Week 4 - Good things come to those who wait

This week I had what I would call my first real run-in with "Uganda Time." I arranged to accompany a team from Butabika National Mental Referral Hospital on an outreach activity. I knew that I wouldn't be able to make it to Butabika in enough time to leave with the group to the outreach location, so I figured that I would meet them at the site. Centurio was gracious enough to accompany me so that I didn't get lost. We made it all the way to Old Park (a crazy-busy parking lot full of mutatus going all over Kampala) before figuring out that it would be easier for me to get picked up by the team half-way to the site.

So Centurio figured out how to get me to Ntinda, where the group from Butabika would meet me, and left me there to wait for their arrival. At this point, I called my contact from the outreach program, and it sounded like she said they were waiting for a driver. Now Butabika is on the far eastern side of Kampala, so I had a feeling that I would be waiting for awhile. Sure enough I stood in the sun in Ntinda for about an hour and a half before the Butabika truck pulled up and I jumped in the front seat. (They picked me up about two hours after the time that the outreach event was originally planned to begin.)

The outreach experience was definitely worth the wait, though. I went with the outreach director, two psychiatric nurses, and a psychiatric clinical officer to a health center in the northern part of Kampala. The health center was located within a school complex that was associated with an orphanage. When we pulled up, there was a small room full of people waiting to meet with the clinical officer. While the outreach director went to resettle a rehabilitated patient in his home, I sat in as the clinical officer interviewed patients briefly and updated their prescriptions.

Once again, I was alarmed by the amount of access I had to the patients' personal information. The clinical officer conducted the meetings in Luganda, but often he turned to me and explained what was happening in English. Through his comments and those of the health center nurse, I learned that many of the patients who came to the outreach event suffered from epilepsy.

Before coming to Uganda, I knew that epilepsy was often treated as psychiatric illness, even though it is treated more strictly as a neurological disorder in the United States. Thus, it struck me as odd that epilepsy would be categorized as a psychiatric issue. I learned, however, that epilepsy in Uganda affects many children, and psychiatric complications often accompany seizures. Because of these psychiatric complications, epilepsy is treated with other mental illnesses. There was also a mention of the tie between epilepsy and malaria, which is something I would like to investigate a little bit more.

The story of a young girl attending the outreach event for the first time provided the most striking example of psychiatric complications related to epilepsy. The health center nurse and adoptive mother of this child described how this girl would hallucinate during her epileptic episodes. As a result, the child would try to run away, jump from high places, and become violent. The mother thought that her daughter was possessed or cursed. When the girl was not having an episode, she was very calm and well-mannered. Luckily, someone convinced the mother to bring her child to an outreach event, and the young girl received medication for her condition for the very first time during my visit.

Overall, I learned a great deal about different conditions that affect people in Uganda and the way that illnesses are categorized differently depending on the manifestations of symptoms. As a result of my visit, I am thinking about working with the outreach team from Butabika or another group on a presentation that would raise awareness about epilepsy. Without an understanding of epilepsy, patients and their caregivers may be confused and not seek medical support as early as they could. Furthermore, stigma is often attached to anyone who suffers from a mental illness, and this need not be the case with sensitization.

I'm sure that Butabika and the health center do a great deal to educate the public about epilepsy and other conditions. Because we were running late on the day that I accompanied the outreach team, I was not able to view the presentation that the group normally gives in the community before personally meeting with patients. I look forward to learning more about the outreach program and epilepsy in Uganda in the coming weeks. My experience with the outreach team was certainly worth the two-hour wait in the sun.

Location: Kampala, Uganda