It has been a busy week in Mbarara. Much of the first day in town was spent with introductions, meeting clinical faculty at Mbarara Hospital and academic administrators at Mbarara University (MUST) who help coordinate post-graduate training and the relationship between MGH and MUST. The short meetings made me not only feel welcome but also gave me a better idea of the structure of collaboration here. It is nice to witness the outstanding relationship that has been established between MUST and MGH by dedicated individuals from both sides. On the first day in clinic, starting around 8 AM, the line of patients had already stretched a good distance outside the one-room clinic that has handwritten letters "ENT" on the door. Multiple patients are seen in different corners of the room at the same time by the resident, attending, and clinical officer. There is a nurse who directs traffic, calling in new patients when a seat opens up, handing charts or referral notes to free clinicians, recording all patient visits in the master log, translating when necessary, and seeing to it treatment plans are completed. Patients carry in their own medical records, records that consists of a soft notebook in which clinicians have documented past illnesses and treatment plans. The majority of patients have no records.
The clinic flow is steady and efficient. On a small table in the center of the room sit an assortment of medical instruments that are constantly being reached for; sometimes the absence of something needed is quite noticeable to me but quickly improvised. When the power goes out, the head-mirrors used to look in mouths, throats, and ears can no longer be used. I'm glad I brought several battery-powered headlamps so that the exams can continue.
Most of the patients present with problems I've seen before; hearing loss, cerumen impaction, ear pain, foreign bodies in the ears or nose, hoarseness, trouble swallowing, tonsillitis. Several patients are seen with more complex, less common issues, like a new presentation of laryngeal tuberculosis and several advanced head and neck lesions/cancers not yet fully diagnosed. When clinic ends, I'm am eager to find Internet access to do some reading. I have no idea how I would treat a suspected enlarging nasal dermoid cyst in a 4-year-old seen that day (a cyst that has about a 30% chance of intracranial connection) without access to MRI or a CT-scan, tests that would normally be used to exclude or delineate this possible central nervous system connection prior to surgical removal. I am told that there is a CT scanner in the capital city of Kampala, a 5-hour drive away, but no one I ask seems too sure of the cost or wait time for a scan. I am certainly, and perhaps predictably, being challenged to think in different ways some of the time here.
When I look back at the past week, I feel very grateful to my Ugandan colleagues for allowing me the opportunity to work with them. As a junior resident in otolaryngology, I find no shortage of learning opportunities in Mbarara. I also see opportunities to build surgical capacity in several areas related to otolaryngology here and am beginning to brainstorm the creation a few small projects with the outstanding MUST resident. I hope to touch on these projects the next time I write.
Kyle Chambers, MD - PGY-2
Harvard Combined Program in Otolaryngology-Head & Neck Surgery