10%

On-Call in Uganda

Dr. Micheal Ogwal at the CURE hospital in Mbale

By CURE International

May 23^rd, 2019

A Day in the Life

"It's to make a difference, really," says Dr. Micheal Ogwal.

"To see someone come in and know they are in despair. By the time they go back home, they have hope. It's more than a job. To me, it's more than just a job. It's a calling, a responsibility that God has given me. I may not stand up on a pulpit and preach, but I have been taught that living is a sacred act of worship. All of it. So whether I am taking the history of a patient or resuscitating a patient, it's all about God giving me the opportunity to make a difference in someone's life."

Fifteen hours after entering the hospital, Dr. Micheal crosses an empty, dark road after completing his nightly ward rounds. It's his third night on call. He enters his house and turns on the television to make the room feel less empty. The world news plays as Dr. Micheal sits in front of the TV with a plate of french fries. He enjoys knowing what is happening in the world. His dining room is empty aside from a refrigerator and a keyboard, which he has had since medical school.

Soon comes a power outage—a fairly regular occurrence in Uganda—yet he plays anyway, the only sound: his fingers tapping against the keys. Playing music helps Dr. Micheal to process the day and relax. It's one of the things he enjoys most.

Dr. Micheal is tired and hopes he won't get called back into the hospital. He sits on the couch with an open textbook next to him. Eventually, he goes to bed. He sleeps through the night, waking at 6:00 am and arriving at the hospital an hour later to start his day all over again.

. . .

The photographs below document the joys and the heartbreaks that come with being a doctor at the CURE Children's Hospital of Uganda.

7:00 am- 7:30 am: Dr. Micheal arrives, does a quick pre-round and is ready for the main round to begin at 7:30.

"I like the on-call week in particular, because I have the greatest opportunity to make an impact directly. You are coordinating all the input that comes in from various members of the team. Those weeks engage me the most, I think. I grow professionally each time I'm on call."

Dr. Michael addresses his team before morning rounds. He briefs them on each patient's condition, who they are, why they are here, and the treatment they've been receiving.

After morning rounds, Dr. Micheal heads to the ICU to examine the patients and write down the day's plan.

Maria, held by her mother Mercy, plays with Dr. Michael's pen.

"My favorite part of the job is also the most draining. It's when I have a very sick patient, and I take care of them and they pull through. You are thinking really hard ... what can we do differently? What is missing? Is there anything we can do to make sure this patient pulls through? It's those moments when you are thinking hard and losing hope and then the patient starts to pull through, and God gives you an idea about what you can do. The patient actually starts getting better."

Lorna watches as Dr. Michael treats her son in the ICU.

"On a sad note, there is Ednan. He came in on a busy night. He had an infection and we started him on antibiotics. Unfortunately, he had really bad complications from his spina bifida. His parents had such high hopes that everything would be fine. Ednan went into respiratory arrest during surgery and we lost him. The mother and I had formed a friendship, and she would call me when something really scared her. Sometimes I didn't have the answers. She still calls me up to see how we're doing at the hospital. She really loved her baby. I was so broken by the loss of that child."

Ednan lays in bed with an oxygen mask while Dr. Michael examines him. Ednan's mother, Esther, watches from the side of the bed.

10:00 am: Dr. Micheal tries to finish writing notes in the ICU by ten, allowing him time to get a quick cup of coffee or tea with his co-workers.

"Work strains relationships. I thank God I don't have to balance between my work and faith, because I believe what I do here is what God wants me to do. This is ministry to me."

After tea, Dr. Micheal bounces between the ICU, the outpatient department (ODP), and the treatment room.

Michael taps Esther's knee with a reflex hammer. Esther has come in for a follow-up appointment in the outpatient department.

Concerned about John's deteriorating condition, Dr. Michael performs a CT scan immediately rather than waiting for a radiographer. Nurse Richard and John's mother, Judith, watch him prepare the scanner.

The main procedure Dr. Micheal performs during any given day is a ventricular tap to remove cerebrospinal fluid (CSF) for testing or to temporarily relieve pressure on a child's brain. Before a patient goes into surgery, a CSF sample is taken. During a busy week, Dr. Micheal may do up to a dozen ventricular taps in a day.

