"Sleep in Safety"

"SLEEP IN SAFETY"

(SOMNUS IN SALUTEM)

A Blog post dedicated to our Comrades-in-arms: Uganda's Anaesthesiologists 

Uganda 2014:

Estimated population: 36 million

Number of Conventionally trained Anaesthesiologists: 43

Number of Emergency Physicians: 0

Number of Emergency Medicine Enthusiasts in Uganda: Growing by the day 

Many Years in Waiting!!

After months of grueling planning and discussions, the details of which we may never know, a new chapter of patient care in Uganda was opened. The Association of Anesthesiologists of Uganda (AAU) and the Intensive Care Society of Uganda (ICSU) were both launched on the same day-22^nd November 2014.

If you have never been to or practiced in a hospital in Uganda, you may wonder at our excitement at this “regular” event that probably should have happened many years ago.

If you are thinking that, then you have surely never been to Uganda. You have not seen the cancelled theater lists, the emergency operation that could not be done, the critical care decisions that were never made, that hospital theater that was temporarily closed- a long list of  “problems” that extend beyond the Operation room, spilling into all Emergency Care departments in Uganda. Problems that  would have been solved if only there was an Anaesthesiologist. 

Why is “Emergency Medicine Uganda” excited about this?

This is what one of my Anaesthiologist friends, key to the dedevelopment AAU said to me after the launch: 

“I do not know if you have noticed but anaesthesiologists are probably the only people formally trained in Emergency Medicine in Uganda?”  We actually discussed keeping Emergency Medicine under the same Umbrella as Anaesthesiology until it is able to fly on its own”

Why do I absolutely agree with him?

The department has grown from the dynamic duo of Dr. JVB Tindimweba and Dr. Cephas Mijumbi to an entire team of enthusiastic and dedicated anaesthesiologists and Residents, pushing the boundaries of medical practice in Uganda and reaching for their own on the global scene.

Comrades-in-arms:

The Makerere University Department of Anesthesiology and Critical is leading the charge for development of Emergency Medicine in Uganda. And we are proud to say after years of winning and losing some battles, the war is now set to be won. 

Uganda is nearly set to start training Emergency Physicians!!

ANAESTHESIOLOGISTS	EMERGENCY PHYSICIANS
Today’s anesthesiologists are physicians who apply their knowledge of medicine to fulfill their primary role in the operating room, which is not only to ensure your comfort during surgery, but also to make informed medical judgments to protect you. They diagnose and treat any medical problems that might arise during your surgery or recovery period. Anesthesiologists work in intensive care units to help restore critically ill patients to stable condition. ( www.aau-online.com)	Emergency medicine is a field of practice based on the knowledge and skills required for the prevention, diagnosis and management of acute and urgent aspects of illness and injury affecting patients of all age groups with a full spectrum of episodic undifferentiated physical and behavioural disorders; it further encompasses an understanding of the development of prehospital and in hospital emergency medical systems and the skills necessary for this development (http://www.ifem.cc)

Why AAU and ICSU?

Dr. Stephen Ttendo Ssenyonjo (First AAU President)

The aim of the Association is to provide a platform for members to associate and advance the interests of the Association and its members. We shall achieve this by advocating for improved patient care and safety, facilitating the process of knowledge acquisition of our members, encouraging regional and international collaborations and always advance and support any other interests of our members. I therefore encourage you to become an active member of the AAU. Help us shape our Association by providing us with your comments and ideas. 

What does this launch mean for the development of Emergency Medicine in Uganda?

This is what Dr. Arthur Kwizera the founding President of the Intensive Care Society of Uganda (ICSU) had to say about what this double launch means for the growth of Emergency Medicine in Uganda. 

Like Anesthesiologists, Emergency Physicians are trained to work in an Intensive Care Unit.

However, specifically, Care for patients in the Emergency Department sets the tone for patient outcomes downstream.

Bad Emergency Department care= Bad Intensive Care Outcomes.

Intensive Care Medicine completes Emergency Medicine; care for critically sick patients saved in the Emergency Department will be taken up in the Intensive Care department and will see these patients later out of the hospital

.

