Archive for February, 2009

Feb 26

February 26, 2009

In response to Kyom, aka Denise (should I still call you Denise?), I don’t necessarily think the food is bad, it actually has a lot more flavor than I expected, it’s just so different from what I’m used to! It doesn’t help that I’m sort of picky at home as well. I don’t know what you’ll think of our food when you get there. Hopefully the woman you are staying with is a good cook!

To fill everyone in…Jon and I are actually a part of an exchange program with the medical school here in Uganda. We both got to come from DMU and there are two students from here (Denise and John) who will be leaving tomorrow for Des Moines! We’re the first 4 in the exchange, but it’s set up so that students after us will get to be a part of it as well. It’s really quite exciting and we’re both proud of our school for helping both us and the students from here in the funding. Hopefully we all learn a lot and take what we learn back home with us.

Don’t tell anyone, but a few of us are skipping out tomorrow and going to a local craft fair. I don’t know the name of it, but Allison’s friend has been there and so is going to take us in the morning. Apparently all the proceeds go to women who have HIV.

The four of us in the exchange as well as Susan who is the coordinator here, the other Susan who teaches our language class, and Dr. Charles who graduated from DMU, are going to dinner this evening at a place called Crocodile’s. Sounds exotic! We’re also going to church with Susan the coordinator on Sunday and then to her place afterwards for lunch (she’s cooking). πŸ™‚ Tomorrow evening we’re going to a restaurant that all the American and Canadian students say is wonderful. For about $7 you get steak that’s supposed to be wonderful and 4 other courses. Seems like we’ll have a pretty good weekend. πŸ™‚

As for Chris and Jane…we are supposed to hear from them sometime this week so I think I’ll text or call them today and see if they’ve made it back from wherever they were. I’m hoping to meet with them soon.

No fantastic stories today…saw some cute kids (but then I think most all kids are cute). Maybe I’ll go eat some jackfruit…

Love to all,
Katie

Lub Dub Lub Dub

February 26, 2009

Hello again, it is your favorite Cardiologist here. Today was a pretty good day on the wards. We didn’t lose any patients overnight and we actually discharged quite a few home! Yesterday, rounds were scheduled to start at 9am but did not start until 1130am…. lots of waiting and playing solitaire on my PDA. However, today we started at 1000am, only and hour behind schedule! I planned for it today and went and checked my email before checking on the cardio team. It will be quite an adjustment when I get back home and starting at 9 means 845.

I saw a couple very interesting patients today that I would like to share with you. First off, we have a woman that was admitted to the cardiology floor with chest pain. Now all she complains of is that her leg hurts… hum… fishy. As the attending physician went through all the students and intern asking if they knew what happened… I was on to something. He then asked me last (as he always does if none of the students can answer) if I knew what happened. I said the woman was probably having a MI (heart attack) and fell to the floor and broke her hip (femoral neck). He was pretty amazed that I knew what had happened. Little did he know that we have many elderly people in the US that frequently break their hip, either after a CVA (stroke) or MI. I let them all think I was very intelligent for the rest of rounds…. hehe. After that patient, we had 2 patients in a row that had pericardial effusions (fluid around their heart) from TB. We were able to diagnose the condition with an echocardiogram. It was pretty thrilling for a medical nerd like myself! Unfortunately there was not enough fluid around the heart to tap and take a sample. I have found in my short time here that there is much more syndromic treatment (presuming someone has a certain diagnosis based upon their signs/symptoms without concrete lab results (or investigations as they call them)) than at home. This approach would probably save the US millions of dollars a year… but the insurance companies wouldn’t like treating things that weren’t confirmed. Darn those medical hoops!

If you didn’t catch the last line of Katie’s last post, I got my haircut yesterday. What a scary experience! I went to a place called Salon Ultimate. There was a side for men and a side for women. I was promptly seated and tried to explain to the barber how I liked it. I knew that if my hair turned out to be a disaster, I could always buzz it all off, as many of the other students have done this while they were here. I was hoping to avoid the buzz, but taking the tropical climate into account… I probably wouldn’t mind that much. Long story much shorter (as you can see from Katie’s posts… I tend to abbreviate a bit more), the barber was using the clippers/buzzer by going from the top of my head to the bottom… opposite from every other haircut I have received… but I was going to let him do his magic. He was concentrating so hard a seemed to be quite the perfectionist. My hair was blowing all around the room and Katie actually had to wipe a bit off herself while waiting for me… isn’t she nice, waiting for me in a room full other people’s hair? In the end… I was actually surprised. Aside from not cutting any hair off the top of my head, missing the left side of my head, and not trimming around my ears… he did a pretty good job. This is not what I expected from someone concentrating so hard and taking 30 minutes. I had to go home and finish the job with Katie’s little pair of scissors from a Gerber multi-tool that she got just before going on this trip from her bf Robb. What a handy tool… we have used it for so many things so far! Unfortunately… I don’t think Katie is going to get a trim while she is here… what a story that would be.

