Burns Unit at Mulago Hospital

I found a picture of the halls of Mulago hospital. Here family members are lined up with their suitcases. They basically live at Mulago. They bring straw mats to sit on, buckets to wash the clothes in and for their family members to go to the bathroom in and throw up in, thermoses... etc.


BURNS UNIT

I had heard rumors of a burn unit at Mulago. There was, there wasnt..... Finally I stumbled upon the very well established burns unit of Mulago hospital. The ICU required and entire changing of clothing and shoes to protect patients from outside bacteria. I wore a hair net and Burn unit cover all. This is the same as I would at MGH. I had once read a book on the history of burn care and basically it hasn't really advanced since the turn of the last century. For this reason, I found the practice of burn care at Mulago very similar to MGH. My day started with washing the patience and soaking the tub in alcohol between. We would wash and hold down screaming children and then bring them to the dressing room where we would hold down screaming children once again. They don't give pain medication unless the case is severe (which there were some very very severe cases so I don't know what it really takes to be considered severe). "It causes addiction" said one nurse. So dressing changes are done without any analgesia. It took 3 people to hold down one nine year old boy. He was fighting us, begging us, losing his mind. So the nurse smacked him in the face. I'm not trying to say these nurses aren't compassionate but the approach is different. Some of the kids were so tough, just taking the pain. Some were so tired of the dressing changes and begging for us to stop. Here the dressings are changed every 2-3 days as opposed to every day like what I'm used to in the States. And the wounds really do look good. I didn't even see any that were infected. I did see one man with exposed bone and no dressing but he was headed for surgery to fix it. In the ICU there were 2 patients: one 45% burn and one 70% burn. In the back room I found a heating lamp, an oxygen tank, a ventilator from 1920, and a couple other machines they must use when the big burns first arrive. "They usually don't make it" the nurse told me. But obviously some did. 70% is a big burn to be able to manage. They get all their supplies donated. They use cardboard from boxes for splints to prevent contractures. They use silver cream and iodine which is very inexpensive. I was impressed by how well managed the burns were, aside from lack of pain medication. It was definatley one of the nicer units at Mulago.

Casualty Ward

Casualty Ward is the equivalent of the ER in the states. It is a dark lobby with where motorbikes and cars constantly arrive carrying bodies. There are ambulances here- usually an old small toyota truck with a siren on top. The medics sit on the sides of the truck- but they do any interventions till the patient gets to the hospital. Even then the doctors yell at us white girls constantly "leave him", "let her rest".... then maybe we can treat the bleeding, painful, complete femur fracture in like an hour. That didn't happen once- it has now happened 4 times. It's Africa- things are done "slowly slowly" or else people feel uncomfortable. I've also seen matatus crammed full of people and one half dead. Sometimes there is nothing but public transport.
Anyway- the casualty ward is F*****!.
Day one begins like this... I walk into a room with 3 men all on old rickety metal gurnies crying out. One has obviously fractured both femurs and they have been dressed but there is still about 1 liter of blood on the floor and that is a conservative explanation. This blood remains there for the next 3 hours till someone mops it away- no disinfectant. The man is obviously loosing too much blood. I mean obvious. It is not until we suggest that the man get some blood that they take some blood to then crossmatch for a unit for him. For example: in the states. The second a trauma comes in vitals are taken, a monitor is hooked up, lines are placed for ressusitation, blood is taken for crossmatching, .......... and also- pain is managed. Here we give a strong NSAID (the equivalent of 4 ibuprofens) as an IM injection in the ass after your fracture has been reset. I have seen so many open fractures from Boda Boda accidents in the past few days it's crazy. There is no morphine in the ED. The Ugandans just grin and bear it like soldiers. I am positive I would be swinging if someone did the things they do without explanation. The orthopedist walks in tosses a piece of cardboard (a splint) on the patient, lifts the leg, sets it- done. He does this with the same facial expression of someone tying their shoe. I got to do some stitches on a man beat by the police. Stitching the scalp takes a lot of muscle. That's the other one I see a lot- people beat by the police.
BUT here's the best one.
I could smell him the minute I walked on the ward. When he opened his jacket I saw a growth like a hollowed out mushroom cloud on his chest. The center was necrotic and inside - what is that crawling all around? magots.
I have also seen a penis that is unrecognizable due to genital warts.
A nose that is necrotic to the bone.
Text book things in my face, so much blood on the floor, and doctors that say "this man is giving me a headache with all this carrying on" and "leave him". (not that they aren't compassionate.. it's just very different).