Dr. Michael performs a cerebrospinal fluid (CSF) tap.

Late afternoon: Dr. Micheal meets with the other doctors and surgeons in the CT-scan room to review scans and to discuss who will be undergoing surgery the next day. The decision about who will receive surgery next is based upon how critical the patient is, how long they have been in the hospital, and what surgery they need.

Since first coming to visit CURE Uganda in the fall of 2016, Dr. Micheal has been impressed by the staff's mutual respect for one another and the time they take to talk to and listen to the patients. "I was amazed by how our bosses turned out to be our mentors. Dr. Peter, Dr. Justin, and Dr. Mugamba are genuinely concerned for you and help you to grow professionally."

Dr. Michael and other members of the medical team discuss the following day's surgical schedule.

5:00 pm: A lot of the staff heads home. "This can mark the start of a really busy day, because it's mainly you," says. Dr. Micheal.

"Someone comes in needing a CT-scan, so you take them and get them a scan. If they need to go to the ICU, you take them to the ICU. If they need their airway protected, you intubate them. It's amazing, the hive of activity that occurs here. Then of course I do the evening rounds. Before I can safely go home and wait for further calls, I know the state of most patients. This helps me if I get a phone call from a nurse. I can think fast and be able to direct them. The night is very unpredictable. There are nights you won't receive any pone calls, and then there are night when you are kept awake most of the time."

Dr. Michael spends a lot of time caring for the patients in the ICU, which is full to capacity.

Dr. Michael explains that the hospital has done everything possible for this child. The following day they were referred to a hospice facility.

"There was a mom who came to us, a happy mom who really loved her baby. The baby was three months old but had an arachnoid cyst posterior fossa. The surgeons went in to fenestrate the cyst. The patient was extubated, but began developing trouble breathing, and was re-intubated. The patient was kept intubated in the ICU for weeks, and as time passed, we saw him deteriorate. There was nothing more we could do for the patient.

"His mother was discouraged. The spiritual center had spoken with her, but you could tell she was tired. Then, her son made an impressive recovery after three whole weeks in the ICU! We were able to discharge him. Now, whenever the mother brings him in for review, she always makes sure she sees me.

"Everyone loses hope when you are doing the best that you can but nothing is happening. Somehow, patients go and make amazing recoveries. The patients that most excite me are the ones who are in hopeless states, because I know that God can actually step in and do the impossible, making sure the child improves."

A mother signs a consent form to allow Dr. Michael to operate on her child the following day.

At night, when much of the staff goes home, Dr. Micheal finds himself in all parts of the hospital, including the ICU, the CT-scan room, the exam rooms, and of course, the general ward.

Mariam is being seen in the outpatient department for a persistent pressure sore.

Dr. Michael plays with Maria a few days after her surgery.

An ultrasound is performed to see where to place the needle for a CSF tap.

Dr. Michael takes an outside pressure measurement to see how much pressure has built up on the brain of his patient.

Esther holds her daughter while Dr. Michael cleans the table in the exam room after performing a CSF tap.

Dr. Michael sits alone in the cafeteria on a Sunday morning. His break is interrupted by a phone call and also a nurse coming to find him.

Dr. Michael talks with Dr. Peter moments after losing a patient in the ICU.

Dr. Michael works on a large stack of medical files.

After finishing his nightly rounds, Dr. Michael has a plate of french fries for dinner while watching the world news.

Dr. Michael practices piano. It helps him relax after a long day.

"I want to become a neurosurgeon. The surgeons here have inspired me. They are very humble and down to earth. Most of the neurosurgery I was expose to in medical school was disheartening. Patients died in large numbers; children who spent too much time in the ward deteriorated. When renovations happened at a government hospital, they evacuated the wards and sent children with hydrocephalus home, untreated. There was no way I wanted to be a part of something like that. But then you get to a place like CURE and you see the difference they are making - that is what I dream of being a part of. It is God-inspired, to take care of His children. I will keep dreaming and see what God can do."