Medical Matters

This week I thought I would write about medicine here in Uganda. The week has been interesting but frustrating
On Monday I did a ward round with the clinical officer. One of the HIV patients on the ward was still complaining of a severe headache and we were concerned she may have cryptococcal meningitis. We decided she needed a lumbar puncture. This means an relative had to go in to town to buy a cannula and some gloves before we could proceed. Reluctantly the nurse found a tray to put some swabs and hibitaine on to clean the patient. We managed to get her in a reasonable position on her bed and I proceeded to do the lumbar puncture, with no anaesthetic. Luckily I got some fluid without too much difficulty and we sent it off to the lab. This was my third LP since I have been in Masindi. It is 30 years since I did them in the UK.
Unfortunately the lab technician had decided to go off to his village but promised he would look at the specimen in the afternoon. We only have fluconazole as treatment and I decided to start her on it straight away. He did not arrive back until the next morning when he looked at the fluid and confirmed she had cryptococcal meningitis. When I went to check on the patient the next morning I found she had not been given fluconazole as no one had bothered to collect the drug! This time I insisted the nurse collect the drug and start the patient on it. On Wednesday she was definitely getting the drug but on Fridays ward round no one could find her. The nurses did not know if she had run away or just gone for a walk. Nurses unfortunately seem to have little sense of what is happening on their ward. There is no hand over and no sense of any one being in charge.
The nurse who had been on night duty Thursday night told me she had been ill with fever so she had rested and persuaded a fellow nurse to give her a drip, IV quinine plus an injection of chloramphenicol. She was walking round the ward with a cannula in her arm.
On the Friday ward round there were two patients who needed blood transfusions. One was a 12 year old girl with chronic anaemia and a huge spleen. Her haemoglobin was 6 after a transfusion. She needed more blood and referral for investigation. She probably has hyper-reactive malarial splenomegaly but she definitely needs blood. I was asked to see the other patient when she had collapsed out side the out patients. The story was of weakness and decline over the last few months. She was very pale and in heart failure.We admitted her to the ward and found she had an Hb of 4 and was HIV positive. Both these patients urgently need blood. There is no blood in Masindi or any hospital in the region. At this time of year the blood banks often run out of blood. I do not know if these patients will survive over the weekend
A patient I first saw in September returned this week. He is 14 years old and has a huge tumour in his abdomen. Last time I saw him he looked ok but he had not had the money to return to see me. This time he looked unwell and was obviously in some discomfort. The tumour had grown. I was able to contact another VSO doctor in Kampala who agreed to take him in to the charity ward at the international hospital. Luckily Sallie was going down the next day and she agreed to take Yoweri. The scan he had in Kampala looks like a lymphoma so he is going to have a biopsy next week.
On Wednesday I managed to persuade the leprosy nurse to follow up some patients we had seen a week previously. It was good to see some of them making good progress on treatment but one man has reacted badly and we had to bring him in to hospital for steroid treatment. We found another new case much to the nurses dismay. He thinks we are finding too many cases as it is making his work difficult! I had seen another case in a village but we could not reach him as the vehicle could not make it through the flooded road. Hopefully we can get him on treatment soon but we have run out of treatment at the moment.
We were asked to look at the children in a family were both the wife and husband have leprosy. I was surprised to be faced with 12 children from 2 to 15. The husband had 3 wives. Unfortunately he could not remember the name of the wife with leprosy! Luckily all the children were clear.
So apart from having few drugs, no blood and uninterested nurses things are fine here. Luckily we did get a supply of ARVs last week so we can continue treating the HIV patients.

The net distribution is going well. We have a net sale on Monday which is the first one without Pam’s support. Thanks to every one who has given through the Just Giving Site.

Merry Christmas

Chris and Maggie


PS Unfortunately Monday morning ward round found that the young girl had died on Saturday. Blood had finally arrived on Sunday too late for her but the other patients were improved.