Today I switched gears again and headed over to the outpatient department (OPD). This is the first contact point for patients coming to the hospital and the first building after the entrance gates. Patients are triaged outside in a tent by a nurse. If they need attention sooner they are walked into the back of the building which is the “emergency department”, but if they are stable and can wait they are given a slip of paper and told to sit at station number 1. Patients are then called one by one to stations 2, 3, and 4. Station 2 is the cashier (see below for explanation of medical expenses). Station 3 is registration where a nurse enters a patient’s name, age, sex, tribe, and chief complaint into a big 11×18” log book that is sent to the Ugandan Ministry of Health periodically. Station 4 is vitals, taken by a nurse. After all this, the patient then waits for station 5 or 7 depending on severity of condition. (Station 6 used to be functional but the room is now tuberculosis clinic.) Station 5 is manned by a clinical officer and station 7 by a doctor, either an MD or a medical officer. A clinical officer is different than a medical officer in that they have had slightly less training and their training is focused on learning algorithms for the most common diseases in the area. After seeing one of these providers, the patients then are directed to either lab (which they walk across the hospital to go to), ultrasound or X-ray (which is in the back of the OPD building), pharmacy (which is next door), or for consultation with a specialist in their “clinic” which just means they go see them in their area of the hospital but are not yet admitted. These specialists include surgery which covers general surgery needs, urology, dermatology, and orthopedics. There is also obstetrics and gynecology, pediatrics, and internal medicine which covers all internal medicine sub specialties (if possible). Before they go to any of these follow up areas, however, they have to go back to the cashier and pay for their services up front. Finally, if their are any results that need to be reviewed by the provider, they bring them back to the provider and wait to see them again (station 5 or 7) and the process starts over as many times as needed. This, while sounding very convoluted, is a very functional system and, again, speaks to the self responsibility of the people here.
Alright, a side note about medical expenses in Uganda. There is no medical insurance in Uganda. There are government hospitals which you can go to for free at any time. I am told they are not desirable and have very poor outcomes but have not verified this myself. “Private” hospitals like Kiwoko Hospital are run by in or out of country non profit organizations for the most part and usually require a small fee for service to help provide quality care. At Kiwoko Hospital, patients pay 3,000 UGX (Uganda shillings) to see a provider in OPD. That is about 90 cents USD. Fees for labs are about 1,000 UGX, radiology is about 3,000 UGX, and medications are close to free. Admission to the hospital ends up being 5,000-10,000 UGX regardless of length of stay. In the NICU, because there are many government grants and non-profit organizations supporting it, parents pay 1,000 UGX for the entire stay for their baby. This is about 30 cents USD. Then, at the end of the day, if a patient or family really cannot pay I am told there are ways to waive the fees but mostly everyone coming to the hospital already knows this pay structure so that is not usually an issue. Learning all this really reframed my perspective on donating to organizations in the US that support hospitals such as these- the US dollar is stretched a far way here.
Lugandan word of the day: jjajja (noun, “jaw-jaw”, old person- spoken in an endearing way as if to name your grandmother or grandfather; jjajja mukaz= grandmother, jjajja musaj= grandfather)
Medical learning point of the day: The presence of parasites (malaria) makes the rapid typhoid antibody test result as false positive.
