I believe that the experience gained by the undergraduates, faculty, alums, and friends participating in the Wabash College Global Health Initiative (GHI) may be transformative as we struggle with the questions of justice, rights, and accessibility to healthcare whether in Peru or Montgomery County, IN, USA.—Dr. Sam Milligan ’68, Member, Wabash GHI Advisory Board
Mulago Hospital, Ward 4C
Welcome to Ward 4C in Mulago Hospital, Kampala, Uganda, the last stop for many HIV patients and my second home for this summer.
You can practically feel the sickness in the air.
Imagine your last hospital stay (and if you are fortunate enough to never have been admitted into a hospital, think back to visiting a friend or loved one). You probably have a room to yourself or with one other person, a nurse who visits every hour or so, clean bedding, and food to ensure the best chance at recovery. When you go to bed, you feel comforted by the fact that the best doctors, armed with nearly unlimited medications and technology, will be present if anything were to go wrong.
Now, welcome to 4C. First, lose your individual room and replace it with a large, open-aired room, packed to the walls with hospital beds.
Inches to your left and right and at your feet are some of the sickest people in the world. People battling HIV, tuberculosis, meningitis, malaria, hepatitis, rabies, or most often, a combination of several infectious diseases.
When you go to bed at night you can hear your neighbor convulsing from a seizure, or someone across the room moaning from pain. In the morning you can smell people who urinated or defecated on themselves, or hear the cries of a family mourning someone who did not make it through the night.
You depend on your family to visit you, clean your sheets, and feed you, because the hospital does not have the proper resources or staff to provide for you. At the same time you are fighting your own battle. Not a broken arm or the flu, but diseases that require the best care in the world—but you do not have the best care in the world, because you belong to Ward 4C.
Now imagine the doctor’s challenges. From the day your patient is admitted you’re in a race to get him or her discharged. You are treating HIV patients with already weakened immune systems, so hospital-acquired infections are a real danger. The ward where people go to heal can actually be a source of illness.
The limited availability of drugs and equipment like ventilators and MRI mach-ines makes the battle like fighting a Goliath blindfolded. In fighting the “Goliaths,” there is definitely a danger to the “Davids” —stress, emotional struggles, or even worse. Although many of the doctors and nurses whom I have spoken to won’t admit it, there is certainly a health risk of just working in Ward 4C. TB is in the air, and HIV+ infected needles are everywhere.
I myself have handled HIV+ needles and cerebrospinal fluid containing HIV (of course, having received the proper training and precautions). While these are trained professionals and historical occupational exposure is relatively low, it is always frightening knowing that you are a single accident away from needing post-exposure prophylaxis.
The week before my flight to Uganda, I learned that my father had suffered a heart attack. Instead of taking my chemistry final, I spent nights in the hospital in Indianapolis with my father, awaiting and following his open-heart surgery. While we were all nervous, I knew in the back of my mind that everything would be fine. I trusted the quality of care.
Fast forward only a week and half and I can’t say the same for the patients battling HIV/meningitis. I’m witnessing these harsh realities firsthand. For both the patients and the doctors, it truly is a war out here, but I am glad to be a part of it in any way I can.
Bilal Jawed ’17 is a GHI clinical research assistant thanks to an internship made possible by David Boulware ’96.
Jawed is working with doctors on a clinical research trial of adjunctive sertraline for the treatment of [cryptococcal meningitis.