Sunday, April 26, 2015



Part of medical team walking down to clinic
Each day we walked a kilometre down to the clinic around 7.30am to begin the day. That walk back and forth each day, became the time when we could talk through different approaches to ensure people who needed immediate care were identified and brought into doctors first, the medical team discussed interesting and very sad cases on the walk home and we generally tried to understand how, and if, we were making a difference. It was tough on the clinical team members as they had very very limited resources and could not practice medicine how they would like to.
One of the 3 four-bed wards at clinic.

 The clinic had three small wards where the very ill (most often young children with malaria) were admitted. Concrete floors, plastic covered mattresses, no mosquito nets and no bed linen. Note the wooden bench for visitors or family. If you or your child was admitted it was up to you to provide sheets, water and food. We often found ourselves paying what amounted to 40c for bottles of water and handing them out to people in the wards, mothers with young children. We also regularly went round and bought plates of food (about $2) for them as many might have walked from villages 15km away and not have the means to purchase food or to contact relatives.

Annette, mother of 4 including twins Catherine & Nicholas 
Babies ride on back
 The clinic faced over 300 people each day in week one and then around 280 each other day - the first few days were the hardest and this is when we encountered the most gravely ill. We turned up to 50 people away on days 1 and 2 and then the pressure gradually eased. There would typically be 100 people waiting when we arrived at 7.30 - 8am.
As a non-medical team member I assisted with registration, taking blood pressure, weight and generally ensuring that we kept the lines outside the 3 separate consulting rooms (2 doctors or nurses one each) and the dentist moving. The local people were incredibly patient - many had walked significant distances to be there, some had slept under the tent shelter the night before, most waited hours before they were seen by the doctors and then a further hour or so to receive their prescriptions.
Waiting at pharmacy window

Over nine days we saw over 2600 patients and for many people it was the only time they consult a doctor - when the international team comes each year.

Waiting for dentist
Having seen the doctor and/or dentist there is another wait at the window of the pharmacy to receive any medication. All patients receive a worm treatment (as did all mission team members on our departure) and other prescribed medications. When there is no international clinic local people must pay for medication so these two weeks are an opportunity for everyone to consult a doctor or nurse practitioner at no cost. Patients can ask for HIV/AIDS tests (which are always free) but at any other time of year all other tests and medications cost, and the hard reality is - people do not have money.

I captured these children before they had seen the dentist - people waiting at pharmacy window behind them. The medical team has services of a volunteer dentist from Kampala - a very small statured woman whose sole role during the clinic is to extract infected teeth! An infected tooth could lead to greater infections, illness and, in worst cases death. With limited resources - all done in a  plastic garden chair with dentist wearing a camping headlamp - everyone visiting the dentist goes in first to get an injection of Novocain and then to have the tooth extracted some 10-15mins later. The dentist is an amazing woman - works solidly through the day with minimal equipment.  Some kids have to be held in the chair and scream - but many are quite stoic and take it as necessary. I think I got the photo above before their dentist visit since they are ready with their smiles.

Waiting for relatives still with doctors.
At the end of the day the tent, so full in the morning,  is almost empty
As the day draws to a close - we stop the waiting lines at about 4pm - the registered people are all in doctors lines or waiting for prescriptions or have begun their journeys home.  The pharmacists are always the last to finish up their day (sometimes as late as 6pm) and one by one the medical team makes their way back to the Boys & Girls Club to play with kids, shower, wind down, complete statistics, have dinner and head to bed.

The daily routine of the medical mission as described above masks some very difficult and heart rendering experiences. I was not a medical team member so witnessed far fewer cases than did the nurses and doctors - but there were times when the poverty, the sickness and the lack of basic health understanding brought each of us to tears. A little girl with malaria, a raging fever and little response was hooked up to a drip in an effort to hydrate her and I was charged with wiping her little body down with cold cloths to try and help cool her - she passed away on the first night - teaching me the fragility of life where lack of knowledge and basic medical care is so difficult to obtain. There were countless others - children and adults without shoes, women with hands so rough, cracked and creviced from working in the gardens you thought you were holding concrete when you took their blood pressure. Most of the adults I weighed were under 50kg and when I noted someone was around my age, I was shocked at how tired and worn out they were. But amongst all this was astounding human resilience which in and of itself was a rich and deep lesson for me.

Images beyond those posted above will stay with me as I try to make sense of the challenges the people of Kamengo face. I had an incredible experience on the medical mission and am committed to returning to work with the students, teachers and schools to see if basic education can be enhanced and can perhaps mitigate some of the suffering I witnessed as part of the CACHA medical mission.

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