Blog Post from Masindi, Uganda by Michael Maccia
Beginning this week and continuing next week, we are working with the Masindi Kitara Medical Center (MKMC). On Monday, Ben, Dr. Bohan, and I met with Newman, the business director of the medical center. He gave us a tour and a brief history of the clinic. The clinic was started by the Palmetto Medical Initiative, which is based out of South Carolina. The Medical University of South Carolina has been running medical missions for many years in Uganda, using both students and licensed healthcare professionals. The mission would come for a week and see about 300 patients a day, but when the week was over, there was no follow up. The organizers decided to start the MKMC to be able to provide follow up after the mission group left Uganda.
Masindi Kitara Medical Center is funded in two ways. Private donations from the United States have paid for buildings and capital purchases. Operational costs are paid for by patients paying for visits, lab tests, inpatient visits, and drugs. An outpatient visit is equivalent to 4 US dollars and most lab tests were 1-2 dollars. The clinic currently has 3 buildings, but there are more planned in the future. The main building is an outpatient clinic with consultation rooms, a lab, and a pharmacy (The clinic does not have a pharmacist on staff, but have trained a nurse to dispense medications). Another building is an inpatient unit with 16 beds and a brand new labor and delivery building with 2 operating suites. The clinic saw its first patients 18 months ago.
After getting a tour of the facility, I began to observe outpatient clinic visits with Dr. Dan. Most of the patients I saw were children with malaria, but I also saw a 71 year old women with asthma and hypertension. Even after the first few visits, I could tell the physicians were compassionate, knowledgeable, and strive to work within their means to provide quality care. After the physician or clinical officer (like a physician’s assistant) saw the patient, they would send them to the lab, if necessary. The patients would get the lab results within about 15 minutes when they would have the final visit with the physician and they would write for any medications. The patient could then go to the pharmacy to get their medications. It was also surprising to see the language barrier experienced at the clinic. The physician is from Uganda, but he needed multiple nurses to help him translate some of the dialects so he could effectively communicate with the patients. When the patients leave the clinic, they are given their medical record that they are supposed to keep and bring back for future visits. Most patients do not come with these and they are not good historians about their own medical conditions.
The next day we rounded in the inpatient ward with Dr. Dan. Again, most of the patients in this ward were children with malaria, but these children had a more severe infection and the physicians felt the children needed to be on intravenous medications in order to eradicate the malaria. There was an elderly female who had obvious pill rolling tremors, indicative of Parkinson’s Disease, but the clinic did not carry any medications to treat the disease, so they were going to have to refer her to Mulago National Hospital. Also in the ward were 2 children, one with diagnosed Sickle-Cell Anemia and one with possible Sickle-Cell Anemia. To confirm the diagnosis, the clinic was going to take the young boy’s blood to the local district hospital, since they did not have the ability to do a complete blood count to accurately diagnose the condition. One of the last patients we saw was a young girl who had a skin graft on her cheek. She has had 2 graft surgeries, one failed and one was successful. The first graft was taken from her leg, but did not get adequate blood supply post-surgery. She needed another surgery, this time they flew in a doctor from Germany and an American donor funded the surgery. To make sure the graft was successful, the surgeon branched the carotid artery to force a blood supply to the region. The girl was doing well after the surgery, but had a wound infection in her leg at the site of the first graft. The physicians were confident that she would make a full recovery. I had a good experience my first 2 days at the MKMC and will look forward to my time there next week.