In the centre of attention: the voluntary humedica practitioner Winnfried Rossmanith. Photo: humedica
To help with the simplest of means
A review of humedica relief team member Winnfried Rossmanith
Since 2008 humedica sends regularly voluntary physicians to the St. Francis Hospital in the South-West of Uganda to improve the medical care of the patients and to enforce the work of the local team. The practitioner Winnfried Rossmanith from Ettlingen worked there for three weeks. He prepared the following empathetic report to tell you about his experiences with the county, its inhabitants and his daily routine there.
The green pearl of Africa
„As soon as I, the strange white foreigner, left the premises of the St. Francis Hospital in Mutolere even if only for a few steps abroad, people paused full of interest and greeted me friendly while a whole flock of curious children surrounded me. Everywhere I felt welcome, in good hands and safe. It was not my first intervention in Africa, but this time I had the impression that the population of South Uganda, a mixture of neighbouring tribes, the indigenous pygmy population and the manifold group of refugees, who had arrived here within the last decades from the Congo and Rwanda, was particularly friendly and courteous.
My operation site, the St. Francis Hospital in Mutolere, is situated 2.000 meters above sea level in the mountainous highlands of South West Uganda. The confessional hospital with 250 beds for inpatient and an expanded outpatient treatment provides for the basic medical care of about 80.000 people. The clinic covers four fields: surgery, gynaecology respectively obstetrics, paediatrics and internal medicine with a focus on infectiology.
The scattered settlement Mutolere besides the hospital is situated in the midst of lushly overgrown and deep green hills in front of the big volcanoes at the border to Congo and Rwanda. This exceptionally gorgeous landscape offers a wide range of natural beauty including steep mountains and hills as well as lovely placed lakes. The plentiful rain at the equator renders the country very fertile, with the tropical plants and the jungle it looks abundantly green.
At midday mist rises from the dense rainforests and the tea plantations surrounding the clinic and infolds the mountains and volcanoes with white caps. This land of rainforests, lush plantations and volcanoes seemed like a dream to me – for good reason it is called “Pearl of Africa”.
A life below the poverty line
But my enthusiasm for the cheerful and friendly people as well as for the great landscape could not blind to the many problems of everyday life: due to the huge influx of refugees in the last twenty years the region has become the most densely populated area of Central Africa. Besides the thousand natives live about 300.000 refugees from the adjacent neighbour countries around the hospital and on the hills nearby. All of them do not have much to live on: thanks to the fertile soil and the extensive agricultural use there is no famine, but the extensive partitioning of arable land means that most of them can just about survive.
The major part of the population lives below the poverty line; state subsidy and funds are limited. The future will not change much about the spatial narrowness and the extensive farming of the land, because many refugees can not return home, where armed conflicts still rage. Most people live without water and electricity, they cook on open fire and the traffic routes to the outskirts are extremely hard and uncomfortable.
Most families have many children, which are still regarded as provision for old age. I rarely saw so many children in schools, but only few of them receive a reasonable and comprehensive education. On top there are the bad hygienic conditions, which favour recurrent infections like tuberculosis and malaria. The federal health care system is inadequately funded, there is just one physician for each 20.000 inhabitants, basic medical equipment as well as efficient prevention and vaccination programmes are lacking.
Back to the medical roots
I worked for about three weeks at the St. Francis Hospital. The time was short, but very memorable and full of impressions for me. What insights did I personally gain from this time? I can only word but some impressions: For a medical operation like this you need much resourcefulness and most of all a good knowledge of medicine in general. You must be ready to engage in the whole medical range, it is nearly impossible there to focus on just one special field. As practitioners for paediatrics and infectious diseases were lacking, I worked not only in gynaecology, but tried also to help out in these disciplines as best as I could.
To diagnose diseases I had to rely on basic measures such as listening or careful looking, feeling and hearing. Time and again I had to decide what to do when electricity broke down and we nevertheless needed a diagnosis without features such as ultrasound technology available. Or to decide on a treatment when surgery was not possible and only standard medicaments were at hand.
You have to relate many answers to medical questions to the local conditions, you can only understand them if take the local conditions into account: What to do, when a promising treatment proves to be too time- and cost-intensive and the patients and their families can simply not afford it any longer? I was also overburdened by the request of a parental couple to end the treatment of their seriously ill child, because there was still hope for another child.
My work comprised both pleasing and disillusioning experiences, successful highs and bottomless lows. I was very happy, when minor medical measures were successful, but sometimes there were also situations, when I simply felt helpless. But if you think of the enormous differences in the medical treatment to those under Western conditions, this is hardly surprising for anybody.
It is difficult to lay hands on medical materials in Uganda and when you succeed, mostly you get only one single instrument or medicament. You can count available drugs on two hands, suture material is used sparingly and often its expiration date has passed for years. Hygienic and sanitarian conditions are deplorable even at privately managed clinics. Flies fly around in the operation theatres and narcotic gas is discarded faultily so the surgeons get drowsy during the procedure.
My relief service revealed to me, how excellent the circumstances for our health care system in the Western world are. But it also showed me the way back to the basics and roots of clinic medicine. In order to cope with the given means, improvisation talent, a broad medical knowledge and flexibility were mandatory. But it has become very evident that you can do a lot also with small means. The many adult and child patients are grateful for every bit of attention and support, no matter how small it is.”
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