it's time now

i admit it.  i've been completely avoiding mulago.

mulago is the big city hospital/ referral medical center for uganda.  i send people there all the time from clinic to get treatment or surgery or a diagnosis, because our 'little clinic-that-could', often can't.  but i've been avoiding it because i'm scared that i will be so appalled that i won't know what to do.  in other words, ignorance is bliss, or at least it allows me to hope for the best.

but i went to clinic today. and oh dear.  the number of eyeball poking experiences i had in the 4 hours i saw patients was impressive.  and the number of times i started to cry inside, was perhaps equally impressive.

what was it about today that changed things? that pushed me to the point of needing to know?

was it the man who was back again after i'd sent him to mulago in december - but now worse- his lung still filled with pus, or fungus or both, weighing even less, still febrile and tachycardic, but now with diarrhea, anemia and a few other complaints.  was it the fact that he'd been not properly diagnosed, not fully treated, and it seems like people must just not care that much? or is the system that overwhelmed, the resources so poor, that the really ill guy with a CD4 count of 50 gets blown off because he'll probably just die anyway?  i was mad mad.  i wanted an explanation.  i wanted to know why there was no pending plural fluid culture, why they'd discharged him no better than a few days before?  and did i mention that he now can't hear either and has ringing in his ears, i'm assuming he was given gentamycin- lets hope they had a good reason- and not just throwing antibiotics around- remember that first rule of medicine? do no harm.

then i saw the baby with the big head that i'd seen last week.  it was a little bit bigger, she hadn't been to the neuro clinic and said she had transport problems so the dad had taken her to the 'local clinic' where they had not measured her head or examined her, and were told they'd just have to wait and see.

probably the same 'local clinic' that has been "treating" the next lady i saw, with a massive, fungating, vulvar lesion, that was clearly super-infected, most likely malignant and oozing with malodorous pus and blood as she lay sweating and paining on the table.  i asked her how long this had been going on - 5 months- she'd been going there for 5 months, with no referral, no biopsy, but getting 'shots' of some kind or another.  i wanted to cry.  i gave her transport money and wrote another letter to a doctor at mulago - imploring them to see her, examine her, admit her and treat her.

i'm just done with hearing TIA (this is africa).  where are the standards? who is running these clinics that seem to be on every corner?  it reminds me of that line in an adam sandler movie, "we are all stupider now after hearing that speech."  people might actually be worse off having been to a health clinic.

so now i'm ready.  i need to know what is happening at mulago- how they do things.  i'm ready to know if they admitted the lady with the lesion, if she was examined, or sent out with an appointment somewhere, at sometime, at best.  i'm afraid, but ready, to face that guy with the lung infection and go to bat for him, if he's lying in a hallway - getting more antibiotics without any diagnosis or drainage of the pus.

on the way home from clinic i was surprisingly full of hope.  i had that excited feeling like, 'there is so much good to be done'.  there is so much room for change or growth or improvement and it needs to start with me.  me not being overwhelmed or sad to the point of stagnation or avoidance, but me doing the best i can for each person i see.  me caring, following through, not giving up, letting people feel loved, valued, and attended to- and teaching these things, that this is good medicine.


instead of crying about it, or complaining about it, or running from it; i need to be in it, see it, learn about it, work with it. i need to “Be the change that you wish to see in the world.” (Gandhi)
otherwise i should pack my bags and go home. 



“For what it’s worth: it’s never too late or, in my case, too early to be whoever you want to be. There’s no time limit, stop whenever you want. You can change or stay the same, there are no rules to this thing. We can make the best or the worst of it. I hope you make the best of it. And I hope you see things that startle you. I hope you feel things you never felt before. I hope you meet people with a different point of view. I hope you live a life you’re proud of. If you find that you’re not, I hope you have the strength to start all over again.”
― F. Scott Fitzgerald