The Ugandan Medical Safari... Part V -- New Role as a District Medical Officer

After a year of my work in Kapchorwa I was transferred to Mubende Hospital, 100 miles to the west of Kampala. I was assigned the role of the hospital in-charge as well as head of the district medical/health services. Being rather new in the profession and the country, it was a daunting task for me. 

When I arrived in Mubende, there was no vacant accommodation for me and the guest house also happened to be fully occupied. The hospital made arrangements for me with an army doctor stationed there, who happened to be from Tororo. The doctor and his family were very nice and good hosts to me for the few days I stayed with them. However I cannot recall his name.

Back in the day in Africa, when you travelled to a new town, you almost always stayed with other expats, Indians or other foreigners. It didn't matter whether you knew them or not, or even if they were from the same profession as you. This fostered new bonds, new relationships. Over the years I played host to a motley set of visitors. This constant stream of visitors made life in the bush much more enjoyable.

Later when I moved into my own house, I had a visitor from Kampala's Mulago Hospital, a TB specialist by the name of Dr Anil Patel. He had come on an official visit to the hospital. I tried to book accommodation for him in the guest house which he declined and said that he preferred to stay with me in my house. My problem was compounded in those days since my houseboy had quit all of a sudden, and I already had to do manage meals myself alongwith my call duties. I was finding it diificult since I hardly knew any cooking and in the Mubende of those days, take-out was not an option. I explained my predicament, but Dr Patel insisted he could manage with tinned food available in the shops there, like baked beans, beef and bread and the like. He was an old settler and he knew very well how to manage and survive. Later I learnt Dr. Patel migrated to Australia in 1972 at the time of exodus of Asians. On another occasion, an American water engineer, a Mr Wintergreen, happened to stay with me and I was able to look after him well.

Apart from the usual hospital duties with emergency calls according to the duty roster with my three colleague doctors, I had to fulfill my responsibility towards the health centres/dispensaries in the district. This involved a regular inspection and timely supply of the drugs and foodstuff for the patients from the district headquarters. I also had to oversee staff discipline. For this I would undertake the tour of the various centres at least once in a month to see myself if everything was in order or to study the issues and find a solution. During one year of stay in Mubende, I must have attended Mbale court for the medico-legal cases at least 10 times, a distance of 269 miles. It was a good change for me and gave me some confidence of driving too in my new Ford Escort.

In Mubende district, I managed to establish a new dispensary in Naluggi, where there was virtually no medical facility available in the vicinity for the people there. In this task, I was able to elicit a good cooperation from the Catholic church there. I was very proud of this.

The months went by and soon it was time for me to proceed on home leave after the completion of my first tour of service in late May, 1972. I kept my car with the PWD in Kampala for safe custody, and travelled by East African Railways from Kampala to Mombasa via Nairobi. It was a good, memorable and comfortable journey. I got to see the beautiful countryside of Uganda and Kenya as well. The rolling hills, verdant greens. I boarded a ship, called 'State of Haryana' in Mombasa, owned by Shipping Corporation of India. It was my first journey by sea. I was overcome with sea sickness for the first two days but after that it became a very exciting and pleasant journey in which, among other things, I also got to judge a beauty contest!

The Ugandan Medical Safari... Part IV -- Reconstructing Noses...

How bitter disputes end or get resolved depends on the tempers of the persons involved. The gravity of the anger sometimes leads to weird conclusions. 

When stationed in Mubende Hospital in 1971-72, I was called to the Mbale court for a medico-legal case. I was asked to identify the lady in the stand and testify that she had been my patient earlier at Kapchorwa Hospital when I worked there. When I finally saw her, I couldn't help but feel amazed. 

The lady had come to me months before with a bloody wound over the tip of her nose, the result, as I was told, of a nasty dispute. As I examined it, I was horrified to see that this was actually a human bite. Some of the skin and subcutaneous tissues were missing. This was a very suitable case for cosmetic surgery, but sadly that was not available in remote Ugandan hospitals. But I had to do something. I took the patient to the theater and under local anesthesia, surgically repaired the wound. 

