LIVE: UBC INSIDE MULAGO || 21ST JULY, 2026

[00:00:00]This is the pediatrics [music] acute care unit, the hospital's front line.

[00:00:06]>> My role is to make sure the unit runs smoothly uh by ensuring we have staff coverage and the resources that are needed to make sure the unit runs. So I have to oversee all that the coverage uh the supplies uh the drugs so that the unit can run responsibly when the patients come to us. When patients come through, they start from here before we go to the wards. So it is the emergency department. For many families, the journey to Mulago [music] begins with uncertainty. For the medical teams, it begins with [music] assessment. Every patient must be evaluated. Every minute matters. [music] >> There are those two patients who come in from like from other hospitals with an ambulance.

[00:00:54]uh you clearly know they already very sick. They've come with with an ambulance. Those types of patients many times the table here just recognize that they have come through but those patients go straight through to the resistation or emergency room and they are registered that side. So whoever is referred here we have a special booth where we register them. The other patients who come in and they are very sick who have not not necessarily come via by an emergency I mean like an ambulance or psych assistant they come through here. So this is called the triage.

[00:01:37]Triage is medicine's difficult medicic who needs help first who can wait who requires urgent intervention. The decisions happen quickly but they carry enormous consequences.

[00:01:50]>> At the triage we assess severity of disease and so we look at the very key danger signs. Now danger signs are the signs that give us an indication that this patient is very sick. So the thing that you can look at very quickly one of those is if a child come comes in and is very hot. So that's why we take that's why we take temperatures. So when they come in we must take a temperature. So that is to help us know the child is very sick. So every child whose temperature is about 38 we automatically think those are in a dangerous situation we quickly mark them as emergency patients who need immediate care. So we check that. There are other danger signs like a child who comes in and is convulsing. Those are danger signs. So that type of child is an emergency patient. And then other children who come in and they have collapsed other unconscious they're unconscious those are danger that's a child who's very sick and is an emergency patient or those who come in not really collapsed but they are obviously looking very sick what we call um lethargic I mean a child you call a child and is normally children should look at you if a child can't look at you and that [music] child is very sick and so we categorize them as emergency patient. Plus those ones who are maybe who are severely dehydrated and you can see the eyes are falling in you know their skin is dry, their lips are dry sometimes they are also unconscious. We classify them as emergency and once we classify as an emergency patient we then give [music] the mother this.

[00:03:34]So the reason we give the mother this so that as the mother go through because the emergency special don't sit here.

[00:03:40]They are too sick to sit here. So as the mother go through, she puts on like this.

[00:03:46]So as she walks through there, whoever sees them knows that this is an emergency [music] patient. And as soon as they reach the other side, the clinician not behind every child is a family, a child with severe fever, an accident victim, [music] a patient struggling to breathe. The departments must be prepared for all of them. The department never truly sleeps. [music] Patients continue arriving. Staff continues working. Decisions continue being made. The rhythm of emergency medicine rarely stops.

[00:04:22][music] Now the immediate patients also they also triged here. The difference between these two is that this emergency patient as you going to see the other side when they go the other side we can put them in a high dependency area or a place where we can quickly look at them. These ones enter in the emergency room direct.

[00:04:46]So those type of patients you can see we have tried to categorize them there. The patients who are immediate are the patients who are most sick. They're actually at the verge of death. Actually that's what I was going to ask.

[00:05:00]>> Yeah. On the verge of death these ones you have got to act in the shortest time possible otherwise they'll die. And the types of patients [music] those are patients who come in and they are in shock. Shock means that some of the body organs are not working. You know there's dehydration. You have no not enough fluid. But when you're shocked it means that some [music] of your main organs of the body are not working anymore. Like your kidneys are not working. you are shocked and so [music] those type of patients go in straight those ones who have obstructive [music] airway disease I mean they come and they can't breathe so when they come we check for we always check for their oxygen saturation we put something here to know how much oxy oxygen in their blood so if a child comes in can't breathe and the oxygen is little they don't stay here they go immediately the other side the other ones are those ones who cannot breathe I've talked about child comes and it's not the breathing or sometimes called gasp they go straight the other ones are those ones who have severe anemia they have no blood and their blood because low blood oxygen low those ones also they don't sit they go straight the other group are those ones who have there's a condition children who have [music] blood sugar what we call diabetes some of our children diabetes can end up with um a bad condition that we for diabetes ketoacidosis.

[00:06:29]It's a condition whereby the body is not able to function anymore because the glucose is not I mean the cuc in the blood is not enough. So the body produces too much acid and those children can end up [music] being uncautious and they breathe very badly. Those patients don't keep them here. As soon as they come and identify that they go straight through. Those ones who have asthma very bad attacks of asthma.