And here is a promise from the ICSU President himself:

“ICSU will force/foster and fight for the Growth of Emergency Medicine in Uganda.”

Can I hear An Amen?

Please visit http://www.aau-online.org/ and follow AAU&ICSU @AAU-ICSU on twitter

The EMU-Editor

@EmedUg

That Shaft Shift

THAT SHAFT SHIFT!!!

Somewhere in Mbarara Regional Referral Hospital, Southwestern Uganda

7:30am: My spirits are high, lots of ATP stashed somewhere in my cells, my mood: perfect!! I cannot recall the date. I do know, however, that it was a public holiday and I had been looking forward to this rotation since my 3^rd year of Medical school. This was my first day on the Emergency Ward, which only handled acute life-threatening surgical conditions. The Surgery Resident I was working with that day, a brilliant friendly guy, confidently forecast the day: slow during the day-time, maybe 1 or 2 minor cuts to stitch but brace yourself for the late evening. Check that we have enough 50% dextrose, sutures, local anesthetic and STS (Surgical Toilet and Suturing) kits for the public holiday associated “toxic-traumas”, as he called them.

I was one of those interns that worked like I literary ate ATP for breakfast, and had a tiny 500 Watt generator at the base of my spine. You see, my elder sister is a surgeon, and her colleagues were now my supervisors. Many of them already called me her “little sister” but I intended to stand on my own feet and prove myself.  An hour later, everything is set. I even have the mobile phone number of the anesthetic officer on call.

9:00 am: Calm day, getting to know the nurses and Residents. Chatting about food, friends, family and other things I cannot write here.

9:30 am: I notice a boy about 12 years old, seated in a wheelchair near the A&E gate 30 meters from the office we are seated in. He is calm and lazily watching the happenings on the A&E verandah. I think he is an orthopedic patient, out to bask in the bright-warm Mbarara morning. His parents or caretakers should be around somewhere. The Outpatient clinics are closed today, so there is no traffic through the usually crowded gate. One of the nurses follows my gaze, and interrupts my thoughts
“He is a psychiatric patient. No known relatives. He comes to the A&E often to play on the wheelchairs. He is harmless so we let him be.”

10:00 am: I join the nurses in rolling cotton balls and gauze for sterilization. The boy is still seated there.  This time I take a close look at him. He is unkempt, a bit malnourished actually. He is seated with an almost blank expression, looking right back at me. I notice that the shirt I thought brown was actually originally white, with a collage of dirt, food-stains and smears of other things I cannot identify. The wheelchair is facing away from me and I cannot see his shorts, but his feet are bare and there is a small wet patch on the ground beneath him… perhaps he has wet himself. Something on his lap caught his attention-maybe a toy. He wasn’t looking at us anymore, but concentrating hard on whatever it was on his lap. I keep folding gauze and chatting with the nurses and the Resident. I think I will like this rotation.

10:30 am: The boy is still there concentrating on whatever he has on his lap. He waves his hands randomly in the space over his thighs and I think he is waving away flies. Bored with folding gauze, I decide to go to him and strike up a conversation. He looks up at my approaching frame, and maintains that blank look. Closer to him now, only 2metres away, I could see that there was something amiss with both his expression and posture. I search his face, nothing. My bored eyes slowly move lower and then I see it!!!! 

His right hand is  tightly wrapped around a 3-4 cm long rod-like structure, about the size of my pinkie finger, with bright red blood slowly oozing all over the pink tissue. In his left hand he holds something that looked like of soft black-brown leather. My brain makes the diagnosis but I cannot believe the sight! The nurses saw my expression before I even shouted out Help!!!” Like a skilled surgeon, this mentally disturbed child had separated the skin off his penile shaft with a rusty razor blade that I found beneath the wheelchair. For the past 30 minutes, he had been slowly bleeding and neither he nor the bored A&E staff seated 30 meters away knew of the sad twisted injury going on that could have ended in tragedy.

I wheel him to the resuscitation bed, insert the largest IV line I could find, drew off blood samples while the nurse prepared a minor surgery kit and tetanus toxoid. An hour later, he is stitched, pain free, admitted and the Psychiatrist has come to review him. The Resident and nurses commended my actions but I am still shaken by the experience.

