Lessons of Kagando: Post from Uganda

Kasese, Uganda
Monday, August 22, 2011
It is ten o’clock at night. Inside an examining room the X-rays go up on the light box, the patients are queried about their problems, a decision is made about whether they will be operated on tomorrow.
Outside in the hospital courtyard, some 90 men, women and children sit quietly waiting to see the visiting doctors from AMREF. It will be impossible to see all the sick tonight: the two surgeons have been in the operating theater all day,performing six urological surgeries. Six more are scheduled for tomorrow, and with the endless evaluations of the patients who keep on coming, a week of outreach may not enough to treat everyone. Patients have been camped out on the hospital grounds since Sunday anticipating the arrival of these specialists–they will be waiting tomorrow–and beyond, hoping to be seen.
Today we saw babies being born and a child taking perhaps his last shallow breaths, the elderly being treated for deep wounds, patients with leprosy. We are told by Dr. Robert  Oluput, head of the fistula repair program here, that last week he performed 30 operations, including that of a grandmother who had been injured delivering her 8th child–20 years ago.
We have just spent our first day within the compound of Kagando Mission Hospital in Kasese, Uganda, which rests at the base of the Rwenzori mountain range and serves a community of some 400,000 people–800,000 if you count the people who won’t go anywhere else. Kagando currently has five doctors on staff. Another 120 nurses and a support staff of 116 care for more than 70,000 thousand patients a year. That’s an average of 50 patients per day per doctor. With support from the Anglican church, the Ugandan government and US and UK foundations, Kagando, originally a hospital for lepers, now sprawls across an enviable campus with twelve buildings. Add to that its nursing and midwives school, primary school and housing for staff, it’s a true medical center.
This part of Uganda is lush: while the people tend to live in the mountainside, they farm on the flatlands below, growing maize, cassava, coffee, nuts. An impressive resident elephant, meandering in the trees not far from the main road, was our welcoming committee of one. We are just minutes from the Congo border, having flown and driven nearly 700 miles from our headquarters in Nairobi, Kenya.
The “we” includes Dr. Rodney Davis, Professor of Urology at Vanderbilt University and a board member of AMREF USA. He has brought a surgery resident with him, Dr. Ekene Enemchukwu. Dr. John Wachira, AMREF’s coordinator of clincal outreach–who flies to a different hospital on the continent every week–has arranged  for these American doctors to bring their expertise to this rural part of Africa. The mission is twofold: treat the patients and teach the local health staff of doctors, nurses, midwives and community health workers.
AMREF has done this outreach since 1957. It goes to our founding roots as The Flying Doctors: three surgeons including American Dr. Tom Rees, taught themselves how to fly to deliver services in remote parts of Africa. Last year we were in 150 hospitals in Ethiopia, Rwanda, Somalia, Southern Sudan, Tanzania, Uganda and Kenya, using our aircraft to deliver doctors from teaching hospitals around the world for weeklong assignments.
This time our team in Kasese has an additional mission. AMREF USA board member Christine Grogan is producing a film about our work, and so she has brought cameraman Rick Brandt, Endo Pharmaceuticals executive John Campell, and businessman Mike Desmond to add their expertise. All are AMREF volunteers.
This is the 8th outreach that Dr. Davis has taken in the last three years; Dr. Enemchukwu is the 4th resident he’s brought along at his own expense. His reaction after this first day: adjusting to the sheer numbers of patients. Because the Ugandan government and Kagando Hospital are underwriting this urology visit, the consultations and surgeries are free, unlike other country visits where patients must pay a small amount to their hospitals.  AMREF fully donates its contribution, including the flights.
The doctors here today have had to respond to the absence of  equipment  US hospitals take for granted: for instance, the lack of cauterization tools meant that Dr. Enemchukwu had to manually tie off every vessel; the power in the operating theater went out three times: Dr. Davis’s headband light was the only thing that allowed him to continue to work; even though they saw several children, they are not able to operate on them, because there are no tools small enough.
These are shortcomings of sheer funding needs. Father Benson Baguma, who runs Kangando Hospital, apologized to us in advance  for what we might see on our tour: mothers who have just delivered babies, lined up on the floor along corridors due to overcrowding; the power outtages in an antiquated and collapsing system; equipment that does not work because there are no trained technicians to make repairs.
But what is accomplsihed here at Kagando is admirable: today four mothers delivered by C-section, saving their own lives and those of their babies; women ostracized because of fistula complications are on their way back into their families and communities; men diagnosed with prostate cancer were seen and advised.
For Dr. Enemchukwu this first day, she said, was “overwhelming.” She realized that despite the fact that people had traveled hundreds of kilometers to get here, they would most likely not get to see everyone. “We just have to do the best we can.”
A lesson, at Kagando, that we are all learning.

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