Mar 8

March 17, 2009

According to the large group of women and girls who just marched past our hotel, today is international women’s day. The beginning of the parade had a small band and several different women’s groups followed, with a total of several hundred marching. Great entertainment right at our door step!

We are now in Gulus and arrived Thursday evening. We were brought here by Sam, who is the director at the Ndere Cultural Center, and also a bit of a movie star. He was in ‘The Last King of Scotland’ and is now good friends with Forrest Whittiker (sp?)! In addition to being multi-talented, he also has quite a personal history. At the age of 14, he was abducted and made a child soldier. He later escaped and after he made his way to Kampala (all the way from Sudan), he started working with the Ndere Center. It took him 4 years from the time he was captured, to find his mother again at which point he moved her from Gulu to a safer location. Sometime later, he learned his younger brother had been abducted as well and later killed. When he learned of this, he became angry and distraught and knew he had to do something. He found some supporters and with their help, bought 40 acres of land in the middle of nowhere, hired some vans, and brought as many children from the north as he could in order to give them a safe place to live. This land began what is now called Hope north and now has around 180 secondary and vocational students combined. They started with nothing more than an empty field and now have dorms for each the girls and boys, living quarters for many of the teachers, a guest house, and even a bore hole for clean water. There are many plans in the works to improve the facilities even more, but already they’ve come a long way. If you want to look into this more, their website is: http://www.hopenorth.org.

Back to chronological order. Thursday we spent the night in Gulu, then Sam picked us up around noon on Friday (he told us he’d be there around 9, but 9, noon, what’s the difference really?) and acted as our ranger through Murchison Falls National Park. The park is beautiful and we saw so many animals really close! There are several different types of antelope which were everywhere and fun to watch. More exciting were the elephants who crossed right in from of Sam’s land cruiser, the giraffes who were right off the side of the road, the warthogs with their cute little babies, and the enormous hippo who was literally right next to our vehicle! had we not been inside the car, I would not have wanted to be so close to him. Apparently, hippos kill more humans than any other animal in Africa! Not the docile giants I thought they were!

During our mini safari, we got dirtier than we’d been during any other portion of our trip thus far. We stopped for a quick break at a hotel in the park (absolutely gorgeous hotel) to get drinks and use th toilets and Jon and I washed our hands and faces and turned the sinks brown. And keep in mind, we had been riding inside a car the whole day! It’s much drier in Gulu than in Kampala where the humidity makes us wilt. It’s hotter here as well, but somehow still more comfortable.

Friday night and Saturday day, we spent at Hope North. We didn’t do much besides sleep and eat, but did get to play with some of the young kids which was fun (there are a couple families who live on site as well who are refugees from the north). They mostly just laughed and copied whatever we did, but there was mutual entertainment provided.

We left Saturday evening and took a matatu to Gulu (about a 2 hour ride) where we went back to the same hotel (which has a nice fan, a tv, and a real shower). We went to sleep early, slept in late, and did some laundry.

Now that you’re caught up, I’ll tell you a bit about the area we’re in.

This is the area of the country where much of the war took place, and Gulu is the town Kony is from (the leader of the rebel army called the LRA or Lord’s Resistance Army). He is the man who caused the country so much terror and heartache. The rebels made it their practice to kidnap children and then turn them into soldiers. Many of these children, though now out of the army, no longer have anywhere they can call home and so they are refugees in their own country. The government also moved many of the people from the north to a sort of refugee camp set up and although it is safe for them to go back, so many of them have no family left in their home town and have lived in these camps for so long, they feel the camps are more home than the places they are actually from. Many of the camps are made up of mostly young people, so they often know only these camps as home. It has caused a huge economic problem as most of these people live in poverty.

As we were on our way to Murchison Falls, we saw many of these camps, which are called IDP camps (Internally Displaced Persons). There are literally hundreds of small round bandas, each one housing at least one family, and many different groups of these hundreds of homes. Many of the families have little or no income as they are used to being farmers and now have no land. The surrounding communities are quite small and I imagine offer little in terms of job opportunities.

Gulu itself is a medium sized town, but feels quite small. It’s much poorer appearing, though I don’t know if it actually is or not. Not many tourists come to this part of the country, so we are even more of a source of entertainment here! The people though are very friendly and don’t seem to be nearly as quiet as the people in Kampala.

