Lottie’s Report ’25

Lottie’s Report ’25

It’s difficult to fully capture the breadth of experiences and emotions that the Uganda trip encompassed. It was an incredibly rewarding journey, though at times confronting, raw, and emotionally intense. I was fortunate to be part of a dedicated and supportive team, and we faced these challenges together—processing, reflecting and troubleshooting to implement changes as a group.

The core of the work took place at the regional referral hospital. While staffing numbers were higher than anticipated, there was a striking absence of effective systems or operational structure, leaving healthcare workers to navigate a highly chaotic environment, often full of very unwell patients. Senior clinical staff were rarely present, often leaving nurses to manage complex cases independently or with limited support from junior doctors—if any were available at all. Despite these constraints, we encountered exceptional individuals who demonstrated extraordinary commitment. They took on significant responsibility, actively supporting their colleagues through education and advocacy, and went to great lengths to deliver the best possible care to their patients.

Two exceptional ICU nurses and I initially intended to focus our efforts within the intensive care unit. However, we soon discovered a significant overlap in staffing between the ICU and the dialysis unit. We earned the trust of the team by supporting the management of a critically unwell patient, during which we were able to teach and demonstrate a range of clinical skills in real time. We continued to engage with the team and identified a particularly capable and forward-thinking nurse who was highly motivated to implement meaningful change.

Collaborating closely with this outstanding nurse, we developed three practical tools to support and improve clinical practice:

1. A pre-dialysis safety checklist – designed to ensure all necessary conditions were met before initiating dialysis, enhancing patient safety.

2. An ICU patient checklist – aimed at promoting continuity of care, reinforcing clinical ownership, and prompting timely and appropriate interventions.

3. A troubleshooting chart – developed in response to challenges in recognising deteriorating patients. This tool guides the clinical assessment and taking of clinical observations, helps stratify severity, and supports timely escalation and intervention.

These resources were designed to be sustainable and easily integrated into daily workflows, with the goal of improving patient outcomes and supporting staff, especially in high-pressure situations.

In addition to developing these resources, we delivered a combination of formal and informal teaching sessions, many of which were based on topics requested by the staff. These included essential subjects such as A–E assessment and airway management.

Witnessing the tools being adopted in clinical practice, alongside a noticeable increase in staff confidence—and knowing that these improvements would directly enhance patient care—was immensely rewarding.

I spent time in the emergency department on several occasions, where the lack of structure and the difficulty in recognising critically ill patients were particularly apparent. One notable success, in collaboration with our highly knowledgeable ED consultant team member, was a significant discussion on the recognition and management of bleeding in acutely unwell paediatric patients.

This was prompted by a case involving a young boy with malaria who had fallen from a tree—a sadly common scenario in the region during May, when both malaria prevalence is high (affecting over two-thirds of the local population) and mango season is at its peak. The combination of trauma and malaria-related splenomegaly often leads to significant splenic haemorrhage, making early recognition and appropriate intervention vital. Seeing the surgeon undertake these principles and treat more paediatric patients appropriately made those discussions hugely worthwhile.

I was also involved in recovering the neonatal CPAP machine, which had fallen out of use—this included cleaning a severely contaminated filter! This was made possible after a resourceful paediatric registrar simplified the existing protocol, making it significantly more accessible for the NICU team. The healthcare professionals were highly engaged and eager to learn how to operate the device. It was incredibly rewarding to return the following morning to see the NICU team visibly proud, having successfully initiated CPAP on a critically ill neonate who had already shown signs of improvement.

Although I had limited prior experience with neonatal CPAP, I relied on fundamental principles and practical reasoning to understand and troubleshoot the system. As was often the case in Uganda, a strong grasp of clinical basics and a willingness to improvise were essential. One example I was particularly proud of involved creating makeshift ECG electrodes using press-studs from the local market attached to adhesive stickers—an effective, low-resource solution to a common equipment gap.

It would be impossible to reflect on the Uganda experience without mentioning the incredible safari that took place over the weekend between the two clinical weeks. It was a truly breathtaking experience that offered a much-needed opportunity to recharge, leaving us refreshed, returning to the clinical environment with renewed energy.

For anyone considering going to Uganda: if you’re adaptable, resourceful, and able to think critically in a challenging, low-resource environment, without some of your usual comforts (and don’t mind a cold shower!), this is one for you! It is an immensely worthwhile and rewarding opportunity that will stay with you for a lifetime.