Megan Hilger's Reflections on Her Experience at Mulago

 Posted on behalf of Megan Hilgers, Pediatric 2nd Year Resident

Hello from Kampala, Uganda!

As my time here is nearing the end, I am thankful for the experiences I've had, relationships I've formed and vast amount of knowledge I've obtained. I spent my first week working on research in the hematology lab with Dr Troy Lund looking at markers of oxidative stress in G6PD deficiency. My remaining time was spent doing clinical work. 

Megan Hilgers with Derrick, the Hematology Lab Tech

Most of my clinical time was spent in the resuscitation room of the Acute Care Unit.  This unit is where the Pediatric ED, PICU and a transition ward are located.  I worked alongside the Ugandan residents, interns and medical students. As you would expect from the name, the patients brought into the resuscitation room are critically ill and require rapid interventions.  After patients are stabilized they are transferred to the PICU or ward where we continue to follow them with the team. The most frequent conditions we care for are sepsis, respiratory failure from pneumonia, severe acute malnutrition, hyperbilirubinemia and severe anemia. Oftentimes, these are in the setting of sickle cell anemia, TB, HIV or chronic malnutrition. Not only have I gained knowledge of these diseases and complications but I've improved my exam skills, procedure skills and even my ability to read blood smears. As a resident in the resuscitation room, I provided full spectrum care and I can now draw blood, place IVs, place I/O's, reconstitute and draw up meds, mix IV fluids and run a code with a lot more confidence.  I greatly enjoyed the mutual collaboration with the Ugandan residents as we discussed various patients and how management differs in the US. 

Ugandan residents with Megan Hilgers and a visiting Anesthesia resident from Stanford

Resources and healthcare staff are stretched thin in the hospital and posed many challenges that often fell to the parents/caregivers. Parents are relied on to monitor their child at bedside, administer medications, purchase certain medical supplies- such as blood culture bottles, pick up test results from the lab and even go to a nearby pharmacy to purchase inpatient medications when the unit is out of stock. Parents form a supporting community together within the unit and I often witnessed mothers teach each other how to express breast milk, use NG tubes, share meals with those in need and care for abandoned or orphaned children.

This is a great setting for residents interested in learning about management of critically ill patients in a hospital setting with limited resources.  There were a lot of opportunities for hands on management and teaching students and other residents.  It was very humbling and I cannot express strongly enough how grateful I am for this experience.