So far, so good…we’ll keep you posted.

Katie

Lumping around…

March 15, 2009

Hello Everyone,

I am posting a very brief note here to let you know that I am waiting for Katie to post her blogs and then I will fill in the blanks or add my comments on the events mentioned. This weekend we are pretty much just being lumps on the couch (hence the lumping around title) reading our textbooks on infectious disease. We are trying our hardest to prepare for the last week of rounds at Mulago (we will be working in the infectious disease ward) and we haven’t been as diligent as we maybe should have been. We are also becoming more sedentary to prepare ourselves for life back home… or something like that.

your procrastinating pupil,

Jon

Mar 14

March 14, 2009

Hi again to everyone!  We’re back safely in Kampala, but haven’t made it to the hospital to check our email yet.  We’re currently using an internet cafe which is quite nice and makes for a little change of pace.  We considered going to the chimp island in Lake Victoria, but decided we’ve spent enough money so opted to just stay in Kampala and be lazy :).

I did write a couple blogs on my pocket pc while we were in Gulu, so I’ll upload them as soon as I find a wireless internet hotspot.  The blogs will be a bit out of order, but at least you can read what we did while there if you’re interested.

Before going to Gulu, we didn’t truly appreciate Kampala.  However, now that we’re back, we can see how truly nice it is and how much it has to offer in every way.  There are lots of things to do, lots of places to see, a variety of choices concerning food, and of course our favorite coffee shop!  There are some new students/residents at the house as well which is fun.  We’ll actually only be at the hospital for one more week, but it’s fun to meet new people, even if just briefly.

We found another craft market and located a couple safari hats for $2.50 each!  Quite a steal.  I think this may have been the craft market you were talking about, Kyom, and it was quite nice!  Jon wasn’t too excited about going, but he was glad to have found the safari hats.  Surprisingly, we had quite a difficult time finding them, and the ones we had found previously were more expensive than what we wanted to pay.  We’re glad we won’t fry on our safari next week!

I haven’t gotten in contact with Jon and Molly, but I will, and I must say I’m quite excited we may have an opportunity to see the orphanage in Nairobi!  It would really make my day if it works out for them. 🙂

No terribly interesting stories to report.  The bus ride back from Gulu was fairly uneventful, though we did have a chicken or two join us as passengers which was a bit different from home.  We got ripped off by the boda drivers for the trip from the bus station to our house which was a surprise.  Up to that point, they hadn’t ripped us off ever!  We haven’t given up our faith in the drivers though, as the rest have been honest.

Oh, we did try to go to the embassy yesterday to see about our single entry visa, but to our surprise, they embassy closes at noon on Fridays!  It’s kind of far, so a little annoying that we have to go back, but oh well.  The US embassy here is like a fortress!  It’s so huge.  You’ll just have to take my word for it though, because we can’t take photos of it :(.  We also couldn’t use the bathroom there, which was a little sad since there was really no where around there to go.  We were under the impression that we had free access since we’re US citizens, but clearly that is not the case.

As we were being lazy this morning, Jon was browsing through a local paper, and happened upon some interesting articles.  One talked about how the new craze in America is to swap partners with other couples and another talked about how to have casual physical relationships!  I had no idea of this new craze, and quite honestly don’t think it’s true, but we’re wondering where they got the idea this is what we do!  We found it a bit concerning that the local paper would suggest such loose morals especially considering how high the percent of HIV there is.  I’m still not quite sure what to make of it.

It seems there are some interesting ideas of what Americans are like.  A student in Gulu told us the reason we have such a low prevalence of HIV in the states is because we medicate our patients to the point of killing them so that our stats will look better to other countries.  The other thought as to why the prevalence is low is that we apparently have stronger condems.  Obviously both of these statements are false, but they sure caught our attention.  We tried to explain that these things weren’t true, so hopefully we got that straightened out!

Well, I think that’s about all for today folks.  You’ll undoubtedly be hearing from us again soon!

Love,

Katie

Mar 4

March 4, 2009

I’m writing once again since we may not be able to write for several days. I imagine we’ll have access to internet, but just in case, I’ll log my thoughts from yesterday and today.

