International Clinical Elective in Palliative Care in Kampala Uganda - Part 2

Kayla Wolofsky, M.B.B.S. 

Fellow in Hospice & Palliative Care at MGH 

PGY 4

May 10, 2019.  

Everyday at Massachusetts General Hospital we see people who are suffering and terminally ill. I was recently asked to reflect what made providing palliative care in Uganda different and at times more morally distressing. This question is best answered by reflecting on my last two weeks in Uganda.

During the second half of my elective I had the privilege of visiting patients in their home and providing palliative care. I worked with Hospice Africa Uganda (HAU) visiting patients in their homes in Kampala and the surrounding area. I later spent time in Naggalama, a small town in the central region of Uganda, working with nurses and nursing assistants at the St. Francis Naggalama Hospital visiting patients in their villages. It was such a privilege to be invited into the homes of these patients and their families.

Daily transport carrying our  medications and
supplies for the day 

At HAU our day would begin with prayer where “hymns were sung, drums were drummed” and daily announcements were made before we tended to some of the poorest of the poor with life limiting illnesses. The team would then meet and discuss the patients we planned to see that day. We would all then pile into a white van, alongside the much needed medications and supplies and begin our long commute in Kampala traffic to bring clinical care to patients in their homes. 

Beautiful drive between home
visits through the Countryside

In Naggalama this meant driving along long stretches of beautiful back roads in the Ugandan countryside.

During my visits we encountered complex ranges of psychosocial problems, diseases, cancers, and very poor living conditions. Many of the homes were made from homemade brick or mud covered with roofs made from thatched-grass or iron. Most homes had  plastic mats that covered the mud made floor or homemade rugs to protect the hand cut wood floors. Walls were lined with beautiful fabrics and the one large room that existed was separated by a curtain to make additional rooms.  The homes were frequently decorated with family heirlooms, biblical posters, and some even had a TV or radio. Unfortunately, some homes were often only large enough to provide shelter and home visits were had outside in the field on the ground or on wooden benches.  

Home with with the team from
St. Francis Naggalama Hospital 

There was no running water in many of these homes, and the nearest water well for many was at least half a mile away. Many of the patients we saw were so critically unwell they were unable to get water or food and  were very dehydrated and malnourished on our arrival.

What made this elective challenging, was being aware that if there was better access to health care and medications we could minimize their suffering. Despite the team's best efforts they were limited by lack of medications or resources. However, despite this very difficult path, where access to even the most basic medical care and treatments are a luxury,  patients, their families and communities continued to demonstrate their resourcefulness and continued to have a unwavering positive attitude. My past month in Uganda was such an amazing and unforgettable experience. I am grateful for the staff, volunteers and those that made this experience possible and to the patients who shared their story.