doc w/ Pen

journalist + medical student + artist

Tag: physician

One who listens

In addition to this blog, I also write a monthly column called Bio-Lingual for the online magazine The American In Italia. I don’t usually cross-post. But the piece that was just published there is about my time in Uganda so I wanted to share it here, with those who are following my experiences. Here is the link:

One who listens

A brief preview, in case you’re deciding whether to click on the link: In the essay, I explore the kind of doctor I want to be. Being in Uganda for two weeks helped me better understand how I want to treat patients.

Typical weekday in Naggalama

Dining room table

The table in the guesthouse where we ate our meals.

While I’ve written extensively about my experiences in rural Uganda, it occurred to me that I never made it clear what a typical day was like. And that’s an important piece of my time there. Although I have listed times here, these varied by day. We learned to expect the unexpected.

7:30 a.m. – 8:30 a.m. — breakfast. Our group gathered at the table in the main guesthouse for this very important meal. I say “very important” because during the week, we never ate a full lunch, merely snacks on the go; we were out in the community all day. Breakfast usually consisted of hardboiled eggs, toast, fruit, and coffee or tea. (And after two straight weeks of daily hardboiled eggs, I still have no interest in eating one.)

8:30 a.m. – 10:30 a.m. — hospital rounds. Randi, Howard, Jemella, and I headed to check on the hospital patients who had been referred for palliative care, mostly pain management.

Typical home

The view of a typical home in the rural community, seen through the window of the palliative care team’s van.

10:30 a.m. – 5:30 p.m. — house calls. After hospital rounds, we met up with the local palliative care team (a nurse trained specifically in palliative care and her two nursing assistants) to head out into the community for palliative care house calls. Some patients lived in nearby towns; others lived in villages an hour away on rutted, dirt roads. The distances we often traveled, plus visits that might last 30 minutes to an hour, meant we usually saw no more than four or five patients a day. I knew that these visits would be emotionally challenging. Some of them were. But I learned, through watching Randi, Howard, and Jemella, how to better listen to patients — and how rewarding that kind of intimate interaction could be. What I wasn’t expecting were the physical challenges of being out in the community for six or seven hours. We all got hot, sweaty, tired, hungry, and thirsty (and didn’t drink much water because there weren’t any bathrooms).

5:30 p.m. – 8 p.m. — decompress. After a long and intense day, we’d come home to both unwind and to process what we’d experienced. This usually happened over cheese, crackers, and hummus — delicacies procured in Kampala, the capital city. Sometimes we sat in the living room; sometimes outside on the lovely back patio.

8 p.m. — dinner. Meals in Uganda consist of a lot of starch — potatoes, also called “Irish,” as well as rice and pasta. Vegetables and meat were accents. That was a big change from my diet in the United States, which is mainly fresh produce and protein. So food was a challenge for me. Though I must say, the housekeeper certainly made some mean french fries.

10 p.m. — bed. Growing up, I always wanted a canopy bed. That never happened. But in Uganda, I slept every night under a mosquito net, which is pretty much the same thing, but with a purpose!

My "canopy" bed.

My “canopy” bed.

The hospital stay in rural Uganda

Naggalama HospitalWhen I had my tonsils out in 2014, I spent a couple days in the hospital after minor complications with the surgery. It was by no means a vacation. But I certainly felt well cared for. I expected it. And I took for granted the clean sheets, three daily meals, and constant (amazing!) nursing care. My time in Uganda taught me that my hospital experience is not necessarily the norm, and I shouldn’t take it for granted. These pictures are from Naggalama Hospital, but I also spent a day at Mulago, the government hospital in Kampala. The same principles applied there, from what I could tell.

Hospital laundry

Attendants must wash patients’ clothes and bed linens behind the hospital.

Three things that are expected in an American hospital — clean bedding, three daily meals, and constant nursing care — aren’t part of the hospital stay at Naggalama. As a hospital patient, you are required to bring an “attendant” to care for you. This person is usually a family member. He or she washes your clothes and bed linens (there is a washing station behind the hospital). The hospital doesn’t provide bed linens or gowns; you have to bring these in yourself. The attendant also either cooks or brings in your food (there is a place to cook behind the hospital, as well as a small restaurant called St. Peter’s). There are nurses, but few of them, and they serve many patients. Nurses administer IV medications, but attendants hand out the oral drugs, after receiving instructions from the nurse.


Attendants pay in advance for medical services with the cashier.

The attendants also play a major role in the patients getting proper medical services. If a patient needs a blood test, the attendant must take the doctor’s order to the cashier, pay for the blood test in advance, and then bring the receipt back to the ward so the nurse can draw the blood. Some medications must also be paid for in advance. The bulk of the hospital bill, though, is settled upon discharge. The patient can’t leave, however, until the bill has been paid. Supplies are precious and expensive, so the bills are incredibly detailed, down to every pair of latex gloves used in the patient’s care.

Having been both a hospital patient and a hospital employee (and now a trainee), I have a certain picture of what a hospital room looks like. At Naggalama, the majority of adult patients are not in rooms. They are in the male or female wards. There are a handful of private rooms, but these are very expensive, by Ugandan standards. The wards are made up of units (my own term). Each unit has two rows of three or four beds facing each other. The units are separated by walls that go about halfway from the floor to the ceiling, so you can see across the ward. Above each bed is a knotted mosquito net, pulled down at night to protect the patient from malaria-carrying bugs. Next to the beds you will find colored straw mats where the attendants sit during the day, and where they sleep at night.

Here is a brief, visual tour through the adult ward, and several other parts of the hospital. (Click on any image to enlarge and begin a mini slideshow.)

Adult ward:

OPD (outpatient department):

Emergency room:

Hospital laboratory:

Hospital pharmacy:

Staff housing on the hospital campus:

Surgical gowns drying outside after being washed:

Surgical laundry