Mobile Medical Clinic in Rural Uganda
Dr. Scott guided the scalpel in my hand as we made a small incision in the sand dollar-sized abscess on the two-year-old boy's rear end. Blood and pus immediately burst from the cut. Carefully, I dropped the scalpel blade into a safety receptacle for needles and blades. Then we inserted a forceps into the incision and widened the opening.
"Great job, Michael," Dr. Scott said. "Now you want to start squeezing the pus out."
Although we'd given the boy a local anesthetic, he was wailing nonstop. His mother held him tightly on her lap.
I applied light force around the incision. Yellow, angry-looking pus began blobbing out. More pressure around the incision brought out several fluid ounces of watery pus along with semi-solid globs that resembled cheese curds.
"Look around you, Michael," Dr. Scott said.
A group of around 50 people crowded tightly around us in a semicircle. They grimaced and winced right along with me throughout the gruesome procedure.
Once I was finished Dr. Scott poked around inside the incision with the forceps and gave the boy a final check before pressing a wad of gauze to the wound. The operation was over. We took off our gloves.
"Congratulations," Scott said proudly. "You just saved a life."
I met Dr. Scott Kellerman, MD, MPH & TM, at the Buhoma Camp in Bwindi National Park. He was with a team of documentary filmmakers who were shooting a piece about the Batwa pygmies whom Dr. Scott works with. (Original inhabitants of Bwindi Impenetrable Forest, the pygmies were relocated from the reserve when the government declared it a national park in 1991. Forced into a way of life that runs contrary to their hunter/gatherer roots, the pygmies are struggling to adapt.) Dr. Scott provides the pygmies with medical, educational, agricultural, and construction assistance. He also helps give them a voice in the government and abroad.
A retired family practitioner from the USA, Dr. Scott and his wife moved to Uganda two years ago. With the help of the church of Uganda, the Kellermans are building a hospital and clinic near Bwindi. The project is still under construction, so each week Scott sets up a mobile medical clinic beneath a giant fichus tree in a nearby field.
I was hanging around the park after visiting the mountain gorillas when Dr. Scott invited me to check out the clinic. "Come down for a few hours, take a look," he told me over breakfast. "You'll see a different side of Uganda."
A crowd of about 75 people was waiting for us beneath the tree as we came groaning up in 4WD over a dirt track in Scott's Landrover. The crew consisted of Dr. Scott, four local volunteers, two volunteers from the park, and me. We parked near the tree, pulled two big plastic containers out of the truck, and set up shop.
Crash Course in Tropical Medicine
"How much do you want to learn?" Dr. Scott asked me.
"I don't know. I'm here for the whole day."
"That's great," he said. He put a stethoscope around my neck. "Let's look at this little girl here…"
I did what I could. I took temperatures, inquired about diarrhea and vomiting, checked tongues and eyes for discoloration, and listened to hearts and lungs.
"Diagnosing malaria is essentially a process of elimination," Dr. Scott instructed. "If it's not malnutrition, pneumonia, or worms, then it's malaria."
In my evaluations I followed a simple equation: high fever + diarrhea + vomiting + chills = malaria. I'd make my diagnosis and then Dr. Scott would confirm it.
The vast majority of my patients suffered from malaria. One of the local volunteers told me that 90% of Ugandans suffer from malaria at one time or another. Dr. Scott estimated the percentage to be even higher.
The malarial patents were treated with quinine (followed up with additional drugs). In most cases, quinine was administered orally; if the patient's nausea was too extreme the drug was administered via injection.
"No Michael. You're going to do it."
With Dr. Scott's hand guiding my own, I plunged the needle into the (now shrieking) girl's thigh. We pulled the plunger back slightly to make sure our position was right, and then slowly emptied the contents into her muscle.
"Congratulations," Dr. Scott said afterwards. "You just gave your first shot – and you saved a life."
"Yep. No question. This little girl would have died in a week without that medication."
Over the next seven hours I diagnosed and treated twenty patients (all under the supervision of Dr. Scott). I gave three more injections. I drained two abscesses. I learned to diagnose scabies, pneumonia, tropical ulcers, and malnutrition.
It was exhausting work, emotionally shattering. The atmosphere under that tree was charged with suffering and intensity. At all times there was a great cacophony of crying children. And people just kept coming – literally hundreds more. There was no way we'd be able to see them all.
At 4pm everybody in the group was drained, Dr. Scott included. It was time to pack up shop. In total, we'd seen and treated 388 people.
"You did a great job out there today," Dr. Scott told me as we loaded the truck. "I mean it. You're cut out for this work."
The day had stunned me into silence. I did my best to break out of it and thank him for the unique opportunity.
For more information on Dr. Scott's work with the Batwa pygmies, visit pygmies.net.