know. That was the path followed by hospitals belonging to religious orders in Spain during the last decades.
To conclude with, I am sincerely grateful to Rotary Doctor Bank UK for sponsoring my visits to KH all these years.
Zaragoza, Spain, 28.09.2018