Kampala is a city of hills and the Makarere University -Mulago Hospital sits on Makerere Hill. I believe the Mulago Hospital has about 1500 beds and serves as the National Referral Center for the entire country. I was planning on starting with Medicine wards but soon found out that the wards in Mulago are organized based on specialty – ID, Nephrology, Cardiology, Pulmonology and such. Each unit is staffed by a registrar and consultant, couple of residents, 1-2 interns and 3-5 medical students. The interns pretty much do the scut work here and take call every 6-7 days. I still have not figured out the whole system yet but it seems that patients present to the ER (called Casualty), get admitted to a holding ward for 24 hours, where the medical resident finally determines which specialty the patient would be finally admitted. It sounds difficult but somehow they make it work.
Rounds here are a bit different from what we are used to – there are no flow sheets and labs are done only at admission. Most management decisions are based on clinical assessment and I find myself having to retrieve my medical school memories for physical exam signs and findings. One medical student asked me why the patient had a loud P2 if he only had systemic hypertension! They measure blood pressure, pulse and weights on all patients during rounds and the family members (gu) estimate the intake-output. Patients are responsible for their meds and have all oral and intravenous medications at bedside -I suppose that’s one way to make sure your patients are taking their prescriptions.
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