Dominic Moor GAA Award

Electives are what most medical students consider to be the highlight of their training. 

I had spent years planning where I was going to go and so, when my bus finally bumped and rolled across the Kenya-Uganda border and on into Kampala, my excitement was indescribable.  With great difficulty and endless confusing phone calls via what has got to be one of the world's worst telephone networks, I had arranged a three-month placement in International Hospital Kampala (IHK), a 200-bed hospital in central Kampala.  What I didn't know was that the hospital was private, and when, on my first day, a senior government member's daughter came into A&E with appendicitis, I knew this wasn't quite the place that I had imagined arriving at. 

Then, one night I was with a group of local doctors in a seedy bar in downtown Kampala and met a Dutch plastic surgeon who was in the process of setting up a Burns Unit in Mulago, the big government hospital in Kampala - he suggested that I join him for a week or two.  I immediately accepted his exceptionally generous offer, and the next day arrived at what has to be pretty close to ‘Hell on Earth'.  Mulago is a 1500-bed hospital given to Uganda by the Brits in the 1960s.  It is enormous - even compared to UCLH and the Royal Free in London where I was training.  In addition, often we found more than one patient per bed and every patient's family eats, sleeps and cooks on the floor around the bedside. 

I spent the day in theatre operating on children between the ages of 8 months and 16 years.  One of the cases was a young girl who had been badly burned in a battery acid attack and needed extensive skin grafting.  The surgeon handed me a set of instruments and said "the burns are the same on both sides, I'll do one side, you do the other".  It was with a great deal of reservation that I cautiously sewed my first skin graft in place.  It would take many years of training in Britain before you would get the opportunity to be involved in this kind of procedure and here I was actually doing it myself!  This was exactly the kind of thing that I had come to Africa to do. 

I stayed at Mulago for two weeks, but the staff there were adamant that I should get out to a rural hospital while I was in Uganda.  So I packed up my things and met up with a friend, Dagan Lonsdale, who was also on elective in Kampala.  We got on a bus to Fort Portal, a small town in the west near the Congolese border.  Once we arrived we asked for the directions to Virika, the local mission hospital. 

As we approached the hospital there were hundreds of people lined up against the wall outside.  At the gate there was a young guy who I thought was perhaps in his early 30s (we later discovered he was only 27).  He introduced himself to us as the ‘doctor in charge'.  We explained that we were final year medical students from the UK and wondered if there might be anything we could do to help.  He immediately grinned at us and said, "Actually, you couldn't have come at a better time, we have an open day today and everyone is getting free treatment.  There are 1000 people waiting to see 4 doctors.  We're pretty busy, would you guys mind sorting out the wards for us?"  The two of us looked at each other in disbelief, maybe we had bitten off more than we could chew. 

Fifteen minutes later we were on our own ward round seeing 70 children - most of whom had Malaria (I'd never even seen Malaria, let alone treated it before), some had Meningitis and a few suffered from severe malnutrition known as Kwashiorkor.  I was way out of my depth and very cautious about changing any prescriptions or starting new ones. 

Until that day "Ward Round" had meant following some Professor in a pin stripe suit round the wards at the Royal Free, trying hard to stay awake just on the off-chance that one of the doctors would ask you to do something, which rarely happened.  Here I was doing my own ward round seeing some of the sickest patients that I'd ever laid eyes on.   If that wasn't enough one of the babies stopped breathing and we had to resuscitate him.  We asked a nurse to go up to the clinic to get one of the doctors but they were too busy to come down.  After about 10 minutes the child started to breath for himself and we got him to theatre, not for an operation, but because that was where the oxygen machine was. 

There was one blood test available in the lab - that was for malaria.  We were told  that, "even if the test is negative, assume it is wrong, and treat them anyway".  The x-ray machine was waiting to be fixed (having been broken for six months).  There were up to three children or two adults per bed and, once again, the family stayed on the Ward. 

Many of the patients lived several days walk from the hospital and arrived in a terrible state.  This was particularly true for the women in labour who often arrived in the advanced stages of emergency situations.  We were often called out in the middle of the night to help out with caesarean sections, and sometimes it was too late for both mother and child.  More often than not however, everything went to plan and both the mother and child were fit and well. 

I have an immense amount of respect for the doctors who work year in year out in such poorly resourced hospitals.  All four of the doctors at Virika were under 30 and  they were dealing with the full spectrum of medical problems on a daily basis.  All that you have to rely on is your clinical judgement and just hope that there won't be a power cut before you've finished what you're doing.  I remember one instance during a caesarean section at 4am when the lights went out.  The baby had been delivered and was fine, but we still had to finish the operation and all the light that we had was that of my torch and a mobile phone until the generator started up, ten minutes later.

For the last week of our time in Uganda we returned to Kampala to fulfil our commitment which was to start a course in Basic Life Support and CPR for the nurses at IHK.  Cardiac Arrests are not a common medical scenario in Uganda and there is often no protocol in place within hospitals to deal with them.  We were asked by the hospital to initiate a strategy to deal with cardiac arrests and to set up a rapid response system.  In one week we taught 110 nurses the basics on what to do when patients become unresponsive.  This has since been passed on to subsequent medical students and is now an established protocol.

I will never forget my time in Uganda, it has already made the six years of medical school worthwhile - and I fully intend to go back next year with equipment for one of the hospitals.

And finally, I would like to extend my thanks to Worth Society for generously donating £500 which paid for the majority of this project.  It was a fantastic experience that has given me a great deal of confidence in my new job at UCLH, and I'm sure it will have an enormous impact on my life in the future.

Dominic Moor - December 2007