The last two days, Jon and I have spent rounding on the cancer wards. There is one ward that is mostly children with some adults and another ward with what they call solid tumors (those that are more related to specific organs rather than the bone marrow or lymphatic system). Yesterday we saw many children with Burkett’s lymphoma, several with retinoblastoma, and many with non-Hodgkin’s lymphoma and Hodgkin’s lymphoma. Although Jon thought he was likely to spend the day in tears, I think childhood cancers are not nearly as sad as adult cancers. Children typically respond better to treatment and the cancers they generally have are often curable. Here it’s not quite as good as at home, but many of the children do go into remission even with the late presentations.

Today we were on the solid tumor ward…a bit more depressing in my opinion. The adults also present very late in their disease process so often it’s difficult to treat and most of them will die from their diseases. There is an organization in Sweden that pays for chemotherapy for a certain kind of stomach cancer (gastrointestinal stromal tumor) and these patients respond very well and have a pretty good prognosis. There were quite a few patients with Kaposi sarcoma which is a malignancy associated with HIV. The disease responds well to chemo, but there is still the HIV to deal with. Interestingly, the incidence of cancer seems to be much lower here than at home. We were talking to a doctor here (who is starting residency in Cleveland in July) about it and though there aren’t any studies on it, he felt that even accounting for the facts that we live longer and have a poorer diet, he still thinks there is less cancer here. I don’t know if this is true, but I do know that I’ve seen a lot more at home than while here. However, we have no idea how many people die of a cancer that was never diagnosed and it’s pretty obvioius that HIV/AIDS is a bigger problem here than cancer! Either way, there are very few hematologists here and this doctor is planning on becoming a hematologist and then coming back here to work eventually.

In response to both my mom and Robb, I’d say that our blessings and hard work are both part of our great country and opportunities. Of course it’s true that the men and women before us and now have and are working hard to keep us free. It is interesting that so little of Africa has been developed even though these people have been here forever, but I’ve had to remind myself many times that so much of the culture even now is tribal and there are so many tribes that this seems to contribute to the lack of development. For example, in Northern Uganda, there is still a war being fought, so while the people up there are continually suffering, the government down here in Kampala is continuing with its corrupt ways. There isn’t democracy here, even if the government pretends that’s what it is. We can’t forget that Uganda was a war zone not that long ago and although things aren’t great here, the people are just so glad to have (mostly) peace, that they haven’t begun to care about what we see as lack of development. As to why African countries have remained tribal for so long when other areas of the world haven’t, I don’t know. But I do know that none of us chooses where we are born, and to be born American is a privilege and a blessing we, as individuals, didn’t do anything to earn. Once we have grown up a bit, there are lots of things many individuals do to enable future infants of this same privilege, but I don’t think we can just ignore the fact that where we’re born and what nationality our parents are, makes a big difference. Basically, in case I didn’t explain my thoughts well enough, I think the combination of blessings and hard work has made us (as Americans) who we are today.

Tonight Jon and I are taking Susan and Dr. Holt out to dinner. We’re going to some place we saw pictures of and Susan says is great. The food we order is put in front of us and then we cook it right there at the table. Sounds like an activity and a meal all in one!

It seems I’ve made a little into a long blog once again! I hope I can write again soon, but if not, don’t worry we’ll be back in a little over a week!

Katie

Last day working at Mulago?

March 4, 2009

Well, today may be the last day we are working at Mulago Hospital in Kampala, UG. Our schedule was never really set in stone and we have been planning on doing some rural rotations. A few things came together in a hurry. As far as I know right now, we are going on a rural rotation possibly starting tomorrow and lasting until the end of next week. After that, we may be going to the island clinic. After that, we are going on a safari in Kenya. After that, we ran out of time in Uganda and we are going to head for the States! Time just flew by, as expected.
SO…. today I finished up the oncology ward. Today, Katie and I were in the solid tumor ward. We saw some pretty interesting cases, although only a few were different from what we would see back home. We saw two very different cases of Kaposi’s Sarcoma (KS) that were so far along that it made us a bit sick to stay in the room, due to the smell. KS is a cancer that is associated with Human Herpes Virus 8 (HHV-8) and is mainly found in patients with AIDS. These two patients had AIDS and had waited several months before they came to the hospital to get treated, allowing the malignancy to get out of control! Oddly enough, it was on both of the patient’s left leg, from the foot to the mid-thigh. Katie got a couple great shots of it if you are interested in seeing it when we get home.
Tonight, Katie, Dr. Holt, myself, and Susan (the coordinator) are going to dinner to discuss the future of the Des Moines University- Makarere University collaboration/exchange. I hope we can put our ideas together and make a strong program for future DMU-MakU students! The restaurant we are going to is almost as exciting as the program work we will discuss. It is a restaurant where all the food is cooked right in front of you… so we will get to find out all their secrets! We will definitely take some good pics and I am sure we will have some funny stories to tell afterward.
I hope everyone at home is keeping warm and having fun shoveling the snow.
We will continue to keep you updated as we can.

