A few things to wrap up the week

By Prosperity Eneh

TGIF. Happy Friday from Kampala. Since it was the end of the week, some of the staff at the general ward at Nakasero hospital where Kunkun and I have been working the past week were easily convinced to take a fun picture for our blog. We have been fortunate to participate in patient rounds and converse on unique differences in patient management strategies with this amazing team this past week. We also interacted with many healthcare professionals that are not pictured below.

From left to right; Esther (Pharmacist),Liz (Floor Manager), Becky (Nurse),Kunkun,Prosperity and Lucious (Nurse)

Here are a few things that peaked my interest and I thought I would share today to wrap up the week;

>> Something that is quite different here in Uganda compared to the U.S. is cost transparency with healthcare services. Since most of the population served in hospitals in Uganda are not  covered under insurance, there is need for transparency with cost so that patients can anticipate what they would have to pay in cash for the services provided. Pictured below is one of such notices to patients. In the U.S. we often do not have a sense of what the "real" cost of healthcare services are. Increasing price transparency to an extent is something that I personally think can help with the ever increasing cost of care in the U.S. If more people knew how much procedures really cost, then there might be an incentive for more rational use of healthcare services, but hey that is just a hypothesis and no way of knowing if it would make any difference.

Prices for various services inpatient

>>The British National formulary came in super handy! As we were working in the ward today, a case came up that involved medications that we do not use in the U.S. So we consulted the British National formulary for guidelines and recommended dosing. It turns out this guide is used often by the medical officers here at Nakasero in addition to the Uganda Standard Treatment Guidelines.

BNF

>> Use of paper patient charts. In the past, I would often complain when I found it hard to locate things on EPIC (an electronic medical system used in many U.S. Health-systems), even when there was a Ctrl-F option. Not having Ctrl-F for paper patient charts really made me appreciate EPIC more. Paper charts as pictured below are used for documenting patient course while in hospital. It is organized by admit information, labs, doctor notes, nursing notes, billing etc. Once patient is discharged from the hospital, the chart is taken to records. I was not able to find out if the same chart is located if the same patient comes back or if another record is created but I will ask about this next week. There is obviously some convenience with electronic medical records but to implement that in this setting will require introduction of computers to students in early ages in school. Merely installing computers and expecting hospital staff to use it would not be the right approach according to my discussion with one of the leadership staff. Doing this would actually hurt patient care and take a longer time for care provision and documentation given the level of comfort of staff with using computers/typing information into such a system. A more country-wide approach of introducing computers and typing lessons at a young age would lead to a generation that is comfortable with use of computers for any future work opportunities. This was definitely an intriguing conversation and I am glad it happened.

Cart with paper charts

So we ended the day at the Uganda hub in MUJHU where Sara and Kunkun gave case presentations for a case they picked out for this week. We also made final plans for our trip to Murchison Falls for the weekend. Be on the look out for our Safari Adventures.. Woohoo!