Viviane Tchonang Leuche, MD
Viviane Tchonang Leuche, MD
Pediatric Emergency Medicine · Minneapolis, MN

Mulago Hospital Pediatric Acute Care April 2019

April 1st
Kampala, Uganda

Project Description

I will be at Mulago Hospital in Kampala, Uganda. I am board certified in General Pediatrics and currently at the end of my second year of fellowship in pediatric emergency medicine. I intend to work alongside Pediatric attendings, residents and medical students in the Pediatric Acute Care department of Mulago Hospital as a medical volunteer with Health Volunteer Overseas. I will be primarily participating in clinical duties and patient care. In addition, I will be participating in medical education activities (journal club, case presentation) with Pediatric residents and medical students on the Pediatric Acute care wards.

Population Served

I will be primarily serving the Pediatric population at Mulago Hospital in the Pediatric Acute Care (Emergency Department) which is the largest hospital in Uganda with an estimate of 1500 total beds for pediatrics, adults and obstetrics combined. The hospital had an estimate of 61,000 ED visits for adults and pediatrics according the Ugandan Ministry of Health in 2014-2015. The pediatric population is within the scope of my practice.

Expected Impact

I am originally from Cameroon in central Africa and completed my medical training in the United States. One of my long-term goal is to be able to give back to my continent and provide medical care to
communities in sub-Saharan Africa. I would love to work alongside local health care staff to provide quality health care to communities as well as education and teaching to healthcare professional in training in these communities. I also believe that the interpersonal relationships, the team dynamics and the clinical knowledge and skills that we will share as a team, will also allow for more positive growth as pediatricians for the team members that I will be working with and myself.

Trip Photos & Recap

Mulago Hospital Pediatrics
On my last day in Kampala, I was already filled with feelings of nostalgia and longing to come back again and work with the medical staff in Mulago Hospital. I am currently finishing up my second out of three years of fellowship in Pediatric Emergency Medicine thus I spent the bulk of my time in the Pediatric Acute Care unit at Mulago Hospital. The remainder of the time was spent in the Special Care Nursery at Kawempe Referral Hospital, Mulago Hospital PICU, Mulago Malnutrition Ward and Sickle Cell clinic which were additional areas of interest for me. In each one of these settings, I was interacting with Pediatric Senior House Officers (SHO), Pediatric Interns, medical students, Nurses and nursing students, Medical officers, attendings, visiting medical students, visiting nursing students, visiting physician assistant students. Therefore, there was lots of opportunities not only for getting to know the local staff, but also for collective teaching and learning as a group during patient care. Thursday and Friday mornings were didactics so more opportunities for learning from cases presentation or journal club by pediatric residents.
In the Pediatric Acute Care, I was functioning as a consultant. With the SHOs, pediatric interns and medical students, we would care for sick patients with varied complaints, mostly infectious (pneumonia, newborn sepsis, malaria, sickle cell sepsis), sickle cell crisis, intracranial or spinal cord pathology, heart failure with newly diagnosed congenital heart disease, HIV encephalitis, upper airway pathology. The majority usually would get admitted to the wards due to their acuity. There was decent amount of procedures such as lumbar punctures as well and I would supervise the pediatric interns if needed. For kids in need of higher respiratory support, we would set up bubble CPAP which was an occasion to teach the setup for this. Intubation was very very limited due to resources so this was mostly our highest level of respiratory support. I participated in rounds for the patients who were in the PICU or admitted to the pediatric acute wards shortly after their admission. This was an opportunity to interact with the Attendings and collectively learn as well.
Needless to say, the stages of disease progression, the pathology and disease types were different than what I have encountered before during clinical care, so I learned a lot from the SHOs and attendings for some of the cases. A lot of patient also primarily spoke Lugandan or another Uganda language so I needed help from staff or family members or friends if we could not find someone who spoke the language. My favorite Lugandan expression remains Weebale!
My time in the Special care nursery was primary spent resuscitating sick newborns and setting up bubble CPAP for the sickest newborns and teaching the set up to pediatric residents/interns and nursing students as well. Intubation capacity was also limited here due to resources.
In the malnutrition wards, I was present during rounds and mostly learning about their malnutrition protocols and seeing interesting cases and pathology. In the sickle cell clinic, I was shadowing a pediatric hematology/oncology fellow who was seeing sickle cell patients for follow up. This was interesting as well, mainly to see sickle cell complications and their care on the outpatient side.

I have an interest in Global Health education and sustainability and look forward to be able to return to continue this work. Some of the pediatric residents come to the University of Minnesota for an global health rotation and we get Ugandan visiting attendings as well so I get to interact with them as well they come to the US and keep these wonderful relationships. Thank you Doximity Foundation for funding the airfare for this trip which was a great help!