Tonight we are going to a restaurant called the Crocodile with the doc from DMU, a student and program administrator Susan, and John and Denise (the 2 students going to Iowa from here). John and Denise leave at the end of this week… so if you are in Des Moines… give them a warm welcome!

One last thing. The head Cardiologist on my team told us today that he heard that the UN did a world survey and Uganda was the top country for alcohol abuse. He was wondering if I thought that was true. He said that he didn’t think it was true because there are so many people here that can’t even afford food, let alone alcohol. I tend to agree with him, as there are not that many people in the hospital here with alcohol related diseases… but who knows, maybe they are all at home and can’t make it in? Let me know if anyone has heard of that stat before… pretty bizarre.

in keeping with the alcoholic spirit…

cheers,

Jon

Feb 25

February 25, 2009

Today is the last day to change my rank list for residency! I’ve considered changing the order slightly, but have decided against it every time I think of it and after today it will be final!

Seems like today was a particularly typical Uganda day. Jon was supposed to be on the cardiology ward at 8 am so I decided to walk with him (after all he is my pack mule!) and do some research on safaris. As soon as we were on the hospital property, a local student informed Jon he didn’t actually need to be on the ward until 9 (we had hypothesized this might happen, but wanted to be here in case 8 was the actual time). I was supposed to start at the sickle cell clinic at 9:30, so after doing some research, I showed up at 9:30. Anyone want to guess what time the doctor showed up? Just after 11! I was giving him until 11 and then just going to go back tomorrow, but he ended up showing up. Most of the time I was in the clinic he was out of the room and left me sitting with a patient I couldn’t speak to and who just stared at me. It was rather comical. I made at least 1 friend and at least 1 enemy. My enemy, a 2 year old, was really just scared and didn’t want to be poked and prodded, so I won’t take the screaming personally. My friend, a 6 year old little girl, came in and out of the room the whole morning just so she could touch my arm. When she actually came in for her appointment she reached out and touched my leg and I grabbed her hand before she could get away. She thought that was a fun game. I tried to talk with her, but she mostly just giggled. Well, that pretty much sums up my morning. πŸ™‚

I had what I think was Jack fruit for lunch today. It’s a weird texture. Kind of a mix between a flower petal and actual melon like fruit. I know, difficult to imagine. It didn’t really taste like anything in particular, just a little sweet. Jon informed me this morning that he’s often seen ants in our rice and beans here at the hospital, so I’m just not sure I can eat that anymore. I’m not sure what I’ll eat instead…that’s the only problem. I tried the g-nut sauce (ground peanuts somehow made into a gravy and then poured over your whole plate of whatever food you order) and wasn’t a big fan. I like peanuts and I like gravy, but I don’t like the two as one. Another food adventure – we ate rolexes last night (no idea how to actually spell that). Not watches, don’t worry! It’s basically an egg burrito with a different sort of shell. We each got one plain one and one with chaps (a breaded ‘beef’ patty – we don’t really think it’s beef, but we pretend). They were delicious..until this morning. I’ll leave the rest to your imagination.

Jon thinks he needs a hair cut, so we’re off for that adventure.

Until later,
Katie

PS Robb, we were a little sad we didn’t have time to watch the water demonstration at the equator, but you just relieved it. Jon is disappointed that toilet water doesn’t swirl in different directions based on the hemisphere it’s in though..he says he doesn’t like you now. Don’t worry, I still like you!

Life in the Jungle.

February 24, 2009

Katie and I will most likely be writing about the same stuff… but hopefully we will have a different spin on the events that took place last weekend. Last Thursday we headed out for our long weekend away from “home.” We departed at 5 am and sat in the bus for 3 hours before it left for the bumpy road… although it was scheduled to leave much earlier. We fully experienced Africa time that morning. After sitting on the bus for appr. 10 hours, we arrived to Butogota, Ug. We then took a truck to our gorilla tracking site in Buhoma. Yes Dad, it was only 5 km away from the DRC border and I know I promised to stay away from that area… but hey, I am still alive! We actually did not see and crazy guerillas (although they are reported to be in that area, causing a ruckus year round) as Arlene was wondering but we saw many wild gorillas! On Friday morning we went to tracking orientation and then set off for a 45 minute drive in a Land Rover to our insertion site into the Jungle (Bwindi Impenetrable Forest). After we arrived (feeling motion sick like I always do but miraculously did not vomit out the window this trip, unlike the trip I took to Jinja for the white water rafting), we set off into the thick Jungle. When I use the word Jungle here, try to imagine the most thick foliage you have seen and multiply it by 100. The armed guards/guides had to use a machete and other devices to get us through the mountainside as we were tracking the peaceful giants. After 1.5 hours of tracking, we came upon the 23 member mountain gorilla family. This was the largest habituated family in the country. By habituated, I mean they shouldn’t attack us and kill us as the other non-habituated groups would. They were sitting around eating, as they do most of their lives. I was so excited when I saw them that I was squealing like a pig! If you didn’t already know, gorillas are one of my favorite animals and I always spend the most time watching them at the zoo. I did not know what was in store for me that afternoon. The sun was unbearably hot and I was fully dressed with long pants, hooded sweatshirt and fully loaded backpack. All of the pain, fatigue, and feelings of impending doom from the hike melted away as I approached the gorilla family. I was able get a few feet away from many of the gorillas in the family, including the mothers with babies clinging to their backs, the feisty adolescents and blackbacks, as well as the stubborn silverback. Our group was charged twice by the silverback. The first charge caught me off guard and nearly made me soil myself, as the silverback came from behind the bushes and was running at me and stopped only a few feet from me, snorting, howling, and pounding the ground with his massive arms/fists. What a thrill. The hike back was torturous as the sun was high in the sky and we were out in the open (unlike the hike in). Lucky for us, the lodge we were staying in had a full shower, not just a bucket with a faucet. I have never felt so clean than I did after that shower.