1:00 pm: Lunch time. I cannot stop talking about this case. My Resident tells me to expect anything in the A&E. Only 5 hours and one case but I actually believe him.

2:00 pm: There is no more gauze to fold, and the nurses are busy giving medications. The Resident decides to teach me about patient assessment in the A&E. Somewhere between Primary and Secondary survey, we are interrupted by loud angry shouts. An angry mob is rushing through small gate where the boy had nearly bled to death only hours earlier. Somewhere in the middle of the mob where the crowd is thickest, I see a man in a white shirt stained with spots and smudges of bright red blood; he must be the patient. The patient is supported on either side by two calm-faced burly men, but all around, people are pointing fingers and hurling insults at the man they are supporting.

By the time we get our patient to the resuscitation room, there is a mob of about 40 angry people outside the A&E. The Resident calls the security guard to handle them. I make a mental note to always know where the security guard sits.

The Resident is still with the security guard and I have to handle the case alone for a while. When the patient is placed on the bed, I immediately notice that instead of a trouser or shorts he has a blood stained kitenge (a sarong-like multipurpose cloth that we African women love to wrap around our waists) wrapped around him. I carefully unwrap the bloody kitenge and then for the second time in less than 6 hours I see it again - A bloody penile shaft, with a neat cut at the base where the skin was cut and then peeled back all the way to the tip. The man is in agony!!! I can see the expression on his face - a mixture of pain and fear!!

And this is his story: This 42-year-old man, had been Caught sleeping with a married woman from the same village. He had never paid attention to the several warnings and threats from the woman’s husband. Tired of this, the angry husband and his friends waylaid our patient on a dark village path and left him 10 minutes later with the “presenting complaint”.

The good thing is I now had experience with this particular shaft ‘complaint’ and knew exactly what to do.

10:00pm: Both our patients are doing well, and surprisingly no more severe injury cases.

The Resident (now surgeon) teased me about my “shaft shift” for the rest of my rotation. I learned several lessons that day. At the end of that five month rotation, I knew I did not want to be only a Surgeon. I wanted every exciting bit about every specialty. I had found my calling: Emergency Medicine.

By Annet Alenyo Ngabirano

My Red Helmet ( Boda Boda Series)

2^nd post on the “Boda Boda” Trauma series

Theme: Road Safety

MY RED HELMET

1.    Bad roads

2.    Bad driving habits (speeding, intoxication etc…… )

3.    Unrestrained and Unprotected drivers and passengers

Every day from dusk till dawn, these 3 ingredients; mingle, collide and touch, twisting across the country like a death-dance, fueling the trauma epidemic in Uganda.

It is not surprising, therefore, that road traffic injuries (RTIs) contribute over 70% of Accident & Emergency Department admissions at Mulago National Referral Hospital with boda bodas involved in 25% to 41% (Naddumba et al, 2003. Kigera j, 2010 ) of these cases. Records at the hospital trauma unit show that at least one patient is admitted daily with severe brain damage resulting from an RTI directly involving a boda boda.

Chances are that everyone reading this in Uganda will either have lost a close friend, relative, or work colleague in a road traffic crash in the last couple of years.

Road traffic injuries are a huge public health and development problem that kill between 800,000 to 1.18 million people, and leaves another 20 to 50 million more with severe injuries and disabilities every year¹. Data from the WHO and World Bank shows that without appropriate response, these injuries will rise dramatically by the year 2020, particularly in rapidly motorizing countries like Uganda. In addition, apart from the enormous impact on families and communities, road traffic Injuries cost governments between 1 and 3 percent of their Gross Domestic Product.² Health facilities in particular are over-burdened with victims of road traffic injuries, overstretching their already meager health budgets.

Every day from dusk till dawn, at the receiving end of this “death-dance”, Health workers across the country dedicate their time to minimizing the impacts of these injuries; winning some battles and losing others. However, despite our firsthand interactions and knowledge of the impacts of this epidemic, our attitudes and choices do not reflect our experiences. It surprises me to see those who interact with these victims of “irresponsible road use” hop onto a boda boda and at break-neck speed weave through the city traffic or dusty village paths; heads bare, unprotected, and without a care in the world, joining in the death-dance.

