Daily Routines and fistulas …

We have been in Bwindi for a week. What a full week (in fact, by the time of posting, I have been here a bit longer , but haven’t wanted to post without the hospital’s agreement.) Anyway…..

I am now getting to understand the pattern of the working day, so I thought I might describe what happens.

The day starts with morning prayers at 8 am. The staff all gather in the Out Patient waiting area, which is a covered outdoor area, and there is drumming and singing and preaching. Miss A and little Roo have been coming with me, and enjoy swaying to the music and clapping and trying to follow the words in the hymn book, in the local language, Rugika (pronounced ‘Ruchiga’) Morning prayers is followed by announcements to the whole team. This could be about visitors to the hospital, or meetings, or achievements of some of the staff. So far, it has been warm and sunny sitting outside with the sun on our faces and the swallows swinging in and out of the surrounding buildings, building their nests. After morning prayers, there are regular departmental meetings. On Monday, there is a clinical meeting, on Tuesday, an operations meeting for each department, on Wednesday the meeting is about quality improvement projects. Thursday is for reviewing maternal and perinatal deaths to look at processes and lessons to learn. Friday is a departmental teaching meeting, and Saturday is a Grand Round (that means the doctors go and see all the challenging or interesting cases currently in the hospital.) After the morning meeting comes work on the ward or other meetings until ‘break tea’ at 10:30. More of the same after break tea, a lunchbreak at 1ish, and work resumes in the afternoon until 5. Part of my time is to be spent doing clinical work, and part doing quality improvement. That means working with the hospital to support efforts to improve the services offered to the patients. More about that later.

I am assigned to the Adult in patient ward for my clinical time. I have yet to fully understand all the systems. This week, the ward has been very busy indeed as the hospital is having a ‘’Fistula camp.’’ This means that a group of visiting surgeons have arrived and is operating on ladies who have particular surgical problems, doing many cases very intensively over the course of a week. The surgeons and anaesthetists come from Switzerland and Germany, and also from Mbarara, a university town in the South of Uganda. The surgeons are assisted by the Ugandan Medical Officers here. The camp has been running for a week in October for seven years. It runs as a very smooth machine!

Fistula surgery is very important as the problems are so unpleasant and disabling. It is very specialist surgery, not readily available here, or if it is, it is at a cost that most people could never think of affording. A fistula is a connection between one part of the body and another, and in the case of the ladies on the ward, it usually forms between the bladder and the vagina. As a result, the bladder empties out of the vagina and these poor ladies suffer with a continuous and uncontrollable leak of urine. This of course has profound emotional and psychological consequences in addition to the physical effects. There are many causes of fistulae. Sometimes people are born with them, but in this context, the most common cause is problems during labour, when the baby is stuck and can’t be delivered, and the pressure of the baby cuts off the blood supply to the tissues in the mother’s pelvis, causing them to stick together and form the connection between them.

Ladies have come from far and wide to have the procedure. News of the surgical visitors has spread by word of mouth. In particular, I understand that there have been the efforts of a particular man whose wife underwent the surgery a few years ago, and was so grateful for the intervention on his wife, that he wanted other people to be able to access it too so spread the word far and wide.

No pictures of fistula surgery, but here is one of the view from the balcony of the admin block where I was sitting with my computer this afternoon.



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