In May 2014, I gave my Grandma Lou a call to say goodbye before heading to Guatemala for two months of research. She took the opportunity to tell me her cancer had relapsed, and she didn’t think she wanted treatment. I was so anxious the entire trip that that phone call would be my final goodbye to Grammy but she conceded to my family’s pleading to receive treatment that was in post-marketing trials and she was doing well when I reached home.
This summer, I stopped in to see her before taking off to Uganda. I joked about her making new friends in the assisted living center she would move into that weekend and told her to challenge some of them to a race with her new walker. She had recently taken a turn for the worse again, but this time I told her I would see her at our family reunion in a month and skipped the formal goodbye. At the midway point of my volunteering trip, I called my mom to find out Grammy had passed away.
One of the first surgeries I assisted at Iganga District Hospital was a debridement of an 80-year-old man. Mzee (a Swahili term used to address respected elders) had been an inpatient in the male ward for some time before I arrived, presenting with a suspected hernia which turned out to be a perforated bowel that had become infected. He was very weak, and his open wounds were seriously infected. I took an interest in him because bedside manner is very different in Ugandan culture than in American culture (and probably because he reminded me of my sick Grammy at home).
In Uganda, doctors don’t worry themselves over patient satisfaction scores and patients don’t often question their treatment options. My osteopathic self couldn’t resist putting a gentle hand on his shoulder after he suffered through a radical circumcision and the removal of a testicle with only local anesthesia. I helped Mzee in, out, and through, four more procedures and surgeries before my trip came to a close. Even though we could only communicate with a few words of Lusoga I had picked up and body language, I felt as though we were friends, that he may have trusted me and trusted that he would be ok when I brought him in for yet another procedure. I wish I could have done that for my Grammy as she went through her chemotherapy.
Mzee’s son sat next to his bed in the ward every day. He ran to get his father medications, including the best anesthesia he could afford, and helped me wheel Mzee back to the ward after procedures. In the government hospitals of Uganda, it’s almost impossible to show up alone and get the care you need. While the vision of Uganda’s National Medical Stores is “a population with adequate and accessible quality medicines and medical supplies,” the reality falls short.
Iganga District Hospital had not received stocks for the past three months before my arrival. They had run out of everything from antibiotics and painkillers to gauze and tape. If the hospital has not received stock of equipment or doesn’t carry the medication a patient needs, it falls to the family to run (sometimes literally) to a private supplier in town to purchase the needed medical supplies. The families of most patients sit on mats on the floor next to their loved ones, supplying food and cleaning and caring for them. They are responsible for administering any tablet medications and for ensuring the nurses administer IV medications when needed. Every day during rounds in the male ward, Mzee, with his son by his bedside, reminded me of my Grammy, mother, and uncles at home in New York. They had been taking Grammy to all of her appointments, managing her medications, and, unlike the Ugandans, questioning her doctors to understand her treatments. They reminded me that relationships are critical for healing and that family is important, no matter where you are in the world.
In the race between an 80 year old fighting off sepsis in Uganda and an 88 year old battling leukemia in America, who wins? You would think it would be the patient who is in an environment with the best technology and resources, the one with a cutting edge treatment, fresh on the market. But that’s not how the world works. And that’s not how medicine works.
Adequate resources are critical to provide the quality care that everyone deserves, but at some point, the body becomes unable to continue functioning, regardless of technology and equipment. However, both these people showed remarkable resilience: most of the hospital staff did not believe Mzee would make it when I arrived in Iganga, and I didn’t believe my Grammy would make it through last summer. But she did. And Mzee did. He is still recovering on the ward but is doing well, feeding himself and walking around. He was encouraged to get out of bed but this increase in activity caused his abdominal stitches to burst.
Mzee showed incredible strength for a frail elderly man by recovering from that setback with a fresh set of tension sutures as well. Some patients are capable of muscling through an illness on their own but to truly return to health it takes the appropriate technology and resources, support and love of a family and care team, as well as hope and personal drive. My Grammy lived a long and loving life, and she passed away peacefully surrounded by her family. I can only wish the same for my friend Mzee.
Teagan L. Lukacs is a medical student.