St Stephens Hospital has been a valuable place to spend my time while in Uganda. It has a small-town vibe with welcoming staff, and a strong sense of community as everyone has tea and lunch together every day. The hospital does home visits and other community outreach projects. I wanted to spend most of my time here because while Mulago Hospital is the place for seeing more pathology, it is not representative of the environment in which I am most likely to be practicing in the future. Eveni though St Stephens is small with only forty inpatient beds, it has it all: inpatient, outpatient, and obstetrics and gynecology. They even have an operating theatre. Most mornings I round with the medical officer, Catherine, on our inpatients. We begin at the more “acute” end and then move to the pediatric, women’s, and men’s wards.
I spend the second half of the day in the outpatient clinic run by clinical officers who have training similar to Physician Assistants in the U.S. On the inpatient side, there are many patients recovering from orthopaedic injuries who require periodic wound care and dressing changes which I was able to help with. Other conditions among inpatients include severe malaria, sickle cell crisis, pneumonia, sepsis, and other common conditions. The hospital is not equipped for seriously ill patients. However, there is one patient who we thought would not make it through the first night who has been here for three weeks, in and out of cardiogenic shock due to atrial fibrillation. Because his family does not want to transfer him to the cardiac institute, we have been managing him as well as we can.
The medical officer who does not often treat cardiogenic shock asked if I had input on management. Knowing that pacing his heart was not an option, I consulted my trusty Oxford Handbook of Clinical Medicine which suggested diuretics to get rid of excess fluid and inotropes to improve how the heart pumps. However, we did not have inotropic agents, and I was worried about bottoming out his already low blood pressure with the diuretics. I was standing in his room wishing I could just call up a cardiologist of intensivist as in an American hospital. I then remembered that we were living with an ICU doctor and gave him a call. He reassured me that we were doing the right thing and gave a few suggestions like using nitrates to lower the preload on the heart. It was amazing to have him as a resource but sobering to realize that without him we would have been on our own.
Some afternoons are quiet on the outpatient front at St. Stephens while others are exciting and engaging. Last week a trauma came in by ambulance. The patient was a young man who was struck by a falling tree. Given that I did not need to be proficient in Luganda to help with this situation, I jumped in to help with the primary trauma survey. We found that he was stable but had a mandibular fracture, so we transferred him to Mulago Hospital. The orthopedic surgeon in the next room then called me in to see a massive inguinal hernia. This young man presented in severe pain with a scrotum the size of a melon. The hernia was at best incarcerated and at worst strangulated, so we took him to the theatre where I was able to first-assist on the repair. We did the procedure under local anesthesia. Although as the orthopedist was dissecting down to the hernia sac, he cauterized a small vessel and our patient kicked violently in pain, knocking some of our instruments on the floor, we did not need to wait for an anesthesiologist, and the patient walked from the theatre.