Prehospital Study Planning

A glimpse into another side of healthcare in Kampala.



We are currently in the process of coordinating our prehospital study. You can read about it in detail on the "projects page." The general idea is that here in Kampala, there is no public ambulance system. There are a few private ambulances, but they are too expensive for the vast majority of the population to even think of using. As a result, most people with injuries are either not brought to the hospital at all, or are brought in by taxi drivers, police, or relatives... and no prehospital care is provided. We believe that as a consequence, many people with survivable injuries are dying because of a lack of extremely basic prehospital care (ie airway management – turning an unconscious patient on his side, or controlling bleeding before loading the patient into a taxi, just to name a couple). The other week I visited the city mortuary and not surprisingly of the ~1000 deaths that were brought there in the last 6 months, it seemed that about 90% were injury-related.



We are planning to train taxi drivers, police, and local council members in basic first-responder skills (~300 in the initial training courses in May 2008). We will also provide them with a basic first aid kit. This study is based on similar efforts in other countries. We hope to measure its impact in a small area of Kampala over the next year.



In order to collect some data for the study we have been traveling to the health clinics in Kampala. This has been an interesting and informative experience.



We have visited five health centers around Kampala that we hope to designate as potential health facilities for our first-responders. Most of our trips have involved a few common themes:



1. Traffic
A near accident or pedestrian collision seems to occur almost every few minutes. After each of these we look at each other and repeat the comment,"I hope the data collection doesn't start on this fieldtrip." Long-lasting "jams" are everywhere, and can occur at anytime of day. The few traffic lights around the city are rarely working and as for the condition of the roads - red dirt and gravel that is broken up by pothole-strewn, paved portions.



2. Understaffing/waiting
Despite appointments, the clinics are so badly understaffed that they understandably have trouble meeting with us – so far most of the clinicians we have talked to, report seeing about 150-300 patients between 8AM-5PM, as there is only one doctor, a few nurses and medical assistants in each clinic.



3. Inadequate facilities
Though many of these clinics, by definition of the ministry of health, are supposed to have basic instruments and supplies for first aid, we have found that many do not. Some do not have even gauze, more or less suturing instruments. And those with suturing instruments may not have a sterilizer... etc.



4. Traffic
Worthy one more mention.



5. Optimism
Despite the discouraging conditions that we found in the health clinics, we were consistently greeted with optimism by the health clinic staff. All have been in agreement that it is time to at least try for a change or attempt to learn what may or may not work for prehospital care in Kampala. We have been invited back to the clinics to provide a basic orientation course to the staff regarding the study forms – but per their request, we are using this opportunity to provide a brief course on basic first aid and the approach to an injured patient.