lions, zebras, and elephants...oh my

Hi all!
So we have returned from safari and had an awesome time! I put the itinerary up before we left so I will try to spare you exhausting details and just go through the highlights. The pictures really tell the story the best, but I will have to wait to scho you those until I get back in the states.

On Saturday we met our driver and guide, Joseph and Mike who took care of us for the next 5 days. We had an awesome land cruiser to travel in, with a roof that pops up so you can stand during the game drives and get the panoramic view. I am not going to lie, we felt cool standing there with the wind blowing, hehe.

In Lake Mburo, we saw more zebras and impalas than we ever expected!! Both of these are not seen in other parks in Uganda. We also got to hike here, of course we were with an armed gaurd...but we got to see all the animals including the zebras on foot! Our banda where we stayed had a pit latrine about 30 meters outback, but the path was closely gaurded by warthogs, and after they started chasing each other and almost ran into me during the day, I did not venture out at night. As we sat reading our books by carosene lantern at night, we were lulled to bed by the howel of the hyenas. All day long, Mike and Joseph had been slowing down, pointing out and naming animals and birds. So on of the highlights of the day was when Lisa and I had our heads out the roof and the car started to slow as we approached a tree, at which time Mike shouted up to us “mindurface”...my reaction was “where where..i don't know that bird” well its not as funny on paper, but it was in real time!

Sunday afternoon, we drove off to Bwindi Impenatrable Forest National Park to get ready for gorilla tracking the next day. It was a long bumpy drive on dirt roads that left the red dirt of africa plastered to our skin and clothes. We got to do a little craft shopping and see the local orphans preform songs and dances typical of different tribes throughout uganda. Of course they had really cute pictures and crafts to sell afterwards! It is amazing how the community absorbs the orphans, and they all live in foster homes in the local villages.

Monday was an early morning to get off and see the Gorillas. There are about 700 mountain gorillas in the whole world, 350 of which are in Uganda, the remainder in the bordering DRC and Rwanda. In Bwindi, where we left from there are 2 families that are habituated, and 8 people can go each day (for a pretty large fee!) We got to see the Habinyaja family, which has 23 members, 2 of which are the male silverback gorillas. Each on has a name based on there features such as the local word for lazyeyed, playful, ect. There were 6 of us total, and we had a 1 hour drive up the mountains, at which point we started in on our trek through the “impenatrable” forest. Honestly, the thickest jungle I could even imagine. We were led through the forest with rangers carrying machetes to cut the way. The trackers were a few hours in front of us and guided us where to go, so the hike in was only about 1 hour. When we got to the gorillas, we got to spend 1 full hour with them, but it flew by! Because of how close we are genetically to the gorillas, they were really strict about how close we can get, sneezing/coughing/letting sick people come, and no eating/drinking near them. They truly are gentle giants! We estimate we saw about 17, including 1 silverback, many blackbacks, females, juvenilles, and babies! The young ones were the best to watch, they would restle like 10 feet from us! We didn't even seem to phase them. I have so many pictures and videos that I will share when I get back.

After seeing the gorillas, we took a short hike to see some of the pygmies, the traditional forest people that are known for their light skin and short stature in comparison with most african tribes. We were actually a bit dissappointed by this, they built a mock house, and about 6 came to sing and dance, but they wouldn't let us go to there village. They were much taller and darker than we expected. We were told that during Uganda's conservation effort in the 90's, the pygmies were given land outside the forest, and since then their nutrition has improved so they have become taller and darker as a result of being out of the forest. Insteresting... Well they did some singing/dancing which was a cool way to end our stay at Bwindi. Next was off to the Ishasha sector of Queen Elizabeth National Park.

In Ishasha we stayed at the bandas, which we were the only people there, we even had our very own 2 armed gaurds camped outside our banda. Since we were the only people there, we moved our table out under the stars and had an awsome star and moon lit dinner to the sound of hyenas and hippos near by. We even got to see a hyena run across the grounds about 30 meters away at dusk!! We couldn't see the details, but you could see that it was a hyena...something that isn't commonly seen because it is nocturnal. Immediately when lisa and I walked into the banda we knew we were in for an interesting night. The banda was very nice and clean, but we had become familiar with the smell of bat droppings, and this was definitely that. I think I slept a total of 1 hr as I could hear bats and mice or rats above our heads between the ceiling and the roof. Not the highlight of the trip.

That next morning though we got to leave to do a game drive in the Ishasha section of QENP. We had heard how hard it was to see the tree climbing lions, but we got lucky@!! Only like 15 meters from the car, up in a fig tree was a male and a female, just relaxing, presumably after a night of hunting. Apparently this is the same lion species as in other parts of the park, but they have just culturally adapted to climbing the trees.

Then in the afternoon we headed to the north of QENP where we saw more animals than I could have hoped for! When we came around a corner, we almost ran into an elephant eating in the middle of the road...after backing up to a safe distance, we got to watch the heard of elephants, 17 total with 8 baby elephants, cross and eat. We also got to get incrediably close with a boat ride up the kazinga channel. At our hostel, there where mongoose families all around. At one point I had stepped out and left our door open, at which time one of the adults decided to explore our room. I went in to try to get it out, and could not origanally find it, until it jumped out at me with its long claws. The whole lawn and bar laughed at my girly scream...I was pretty embarressed. Some of our friends from the UK got to see some lion cubs and a python that night, but we missed them.

