February 2015: Amelia Fisher, M.D., pediatrics resident at UVM Medical Center
Mulago was not always like this.
My host family tells me that Mulago, the national public referral hospital in Kampala, Uganda, was the best hospital in the region at one time. This all changed when Idi Amin became president in the 1970s and government money was diverted from health to the military and security. Now, Mulago is a bleak place, where resources are limited in not just one, but two ways. First, there is a general lack of equipment (the CT scanner was down for two months when I arrived) and personnel (one pediatric resident at night to cover 30+ sick ward patients, a pediatric ICU, and an emergency department). Second, there is also a lack of subsidized services such as labs, imaging, and medications, such that while many services are offered, they are limited to those who can pay. At Mulago, the majority of patients and families do not have the financial resources to pay for these necessary items.
As a visiting pediatric resident from the USA, the doubly limited resources at Mulago made me feel helpless and frustrated. I became frustrated with the system and the limited stock of medications, such that parents had to leave their sick children unattended on the ward to find a pharmacy to buy the necessary medications, or even worse, wait until the money came from a friend or family to purchase the medications. I also became frustrated with myself and my dependence on laboratory and imaging; at Mulago I would often feel paralyzed by lack of data, while my Ugandan counterparts easily moved on in the management.
Having worked in East Africa before, I had known that there would be limited resources in Uganda. Knowing this in my head, however, did not prepare me for experiencing this in real-time, with sick patients in front of me. In my head, I knew there would not be ventilators, but I would not truly understand what this meant until I was part of the team that ended a long resuscitation while a baby was still gasping. As a physician, the emotional distress of these events was compounded by the lack of diagnostics, which often meant we did not know why the patient had become so sick.
Through this frustration and sadness, I began to understand the emotional and intellectual toll of practicing in a “resource-limited” setting, something one could never obtain from just reading articles. As difficult as it was to reach this understanding, it has reinforced for me the need for improved access to healthcare in these settings, and has hopefully made me more informed and relevant as I look towards a career in global health.