by Dr. Gregory Bartha
February 15, 2021
The Cross Clinic is located in the small village of Katekwan in the northeastern part of the country. It is about 45 minutes out of Mbale, a city of 100,000 to 150,000 and with a surrounding population of 500,000. Mbale is the regional center for processing and transporting agricultural products.
We remodeled an abandoned guesthouse (a small hotel) to form the clinic. There was no running water, and electric power was intermittent. A pit latrine was in the back. The lab was equipped to perform a few basic tests, and the pharmacy had a supply of medicines needed for common medical complaints.
I worked along side Luke, a clinical officer – same as a Physician Assistant in the US. He was quite skilled in diagnosing and treating common medical conditions. Malaria was the biggest problem. It is widespread in Uganda because of the large number of swamps. As you probably know, it is caused by a parasite which is injected into the bloodstream by a mosquito bite. Children from 6 months to 3 years are most commonly infected, and most deaths occur in this age group. It is best diagnosed by using a microscope to see the parasites in a blood smear. If microscope or electricity is not available, there is a rapid diagnostic test using a small device and a drop of blood from the patient.
Just recently trials have been completed on a new malaria vaccine made in Oxford, England. Reports say it is 75% effective in preventing the disease. This vaccine should be available in one to two years and will greatly reduce the burden of disease in Sub Saharan Africa. Until the vaccine is available the best practices to prevent malaria are to sleep under a mosquito net treated with insecticide, eliminate standing water near homes, keep bushes trimmed short, and avoid outdoor activities at night.
Other problems seen frequently at the clinic are diarrhea, pneumonia, wounds, skin infections, abdominal pain caused by ulcers or pelvic infections in women, and a variety of bone and joint conditions. We refer more complicated medical problems and surgical conditions to the regional hospital in Mbale. The regional hospital is well staffed but poorly supplied. The patients are often asked to purchase antibiotics, IV fluids, bandages, and skin cleansers for their treatment.