Finally, our OOPE begins...

Arrived at 0100 on 25th February after a flight that was slightly delayed.

We were met at the airport by Noella who works for the Ugandan Paediatric association.  It had been a long journey but finally we were here!

We were taken to our accommodation which was next to Mulago hospital, the national referral hospital of Uganda.

Views over Kampala

Waiting at the accommodation at 0200 was the housekeeper who gave us a very warm welcome and showed us to our room which was extremely clean and came with everything you need (bed, mosquito net, toilet).

The first days- a tour of Kampala.  

Noella was our tour guide and was joined by Juliet, both of who were fantastic guides and showed us some amazing sights and views as well as helping us to negotiate the local market.  We were shown the martyrs shrine and learnt about the history of Uganda and the background to one of Uganda’s public holidays.  Following this we travelled to the cathedrals of Uganda and enjoyed great views across the city.

On day 2 we were shown around Mulago national referral hospital.  The paediatric unit has 60 admissions per day.  It has 6 paediatric wards as well as a outpatients department, a cancer centre and HIV centre.

The acute care unit (ED) is responsible for triaging infants and children according to ETAT and then commencing the necessary immediate management.

At the time of being shown round 4 patients were being treated as emergencies - all of whom had a reduced GCS and were several dehydrated and malnourished, before even considering the diagnosis that had brought them to hospital - it was not expected that any of these children would be admitted to PICU.  ACU had a small lab able to estimate haemoglobin and test for malaria.  The test for malaria could be turned around in 2 minutes!

PICU is a 7 bedded unit situated next to the emergency department that allows intensive observation. No ventilation is available, but bubble CPAP can be used.

I could write for hours on each ward we visited, but I will mention only 2 more.  

Firstly, the malnutrition unit: looks after those children who are severely malnourished.  These children often had single or multiple co-morbidities and were at risk of many infections.  It takes children here 3 months before they are in a position to go home, due to the poor condition of their underlying health. The challenges in fluid management and feeding are huge and it is only with expert care and parental education that so many make a recovery.

Secondly, the respiratory and cardiology ward had children sharing 2 to a cot, with no room between to ensure all children can be close enough to the oxygen supply. Each oxygen cylinder is divided between 4 children, so it is unclear whether any/all are receiving much benefit, particularly because there is no SATs monitoring. Therefore, the need for oxygen is all down to clinical signs.

It was a truly eye opening day. There was a huge amount to see and try to understand that is done so differently. This is only the beginning. In order to ever become useful here, I have a huge amount to learn.

That is the challenge of accepting a placement abroad.

Colin with "tour guides" Noella and Juliet

Colin and Jess