Day one at Mulago Hospital

Today us PT students and our professors went to Mulago Hospital for the first time. It was an experience that I don't think I will ever forget. Although I can't say the conditions were completely unexpected, it was still very shocking to walk through the hospital.

We began by taking a tour of the physiotherapy department, a small wing off the main entrance. Upon entrance, there was a small waiting room where it appeared histories of patients were taken at a table in the middle of the room. Walking a bit further was a physio gym, a medium sized room with some mats, a few sets of stairs, a few pulleys for range of motion activities, and parallel bars. After a quick tour of the physio room, we made our way to the main hospital which was gigantic and completely overwhelming. It's nearly impossible to describe the things that we saw today and convey what it was like to someone who has never experienced a hospital in a third world country, but here are a few observations and thoughts while we were on our tour..

• Everything was in the open air. All windows were open, even when patients had open wounds. Getting from one part of the hospital to the other required being outside. 
• There were no single rooms, as everyone was placed into giant wards. Each ward contained at least 90 people, and I observed at the most 3 nurses in a ward (though I'm not sure each one would be considered a nurse per se)
• The vast majority of the cares were taken care of by the patient's family. This was really shocking to me. People were scattered throughout the entire hospital, sleeping on the floor in hallways and on the floor next to the patients in between beds, eating in the hallways. There were fliers in the hallway posting ads for private hire aides to come to the hospital and help with things like feeding, dressing, personal care etc. The hospital seemed so understaffed that these things absolutely needed to be done by family or it wouldn't be done
• The wards were so full that many patients were on beds in the hallway outside of the ward.Many of the wards can only be described as shelters, with cement ground, open windows, and no lights.
• I saw several medications and injections just lying around on carts, on the floor etc. The pharmacy consisted of a glorified closet that had shelves of meds.
• I saw at least 2 or 3 stage four pressure ulcers (basically a big giant open wound) that were uncovered and in open air. Bedsores are a large problem at this hospital for many reasons. For example, our Physiotherapist told us that it is not uncommon for an individual to be in bed and in traction for 8 weeks for something such as a femur fracture. After traction, they were take another xray and if it didn't heal right, they would THEN consider surgery.
• I saw no indication of any types of sterilization procedures, and only saw someone use gloves once.
• The burns unit was probably the hardest for me to see. Patients were all together and had burns covering their hands, faces, chests and pretty much everything else in between. Acid/chemical burns are very common in Uganda, as many people clean with certain dangerous chemicals. Sadly, acid is sometimes used as a weapon and was used on several patients we saw.
• I saw surprisingly few elderly patients. Unlike hospitals in the US, a very large portion of the patients were in because of traffic accidents, mostly from motorcycle use (the traffic here is CRAZY. I'm pretty sure they don't have road rules whatsoever. It is far worse than Mexico if those of you who went to Mexico with me!)

It's impossible for me to convey what seeing that was like today. I left a bit overwhelmed, extremely thankful for all we have in the US and take for granted, and upset at how the whole thing just seemed so unfair.  I have a feeling these next few days will be hard in terms of getting used to seeing these things and working with these patients, but look forward to helping out this understaffed hospital as much as I can!

Miss you all!