The
hospital property began approximately 50 meters beyond the paved main
road. It was composed of several single
story buildings arranged in an L shape.
A round structure was being constructed in the centre area and several
men were working in the sun with hand tools, digging in the red clay soil. Without any visible signs indicating the
appropriate direction for reception I walked through the complex. First, passed the restaurant, then the gift
shop, and eventually on to a section with a sign above the door saying
“lab”. To the right, was a final door
with “children” hand written on a block of green painted wood. Through the open door I could see children in
cribs lined up against the distant wall.
I decided I had walked too far, and began to back track past the
construction area.
I came upon a wooden
bench poised under an open yet barred window, with two men sitting in the
afternoon sun. One man appeared much
older with thin grey hair.
“How can I speak with a
doctor?” I asked of the men.
The younger man pointed
to the open door to the left of the bench.
Gathering this was the reception and waiting room, I took a seat,
looking up at the small roof extension providing little shade. I wondered where people wait during the nearly
daily torrential downpours of rain.
Then
it began, again - the children’s
curiosity / infatuation with white skinned people. One observant young child had noticed me, and
sent out the call, alerting all children in the nearby area. “Mzungu! Mzungu!” (translated to white
person).
Suddenly, a group of 8
– 10 children appeared, running at full speed, swarming me and yelling
“Mzungu! Mzungu!” While typically not bothersome, I was not in
the mood to deal with hoards of screaming children who wanted to touch and poke
at my white skin, or receive high-5’s. I
had gone to the hospital because I felt ill.
The Mzungu commotion
extended down to the paved road, attracting a young man who wandered over, shooing
the children away. While immediately
grateful, I quickly realized the man had ulterior motives.
“How can I be your
friend? What is your phone number? I would like to call you.” He began.
“Seriously?” I thought,
“This man doesn’t even know my name.
People come to hospitals to get better when they feel ill, not pick up
their next fling!”.
At
that moment a young woman left the “doctor’s office” and the younger man rose
from the bench, helping what I now understood to be his elderly father. As the old man rose, the bench tipped
sideways like a teeter-totter and I barely caught myself from slipping to the ground. My new “friend” took this as an invitation to
join me on the bench.
“Ah!” he exclaimed, then
repeated “I cannot be your friend without your phone number.”
“I’m sorry, I don’t
give out my phone number – it is the orders of the organization I am working
with. It is their phone. Besides I am married” I lied.
“Ah!” he repeated, “but
you wear not ring” he replied flashing a cheeky grin. Clearly there was no fooling this perceptive
young man. In the moments that followed
we made small talk. He asked where I was
from, what tribe I represent, what I was doing in Uganda, where I live in Kasana
(nice try)…
After
what felt like forever, the elderly man shuffled out of the doctor’s office
with the young man supporting his arm.
In Canada this man would likely be using a wheelchair or a walker at the
very least, but with uneven clay mud roads, and boda-bodas (motorcycle taxis) as
means of transportation, both options seemed impractical. I stood up, to walk into the office, saying
“bye” to my new friend who assured me he would wait for me.
The
office was small with a blue vinyl examination table sitting under the open
uncovered window (separating the examination room and waiting bench) and wooden
desk in the centre. I walked over to the
blue plastic chair adjacent to the doctor’s table and took a seat. Getting right down to business the man asked
“How can I help
you?”
I explained that I had
a very sore throat with white patches on my tonsils, and a fever.
“I will test you for
malaria” said the man, making illegible notes on a piece of paper. “The malaria test may be negative because the
parasite stays in your liver first, before replicating enough to be detected in
the blood which we test.”
I nodded in agreement,
and tried to re-direct the conversation back to my throat (not a symptom of
malaria).
“Take
this to the lab” directed the doctor.
“You will be tested for malaria.”
“The
lab is that direction?” I clarified, pointing to the direction I had previously
passed.
From
outside the door my new friend called out “I know where the lab is, I can show
you.” Clearly I was experiencing public not private health care.
Walking
toward the lab, my friend once again requested my phone number, this time in
order to monitor my speedy recovery. I thanked
him for the well wishes, but insisted I would not be disclosing my telephone
number. Now, outside the laboratory
door, he wished me well and left.
The
laboratory was nestled between two sequential buildings, and adjacent to the
pharmacy. The open door revealed a young
woman sitting in a chair, supporting her downturned forehead with her right
palm while her left arm was inspected by a man I presumed to be the lab technician. I elected to wait outside, sitting on a bench
covered by cool shade cast by the neighbouring examination rooms.
From
around the corner crept two young children, a girl wearing a torn, dirty, pink
dress who appeared older, and a shorter boy who presented a more confident
demeanor.
“Mzungu.”
Stated the young boy definitively, touching my arm and confirming that in fact my
skin remained white when touched. I
smiled and waved, not wishing to become engaged in a further discussion. My head felt foggy, and the infection in my
throat meant talking and swallowing were incredibly painful. At that moment, my only wish was to be
magically transported back to my bed.
Moving
on, the children wandered into the laboratory.
Words were exchanged in Lugandan, which I did not understand. As the young woman stepped out of the
laboratory, the woman turned back and muttered something to the children, then
disappeared around the corner of the building.
Walking
into the lab, I took a seat, without waiting to be offered. The lab technician was preoccupied with the
children, counting bills and coins from his pocket which he gave to the young boy,
followed by clear instructions to “return
a immediately.” Taking advantage
of the distraction the young girl picked up a pair of tweezers from the table,
first inspecting them, and then trying to pick up the little blue plastic
pieces scattered across the table’s workspace.