your rural renegade,

Jon

26 years of existence

March 3, 2009

This weekend was the most relaxing weekend we have had since our arrival. Friday started off with my favorite activity, shopping (this of course is written with much sarcasm). We went to a few different craft shops around town and loaded our bags with goodies that we thought had the most local flavor. The shops that we went to contained many crafts that were made by the people of Uganda and other surrounding countries. Being the strong supporters of Uganda that we are, we made sure to get things that were made here so that we could keep our money in the local economy as much as possible. During the day we visited a trendy coffee shop that had a logo that was very similar to Starbucks. This was probably to attract young mzungus like ourselves into their shop. It worked, but only because it is one of two coffee shops we know of in Kampala. Coffee export is a big part of their economy but very few Ugandans that we met actually like coffee. This is very unlike Central America where everyone drinks it, including the small (hyper) children.
Friday night was the last day here in Uganda for a couple students so we went out to dinner at a place called Tuwhendes (sp?). Pretty much everyone had the steak because it is well known for their Filet Mignon (beef tenderloin) meal. I just about passed out after that meal because it was so good. Saturday morning was not recorded in my memory because I slept until Saturday afternoon. I love sleeping and if it is cool enough in the morning, you have to take advantage of it. Saturday night we went out to dinner at one of my favorite places (due to the heavenly chocolate ice cream) called Sam’s. On Sunday, we went to the large church in Kampala with the coordinator Susan. Church was pretty much like back home in the states and the preacher was actually a white guy from Canada. I guess there were only about 15 white people in the church, so that was different from home.After church we went over to Susan’s house for lunch and she made us a wonderful traditional Ugandan meal. She made chicken, Irish potatoes (they call regular potatoes Irish potatoes), matoke, ground nut sauce (basically peanut sauce), fresh passion fruit/pineapple juice, and some other stuff I can’t remember. She said she made the matoke a special way for us so that we would like it (normally it has no flavor and so she put some onions and tomatoes in it). She did a great job, it was actually quite good. After sitting around talking for a bit, we made our trek home. Sunday night we went to a place called Ndere and watched a show and had dinner. I see that Katie is writing a lot about that, so I will refrain.

Monday was a magical day because I took it off, as it was my B-day! I slept in and lounged around the house most of the day, fighting the wrinkles and trying to preserve my youth. I got in some good leisure reading and went outside and exercised a bit. I went jogging and lifted water jugs (my version of free weights). The house was empty and I was able to collect my thoughts. My senses rejoiced, “peace at last”! Monday night I went out with Katie, Alison, and Michelle to dinner at a Thai restaurant. I filled up on all my favorite dishes and a couple Nile beers of course.

Today I decided to do a pediatric rotation, just so that I could experience it. I picked a doozie… Pediatric Oncology. I have great respect for those that are able to work with sick children all day (like Katie). It is heartbreaking. I know that I made the right decision to go into Internal Medicine because taking care of sick/dying children drains my soul in minutes. One positive note about Pediatric Oncology is that many of these kids will have good outcomes. Peds are much more resilient that adults. Oncology here is very similar to back home with the exception of CT treatment technologies such as CT guided radiotherapy. Much of the chemotherapy is the same as home. For those interested in some of the pathology I saw today… there were many patients with Burkitt’s Lymphoma (Epstein Barr Virus associated) which is pretty unique to Africa. We saw a few patients with retinoblastoma (uni and bilateral), Hodgkin’s, non-Hodgkin’s lymphoma, as well as the other more typical lymphomas/leukemias we see back home.