For those few minutes in the death-dance, your life is in the hands of a dance partner who could be leading you back to the Accident and Emergency Ward where you just ended your shift. There is no way to ascertain if he has a valid license, if he is intoxicated (a common thing in an attempt to work long hours), if he is experienced or just “borrowed” a friend’s boda boda to make a quick buck.

Like many of you, I pray! I say a prayer every time I sit on a boda boda because at that time I know there is a thin line between life and death. And I fear. Four months ago I nearly crashed. Actually, I crashed!!! On a “regular” day, I flagged down a “regular” boda boda for a short ride that nearly cost me my life! Falling off the boda boda was not at all scary. It was the dirty blue, heavy laden truck, smoke billowing from somewhere at its rear, making that sound and moving straight for my head that I will never forget!! Like a 10-tonne sand compactor accelerating towards a 10cm melon. The thought of my mangled brains thinly spread on those huge tires jolted me in time into a dash for the safety of the pavement. Like I said, I pray. This time God had answered my prayers long before I prayed: the day those speed bumps were placed just meters from where I fell. Those few seconds of “bump” slowed the truck, giving me the time I needed to survive. To survive death or the disability and quality of “life after a road traffic Injury”.

You see, once you survive death at the scene, you could lose all your belongings to what I call roadside “bad Samaritans”. Thereafter, you may be end up shoved underneath the officers’ seats on a police pick-up truck because that’s the only place with enough room for you.  Since your identification is missing, you are a John or Jane-Doe and your file says: “unknown” where your name should be. The hospital course, should you survive your first day of admission gets sadder and sadder; surgery, physiotherapy, long days of antibiotics, perhaps tubes in and out of nearly every entrance and exit of your body; taking out fluids, putting them in, taking them back out, putting in some more. Your sad family carrying food, buying drugs, loosing sleep, buying more drugs, then supplies, and then more drugs. Did I mention, you might end up in the Intensive Care Unit? Or that you may lose a limb or two or four? And if you were the bread-winner for your family, the huge socio-economic burden will make you wish you had died at the scene-Only because we are not concerned about road safety-because you didn’t wear a helmet for a 50m dash across town on a bodaboda.

So this is a promise I made to myself:

1.    I shall wear a helmet every time I sit on a bodaboda.

2.    I shall only use a bodaboda whose driver wears a helmet. If he cannot be responsible for his own life, how can he be responsible for mine?

At my place of work, for a long time I have been “the doctor without a motorbike, who carries a helmet”. I have chosen not to be irresponsible with my  life.

My friends joke about buying me knee and elbow caps (what you see in Motor GP) a full spine suite and a neck collar (what you see in formula one), and shin guards (what you see in soccer).  
Helmets reduce the incidence of fatal head injuries by between 20-45%, as well as reducing the occurrence and severity of other injuries. They are so far the most successful intervention to preventing injury among motor cyclists. ³

I do not care what you say about a doctor carrying a red helmet. My red helmet is the best gift I ever received .

Do not leave your precious life in the hands of a random irresponsible guy. Get your helmet, use it or DO NOT sit on a Boda boda.

References:

1.    J. Kigera , L. Nguku, E.K. Naddumba (2010)The Impact of Bodaboda Motor Crashes on the Budget for Clinical Services at Mulago Hospital, Kampala . East and Central African Journal of Surgery, Vol. 15, No. 1

2. Naddumba EK. A cross-sectional retrospective study of boda boda injuries at Mulago Hospital in Kampala. East and Central African J Surg (ECAJS).  2004;9:44–47.

3.   Servadei F, Begliomini C, Gardini E, Giustini M, Toggi F and J Kraus (2003) Effect of Italy’s motorcycle helmet law on traumatic brain injuries. Injury Prevention 2003, 9:257-260

Dr. Fred Bulumba

The writer is a resident in anaesthesia and critical care at Makerere university (MakCHS) with special interest in emergency medicine, Neuro-anaesthesia and pain.

