One brisk “ring” and then silence. I jolt from a deep, and too short, sleep into the darkness of the Nyakibale guest house in rural Uganda. Confused at first, I listen to the drops of rain on the metal roof vibrate before I realize that my mobile had rung—in the standard fashion of the OR nurses calling once and hanging up to inform me of a patient arrival. It was my night on call, and my colleague, Dr. Mark Bisanzo, was getting some much deserved sleep. On that moonless night in 2007, I shuffled down to the Operating Theatre through the mud, using my headlamp as a guide, and opened the door to find a patient lying alone, on a small narrow rusty minor theatre table, unresponsive. No nurses, clinical officers, or doctors were present, blood was pooling on the floor from a head wound. She had obvious leg fractures. I resuscitate the patient, treat her for an open skull fracture, give her antibiotics, do a FAST exam, set her fractures, and admit her to the hospital.
Over the next few hours, I’ve diagnosed someone with respiratory distress with newly found HIV and related tuberculosis and pneumonia, and taken care of a few children with cerebral malaria. I’ve seen a few nurses but haven’t seen a clinical officer or a Ugandan doctor, and I realize that most patients who present to the hospital aren’t seen by a licensed provider for over 24 hours. As the sun is rising, and I collapse into bed, I realize that after I leave here after a few short weeks of a residency rotation, that woman (and everyone else who arrives with emergent conditions) would have died or become severely disabled. While I feel good about saving these patient’s lives tonight, I am conflicted about whether I am serving the community in the long run if I leave nothing behind when I go.