[00:06:53]asthma can be very bad and they cannot breathe. We [music] take them through even the other ones who have uh severe respiratory problems. Those who are convulsing and those who uncautious they are immediate.

[00:07:07]Then the other group this which is this one are the other another immediate group those with severe dehydration [music] those who have bad severe malnutrition those who are bleeding you know they just bleeding they quickly go through those ones who have uh who have been [music] poisoned they come come and say oh the child took poison drunk something we don't keep them here they straight straight go through cell disease and and in pain [music] we never kept it in here they quickly take them through. Uh the other ones if they have for instance acute malnutrition, severe diagnation.

[00:07:44]Okay. So this is a trial place. So this place is extremely important for us because it helps us to work and function well.

[00:07:58]Behind the crowded corridors and busy words lies a simple purpose. to [music] save lives, to offer hope and to ensure that during the most difficult moments, no [music] one faces illness alone.

[00:08:10]>> On average, we are seeing 50 patients admitted. However, we also see the outpatients as Dr. Eric was explaining.

[00:08:19]Uh, ideally the outpatients are supposed to go to the outpatient clinics, but there are those who actually come in late in the evening and at night when the clinics are closed. So we end up also seeing the like 40 to 50 outpatients as well that is on weekdays.

[00:08:36][music] However, on weekends, we go up to 120 because the clinics don't work uh over the weekend, the outpatient clinics and there are those attendants around Mulago. Okay. Who decide to walk in uh in late in the evening or on weekends even though they were not fit to come to acute care unit but because it's the unit which is open then we have to attend to them as well.

[00:09:05]Our commonest agent cases one is unconscious children. The children who just come the parents wakes up and they're unconscious or they just they collapse. Two severe dehydration.

[00:09:22][music] Children who are severely dehydrated. But three the most common is severe anemia. [music] Severe anemia is our biggest emergency here. Children just no blood. Then um the other one that uh comes in with several [music] respiratory distress specifically asthma what we call asthma attacks they are an in asthma attack and um I think those are the commonest malaria severe malaria >> um plus oh yeah plus other severe pneumonia the [music] children who come in and they are cannot breathe because of pneumonia >> for the teams inside Mulago's acute department.

[00:10:06]Every day begins with uncertainty. Here, medicine becomes a race against time.

[00:10:13]There is still little room for hesitation. [music] Experience, teamwork, and preparation become the difference between life and death.

[00:10:26]When this was come, no, no, no, no, not that. Because at that time, our eyes are actually on the patient. We don't even ask who's the mother, who's the father.

[00:10:33]That's not our point at that time. We want to save life. We ask other questions in the school.

[00:10:38]>> The demands are immense. The needs are growing. Yet the door remains open.

[00:10:47][music] >> Along the way as you get trained, you learn how to handle crisis. So along the way, I've learned how to handle crisis.

[00:10:59]And uh so when the child is very sick we have realized that when you also panic then you will not be able to handle. In order for you to [music] handle and deal with the emergency you need to come down. But your coming down does not mean you slow down. You need to work fast but when you are calm because if the attendant [music] sees you panicking then you will be more panicky and the situation will escalate.

[00:11:31]When parents come to hospital they are worried they are very anxious they have meats which they've had and they have their own beliefs the naturally they are traditional beliefs. So sometimes a mother comes to you with a child who is very sick convulsing you see them with other native medicine and they believe if you remove they will not be able to the child will not survive. So after making sure the child stabilizes then you sit down to health [music] educate you talk to them about what has happened and then allow them to ask questions or to share with you. Usually they tell you I believed this was witchcraft. I believed this was the cause and then you try to handle the to educate them.

[00:12:21]Thankfully all the services here are free. Um all services are free of charge. So we always remind the parents services are free of charge and uh we always have and this is our team at that point in time especially for the very sick children. We want to give the mother or the whoever has brought them the comfort that we in control. So we always calm them down say you know what if we are here and we're in control everything is fine. So we always try to ensure to encourage them that actually everything we always of course the mother always be or parent is panicking but you tell them sit down and uh when their children are very sick we try to get them say you know what because when they seeing what we're doing sometimes how patients come in and they said which they are some of the maneuvers that we do to save them for you who does not know you may think we're going to kill them because there are things we do pop their chest do they look like we are killing the patient so some of those situations Tell the parents to to factor aside a bit so that we can be able to work.

[00:13:28]>> For Nancy's emergency care extends [music] beyond treatment. It involves coordination, communication, leadership and constant vigilance.

