Mulago Hospital Week 1

Most of my time in the hospital this week was devoted to the infectious disease ward. As I noted in my email update, most of the cases that I have seen so far involve opportunistic infections secondary to AIDS. The most common diagnosis on the service has been cryptococcal meningitis, or un-affectionately known to all the staff as CCM. Our morning team usually consists of 5 Ugandan medical students, 2 senior house officers (3rd year residents who pay to work for an extra year in the hospital), and a consultant ("attending" in our vernacular). The wards are overcrowded with patients and their companions taking up residence in any vacant space that they can find on the ground. Men and women are placed in two separate large rooms on the ward, and each room is further divided into three sections with two rows of metal hospital beds, with little paint left to peal and from circa 1960, running the length of each one. In between the rows of beds, I tiptoe my way around the heads and hands of patients lying on the floor in order to keep up with our team's soft-spoken consultant as he demonstrates over and over again another unfortunate patient's stiff neck.

One of the most challenging cases that I saw this week was a 50 year old man being treated for CCM with deep bed sores on his torso, buttocks, and thigh. He has been barely conscious after 3 weeks of treatment with anti-fungal medications and anti-retrovirals, but developing more muscle strength in response to being disturbed, leading our consultant to note "he's doing well." I can't help but think, however, that if this man survives his meningitis, it would be such a tragedy for him to succumb to another infection from his sores simply because there wasn't enough staff able to rotate him every two hours while confined to his bed. In the middle of the week, I was also given an assignment to follow a 19 year old man with CCM, who was recovering quite nicely after a week of treatment. During his workup, however, he was diagnosed with pulmonary and abdominal TB. Though it's only been a week in Mulago, I'm already developing the suspicion that there is usually something lurking around the corner for these patients as they try to make their way out.

On a positive note, I am learning a tremendous amount from the staff and students here, as well as found a useful role for myself in reviewing what I've learned in medical school with them. Blumenfeld would have been proud yesterday morning, I had to demonstrate the complete neuro-exam for the students on rounds. On Monday, I head to Gulu for a week long rotation on surgery at the famous Lacor Hospital.