The rest of the weekend we were able to relax and visit the local community sites. We were lucky enough to take a community walk and visit with the “traditional healer” and the Batwa pygmies. The traditional healer was not what I expected. He was basically a herbalist, not a witchdoctor as I assumed. He said there are other “witchdoctors” around and they heal through witchcraft and casting of spells. The Batwa pygmies were very happy people, although their stories were enough to bring Katie to the verge of breaking down. They are very small people, as the adults barely make it to my upper abdomen. We have some good pictures and videos of them putting on a show for us.

During our weekend adventure, we met many interesting people from other countries on vacation/trips. We were fortunate enough to make friends with some Canadians and they offered us a ride back in their tour van so we wouldn’t have to take the public transit home. How friendly eh? We were able to go home a different way and made a pass through Queen Elizabeth National Park and had a teaser of the “big 5” safari experience. We were able to see 2 of the big 5 just in that short detour (elephants and water buffalo). We were also able to stop at the equator but didn’t have enough time to watch the water spin in opposite directions on either side of the equatorial line. Maybe another time.

Now we are back to Kampala, working in the hospital as we were before. This week I am working on the Cardiology ward. I have already seen half the tropical cardiac diseases in one day of working! I will try my best to keep the hearts of Africa beating this week. For those of you that are medically literate, I have already seen Dressler’s Syndrome, pheochromocytoma (with malignant hypertension), and Endomyocardial Fibrosis.

At Edge House (our residence) we are mixing up the international student pool and getting a few new students and seeing a few go back home. It has been a great experience meeting people from medical schools all across the globe and expanding our physician network. Also… Katie and I will be here for our Residency Match day and will have to submit our final rank list on the 25th of Feb.! After that, we will be waiting in anticipation for Match Day on March 19th! We are both praying we get our #1 choice.

As with every post, let me know if there is something you would like me to type about in more detail, because there are so many things to talk about but I am unable to fit everything in with each post. Hopefully Katie is able to hit on some things that I have been unable to pull out of my jumbled brain.

your dirty mountain man,

Jon

Feb 24

February 24, 2009

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Welcome back to reading our blog. We have been absent for quite some time, but have not forgotten you all!

We may be repeating each other a bit, so I’ll apologize for that at the start.

As you may have heard, we visited the gorillas over the weekend. To get a gorilla permit you have to go to the Uganda Wildlife Authority first and see if there is a date available. Only 6-8 permits are allowed per day per gorilla family (there were 3 families in the area we visited). Luckily for us, this is the low season for traveling so we were able to book a date quite easily. Feb 20th was the chosen date for the adventure. We left the day before at 5 am from our house to get to the bus ‘station’ by 5:30 to assure ourselves seats. The bus was supposedly leaving at 6, but in keeping with Uganda time, it left at 8:30. Not 10 minutes after we had left the lot we had our first delay! I’m not entirely sure what happened, but I think we cut off a matatu (taxi) and of course there was a bit of an argument over whose fault it was. Many people from the bus as well as the matatu got out to argue for a bit and it was eventually decided that it wasn’t the bus’ fault, so we continued on our way.