I later discovered these pieces protected the needles used to perform
malaria tests.
The room’s temperature was
cool. Along one side were open windows,
each covered by decorative security bars but no screens. A stand up work space under the windows
contained a microscope and what appeared to be several slides waiting to be
inspected. An old centrifuge type
machine caught the attention of the young boy (who still had not yet left with
the lab technician’s money). He began to
spin the moveable parts as if it were a miniature mary-go-round for parasites.
“Ah!” gestured the lab tech,
pointing the children out the door.
Turning his attention to me, he asked for the piece of paper provided by
the doctor. Without saying a word, the
man began to open the materials necessary to perform a malaria test, then
pausing “Name?” he asked “I must put your name on this test”.
It was at this moment it donned
on me that the doctor I had spoken with did not know anything about me or my
medical history, and he still (in my mind) had not addressed the reason for my
presence in his office.
After writing my name on the
plastic test piece, he pricked my finger with his un-gloved hands (not washed
after handling money and who knows what else) and directed the droplet of blood
into the test receptacle. He added a few
drops of liquid, and told me to wait 15 minutes during which time he returned
his attention to making microscope slides.
I sat, amazed by the hygiene and protocol for interacting with blood,
especially in a country with such a high rate of HIV / AIDS infection. Legislation in Canada dictates that all food
and beverage preparation areas must have a dedicated hand washing sink, and
here, I was in a medical laboratory which did not have running water or access
to gloves!
After waiting 15 minutes, the
lab tech returned the slip of paper to me, and said I must return to the
doctor. He did not clarify the result of
the malaria test, but I assumed it was negative, a result confirmed by the
doctor who’s response was “I think you know why the test came back negative.”
I wanted to say “because I don’t
have malaria?” but decided he was instead referring to his earlier explanation
of hepatic parasitic replication.
Despite the negative malaria
test, he decided to write me a prescription for malaria, which made me question
why I’d gone to through the motions of having the test done in the first
place. Now concerned about drug
interactions, I reached into my backpack and found the only medication I’d been
taking while in Uganda
Presenting the unopened sleeve
of pills for the doctor to review, he asked “What is this?”
I explained that Malarone is an
anti-malaria medication like doxycycline (another anti-malaria drug more
commonly known here), and provided the man with the thin, folded paper supplied
by the drug company to explain the medication.
“I think I will keep this, so I can learn about this drug” he insisted,
handing me a prescription, not having even glanced at the Malarone drug
details.
Still convinced I did not have
malaria, I mentally decided I would not take his prescription, and therefore
did not press for details such as whether it would be advisable to suspend
taking Malarone while on his treatment.
I did, however, try again to redirect him back to my throat. Still uninterested in looking inside my mouth
(or inside my ears, or feeling lymph nodes… all doctor-like behaviours I have
come to expect in conjunction with complaints of a sore throat), I made him
look at a picture of my throat that I’d taken with my iPhone camera. He told me he would give me something for my
throat, and added it to the anti-malaria prescription list, but never did look
in my mouth. He instructed me to fill the
prescription next to the laboratory, and to return for a follow-up in 10 days.
The pharmacy resembled the
laboratory. There was no sink, and pills
were counted by hand on a wooden table.
Flies buzzed around, and I tried not to question the hygiene of having a
pharmacy with open windows. During my
first week in Uganda, I met a couple who run an NGO that educates families
about home hygiene in order to minimize illness and disease. Part of their mandate involves communicating
the importance of covering latrines to prevent flies from transferring
pathogens between excrement and food.
Since that time, I haven’t looked at flies the same way, and at the
pharmacy I tried to shut out thought questioning where the flies had been given
the hospital setting.
I returned home, wishing I had
simply spent the day sleeping in my bed.
I paid 16,000 Ush (less than $8 USD) for four prescriptions, a
“consolation” fee, and a lab fee. While
inexpensive by Canadian standards, this service would consume 20 – 25% of a local’s
monthly salary, and in the end, I was not convinced I was any better off. The next day I went into Kampala to a western
style medical clinic where I was given a prescription for penicillin to treat
strep throat. The doctor there, (after a
thorough examination) assured me that I did not have malaria, and instructed me
not to take any of the prescriptions filled the previous day. The visit and penicillin cost 59,000 Ush
(approximately $30 USD), and while still inexpensive by Canadian standards,
when combined with the 100,000 Ush ($50 USD) I paid for return private transport to Kamala, accessing
this type of medical service would be out of the question for most Ugandans
living in Luwero (this would account for approximately 1.5 month’s salary).
The consequences of
inaccessible, quality, medical care in rural areas are multi-fold. Mis-diagnosis and over prescription of
certain medications leads to ineffective drug treatments and pathogenic
mutation. Lack of proper care, means
locals are unable to adequately work and provide for their families to say
nothing of their own personal discomfort.
Poor hygiene and lack of access to utilities such as water and
electricity exacerbate illnesses and augment the transmission of disease (to
say nothing of the health risks associated with a medical facility that does
not have access to running water, or means of physical protection – ie. gloves,
for staff members). There are also
significant health risks associated with misdiagnosis, and untreated conditions…
I could go on. Though grateful to have
had access to the clinic in Kampala, I wish those I work with in Luwero could
have the same opportunities. After all,
access to medical care is a human right.
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