Uganda Update and Reflection

We've done a lot since my last post. Internet has been more difficult to come by, so sorry for the lack of updates! We've been spending a good amount of time working in the clinic, going on outreach, and finishing some basic physicals at the local Bushika school for orphans and vulnerable children. Too many experiences to cover them all! So instead is a personal reflection of mine:

The scope of what we see in our clinic pediatrics is huge, but for the most part, we see very young children, usually newborn to about 4 years of age. The most common problems are upper respiratory infections, gastroenteritis, skin rashes, malaria and pneumonias. The problems are similar to what we see in the US (other than malaria); on occasion, though, there are cases out of the ordinary. 

One such case was a patient being seem by another volunteer, a retired physician from the UK. I was passing by, and he asked my opinion. He pointed to the child's growth chart, at a mark ridiculously below the curve, so much so that I assumed it was a mistake. I looked at the child, held in the arms of an older woman. I could see some of his tiny body: the body, at first glance, of a newborn. 

I quickly demanded the translator ask the woman again what the birthdate was, stating that June, making the boy 8 months old, was clearly not correct. I realized after the words came out of my mouth that my voice was harsh and snappy. I was annoyed anyone would try to tell me this tiny child was anything more than a few days old, annoyed I would have to even consider a horrible possibility, so I blamed the translation or the old woman's lack of knowledge of months. 

She insisted June, the translator said. He weighed about 7 pounds. At 8 months of age, he should weigh about 20. Not possible. I would prove they were wrong... I unwrapped the child, convinced my physical exam would show them all what this child was: not more than a month old, a funny mistake, a confusion between June and January. 

General Appearance first. If those Clinical Skills classes taught me anything, it was that. So what was general appearance? First, what did I want to see? I wanted to see the taut, plush skin of a new baby, the blinking, wandering eyes of a child yet to see the world as we see it, vigorous limb movements, proportions that make sense. So student doctor? What did I see? A skull, broad and large, funneling down, with angles just a little too sharp, a little too steep, to a face sunken and loose. Eyes were large in their small surroundings, and irises followed objects... 4 months at least? Limbs were limp, with little movement. His arm, 8 cm in circumference, was covered in skin that seemed to only loosely fold around his baby arm-bone. I pinched it between my fingers. The skin stayed pinched when I let go, as if I had molded it. Tenting. A thought crossed my mind, I gripped his hands, and lifted them towards me. He picked up his head, brought it forward, neck muscles strengthened, just enough to tell me he must be at least 5 months old. I continued and finished my brief physical exam.

So 8 months? Believable. Along with unbelievable. 

At that moment when I finally understood the truth, I felt many things, some of which I'm not proud of. I felt angry, disgusted, naive for not believing it was possible. Mostly I just felt like running away. I'd like to say my voice was impassive as I gathered more history from the old woman cradling the child, but that would not be the truth, though I tried. Who was she? The grandmother. Where is the mother? Mad. Crazy. The father? The same. Has this child ever breastfed? No. What does he eat? Porridge. 

Don't ask me why, but it was this last answer, this last word, porridge, that really set me over my internal edge. Imagine a little baby, a little child, brain, muscles, bones, cells, all furiously trying to grow. On what? Porridge. 

I have seen many sad and disturbing cases since starting my clinical training, but only a few of them have such an impact on me, the others I acknowledge for what they are, and leave it at that. It's hard for me to predict which few these will be, and I doubt I will ever be able to. So does this make me soft? Is it inappropriate for me to ever have such emotions? Do these moments I have mean I may make a weaker doctor? These questions swam in my head and worried me as I reflected on my day that evening. They made me want to hide the experience from my colleagues in medicine. If the answer was yes, I didn't want anyone to know. 

So why do I choose to write about it now? Publish it for the world (though more likely only a handful of people) to read? As I'm writing this, I'm still thinking of just keeping it here, hidden away. The thing is, hiding it won't make it disappear. Actually, if some of my experiences in the past few years have taught me anything, it just emboldens the problems and the fears. Perhaps they are tucked away from others' lines of vision, but they become more ever present in my own. 

Regardless, that experience was important in my growth as a future physician, and I'm glad I had it. It added to what I've been thinking for a while: this 7 weeks has been a great capstone to my clinical years of medical school. It has somehow managed to encapsulate many of the most important learning points of all of third year, and reinforce them. It has helped me really think about what I want in a future career, and the roles I can, can't and shouldn't play in seeking to serve those around me. 

Our days left in Uganda are numbered, and we are trying to make the most of them! Below are a few pictures from the last few weeks. We are sad to leave this beautiful country soon, but excited to meet up with everyone else in LMU to share experiences! 

~ Monika 

Painting nails after physical exams at Bushika School for Orphans and Vulnerable Children

Checking BP for one of the clubs at the clinic