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The hand-sanitizer dilemma: My experiences treating patients in Uganda

Ugandan hospital - smallSMS ("Stanford Medical School") Unplugged is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.

A thick green glob landed on my scrub top at the same time that the first drop of sweat rolled down the small of my back. I tried not to grimace and discretely walked over to the hand-sanitizer dispenser. But like every other hand sanitizer I had tried, this one was empty. Yesterday I had also discovered that the only bathroom in the hospital had no toilet paper. It was 7 AM, and I would be using my pocket toilet-paper stash to clean off sputum from the hacking patient that apparently all the doctors knew to avoid standing in front of. The day was off to a good start.

How, I wondered as we continued rounding, did doctors respond to this dilemma - having to care for patients without being able to fully protect themselves - when they were in health centers treating Ebola. I tried not to think about what I would tell my parents if I developed rare infectious symptoms in a few days. We were in Uganda, countries away from the Ebola outbreak, but there were still plenty of infectious agents we could and probably were exposing ourselves to.

Just as I was wracking my brain for the names of the bacteria and viruses that might be deadly, I noticed one of the doctors rest his hand on a patient's shoulder. And it dawned on me that the real dilemma was not about what I, who had access to the best medical care, might pick up, but rather about what I might pass from patient to patient.

It's ironic that in the U.S., patients have to remind doctors to reach out and touch their shoulder or hand at an appropriate time - to make patients feel that the doctor connects with them on a human level. Yet here in Uganda, the  doctors know when to reach out to their patients, they know how to talk to the patient's family. My clinical-skills professors would love to see this.

But if the hand-sanitizer dispenser was empty for me, it was empty for the  Ugandan doctors as well. We were told as first-year medical students that we would fail our "Practice of Medicine" final if we forgot to sanitize our  hands upon entering our standardized patient's room. So what were we to do when we had more than twenty patients in one room, each with at least two family members, and no hand sanitizer for anyone? How many of these dozens  of people were walking around with my hacking patient's sputum on them as  well?

The doctors certainly could be spreading infectious agents. But given the proximity of patients on the wards, those very same infectious agents had likely already been spread between the patients overnight - before we even arrived that morning. I couldn't help but wonder which was more important to the patients who had a 50 percent chance of survival: to feel that their doctor was treating them as a human being or to increase their chance of survival by a negligible margin? How big or small would the margin introduced by the doctor's touch have to be to tip the scale one way or another?

Before I could finish thinking through my ethical dilemma, we left the ward to scrub in for surgery. There I found the only working hand-sanitizer dispenser.

Natalia Birgisson is a second-year student at Stanford's medical school. She is half Icelandic, half Venezuelan and grew up moving internationally before coming to Stanford for college. She is interested in neurosurgery, global health, and ethics. Natalia loves running and baking; when she's lucky the two activities even out.

Photo of Ugandan hospital by Natalia Birgisson

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