Wednesday, November 22, 2006

Kitagata noodle parlour

We've just had a couple of good days visiting Allan Sande at the district hospital in Kitagata, an hour and a half west of us. Allan's a VSO GP from the Philipines who's been in post for exactly a year - a proper old fashioned GP probably quite capable of doing appendicectomies and caesarian sections on the kitchen table. He's one of 4 docs in the hospital and does literally a bit of everything. Not only did we have a fun time being cooked for and looked after by Allan (the Kitagata noodle parlour!) but he is a wonderful mix of funny, outrageous, kind, wise and plain sensible. Kitagata is a single dirt track of a town with open shop fronts just like in the cowboy films. We embarrassed ourselves playing pool with an audience of 60 Ugandans ( in varying states of sobriety) but were warmly greeted by everyone.

Allan's enjoying Kitagata, and its easy to see why. Kitagata Hospital works!! There are reasonable staffing levels, the pharmacy has nearly all its essential drugs nearly all of the time, and it can cope with most of the problems people present it with. This is very unlike our experience of all the other government health units we've come across so far. The consensus seems to be that it works is because of effective leadership. Wilber has been medical superindent for 5 years. There is no obvious corruption here. A good job is done by capable people at all levels of staff and morale seems high. An important lesson.

I remember one of Alastair's important ingredients for a better Uganda was to improve the use of existing resources. This was brought home today during a chat with the cheerful and bright pharmacist Olive. Yes, national medical stores are a nightmare & disgrace. This organisation in Kampala is meant to provide all government health units with their essential drugs every 3 months - and it doesnt. Kitagata frequently has to buy in drugs from a private provider. However, Olive spontaneously suggested that pharmacy stock would go further if only the clinicians stuck to the principles of rational prescribing. Some of this tends to be the I'm not quite sure what is going on here with this feverish person so Ill give them an antimalarial a broadspectrum antibiotic and something for the indigestion they also happened to mention. Some of it is also about patient expectation. Various members of staff would come in to see us after consultations and say the patient says you haven't given them anything - don't you think you ought to. But they're perfectly fine and they haven't even got a fever. Yes I know but really the patient won't be happy unless you give them something.....or do something to them. At Bwindi numbers are especially high on Thursdays - ultrasound day. Everybody wants a go with the new machine. Witchdoctors magic.. and familiar old stuff.....!!!

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