Aravind Addepalli – Uganda ??

The lockdown has proven quite interesting at the southwestern tip of Uganda. Having had experience with Ebola, Yellow Fever, Marburg, and more in regular succession, Uganda employed a swift and widespread lockdown to contain COVID-19 early in the pandemic. This ensured that even now, at the end of May, there have only been 281 confirmed cases and 0 deaths in Uganda from the insidious virus due to an absolute stop on any mobility into or within the country. With the obvious caveat of the complete lack of testing, Uganda seems to have held the virus at bay for now.

What this type of policy results in within an almost completely subsistence under-served community is a tipping of the scales from poverty to starvation, from end-stage disease to death. Under normal circumstances, working at a local district hospital here provides a spectrum of pathology from ED level stabilization to ICU level maintenance all in the same 80 bed floor. With a lockdown on transportation to get to the hospital, COVID-19 has resulted in the hospital emptying out…the end-stage disease still exists, just playing out and killing in the community now. COVID-19 may not have caused any deaths directly here yet, but it is devastating an already brittle healthcare system by increasing lack of access to care.

However, what the lockdown DID give us was the time to set in place proper social distancing and open-air clinic and hospital procedures. With the ingenuity and diligence of the staff, it allowed us to repurpose our community outreach infrastructure to deliver medications at home to those at highest risk from COVID in order to keep them out of the potential COVID-nest of our hospital. With the initiative of the local staff, we have implemented an educational intervention to increase knowledge and awareness of COVID and relevant facts. All of this before the first case in our rural district. Seeing the lockdown procedures slowly lifting though, that first case is not far off. Just as the staff here have been adaptive in their mitigation of damage with the constraints of a low-resource system, they have been prepping for the virus. We hope to be ready both as a hospital and as a community as this virus makes it way to rural Uganda. The one resource we do have is a culture of grit.

*All photographs used with permission*

Aravind Addepalli is a fourth year medical student in the United States. He is participating in a Global Health Fellowship with a NGO-District Hospital Partnership in Southwestern Uganda.