Last Thursday, all members of the Double Cure Medical Centre team save two were loaded into the ambulance and driven approximately 45 minutes along a bumpy, single lane dirt road to the village of Bubebbere. The village had been previously notified that DCMC would be performing an outreach today, providing residents with dental care, immunizations, HIV testing and brief medical consultations free of charge. With geographical isolation and poverty as limiting factors, this outreach was offering many villagers the only medical services that they had received in years.
The village of Bubebbere is comprised of a few small buildings lining both sides of a dirt road. Some of the residents sat waiting for us under an awning made of dried cane, more gathered as the DCMC staff set up their tent and equipment. Separate stations were created for for dentistry, HIV testing, immunizations and family planning, blood pressure screening and medical consultations. Ther was also a small "pharmacy" from which magnesium tablets, paracetamol (tylenol) and two antibiotics could be dispensed at no cost to patients.
Once everything was in place, the team was introduced to the crowd, and the services to be provided were outlined. Dr. Lydia gave some general counseling about preventative health measures, Dr. Moussa did the same for dental health. Patients were then asked to visit the various stations in whatever order they chose.
With the exception of a midday downpour that forced staff and attendees under cover for a while, the outreach went smoothly. Mothers lined up with their babies to get immunizations; a large crowd gathered outside of the lab area, awaiting HIV testing. Moussa, the dentist, later estimated that he performed more than 20 tooth extractions over the course of the day.
I was paired with a (very patient) translator, and sat underneath the medical consultation tent alongside Dr. Lydia and Frank, the clinical officer. The lists of problems that patients presented with often seemed overwhelming- lists of 5-10 chronic issues that had gone untreated for years. Many of the complaints stemmed from issues that we could not address that day: cataracts, hearing loss, neuropathies, chronic back pain. For some complaints we were able to offer advice or treatment, and many patients were advised to seek additional medical care or testing in a clinic.
Towards the end of the day, a large group of children in various school uniforms gathered at the periphery of our set-up; I was told that they were there to receive deworming tablets. Throughout the day, many of the adults that I saw told me that they had "worms in the stomach", as well as burning and tingling in their arms and legs. I later learned that chronic parasitic infections can result in such neuropathies if left untreated. I asked DCMC's clinical officer why we didn't provide deworming tablets to adults, as well, in light of the potential consequences of chronic infection. He explained that the deworming medication is provided to clinics by the Ministry of Health for free, but in limited supply. Clinics therefore have to prioritize when dispensing the tablets, and children and pregnant women are at the top of the list.
We left Bubebbere at around 6 pm. There were still patients waiting for tooth extractions and HIV testing; a large number had been advised seek further evaluation and treatment at a medical facility, DCMC or otherwise. For reisdents with limited resources and living a significant distance from such facilities, the services received during the outreach could be the only care they get for some time. Another outreach is planned for this week, this time the village is located on 15 minutes fro Mpigi. It will be interesting to see if the needs of these villagers, who live so much closer to medical facilities than the residents of Bubebbere, have different health care needs.
Side note: I just wanted to provide an update on the infant that I wrote about last week. After discharge from DCMC, she had her wound dressing changed at a local clinic. Her mother brought her back to DCMC on Saturday for evaluation. She continues to be free of fever, but there was new necrotized (dead) tissue that had to removed. Dr. Faisal, the physician who saw her, was concerned that as an outpatient, the baby couldn't receive the sort of aggressive therapy that this bacterial infection required. He referred the family to the government sponsored hospital in Mulago, where she could receive IV antibiotics and daily wound dressing changes. While this hospital does provide services at no charge, Dr. Faisal explained that it is extremely busy, and is often viewed as a "last stop" by Ugandans. The mother agreed to go; we will hope for the best.