Our visiting doctor, Kathleen Mcgeough, who had been with us at Cairdeas for four months this year, shares some thoughts on the routine they built while volunteering in Uganda. She submitted this particular blog at the very beginning of her work with the Mulago Palliative Care Unit / Palliative care Education and Research Consortium. To hear more about our visiting doctors and their time in Uganda, visit the complete blogs at Kate Howorth and Kathleen Mcgeough. 

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The time my day starts depends on whether I am at Mulago Hospital (leave the house at 7:05) or Kiruddu Hospital (leave at 7:35).  We generally start the day by meeting with the clinical team in the morning to go through our list of patients and decide who needs seen. These patients are then divided between us (with a translator for Kate and I) and we start our reviews.  A large part of the job is assessing and trying to treat symptoms, but a large part is also discussing (sometimes more debating) with other doctors what our treatment priorities should be.  An example of this is on the renal wards.  We get a lot of referrals of patients who cannot afford dialysis; either they cannot afford to start it or it has been started but they can no longer afford to continue.

The cost of initiating dialysis is over £200 as patients have to pay for central line insertion, blood tests, medications and the actual dialysis.  This is more than the annual salary for many patients and many families face choosing between financial ruin and starting treatment.  We spend a lot of time on the renal unit discussing with the ward doctors what our treatment goals are; it is painful to hear that families have sold their homes and everything they own for 2 weeks- worth of dialysis before having to stop treatment and facing the inevitable deterioration from renal failure.  Instead we try to ensure that the ward doctors have frank and honest conversations with their patients and consider the benefits and risks on an individual basis.

We tend to finish our reviews and clerking new patients by the afternoon and try to beat the traffic on the way home.  Alongside the ward reviews we have been doing a lot of teaching. This has ranged from undergraduate to postgraduate teaching.  Thanks to zoom, we can often do these from home as most teaching has remained virtual.  As well as delivering lots of teaching there has been plenty opportunity for me to attend teaching. This has been either “mini rounds” where an interesting case is presented followed by teaching and discussion as well as journal club. 

The main week to week variation has been medical students.  We teach students from 2 different universities- one university sends a large group of students (currently 32!) to the unit for a block of 4 weeks while the other university sends a smaller group (8 students) on alternate weeks.  This makes a massive difference to the workload for the week; the weeks we have medical students involve a lot more bedside teaching and therefore slower ward reviews.  There is also the Friday PBL session which takes a good few hours going through 3 different cases- wish me luck doing that with a class of 40!  We have been lucky to have post-graduates rotate through the department, once they have been with us for a week or so they are able to work more independently and help share the work load. 

The weekly routine generally involves 3 days at Mulago and 2 days at Kiruddu- though this can change with public holidays, staff absences or when the case load is much greater in one hospital.  We have also managed some routine in our personal life.  Tuesday evening is yoga, Wednesday is Quiz night and we have tried to stick to a “Fun Friday” where we treat ourselves to a milkshake, cake or even a cocktail seeing as its Friday!  We try and go to the gym regularly, luckily it is walking distance so we tend to manage at least 3 times a week.

Generally the variation month to month has been dependent on medical students. March was an overwhelming month as we had a large group of students, GP trainees and internal medicine trainees whilst Kate and I where trying to find our feet with how things are done.  There was also loads of teaching that we delivered and attended.  April was slightly different, we did not have many medical students which made it easier to get stuck into clinical work and get to know our colleagues in both hospitals better.  In May we where lucky enough to travel to the North of Uganda to participate in some research, though I’ve already bored you with this in another post.

We have tried to make the most of being here and filled our weekends with adventures and activities.  Being away in Uganda for a longer period has meant we have been able to build up a network of friends outside of work and have started to feel like we have managed to build a bit of a life here.  Our colleagues have expressed how grateful they are for the extra woman-power but have also been keen for us to explore the Pearl of Africa and enjoy everything Uganda has to offer.  I have just had some annual leave travelling around Uganda, and it truly was amazing.  3 days back at work now and it’s like I’ve never been away… though there is something comforting about a routine. 

Hello! Allow me to introduce myself; my name is Hannah Ikong and in March I joined the Palliative care Education and Research Consortium (PcERC) as an Education Programming Consultant. I have experience in both education and administration in Uganda, the UK, and the USA, and I am delighted to provide support to our most recent education programmes. This year has been marked by growth in the educational programmes; namely, an expansion of our medical student resources (i.e., the MMed Family Medicine Expert Lectures) and a rebirth of the Palliative Care Fellowship Programme. 

The MMed Family Medicine Expert Lectures are a response to the learning needs of the Makerere University family medicine (general practitioner) students. Postgraduate students often have clinical instructional rotations in different specialities, including palliative care, at the end of their course. The most recent rotation during March 2022 spurred us to create an expert lecture series addressing the primary medicine approach to palliative care. Through the partnership of palliative care specialists around the globe, engaging 30-minute lectures were recorded, designed for group discussions and immediate application in clinical rounds. Topics surrounding complete healthcare worker participation and hospital-specific set up of palliative care and perspectives on palliative care in global, rural, and fragile settings were covered. The students were inspired to incorporate palliative care in their own daily practice. The expert lectures are now being organised and saved for future family medicine students on a private YouTube channel (watch our playlists here). 

We are also in the thick of building a Palliative Care Fellowship Programme, which will be the first of its kind in Sub-Saharan Africa (SSA). Our plan is to start the Fellowship in Uganda and later branch to other countries under the ambit of the East, Central and Southern Africa College of Physicians (ECSACOP). We are delighted to have partnerships to support the Fellowship through Cairdeas IPCT, members of the Royal College of Physicians of Edinburgh and London and members of the Association for Palliative Medicine, UK. The Fellowship planning has been a process with monthly steering group meetings since March 2022 of both Ugandan and UK palliative care experts, while we have benchmarked and wrote a curriculum, structured a proposal, submitted the work for senior review, and investigated routes of accreditation. We must note and thank the ongoing collaboration of several palliative care specialists in and outside Uganda, led by Dr Mhoira Leng, Dr Elizabeth (Liz) Namukaya, and Dr Kate Howorth (six-month UK volunteer with PcERC).

As we reflect on both the tasks accomplished and remaining, one word comes to mind: collaboration. Palliative care specialists across the globe have provided their expertise and time to create the MMed Family Medicine Expert Lectures, and others are continuing to support in the Fellowship’s Programme creation and approval. We also have excellent support for the Department of Medicine and Family Medicine at Makerere. We are so grateful for the teamwork and passion being invested in palliative care education. We look forward to outcomes of improved clinical skills and research, and improved access to palliative care in communities around Uganda and beyond. We also invite further collaboration from those interested in palliative care education programming; for enquiries, please contact me, Hannah Ikong at hikong256@gmail.com.