Dr Aaron Madhok reflects on his time working in Africa

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• Discover what it is like to work in a busy hospital overseas

Like so many other junior doctors, after finishing my foundation training I decided to work abroad to gain some life experience. I chose New Zealand initially, and had an amazing time there working and travelling over the next eight months. Subsequently, I decided to extend my adventure and moved to Australia, where I worked for another nine months. 

It was near the end of my time in Australia that I first decided to volunteer in Africa through the Gulu-Man Link. The Gulu-Man Link is a programme between the University Hospital of South Manchester, the University of Manchester, Gulu Regional Referral Hospital (GRRH) and Gulu University.  

Gulu is the largest city in northern Uganda and the aim of the Gulu-Man Link is to help improve healthcare in Uganda through education and clinical support. GRRH provides free healthcare and is a facility where newly-qualified doctors can do their internship year. The hospital itself consists of a casualty department, medical and surgical wards, paediatrics, obstetrics and gynaecology, as well as a few outpatient clinic areas. As a budding emergency medicine trainee I had decided to work in casualty.

A typical day

On a typical day of work, I would firstly assess the bed situation and try to figure out who had and hadn’t been seen. There were eight beds, but often 20 or more patients, many of them on the floor. Patients’ notes were usually sprawled over the desk, with no semblance of order to them. I would first try to review the patients who had been seen and attempt to determine whether they had got their treatment yet, could be discharged or needed further tests. 

I had access to a few blood tests, and occasionally to ultrasound. More complicated blood tests and x-rays would have to be paid for. After finishing this, I would then start to see new patients. I would attempt to take a history from the patient, examine them and then come up with a plan. This proved tricky as the majority of patients didn’t speak English, but spoke the local Acholi language. Sometimes a patient or family member would speak English, which made it easier to get an accurate history. Occasionally, this same person would see me struggling with other patients and would offer their services as a translator. 

As well as me and, sometimes, an intern in the department, there was one nurse, whose job it was to ‘oversee’ the department. If anything needed doing, such as bloods, taking observations or giving medications, I would mostly be expected to do it myself. Usually the family members played the role of nurse for their relatives, helping to clean and feed them. 

Due to a lack of money, most government-run hospitals are not only poorly staffed, but poorly stocked. We had access to a couple of antibiotics, paracetamol and a few other random medications. For a country in the midst of a malaria epidemic, there was a surprising lack of malaria treatment. Unfortunately, when we had run out of medication (which was often), patients would be required to buy these themselves from a pharmacy. 

In my spare time

On our days off we had plenty of chances to explore the markets in the town of Gulu, and visit the local restaurants and cafés. At the weekends we would travel around the local area or go further afield; twice we managed to go to the local safari park. 

Overall, the trip to Gulu was an amazing and humbling experience. Unaccustomed to working in an environment without adequate staffing, supplies and senior support, my time spent working in the hospital proved challenging. This was not only in medical terms, but also relating to differences in culture, as well as the language barrier. The Ugandan doctors and medical students, having to work in these challenging conditions every day, are some of the most hardworking and caring medical staff that I have met.

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