We sat in the front row (Jon tends to get motion sickness) and thought we had 3 seats between the two of us, but it turns out they sell every single seat on the bus, so we had a lady sitting with us. Luckily she spoke English and was very friendly. She made sure we weren’t cheated on the price of our tickets and found me a restroom twice on the way. I must say, the worst part about the ride was the lack of facilities! The bus did stop for a short call (you can guess what this is) along the side of the road, but I couldn’t quite make myself participate. Not that the actual toilets were much better, I just had a small bit of privacy that way. The roads themselves were at time ok, but at least half of the way, they were terrible. The bus drove very fast and didn’t seem to care if there were potholes, other vehicles in oncoming traffic, or people along the side of the road. It seems if you honk enough times that gives you free reign of the road. πŸ™‚

We managed to make it all the way to Butogota in only 10 hours (seems long, but a couple girls who are staying at our house made the trip in 14!) and there was a driver to pick us up and take us to the campsite. Once we got to the campsite we decided the bus ride had been worth it. It was gorgeous! Right in the mountains, with gorgeous foliage all around, and it was peaceful with no diesel trucks going by or people singing until 4am! We chose to stay 3 nights so we’d have a day to relax before being tortured again on the bus ride back. After getting something to eat and going to bed (in a cute little cabin they called a banda) we woke early to start the gorilla trekking!

The morning began with freshly baked bread, fresh fruit, and scrambled eggs and then with full stomachs we made our way to our group. We were briefed on what to expect (basically told if a gorilla charges, hunker down and back away) and got in a jeep to drive closer to the gorillas. Our family was the biggest with 23 members total which included 2 silver backs (very unusual) and at least 5 babies. We drove for 45 minutes (very beautiful drive) at which point we entered the forest. Now before this, I had thought we’d be hiking and that it might be a good work out, but I assumed there would be paths to walk on. Not the case. Instead of paths, we had a man in front with a machete who chopped down a few branches here and there to make it passable and then of course we had our feet for trampling. I’m not sure how far we walked, but I think it wasn’t nearly as far as it seemed. Imagine walking through those hedges that many people have around their houses and then imagine trees above you with branches hanging down all around you and lots and lots of foliage underfoot with lots and lots of vines to get your feet caught in. Now imagine walking through all of this for 1.5 hours. That’s a little bit like what we did to find the gorillas. Once we found them we forgot how hard we had to work and were just so excited to see them! We had been told we would need to stay at least 7 meters from them, but that must have just been a suggestion, because we were definitely closer than 7 meters! At one point, Jon could have reached out to touch the silver back! It was pretty amazing. They all just sat around looking at us, some of them ignoring us, the young ones playing in the trees, and all of them eating lots and lots of leaves. We were so close we could hear them chewing (or even tooting as the case may be!). They are really incredible animals. The families that tourists visit are all habituated, as they say, and are used to be stared at so they aren’t afraid or aggressive towards people unless they are scared or threatened. There are lots of families in the area, however, who are not used to seeing people and at times can be aggressive. Thankfully we didn’t run into any of these groups.

We spent 1 hour with the gorillas (trying to take pictures and maintain our balance on the steep hill) before we had to journey back to the camp site. The way back was like night and day difference in difficulty! I’m sure we went much much further on the way back to the road and yet it probably took us less time. Once we were out of the forest (which I forgot to mention is entitled Bwindi Impenetrable National forest), there was a group of school aged children selling pictures of the silverbacks, carvings of them, and some other artwork they had done on scratch paper or whatever else they could find to draw on. Many of the pictures were actually quite good and it was so cute to see them. At first we just walked by and smiled, but then I decided I just had to buy one of their drawings. It’s like passing a lemonade stand on the sidewalk and not stopping for some. So I bought a picture of a couple silver backs and took a picture of the kids. Highlight of my day minus the actual gorillas of course.

Once we got back to the campsite we immediately showered (in a real shower!). I had fallen at least 4 times (more like slid down the hill), so was rather muddy and of course very sweaty! The shower felt wonderful! We then proceeded to fall fast asleep in our extremely cool dorm room (the building was made of cement so the room was always nice and cool). We slept until someone knocked on the door and asked what we wanted for dinner. What a day!

Saturday was spent sleeping until neither of us could sleep anymore. It was wonderful to sleep in a quiet place. We then had a wonderful breakfast and next signed up for the community walk. The money made from tourists visiting the gorillas as well as spending money in the various camp sites and buying gifts in the town has really helped the town prosper. Schools have been built and people have jobs. Some of the money is also used to help families pay school fees for the children if they are unable to. We learned all of this through the guide during the community walk and I just really hope it’s the truth. I’m sure the camp sites provide lots of jobs and tourists always buy gifts, but I wonder if the children see any of the profits. Anyway, back to the walk. We stopped at one shop where women weave baskets largely from banana leaves. The woman there that day showed us how she wove the baskets and informed us that the proceeds benefit the individuals who actually made them, mostly women who are unable to obtain other work for various reasons. Our next stop was to the traditional healer. I thought traditional medicine and witchcraft were largely the same thing, but came to find out this isn’t the case at all! There is lots of witchcraft here, but this man was not one of them. He learned traditional healing from his father and grandfather and serves his community even if his patients are unable to afford treatment. Additionally he has a coat from the hospital and once a month he meets with other traditional healers in the area as well as some staff from the hospital and they discuss how to better help their patients. If he is unable to assist a patient, he sends them to the hospital where they are treated with western medicine. He seemed so knowledgeable and the experience was so intriguing. He showed us different herbs and what their uses were and let us smell them too. Some of them smelled so lovely I’d actually put them in tea! Since so many of our western medicines come from plants, I have no doubt that many of his remedies really do help and since he consults other healers as well as western trained physicians, it seems like a reasonable approach to some common ailments.

