More medical stuff

For a little change of pace I hung out for a few hours today in a private clinic. (There are three types of medical services provided in Uganda- “free” government facilities which are far from free and most often the most inefficient trying to treat the highest volumes with the poorest resources. There are the NGO services for small fees with adequate care but these are few and far between and there are the private clinics which are the most expensive but have the best doctors and resources- like accurate laboratories and working equipment.) I was waiting to see an orthopedic surgeon for his opinion on two kids who are not able to walk. He was nearly 3 hours late and had 4 surgical cases that came first. So even though I was at this place at 8 sharp when they opened the kids were seen at 2pm. And this was the place that is the most efficient! It would have been worse to try to get an ortho specialist in the hospital and I most likely would have waited days. I also spent time “wandering” the wards again looking for another patient- an adult this time. The huge amount of suffering is so blatant there and the medical care is so bad compared to what I know is possible in parts of the world. We are leaving for a retreat in Kenya tomorrow and honestly I'm really looking forward to being away from all of this for a little bit.




*For those who are interested in the medical part: Of the two kids I was having seen this time the first little girl is 3 years old. When you stand her up she only stands on her tip-toes though she doesn't point her toes when she sits. Her knees and ankles feel really tight with passive ROM but no indication of pain. She “walks” with the most obvious scissor gait I've ever seen. She has absolutely no balance or coordination when supported to stand. But she hit all other developmental milestones without difficulty- crawling especially was normal. She is HIV positive but in otherwise good health. The doctor seems pretty convinced that it is spastic Cerebral Palsy with nothing we can do. The second is a 2 year old who cries when you make her stand so she only sits or gets held. The mother believes damage was done when she got a quinine shot in her hip. I have heard of a lot of muscular and nerve damage from those shots (which are almost NEVER called for) but this doctor thinks the child is just stubborn and needs to be made to walk. I think I would have more respect for the diagnosis if he had actually touched the child at any time during his “exam”.

*Another side note- in our hours of sitting waiting to see the surgeon while he was in the OR the windows were at such an angle to the yard that I could just see a little of what was going on. Patients went from the OR table to a wheel chair (he was doing pretty major orthopedic procedures) and then were wheeled outside into the shade to wake up. It was all I could do to keep myself from moving a little closer to keep an eye on respiratory rates. Two of the four patients sitting outside had pillows propping up their extensive plaster jobs or external fixation hardware. The other two were just using coats and clothes from family members. All seemed pretty uncomfortable as they came around but nothing like the majority of the post-op patients I'm familiar with.