Buluba - Living Like a Real Rural Doctor

I realized I haven't done any updating in pretty much two weeks. The biggest reason is that for 5 days I was in a rural area called Buluba working at real village hospital. I could have had internet access, but I chose to leave my technology behind and read a lot of books every night instead.

Buluba hospital was founded in 1934 and originally served as a Leprosy hospital until 2003. During that time any patient diagnosed with Leprosy in the central and eastern part of the country were sent for support and treatment (when it eventually became available). Similar to the United States, before there was treatment for Leprosy, patients were isolated in "colonies" in order to prevent the spread of disease.  The hospital compound covers pretty much the entire village, located along the shore of Lake Victoria. At its prime, Buluba Hospital had dozens of homes, a church, a farm, and pretty much everything that people need to survive. Patients would be treated and then were allowed to stay and have a job and a place to live for as long as they wished. Any prosthetic limbs, special shoes, wheelchairs, or special tools were made there. In fact, today they still make anything that patients need in workshops, but there are far few patients. In this shop, they make special shoes that don't have any points that rub and if a patient has an ulcer, they cut them in special ways to decrease pressure on that part of the foot so they heal better.

If all you know about Leprosy (Or Hansen's Disease) is that they were shunned in the Bible, I will give you a little idea of what happens to people with the infection. The organism that causes Leprosy is related to Tuberculosis (so the hospital also did a lot of research and treatment of TB - which is much more common). The infection is surprisingly difficult to get because it requires that the person has the genetic make-up that doesn't carry a lot of immunity to getting an active infection. For those that do get infected, the symptoms can range from small discolorations in the skin which lose all sensation to pain and touch all the way to damage of limbs which eventually leads to the person's body basically self-amputating the limb. Many patients have facial deformities or require amputation because of trauma to their feet and legs. I had never really seen patients with this disease before, but I now have now seen dozens of them and they are really able to live normal lives except when they damage extremities that they can't feel. Overall, I picture support as being similar to patients with diabetes who have trouble with ulcers and decreased pain sensation in their feet. The treatment is up to 2 years long, but most of the symptoms resolve if it is caught early. I came very close to posting some pictures of some of the patents, but out of respect for them, and for those of you that don't want to see some severe ulcers, I decided against it.

As far as the hospital itself, there are nuns that run most of the wards - who are also trained nurses. I think there is a total of 5 doctors who basically do whatever they can. That means if a woman comes in and needs a C-section, they do it. If there is a fatty tumor on somebody's back, they become the surgeon. If a child was burned, they do all the dressings. They do what they can with very little choice of medications and limited laboratory tests. In fact, I think that they only have certain scans 3 days per week. I am excited to be a Family Practice Physician, and maybe be working in a rural place, but these rural doctors are incredible. They have to know a lot and be confident in so many skills.

Because there aren't always a lot of patients, the team of 2 medical students and 4 nursing students were able to basically see every patient by 1 or 2 pm and then maybe stick around to see patients that walked in later (which could be zero or 20, but usually it was on the low side). This meant that we got to enjoy some relaxing time sitting by the lake. I woke up early every morning for gorgeous sunrises and watched as the fishing village woke up and men went out in their small boats to see what they could catch. It was a very welcome change from the busy-ness of Mulago Hospital and Kampala.

There were also some pretty dramatic medicine moments that will stick with me for quite some time, but I don't want to get into too many of the details. If you want to some day, I can share them personally with whoever asks. I guess I am just not used to the rapidity of how things work. We had a patient pass away from what with think was DKA, basically an emergent situation caused by poorly controlled diabetes. In a matter of 30 minutes, the family had their dramatic goodbye, we transported the body onto a boda boda, and they were gone to bury their father, husband, and brother. As I watched them drive away I felt like I had to be dreaming because it was so different from the way I know things work back home.

I think I sometimes forget what happens after we are with patients. So often there are other people assigned to every job that doesn't include assessing and deciding on treatment, that we forget what really goes on. In Buluba, and in most of Uganda, there are not such defined roles in health care and nurses and doctors are responsible for most tasks. There are not often social workers, there definitely aren't nurses' aides, and lab technicians never collect blood samples. You really have to learn how to be a self-sufficient doctor. I am very thankful that I am learning skills that I don't get to do enough at home, but it can be extremely intimidating when I realize how skilled the physicians are here, simply out of necessity. I just hope that I can learn in a way that is respectful for the care of the patients but will also provide a solid foundation for being a rural doctor in a slightly less resource limiting setting in the future. I don't really love being in an operating room, but I apparently looked like I was having fun with the other students in the OR!