Our visiting doctor, Kate Howorth, writes about her first month volunteering in Uganda with Cairdeas. She has since completed her six month volunteering stint and is well-missed by our partners in Uganda. 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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I thought it would be a good idea to share a bit more about what day to day life looks like for me here. In the first few weeks, we were trying to gather as much information as possible about the team and it’s responsibilities, what tests and treatments were available, paperwork and the different training pathways for students and healthcare professionals, all while learning lots of names and avoiding getting lost! Two weeks in I was heard talking about what “normally” happens on a particular day and soon realised there may not always be as much of a predictable structure and schedule to the week as I was searching for, so keeping a level of flexibility to our days and weeks was going to be necessary. Having said that, I’ll try to share a flavour of the different things we’ve been involved in.

 

We are working as part of the Makerere Palliative Care Unit. This is a great Ugandan team including specialist palliative care nurses, a social worker, admin staff and some great volunteers. The team is supported by Mhoira and has two Ugandan doctors who have spent a number of years working in palliative care and help with the work for three days a week at the moment. Most of this team is very experienced having worked in the team for a long time and we have learnt a lot from working with them already. We work in two hospitals: Mulago and Kirrudu. These are both government-run hospitals and the referral centres for the country. Mulago also has the Ugandan Cancer Institute (UCI) on site so we visit there too. The team is a liaison service meaning we go and review hospital inpatients on the wards who are referred to us (which is often via word of mouth of Whatsapp!). The team is referred large numbers of patients and have been stretched in what they are able to do especially with the challenges of Covid, so we have bolstered numbers, been able to provide extra senior medical cover and hopefully free some of the nurses up to do other managerial, research and leadership tasks they have needed to.

 

Most of our days are spent on one of the hospital sites reviewing patients on the wards. Similar to the UK, we are referred any patients with life-limiting conditions who need our involvement to help manage complex physical symptoms (pain, nausea & vomiting, breathlessness), support with difficult communication issues or sharing bad news, provide psychological and social support, or family support. Different to the UK is the patients we are seeing. The age of our patients is much younger overall, we are seeing lots more infectious diseases like TB or complications of HIV, and many patients seek medical help much later so their disease is already more advanced. One of the reasons for this is the cost of healthcare, but I’ll discuss this more in another post. A particular challenge for me is that we see a lot of patients who are children here. I mostly look after adults at home, so this has meant me learning lots in terms of the different conditions children have here, how to prescribe medication safely, and supporting parents. Being in the country’s main referral hospitals means there are a lot of tests and resources available but still significantly less than in the UK particularly one that are affordable. It has been really hard caring for patients knowing the different care they would be able to access if I was caring for them back at home, particularly when this impacts on how well we are able to manage their symptoms or give them information about what is happening. It has once again made me grateful for the free healthcare accessible to all that we have in the UK and reminded me of the need to keep working towards affordable palliative care to be available worldwide.

 

Considering the size of the team, we do a lot of teaching which I’ve really enjoyed being part of. In our first week, we had 17 medical students and 4 junior doctors training in internal medicine or family medicine (equivalent to our GPs). It is much more common in Uganda to do big teaching ward rounds where a senior doctor takes a big crowd of students to see patients and grills them with questions standing round the patient’s bed. The first time I joined one of these to help see how this worked and contribute to the teaching made me realise that being 5 foot was going to be a significant disadvantage in this method – even on tiptoes I couldn’t see the patient we were discussing! I was surprised to see the patients and families don’t seem to mind either – it seems to be accepted as part of being in hospital and if anything, a sign that their case is being thoroughly looked at. I’ve also been doing some bedside teaching for postgraduate exams and we have weekly journal clubs and mini rounds, so there is lots to get stuck in to!

 

Finally, one of the other main focuses of my time here is helping to develop a Fellowship programme. I am 3/4s of my way through my specialist palliative care training in the UK but there is no equivalent training programme for doctors to specialise in palliative medicine in Sub-Saharan Africa. This means that despite the Ugandan doctors working in our team having a lot of experience, skills and knowledge in palliative care, this is not formally recognised or accredited. The team here with support from a number of UK colleagues have been wanting to set up a Fellowship programme for a while to facilitate this, so I am spending time reading curriculums, arranging meetings and making proposals to try to make this happen. Watch this space….

 

As you can see, work is busy, challenging and rewarding. But we are also getting lots of time to explore Uganda and meet people, but that sounds like something for a future blog post!