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Mbarara University of Science and Technology
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Nyakibale Hospital, Rukungiri
page for Some Tips from Previous Students
Nyakibale Hospital is a Catholic mission hospital located in the southwestern part of Uganda. It is about 7 hours by paved road from Kampala. It receives roughly 15% of its budget from the Ministry of Health – the remainder comes from patient fees and donations. Dr. Ronald describes the patient fees as minimal, and heavily subsidized by the hospital. In exchange for fees, at the very least patients are assured a consistent supply of medications – per his numbers, 97% of patients’ prescriptions are successfully filled by their pharmacy. Ministry hospitals do not charge fees, but only fill 67% of patient prescriptions. He notes that unfortunately, charging patients sometimes results in premature discharges. Despite the diverse sources of funding, the hospital lost USh13.5 million last year alone.
Nyakibale Hospital is staffed by four general practitioner medical officers and a surgery resident from Mbarara University. Visiting expatriate specialists (mostly missionaries) spend anywhere from a few months to a few years at a time. These volunteers are of varying specialties. Nurses and nursing/midwife students comprise the majority of staff. There are two full-time anesthetists and a radiographer.
Layout and Resources
Nyakibale Hospital has a ~160 bed capacity. The physical plant is typical of other mission hospitals in the region, containing a male and female medical ward, a male and female surgical ward, and a pediatric ward. There used to be an isolation ward, but it is not used since the introduction of a home DOT program for TB. There is a very large maternity ward with space for expectant mothers, complicated cases, post C-section recovery, nursery, and post-partum recovery. With the exception of a few select private rooms scattered throughout the hospital, patients are in a ward-style layout in very close quarters, with a maximum reported capacity of 25 patients per room. Bed nets are above all beds.
Renovations to the outpatient department have displaced the pharmacy and much of the outpatient care to temporary buildings. There is a separate clinic for antiretroviral therapy (ART).
A portable ultrasound machine and X-ray arm comprise the radiology department. The radiographer performs and interprets X-rays and ultrasounds, including cardiac ultrasound. He states that he is qualified to perform fluoroscopy, but there is no C-arm for him to do so.
There is a malnutrition unit that receives funding support from Dr. Keri Cohn from MGH, in which children are admitted for acute and chronic malnutrition, staying on average for a month. There is also an operating theater, for which Dr. Ronald is hoping to get support for much-needed upgrades and renovations.
One of the unique features of Nyakibale Hospital is the presence of one of the region’s only functioning emergency departments. Dr. Ronald describes this unit as being different from the standard casualty departments found at other hospitals, in that more severe acute cases can be triaged and managed at the point of entry rather than waiting for care in the ward. The ED was started in collaboration with an organization called the Global Emergency Care Collaborative (GECC). The GECC is also involved in a mid-level provider training program for Emergency Care Practitioners (ECPs), who complete two years of training following the completion of nursing school.
The hospital has rudimentary on-site lodging for visiting trainees. They live in one of two group units that are cared for by the hospital. Lodging includes room, lunch, supper, electricity/water, and laundry. Meals can be taken in one of two dining halls in the same unit as the rooms. Bathrooms are shared. There is security at the entrance of the hospital.
The hospital has several years of experience working with foreign medical trainees. Students from Belgium and the UK are the most common rotators. Nyakibale has also been asked by Makerere University to facilitate a community health rotation for their 3rd and 4th year medical students.
The 6-week community health rotation that the Makerere students undertake involves three elements: case-based discussions of rural African health care issues, community site visits for patient education and basic primary care, and clinical observership. To date, no foreign students have participated in this rotation.
Visiting students are typically asked to prepare course objectives and then to create a rotational structure for themselves in which they outline how they will achieve those objectives. Junior students (1st/2nd years) typically participate in three days of community work and two days of clinical work. On the clinical side, they are placed alongside clinicians and are allowed to shadow in ward settings as well as the OPD. They are asked to learn basic tasks such as blood draws, NG tubes, IV cannulas, and catheters. The remainder of their time is spent with a community-based project, which may involve malnutrition or household HIV screening. Senior students (3rd/4th years) can have a more “hands-on” clinical rotation.
Students may also arrange rotations through the GECC – in the emergency department, they assist the ECPs and hospital staff to collect data regarding outcomes of cases evaluated and managed in the ER. There seem to be possibilities for either junior or senior students.
Nyakibale is located in a relatively safe and stable part of the country. The highest travel safety risks are malaria and road traffic accidents. There is full-time security at the entrance of the hospital and the accommodations are inside the hospital grounds. Reports of petty crime are rare, and seem to only occur when an individual engages in activities that are dangerous in any setting (walking home alone at odd hours, for example).
HIV prevalence in Uganda, though improved in recent years, is still quite high and patients that are admitted to the hospital often present late and likely have high-grade viremia. The hospital has made post-exposure prophylaxis available to foreign students, should any blood or body fluid exposure occur.
The hospital superintendent is the attending of record for external rotators. While he is not directly involved with each day’s activities, he assures that junior students are always to be attached to medical officers and will not be left to deliver patient care unsupervised. Senior students are given more autonomy and may see patients on their own, but would be expected to discuss them with their medical officer supervisors.
Previous Students have said:
Schedules- It can be difficult to locate a doctor for rounds. If there’s no doctor in sight, usually the Emergency Department or the Outpatient clinic will have medical staff that you can shadow.
MWF Mornings, see Dr. Kasyaba
First Tuesday and Last Thursday of the month, see Nurse Angelamachika
MWF Mornings, see Dr. Felix
Every Thursday Morning, Antenatal clinic
MWF Mornings, see Dr. Felix
Everyday, see program directors
MWF Mornings, see Dr. Joseph
Varies, see Dr. Joseph
Emergency Care Lectures
Varies, see GECC Staff
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