Once we finished with our questions of the traditional healer, we moved on to the banana brewing plantation. The plantation grew 4 different types of bananas (ones for eating, cooking, brewing, or roasting) and made their own banana juice as well as wine. If you remember the episode of I Love Lucy, where Lucy stomps on the grapes to make wine, you’ll have an idea how they make the banana wine. It was interesting, but strange too. Once the juice is made, they ferment it to make the wine and then take the wine to a local man who makes it into liquor known here as waragi…something we’d call gin! We saw the man who distills the wineβ€”using the cool river water to cool the coils and make the steam back into liquid form. We tasted all 3 of the banana products (well, I didn’t taste the waragi since I’d tasted it in Kampala) and I’m not really sure I could drink an entire glass of either the juice or the wine, but the gin is tasty mixed with soda. πŸ™‚

Our last stop was to see the batwa people – or as we would call them, the pygmies. When sitting in front of them, they didn’t appear to be so small, but when standing next to them, I soon realized they were quite tiny indeed! They did a short singing and dancing performance for us and then had all of the crafts set out for us to buy. Although they likely benefit in some small way from the money we spent on the community walk, it’s probably very little. Jon and I were the only tourists on this particular walk and so we spent entirely too much on a gorilla carving that we didn’t particularly want! However, we left knowing the money would go directly to the people in front of us. I can’t quite explain the feeling I had while watching them sing and dance for us, but it was very emotional. I took videos with my camera and knew that if I stopped and just watched I would probably cry. These people are sort of the forgotten people of Uganda. They used to live in the forest, but as it is now a national park, they were sent away and given land near the park. Before 1991, they lived completely off the forest and though they lived difficult lives, the forest was their home. They now have been taught ways to subside off the land they live on and their children receive education at the local school and they also have free healthcare. When they were first transported out of the forest, the mortality rate was 50% for those less than 5 years old. The hospital that is now in the area was actually started for these people by a missionary doctor from California. We had an opportunity to tour the clinic and the facilities are very nice and clean and the hospital is even expanding. Unfortunately it wouldn’t be able to survive if not for outside donations largely from the UK and US. In fact 80% of their income comes from outside funding and only 0.1% comes from the Ugandan government. That being said, the facility is much much nicer than the government hospital, Mulago, that we are working at in Kampala!

Well, this is sure getting lengthy! I think I’ve pretty much summed up our trip to Bwindi. Oh, except for the fantastic ride back to Kampala! We actually met a couple from Canada who were with a tour guide and had extra room in their van. They were leaving to go back to Etebbe (very near Kampala) on Sunday which is the same day we were planning to leave, and they asked their driver if it’d be ok for us to ride back with them. He said he’d charge us $10 (the same price we paid for the bus ride!!) so we definitely agreed! We were so happy not to ride that crazy bus. The van was much more comfortable and the company was pleasant as well. We stopped for proper bathroom breaks and apart from something mildly wrong with the radiator (which was fortunately fixed at a mechanic shop on the way), the trip back was without any problems!

We weren’t all that excited to get back to Kampala and it’s crazy atmosphere, but back in Kampala we found ourselves anyway. We went to St. Stephen’s yesterday with the American doctor and then started at a new rotation today at Mulago.

Yesterday was actually quite a frustrating day. Though the idea of preventative medicine is not nearly where it should be in the US, it far exceeds where it is here. Here, they basically manage patients when they are in crisis, rather than preventing the crisis in the first place. I and two students from Yale examined a young infant and found a heart murmur. Though heart murmurs are often benign in children, it is best to actually know whether it is a problem or not rather than assuming it’s not. The child did not come in with any complaint of cardiac problems, the murmur was an incidental finding, but we still suggested to the doctor that we get an ECHO to rule out anything that could be problematic in the future. He basically laughed at us. A similar scenario happened awhile later with an older child and he again thought we were silly. The medicine he practiced had very little to do with any specific reasoning and it was very frustrating to watch. The medications they choose to give to people often has no rationale behind it and therefore makes little or no sense to us. Although similar things have been happening since I started at Mulago, yesterday was just sort of a breaking point for me. I know these doctors went to medical school and learned better medicine than they are practicing. It is this sense of pervasive futility that seems to have overtaken the culture that is so frustrating. This is at least my perception from the medical standpoint. I think patients want more but don’t know how to ask. The physicians don’t spend time teaching and then get angry when the patients don’t understand. Of course it was like this even in the US until not so many years ago, so I think there is hope. What gives me even more hope, is the doctor I worked with today. I went to the sickle cell clinic and had a wonderful experience! This man spent time really talking WITH his patients rather than at them and even spent considerable time teaching. Usually I get done around 1pm with clinics, but today I didn’t finish until 2:30 which is just a testiment to how much time he took with each individual. He wanted to do what was best for each patient and although it was a sickle cell clinic, he took time to make sure the children were healthy in all regards, not just pertaining to their disease. It was wonderful to see.

