Oh what a difference....

While this is my third trip to Uganda with the team, so many things differ this time.  Without being able to find a heart surgeon, the mission took on a new life by focusing on the Peds Acute/PICU areas, teaching a structured course for all of the staff, and meeting up with the heart and peds surgeons here to see if we could operate with them or help in whatever way they needed. 

The start of the day Monday, differed only in the area where we were unpacking supplies, and of course the lack of drinks and lunch until late in the afternoon.  Other than that, business as usual....separate the supplies for different areas, take them there and put them away.  As I trucked my supplies "down the hill" to the Heart Institute however, the differences came to light.  Our home away from home here in Kampala, was full of the usual hustle and bustle of patients waiting for care, but the actual ICU that we had established had no patients, and there were only a few staff around, caring for the patients in the adult ICU.  Though I brought supplies down for "possible" cases, we had no set time to operate, no patients designated to operate on, and no connection at this point, to the pediatric general surgeons here at Mulago.  The simple atmosphere, smell, number of patients and supplies & equipment that surround us in the heart institute, after coming for several years, is worlds away from what my colleagues are facing "up the hill."  It is not easy either, to take what you need from one area,  to serve another, simply  because you need it...despite the fact that we've brought most of those supplies, and there were patients dying "up the hill" without them.  As is the case in the US, the Heart institute is looked at as the spoiled child, who is getting funding and support from many sources, while other areas of the hospital go neglected with DRAMATICALLY less.  Lets be clear though, they don't have state of the art equipment and endless supplies......but, they are able to take vital signs because they have the equipment to do so, weigh a patient for appropriate medication dosing because they have a scale, and actually care for the patients because they have staff there.  The care is documented so everyone knows what has been occurring with the patient, and the nurses are well educated through great collaborative efforts, to understand how to provide that care.

I'll describe more of my surgical experience at a later time, but my job here this trip was much shorter and much less involved than years past.  I've tried more, to help the rest of the team cope with the disparity they are seeing.  Many, including some who have gone on missions before, were having a really hard time knowing where to begin and why we were here, when all of the expertise we bring with us gets lost in the fact that there aren't any nurses or doctors available to take care of those in the greatest need.  The shock has stabilized over the first week, and I've been able to watch my colleagues go back day after day with the attitude that today they will make, if nothing else, a small difference.  They are simply amazing.