Underway in Uganda - Julia Törper's Journal

by Julia Törper/SRI,  2008/02/20

29-year-old student Julia Törper (Bremen) has been working since October 2007 as an intern in humedica’s Project Department. After extensive research in Germany, she visited several health clinics and hospitals in Uganda in January. Her goal: to develop a concept for humedica for possible partnerships between German hospitals and those in developing countries. With her journal entries, she shares with us an exciting journey.

January 16, 2008
I am finally in Kampala. My first trip in Africa didn’t go quite how the Foreign Office had suggested: I took a taxi ride during the night to and through Kampala. But other than that everything went fine. I got to bed about 1:00 in the morning, and wondered a little at being in Africa. Actually I am still taking everything in, but the porch here is perfect for that. Hopefully, I can start working in the hospital tomorrow.

January 22, 2008, Day 2 in Rubaga Hospital, Kampala
Today I got to watch over the shoulders of the nurses in the clinic, but not much was going on. They believe that many people are staying away since school is starting next week, and the families can’t afford both the additional school fees and medical care.

I spent the afternoon in the children’s wing. Main disease: malaria. And burns. Water, milk, oil… open flames are still widely used in cooking. Some of the burns are very extensive. There are six to eight children in a room, and the mothers sleep on mats on the floor beside their children.

Examination in Uganda, unusual for Europeans. Photo: Julia Törper

January 25, 2008
Today: Pregnant women everywhere. Health education in the waiting room, tours of the hospital for those who are new. HIV tests and consultations, gynecological and regular examinations. The women wait in long lines to have their blood pressure checked, my ears hurt now from the stethoscope.

Although many women are already far into their pregnancy, they are here for examination for the first time; they don’t generally know when their last period was or far along they are. There are often large discrepancies between when the mother believes she is due and the estimated due date given by the midwife after the examination. Because of the costs, an ultrasound is, if at all, usually administered only once during the pregnancy as a matter of routine. Heartbeats are heard through the assistance of a wooden pipe, and mother and midwife must live with the uncertainty when no decisive heartbeat can be distinguished. But the midwives manage very well even without the technical equipment.

It seems like the trick in getting the husbands or fathers to the clinic for health education and HIV tests is to take the couple through the process as quickly as possible, with minimal waiting.

January 29, 2008
We arrived at the second hospital, Butiru Hospital. We were ready to be picked up at 8:00 a.m., and the van came at 10:00 a.m. Stop 1: Money exchange and grocery shopping in Jinha. About a three-hour drive, swamps, rice fields, tea and pineapple fields, clay houses with straw roofs.


Stop 2: Bought fish by the side of the road - for the rest of the trip a few Victoria perch hang from the windshield wipers. Stop 3: Three of the fish are delivered to Peter’s wife. Stop 4: Bought mangos by the side of the road. Stop 5: Stop off at Joseph’s – his wife left him and so we must pick up the children. The van is already full: two hospital employees, us three Germans and two interns with baggage, water and food for a week because there aren’t many shopping opportunities near the hospital. Stop 6: Mbale Market: An experience for the senses; purchased fruits and vegetables for a week. Stop 7: Even the Peace Corps trainee fits in the van. Stop 8: Bought eggs. Because the vendor was low on cardboard boxes, he gave us our twenty raw eggs in a plastic bag, which I hold on my lap.

This is how we arrived in Butiru: a minivan filled with Muzungus (“Whites”), Ugandans, children, potatoes, onions, pineapples, mangos, in the glistening sun over the gravel road with fish on the windshield wipers and “scrambled eggs” on my pants.

Julia Törper during a visit to the hospital Photo: humedica

6.2. 2008
An African day. We should begin at 8:00 in the morning, but don’t start towards the Kaliro district until around 9:00. I am met by the District Health Officer. First entry in visitor's book. While waiting for another employee, a conversation with the “mayor”. Second entry in the visitor's book. Three other Health Dept. employees get in to a pick-up truck filled with condoms and posters. The first health center we go to is situated on the third floor, very simple, a little dreary. A patient with malaria. Third entry in visitor's book. Lunch: rice, chicken, beans. Continue to the next health center. Not as dreary, but by no means up to standards. The solar panels have been out of order since last April, so there is no electricity. No running water, no doctor.

A patient in critical condition is lying there. They don’t know what’s wrong with him. Since his wife is HIV positive, they assume that he, too, is affected, but they don’t have any more tests. He is too weak to be transferred to another hospital; the next hospital is far away and there aren’t any vehicles. Fourth entry in visitor's book.

The next health center is very isolated. No one need here ask what they need, but rather, what do they have? No electricity or water, no equipment, no microscope for the lab, no beds or mattresses. No sterilizer; the few instruments which they have are sterilized in a water bath placed over a paraffin melter. Few disinfectants. There’s not enough malaria medicine or pain relievers. They’ve been waiting for their next delivery of medicine since November. They had 100 butterflies in August, now they are waiting for more. Gloves are scarce.

There are only one stethoscope and one thermometer for the entire center. It makes one think. Fifth entry in visitor's book.

Result:
The trip was a valuable experience. It was good to visit several hospitals, with and without partners, in the city and outside, in order to get a better picture of the different levels and standards. One can get a better idea as to what the problems, challenges and resources are by collaborating with the African nurses and conversing with employees and patients than from sitting behind a desk. On location, one can more easily free one’s mind from preconceived ideas and see things from a different side.

No prejudice: Chickens are also allowed in the hospital. Photo: Julia Törper

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