He always carries a red helmet

Once we acknowledge that Road Safety does not happen by accident, (and that road safety is the state where we have “no accident”) then we are well on the road to finding solutions. The systemic approach being recommended by the WHO moves from defining the burden of the road traffic injuries (size, nature) to understanding the factors that increase risk and vulnerability, to designing interventions, testing them for effectiveness, and finally, to getting the effective interventions implemented wherever they are needed.  (Dr. Olive C Kobusingye, Regional Advisor, Disability/Injury Prevention and Rehabilitation WHO/AFRO, Brazzaville )

AfCEM Day 3 @EmedUg

#

A number of people, especially our Emergency Medicne Practitioners in Uganda requested that we give them a "running commentary"of the conference.

So today we tweeted all day. 

To get a clear picture of today at #AfCEM2014

Follow us twitter @EmedUg

AND ALSO

African Journal for Emergency Medicine @AfJEM

AND

African Fedreation for Emergency Medicine @InfoAfem

.......AND

Our Partners in Emergency Medicine in Uganda: Global Emergency Care Collaborative (GECC): @globalemergcare

Remember to Use the hashtag #AfCEM2014

A Shout Out to GECC for their Publication in the Annals of Emergency Medicine November 2014 issue 

"Addressing World Health Assembly Resolution 60.22: A Pilot Project to Create Access to Acute Care Services in Uganda"

Happy Reading, tweeting and Retweeting.

Annet Alenyo

AFCEM DAY 2: Official Opening

The African Conference on Emergency Medicine 2014 was officially opened today at the United Nations Conference Center in Addis Ababa!!!!!

I AM NOT ALONE

This for me has been the statement of the day by Dr. Aklilu of the Ethiopian Society of Emergency Medicine Practitioners when asked about how Emergency Care services are being funded in his country.

As Africa continues to define and improve Emergency Medical Care, it is good to know that We are not alone. Network, form partnerships, learn, share!!!!

AfCEM Day One

Oh………… P, QRS, T

And you guessed right!!! I opted for the ECG pre-conference workshop. Too bad I couldnt attend all. Choices! choices!

But first, this morning’s adventure.  I picked a blue taxi from my hotel to the conference venue, but somewhere between my Ugandan English, Ethiopian English and Amharic, the conference venue got “lost in translation”. I end up of all places at the UN Headquarters!!!

The taxi driver checked with the security at the gate and apparently I was in the right place. So, I get out of the taxi and the first thing I realize is THIS IS DEFINITELY NOT THE RIGHT PLACE. Everybody is in suits, ties, sleek hair pulled back and somber. The only thing I got right was my black top. The pre-conference jeans and sandals look hmmmm. I must have stuck out like a sore thumb.  

To cut this not so funny story short AfCEM was not on that list. The taxi driver then decides it must be “the OAU” center. Okay, great!! Let’s go. All this time speaking Ugandan-Ethiopian-and Amharic. This time, however, the security were not as serious looking and even offered a “you poor thing” smile. I decide to go back to the beginning (my hotel) and the receptionist kindly gets the shuttle to VIP me to the conference site. The only thing missing was a siren. I get in late-tea break. Jeans, sneekers, sandles, backpacks, no ties, a few suits ( presenters no doubt) THIS IS DEFINITELY THE RIGHT PLACE!!  

And now the real blog post:

ECG was exciting. See the list of topics for yourself:

  

Take home points I liked:

Treat the patient NOT the ECG

Learn the ECG. You cannot find something you are NOT looking for.

Thou shalt not ignore the diagnostic importance of the T wave.

And now for the Unexpected exciting:

1.       What does the Normal ECG in an African Aptient look like.  Ref: Katibi et al “Normal limits of ECG in Nigerians” published in the Journal of electrocardiography. 

1. Dr. Mulinda Nyirenda gave a thought provoking presentation featuring this study, and its findings which question the applicability of Normal ECG findings in the Western population to African patients. The wonderful thing was that 62% of the study population was rural ( reflecting about 80% of a regular African country’s population). Read this entire study if you can. I intend to.
2. Errors and Technical issues. An exciting presentation by Dr. Richard Lynch on “when reading was done wrongly”” from wrong lead placement to a myriad of things that could go wrong. Including WRONG PATIENT NAMES on the ECG!!