Yes well, now I think I have fully made use of this blog for the day and hopefully made up for the lack of correspondance over the last week!

Until later,

Katie

Feb 18…a bit late

February 24, 2009

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Hello to everyone once again. I understand most of you experienced a bit of snow over the weekend and I’m sad to say I wasn’t around. We tried bargaining with the sun yesterday, but he’d have none of it. We also tried reverse psychology, but also to no avail. Instead we are resigned to wait for cooler temperatures.

Yesterday and today both Jon and I attended a skin clinic which was interesting, but perhaps not quite as interesting as being on the ward. Yesterday we were in a tiny room (smaller than any exam room in the states) with 8 medical students including us plus one physician and the patient. Needless to say it was a bit stifling. Yesterday we didn’t see anything completely unusual, just much more exaggerated than what we’d see at home. Either people wait much longer to seek medical care or it is difficult for them to attain it, but most likely a combination of the two.

Today was the pediatric derm clinic (of course I was a bit more excited about this than Jon) and it proved more interesting than yesterday. We saw a lot of eczema and TONS of bug bites. Not just many kids with bug bites, but many kids with many bug bites. Some of the kids easily had 50 just on their legs. Then of course they scratch them which leads to secondary bacterial infections, but luckily it’s easy and cheap to treat the infections. Teaching the parents to keep their children in pants in the evenings and to have them sleep under mosquito nets is probably the more difficult part of treatment. Since the doctors usually communicate to the patients in Luganda, I don’t know how well they explain treatments and recommendations to them (my extensive knowledge of Luganda just doesn’t help much). Judging by the length of time they spend explaining (10 seconds maybe), I’m guessing the explanation isn’t very complete!

In addition to the bug bites and eczema, we saw one little girl, probably around 3, who had a horrible looking rash on her neck. Her skin was completely broken down with the sore open and oozing a bit. If that sounds gross, then you’re getting the picture. I had no idea what it was. It looked almost as if it was a fresh burn, but in a very strange spot. The doctor explained that it was due to a toxic substance from the Nairobi fly! It’s actually a small beetle that sometimes gets into peoples’ homes and doesn’t actually bite, but when people, and especially kids, feel the sensation of the beetle crawling on them and go to get rid of it, they often inadvertently squish the bug causing the release of the toxins. The toxin is very corrosive to the skin and leaves this horrible patch which is susceptible to infection since it’s open to the air. If it doesn’t get infected it will heal on its on, but he chose to give antibiotic prophylaxis. Not a skin condition I want to personally experience!!

I think that’s all for today…

Katie

Feb 16

February 16, 2009

It seems Jon shared most of what we did this past weekend and seeing as we did the same things, it seems silly for me to comment much on the weekend’s festivities. The weekend was pretty relaxing and we were ready to start seeing patients in the clinic today, but unfortunately there was no doctor who felt the same! Instead, we sat in a stifling room for over an hour and then were finally told there wasn’t a doctor available to see patients, so we left to find something to eat (we’re both feeling a bit under the weather and that added to the heat makes us more hungry than usual). I’m sorry to say that stories of STDs and different skin conditions will have to wait until tomorrow or Wednesday! 😦

Over the weekend, we did have an encounter with some cute kids. We live on the university property, but it seems there are quite a few private homes as well which means there are usually young kids running around. We went to the church that’s nearby to check our email (there is a wireless signal somewhere near there we can use) on our pocket pc’s and there were some kids who were watching us curiously. At least one of them spoke English and would speak to us, the others just laughed or stared. Once we finished, we started walking back to the house and they followed us! They kept yelling wuzungus and then asked if we had any money. We didn’t have any on us so we said no and kept walking. We weren’t sure what we were going to do with them if they followed us into the gate, but luckily they didn’t. They were pretty cute, and evidently we got to be part of their entertainment for the afternoon.

The children here have a lot of responsibility, especially in caring for younger siblings. We often see babies carrying babies! Young girls not more than 6 will be carrying infants or toddlers on their backs just as their mothers do. It’s adorable and sad all at the same time. Most of the children know how to ask ‘how are you’ and respond, but not much more English than that. Perhaps they know more, just can’t understand our accent, but I’ve not been able to talk to them much more than asking how they are. When they respond you have to listen very carefully or you’ll miss it. Everyone here speaks so quietly that if you don’t pay attention and really concentrate on listening you won’t hear a word (and even when paying close attention I usually only manage to understand about half of what is said). Sometimes people will speak up when speaking to Americans, but often they won’t. I don’t have any idea how people here can hear each other, but they seem to do just fine when speaking together.