[00:13:43]I remember very well. We had one of the one I can remember very well and and and that was the power of collaboration [music] is that we had we had a child who had a very bad chest had a very severe pneumonia. It was very very severe pneumonia and we did we did all that we could here. Give them the grass gave them oxygen gave them and we quickly realized the oxygen levels were not improving and we suspected this child will not make it. So we quickly called our colleagues from the ICU the PICU and uh at that time when the charge you see the oxygen going down and there's nothing we could do about it. we are done whatever we could do and thankfully our colleagues when I called my colleague from the their side they responded very quickly within about 10 minutes they were here and when they came in here they came with their gadgets and you have to put a tube in the ches because you see if you can't breathe for a long time you get tired you just get what you call respiratory fatigue and you can't breathe anymore you want to breathe but you don't have the energy so this child was actually giving up kind of read at point in time.

[00:14:58]So when our colleagues came in just on the in of time, they were able to put the tube in and began ventilating each other from here without a machine but physically. Well, so we had a team like six people. There was one doctor, one one four of them push pushing the the [music] cut.

[00:15:19]One of them was on the on the bagging and the other one was monitoring [music] the oxygen station after pic and that child survived. I mean that was that was a great thing naturally. I mean being a being a medical person there is a a a level of professional attachment you have with your patient and that attachment is really completely linked to the fact that you want them to be well.

[00:15:51]So even that very just one day that patient that you really want them to be well there is that attachment that you have. It's it's not like it's so emotional but but it's a it's a kind of responsibility.

[00:16:03]you get to this level of responsibility and you feel you need to do something.

[00:16:09]So of course some of our patients we do so much and they pass on you you feel so sad and how do you cope with that sad?

[00:16:16]>> Yeah. How do you cope?

[00:16:17]>> Ah those are tough things. I don't know how we cope that is I don't know how we cope but you know they are difficult.

[00:16:26]Maybe that's an area we need to figure out how to improve because really sometimes we lose our patience and you really feel you've done so much. If I've worked for six hours to save a patient and the patient dies and and you just look it's it's very depressing but somehow you just got to keep yourself up and you want to save the next. So the next one that you save kind of motivates you and you kind of balances you with the one that you lost.

[00:16:58]I [music] think the biggest one which is well known is the issue of uh our staffing levels.

[00:17:04]We we do our best but the number of time we are constrained on staff that you don't have enough hands to handle.

[00:17:13]>> What would be the ideal number? Uh >> what would you really like?

[00:17:17]>> Um I I I need to get to the I need to get to the for that one. I'm not I cannot be able to give you the numbers of of head.

[00:17:25]But for instance, like at night, you'd want to have a minimum, very bare minimum of three nurses, a very bare minimum of at least four or five doctors at night because night is the most difficult time. It's the most during daytime you can usually mobilize your colleagues at night is really challenging. So that's the very minimum.

[00:17:50]But I think for the nurses staff to be comfortable with at least minimum at least four four because ideally you want to have a doctor with a nurse. [music] A doctor with a nurse.

[00:18:00]So you want to balance the numbers. The next thing is equipment. We [music] need more equipment. Right now we have some as you see we have some monitors but you need more because if you just have one if it breaks down have another. You need some more equipment. The other thing that I think we really think we can make a big difference here. We have a highness area that we're trying to develop. If we can have what we call a high dependence unit which has is it what level is it? It's not an ICU but with a ventilator which can be able to keep like a ventilator. Yes. Which is transition that would make a big difference because a number of children don't need to be nice you exactly but you need to be supported for a few hours and they come up. So if we can be able to establish that kind of mini ICU ventil high dependence area with a ventilation ventilator system that [music] would be very it would help us a lot and of course the other thing is in terms of um which is going to happen be becoming digital if we can be more digital that I don't have keep moving with papers from other it would make us because if we go digital as soon Another comes there [music] and n there hits a battle the people will know that come but for now just see somebody just for arriving much as we have a strategy at night but when we have emergencies everyone who is on site leaves whatever they are doing and we first handle that.

[00:19:42][music] So that is what usually happens >> when an emergency comes. [music] What we say all hands on table whatever you're doing if you call for an emergency or resuscitation everybody you must go and see if we don't need you then you come back but you must go and see emergency people must come.

[00:20:06]>> They stop whatever they are doing. Even one who was in the clinic rooms comes back to the resuscitation area and we first stabilize those ones who [music] are urgent because we know that if we don't do that we can easily lose them.

[00:20:25]the message to the public uh just uh encouraging them to quickly seek medical attention to their nearby health facilities and [music] when referred they should come promptly to hospital because children deteriorate very fast.

[00:20:44]Okay. Sometimes they are referred and they delay at home. Somebody comes with a referral note which was made three four days ago and [music] as they enter the facility they lose the child. So which is very unfortunate.

[00:20:58]So I think they should their way of seeking medical attention should be increased. They should get encouraged to seek attention. Not every emergency [music] begins in the hospital. Some begin at home.

[00:21:13]a fall, a ban, poor nutrition, [music] and a delayed decision to seek medical attention.

[00:21:21]And every day begins again.

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