And then QUIZES of course. Lots of QUIZES!! I still have copies of ECGS to look at. 

So, till tomorrow. Have a good day.

Annet Alenyo

#AfCEM 2014

October 14^th Hmmm. I will not go into the details, not only because this blog post is not about October 14^th, but also because I do not want to transfer that stress to you. October 14^th was just one of those days!

And then October 15^th started with an e-mail: Subject: sponsorship success for AfCEM

It is so difficult to capture my happiness and gratefulness that day. But more about this in a future blog. That’s a promise.

For now, we shall concentrate on AfCEM2014.

The Ebola screening station and Quarantine unit at Bole International Airport are a glaring reminder of Ebola. A reminder that Ebola is still a threat, and throughout the conference as we interact, there is a lot to think about and do.

This morning I read a tweet about the delegates from Nigeria who were denied Visas. Even though Nigeria was declared Ebola Free and even though we know our enemy and how to handle it, they were not granted visas. The fear of Ebola has surely become more virulent than the disease itself. So many lessons, so much to learn and so much to share.

I intend to learn and share as much as I can during these 4 days. Not only for myself and those who couldn’t make it, but also for my patients.

Tomorrow is pre-conference workshop day.

See the conference through our eyes: Follow our Blog from 3-6^th November as we talk about the African Conference on Emergency Medicine. Follow our updates on twitter EMed Uganda @EMedUg

Annet Alenyo

The Fancy Fanatic: DR ABC

3.3 The Uganda National Minimum Health Care package

The HSSP II defines the Uganda National Minimum Health Care package (UNMHCP) and it has four clusters namely:

(i)                   Health Promotion, Disease Prevention and Community Health Initiatives;

(ii)                 Maternal and Child Health;

(iii)                Prevention and Control of Communicable Diseases

(iv)                Prevention and Control of Non-Communicable Diseases 

Emphasis during the implementation of the Health Sector Strategic Plan (HSSP II) was placed on a limited set of interventions which have been proven effective in reducing morbidity and mortality. This section summarises progress that has been made in reaching targets as were set in the HSSP II for each of the clusters of the UNMHCP.¹

In the past couple of months, I have been pondering, so much I have certainly grown a couple of grey hairs. I have been trying to define the state of EMS in Uganda. Does Uganda have an EM Service? Surely there must be a way the acutely ill receive care. Who? What? Where? When? How? Like I said-pondering. A quick survey of my medical colleagues is disheartening, so to speak – a resounding NO!!! No in all languages Ugandan-Jonam, Luganda, Ateso, Rukiiga, Lulamoji etc……  Sadly a No!

How can we even think of EMS when malaria, Diarrhoea, pneumonia and of course HIV/AIDS are lurking at the horizon? Historically, global health policies emphasised multiple, vertically oriented programs that concentrated on Maternal and Child health and the control of Communicable Childhood diseases ^2. This resulted in major public health agencies focusing their support on selective programs that address priority diseases and activities. Unfortunately, vertical programs do not encourage the development of strong and efficient health care delivery systems. The weakness of this approach is most apparent during crises, such as medical emergencies or incidents involving large numbers of casualties.³

The EMS shall come, but not now – we have to get our priorities right; sort out the important conditions first then that Fancy Fanatic-DR ABC with his “irrelevant” bag of tricks can be welcomed. You have to crawl before you walk, RIGHT?

Actually-WRONG WRONG WRONG!!!  (Again, WRONG in all Ugandan languages)

The three fundamental functions of a health system are to improve the health of the population, respond to people’s expectations and provide financial protection against the costs of ill-health. Emergency medical care can contribute positively to these functions. While Prevention is a core value of any health system, many health problems continue to occur despite preventive services. A significant burden of diseases in developing countries is caused by time-sensitive illnesses and injuries, such as severe infections, hypoxia caused by respiratory infections, dehydration caused by diarrhoea, intentional and unintentional injuries, postpartum bleeding, and acute myocardial infarction.

SO LET ME TELL YOU ABOUT DR ABC……

DR ABC (Danger Response Airway Breathing Circulation) has defined emergency care in its entirety world all over. The reality of it is as the famous adage says, “Emergencies occur everywhere, and each day they consume resources regardless of whether there are systems capable of achieving good outcomes”. Therefore, as my Ugandan colleague remarked “This statement challenges physicians around the world to develop systems to improve emergency care delivery for their people”.

