Mulago Hospital is the national referral hospital, which means this is supposed to be the best public hospital in the country, which I am sure it is. Unfortunately, that statement doesn’t really mean very much. This hospital is the last place the large population of poor Ugandans can be referred if they have a serious medical condition and it is almost the last place anyone in the developing world would want to be found if they needed medical help.
Mulago Hospital, Kampala, Uganda has 6 floors and many wings and corridors, filled to overflowing with families of patients living, yes.. living in the halls.. The stench of unwashed flesh, rotting flesh, urine, blood, and death is overpowering in places.
The patients on the medical wards have a wide variety of illnesses like heart conditions, strokes and tumors, but the majority of them have infections (HIV, malaria and TB). The patients are first seen in casualty (British term for the emergency room) where they are either treated and sent out or die. In the center of the room is a large school desk piled with papers and three red notebooks. This is the casulty log. One book reads "Admitted" One book reads "Discharged" and the final book reads "Morgue" The gurneys have very thin plastic/vinyl mattresses that are torn and filthy - filled with blood stains and mystery fluids that are not cleaned between patients. Tubes for Iv's are shared without being washed, and if there are no more, there is no intubation. This temporary medical ward is filled to capacity each night. The patients that are admitted last are put into beds out in the hallway. The walls of the hallway are made of concrete bricks that have many ‘windows’ in them, thus the hallway is essentially a porch – you are outside, but have a roof over your head. (Uganda fortunately has a temperate climate.) The next morning, a decision is made as to whether the patient can be discharged or needs to be hospitalized further. In the case of the latter, the patient is then transferred from ward 3B to the ward of the team that is admitting them. Patient transport is done similarly to the way it is done in the US, only the gurneys don’t have mattresses and the floor has many seams in it, so the patient is rolled in a jarring manner from place to place.
The patients travel from quite a distance to get help and often times they have family members that travel with them. In fact, nurses do not provide personal care for the patients as there is such a shortage of them. Any personal care, bathing, etc. must be done by the family members. Even tube feeding. A patient also will only get linens, food, and water, if they are brought in by family members!! Medication is very scarce, so any pain medication or antibiotics must be brought in by family as well. Even after surgeries, there is no pain medication for the recovering patients. Sometimes there are numerous family members. The wards would get very crowded if all of the family members were sleeping or staying right next to the patient, so they are periodically removed en-masse from the wards by a physician or guard to the hallways and corridors outside of the wards. This means that there are oftentimes a whole crowd of people waiting by the doors or sleeping on the floors as you walk to the wards. One or two family members are allowed to remain with the patient and many of them end up sleeping on the floor next to the bed.
The floors are washed each day, but still are quite dirty. Some patients and many family members end up sleeping on the floor. The hospital doesn’t provide any food for the patients, so the family members do that. The food, tea and preparation equipment is kept under or beside the bed, along with lab slips, chest x-rays, etc. Thus, there is dirt from people’s shoes on the floor as well as liquid dripping from a rare IV or some dried blood, etc. It is not completely uncommon from a patient to cough up a significant amount of blood or vomit blood on the floor. There is noone to clean up the messes.
There are not many IV poles, only about 10% of the patients have fluids running into their veins. Those that are dehydrated hopefully have one as do those that need IV quinine for suspected malaria. The access to oxygen for those patients that are having trouble breathing is an even rarer commodity. I think there is only one spot on each ward where it can be accessed and the oxygen lines can reach about two of the beds. If a patient suddenly needs oxygen, the beds have to be repositioned to get him within reach of the tank. If there are already two patients receiving oxygen, well, unfortunately, the waiting patient will not get any.
Mulago Hospital, Kampala, Uganda has 6 floors and many wings and corridors, filled to overflowing with families of patients living, yes.. living in the halls.. The stench of unwashed flesh, rotting flesh, urine, blood, and death is overpowering in places.
The patients on the medical wards have a wide variety of illnesses like heart conditions, strokes and tumors, but the majority of them have infections (HIV, malaria and TB). The patients are first seen in casualty (British term for the emergency room) where they are either treated and sent out or die. In the center of the room is a large school desk piled with papers and three red notebooks. This is the casulty log. One book reads "Admitted" One book reads "Discharged" and the final book reads "Morgue" The gurneys have very thin plastic/vinyl mattresses that are torn and filthy - filled with blood stains and mystery fluids that are not cleaned between patients. Tubes for Iv's are shared without being washed, and if there are no more, there is no intubation. This temporary medical ward is filled to capacity each night. The patients that are admitted last are put into beds out in the hallway. The walls of the hallway are made of concrete bricks that have many ‘windows’ in them, thus the hallway is essentially a porch – you are outside, but have a roof over your head. (Uganda fortunately has a temperate climate.) The next morning, a decision is made as to whether the patient can be discharged or needs to be hospitalized further. In the case of the latter, the patient is then transferred from ward 3B to the ward of the team that is admitting them. Patient transport is done similarly to the way it is done in the US, only the gurneys don’t have mattresses and the floor has many seams in it, so the patient is rolled in a jarring manner from place to place.
The patients travel from quite a distance to get help and often times they have family members that travel with them. In fact, nurses do not provide personal care for the patients as there is such a shortage of them. Any personal care, bathing, etc. must be done by the family members. Even tube feeding. A patient also will only get linens, food, and water, if they are brought in by family members!! Medication is very scarce, so any pain medication or antibiotics must be brought in by family as well. Even after surgeries, there is no pain medication for the recovering patients. Sometimes there are numerous family members. The wards would get very crowded if all of the family members were sleeping or staying right next to the patient, so they are periodically removed en-masse from the wards by a physician or guard to the hallways and corridors outside of the wards. This means that there are oftentimes a whole crowd of people waiting by the doors or sleeping on the floors as you walk to the wards. One or two family members are allowed to remain with the patient and many of them end up sleeping on the floor next to the bed.
The floors are washed each day, but still are quite dirty. Some patients and many family members end up sleeping on the floor. The hospital doesn’t provide any food for the patients, so the family members do that. The food, tea and preparation equipment is kept under or beside the bed, along with lab slips, chest x-rays, etc. Thus, there is dirt from people’s shoes on the floor as well as liquid dripping from a rare IV or some dried blood, etc. It is not completely uncommon from a patient to cough up a significant amount of blood or vomit blood on the floor. There is noone to clean up the messes.
There are not many IV poles, only about 10% of the patients have fluids running into their veins. Those that are dehydrated hopefully have one as do those that need IV quinine for suspected malaria. The access to oxygen for those patients that are having trouble breathing is an even rarer commodity. I think there is only one spot on each ward where it can be accessed and the oxygen lines can reach about two of the beds. If a patient suddenly needs oxygen, the beds have to be repositioned to get him within reach of the tank. If there are already two patients receiving oxygen, well, unfortunately, the waiting patient will not get any.
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