Tomorrow I will be on the solid tumor ward… so I am sure there will be some interesting and troubled cases there as well.

Sounds like we are going to do our safari towards the end of the month and our rural rotation sooner than we thought… possibly starting on Thursday this week and lasting roughly one week. It will be nice to get out of the city and work in a smaller facility for a while. I am not sure what the internet access will be like out there… so there may be a lull in our blog for a bit.

Well… I am off to search for a safari hat so I don’t turn into a tomato head in a few weeks. Keep up the good comments.

your cancer crusher,

Jon

Mar 3

March 3, 2009

We’ve already begun a new month…the time is going so quickly!

I guess I need to provide an update as to what has kept us away from the internet (or as they say here, intranet) for so many days. As I mentioned last time, we skipped Friday at the hospital and went in search of souvenirs instead. The craft market we were planning on going to didn’t actually exist so we visited a couple others instead! The first was near the National Theatre (a good 30-40 minute walk from our place) and there were many many stalls where people sell various crafts. Some things are just silly (like t-shirts with Mzungu on them) and some things are beautiful (wood carvings, soap stone carvings). The prices aren’t fixed so you have to bargain to get a better price. However, even the prices they first offer are really not outrageous for what you get. Since I love a good deal, I want to bargain for the lowest price I can and also because if you just pay what they initially ask I feel that it just perpetuates the impression that white people have unlimited cash and they tend to look down at you and mock you a bit because they ripped you off so much. I don’t actually like the process of bargaining apart from getting a good deal though and I’m not very good at it either! Sometimes they even make you feel bad for asking for a lower price even though they know they’re charging us more than they would a local. Example: we’ve been given examples of how much it should cost to take a private hire (taxi) certain distances and even when we say how much we’re willing to pay, they try to guilt us into paying them more. We tell the drivers local people have told us how much it should cost but they do whatever they can to get money out of us. Sometimes it’s more frustrating than other times, especially when we actually need their service!

Anyway…the craft market was nice and of course I bought some gifts for my family and then we moved on to the second large craft market which was essentially the same as the first. In fact many of the stalls are nearly identical to their neighbors on either side! It is good to go around and ask prices at different stalls because they’ll all tell you something different and then you get a better feel for how much you should actually pay. I’ll be glad to get back home where you go to a store, look at the price, and if you want it you just pay for it. It’s exhausting having to argue with every seller. We did end up with some good stuff though and now I just have to hope that it will all fit in my suitcase and not weigh more than 50 lbs! Jon is very glad we got our shopping done because now he doesn’t have to go back with me!

One funny story about the shopping…we were trying to find safari hats (we’ll actually need them to prevent ourselves from being scorched by the sun) and at our favorite coffee shop (1000 Cups) they have really nice ones that are inexpensive. However, some of them were used and the man was trying to sell them to us as if they were new! None of them fit Jon’s head, so we’re going to go back later to see if they’ve gotten any new ones and hopefully the new ones really are new!

Friday night we went to a restaurant that is known for it’s wonderful steak…and it really was wonderful! You get appetizers, soup, a main course, and dessert for only 12,000 shillings (roughly $6). All of it was really wonderful and fresh. Two of the girls staying at Edge house left on Saturday, so it was their good-bye dinner. Really, we just like to think of excuses to get everyone together to go for dinner.

Saturday was fairly uneventful. We went to the mzungu mall (Garden City) to go to the big grocery store and in search of safari hats. We got some groceries, but no hats. 😦 We went in search of fans as well to get some airflow in our rooms, but they were really expensive so we decided to just be hot. Alison found soy milk at a natural food store, Jon found pickles (and apparently he was the first person to ever buy them!), and I bought a box of Duncan Heins brownies to attempt to make for Jon’s birthday (I haven’t had a chance to make them yet, so I’ll let you know later if they turn out). We even got a special hire on the way back whose car wasn’t falling apart, was clean inside, and the driver was reasonable. We got his number for future excursions.

