UgandAshis 22 Final examination

UgandAshis 22 Final examination

June 16, 2009

Kampala, Uganda

The clinical officer doing his mock exam was clearly nervous. As I tried to ease his mind with easy questions he blanked. Given our patient we were reviewing was a very complex case. A young man, 28 years with skin lesions (Kaposi sarcoma), generalized body edema, difficulty breathing, extremely anemic and very weak.

Common causes for generalized edema are heart failure (anemia), kidney failure (nephrotic syndrome) and malnutrition (malabsorption). What you look at to determine anemia is palmar and conjunctival pallor, to access the heart I was asking our examination candidate to name some of the findings of our patients fingernails: they were spoon shaped (which you see in iron deficiency anemia, or koilonychias), had fungal infection (discoloration, thickening) and there were signs of cyanosis (blue discoloration of the finger nails)

Not only was the candidate getting quiet, our patient started gasping for breath. He had received 2 blood transfusions over the last 24 hours but was still not doing well at all. As I listened to his chest, felt his jugular artery I noticed he was having no heart beats. I started cardio pulmonary resuscitation as the entire room (about 20 patients) became quiet. Tried adrenaline and while I saw the young man’s father coming into the room with his hands raised to heaven I knew I had to stop.
Wailing broke out straight away as all family members rushed to the deceased. These are moments for which there are no words – just a feeling of deep sorrow. Questions what we could have done better for this individual patient. When examinations of 150 students take place by 8 teachers in 8 subjects it is hard to balance patient care and proper training.

Having contracted HIV and not being on treatment had lead our patient to decline rapidly. When he got admitted we did care for his eminent medical issues. Yet as many fellow people living with HIV/AIDS the presentation to a hospital is often when the patient is either in coma, severely malnourished or suffering from severe opportunistic infections.

As our deceased body was taken to the morgue by the family with 5 minutes the bed had filled up. Examinations continued. There is no doubt there are great needs for patients in Uganda. Besides infra structure medicine and equipment one of the most important is human resources. Trained, qualified and motivated health staff. Our young examination candidate just passed his exam.

Namaskar,

Ashis