Wednesday, August 7, 2013

No rest for the weary

Earlier this week, I (Amber) needed to be admitted to a Ugandan hospital for a minor procedure. This is the story of my experience with African, middle-class medicine.

I arrived Sunday evening at 6pm and called the surgeon from reception. She called the appropriate person and the next thing I knew, I was filling out paperwork for admission. But before I could see the admitting doctor, I needed to pay the fees for my stay. The girl at reception asked how much I wanted to pay. I responded that I didn't know. Then she asked if the doctor had given me an estimate of what the procedure would cost. I responded that the doctor had said it would cost about 900,000 Ugandan shillings ($350). So she wrote this amount down on an invoice and sent me to the cashier to pay. All very informal. No list of services or what I'd be paying for. I asked if there was a normal price list and the receptionist responded that patients are allowed to negotiate the prices with the doctor. I believe my skin color determined that the normal rate would be paid for the procedure.

Next I was directed to the admitting doctor. He took about 45 minutes to ask questions and do an assessment of me. Then he searched for the surgeon's cell number so he could call her for admitting orders. He didn't have it right away, so I offered the number I had saved in my phone. I think he must have been embarrassed because he declined my help and spent the next five minutes calling people to look up the surgeon's number.

I was on my way into another room by 7pm where they were putting an IV in my hand. The nurse who did this took my chart and said she'd call me when the bed was ready upstairs. I sat and I sat and I sat. At 7:30pm, Terrill decided to take our girls back to the hotel because they were getting hungry and restless. I had my Kindle tucked into my overnight bag, so I was fine. 8:00 pm rolls around and I've still not been told what to do or where to go. A nurse finally walks up and asks which type of room I'd like to stay in. I responded that I'd already paid the fees and want to stay in whatever room I paid for. After calling the surgeon again, they determined that I'd be in a shared room (the general ward) with several other patients. This means a shared bathroom as well. As that was not appealing, I asked how much an upgrade to a private room would cost. It was not very much more, so I opted for a private room and asked them to find one.

8:30pm rolls around and I'm told that no private rooms are available unless I want a VIP room for $200 extra. I decided that I'd rather spend $200 on something else and that I could settle into the general ward. The same nurse who was trying to figure out my room assignment (and who was working 2 hours overtime to get me settled somewhere) asked me what my orders were. Since I didn't have my chart, I didn't know. I told him to find the nurse who did my IV and ask about the orders. He went looking for the chart and came back telling me I needed a liter of apple juice to go with the medicine I'd have to drink that night. I assumed they would provide the apple juice as I was not told to bring any, but he told me I'd have to go out and buy apple juice myself. It was 9pm by now, dark outside, and I was in an unfamiliar part of town. But I needed the apple juice, so I prepared to walk out into the dark and find some. The nurse was getting off his shift and was going to guide me to a supermarket to buy it. Just as we were walking out the door, the nurse who had done the IV stopped me and asked why I was leaving. I told her my dilemma and she graciously agreed to go get the juice for me so I could get settled into my room...eh...bed.

I took the elevator to the 6th floor and found my bed in the general ward. My room was built for four beds, but only two were being occupied at the moment. I was quite alone, but the other bed held an elderly woman who was surrounded by a loud and boisterous family. Just after I arrived, changed into my pj's and got settled with my book, the family decided to have dinner. They filled the small room with chairs and small tables to accommodate their gathering. The smell of African food and a foreign language filled the room for the next hour. Thankfully, my privacy was protected by a curtain that divided me from the rest of the room.

By 10pm, the visitors had left and the very gracious nurse had returned with my apple juice. I was so thankful to her. Her shift had supposedly ended at 7pm. I alerted the new nurse on duty that my juice had arrived and that I'd like to start my medicine. It was supposed to be given over a period of several hours and I wouldn't be able to sleep until I finished drinking it. He said he would come after he finished taking vital signs on the other patients. I might add that all the health care personnel I met were very friendly and very interested in what I was doing in Uganda. I had several nice long conversations that ended with exchanges of phone numbers.

I wait and wait and wait some more, inspecting my surroundings while I wait. The hospital bed was fairly comfortable and the sheets were clean. I noticed some sticky spots on the walls and the bed railing, so made sure to steer clear of those areas. I wished for a pillow but assumed that they didn't have any since my bed didn't come with any. I later learned that the lady on the other side of the room had required all the pillows in the room (about six of them). There was a useful bedside table and chair nearby. I made my way to the shared toilet (for the whole 6th floor) to see what I'd have to deal with. I was pleasantly surprised by the toilet tissue available and mostly clean state of the toilet. Only the smell of urine was a bit bothersome.

