TCU - Global Citizenship

Central Uganda

After describing my desired destination and negotiating unsuccessfully for a lower fare, I climbed into the taxi and fastened my seat belt, preparing for the adventure that always accompanies a journey on the streets of Kampala.

“Your English is very good.” I was more than a bit confused by the comment. The driver, speaking hesitantly and with a heavy accent, had complemented my English. He continued, “Most mzungus speak like this.” He reached up and pinched his nose shut. “They speak but we do not hear. You speak clearly. I hear you. Your English is very good.” It seems I was at least partially successful in masking my southern accent that day.

As I write this, I am sitting in a tent, on the banks of the Victoria Nile, listening to a hippo and a warthog graze just outside my tent; literally, just outside. We are taking a much needed weekend off before our final stretch of shifts in the obstetric operating “theater”. We traveled northwest about 6 hours today to the Murchison Falls National Park (not too far south of the area where the Lord’s Resistance Army was at one time so devastatingly active), desiring to see a little more of Uganda than just the congested streets of the capital and the even more congested halls and wards of Mulago.

My taxi trip took me from a private hospital in the southern part of the city to a café where I met the rest of my group for dinner on Thursday night. On Wednesday, I had received a phone call from a friend of a friend asking me if I could help with a difficult situation his family is facing. His elder brother (age 70) is quite ill and has been hospitalized for several weeks. The doctors had recommended that he be transferred to Mulago for further care, as he did have money to receive the advanced care at a private facility. I was given permission to review his chart and then had a long conversation with two of the brothers, as the patient was not alert enough to participate. We discussed the options, none of which are good. The family is from another central African country where the medical resources are much more limited than those at Mulago, which, despite its position as the “National Referral Hospital”, is not a place any of us would choose to have care. It was a sobering visit in the midst of a sobering week.

We have stayed very busy, working long hours in the operating room every day. In addition, I have given five lectures to the residents in the Department of Obstetrics and Gynecology, one to the family medicine residents at Mulago, and conducted (with the help of our JPS residents) four hands-on training sessions in obstetric ultrasound. The OB doctors at Mulago are extremely eager to learn basic ultrasound skills and have made frequent use in the labor suite of the portable machine we brought with us. We have made arrangements to continue their training after we are gone.

The conditions and the pathology at Mulago remain deeply disturbing. We have delivered several babies with severe birth defects; more babies than we can count who did not survive labor or the first few minutes of life. We have witnessed destructive deliveries of babies who died during labor but could not be delivered by the usual methods. Each of these experiences has been challenging and discouraging. Yet, we have had encouraging experiences as well. On at least five or six occasions, we have helped women deliver their babies vaginally in the operating room, allowing them to avoid the first scar on their uterus that, more often than not, leads to multiple cesareans over the course of their reproductive years, with all the risks involved. One of the mothers, as she walked from the OR back to her “bed” in the labor suite, stopped to speak with us and said, through a translator, with tears in her eyes, “Thank you. If you had not been here, I would have had an operation.”

We remain grateful for the opportunity to contribute to the care of the multitudes of women who labor daily at Mulago and for the unparalleled educational experience we are having. We are also grateful for the privilege of a brief respite in a beautiful area of this troubled country (and hope that the hippos and warthogs stay outside the tents tonight!)

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