The Marabou Stork: Ward 4a

The internet has been broken at Makerere Guest House so it's been hard to post lately. Plus, this weekend our group went on a safari where we saw a ton of animals! Lions, Giraffes, Elephants (really close, too!), warthogs (two of which were semipermanent residents in our campsite), several variations of antelope, Baboons, Cape Buffalo, Hippos, Crocodiles... just to name a few. The Murchison National Park is the biggest national park in Uganda and home to a lot of different animals. The roads weren't paved which lead to quite the bumpy ride but I appreciated being able to see nature in it's untouched and preserved form. I left the experience with a new-found appreciation for nature-- the world is an amazing place.

Now we're all back to Mulago. I was able to spend the day on teaching rounds in Ward 4a. I haven't really been on a team with many Makerere medical students yet so this was my first day. It's interesting how similar yet completely different rounds work here. The students take charge of all the patients-- write notes, draw labs, deliver samples to the lab, pick up results. I really think nothing would happen on the wards without the students since there are essentially no nurses. The attending taught a lot which I always appreciate and focused on physical exam skills, something I am definitely lacking compared to these students. Due to the lack of resources and funding, the physicians here rely heavily on their physical exam skills. I feel like in the States even if we find something on physical exam, we still get imaging or labs to confirm it. Here their entire plan is sometimes based on just the physical exam. We saw quite a few meningitis patients today. Some physicians believe it's a requirement that every patient get a head CT to rule out mass lesions before getting a lumbar puncture. This is important because if you get an LP on a patient with a mass lesion, the pressure from mass effect can cause their brain to herniate through their skull. A head CT costs around 200,000 shillings-- about a month's pay for the average Ugandan and much more than that for may of the patients at Mulago. With a thorough neurological exam the attending concluded on many of the patients that there were no focal findings and we could do an LP. I can completely understand why they do this-- there simply aren't enough resources to have the type of protocols we have at NMH.

Somethings I have found on rounds that are similar:

Medical students presenting patients are interrupted constantly by the attending
Attendings like the Socratic method of teaching
Patients will tell students one thing and the attending the opposite.
There are still language barriers between patients and physicians (we had one patient who only spoke swahili, a dialect not many Kampalans speak.. except here there's no interpreter).
Attendings don't carry their own tools.
Everyone is advised to "read more".

That's all for now. Hopefully we'll get internet again at the guest house and I'll be able to post some pictures from the weekend!

Update:
Internet's fixed! Pictures as promised