April 27, 2015
Mondays on the wards here are always a little harried. No one rounds over the weekend so come Monday morning you often find patients who were admitted over the weekend that little was done for, old patients whose care wasn’t progressed for two days, and beds that used to be filled with sick patients that are now empty. Often no one knows what happened to these patients. They either went home or passed away.
This Monday (today) had the potential to be even more harried. The interns went on strike at 5pm on Friday because the government has not paid their salary in months. Interestingly, at this government hospital, as with all government hospitals in Uganda, the interns are the only house officers who are paid. Like in the United States, the interns are the workhorses at MRRH. They admit patients in the emergency room, are on call overnight, and execute the orders that are written during ward rounds. Without them, I was not sure how things would run given that even when they are there and working, patient care is often sub-par.
But, this Monday found the upper level residents and medical students rallying to take care of patients. During post-take this morning, when we review patients admitted through the emergency room over the weekend, a single upper level resident presented the patients and discussed what she alone had done for them without the help of an intern. She was calm, cool, collected and smiling after what had to have been a very busy weekend. On the ward rounds, the medical students and nursing students stepped up to hang medications, consent patients for blood, and track down lab results – jobs usually completed by the interns. Granted, things still fell through the cracks, orders still weren’t carried out over the weekend, and patients had still left the hospital without explanation. But, this was no different than any other Monday here. What was different was the pro-activity towards patient care. Over the last few weeks I have felt that patient care often comes behind education, research, and the residents’ and attendings’ side jobs that they need to maintain to make ends meet. But today the majority of residents and students seemed to be motivated self-starters and to be putting their patients first.
It was refreshing to see. Today speaks to the underlying devotion that these doctors have for their clinical work and their patients despite being pulled thin by a system that overworks them, doesn’t pay them well (or at all), and makes it difficult to deliver the quality of diagnostics and treatments that they know would be best for their patients. Given these tremendous pressures, I have my fingers crossed that the clinical care system at MRRH can step up for what might be a months-long intern strike. Perhaps more importantly, I hope that the attendings, residents, and students can maintain this Monday’s surge of motivation and accountability even when the interns return to work because this would have the potential to greatly improve patient care. We’ll see what Tuesday holds…