Mar 17

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First off, Happy St. Patrick’s Day! I hope everyone remembered to wear green so as to minimize pinching! I remembered my green, but it seems no one here cares whether or not you’re wearing it, so the day was rather anti-climactic as a holiday. However, both Jon and I did find out that we have both matched to residency programs so we’re both happy and relieved to find this out. We’ll find out where we matched Thursday, but at least we know we’ll be going somewhere!

I added the posts from when we were in Gulu…there a bit outdated now since we’ve been back a few days, but I had trouble with the internet and finding a wireless spot to send what I typed on my pocket pc to myself. I’m sure none of you have anything to do except read our blogs though, so now you’ll be glad to have something to occupy your time! ;)

This week, Jon and I are both on the Infectious Disease ward in the main hospital (I have to see adult patients…scary!!). It’s a bit busy with many medical students, nursing students, and residents, but so far it has been a good learning experience. Most of the patients on the ward are HIV positive and are here due to opportunistic infections. Some of them are on therapy for HIV and some are now, but most of them are started while they’re here if they weren’t previously receiving treatment. Very few of the patients ever get confirmed diagnoses, they are just treated empirically based on their symptoms, physical exam, and what stage their HIV/AIDS is. Quite a few are currently being treated for cryptococcal meningitis, a type of meningitis severely immunocompromised people are susceptible to. If they don’t get better on treatment for this, the physicians look further for a source of an infection. Nearly all of them are tested for malaria as well and of course started on treatment if it is found to be positive. Sometimes even if the malaria smear is negative, they will start treatment for presumed malaria if there isn’t another obvious sign of the source of their fever.

In addition to malaria and cryptococcal meningitis, there are several patients with tuberculosis, one patient who possibly has CMV retinitis or retinitis due to toxoplasmosis, one patient who either has delirium tremens (caused by abrubt withdrawl from alcohol) or a CNS lesion, one patient who has presumed toxoplasmosis (a CT was done and he has been getting better on treatment for toxoplasmosis, though based on the CT it could be something else) and one patient who had alcoholic liver cirrhosis. This last patient passed away this morning right in front of us. As they were trying to do something for him (a line was put it, fluids given, and an NG tube placed for the delivery of lactulose), we helplessly watched and knew that he wouldn’t be here for long. We learned from a doctor who has seen this patient many times for follow up care, that he was an alcoholic and had had severe cirrhosis for a long time. He was also HIV+, but had been receiving treatment and doing ok from that standpoint. However, he refused to quit drinking and so no matter what country he lived in, would not have eventually succumbed to his liver failure, we just felt it wouldn’t have been quite so soon. This man came into the hospital only 3 days ago able to talk and was fully conscious. Even yesterday he was fully conscious, though looking quite terrible. Although he wouldn’t be a likely candidate for a liver transplant, we could have treated his symptoms better and he could have had some quality of life. Granted, if he didn’t stop drinking there would be little anyone could do for him. This really about pushed me over the edge, watching him die this terrible death. Being here is often overwhelming for a number of reasons, but things like this make it even more difficult.

The doctor who had previously been taking care of this man, stood and talked to us for quite awhile. He seemed very wise for his years (he couldn’t have been more than 30 at the most) and had some interesting thoughts on the state of health care here. He thinks there are many things that need to be improved, but the one thing that most needs to change is the attitude of the health care workers. He thought if more people could visit the health care settings of more developed countries and see what is possible, maybe things would start to improve. He didn’t buy the argument that it is just a matter of lack of resources here, but thought the attitude was more to blame. He thinks it is helpful for westerners to come here and teach and explain how things are done elsewhere, but these people have to realize that change will happen, just slowly. Sometimes we westerners come in and want to change everything to exactly the way we do things, when that isn’t necessarily appropriate. Certainly there are many improvements that need to be made, but offending people and pushing them around as if they’re simply unintelligent isn’t the way to go about making a difference. He seemed to be of the mind that showing rather than telling was the best method toward improvement. He also thought more people who had the resources should share what they have been given, and although I definitely think this is necessary, I tend to think resources from other countries should be used to aid in teaching people how to fish rather than providing them with the fish, the latter seeming to happen more often than the former.

Although today was very sobering, it was more the combination of several things that made today have so much more of an impact. Last night after we found out we matched, we went with a group of students to dinner and had a little celebration (more of a celebration to be had on Thursday when we know where we’ll be going). After dinner, Jon and I were walking back to campus, and saw this young boy (not more than 5 or 6) sound asleep on the side walk. Not more than a few feet away from him were 2 men selling shoes. I asked the men if the child was one of theirs and they replied, ‘no, he’s just a street kid’ with no feeling. In our hands we had leftovers and our stomachs were full (too full in fact!) and this little boy had nothing. I tried to wake him up and see if he was ok, but he didn’t respond he was sleeping so soundly. It takes a lot of practice to be able to sleep that soundly in the middle of a busy side walk. I thought at first may be he was sick, but once we got him awake, we realized he was ok. We gave him our food and he immediately started eating. It was just about more than we could handle. There are often children asking for money, but I hadn’t ever seen one sleeping in the middle of the side walk. I hadn’t seen any children sleeping on the street unless they were with their parents! Of course there are people who ask for money constantly, but this child seemed so alone it just broke our hearts. Just a few blocks away, the university students were yelling and running around because their new student president had been elected earlier in the day, and yet this child seemed to have nothing and no one.

Sorry for the terribly depressing stories, but it is what we are experiencing. Certainly we have many wonderful times here as well (such as getting to know the local people, seeing the amazing animals, and getting tan in the middle of March), but so many of the big differences are the heart wrenching things.

Again, it’s good to be back in Kampala and in touch with everyone we care about!

Until next time,

Katie

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4 Responses to “Mar 17”

  1. Diane (Jon's Mom) Says:

    Hi Katie,
    I’m still waiting for Jon to write something. I’m so glad that you took the time to wake that boy and feed him. Did you find out his name? I pray that he will grow up and have a better life. There seems to be so much heartache there – and hopelessness.
    Yes, I believe that westerners are focused on helping with money and things. Perhaps we are too dependent on things and we haven’t had to use our creativity for so long (we are spoiled and dependent on our technology).
    I believe you and Jon are learning that your attitude and care for people are paramount. Your hearts are growing!!
    God bless you for all you are doing – I pray for you throughout my day as you come to mind.
    Love, Diane (mom)

  2. Mom (Erin) Says:

    So glad to see all of your postings and read all about your adventures in Gulu. I so enjoy reading your blog and it gives me something to look forward to but I still would rather have you at home! As you knew it would this experience will change you and Jon forever but once you have processed things then it will be your patients who will be the benefactors. I think it is great that you got to really talk to a young doctor there about his view of developing countries and medicine. Always in my prayers,
    Love,
    Mom

  3. Susan from Nebraska Says:

    So good to hear from you guys again and that you survived GulU!!! I never heard of the place before but it reminds me of places I have lived before! Hope you get a chance to see my brother Jon in Nairobi. You will love seeing the kids at King’s Kids Village! It will be good to have you home too.

  4. Arlene Hiatt Says:

    Katie, the children always touch our hearts, and now your post about the little boy. You and Jon are being changed forever. Not only are we changed by mission trips but also challenged in how and in what way can we continue to be a part of the people’s lives. You and Jon continue in my prayers.

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