Sunday was a bit more interesting. We started the day by going to church with Susan at KPC downtown. This is the church with the Canadian pastor and the church is quite large. The music is really good and the pastor is pretty good too. They do a lot of really great things here in the community. One group is called Watoto (look it up if interested) which is a group of young people, who previously were on the street/orphaned/destitute, they bring together and form a choir which then tours all over the world. I’m not sure what they do about education, but their must be some sort of education given to these kids. Their hope is that these kids will become leaders in their own communities. We met one guy who seemed to be around our age, who had been a member of the group, and he was definitely well on his way to achieving great things! They also help orphaned children to be placed with families here and support the family financially so the child can go to school and have basic necessities. Their goal in all of this is to get the local communities involved and to get them to take care of their own orphans. However they’re organizing these things, they seem to be doing a good job!

So after lunch, Susan took us to her house and made us lunch. She made way too much food and complained that we didn’t eat enough, but we both had 2 plates full of food! She made ‘American’ matoke (she put spices in with the bananas and then didn’t mash them up) and it was actually much better than any other matoke I’ve had! She also made the staples of rice, beans, g-nut sauce (also better than the hospital’s), potatoes, and chicken (which was really good!). One of the best parts of the meal was definitely the freshly squeezed pineapple-passion fruit juice (we watched her make it). Delicious! After we ate, we just sat in her living room and talked for quite some time. Susan likes to tease Jon about being single and relentlessly tries to set him up with someone. Now she has even started praying for him to find a woman! She doesn’t think he should be single any more I guess…we’re not really sure why she’s decided this, but there is no changing her mind.

She gave us her opinions of Americans and says we are so confident and although she admires our confidence, she thinks sometimes we are too confident to the point that we’re annoying and egotistical. She has said several times that Americans act like they own the world and that we can push other people around. Sadly, I’ve seen several American students try to do this and it’s really frustrating to watch. I think sometimes they forget that this isn’t America and things will be different here. Obviously we all get frustrated when we’re put in a completely unfamiliar circumstance, but there’s really no reason to be rude. Thankfully, Susan doesn’t seem to think Jon and I are like some of the Americans she meets (she says we’re very quiet and calm no matter what the situation and for some reason she calls me ‘the Queen’! I haven’t really figured this one out, but it is funny) and there are things she really likes about Americans too. She thinks our dedication to work and generally being places on time is good and she wishes the opportunities for education that we have would be something attainable here.

There really isn’t such thing as school loans here to my knowledge, so it’s difficult for people to get an education beyond high school. Many children don’t even get a high school education because their parents can’t afford the school fees. Although there are plenty of Americans in the cycle of poverty, we still hold on to the belief that if you work hard enough you can make it. Here, I think this concept is much more difficult to attain. It’s not impossible, but in some cases I think it’s pretty nearly impossible. For starters, the opportunity for a good education isn’t free and good healthcare really only exists for the wealthy. It’s not that the doctors and nurses at Mulago don’t try, there are just very limited resources and the government doesn’t seem to put the money towards preventative medicine or even basic health needs. As if the lack of money isn’t enough, they struggle with communicating with patients due to a lack of education about medicine specifically. There is still a lot of witchcraft practiced and we are told these ‘doctors’ often specifically tell patients NOT to seek western medicine or their loved one will die. There are also a lot of people who believe evil spirits have given them HIV or whichever ailment they have. Imagine trying to explain pathophysiology to patients to encourage them to understand their illness and therefore take care of themselves, while the patient is convinced the hex their neighbor put on them is the reason for the illness to begin with!  It makes everything so much more complicated.

While I was on the sickle cell ward, the doctor explained to me that people don’t understand that sickle cell disease is a genetic condition which is passed on to a child from both parents (the average person in the US doesn’t know much about sickle cell either, but here 6% of the population has it and even more of the population are carriers).  Often one parent will blame the other because only one side of the extended family actually has the disease.  What they don’t realize, is that each person contributes 50% of the genes for the disease.  To put this in perspective, it’s a similar mechanism to how Cystic Fibrosis is transferred in families.

