doc w/ Pen

The men’s ward at Naggalama Hospital. I would sometimes see Joshua*, a patient we cared for there, sitting in a wheelchair outside in the shade.

“Time” is perceived differently in Uganda than in the United States, at least by some people. In the United States, so often we’re tied to our watches, computers, and cell phones — all of which help us get where we need to be right on time. In Uganda, time is a more fluid concept. Many people think of their lives in terms of events and stories — not in terms of hours or days. Kenny, the Ugandan man who was assisting the documentary film crew working with us, explained this to us midway through our two-week time doing medical work in rural Uganda. After that explanation, so many mysterious things suddenly made sense. We asked patients many questions that relied on our American concept of time. Questions like this: “When you took the morphine, how long until the pain came back?” Some patients struggled with these questions. After Kenny’s words, it became clear that this difficulty might not be with our wording, but with a broader concept of memory and time-keeping. I’m not sure how you bridge that gap, but it’s something to think about for future visits.

Toward the end of my time in Naggalama, I realized that my own memories of this trip may have more in common with the Ugandan concept of time than the American one. The long days there, spent first rounding in the hospital and then in the community making house calls, quickly blurred together for me. I couldn’t tell you that on Monday, we saw patients A, B, and C, whereas on Tuesday we saw patients X, Y, and Z. Half the time I didn’t know what time it was — only whether I was hungry or thirsty or tired (which was most of the time, given the rigors of this work). It was all a jumble — a jumble of people and faces. And especially of their stories. Here are a few such stories that stood out to me during my two weeks in Naggalama, both from the hospital and from house calls.

This is the kind of home that most of the palliative care patients lived in.

While working in Uganda, we saw many women with breast cancer. In the United States, breast cancer has a high cure rate if caught early. But in Uganda, women often present late to the hospital, too late for treatment, and they die. Two women with this disease especially stand out to me. We met Margaret* outside her house. We all sat on straw mats in the dust to talk. Like many women, Margaret didn’t seek conventional medical treatment when she first became ill. Now, her tumor was very advanced. Surgery and chemotherapy were no longer options for her. But we could still help her pain, which we did, with medications. We could also help her in other ways. Margaret was extremely poor, even by Ugandan standards, and had only one dress. A Dutch woman who helps fund programs at Naggalama Hospital had sewn Margaret a skirt and a blouse. When I presented them to Margaret, she immediately slipped them on, stood up, and began dancing. I’ll never forget how something so simple brought this woman so much joy.

In contrast to Margaret, Elizabeth did have surgery for her breast cancer. She told us that as soon she felt a lump, she went to the hospital. We asked why she had decided to go the hospital immediately. Elizabeth softly started to cry, telling us that her daughter had developed a breast lump some years earlier. Her daughter did not go to the hospital and died. Because of this, Elizabeth didn’t listen when her friends and neighbors told her going to the hospital would be the death of her. Elizabeth’s situation represents the potential for public health education, in the form of patients telling fellow villagers about their positive experiences with medical care.

Cecilia was an older woman who had fallen and apparently dislocated her shoulder. That was months ago. At this point, it would take surgery to correct — a surgery that wouldn’t likely be done in Uganda. So Dr. Howard Eison, one of the New York physicians on our team, fashioned a makeshift sling. Howard rested Cecilia’s arm in a long, narrow swath of lacy fabric and tied the cloth in a knot behind her head. Then to further immobilize the shoulder, he wrapped a purple-and-white scarf around her upper body and tied it at her side. After applying the two-piece sling, Cecilia was able to be pulled into a sitting position. She started talking, even laughing — no small miracle.

We found Michael lying on a foam mattress in his small, brick house. His limbs were sticks. We learned from a neighbor that he had essentially been abandoned, unable to fetch food or feed himself. As we talked with the neighbor, she found a bottle of orange soda next to his mattress. She put a straw in the bottle and held it to his lips. Michael sucked until the drink was gone. Watching her care for him, we decided to take a chance and give the neighbor a small sum of money (about $3 U.S. dollars) to buy him food. Whether she would use that food for Michael or her own family, we didn’t know. But we had to do something.

I’ll never forget Jane’s face. Most of the time, I saw it behind mosquito netting. Even through the tiny pin holes, I could see the peeling burns. Jane had been brought in one night early on in my stay in Uganda with horrible burns over much of her body. But in Naggalama, there’s no intensive care unit. No dedicated burn unit. She was left on the general medical ward like everyone else.

Talking to Joshua in his bed, listening to him speak softly in Luganda entwined with broken English, he struck me as such a gentle man. Joshua was in the hospital with a very serious leg infection. He needed an expensive skin graft. We saw Joshua every day to check on his leg and his pain. Sometimes I would see him outside the medical ward, sitting in a wheelchair in the shade. We would both smile and wave to each other.

I may never know how these stories end. I can only hope that the small role we played made at least the tiniest impact. I can only hope that we brought some joy or happiness, some comfort or relief, to people who are, in my American eyes, experiencing so much tragedy.

*Patient names changed to protect privacy.