Together, for better
medical care in East Africa

The Story Behind Kilimanjaro Doctors

A special event lead to the creation of Kilimanjaro Doctors e.V. Please take a few minutes to learn more about the story of our association:

"East Africa, something I only remembered vaguely from geography class! To be honest, I knew next to nothing about it. However, a colleague from Kenya had invited me and another colleague to visit her parents who were then living in Uganda. We tried to educate ourselves about East Africa, especially Uganda, Kenya and Tanzania, but there wasn't much we could find. We had decided to bring some medicine, first aid material and a small doctor's kit, since our friend had warned us that many of these things would not be available."

First impressions

But Uganda proved to be quite different from what our Internet research and glossy travel brochures had led us to expect. Instead of a hotel, we stayed with our colleague's, by Ugandan standards, wealthy family. Much seemed foreign and took some getting used to! For both of us, this was our first time in Africa where we did not stay at a hotel. We learned that people cooked outside on open fires, rarely inside a kitchen using gas stoves, and that the national dishes tasted better than we expected!

That "white people" had to pay twice the market price and that bargaining was part of everyday life. Water used for cooking is boiled and fresh fruit and vegetables are rinsed off thoroughly. Everything was much better than we expected! The people were friendly, open-minded and talkative. The travel warnings on the Internet did seem to be exaggerated. Yes, like in every country, there was theft, fraud and violence. The national means of transportation are motorcycle taxis called “boda boda”, not Toyota mini-buses (public taxis) you can call and ride for a few shillings.

Death and joie de vivre go hand in hand

We learned that illness and death were considered inevitable and that people rarely visited doctors or hospitals! We were told that, on the countryside, dead relatives were buried next to one's house by the living relatives—much unlike in Europe. However, what is comparable to Europe is the nightlife. In the larger cities, there are many entertaining and moderately-priced clubs, restaurants and live music bars. 

One Saturday night, at 3 AM, we were on our way home from a Ugandan club, the warm night air blowing at us on the boda bodas, when we spotted a large crowd of people on the street a few kilometers from our village. We asked our colleague what was going on. She explained that a girl had been run over by a car. Alarmed, we wanted to check on the girl, but our colleague said that was too dangerous at night. We ignored her and made our way through the crowd. We sent our friend home on the boda boda to get our emergency kit. 

Nightly emergency response in East Africa

The police let us through when we identified ourselves as German doctors. Nothing was being done. The girl was laying next to the car unconscious and bleeding heavily. We asked the police officer if an ambulance was on its way. He laughed and said, "This isn't Germany! There are no ambulances here at night. Besides, the girl doesn't have any money. So she won't be seeing a doctor anyway." My colleague and I looked each other in disbelief. We couldn't believe what we were hearing! My colleague was resolute, "I am an emergency physician from Germany. And I need an ambulance for this girl now! She needs to be taken to a trauma surgery hospital immediately!"

But the police officer laughed and replied, "If you want an ambulance, call one! But our hospitals aren't staffed at night. So we can't admit anyone." I asked him how injured persons were normally transported. He pointed to a police pickup truck and explained, "We put them in the back." However, there were no bandages or splints in the car. Our examination discovered several fractures, lacerations and broken ribs and internal bleeding in the abdominal area! "Polytrauma!" my colleague exclaimed! Finally, our friend arrived with the emergency kit! 

Emergency first aid

We put a neck brace on the girl, gained peripheral access, secured the airways and put her axially in a blanket a local had brought to the scene! My colleague pleaded, "We need a vacuum mattress!" But this wouldn't be the only thing missing that night! Bystanders brought us a sufficiently wide wooden board that served as a "spinal board." Fortunately, we had packed two "SAM" (structural aluminum malleable) splints. So, we used what we had.

Helping hands

I was amazed by how eager the bystanders were to help us, something I had never experienced in Germany. We then carefully carried the girl onto the back of the pickup truck. We asked the police officer to drive slowly over bad roads, but to the hospital as quickly as possible. Even without being injured, riding on the back of the pickup truck was anything but comfortable. I wasn't surprised that most accident victims didn't survive! The proximity to the siren made any communication impossible. After fifteen grueling minutes, we reached the public hospital which was approx. 15 kilometers away.

Awakened by the siren, the night nurse opened the door to the emergency room. "What do you want at this time of day?" she asked. "There are no doctors here! They only come at 8!" We carefully put the girl on a rollaway bed. Doubtingly, the nurse asked me, "Is the lady in the red miniskirt and high heels really a doctor?" "Yes, and the best I know!" I replied as I examined the girl and made preparations for the operation with my colleague. The hospital equipment was, shall we say, "minimalistic." Nothing we had hoped to find was there. "The chief physician won't be pleased that you're doing everything on your own!" the night nurse added while assisting us. Two and a half hours later, we moved the girl to the monitoring room. She was no longer in mortal danger and her condition was "stable," as physicians say.

