Lacor Hospital

For the past two weeks I worked in the medicine department of Lacor Hospital in Gulu, northern Uganda (pronounced Lah-chore). I also spent a day in the outpatient HIV clinic and was able to travel to an internally-displaced persons camp with a physician who provides HIV care there.

In 2000 Lacor hospital was made famous by an Ebola outbreak that killed many patients, Dr. Matthew Lukwiya the head physician of the medicine department at the time, and several other hospital staff. Evidently the patient who was the sentinel case sat on the ward for days before medical professionals were able to recognize exactly what was going on. Ebola is caused by a hemorrhagic fever virus that infects endothelial cells lining blood vessels, damaging them and causing the infected patient to bleed to death internally and from every bodily orifice. It’s highly contagious (transmitted through bodily fluids) and difficult to recognize in the prodromal phase because the symptoms are like the flu: fever, fatigue, body aches. It isn’t until the advanced stage, after the patient has had many contacts with other people, that it is usually recognized and attempts are made to contain it. But at that point there are usually many other infected people, which is why you typically hear about Ebola “outbreaks” instead of isolated Ebola cases. Though there is an isolation ward at Lacor and many staff members who were present in 2000 are still working there, it is difficult even now to imagine identifying Ebola in the early stages of the disease to be able to act quickly – particularly when most physicians have never seen and will never see Ebola in their careers. There is no emergency department (called a ‘casualty’ department in Uganda), so patients are sent from the outpatient medical clinic directly to the hospital ward if they need admission. However, once there they sit on benches in a waiting area until the medical officers on the ward have a chance to see them and give them a bed, assuming they are deemed sick enough to need admission. Yet this doesn’t typically happen until the afternoon, when rounds finish on the 40-50 in-patients that have to be seen. So an Ebola-infected patient could presumably sit in line all morning at the outpatient clinic, then sit for a few more hours in the waiting area, then could be given a bed and their condition not identified for however long it takes the patient to present with fulminant manifestations of the disease. This is further complicated by the fact that there are so many deathly ill AIDS patients and one tends to put very sick patients into that category until proven otherwise. I must admit, it’s frightening to think about.

But not to worry – that was nearly ten years ago and there’s been no Ebola since then. My time at Lacor was actually very quiet and rewarding. It was good to see a relatively well-functioning hospital in a resource poor setting like northern Uganda, particularly taking into account that this region was heavily affected by the now-quiet civil conflict with the Lord’s Resistance Army.

Lacor is a much smaller hospital than Mulago, and privately funded, mostly by the Italians and the Catholic church. It has pediatric, medicine, surgery, and osbstetrics/gynecology wards, in addition to a tuberculosis ward, burn unit and an intensive care unit. There are also outpatient clinics, including an HIV/AIDS clinic where patients are provided with antiretroviral drugs courtesy of PEPFAR (former President Bush’s funding). The medicine ward has 80 beds officially, but at any given time you can find 20-40 patients on the floor in between the other beds. I worked with Dr. Anthony Muyingo, an internist who did half a year of training at Yale whom I met briefly while he was there, a medical officer named Patricia and an intern named Ruth. We split up the patients evenly with another medical team headed by an Italian doctor. The number of patients to be seen is daunting, but somehow we managed. As compared to Mulago, Lacor functions much better in many ways. Although it does not have some things like a CT scanner or amphotericin B to treat serious fungal infections common with advanced HIV, things seem to work a bit more efficiently for several reasons. First, patients pay a base fee of 25,000 shillings (equivalent to about $12) and then receive all the care that they need. Second, patients are not required to pay before they receive treatment so care is not withheld if a patient can’t afford it. Third, the nursing care is MUCH better at Lacor. It makes such an enormous difference when nurses are rounding with the medical team, reading patients charts and starting to fulfill orders soon after they are written. If a nurse is asked to do something at Lacor, within limits, it can be expected to get done. This is not the case at Mulago. Fourth, medical patients can actually be admitted to the intensive care unit, which is run by a British anesthesiologist. We had a young woman with severe persistent asthma admitted with what could have been a life-threatening asthma attack who was admitted to the ICU with no problem and we were able to discharge her home a week later. It was enormously satisfying to work cooperatively with the intensive care team for the benefit of the patient. Finally, at a smaller hospital most of the doctors know each other, which facilitates communication about patients, making it easier to carry out relatively comprehensive patient care.

I have a lot more to write about my time at Lacor, but it will have to wait as Nathan, my boyfriend, arrived in Kampala this past Sunday and we’re preparing to travel to Lake Bunyoni in the southwest part of Uganda near the Rwanda border early tomorrow morning.