The last day in Scotland

They say to go out with a bang. In my case, more of a whimper.

I returned to Mulago hospital for the last time packing the final boxes of supplies we had brought with us leave for them to use as needed. There wasn't much of a team to meet with. The new interns were not entirely as enthusiastic as the last, with one AWOL and another last seen eating and reading an old magazine in the OR breakroom. The staff surgeons were no where to be found. Fortunately a frazzled resident was around to review new patients that had come in over night which included some large burns and an traumatic amputation (you guessed it: those damn bodabodas). We had a busy slate booked in the OR but there was a problem. They were out of oxygen. Low oxygen had been an issue all week. No one had gotten around to ordering more, likely budget issues or maybe good old fashion laziness. No oxygen, no operating on our patients. We scrambled to see what our options were but it was too late. The OR personnel had smelled opportunity and jumped ship. Anaethesiaologists, nurses, cleaners all fled out the back. There were literally sheets of paper blown about from the mass migration. "Don't worry!" I was told, they'll be back for the lunch you guys are supplying so at least that won't go to waste. Son of a ....

I'll miss the  OR at Mulago along with the sterile drapes with huge holes you can peer through. That's quality.

We checked on all the patients still admitted as well as some that had been discharged already, some days ago, but still hanging out in what ever corner would fit them. It wasn't uncommon for patients to stay due to financial issues or long travel distance, waiting for an opportunity to catch a ride with a relative or friend at some point in the future. Some would create jobs for themselves, like door guard to the ward in an effort to stay. The little boy with the head injury was holding on and back on a oxygen tank on the plastics ward where he belonged. I don't think  he is going to make it though. His breathing has continued to become more laboured. He will eventually fatigue from the muscle excursion and go into respiratory failure. Normally we would put such a patient on a ventilator to relieve the patient of this work load but there are no pediatric ventilators available and the adult ones are on a private ward, costing half a million shillings a day ($200). It is this reason that when seriously injured patients come into causality, it is rare to intubate (place a breathing tube). While short term a person can manually breath for these patients using a squeeze bag, the lack of ventilators means eventually they have to give up. This puts families into situations where they desperately hand pump the respirator for their love ones in shifts until exhaustion and inability to remain at the hospital constantly force them to stop. It is a horrendous situation that is best avoided.

The electrical injury is improving, but like all electrical injuries, the damage is much worse than it first seemed. It is clear she is suffering from some psychological issues sounding the trauma but the resources for this are almost non-existent. She will need further surgeries to remove the devitalized tissue and regular wound care but should recover if they stay on top of things.  It is diffiult leaving and not being able to finish these patient's treatment but they have surgeons here at Mulago and they can continue plan. Arrangements have also been made to follow up by email with updates and pictures.

Of course getting paid might help with the appreciation part.

With no OR to work in, I spent the rest of the morning wandering around the various wards checking out all the hidden areas of the hospital. I had a tonne of candy and little toy lights that clip onto your finger I had picked up before I left and the various children I came across children seemed to get a big kick out of these little gifts. The candy is eaten immediately and the finger lights will keep them entertained until the batteries die or they break but none of it will last for ever. Sort of like Humanitarian aid on retrospect.

Children are particularly taken with us Muzungo (white) doctors and commonly reach out to touch you as you walk past them. These little guys are all smiles after receiving their sweets and toy lights. One of my colleagues wanted the photo to include me handing them the items but I declined on the basis it was already a bit too colonial.

While trying to catch a photo of the UN craft in the back ground, this Russian made MIG 29 landed out of now where. The Ugandan government acquired 5 of these planes which were shown off extensively during the independence day celebrations.

There appears to be no limit to the carrying capacity of the bodabodas (local motorcycles)

It felt strange being back at the guest house during the day. It is usually pitch dark by the time I arrive back. I spent the afternoon relaxing in a chair under a small gazebo and even had short nap. I declined to participate in the evening activities and just continued to unwind.

It is easy to forget you are in the tropics working 12-14 hours a day. This quiet spot in the yard was only just noticed on my last day.

I fly out tomorrow. I'll spare everyone a painful rendition of my inner thoughts as I think about the last few weeks. The mission went largely as expected and we didn't kill any of our patients, in fact no complications, even minor ones, occurred. For this reason I would call our time here a success but it is just a drop in the ocean at the end of the day. I'd like to come back though even if it is just another drop. My final words of this blog will not be to encourage all you reading to open your wallets. The problem's here can't be spent away though If you really want to contribute, supporting an organization like MSF (Doctors without borders) ensures your money will largely go to good use. No, I would instead urge us to lift our heads and look around us once in a while and appreciate what we have at home and more importantly stand against those trying to take it away

I'll see many of you soon.