Orientation and disorientation

I wrote this last week, on my second day in the hospital…. I’ve delayed posting it because I wanted to check that the hospital communications team were happy with me writing things about the hospital.

………………………

I am now ‘at work’ to Brian’s disappointment, as he wishes I would spend more time with the family before disappearing into the hospital. But I feel that we are here at the hospital’s generosity, and that it is courteous and respectful to start making a commitment to the hospital as soon as I can, and I also want to get to know the community we are becoming part of.

 

The hospital has an extensive orientation programme. I have not seen anything like it in any place in which I have worked before. It includes a list of departments and a list of issues to be covered through a visit to each department, and the name of the key person to contact for the information. It may well take me weeks to get through it all, but the idea is an excellent one. It means that everyone working in the hospital has an insight into its running from how the finances are organised, to how waste is disposed of, to what to do if a person dies, to how the community clinics work. I have to complete the orientation before I can really start working as a doctor in the team.

 

This morning, I visited the HIV department. HIV is prevalent here, 8.1% of the population are infected / affected (2012 data.) There is still considerable stigma attached. The clinical officer told me about all the regimens for giving antiretroviral drugs to HIV positive patients. Whereas when I worked in South Africa, antiretroviral drugs were not yet available, they are now much more readily so. In Uganda, the policy is to start treatment as soon as someone tests positive.

 

Whereas in the UK, HIV has taken the status of any other chronic disease, with an almost normal life expectancy, here it is another story. Lots of patients only present when their disease is very advanced, and they are showing the signs we associate with AIDS, that is, when their immune system is very compromised and they are unable to fight off infections that take hold in odd and complicated sort of ways. Even for those whose diagnosis is made sooner, there remain issues around adherence to treatment, to how to prevent mother-to-child transmission, and the relationship between HIV prevalence and the power dynamics between genders in a context where having multiple partners is very common. I learnt about the policies for testing, for changing drugs, for treating TB in those who have HIV  (TB and HIV co-exist very often.) The hospital runs support groups for those with HIV – seven groups in the district. It also has a very creative approach to recognising the broad impact of the diagnosis on those newly diagnosed. All new patients with HIV are given a care package that includes a jerrican for collecting water, water purification powders (drinking dirty water carries risks for anyone, but much more serious if you can’t fight the infections), contraceptives, a bed net to prevent Malaria and many more resources.

 

After spending a morning in the hospital, I came back home to spend time with the family. Our hospital colleagues and people around us are so friendly and welcoming, this is feels a happy place to be. On the other hand, there are so many things that leave me feeling disorientated. Whilst I am recognised by everyone in the hospital, I am still confused about who does what, and which names go with whom. I am doing lots of waiting. Waiting for people to be free, waiting for meetings in the hospital, and as I do, I see doors open and close, people coming in and out, and I don’t understand why, and I feel a bit ‘outside.’ I am sure this is a passing phase, the sort of thing that comes with being new anywhere.

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