So it turns out Mulago is going to get a facelift. At least on the surface that is what is supposed to happen. Whether this will ever translate into better patient care is another story.
We had a good conversation at journal club this morning about what people donate and why. It all started with a [fabulous] presentation by our favorite Internal Medicine resident, Ms. Gloria Temu. The article she presented highlighted the deficiencies of a national referral hospital - Mulago - and the even worse conditions in a regional health center - Masaka - for septic (really sick with an infection) patients. One of the authors was at the presentation and happens to be our Ugandan Principal Investigator (aka Boss), David Meya.
The conversation was very detailed with lots of technical terminology that would bore most of the readers of this blog. So in summary, the outcome of the study gave signs that help predict whether people will die when they come into the hospital in severe sepsis, to be used to prioritize patients and their care. But it also showed that if the hospital could get a hold of iv fluids and antibiotics, it would mean less people would die in a setting like this. If you have ever worked, or been a patient, in a hospital in the US or another developed country, you know that iv fluids and antibiotics are given out like candy. I am going to quote part of the article here to highlight how fluids are such a scarcity - "...on a 50-bed ward at Mulago Hospital where the number of patients can approach 100, we observed that the nurse to patient ratio was less than 1:20 and the volume of IV fluids provided to the ward per day was limited to 20 liters." [!]
For those of you who are interested in reading the article, here is a link to get the free article (another issue in itself - publishing to free online journals).
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2771355/?tool=pubmed
There is a lot of medicalese going on, but certain parts are very lay-person-friendly, such as the site descriptions and site resource capacity under the methods section, to get an idea of where this study is taking place, the resources available (or lack thereof), the implications and how it could be implemented in poor setting.
At some point, I made a (half-joking) comment about the 60 million USD that will be going to a Mulago renovation, and maybe they should buy iv fluids instead. It seems the Ugandan government, Ministry of Health, is getting a loan from the African Development Bank (www.afdb.org) to improve Mulago. I am not privy to the details of the whole deal, but I heard that they are going to use the money for structural improvements (hopefully aimed at reducing crowding on the wards). Important - yes, but most important - arguable. There are many, many opinions on what should be improved or added and how to go about it. The ultimate goal is to improve patient care, but sometimes that gets lost in the debate.
This brings us to what people donate/loan and why. How are organizations or individuals who donate able to show they did something? Is it easier to showcase a new building, a paint job, new beds, or to find those patients who benefited from an intervention? If you found those patients, how do you prove it was what you did that helped them? Who gets the credit? If five, or a hundred organizations are working on tuberculosis, or HIV/AIDS, how can you say what you did made the difference, or if there truly was any difference in the first place?
Something to ponder.
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