The differences

It’s been too long.  We hope you have missed us?  Apologies for the delay in updating the blog, work has got the better of us (like so many others)!

We promised to document the many differences in working as a paediatrician in Jinja and so will try to do so.  This is just a taster of the differences we feel are most important.

Always ask for help early!

When attending any resuscitation course in the UK one of the first things you are taught is to shout for help early.  In the resuscitation scenarios often the help isn’t available.  This makes for excellent preparation.  In the emergency department in Jinja, there is no crash bleep (or any bleep for that matter) to get people to come running.  There’s only you and the nurse (or student nurse). 

Intubation does not exist. The airway is managed with a bag and mask (mask singular – one size fits all).  The staff are not trained in neonatal or paediatric resuscitation, but they will help if you tell them what to do.

Cannulation

A task almost exclusively performed by nurses in Uganda.  And done to a level that puts me and every paediatrician I know to shame.  The nurses are able to cannulate in the most extreme and difficult situations. 

The hospital at night

Triage area- paediatric hospital

There are no doctors.  None.  The interns (doctors with less than one year experience following medical school) leave the hospital around 20.00 and return at approximately 09.00.  During that period clinical officers (people who have undertaken a 3 year diploma to learn to treat common local conditions) clerk the new arrivals whilst in-patients are cared for by the nurses.  In an emergency, the patient will be sent to ED and the nurse will be responsible for initiating treatment.  At times the same situation is true in the day.  This is what happens when a hospital which covers a population of 2.5 million has only 6 doctors: three consultants (one of whom is out of the region) and 3 intern doctors.  Just to put this in perspective, there are single children’s wards in the UK that have more doctors than this for 20 patients!

Neonatal Intensive care

A morning ward round at approximately 0900 in which all the in-patients and post-natal ward babies are seen.  No medical presence until the following morning.

Special care unit- incubators and oxygen concentrator

New admissions are seen and commenced on treatment that the nurse decides. If the nurse is unable to get iv access for that child, then no treatment is given until the doctor arrives the following morning. If there is a power cut (which happens frequently) there is no oxygen and incubators do not work.

A doctor trained in neonatal resuscitation does not attend deliveries and would not be easily contactable even they could attend, as the Children’s hospital is on a different site to the special care baby unit.

If a mother cannot afford to stay in hospital and cannot feed herself, then she does not produce breast milk the baby does not get any; this mother is also unable to buy formula.

Resuscitation area- special care unit

There is no phototherapy available in Jinja. Bilirubin levels are not checked, indeed blood tests are rarely taken at all. Treatment of jaundice involves holding the baby near the window and hoping for the best.

Clinic room (2 desks)

Clinics

Clinics have no maximum number and a ‘morning clinic’ will often run on until 3pm because of the volume of patients to be seen. The patients do not have a set appointment time- they simply attend on that day and wait until they can be seen, which is often several hours. The concept of ‘new patient’ or ‘follow up’ slots with allocated times is a distant dream here.  The time with each patient is limited and so consultations have to be kept very short and to the point.  Clinicians have to share clinic rooms as there is not enough space for each patient to be seen in a separate room and therefore patient confidentiality is not achievable.

More very soon....

Colin and Jess