Report for visit to Lira Bruce Hopkins Main functions

Report for visit to Lira – Bruce Hopkins

Main functions:

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  Teaching in Lira University
  
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  Clinical teaching in ED
  
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  Clinical teaching in OPD
  

After initial orientation to the hospital I spent some time trying to integrate into the ED. This was challenging initially as there appeared to be a lack of leadership and no real routine care of patients. There were a large number of students from Lira School of Nursing (LSN) who were left largely to their own devices. I had quite a long discussion with the doctor that was based there, but unfortunately it was his last shift. Getting into the OPD was even harder as they were split into so many consultation rooms.

Teaching in the University in the first week was sporadic, but I did have the opportunity for some quality teaching with the first years who were incredibly receptive and enthusiastic. It appears that teaching in the University is quite “talk and chalk” based and the students enjoyed our teams style of teaching.

After spending more time between the ED and OPD the staff and students there became more receptive of my presence. Unfortunately after the first day there was no doctor based in the ED which meant that there was often no medical support from late afternoon to midday the next day. The Lira University students that were based there seemed to be abandoned and at one point they were the only staff there as everyone else had left. This led to some unique training opportunities.

The ED was fairly clean, but was in a state of disrepair. There was also a severe shortage of drugs and equipment. The OPD was run by medical technicians who seemed to have varying levels of skill, some working at the level of a UK SHO, others that struggled more.

Although there weren’t large numbers of patients coming through the ED, the ones that were there were often very unwell as they hadn’t been deemed to be fit enough to go straight to one of the wards from the OPD. Again this led to some good teaching opportunities not only for the Lira uni students but for the LSN students and the nurses based there. I did a lot of work around care of trauma patients and adult observations and neuro observations. There was a huge deficit in hands on care delivery and recording of observations. This culminated in my discovery of a female trauma patient who had no treatment or observations for approx 6 hours and was seriously unwell. With the help of Antoinette we helped the students initiate treatment, mainly fluid resuscitation.

This patient presented an ethical dilemma, as we are not licensed to practice in Uganda, but the alternative would have been for me to stand and watch a patient die an undiginified death I found this case and other similar episodes with a lack of care delivery upsetting, but used it as an example in teaching the Lira University students. What I found interesting is that there was very good theoretical knowledge amongst the students (probably better than their equivalent in the UK), but they tended to follow the lead of the full time nursing staff and not put the knowledge into practice.

The OPD presented some really good teaching opportunities as the students presented cases to the medical officers. I was then able to discuss these through with the students from a nursing care as well as an anatomy and pathology perspective. I was surprised at how much independence the students were granted, they seemed to be a integral and essential part of the workforce. The Lira Uni students really stood out in terms of their enthusiasm and skills, however, they would still follow the lead of the full time nurses even when they knew that it was sub-standard practice. For instance when triaging children they would take a temp, but not a pulse as they had been told that it would take too long. When I explained they could do both at the same time, they quickly adjusted.

The teaching at the weekend at the Uni was enjoyable and all the students seemed to fully engage with it. I cannot see UK students ever attending in those numbers. Although there were some good teaching opportunities in the University, I regret not being able to do more, as I think we could have added real value here.

Overall, I enjoyed the experience and think I made some small difference. It was in some ways disheartening to see an ingrained lack of care in the ED, but the Lira Uni students did give me hope.

I think for the future, if we want to make a real difference we need to not spread ourselves so thin. The best way to do this is to not work at the Lira Referral Hospital at all and concentrate completely on the University and its hospital. By working from its foundation we may be able to provide a real impact on basic care. I would also question what and how we teach, for instance the relevance of basic life support where there is no high dependency aftercare. I think our work would be better spent on basic care and spotting the unwell adult.