Everyone has a UTI…
Today was a general clinic day at TASO Gulu. This means that HIV+ individuals from around the region flock to HQ for a refill on their ART regimens and Septrin as well as come in for counselling and a check-up if an opportunistic infection is just a bit too much to handle.
Sarah and I were attached to the medical coordinator, Rebecca, who also happens to be a staff clinician for the entire day. Knowing that she was going to be absolutely swamped with clients, Sarah and I took an (ridiculously) active role filling out paper work allowing Rebecca to focus on histories and diagnosing whatever the patients had. As an aside, I feel we would be much helpful if we could also take some basic patient histories to lighten the workload, but the majority of patients (literally 95%) only speak Luo with little to no English skills.
Since TASO (and most hospitals around here, apparently) is always short of medical supplies here are a couple of examples of the limitations:
- Rebecca was called in to do a thoracentesis (removing fluid in the space that surrounds the lungs) on a patient with possible pleural effusion. Since TASO didn’t have any cannulas on site, Rebecca had to use a syringe used for vaccinations to attempt the tap. As expected, it didn’t work and the patient was left with inconclusive lab results.
- There is a lack of latex gloves, speculums, vaginal swabs and other tools required for a full gynecological check-up. This required a diagnosis to be made simply on inspection (rare since the females did not want to display their genitals) or word-of-mouth from the patients themselves. This lead to many STIs being treated with broad-spectrum antibiotics. Sarah and I got used to writing out Ciprofoxacin, Doxycyclin and Acyclovir many times over-and-over again. Honestly, I think we gave away about 500 units of those drugs alone, today.
As for the title of this post, about 40% of women came in today complaining of abdominal pain, general fever and painful urination. I wrote out “urinary tract infection” and its associated code at TASO (GT08, in case you were wondering) about 20-something times today. When Sarah asked why there were so many UTIs in this region, all Rebecca replied was, “…hygiene.” Yikes.
Regardless of the lack of supplies and long-ass waiting times, I have to reiterate a point that Sarah made yesterday. Everyone was so well-behaved. Based on my experience in family practices and emergency rooms in Canada, there would’ve been at least a few fistfights if Canadians had to put up with the patients here had to experience.
Tomorrow, we’re off to the field for an outreach clinic. Where exactly? We don’t know. At least we have bananas to bring with us.
Casey