I repaired the wound as best as I could, and it wasn't bad at all. But the final shape of the tip of nose was not all that satisfactory cosmetically as it might have been under the expert hands of a plastic surgeon. But that was the best I could do under the circumstances. Recovery was uneventful, and I forgot about the case till I saw the lady in the court.

I was amazed to see her reconstructed nose. The lady had finally taken the culprit to the court for the bite and was demanding compensation and punishment. I finally had an opportunity to take a closer look and found that my effort, after all, was not that bad. Her appearance was fair and the nose was not so crooked as I had thought earlier.

It was indeed satisfying to see her recovered with little disfiguration...

The Ugandan Medical Safari... Part III -- Certainly Not A Cupid's Arrow...

After a very brief stay in Tororo, I was transferred to Kapchorwa Hospital. Kapchorwa is in the eastern part of Uganda and is located at a height of 6,000 feet above sea level. The beauty of the lush green mountains is breathtaking. The air is cool and crisp almost all the year around. I still remember vividly the red earth that stood in stark contrast with the lush green mountain slopes. Kapchorwa is in the Mount Elgon region of Uganda, a massive volcanic mountain that borders Kenya. Kapchorwa is home to many indigenous tribes, most notably the Bugisu tribe, that were still very traditional in those days.

It was here in Kapchorwa that I saw the beginning of the biggest upheaval in the history of Uganda. The brutal dictator Idi Amin took over the reins of Uganda on 25 January, 1971, in a sensational coup that took place while President Milton Obote was attending the Commonwealth Heads of State conference in Singapore. 

On the same day, I was summoned to attend court in Tororo in a medico-legal case concerning a patient I had treated while I worked there. The matron of the hospital dissuaded me from traveling to Tororo as it might not be safe. She was quite careful in using the words of caution regarding the events unfolding there in Kampala at that point of time. Somehow I was made to understand the gravity of the ground situation. 

Eventually I sent a radio message (these were the days when you used Ham radios for long-distance communication) through the kind (and understanding) police there regarding my inability to attend the court on some vague pretext. 

Over the next few months I had the chance to meet Uganda's most brutal dictator (some call him butcher) in person. Idi Amin visited Kapchorwa a few months later. He was traveling around Uganda telling people his reasons behind the coup. I had a close look at him, while I sat a few feet away from him with other town functionaries on the dias. He and his reasons seemed so genuine at that time.

Kapchorwa had a salubrious climate, which I enjoyed for a year. In those days there was no electricity in the town, but it didn't bother us much. The hospital did have a generator but we had to use paraffin lamps at home. Here I was completely on my own, the only doctor in a 60-bedded hospital. There was no one like Dr Gosavi to turn to in an emergency. I had to manage everything alone with my little acumen for almost one year, June, 1970 to May, 1971. There was no radiological facility, so for X Rays I had to send patients to Mbale Hospital, 32 miles away almost once a week. Referrals were also made to Mbale Hospital.

One morning I received a patient and one look at him left me dumbfounded. None of my textbooks in medical college had prepared me to handle arrows. The patient had an arrow piercing through the epigastric region (upper abdomen). As the patient was lying on the stretcher, the arrow stood stuck vertically. It was the kind of thing you'd probably see only in movies.

My first reaction was that perhaps it could be pulled out. But then it dawned on me that the structure of the arrow could do more harm on its way out. I asked the anesthetist in the theater to explain the structure to me. He illustrated with a diagram that the arrow had a set of fangs on two sides, hence pulling out would mean more damage to the tissues or organs. It was illuminating to me and I patted myself on the back for not taking quick action without understanding the full import of the situation. 

Eventually I had to make an incision at the entry point of the arrow in the epigastric region just to widen the approach and visualise the fangs directly and gently remove the arrow without hurting tissues or internal organs any further. I inspected the inner tissues and stomach which were okay. Then I sutured the wound, and kept the patient on intravenous fluids and nil food by mouth for two or three days. He recovered well and was later discharged from the hospital in a satisfactory condition.