I digressed, but now back to the weekend.  After lunch and conversation with Susan, we went back to Edge House and got Alison and then headed for Wande Geya (although I haven’t mentioned this before, this is the area of town we live in) to get a special hire to the Ndere Cultural Center.  There’s a dance performance there 5 nights a week, but the best shows are on Sundays.  Alison’s family knows the man who is the director, through another friend, so we got to meet him at the end of the show.  The whole evening was wonderful.  There was a buffet for dinner and while we ate we were entertained by traditional Ugandan music and dancing.  The performers were really good (at one point, the women each had 7 pots balanced on their heads while they continued wiggling their hips back and forth and dancing around the stage!!) and the director (who acted like an MC), was hilarious!  While the performers were changing their costumes, he would give anecdotal stories, nearly all of which were very funny.  One of the first things he talked about was the lengthy Ugandan greeting process.  Instead of just walking in and asking a clerk at the store what you are looking for, you have to greet him/her for 30 minutes.  You must ask about his/her children, parents, siblings, goats, cows, pigs, the farm, and anything else that comes to mind.  He also said the reason Ugandans are so poor is because they spend all of their money on phone bills!  Instead of making the calls quick, in order to get the information you need, you first have to greet the person on the other end for several minutes at which point you may have run out of money to ask whatever it was you needed to know, so then you have to buy more air time and start the whole process over (including the greeting again and now adding an apology for being cut off!).  We thought this was particularly funny because we’ve noticed it so often!  A child may be convulsing, but before anything is done, you better make sure you greet each nurse and physician and even medical student!  This may be a bit of an exaggeration, but I assure you, it’s not much of one.

I’m talking so much through this blog that no one is going to want to listen to anything I have to say when I get home.  In fact you’ll probably all be able to tell the stories to each other so I really won’t have to do anything!

Did I tell you about the toilets that are literally holes in the ground?  Well, that’s really all that needs to be said about them.

Yesterday I went to St. Stephen’s again with Dr. Holt and Jon decided to take the day off because he’s getting so old he needed some extra rest.  I think many people would call this being lazy. 😉

Today we both went to the cancer ward and rounded with two doctors who seem very great.  Let me tell you what distinguishes the ‘great’ doctors from the ‘not so great’ ones in my mind.  The great ones are those who talk to their patients, communicate with them, and also communicate with us whities who can’t understand anything that’s going on unless it’s in English and spoken at a fairly loud decibel.  We actually even got in trouble a couple of times for not paying attention!  Although at home I’d be mortified, here I was kind of glad because at least they cared enough to notice we weren’t listening.

Obviously the cancer ward isn’t one of happiness and joy, but many of the cancers are treatable and especially if they’re caught early.  Of course they’re not often caught early, but they do the best they can.  Still, it’s great exposure and there are cancers here that are very uncommon at home.

Sam, the director of the Ndere Center, has asked me, Jon, and Alison to join him at a rural site where he has a project to help children.  We’re not entirely sure this is definite, but we’re hoping.  Apparently this rural site would be a great opportunity, so great, that Susan told us to stay the whole week and work at the hospital there!  We were a little surprised by this, but it should be fun.  Dr. Holt told us the hospital is terrible.  Worse, way worse, than the government hospital in Kampala.  A medical school was started there 3 years ago, and the hospital is so terrible that the medical students actually had a strike against it.  I don’t know if anything changed after that, but by the way he made it sound, it doesn’t seem like much was improved.  There is also a private Catholic hospital he said we should tour and another hospital which is supposed to be state of the art.  He’s not sure if it’s been kept up, but some philanthropist from Europe built it thinking it was a good way to make money (he must not have been very smart to think a hospital would make him money, and especially a hospital in a developing country!).  There is also a displaced person’s camp there which will be heart breaking, but yet somehow still a good experience.

We may also have an opportunity to go to a remote village on an island in Lake Victoria.  It’s a couple hours south of Jinja and it’s called Lingira Island in case anyone wants to look it up.  In order to get on the boat to get to this island, we have to be carried on a man’s shoulders through the water!  The men charge 500 shillings per person (roughly 25cents).  I’m worried about keeping my pump dry, but I’ll talk to Dr. Holt and make sure he thinks it’ll be ok.  I’d really appreciate prayers about it though as I don’t want to miss this opportunity.  Thanks!

I don’t think I have any more news (sure you’re glad for that seeing how long this is!).  Hopefully we’ll know more about our trip to the wilderness soon!

Until next time,

Katie

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). 🙂 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. 🙂

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. 🙂

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!