Saving Lives in Developing Countries. Charity Number 1081630

Report from Dr Mary Rimbi – Kitovu – August to December 2018.

I arrived in Kitovu Hospital on 12 August 2018 to work on the medical ward as a medical officer (MO).  My role included conducting ward rounds, supervising interns and seeing patients in the out patients department (OPD).

There has been no full-time physician in Kitovu for over a year.  The current arrangement is that one physician comes down from Kampala on a Tuesday and another on a Thursday. When they are in Kitovu they run the medical OPD clinic and review any unwell patients on the medical ward that they are asked to. Apart from a two week blip where we had no physician they can be relied on to come and are extremely helpful when it comes to managing complex patients. When I arrived, I found three interns who were on their last rotation of internship.  They were excellent and were a great help with orientating me to working in Kitovu and the management of common tropical and infectious diseases that I had not seen before. Although I knew the theory from my DTM & H studies, practicing is very different and I was grateful for their help and patience whilst I settled in. Towards the end of September Dr Angel, another Rotary Physician, came out to Kitovu. It was such a luxury to have a full time physician available for the two weeks that he was there. Both myself and the interns learnt a lot from him and we were sad to see him go when his two weeks were up.

Around the first week in October the original interns left and the new ones took about a week to report. As you can imagine this left the hospital short staffed throughout all departments, as was the case throughout Uganda that week. I was glad to see the new interns (Dr Kisembo Peter and Dr Allier Whai Jacob) arrive who were hard working, knowledgeable and aware of their capabilities. Unfortunately, during October there was a 2 week period where no physician came from Kampala. This proved a bit of a nightmare and it meant that sick patients on the ward were not reviewed by anyone more senior than myself and that we had to cover the MOPD clinic in addition to the ward.  In November the MOs switched over and Dr Muhumuza Andrew arrived on the medical ward – I was glad to have someone slightly more experienced than me on the ward on a regular basis. Dr Andrew is an excellent MO and he was a pleasure to work with.

The main issue regarding diagnostics in Kitovu at the moment is TB diagnostics. The laboratory are unable to analyse sputum for TB as the safety cabinet is missing and hasn’t been replaced. Sputum was being sent to Masaka Regional Referral Hospital for gene Xpert staining but results only came back to the hospital a handful of times, often long after the patient in question had passed away or had been discharged. Towards the end of my stay an agreement had been made with a private laboratory in town who would come and collect sputum and analyse it microscopically. Unfortunately patients have to pay the private laboratory for this service.

For about 6 months we could not do RFTs, electrolytes or LFTs as the machine needed maintenance,  then reagents were out of stock. As a result patient’s attendants had to travel to Masaka with samples and pay a private laboratory to analyse them. This arrangement negatively impacted patient care and costs but by the time I left in December all three tests were being done in Kitovu again, albeit for a higher cost than the laboratories in town.

The only radiology investigation that was consistently available during my time in Kitovu was ultrasound scan. The results we got on the whole were reliable although they were operator dependent (as they are everywhere). The X Ray machine and CT scan were frequently out of order during my stay. Unfortunately, the engineer responsible for fixing these machines comes from Turkey so there can be considerable delay in getting them fixed.

It is a sad reality that wealth dictates access to healthcare in Uganda, and I definitely struggled to work in an environment that asked for money before commencing treatment. There is no doubt that the medical ward needs a full time physician – someone to supervise and run the ward in a consistent manner. The nurse in charge, Pauline, is doing her best in this regard. However, the medical ward remains as the only ward without a full time senior – the paediatric, surgical and maternity wards all have one (or three in the case of maternity).

Despite the challenges, of which there were many, I look back at my time in Kitovu fondly. It was an eye opening experience and I am certainly more realistic about what can be achieved by foreign doctors and foreign aid. I want to thank the Rotary Doctor Bank for the opportunity to work in Kitovu. It is certainly something I would have struggled to fund without Doctor Bank funding. I will definitely return to work on the African continent in the future. Thanks to Jim, Mansel and Angel for all their supportive emails over the past few months.

Mary Rimbi.

January 2019.