A Day at Reach Out

David:

The call to yoga attracts gradually increasing numbers to the morning-sunlit compound of Reach Out Mbuya - the project where my parents have been working.  It has the feeling of a school assembly - collective gathering to state a common purpose, and in this case share some humour before the more serious aims of the day begin.  Us muzungus (white people) seek the shade of the tree, and this is good especially as we are about to commence the daily yoga workout - simple stretches to iron out the muscular crumples from the many African massages over the last few days.  "African massage" is a euphimism for the many potholes encountered on even short commutes across Kampala, and probably rates as one of the more traumatic types of massages to be had.

By now over fifty staff have joined the circle, and a few clients linger in the background.  They are very welcome to join in, but a deep respect for the work of Reach Out seems to prevent some of them from doing this.  They realise this is important time for Reach Out staff.  I am to see the benefits of this team spirit as the day progresses.  I am introduced to a warm welcome, and even "inducted" by way of a song and a prayer.  Humbling stuff indeed.  Humour punctuates the many intimations that people are keen to contribute.  The most chilling was when one staff member reported the death of her adult son.  He had achieved a great deal, and yet was to become yet another statistic of road deaths in Uganda.  I am to learn that this is an all too frequent occurrence; a reflection of the daily accidents that claim the future potential of Uganda in one tragic moment.

The staff break off to their individual departments.  Impressions are of a well-organised and committed project, with a quiet air of efficiency - certainly amongst clinical staff who get through up to ninety patients in a morning.  In a country where free healthcare doesn't come easily, it's so tempting to take the services for Reach Out for granted, and yet there is absolutely no sign of this from patients.  The operation affords dignity, time and personalised care, and this makes for frustration when the logistics of drug availability and referral options are not able to support the assessments of clinical staff. 

This is made apparent when I am asked to help in seeing a patient presenting with an acute asthma attack.  Fine - so we check respiratory rate, pulse, auscultate the chest and assess the case as moderate to severe asthma.  But the patient has no inhaler - they are much too expensive, her daughter explains.  The nebuliser, held at a satellite clinic, has been sent for by boda-boda - in Kampala traffic this will take at least an hour to arrive.  Oxygen isn't available, so a pulse oximeter - which isn't available either - wouldn't be much use anyway.  We sit the patient forward, encourage her adopt the most comfortable position, and hope for the best.  There are additional complications to her case - largely as a result of her HIV - and so the clinicians decide to start an IV infusion of some antibiotics and steroids... but we really need salbutamol. 

The rest of the day is a crash-course in HIV, and I begin to understand the wider ramifications of a disease about which I felt differently before coming here.  The challenge of education, correcting myths, and overcoming the high degree of corruption that continues to permeate every aspect of Ugandan society, makes me feel selfishly glad that this is "not my problem" once I get back to my GP registrar job in Kilmarnock.  Sorting out how my own training could be applied - including drilled-in concepts such as ICE , patient ideas, concerns and expectations - in such a clinical setting, becomes a headache; one which I have the luxury of having an easy escape from by means of KLM on Sunday.  I feel like a thought-tourist.  With guilty relief.  It's interesting to consider problems at a superficial level, think about "what I think needs to be done" and then return home without contributing any more than passing, and likely ineffective, comments. 

Thankfully, Reach Out does not have the same approach.  It has obviously developed with amazing speed, now overseeing the HIV and related treatments for more than three thousand clients.  Daily clinics, home visits, community adherence teams, moonlight testing teams (for prostitutes and lorry drivers), the children's brass band, and grandmother support in the form of a piggery, are supported by a backbone of administration, IT, marketing and finance.  For such an organisation to function in the context of regular power cuts, limited funding and slow internet is quite remarkable. 

The nebuliser eventually arrives for the patient with asthma.  She makes an acceptable recovery, and it's agreed she can return home. 

I leave with respect and admiration for the work of Reach Out, and the hope that such efforts are rewarded with ongoing success in addressing the massive problem of HIV in Africa.