TODAY I WATCHED A MAN DIE. His life left his body right before my eyes. His struggle for breath became harsher and harsher until an abrupt silence fell.
The immediate cause of death was asphyxiation; he literally suffocated to death in front of his loved ones. The mother sobbed on my shoulder. After a few moments we went our separate ways.
I was shaken by how quickly he was replaced. Within five minutes his face was covered with a blanket and the bed was carted out, only to be replaced by another sick individual in the already overflowing ward.
I was shaken, too, by what seemed to me the medical professionals’ apathy toward death; it was almost casual. The team noted the man’s death and methodically moved on to the next patient as if he had only fallen asleep.
At times it is easy to see these physicians as cold. But after talking with them, I believe this appearance comes not from a disregard for life, but from an understanding. They are only a quick blip in their patients’ lives. They understand that they are simply the final stop for these patients after years of poverty, sickness, and societal failures.
The medical system in Uganda failed our patient in two ways. First within immediate care facilities; Mulago Hospital has only a handful of ventilators for its hundreds of patients. Unfortunately for our patient, medical officers decided that his chance of survival was too low to justify use of the ventilator; he would take away from another patient who would have a better chance.
The second failure is more complex.
Although our patient’s immediate cause of death was asphyxiation, his underlying causes were opportunistic infections contracted from being HIV-positive. If he simply had taken his HIV medications, he likely would have lived a long and healthy life.
Exactly where the health system failed him is difficult to pinpoint. Was it a lack of medication adherence and follow-up by physicians? Was it the lack of availability and accessibility of antiretroviral drugs? Or was it perhaps even earlier, with lack of counseling on safe-sex practices that allowed him to contract HIV in the first place?
Structures are crumbling not from just the top but from the core foundation.
Being around so much sickness and death often makes you forget about the other side of the work. After this long day I was dragging myself back toward the office from the ward when a man stopped me. (It isn’t uncommon to be halted in the labyrinth of Mulago Hospital by people needing directions.) Not knowing the hospital well, I began to lead him to the office where he could get better directions. Then he asked me something that stopped me in my tracks. He asked me if I remembered him.
It was Kasim!
We had discharged Kasim a few weeks earlier. He had arrived with severe confusion from cryptococcal meningitis and seizures. I was barely able to recognize him now; he was standing, smiling, speaking clearly, and wearing his nice clothes.
I will never forget what he said next: “You saved us, you saved us!”
We shook hands and had our picture taken together. And even though I had a minute role in his recovery, that moment changed me. I returned to my desk with a big smile and a different point of view. I have no doubt that my few moments with Kasim will remain the highlight of my experience in Uganda.
I JUXTAPOSE these two patients for contrast, not to reconcile the ups and downs. The success stories remain independent of the failures. Each day has its unique combination of joy, sadness, challenge, frustration, and success. I would have it no other way.
Bilal Jawed ’17 was a Wabash Global Health Initiative clinical research assistant last summer through an internship made possible by David Boulware ’96. Jawed worked with doctors on a clinical research trial of adjunctive sertraline for the treatment of cryptococcal meningitis.