Life in Kampala, and a Review of Tuberculosis

A post by Joe Corbino, PD4

View from Kirrudu General Hospital

After a few days I feel like I am finally getting settled into life in Uganda and my first APPE rotation. So far, I have been able to experience healthcare at the Infectious Disease Institute and Kiruddu General Hospital both of which are situated in different areas of Kampala.

The Infectious Disease Institute is situated on the campus of Makerere University College of Health Sciences. This location functions as a specialized center that cares for individuals living with HIV/AIDS who are also suffering from additional co-morbidities. It is estimated that the location is currently following around 8,000 patients. On our second day in the Uganda, the other pharmacy students and I had the opportunity to interact with a pharmacist and three other interns that were completing a four-week rotation at that site. In Uganda, a pharmacist intern designation is applied to individuals that have finished “undergraduate” pharmacy course work and are now completing a year of rotations.

The most interesting experience that I have had thus far has been following the cryptococcal meningitis team to Kiruddu General Hospital to round on their patients that are currently enrolled in research trials. This experience was very different from what I am used to in the United States as patients are grouped into wards, or giant open rooms, rather than individual rooms. One thing that I noticed right away was the amount of family present. I learned that unlike in the United States, families in Uganda will often stay with the patient during the course of their hospital stay administering oral medications, preparing small meals, and sleeping on the floor at night as hospitals are not equipped to provide many of these services. When I arrived a physician was quick to notice that I was a student and offered to allow me to shadow her for most of the morning. This included watching two lumbar punctures in patients that were enrolled in her research study surrounding TB-meningitis. After this I was taken, along with Dr. Nicol, to the microbiology lab to witness how patient samples are handled for further investigational analysis. During my remaining time at the hospital, I was able to join two additional physicians to complete their rounds.

View of Kampala from the top of the minaret at Gaddafi National Mosque 

Inside of Gaddafi National Mosque 

It will never cease to amaze me the severity of immunodeficiency that the patients I have seen are experiencing. One way that this is measured is to look at an immune cell that we refer to as CD4-positive T-lymphocytes. Individuals are considered to be at the greatest risk for opportunistic infections when their CD4 count is less than 200 cells/mL. Almost all of these patients had CD4 levels that were 2-4 cells/mL. This has allowed me to reflect on two things. First, individuals in developed areas of the world are extremely fortunate to generally have access to comprehensive medical care that affords them the latest advances in HIV therapy. Second, improving the lives of individuals suffering from HIV/AIDS in developing countries is something that I want to be invested in for the foreseeable future.

I thought I would take some time to give some brief information on the subject of TB-meningitis for my family, fellow pharmacy friends, and anyone else that may be reading this blog! Tuberculosis (TB) is a disease that is caused by the organism Mycobacterium tuberculosis. The organism is spread through the air and more commonly infects individuals with compromised immune systems, such as those suffering from HIV/AIDS. In school we are taught that the disease generally manifests itself in the lungs, but it is possible that it can disseminate or spread to other areas of the body. Individuals affected commonly present with a fever and headache. They may additionally appear confused if the disease is in a later stage. A confirmatory diagnosis is made through analysis of cerebrospinal fluid, which has high protein, low glucose and a raised number of lymphocytes (immune cells). As is seen in regular TB treatment, individuals are treated with an induction phase consisting of isoniazid, rifampicin, pyrazinamide and ethambutol for two months followed by a consolidation phase of isoniazid and rifampicin for ten more months.

An and Melanie in front of Namirembe Cathedral

Aside from the clinical experiences scheduled this APPE rotation, I have had ample opportunity to explore Kampala and see how beautiful and vibrant of a city it is! So far, I have had the opportunity to go to a craft market, the second largest mosque in Africa, and various delicious restaurants near the Minnesota house. Stay tuned for more updates in the coming week from An, Melanie, and Dr. Nicol!