HOSPITAL IN MBARARA:
I've started observing in the wards at the hospital here, which has been quite an experience. The hospital is affiliated with the medical and nursing school in Mbarara, Mbarara Univ. of Science and Technology (MUST). To describe the layout... the teaching and patient care buildings are mostly separated from each other on the campus. Each department for patient care (e.g. surgery, emergency) is more or less in a separate building, with the buildings strewn haphazardly across the campus. Cement and dirt footpaths connect the buildings.

About 80% of the patients in the medicine ward are there because they have AIDS, many of the remainder suffer from injuries or trauma. The wards are "open wards" divided into men and women's sections. There are very few semi-private rooms. Patients' families bring blankets for the beds, and stay with the patient to feed them (the hospital doesn't feed patients). The hospital beds aren't the American idea of a hospital bed complete with buttons to turn on the tv and to raise and lower various sections of the bed; beds here are metal frames the size of a cot with a foam pad on top. The beds are right next to one another, with about 18 inches of space separating each bed, and patients sleeping on pads on the floor when they run out of space. Smells can be strong. It's hard to describe. I walked by the surgical suite the other day, and there were surgical scrubs and masks hanging to dry on barbed wire out front. There just aren't the resources for sterile disposable gowns, gloves, masks, etc. Surgical gowns and linens are bleached, boiled, and then washed before being re-used.

In addition to the inpatient internal medicine ward, the only other department I've seen so far is the outpatient HIV clinic. The clinic is always swamped with patients. It's actually incredibly encouraging and uplifting to compare the inpatient medicine and outpatient HIV clinic. While the inpatient wards are filled with people suffering serious complications from AIDS- gaunt, very sick- the outpatient clinic is filled with mostly healthy people on anti-retroviral drugs. These patients come to the clinic with a common cold or to get refills, sometimes with side effects from their HIV medications or HIV, but generally are about as healthy as people in San Francisco on anti-retrovirals. It is truly amazing to see the difference treatment with anti-retrovirals makes.

While the limited resources and extent of human suffering can be depressing, it is also inspiring to witness the dedication of the staff here, who day after day care for the patients here. Also, the slowly growing access to anti-retrovirals has brought fresh hope.