I’ve tried several times to load my pictures, but haven’t had any luck yet. I’ll try again today, but I might quit after today if it doesn’t work. It seems like it should, but the program just closes right when my pictures are almost loaded!

Oh, I did finally get a hold of Chris and Jane over the weekend (they are American missionaries who have lived here a long time and are good friends with people from my church at home)! They had been in Nairobi for awhile and were back in Kampala just for a couple days and then taking off again for a week and a half. Jane said she would call and we could get together once they’re back again. It will be really nice to meet them and both Jon and I are excited.

Well, for not having much to say, I guess I managed to say quite a lot. We both really appreciate all the comments and look forward to reading what you all have to say. I very much appreciate the prayers and encouragement as it often feels as if we are doing very little while being here. There are days we love it and days we feel completely overwhelmed and useless…it’s very much a roller coaster of emotions! It’s so nice to hear from people back home though and to know we’re being prayed for.

Weekend Update.

February 16, 2009

Here is the weekend update. Friday night we enjoyed some medical school culture at an establishment called Lavaz with the other local students. It is nice to know that medical students all across the world have a common way of unwinding. In Uganda they have a local gin called waragi. It is dirt cheap, which is perfect for us med students, and doesn’t taste half bad either when you mix it with krest (bitter lemon soda). Saturday morning was pretty relaxed as we prepared to head to town for the soccer game. Before heading to the game, we stopped for lunch at a little place called “I feel like chicken tonight.” It is basically a KFC with a Ugandan twist, as some of items on the menu are a bit strange. A unique item on the menu is something called chaps. It is pretty much a fried burger with a tempura like crunchy shell with ground chickpeas mixed in. If you can get over the fact that it looks like fried feces, it is actually pretty good.
Once we made it through the mad traffic downtown, we arrived at the soccer stadium. It was only $2.50 to get in and we bribed the guard with another $0.50 to sit in the section with the shade providing roof. The shaded are was supposed to be $7.50! It pays to go places with the locals.The Ugandan team won 2-0.The crowd really gets into it and probably gets pretty rowdy, as the field has barbed wire surrounding it and about 20 armed guards with a fire truck for crowd control! Luckily for us, we won and the crowd was well behaved. There was one man that kept on grabbing my arm and holding onto it really tightly, saying he really supported Germany and that he needed money. (he must have thought I was German because most Americans don’t go to soccer games). Once he found out I was American, he then supported the US and of course needed money still. Luckily he was pretty drunk so I managed to get away just fine.
After the game we went to a large park with many restaurants inside and had pizza and beer until we were ready for dancing! We tried going to two local bars/clubs but since it was V day, it was only couples dancing. We then found a bunch of wazungus (plural form of mzungu) having a party and crashed it. We met a few people from the midwest and had some common friends. The world is such a small place!
Once we could dance no more, we took a bota bota (motorcycle taxi)home and slept until the hot african sun poked its head out for the day.
Katie and I then played soccer in our backyard and noticed that white people change colors quite quickly when situated right on the equator.
Well…we are off for another adventure!
Your pink doc,
Jon

Rounding and rounding…

February 13, 2009

Today I finished my final day of Nephrology. Even though I was quite discouraged before with what I thought was futile medicine, today I saw improvement in the conditions of many of my patients. I didn’t write yesterday because I had many patients die and didn’t think my blog would be that cheerful. I won’t go into the sad details…but it was rough. Today was a bit different because we actually sent home a few patients that no longer needed treatment at the hospital. Yeah! Our patient load lightened up a bit due to nature taking it’s course and discharging a few patients, so we were able to have a few teaching sessions on rounds this morning. I never knew I could stand in one place for so many hours… it was impressive. We rounded on 3 patients from 9 am to 1 pm. Efficiency isn’t there forte here at Mulago Hospital.

After rounds, the nephrologist took a resident from Canada and me up to the DIALYSIS UNIT! I thought that we didn’t have dialysis at this hospital but we actually do. I guess what the doctors meant was that they don’t have dialysis for the patients that we see because they can’t afford it. This ruffled my feathers a bit more. I was finally getting used to the idea that they didn’t have dialysis and we were trying our best with what we had. Now I know that it is just a money issue.

On the lighter side of things, it sounds like Katie and I are going to get to attend a “football” game this weekend with a few local friends. It sounds like the games can get pretty heated and the crowds get really involved. I imagine it will be similar to the games down in Central America. We were told only to bring enough money to get in and buy a drink… otherwise we may end up having to make a “charitable donation” to those in need. I am sure we’ll have a great time. Don’t worry Rob we are following “Rob rules.”

