An Awesome Day in the Emergency Ward

Today was our first day in the emergency ward due to all the senior doctors being off for the holiday yesterday. It was pretty amazing.

We started off with another orientation-type meeting with the dean for the school of medicine. It was fairly interesting. Apparently, Uganda has changed its medical system so that the nurses, doctors and other medical personnel all have class together for the first year of medical school. This was done so there would be better collaboration between the different "classes" of medical care professionals. It sounds like a great idea and the dean says so far the students really like it. The dean also talked about his home for exchange programs in the future, etc, etc.

Next we were taken to the Trauma Ward where we were introduced to a really nice Ugandan intern doctor (first year resident after medical school). He was really nice to Annie and me. He asked us to take histories on patients, take vitals and practice some of our physical exam skills. He also kept asking us questions about what we thought the patients had and what could be causing their symptoms. Then he would try to lead us in the right direction with additional questions and he would give us homework when we didn't know the answer.

For example, there was a patient with HIV and TB who had neurological signs and symptoms of meningitis. Our intern had us examine the patient and take a history and then he asked us what we thought could be causing the symptoms we discovered. We listed meningitis and possibly TB that had gone to the brain and some other random disease possibilities. He final led us to his hypothesis that the patient had a toxoplasmosis infection that had reactivated and formed lesions in the brain because of the patient's immunocompromised status. Annie and I both remembered some of the information about toxoplasmosis which we just studied in microbiology: "women should clean the cat litter box while they are pregnant." Then after a breif review we both remembered that Toxoplasmosis infections can reactivate in immunocompromised patients.

Our intern gave us homework assignments to look up the things we didn't know while we were at the hospital. One of the patients was being treated for HIV and among many symptoms had a very unusual distribution of fat deposits - she had very thin arms and legs, but more visceral fat around the stomach and chest. Our intern asked us what this was called and what could be causing it. Annie and I together are quite the brain-power force so we were able to come up with that it is called 'lypodystrophy' or something like that and it was probably caused by her HIV antiretroviral drugs. Then our intern asked us which class of antiretroviral drugs causes lipodystrophy. This totally stumped us. However, tonight I have been doing some searches on the Internet and have discovered a study to help me answer the question tomorrow: It found that 3TC (Lamivudine) and D4T (Stavudine), nucleoside analog reverse transcriptase inhibitors, caused lipodystrophy but protease inhibitors did not. Whew. one question down, about 10 more to go. If you have any more information, feel free to email me!

When we first arrived at the trauma ward we were a little surprised that it wasn't more about car accidents and severe injuries (as the word "trauma" brings to mind). However, throughout the day it became clear that it was pretty much like a normal emergency wing - it is where really sick people came and were admitted and shuttled off to other areas of the hospital. Most of the people we saw today were actually people with infectious diseases or chronic problems that had suddenly had a deterioration of their condition. A lot of the patients had HIV and others had chronic problems see in the US, but that receive less preventative care or that the Ugandan medical system didn't have the resources to treat.

As we were going home, Annie and I discussed that this could possibly be one of our best days of medical school so far. It was incredible even though it was sad at times. We learned so much! We felt helpful (although we definitely slowed things down) and welcomed by the staff.