A paediatrics registrar went on a mission to the Dr. Ambrosoli Memorial Hospital in Kalongo, Uganda. A place where you have to learn when it is right to let go and when it is not, and that every gesture, even the smallest, counts.
Francesca Poma, a paediatrics registrar, spent three months on a mission at the Dr. Ambrosoli Memorial Hospital in Kalongo, Uganda. Her words sketch the outlines of a place where life flows simply and intensely in equal measure, and where every gesture, even the smallest, counts.
From Turin to Kalongo. When you arrived, what struck you about this land so far away and so different from home?
When I think back to those final preparations before leaving, the first tears shed at goodbyes, and the way my heart was racing with every little thing, I can hardly believe that seven days later I found myself sitting on the doorstep of the guest house in Kalongo. Different scents in the air, the sound of Alice chopping vegetables in the kitchen behind me, the other expats' houses in front of me. All around, the chirping of a myriad of birds hidden among the branches of the trees. From there I could see the huts where the staff live with their families, right beside the hospital compound. On the other side I glimpsed a road where motorbikes loaded with people flowed past, people loaded with bundles, mothers loaded with children, children loaded with children, and goats — so many, many goats. My Africa.
At the beginning it was tough — I was thrown in at the deep end at the Dr. Ambrosoli Memorial Hospital: into the midst of its thousand colours, smells and sounds. The dull blue of the walls and the clear blue of the sky, the darkness of skin and the white of smiles, the smell of the oil used to anoint newborns and of the sweat of those who had been waiting in a queue for hours in the sun for their turn. And then words, songs, laughter, never any crying — except from the children who, even if most of the time they are as brave as lions, know how to make themselves heard when necessary. The adults here, on the other hand, do not cry, do not kiss, do not exchange affectionate gestures: these are things one simply does not do in public, out of modesty, I think. It is disorienting.
Kalongo's is a frontier hospital serving a very poor rural area with no road connections — the last paved road stops 150 km from the hospital. What does it mean for a doctor to live and work in such a remote setting?
It is not easy to ensure a regular supply of medicines and equipment to the hospital so that it can offer adequate care to an ever-growing number of patients: in 2017 alone, more than 50,000 people were treated and assisted. Fortunately, the hospital in Kalongo can count on partners such as the Fondazione Ambrosoli, which for twenty years has been firmly committed to supporting it both for its ongoing needs, which are always very great, and for the training of healthcare staff. Because it is only through training that the hospital can be guaranteed sustainability and autonomy.
What is daily life like, inside and outside the hospital?
Living so close to the hospital means you can never switch off — never. One day I went to Mass: two hours of songs and words in Acholi. When I arrived the church was already packed with people. On my way out, as I walked home, I decided to make a brief stop on the ward. There was a child who was really unwell and needed checking on. I looked at the notes and saw that a diuretic we had prescribed had not yet been administered. I spoke with the parents — a few words in English; who knows if they really understood me. Then I asked the nurse to give him at least a little paracetamol and to go and check the other wards for the drug, to find out whether it was in the hospital or whether an alternative needed to be considered. I discussed the situation over the phone with the paediatrician, Dr Maurice, to work out together what to do.
Communicating with people who do not speak your language is never easy, and even more so when those people are in need and suffering. How did you manage to build a relationship with your patients and their families?
I never know how to share joy and sadness with them, and since I cannot speak Acholi, gestures are one of the few options I have left — along with my gaze — so I use it, my gaze, to try to convey my thoughts to them. Sometimes the midwifery school students and the nurses help by translating for me, but it is not the same. It is fine when I ask: "Do you have a fever? Are you in pain? Are you eating?" but when it comes to conveying empathy, how do you translate that? So I look the mothers and the children in the eyes and sincerely hope that something gets through to them. There are very few fathers. In paediatrics and in maternity, men only appear when an important decision has to be made: the fate of women and children is always in their hands.
You are a paediatrics registrar; during these months you have been able to develop your professional skills. Is there something you believe you have learnt in Uganda that you would not otherwise have had the opportunity to learn in Italy?
Going into neonatology alone, among those tiny, fragile little "bugs," is a bit like receiving an emotional slap. On the wall of the paediatric ward's medical room, a sign reads "A child can die only when he must die." The challenge is to distinguish those who truly must die from those who can make it if we intervene promptly and well. I have decided that one of the lessons I want to take home with me — and one that is giving me daily headaches — is precisely this: I do not want to learn how to treat malaria, tuberculosis or sickle cell disease; I want to learn to understand when it is right to let go and when it is not. Because here, above all here, if you let go when you should not, and do not let go when you should, in both cases you do enormous harm."