What is conventional EMS anyway? The purpose of emergency medical care is to stabilise patients who have a life-threatening or limb-threatening injury or illness. In contrast to preventive medicine or primary care, emergency medical care focuses on the provision of immediate or urgent medical interventions. It includes two major components: medical decision-making, and the actions necessary to prevent needless death or disability because of time-critical health problems, irrespective of the patient’s age, gender, location or condition.²

It may seem therefore that Uganda does have a form of emergency care services though not necessarily a system. An emergency medical system is care with interdependent components that link pre-hospital care and health facility based-care, working together to provide adequate acute care for the population.

Imagine you were suddenly in need of urgent care in Kampala – Uganda? (and I hope for your sake you are not-at least not until we have DR ABC). Kampala City-the biggest swankiest place in Uganda with the highest concentration of Uganda’s 4,363 Registered Doctors and 1:24,725 Ratio. So let us imagine you are in Uganda’s “safest city”.  Say, a final year medical student is heading home on a Saturday night boda boda after dumping all that percussion stress on the dance floor, and crosses paths with some drunken fool ( I have no kind words for drinking and driving-unless of course you are “drinking in” the scenery). He is involved in a hit and run accident by that drunken fool, but is luckily is pulled aside by boda boda riders who rush to the scene. Not to search for his phone and wallet  but to actually help.  He is “rapidly” whisked away by the ever dependant police pickup truck, bouncing over potholes to a public hospital, by-passing 3 private hospitals with 24 hour emergency services. (Health care is getting more costly. This is where I tag the long awaited-still delayed National Health Insurance Scheme-#NHIS). Anyways, a quick triage at the Accidents and Emergency unit and he ends up at the “surgical side of the A&E”. (The 6 bed trauma Unit is filled, and oh, Yes we have two A&E sides- Medical and surgical, and you better not have some hidden trauma with no obvious blood, and bleed to death in the Medical side). He is identified by a colleague doing a rotation on the surgical side of the emergency ward who opens quickly fills in his details in the file. Unfortunately he suddenly deteriorates requiring resuscitation. The intern doctor, first day on the job, frantically calls the Senior House Officer (Resident), the patient is stabilised and prepared for an emergency craniotomy by the Neurosurgeons on call, who are luckily in the hospital at that time, reviewing a post-op patient. He has a succesful operation with good long term prognosis. 

This would be one of the luckiest chaps to have an accident in Uganda. Somehow all those not very fitting pieces have “fit”. He ends up at the wrong place but everything thereafter somehow works in his favour. This is NOT a typical picture.

Imagine a link missing in any one of those steps-and this student could have died. That is a clearer picture. And I shall not go into the sad picture, should this accident have occurred in Moroto, or Nebbi or Kapchorwa-hundreds of miles away from a Health facility with emergency services, a trauma center and  a Neurosurgical unit.

The sad reality is that this picture will only worsen unless we have a system in place to ensure timely care for the best possible outcomes. Whether or not Uganda has a functioning EMS, is something I will leave to you. What I am certain of, however, that Emergency Medical Care is evolving in Uganda. One day it will not be a matter of chance, maybe and "hopefully". 

One day Uganda's EMS will be a matter of DR ABC, a matter of certainty and reliability.

Next week we have an exciting Interview from “the Boda Boda frontlines

REFERENCES:

1.       GOVERNMENT OF UGANDA, Ministry of Health, HEALTH SECTOR STRATEGIC PLAN III

2010/11-2014/15

2.        Macfarlane S, Racelis M, Muli-Musiime F. Public health in developing countries.

Lancet 2000;356:841-6.

3.        Walt G. WHO under stress: implications for health policy. Health Policy

1993;24:125-44.

4.       Junaid A. Razzak1 & Arthur L. Kellermann. Emergency medical care in developing countries: is it worthwhile? http://www.who.int/bulletin/archives/80(11)900.pdf (accessed 31/10/2014)

By Joseph Kalanzi