Today I started my 8 week rotation at Mulago Hospital in Kampala. While I had initially wanted to do 8 weeks on the labor and delivery floor, I learned that there are already several students currently on that service. Instead I opted to start with a few weeks of Casualty, or Emergency. Nothing could have prepared me for my first day! While we were touring the hospital, we heard that there had been a big accident in one of the suburbs when a truck lost control of its brakes and crashed into a crowd of cars and pedestrians. I figured it was going to be bad when our tour guide dropped me off and sympathetically said "Good luck, sweetie."
Upon entering the casualty ward, mass chaos ensued. Quickly I donned a pair of gloves and... stood in a corner. Seriously. One of the most helpless feelings you can have is knowing that you have the skills to assist, but not having any idea where supplies are or what you can/should do. Thankfully, one of the Ugandan residents quickly took me under his wing and said "Can you suture? Good, I'll assist you on this patient." After that, I was a suturing machine! One of the attending physicians complemented me, and on the next patient I was asked to teach two Ugandan medical students how to suture. We were directed to a patient with a bandage on his head, so I assumed he just had a laceration. When we removed the bandage, I saw what I thought was a severe depressed skull fracture with some congealed blood over it. I rinsed off the area with some saline, and realized that the "congealed blood" I thought I saw was actually brain matter. It was as if someone had taken a melon baller and scooped out a chunk of this man's head. I'm not sure what happened to him after we sent him for imaging, but that was a scary moment.
Throughout the day, I became more and more thankful for American hospitals. Just as some examples: running out of gloves was a common occurrence, and using sterile surgical gloves was also commonplace when the regular exam gloves ran out. In the waiting area, there was blood on the floor and on the walls, and patients would wait on stretchers in that area after being treated before they could be admitted. The trash cans in the room are metal buckets on the floor, and there is no separation of "biohazard" (anything with blood) from non-biohazard material. The sharps containers are cardboard boxes on the floor with a small hole in the top.
I'm sure my time in the ED will make me more confident in many procedures, but above all I don't think I will ever be able to complain about medicine in the US again!