Day 1 of Working At GRRH

September 23

I reported to work this morning and was just as excited as a five year old on their first day of pre-school. Instead of the ‘normal’ anxious feelings of beginning a new job, I was full of expectation and adrenaline. In true Thiel kid form, I arrived about a half an hour early. I hate to be late anywhere, and because I didn’t know how long it’d take to get across town and make my way to the unit, I left extra early. Turns out Gulu is a pretty small town and the boda ride took about seven minutes, even going slow. I carried a heavy bag today, as it was full of the two lead aprons, four thyroid shields and a few text books I had brought along with me. I wasn’t sure of the condition of the hospital while I was in the States, so I just collected a few things that I thought might be helpful. 

I arrived and the cleaning lady, Atim, was cleaning the unit, but I didn’t see any of the radiographers. I knew that there were some benches in the maternity ward, where the ultrasound machines are kept, so I decided to head there. I also thought maybe Morris would be there. I found a bench, sat my bag down and waited. I pulled out my text book (one of those ones that I had hated while in school) and referred to a few things. Turns out that there is useful info in those books. I felt like I was being watched and when I looked up the sweetest little girl was watching me. She had adorable little corn rows dangling down onto her neck and her sweet smile was full of shy curiosity. I sort of waved at her, and she looked away. Her mother was cleaning the floor in the entryway of the ward, and so she was there waiting. I was so impressed by how patient she was. She wasn’t fidgeting or upset in having to be there, but instead kept on inspecting her little child size fingers, and then looking up every once in a while to see if I was still there. 

Eventually I headed back over to the unit to find that Charles was there. I followed him into the office where I handed over the lead. We carried it into the room and found a place to hang it, on a window handle. I asked what was first and he said that he needed to develop some films from the day before. I said ok and followed him into the dark room. We began developing films and I attempted to understand the process. When I asked how long in the developer, Charles simply lifted a film and looked at it with only the red light and said it was good. Time for a water dunk and then the fixer. I didn’t even see an image on the film, had no idea how he had differentiated the darkness of the room with the image on the film, but somehow he knew. The film remained in the fixer for a certain amount of time (again, Charles just knew) and then back into the water for the washing. I was looking for some hard and fast ‘rules’ about developing the films and then I realized, there were none. Everything I had learned in the books was, once again, a guideline. Then seeing it in practice really taught me what was needed. A lot like life, I suppose. I can ‘think’ all I want about things, but the actions are the things that are going to actually teach me. Interesting lesson to have come from developing x-rays, but sometimes it happens that way. 

We took the films from the water after they had been in there a sufficient time, and walked outside with them. I wasn’t quite sure where we were going but quickly learned what was to happen now. Now the ‘hunt’ began. Much like searching for the hiding place of an Easter egg, we were searching for places outside to hang the films to dry. Suddenly a drainage pipe remnant was a hook, and a clothesline T was a rack. We scattered the films around the outside of the building to let the hot equatorial sun of Uganda dry the emulsion and fix the image on the films. How long do they dry? Until they are dry, is the easiest answer. Its like baking without a measuring cup. Some people just know when things are done, and when there is enough flour in the mix. After the films were dry, we carried them into the office and wrote the info on them. “GRRH - Patient’s Name - Date” And I’d like to tell you this was done in some fancy way, but it wasn’t. Good ol’ permanent marker works great on x-ray film I found out. After the info is written, then we would find the requisition (a pink half sheet with the exam, patient’s name, tribe, age, gender and ordering doctor’s name on it) and fold the requisition so that the film was in the middle. We continued this process until about 11 am and then began taking x-rays. At some point a doctor stopped by and told us that he was seeing a lot of patients who had been part of the ‘conflict’ and he would be sending them for x-rays today and tomorrow. “Be ready because we will deplete your film supply with these patients.” That could be interesting.

We began to see what that doctor was talking about. Patients began to come with requisitions said things like “retained bullet in thigh” and “bomb blast 15 years prior, r/o osteomyelitis.” One patient who really stuck out to me was a 24 year old man. He entered the x-ray room with a limp and the doctor had ordered his right knee to be x-rayed. As he pulled up his pant leg he revealed a slender, knobby knee that was covered in scars. Against his dark skin the scars weren’t extremely noticeable, but they were definitely there. Charles and I began to position the man’s knee for the anterior-posterior view, and then realized that he couldn’t straighten his knee. The back of his leg would not rest against the table because the joint had basically grown together. We did the best we could and Charles asked him when he had sustained the injury. He told us that he had been shot in the knee somewhere around 1996, I believe. He was eleven years old. When I saw his films later, I was astonished. His joint was completely closed and his knee looked like some 90 year old patients I had seen in the U.S. And those sorts of patients kept coming. A 20 year old female with a painful shoulder because she had retained shrapnel in it after a bomb blast when she was 8 years old. A 50 year old woman with a thigh that presented buckled and dimpled after reconstruction of her leg was attempted because she had been shot. Another 18 year old male who had a bullet in his abdomen. Not exactly what I had expected.

We worked hard until about 2:30 pm before taking a lunch break. Both Charles and I could tell from the other person’s face that we needed a break so we locked up the room, told the people waiting we would be back after lunch and we walked out. It was so difficult for me to leave, as most of the patients waiting had been there for hours, but at the same time I knew that if we didn’t leave I would not be doing well in a couple more hours. We walked to town and had lunch at a small restaurant near the clinic. I had rice and goat meat, and of course, it was delicious. After we had washed our hands (because we used them to eat the meat with) we walked further up the road to the clinic that both Morris and Charles work part time at. It seemed like an ethically wrong thing to do, especially with those other patients waiting, and yet it was what we did. Some things I have just realized I need to let happen and wait to see the outcome. Its difficult, but I resolved before I came that I wouldn’t be the person who ‘knows better’ and tries to force that. I would miss a lot of important things and not honor the call on my heart if I did that. So we went to the clinic and I waited while Charles helped Morris develop some films.

The clinic is a private organization and though there are x-ray and ultrasound capabilities there, one x-ray coasts 10,000 shillings. That is roughly $5 in US dollars, which doesn’t seem like much. However, when you realize that most people in this area have no means of coming up with money like that, and especially not for medical care, the magnitude of that price is realized. So if a person can afford the x-rays to be taken at the clinic they have them there, as the lines are shorter and the results given quicker. But if not, they are seen at GRRH, only after getting a referral from a doctor. Again, the process is excruciatingly slow.

Charles and I returned to the hospital about 45 minutes after we had left and began x-raying again. At 5:30 pm we looked at the clock and looked at the patients we had left. We were supposed to be off at 5 pm, but there were still eleven patients to be x-rayed. What do you do when you’ve worked straight since 7:45 am, but there are still patients who have sat all day to get their x-rays and have traveled really long distances to even be seen? You x-ray them anyway, put their films in the dark room to be developed the next day, and then go home at 7 pm. What a day!