Day 7: Jinja Regional Referral Hospital

We woke up to the chatters of monkeys, the bleating of goats, and the chirpings of the birds and cicadas. Used to the hustle and bustle of city life, opening our eyes to the sound of nature was a real treat.

While we were catered a hefty breakfast with an assortment of passion fruit juice, cereals, bread, chapati, and African tea (yes, chapati and African tea as always – as we’ve grown to love), we were introduced to Dr. Acharya’s freshly-sprouted mung beans. “Bountiful in energy,” he says, and so we munched them up for the long day ahead.

After a half-an-hour ride, during which we passed the legendary Nile River, we arrived at the Jinja Regional Referral Hospital. Interestingly, being fed by multiple tributaries, the source of the River Nile is still being debated. Nonetheless, we zoomed past the river over an iconic cable-stay bridge in 2 minutes, the calm river gently flowing beneath, slowly and steadily to its many destinations.

We wound up at the gates of Jinja Hospital, welcomed by a broad stretch of grass on either side of the road. Very quickly though, we would see the signs of a bustling hospital – a father carrying his son out of the doors of the emergency department, a long queue leading into another clinic, ailing patients hobbling towards the respective buildings to seek care. This was a large, open-area hospital resembling a park. If not for the level of seriousness and tension we can sense appropriate of a hospital of this scale, this place could pass off as any other serene place for a relaxing pastime. We would soon learn that the number of people seated on the grass fields were not here on leisure, however, but instead were caretakers awaiting their family members as they went through treatment in the crowded buildings.

Our van dropped us off at the entrance to the administrative building, where we waited while Darius helped us look for the hospital’s administrators. The conference room had a long oak table that occupied the entirety of the room, cushioned chairs encircling, and a large flatscreen TV on the end mounted with a webcam, presumably used for conference calls. Above the panelled windows were pictures of distinguished healthcare team members, with one captioned “nurse of the year, 2018”. The photos almost spoke at us, a clear reminder that we were at a place of eminence.

That became clear as Ojaj and Susan walked into the room. Susan introduced herself as the head nurse of the hospital. Even though she did not speak much, she exuded a sense of authority. After we had our introductions and made clear our desire to observe and innovate for the healthcare setting, Susan gave us a warm welcome and requested that we gave honest feedback at the end of our visit. She reasoned that the hospital could stand to benefit from fresh eyes and fresh opinions – which was exactly what we hoped to do as biomedical engineers and designers. We were, however, advised to get ourselves white coats to put on in our observations so as not to cause our patients discomfort. Indeed, a number of foreigners walking about in their own clothes can seem intimidating – the whitecoat gave a sense of membership that signified we were one with the healthcare team.

And hence we set off on a mission to get ourselves some whitecoats, headed by Dr. Acharya. We asked every doctor and intern with a whitecoat where they got theirs and where we might get ourselves some. We were advised that ready-made white coats can only be found in Kampala. By some twist of luck and some hustle, we found out that the hospital had a pair of seamstress in the next building. Very quickly, we headed towards the two seamstresses, who told us they did not have the white cloth on hand, and would need till next Monday to have our coats ready. After much prodding, negotiating, and ‘hustling’, we got the two nice ladies to head into town to buy some white cloth the very same day – 6 hours later, we got ourselves 6 sets of white coats. Thank you Helen and Helen! As we would find out, they had the same first names and started their seamstress careers together 14 years ago in 2008. They are very passionate about their work and haven’t looked back since.

Maintaining critical medical equipment

Ojaj and Darius led us briefly to the machine shop, where bioengineers work on maintaining and repairing existing medical equipment. We then headed to the maternity ward, where we were welcomed by the nurse-in-charge. We were introduced to the labor room, examination room, and the ward. As it happens, an emergency C-section was happening and Teja and Leanne got to observe the procedure.

Breast cancer

We spent some time speaking to Dr. Masereka, one of the main surgeons on the ground. We wanted to get some insight on breast cancer in the region. To our surprise, the last breast cancer patient Dr. Masereka had seen was from more than half a year ago. Jinja Regional hospital treats around 3 cancer patients a year. As it turns out, regular breast screening is not an option due to the lack of ultrasound machines and its high cost. Most breast cancers are self-indicated and women are encouraged to regularly palpate their own breasts for lumps. Even as lumps are felt, most women go to local clinics for diagnosis and treatment, which lack the knowledge and sensitivity for identifying cancer etiologies. As a result, misdiagnosis at lower tier facilities lead to delay in treatment for these patients. Due to this and other social, financial, and cultural factors, most patients that reach regional and national hospitals which have the capacity to treat breast cancers are at late stages of cancer. Regardless, radical mastectomy is the only surgical treatment option available in public hospitals. Surgeons lack the skills for breast conserving surgery (BCS) and most patients do not have the means to go for adjuvant therapy which are indicated for BCS. Added to the burden for most patients, the only cancer facility available in Uganda is the Cancer Institute at Kampala in the south of Uganda, which can be inaccessible to some members of the rural population who have never been out in the city.

Family Planning

We were then introduced to the family planning ward. It has a relatively narrow hallway with doors to rooms on both sides. It is dark – the electricity and water has been out for 2 months now. We were greeted by an upbeat sister Claire, unbrazened by the impediment. She showed us the tiny room where she does family planning with clients – you can barely see anyone’s face in there, but with her soothing voice she counsels women of their options as they come in for delivery, STDs, and other gynecology complications. As it turns out, those are the limited avenue where she is able to ‘catch’ potential patients as contraceptives are frowned upon by most people. The majority of women who would choose to walk-in for a procedure were mostly working-class and educated.

As it turns out, sister Claire would use an examination bed by the window during her procedures. Some light filters in through the narrow square frames of the window through a good part of a day to afford enough visibility while protecting the privacy and dignity of the women undergoing the procedures. These are not complicated procedures – most involve an insertion of a long-acting reversible contraceptive (LARC) in the arm. However, some myths were spread about the device traversing to the heart and even causing cancers. This misconception, together with the general attitude towards contraceptives make birth control a difficult issue to navigate or even talk about. The current fertility rate in Uganda stands at 7 children per mother. What is really concerning is that the single top reason for mortality for women aged 15-18 are related to complications with childbirth