January 2006
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In her own words:
Angelina Kakooza-Mwesige, MDInsights on medical practice in Uganda
Pediatric neurologist Angelina Kakooza-Mweisge, MD, visted Children's Hospital Boston from November 10 to December 15.
My time at Children's Hospital Boston and Harvard Medical School has been a great learning experience for me, and I am most grateful to the American Epilepsy Society and my host, Dr. Frances Jensen, who enabled me to make the visit.
While here, I've attended Neurology patients in intensive care, the Epilepsy Program and the Division of Infectious Diseases, and the specialist's clinics for neuromuscular disorders, tuberous sclerosis and neonatal follow-up. I've shadowed several neurologists as they did their patient consults. I've also attended resident student case conferences, neurology grand rounds, neuropathology and neuroradiology conferences, and given grand rounds on the "Challenges of Practicing Neurology in Uganda" to the Harvard Medical School community.
What I've found to be different at Children's is that it's very well organized and a highly technical facility. The environment in which the children are received is very child-friendly and clean—the beautiful childish paintings in the corridors and walls of the wards, the cool, suitable colors chosen for painting the walls, the hospital staff who are willing to provide information and assist wherever possible—it's very attractive. The use of a pager system enables the various hospital staff to be in communication at all times, especially if there is an emergency.
In my hospital, the technology for patient care is not of the same standard as Children's. For example, we don't have an ECMO machine or a computerized database for close monitoring of the vital signs for the patients we admit. We use phones placed in the wards for communication. Pagers are not available for all the residents and the staff, only a few possess them.
The investigations done for the patients and the means of accessing them and their interpretation are equally very impressive at Children's. With respect to the neurology unit I visited, a patient may receive more than four MRI or CT scans at a single admission if deemed necessary by the attending doctor. In my hospital, there are no facilities for MRI services, and CT scans are only available at a cost to the patient, which limits any further requests by the attending doctor. Laboratory work-up regarding full blood count, electrolyte levels, liver function or renal function tests can be received within hours, instead of 24 to 48 hours or more, and can be accessed by the attending physician at any computer in the hospital without having to physically go to the laboratory. The investigations that are done on the patients to reach the final diagnosis are very exhaustive. Use of molecular, chemical and genetic testing enables various pediatric syndromes that would otherwise remain unsolved in my environment to be arrived at and the appropriate treatment and means of prevention instituted.
The nursing care, especially for Neurology patients in intensive care, is commendable. The color of the uniforms instead of the usual plain white ones of the nurses is welcoming to the children. In our pediatric ward, we mainly have white ones, which I believe is quite intimidating to the children. Also, the intense monitoring of the babies, especially the neonates, with the ratio of one nurse to one patient is very good. At my hospital, we have a severe shortage of nurses. The ratio is very far from one to one. In Infectious Diseases, the nurse practitioners who see the patients with the attending doctors are very knowledgeable and impressive in their management of the HIV/AIDS children. They basically know how best to manage the child even before they consult the doctor attending. In the pediatric HIV/AIDS clinic at my hospital, the management of patients is left primarily to the attending doctors. The nurses triage the patients and provide nursing care, health education and counselling. They do not prescribe drugs or decide on the treatment of the patient.
Children's Epilepsy Program has facilities for video EEG, EMG and evoked potentials, and for patients with refractory cases, a vagal nerve stimulator is put in place. In addition, patients with poorly controlled epilepsy are admitted for close monitoring as their drugs are adjusted. Once controlled, they are sent home for observation. All these facilities with the exception of an EEG machine (with no attached video) are not available in the hospital in which I work.
There are well-written treatment protocols accessible to all the staff regarding the management of the various neurological conditions, as well as patient information leaflets to educate the patients about their condition. This ensures standard treatment and raises patient awareness; this is certainly something that I plan to follow up with my department back home.
What impressed me the most on my visit, which I hope to emulate too, is the early intervention therapy that is done for those children with brain injury early in life. There is an intense program of physical, speech, occupational and play therapy instituted early in the child's development, which ensures that the child is able to be fairly independent, if possible before school entry. It was very encouraging to see children who would otherwise be considered "failures" back home, in conditions depicting a fair amount of independence.
I appreciate and congratulate all the staff for the tremendous work that is being done at Children's Hospital Boston and hope to visit again some time soon. I wish you all the best in your work.
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