This patient also taught me something -- something I couldn't have learnt if I was working in a big city hospital -- and I felt hugely rewarded when he recovered.

The Ugandan Medical Safari... Part II - Dealing With A Ruptured Uterus

During my stint in Tororo, I had to handle one of the most difficult cases in my first few years as a doctor. One night during my emergency duty I was called upon to see a lady. She had gone into labour for some hours and then suddenly her contractions stopped. When I examined her, I found her to be full term pregnant, but my heart sank when I realized that her contractions/labour pains were absent. On palpation, her abdomen was quite tender and to make things worse, The foetal heart was not audible. 

I had never seen a case like this before. Being raw and very much inexperienced, I was baffled and couldn't make out what the problem was. I had to consult Dr. Gosavi, who in some ways was like my mentor there. I told him everything I could deduce about the patient and related all my findings to him on phone. After a few more queries, he deduced the uterus had ruptured and asked me to get the theater ready and shift the patient.

On opening the abdomen, we found that the uterus had ruptured transversely (horizontally), in the lower segment. Luckily for the patient, it was just at the site where we make an incision for the lower segment ceasarean section. Through that gaping wound, we removed the dead foetus, and then sutured the uterus in a way that it would not complicate matters when the lady had children in future. After that, I watched in amazement as the lady made a steady and uneventful recovery. It was a great solace for me especially to see her recover so well.

No amount of classroom teaching can prepare you enough for a real life situation. When faced with a patient in a grave situation, you need to keep your wits around you and do the best you possibly can. For me there was a lot to learn through my seniors such as Dr Gosavi there. I realized that I had to take big strides in terms of learning on the job and gaining experience so that I could be useful to the ailing community.

The Ugandan Medical Safari... Part I

Going to Uganda as a young medical graduate with a lot of enthusiasm to serve offered me an immense opportunity to grow as a doctor. There was plenty of work to do and a lot to learn at the same time. Soon after I was exposed to the patients there with routine and casualty duties I realized that I was inadequately prepared to handle them efficiently. The internship training period we had in India was not properly utilized, as the young medical doctors would feel elated, having finally qualified after slogging for so many years of rigorous theoretical education. Also, working as a House Surgeon did provide ample chance to handle patients but in that particular specialty only in which you are posted. 

The work in Ugandan hospitals in the seventies expected you to handle cases on your own especially while on emergency duties. This was really a very challenging task and required a sound practical knowledge and grit to tackle the patient.

Here, I found that the young Ugandan doctors were bolder and better prepared as they had already been exposed to cases like minor simple fractures, obstructed Hernias, hydrocoele, minor amputations, D and C, Caesarian sections etc. while in medical school. They would approach such cases with more confidence, whereas in our case we were rather timid or just not able to deal with the problem at hand. This was due to faulty or inept practical training and lack of serious attention to acquire skills on the part of interns or both. However, it was imperative to acquire greater practical skills in order to fit into that medical setup where medical facilities were few and there was a dearth of the specialists as in Uganda of those days.

In such situations, we had to handle the cases with our utmost and sincere abilities, and despite the challenges, the results were 80-90% good. It was sometimes a do or die situation: in case we didn't try to handle a complicated case, there were greater chances of fatality. Referring patients to higher centers was not always feasible most of the time due to lack of transport or fuel, or the sheer distance, or all the factors combined. If one took the plunge, generally the outcome, would be rewarding and greatly encouraging. I stayed in Uganda for 11 years and worked in hospitals like Tororo, Kapchorwa, Mubende, Hoima, Masaka and Mulago in Kampala. This gave me ample clinical work to practice my skills, learn on the job and draw a great satisfaction at the same time. Unfortunately this sojourn of mine (1970 to 1981) happened to coincide with the tyrannical and murderous regime of Idi Amin, a very trying period especially for Ugandans.