For lunch today we had… yep you guessed it, rice and beans. I actually had a couple samosas as well (ground beef, carrots, and spices wrapped in a pastry dough) and a Mt. Dew. The Mt. Dew definitely doesn’t taste like it does at home. I was told it is because of the sugar they use here is less processed and gives it a better flavor. It also makes everything taste similar… so I’ll probably just stick with the fresh juice they have (passion fruit juice is my favorite).

Yesterday we were told by the Coordinator of International Students here that she has already received emails from DMU students that are interested in coming to Uganda. Hopefully we have started a trend. It would be great to establish a student exchange program with this medical school (we were the first from our school to come here so far).

One last note. I was almost hit by a beetle the size of a sparrow last night while taking a walk. Unfortunately I didn’t have my camera. I am sure by the time I get home, I will be describing the beetle as the size of a crow (just as my fish tales end up).

covered with plenty of DEET,

Jon

Feb 12

February 12, 2009

This week I have been on the nutrition ward which I find very interesting and generally encouraging. However, there is one young boy, whom I have named Samuel, who was abandoned by his family. We know nothing about his medical, social, or family history as he is not yet old enough to talk and has no one here to tell us. I am guessing he is younger than 2, maybe around 18 months. He is adorable. He is actually not severely malnourished, but enough so that they admitted him and have been feeding him well. There is a mother whose child is in the crib next to Samuel’s who has been holding him when he cries and seems to take good care of him when the nurses are unable to. Today we had to draw blood from him (since we know nothing about him, we need to know if he is HIV+ or not and also get some basic blood work to follow up with his cough) and this mother was not around so another student and I held him still while the intern took his blood. Of course he was screaming and not at all happy with us! Afterwards, I held him until he calmed down and when I went to put him down, he cried and cried. I picked him up again of course and then he cried and cried again. I couldn’t just keep holding him, so I had to leave, but it just broke my heart. I almost started crying right there. I don’t really know what will happen to him, but he is doing well enough that he can go to the next step which is called rehabilitation. The nurses there will also take care of him and when he is ready to be discharged if there is no one to come for him, he will go to an orphanage. I would ask that you keep this little one in your prayers. Pray that he finds a good home, is not HIV+, and that God protects him.

It seems I owe you some happier stories, so here is the continuation from yesterday…

A week ago or so Jon, Andrew (another student from the US) and I decided to take a different route home from the hospital (you’re welcome Robb) so we took this alley looking avenue. It ended up that this was more likely a slum rather than just an alley (sorry Robb, but don’t worry it was daylight) and there were LOTS of little kids running around. As we’re walking, the kids would shout ‘mzungu, mzungu’ at us very excitedly. We smiled and waved as we passed them and then soon came to a rather large group of kids who decided to run after us. They were laughing and shouting at us and so excited. They ran after us the way you might see kids running after a cute puppy or a ball they were trying to catch. It was so cute to see them so happy and having such a good time just because these alien people came walking through their neighborhood! One little girl even threw herself at Jon and another one at me and several of them would try to catch us so they could touch us. It was so innocent.

Another story with a good ending is of this little boy, aged 13 months, who came to the hospital about a week ago with severe dehydration, semi-conscious, a history of diarrhea for several weeks, oral thrush and severe malnutrition. He was so dehydrated that his arms and legs were actually cold which led to the diagnosis of shock. In asking about his sero-status, we learned his mother was recently found to be HIV+ and based on the presenting picture, it looked like the child was going to likely test positive as well. He was hydrated on the general pediatric ward and his mental state greatly improved and he was looking better each day. Because of his malnutrition, he was sent to the nutrition ward to get therapy. He had also had blood drawn to do a HIV test to determine whether or not he needed to start therapy. Just this morning the results of his test came back and he is negative! I don’t know when the mother acquired HIV, but I was so happy to learn that the child has not acquired it and now that he is over a year and not being breast fed any longer, he will not acquire it! There are several children in this ward who are very malnourished, but do not have any other serious health problems and so if their nutritional status improves they will do very well once they go home (provided the parents understand and can provide appropriate nutrition). Although at first it seems like a very sad and dismal ward to be on, I think it is quite happy because though these children present in dire states, they leave on the road to recovery. As far as I understand, they receive good follow-up care and there is even a plumpy nut clinic held once a week here!

Last night Jon and I decided to make dinner. That was the only part of our dinner that turned out. We had bought beans and rice as well as garlic, onions, and some sort of garlic seasoning combination in a jar. We thought all of this would taste good together, and likely it would have if we hadn’t decided to just throw all of it in the pan at the same time! The rice became a mushy, gelatinous mess and the beans were barely cooked at all! Jon was a trooper and ate a good portion of it while I ate maybe 5 bites and then decided on a peanut butter sandwich instead. It appears cooking lessons should have been in our preparation for Uganda plans!

I’ll be in touch again soon for more African adventures!