Just another day in Uganda

What do I do all day at Mulago Hospital? First you need to understand that Mulago is a colonial holdover. The British established it as a public (free) hospital and teaching hospital (for the Makerere University Medical school) in the 1920's. None of the somewhat dysfunctional post liberation governments have dared to shut it down (it is Uganda's largest hospital). It currently has 1500 beds and a government funded annual operating budget of US $2.7 million, which seems okay in a country with a medium annual income of US$ 490 (as compared to US$ 49,000 for the US) but really (the Kardashian sisters probably spend that much annually on mascara).

So I start my day by saying good bye to Isaac and Dennis making new signs for an orphanage.






Then I walked to the hospital Haematology (love that funny British spelling!) Department. I tried to get there early so I could photo baby Benjamin's needle aspirate biopsy slides for my blog.






Couldn't make the microscope camera work (TIA). Okay. Answer is: NOT CANCER. Infected cyst. Needs simple surgery which they can have done for free at Mulago but it will take weeks to line it up.

Started looking at cases and signing reports with Dr. Susan but got in big conversation with Dr. Susan about the Troy Lund Philosopy of Medical Volunteer Service in Africa, which is, find a small problem that can be solved with little or no money, fix it then come back (or get someone else to go back) a few months later to see if it is still fixed (establish a Metric ). Dr. Susan told me that, as far as she was concerned, the seven or eight bone marrow biopsies done each day in their hospital and clinics were pointless because both the specimens obtained were bad and the slide preparation was bad (unless done by her one assistant, Derek, who has so many other responsibilities that he can't do them all). She asked me to spend the rest of the day showing the Cancer Institute doctors and laboratory staff how we perform and process bone marrow in the US (well, sort of, TIA, you make do with what you have....).

So......I spent the next seven hours running up and down the hill from the hospital to the Cancer Institute. Past the Medical Illustration Dept.






Past the guy selling snacks and Obama shopping bags.












Past the Hospital Laundry.






Past the crowded parking and No Parking signs to the Cancer Institute where I tried to teach some Ugandan staff physicians (who kept being called away to look at other patients) and some sketchy looking Italian medical students (who couldn't understand English) how to correctly perform the procedure, whilst simultaneously showing six Uganda lab tech's ( who were very attentive and very receptive) how to make direct smears, touch imprints, concentrate smears and particle crush smears.






























I even found a box of Pasteur pipettes for making the concentrate smears.







If Dr. Troy Lund is correct, the quality will improve temporarily while I am here and disappear when I do. I wonder if I can get another Hematopathologist to come down here (Tony? Nancy? Katy?)


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Location:Mulago Hospital, Kampala