Sunday


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Today we woke up and had a pretty casual breakfast, and then rode a small bus about 2ish miles over to the hospital. All of the equipment was unloaded yesterday, so today’s goals were twofold. The OR and PACU (post anesthesia care unit, aka recovery room) nurses set up the operating rooms and the recovery room (aka the recovery hallway). While that was happening, the remaining bulk of surgeons and anesthesiologists started screening patients who are seeking care over the next few days. First they get some basic information, then they evaluate the patient’s injuries/malformation and decide what procedures are or are not doable, and then they assess the patients’ vitals to make sure that they are able to be anesthetized.



**//Update from the future://** I've learned a few things that have put my observations from the first day at the hospital in slightly better context. Mbale Regional Hospital is one of the major medical facilities available in eastern Uganda. In addition to treatment for sickness and major injury, which occurs in the wards described below, there are a variety of clinics and services available, and a pharmacy. Since the clinics are closed on the weekend, I didn't see those 'normal' hospital operations on the first day to balance out the sick and injured in the ward, so I had a little bit of limited context for what I did see. Now, it is true to say that providing adequate monitoring, services, medicine, etc., to the worst-off is a considerable challenge. The OB/GYNs on the team, in particular, experienced a few things that are extremely rare or entirely extinct from the hospitals we have at home, including losing mothers and babies due to complications in delivery or surgery. Anesthesia is delivered in the form of ether and ketamine. Both of these get the job done in terms of making you unaware of pain, but ether is pretty (really) unstable (flammable), and both are considerably less precise in their application than anesthesia that we have at home. In terms of operative and post-operative care, there are not as many tools available to monitor the conditions of a patient and alert nursing staff if vital functioning begins to decline. So, read the below descriptions/first impressions with these details in mind, and also knowing that I have a pretty weak stomach, and wouldn't really get a lot of enjoyment out of visiting most emergency rooms in the world.....

I just have a few pictures of the hospital complex, because mostly it didn’t seem natural to take out my camera and start shooting. I might try and get a few from some of the others, but I’m not sure. So, in straightforward but not graphic detail: I’m not sure how the admission process works, because there really aren’t a whole lot of people that seem to work at the hospital. People who are hurt badly are able to be seen quickly in an emergency, but there are a lot of limitations in the type of care that can be provided when compared to Danbury Hospital or something like that. People that don't need immediate attention or are sick and awaiting evaluation basically just lay around on the ground outside. Families with loved ones in the wards might stay on the grounds for awhile and attend to their own during the day. I don’t know how long they stay there, but it seems like sometimes it might be a really long time. They provide their own food and water, if they can, and wash dishes and laundry when they need to. There are a few latrines around the complex, and some are overflowing and spilling out onto the sidewalk. There’s also a lot of seepage up from underneath the ground around the latrines. Inside the wards, where we carried some equipment and where the doctors set up the screening rooms, there are two rows of adjacent beds, maybe 30ish per building, with two or three treatment rooms or offices enclosed in the center. One side of the building we were in is the Orthopedic Ward, so there was a proliferation of people, and a lot of kids actually, in various combinations of casts and external traction devices. One of the surgeons told me that in the States it is preferred to do surgery and support broken bones internally with screws and plates. That just does not exist here, so there are a lot of people surrounded by erector-set looking scaffolds holding their legs elevated, and ropes, pulleys, and counterweights keeping the bone set in the right position so it can heal.



I’m going to be honest that the combination of injuries, pain, close spaces, heat, and body fluids is not one that particularly suites me, and I reached my sensory threshold like 3 minutes after we got there. I spent the majority of the afternoon outside a separate part of the hospital in which the nurses were setting up the operating rooms, and in which there are no current patients. The one thing that I was good at was taking people from there to the screening rooms, including some local media figure who recorded some interviews for the purpose of spreading the word on local radio about the services of these doctors. Bob Schroeder and I met two gentlemen that will be taking us to visit a pre-school in a village about two hours away in a few days. They are associates of Martin Nangoli, the local pastor who initiated contact with Dr. Weinstein several years ago, and helped organize CCL’s first visit a year and a half ago, as well as this one.



Lastly, I will say that the degree of difficulty for the medical team, logistically, is basically at the maximum. When I left the hospital, there was neither water nor electricity, and no supplemental oxygen either. The four nurses setting up the ORs worked basically in the dark, and it was also very hot inside. Dr. Weinstein said that they can operate without water, but electricity is essential for running machines that regulate anesthesia, and for machines that help stop bleeding. A few tanks of oxygen are expected to arrive tomorrow, and that is mixed with gaseous anesthesia to dilute the concentration of the anesthesia to acceptable levels. I was talking with a local, and he told me that Mbale’s electricity comes from the hydro-electric dam that we crossed yesterday near Janji (see pics on ‘Bus Travel’ page). He said that power from there is also sold in Kenya to the east and Rwanda to the south, though evidently not everyone gets their share at the same time. There is a diesel generator at the hospital, and it’s unclear to me if it was a choice or mechanical necessity to keep it off today.
 * [[image:SundayMorning7.jpg width="512" height="341" caption="I'm telling you honestly that these people are unbelievable. "]] || [[image:SundayMorning5.jpg width="512" height="341" caption="Local Crow.  "]] ||
 * [[image:SundayMorning4.jpg width="331" height="543" caption="Diesel generator on the right. Gravity-feed water tank on the left.  It takes electricty to power the pump that gets the water into the tank, so no electricity equals no water."]] || [[image:SundayMorning6.jpg width="320" height="519" caption="Doctors coming to get lunch:  thick pancakes and bananas.  "]] ||