Samena Chaudry's grandfather was forced to leave Uganda in the early 1970s. She decided finally to track down any of her family's previous life there, stopping on the way to do some work in Nsambya Christian missionary hospital

Until 1972, Asians constituted the largest non-indigenous ethnic group in Uganda. In that year, the regime of the dictator Idi Amin expelled 50 000 Asians who had been engaged in trade, industry, and various professions. My grandfather was one of those people. Leaving a successful drapery store in Masaka, he left with his children to come to Britain.

My choice in travelling to Uganda for my elective was therefore more than just a hope for some experience in the medical sense. I hoped to trace down my grandfather's (once upon a time) successful business and to meet the people who lived there now. My grandfather seemed to have erased any memories from his younger days. Talking too much about the subject merely led to a fresh revival of regrets over lost money.

So, promising him a photograph if I struck lucky, I left for Uganda with a few British sounding street names in my pocket.

AP PHOTO/BRENNAN LINSLEY

Uganda

The plane was full of Ugandans going back home, and before I had even landed, several offers of taxis I could share to Nsambya had been made. Stepping off the plane, we were surrounded by the natural green beauty of Uganda (the pearl of Africa). It was breathtakingly beautiful. After numerous failed attempts at negotiation with taxi drivers who all seemed to charge a rate even higher than London, one friendly Ugandan (who was much older than the rest) pointed me in the direction of his car while offering me a much cheaper fare.

A red dusty road full of potholes wound through Nsambya; used by dangerous looking boda bodas (motorbike taxis) and matatus (small minibuses). The stench of rubbish heaps every mile or so was unbearable. Small clusters of families lived in wooden huts a little way off the roadside, and stall-like shops were scattered on both sides of the road selling souvenirs for tourists. Weary looking women with children snugly tied to their backs squatted selling freshly cooked corn on the cob or green bananas, the staple diet in Uganda.

Nsambya hospital

Nsambya hospital was a small Christian missionary hospital located in the middle of a village enveloped by luscious greenery. My time here provided a thought provoking insight into the sharp contrast between medical practice in the developing world and a structured healthcare system such as the NHS. Although I was based at a private hospital where the patients were expected to pay, the hospital itself was surrounded by the desperation and poverty of the
population.

I attended long surgical ward rounds and helped in accident and emergency. I found that almost all the patients on the ward for male patients had fractures from motorcycle accidents. They were stuck in a bed for weeks ticking off the days before they could be discharged. Many were only teenagers, but the healing process had been delayed or even become impossible because many had previously received treatment from the (slightly cheaper) bone healers in the community. Such healers manipulated the fractures--but usually into an incurable state--and it was only at this stage that patients realised the need to get appropriate treatment.

Often it was too late. Patients lay on uncomfortable metal beds in tightly packed rows, with little privacy. Some had a wooden bedside table for their belongings. Other than this, patients relied on relatives to bring them food and bed sheets. Many brought a radio with them to help pass the long hours. Hospital bedclothes were not available, and the blanket of the patients was often the key to how poor they were.

The female patients in the hospital were kept separate. They were often kept in for a longer period than required, simply because the doctors knew that most would not be given the opportunity to recover fully but be expected to start back at their housework almost immediately after discharge. In spite of a large proportion of the patients who had HIV or tuberculosis, many women on the ward had nothing wrong with them physically. Although it was often suspected that cruel treatment at home might have been to blame for their frequent admissions with complaints of stomach ache and alleged vomiting, no psychiatric input was available. Money allowing, the investigations to rule out a physical cause often continued, relentlessly.

Doctors

Juniors in Uganda are expected to be competent at almost everything, from doing circumcisions to putting in chest drains and plaster casting babies with clubbed feet, who were only a few days old. Wages were so low, doctors were almost forced to do moonlight surgeries as community general practitioners in the evenings.

The doctors there were quite shocked to see that I was so inexperienced in practical work. The surgeon in charge (also a nun) expected me to have been surgically trained at least in the basics.

Communication

The almost non-existent communication between doctors and patients and its acceptability as normal behaviour struck me as odd at first. Doctors would stand at the bedside and talk to each other in
a dialect not understood by the patient and then search under the mattress for the latest x ray films. Often a nod would be all the communication a patient might expect.

In outpatient clinics too, the consumerist model of consulting prevailed. Patients left smiling and perhaps even relieved if they were given a prescription of some kind. The doctors took advantage of this, and I witnessed many occasions when nothing was said apart from hello and goodbye. The mother of a child dying of cancer was given no explanations. There was no time for counselling.

Muslim and Christian hospitals

In my wanderings through the city of Kampala, I hit upon an all Muslim portion of the city, which was totally unexpected. The experience of joining in the Friday prayer with the local Ugandan Muslim population in an open air mosque was wonderful, and I was invited to spend a few days at Kibuli hospital. Unlike Nsambya, which was founded in 1903, this hospital was newer (1984) and was able to treat both private patients and patients who were too poor to be able to afford fees (albeit at a simpler level). No proper accident and emergency or maternity facilities existed yet. It was not surprising to see that the diseases in both hospitals were similar. Leaks in the roof, reliance on unreliable power supplies, and overseas donors were common problems. It had been interesting to note that the head surgeon in Nsambya was a nun. Likewise, the head surgeon at Kibuli was a Muslim woman. It was fascinating to observe the two hospitals working in parallel through religion in two completely different areas of Kampala to serve the health needs of their patients.

And the old shop in Masaka?

Although now quite dilapidated and deserted, the small town my grandfather lived in seemed unchanged from the three streets my mother had talked of--except that not a single Asian person was in sight. I eventually tracked down the right location where the shop was meant to have been through a chance meeting with a very old man (who owned the local coach company) and had known my grandfather well. The shop was now a bookstore. The owners looked displeased to see me but became friendlier when they realised that I had not come to reclaim the shop but merely to take a few pictures.

My stay in Uganda was a real learning experience. In spite of the country still being bruised from its political past, with no rail system and poor communication links, the beauty remains in its people, who are so friendly and helpful.

Key facts

• Population: 22 million
• Language: English
• Capital: Kampala
• Currency: New Uganda shilling
• International dialling code: +256