Maundo Clinic

Maundo Health Clinic is what is considered a level 2 health center in Uganda.  This is the lowest level and indicates staffing by a nurse with basic training.  In Maundo, 29 year old Samson is this nurse.  He completed his initial nursing studies then signed a 2 year contract with the government to serve at a health clinic.  When nurses sign up for this, they are assigned to a location that may not be near where they live.  Samson’s village is called Sorroti which is about a half a day’s journey from Maundo village.  He spends the week in Maundo and travels to see his wife and 2 year old son when able.  He has been serving the people of Maundo for 5 years and has dreams to complete 18 additional months of nursing training and then on to be a physician.  Recently, Samson has recruited another nurse named Samuel to join him working in Maundo Health Clinic.  Both of these men have a love for the knowledge and problem solving behind medicine and as Samson said “the first rule is to love and serve”. 

The vast majority of the patients had complaints related to malaria.  Samson has access to a rapid diagnostic test that uses a fingerstick of blood and a reagent that detects the presence of Malaria Falciparum protein.  For those that do not know, Falciparum is the most deadly form of malaria and is incredibly common in Uganda.  Samson’s proudest achievement in the five years he has been working at the clinic is that they have never ran out of treatment for Malaria.  In addition to Malaria, we saw a case of goiter, likely strep pharyngitits, bilateral ear infection. 

The hard part for me was making diagnosis and treating based on symptoms without confirmatory data. 

I worry about appropriate use of antibiotics and I hate the feeling of not knowing if I am right.  

Samson identified that many of the people are not aware of the proper way to take medications which leads to resistance. 

What also struck me was how little Samson has to work with.  He has no stethescope, no pen light, no oto or opthamoscope.  He is only able to weigh children up to 25kg.  It was a fascinating experience to try to make diagnoses based on a history and basic clinical exam, but reminded me how much can be done with so little.