Hearing this was no longer a surprise to me. The realities of practicing medicine in a resource-poor setting had become evident early in my time at Mulago. If the hospital ran out of blood collection tubes and the patient could not buy more, then he could not have a blood test. My US world of abundant CT scans, MRIs, and lab testing every four hours seemed absurd in contrast. The bedside physical exam was of paramount importance and a humbling task when I realized my own limitations and dependence on diagnostic tests.
I inquired about the cost of a scan. About $40 US.
I could pay for this, but should I? Sophie needed a brain CT scan. The elderly man next to her needed a lung biopsy. Another woman needed a medication that wasn’t available in the pharmacy. I decided I wouldn’t treat Sophie any differently than my other patients. I would advocate for her to obtain the CT scan through the hospital system.
It was futile. I chased down rumors of a hospital fund that might exist for indigent patients. I tried to get the hospital to waive the fee; they couldn’t. I even rationalized that for the educational value, each member of the care team could divide the cost of the CT scan, which might be different from me paying for the scan because of an emotional attachment to Sophie.
Meanwhile, Sophie remained quiet. She usually lay in her bed and stared at the ceiling. Other patients’ attendants and the nurses helped her eat food and get to and from the bathroom. She never had any questions or offered more personal information. The hospital’s overworked social workers tried in vain to find any family in the area.
One week later, I paid for her CT scan. Her symptoms were no better, yet somehow I hoped I could save her by crossing this barrier for her.
What did the scan show? It showed a large right-sided stroke and no mass. That explained her paralysis, but it didn’t tell us why this happened, why this young woman would likely be unable to use the left side of her body for the rest of her life. Much like in the US, there wasn’t much to offer her medically that could reverse what had happened. When I left Uganda, Sophie remained paralyzed in a hospital bed, now on antiretroviral medications for her AIDS and antibiotics for a possible pneumonia. Still with no attendant.
Sophie had a positive blanket sign. And I couldn’t fix that by paying for her CT scan.