1/6th of my time in Gulu is over! I can’t believe it’s been a month already. Time’s flown by but it also feel like I’ve been here for much longer. Basically, it’s been busy as sin but I’ve settled.
I’ve sort of adjusted now to having next to no resources on the ward. It still fills me with despair that we don’t have some of the most basic life saving drugs; I don’t think that feeling will ever change. But I feel like I’ve become a bit more pragmatic as a clinician. We currently don’t have a hospital laboratory (meaning not a lot of choice with regards to investigations) so I’m relying almost solely on my history and examination skills. My university clinical skills tutor would be proud.
I’m not really sure why the hospital lab still isn’t functional. We used to have one, but apparently the building became infested with termites so had to be fumigated. The building’s now ready to be used and the equipment can be brought out of storage but the staff are mysteriously AWOL. As a result, now the patients have their blood taken and relatives are asked to go to a private lab to pay for tests, which is making me increasingly uncomfortable. I totally understand being selective with investigations in a resource limited setting but omitting potentially life saving blood tests just because someone doesn’t have £3 spare is just wrong. Everyone from the US to Uganda to Uzbekistan should have access to affordable healthcare. It cuts deep that people here who arguably need it the most don’t have it.
I’ve spent a couple of days in HIV clinic and joined Patrick, the HIV counsellor, on some community visits. We have two HIV programmes here: USAIDs and TASO, which provide such amazing care. The anti-retrovirals are free of charge, any unwell HIV patients can see a doctor on the day and post-exposure prophylaxis is provided via a walk in clinic. And the doctors are incredibly helpful whenever I call them up for advice – which given my limited experience with HIV I have to do pretty often.
Patrick’s job is to visit anyone in the community who was unable to attend their hospital appointment, for pastoral support but also to ensure continuation of treatment. We visited a village in which a young girl was living positively. She was so extraordinarily well, surrounded by friends and family who were supporting her with treatment. But this wasn’t always the way. The community leader spoke to me about when the HIV crisis began:
“We didn’t know what was happening. People thought those who were suffering were bewitched. They took them to traditional healers and cast them out of the house. People wouldn’t sit next to them, wouldn’t share their food. They ate and lived alone. But then we became educated and realised the virus wasn’t contagious if you share food, touch each other, cough. And now we live together.”
I wasn’t alive for the beginnings of HIV but from what I’ve heard it was the same kind of panic in the western world. It absolutely decimated communities, in part because it was ignored by governments for so long. Mostly affecting gay men, prostitutes and IV drug users, for these populations being neglected was the norm and they were ignored even further when they became unwell. In the Gulu clinic we saw patients well into their 60’s living positively. Some groups of people with HIV now can have the same life expectancy as those who don’t have the virus and that’s amazing.
But we still have a long way to go. In the UK, pre-exposure prophylaxis has been rolled out for a select few under the PROUD study and has produced promising results. It’s exciting times for HIV prevention but I wonder what the impact would be for the developing world?
Anyway, settling in a bit better now and finding my feet on the ward. It’s still hard work and the heat most definitely doesn’t make things easier but I feel like I’m making progress. I’ll try to attend HIV clinic again but with ward rounds, research projects, numerous other medical clinics, etc I’m not sure how feasible this will be. I should probably be somewhere I’m needed and HIV clinic has definitely got it sorted without me!
Getting on in Gulu 