The morning after

When the first doctor arrived at approx. 7:30 AM, he asked who the patient in the monitoring room was. The nurse explained, "The girl who ran in front of the taxi last night." "How is she still alive?!" the doctor demanded from the changing room. "There are two Germans in the room. They performed surgery on her last night." Eyes wide open, the doctor stormed out of the changing room into our room, "What?!" "Good morning!" we said. "These are the records and the patient's files."

We had prepared them with the nurse as best as we could. As we entered the patient's room, the doctor read the documents and slowly admitted, "That's damn good work. I can't believe she's still alive!" After a cup of coffee and a long discussion, we said good-bye and a hospital driver took us home. We continued to talk about this night for many days and wondered how to deal with such a situation. 

The gratitude of a mother

A few days later, a simply dressed woman came to our friend's parents' home to bring us a fruit basket and a grilled chicken. She asked if she could speak to the "muzungu doctors," the East African term for "white doctors." It was still early in the day and we weren't quite on our way yet. She kneeled and gave us the presents. We then learned that this was the mother of the girl involved in the accident. She couldn't speak English, so our friend's mother translated from Luganda. The woman was crying. Our friends explained that the woman had no money and no idea how to pay us. We were so touched and impressed! We had our friend assure her that there was nothing to be repaid. The woman was convinced that God himself had sent these doctors to her daughter that night!

An idea takes shape

Our friend's parents invited the woman for a meal and we learned more about the problems with first aid and the lack of medical assistance in East Africa. This convinced me, "We have to do something!" However, my colleague said she never wanted to endure something like that again. These had been the worst hours of her life and she never wanted to go back to East Africa. So, I left on my own to meet with the head of traffic police and made an appointment with the public district hospital administrative director.

I spoke to private hospital operators, the UN, the International Committee of the Red Cross and the German Workers' Samaritan Federation; all had offices in the Ugandan capital Kampala. But the results of my inquiries were disappointing. In sum, they all said that Uganda was a developing nation, but they had the situation under control, things just take time and there was no reason for me to be concerned.

First-hand experience was the deciding factor

But the people on the street, the nurses and the police officers I talked to gave me a different view of the situation! All spoke of a lack of action, that nothing had noticeably improved for decades and that, other than meetings and assurances in the papers and on TV, nothing was being done. I decided to assess the situation myself and traveled to Uganda for another three months. Since I had no local knowledge, I rented a boda boda that drove me across the country for four weeks.

I spoke with children on the street, persons selling telephone cards, police officers, doctors, administrative officials, mayors, taxi drivers and housewives. I visited ten public and ten private hospitals in various regions. Finally, I concluded that what the relief organizations and ministries told me had little to do with reality.

The situation on site

When looking at Uganda, Tanzania and Kenya, you will find modern and relatively well-equipped emergency vehicles. Only a few, but they exist. However, they belong to expensive private hospitals and are not used for accidents or general emergencies, but only when requested by rich private patients or government officials. When looking at the run-down public hospitals in many places, their size and capacities do seem to meet local needs. But taking a closer look reveals that most equipment is broken, worn out or non-existent!

The initial situation can be improved by simple steps

Several hospitals create the impression that diagnostics is not among the strengths of the practicing physicians! There is much knowledge to be provided here. There are often enough modern ambulances, but no equipment. And, unfortunately, the vehicles are often broken and there are no replacement parts or people who know how to fix them. Maintenance, in particular, appears to be a problem. In some regions, the problem was that there was no money for diesel fuel to fill up the vehicles.

Missing equipment costs lives

Another problem is that there are no fire brigades in most districts, so that there is no technical support for recovering injured persons or removing wedged vehicles that hinder emergency efforts during accidents. Especially the lack of recovery equipment costs many patients who are trapped in vehicles their lives. Vehicle fires cannot be extinguished.

A police officer told me how, after a traffic accident, he was forced to watch a woman stuck in her vehicle screaming for hours before she died, only because she could not be retrieved from her from the vehicle. Such accounts make it clear that emergency vehicles must be equipped differently in Uganda than in Europe. Public ambulances belong to the traffic police or public hospitals. Their equipment, if you can even call it "equipment," is minimalistic and by no means sufficient for treating severe traffic accidents or heart attacks. In addition, the staff is often unable to perform required measures. However, things look somewhat better in the capital than in rural areas.

What is needed?

Ideally, emergency vehicles should be equipped with large fire extinguishers and recovery equipment, like those of firefighters. More materials and medicine are also needed, since transportation routes are often significantly longer and hospitals often do not have adequate or any material to continue to treat patients.

Lab diagnostics are only possible at larger hospitals whose staff is also often under-qualified. Another problem is that there are no uniform emergency call numbers across regions. In many areas, the police are called through an official office number that differs among districts. Many people do not even know these numbers. Hospital ambulances are called by the police through mobile phones and, like the police, drivers have no medical training. 

If you are lucky, a nurse may be on the ambulance. This alarm system often works poorly or not at all. This lack of training and equipment often turns trivial injuries into disasters for those affected. In many districts, bicycle trailers are used for emergency transportation, which is neither fast nor adequate for patient's needs. Emergency service becomes impossible.

All of this led to the idea of starting an organization!