12:30am rolls around and the nurse finally shows up with my medicine. He apologizes and says they were supposed to start my medicine at 7pm and have it ended by 12am instead of starting it at 12am and having it finish by 5am. I sighed a tired sigh at the long night ahead of me. Terrill & I had already traveled a good many miles to get to Kampala from Timu and I needed rest. But sleep was not on the agenda.

The juice was mixed with medicine in a pitcher and I was told to drink slowly over five hours. They also hooked me up to two different IV fluids as I drank because they knew I'd start losing fluids. Indeed, I was visiting the bathroom at 20 minute intervals. This might not have been so annoying except for the fact that two family members had settled into roll-out beds for the woman next to me. I had to maneuver around them each time I got up.

For the next five hours, I read, drank and used the bathroom. Finally, 5am rolls around and I can stop drinking the medicine. I'm exhausted by then and a little nauseous. I determine never to drink apple juice again. I was told that my procedure would be first on the list and I'd need to be ready by 7am. At last, I can get two hours of sleep. Right? I turn the light off and try to doze off. My bladder won't allow it, nor will the snoring from three other people in the room. I finally give up my hopes of sleep and just lie there praying. This was my first time of being admitted to a hospital as a patient. It feels funny to be the one in the bed when I used to be the one walking the halls with medicine.

7am arrives and the surgeon, Dr. Kituuka, comes to visit me. My first impression of her was wonderful. She is a calm and cheerful person who clearly loves her job. She explains what will happen and then tells me to get ready to come down. I change into a gown and get wheeled down to the OR.

I find the OR to be a fun and light-hearted place. Everyone down there seems to enjoy what they're doing. They lie me on the table and the anesthesiologist gets to work. I knew I was going under general anesthesia, but I didn't know what this would entail. He checks my oxygen, BP, pulse and puts leads on my chest to monitor my heart before preparing what he termed as his 'special milk'. ;-) It was a syringe of milky, white fluid. As he started injecting the 'milk' into my IV, I thought to tell him that I enjoyed his special milk....but I was out before I could speak the words.

The next thing I knew I was waking up in recovery...and I had a really sore throat. I heard them say, "She's waking up," and then Dr. Kituuka started talking to me. She gave me a positive report of the procedure and said everything was fine. Then she told me I'd be getting a $60 refund because she didn't do a biopsy. I thought it funny that she gave me all these details in my groggy state. As they rolled me back to my bed on the 6th floor, all I could think about was how my throat felt like it was on fire. Then it occurred to me...had they intubated me? This is when they put a tube down your throat to keep your airway open. I'd seen it done many times and always pitied the poor people on the other end of that tube. Over the past two days, I've been pretty convinced that they did intubate me because not only do I still have a sore throat, but I can barely talk and I've been coughing up a little blood. I wasn't aware that this was standard procedure for the minor test I was getting done, but maybe they didn't want to take any chances with my airway.

Back in the ward, they shift me from the stretcher to the bed. It's about 8:30am and I hear Terrill's voice within minutes of being put back in bed. I can finally sigh with relief that I'm not alone in this big unfamiliar world anymore. He brings the girls in to give me hugs and kisses. They had been very upset to leave me the night before and were glad to find me alive and breathing. We wait around for a little while for the anesthesia to wear off, but I'm determined to get out of the hospital. It has not been a place of fond memories for me. We ask the nurse when I can leave and he says as soon as I'm ready. I get dressed right away and start heading out to the elevator, leaning heavily on Terrill's arm. The nurse comes after us with the report from my procedure and the news that I've been ordered some medicine. We wait for him to return from the pharmacy with the medicine. I ask about my $60 refund and he gives me $40 saying that the medicine costed $20. No receipt...just his word. I don't care at this point. We make it out to the car and I sleep for the next several hours.

I'm sure there are details I've left out, but this is already too long, so I'll end here. Just know that if you ever find yourself in a Ugandan hospital, things may be more fluid than you expect, people don't always work according to time frames, and you'll surely need a dose of flexibility. The End.

2 comments:

David and Sunshine Okken said...

IHK? I've had the pleasure of staying in a Ugandan hospital as well, and yes, flexibility is in order. :) Glad to hear things went well. Look forward to saying hello someday soon.

The Reeds said...

You brave girl. glad all was well. WE also had the lovely pleasure. and our experience was pretty similar. A lot of confusion for us and the wrong medicine and wrong dosing given but very friendly people and jacob is fine now so no worries. :) We love you and miss you.

Our January meeting is feeling further and further away.. .:/