Making Friends

Alix and Carolyn arrived in Mbale yesterday, and the four of us have very much enjoyed our time being reuinted! We had arranged to meet two of the student clinicians for dinner, and Alix and Carolyn agreed to come along -- it probably didn't hurt that we were going back to our favourite Indian restaurant, which has several wonderful vegetarian options. :)

Denis and Paul, the two clinicians who were instrumental in setting up our lectures last week, braved the rainstorm to meet up with us, and they both tried Indian food for the first time. We had a lovely dinner together, and then they announced that because we had treated them, they were taking us out to say thank you. The group of us walked to a nearly empty dance club -- it turns out that 8:30 is too early to go out in Uganda, just as it is in Canada. :) Several more of the student clinicians were also at the club, and we had a lot of fun even though the place was mostly empty -- Angela, our instructor, was probably the best dancer of the lot of us! Among other things, we learned that the only Canadian musician that people in Uganda seem to know is Celine Dion. Before we parted ways, Denis and Paul asked if we would like a tour of their school, so we decided to meet Sunday (today) after work.

All five of us (four students plus Angela) spent the day on the ward. Alix was just planning on doing her interviews for her final project, but she brought along some sterile gloves "just in case" -- good thing she did, as she and Lyanne each caught two babies (another retained twin for Lyanne!), Carolyn caught three, and Sarah resuscitated three babies. Interesting things on the ward today included: a retained twin who came out crying, but deteriorated rapidly after his first few minutes of life (he had quite the heart murmer, so we suspect he has a patent ductus arteriosis, for those of you who speak midwifery); a very large PPH, that Carolyn and Alix managed expertly; a manual removal of a placenta; and a woman who spoke neither English nor Lugandan, with sickle-cell anemia, a history two previous cesarean sections and a vaginal delivery of a stillbirth, who had an obstructed labour. Sarah and Lyanne stayed with that woman through several long, frustrating hours, feeling utterly incapable of offering her any kind of comfort or reassurance, wishing we could offer her an epidural, and more than anything feeling the divisiveness of the language barrier in a more frustrating and poignant way. The woman ended up with a cesarean (and her baby needed resuscitation) and not a moment too soon, as a "Bandl's ring" appeared on her abdomen -- the dividing line between the upper and lower uterine segments, which is a sign that uterine rupture is imminent. The lady was really very sweet, and the whole situation, though heartbreaking and frustrating, certainly had its lighter moments -- as when Sarah and Lyanne had to communicate "empty your bladder" through sign language and gesture.

It was a tiring day, and we were almost late for our tour of the student clinicians' school. Like many things in Uganda, the school is in a beautiful setting -- on the lush, green hospital grounds, with a beautiful view of the mountains, lovely trees and flowers everywhere -- though as our guides pointed out, the buildings themselves are old and have not been renovated in a long time. We were invited into Paul's dorm room -- with Angela along, don't worry -- that he shares with three other students. The room has a single desk, and two sets of bunk beds with about 1m between them, and although it's small, it's remarkably clean given that it's inhabited by four men in their early 20s. It made the "bunk and loft" triple rooms at McMaster seem like the height of luxury!

All of Paul's roommates, and a few other student clinicians, dropped by, so that there were about 10 of us in the room in the end. Our hosts had thoughtfully picked up some soft drinks for us ('Stoney' -- Uganda's gingerale, and "Miss Angela"s favourite) and we discussed the differences between our medical systems, and the student clinicians' future goals. There was an aspiring obstetrician, an aspiring neural surgeon, and an aspiring cardiologist in the room -- it seems many Ugandans become clinicians so that they can work for a few years at a relatively good wage to save money for med school. They had a lot of questions about becoming a doctor in 'Canada' (by which they seemed to mean 'North America,' since one of them hoped to go to Johns Hopkins, and last I checked Baltimore hasn't defected).

It's certainly clear that medicine in Uganda is a very competitive field, and that student clinicians work very, very hard to gain the skills they need to get good jobs and build futures for themselves. Several of the clinicians also mentioned wanting to train in North America or Europe in order to bring their skills back home to their people -- certainly a noble goal, but it's not clear that they really understand how different it is to practice medicine with access to so much technology, how easy it is to become dependent on the technology, and how hard it might be to transition between the two. We certainly wish them all the best.