This Busiest Month

July, already one of the busiest months for Akisyon a Yesu Presbyterian Clinic, has been especially active in 2018. While Chloe and I took a few days away helping to see the Okken family off, I got the call from the nurse who had been left in charge that they had seen 113 patients my first day away. It was only the second time during nearly 3 years of my administration that we had seen over 100 patients in a day and, as it turns out, a portent of things to come.

Since then, I have been calculating our progress daily—first we were on track to see 1400 patients this month, then 1500, then 1600. As the dust settles on July, we have seen well over 1800 patients, an average of 87 per day, and a number not seen since the first weeks after the clinic opened nearly 16 years ago. In those days, functional medical care was almost nonexistent in our area, so AYPC was essentially the only game in town. These days, there are some 16 other health units in our district, including 2 hospitals, all operating at various levels of function or dysfunction. AYPC continues to punch far above its weight, seeing eight to ten percent of the total outpatient cases in the district. Last month, we saw nearly twice as many patients as the next most active health center II, and in 2017, we saw seventy-five percent as many patients as our nearest hospital, over 11000 for the year.

This month, even by those standards, is an anomaly. Several factors have caused it to be thus. First, the rainy season came early and hard this year, and with it, the attendant spike in various illnesses, including malaria and pneumonia. Long days of cloud and rain, unusual weather patterns for our area, have made things worse. More importantly, the national drug distribution to government health centers, which should have come at the end of June, never arrived. On a recent visit to the nearby hospital to get some supplies, I found almost nothing on the warehouse shelves. The pharmacy had a single box of antibiotics.

This total shortage of supplies in the district has had a dual effect. Many patients, having tried and failed to receive free care at the government facility, simply return home and hope for the best. Those who do not improve end up at AYPC in more serious distress. Thus we have seen a spike not only in patient attendance in July, but in the severity of cases. Record numbers are also being placed on IV drugs to treat malaria and other infections.

All of this has taken us a bit by surprise and has strained the clinic significantly in terms of manpower, facility space, and supplies. So far, our stock of drugs has held out, but drugs donated through organizations such as USAid have run far short of projections, forcing patients to pay for injections in cases of severe malaria, and increasing the workload in the laboratory as a shortage of rapid malaria tests means that our staff have to look at every patient’s blood under the microscope.

As we are an outpatient-only facility, we are not equipped to treat every case that comes. Of particular concern is the lack of blood in every hospital in our region. Patients with severe anaemia due to malaria have nowhere to go for transfusion except to Mbale, which is both expensive and logistically challenging for those who have never left Karamoja and do not speak any English. In several cases, mission diaconal funds have been given to cover transport costs.

In spite of the challenges, there is other good news as well. The waiting area is overflowing with patients every day when our chaplain teaches his mid-morning Bible lesson. We are exploring ways of improving more targeted spiritual care given to the patients who we treat. And in July we have had the chance to treat with competence and care a large number of very sick people in the name of Jesus. Though the staff have had to work many long days, morale is high and there has been a strong sense of camaraderie as we all work together to show the compassion of Jesus.