Finally Wednesday morning was a game drive in QENP before heading back to Kampala. Our guides had heard 2 lions fighting, so within minutes we found a huge male lion with the huge tufts of hair. It was clear he was injured from the fight as he was limping and breathing very fast. After this, we had a nice long game drive that the best part was finding 2 other male lions right next to the road, the car was within 5 meters! So cool!

Final Animal List: Warthog, bush buck, water buck, impala, kob, oribi, topi, zebra, elephants, lions, tree climbing lions, hippos, crocodiles, african buffalo, mongoose. ALOT of birds that I can't even name them all. I don't think I missed any mammals.

So in conclusion, amazing trip, at a very resonable price, besides the gorilla trekking permit of course. We have today, thursday to tie up loose ends in Kampala (buy presents) and then off on Friday, long layover in London where we are going to go to the tate modern and drink strongbow, and then back on Saturday. Probably no more posts until I am back in the states! Thanks everyone for staying tuned, it means a lot to me! Miss you all.

Crystal

Going on SAFARI!!

I like the way that sounds!

So today we traveled back to Kampala in order to leave tomorrow morning for our 5 day trip around the southwest part of Uganda. Besides some bruises on my legs from the buckles of my backpack that sat on my lap during the 3 and a half hr drive, the trip back was typical for African travel on matatus. We enjoyed some more of the amazing indian food here in Kamapala and got ourselves ready to leave tomorrow. I also started my present shopping, so like I said, anything you really want be sure to tell me soon.

I am going to paste the itinerary for our safari below just so people have an idea of where I will be...just in case. Probably won't have internet at all till next Thursday, so you probably will not hear from me. We got an amazing deal on the safari and are paying 1/4 of what others pay :) don't worry it isn't schetchy, our friends just got back from the same trip!

Crystal


Safari Itinerary Uganda- Gorillas & Wildlife.

2rd –May ‘09: Depart for Lake Mburo National Park
Depart Kampala for Lake Mburo National park making a brief stop over at the Equator for photos and thereafter proceed to the park arriving in time for lunch. In the afternoon embark on a game drive in search for the Zebras, Impalas, Buffaloes, Topis and a prolific birdlife.
Accommodation: Rwonyo Camp.

3rd –May ‘09: Lake Mburo to Bwindi
Today early in the morning at 6:30am go for a nature walk in the park. Remember that this is the only park in Uganda where you explore the wild while on foot. Look out for what you missed on the previous drive. Return to the camp for Full breakfast and thereafter transfer to Bwindi Impenetrable National Park.
Accommodation: Bwindi View Rest Camp.

4th –May ‘09: Mountain Gorilla trekking
Morning breakfast, get ready with our packed lunch, cameras, water, rain jackets, long pair of trouser and jungle boots, you will assemble for briefing from the rangers about the gorilla tracking the great adventure and experience! The time taken to encounter these peaceful primates is unpredictable for may take 3 to 8 hours. You sit in the forest among the gorillas listening to them grumble at each other and marvel at the size of the dominant male, the silverback. It’s amazing to think that there are only 650 or so of these creatures left in the world.
After this awesome trek, transfer to Ishasha sector (a home of the tree climbing lions)
Accommodation: Ishasha Bandas.

5th-May ‘09: Game drive in Ishasha.
After breakfast, embark on game drive in search of the animals like the Topis, warthogs, Elephants, buffaloes and towards the late morning hours search for the tree climbing lions.
Return for Lunch and after transfer to Mweya.
In the afternoon embark on a two hour launch trip on Kazinga channel for an amazing bird life and a variety of wild animals.
Accommodation: Albertine Lodge (Mweya Hostel).

6th-May ‘09: Queen Elizabeth to Kampala.
Have breakfast packed and go for a game drive along Kasenyi track and animals such as Lions, Elephants, buffaloes, Warthogs, Kobs, giant forest hogs and a variety of birds will be seen. Thereafter, drive to Kampala.

Fairwell Tororo...last day of medical school ever!!

So today is our last day in Tororo. I have come to really enjoy this small sized city/town. When I first arrived, I learned very quickly that it did not take long to see the whole town. There is one main round about and a few streets that come off that. With only a few true “roads” the city then branches off to many communities off dirt roads/paths. I would have loved to see Tororo during its hay day in the 1950’s 60’s while Uganda was still a British protectorate. From my observations and talking to people it appears that Tororo was a busy business center back then, which is represented by nearly every building in the city center being built during this time. However, not much in regards to building or repairs has been done since then. The majority of the buildings are run down with windows blown out. In no way though does this reflect on the nature of the people, everyone hear has greeted us with open arms saying “you are welcome.” As you walk around Tororo, from the distance, you can see the roof tops of temples and if you follow the sounds of prayers 5 times a day, you can see the masques, and the muslim influence on the community. It has been great to be in a town where I don’t have to worry about dying while crossing the road. We have met so many people during our time here, that often I will walk down the road and hear my name called, but I can’t see from where, someone passing in a car must have met me along the way. To run into friendly familiar faces has been great.

Today being our last day here in Tororo, makes it also my last day of medical school!!! Lisa and I are going to celebrate tonight with Dr. Welishe by having a beer….or two. Today we traveled to Kiyeyi, a health center level 3 a 1 hr drive from Tororo on a dirt 4WD only road. This and smaller health centers is where the majority of Ugandians really receive there care. When we arrived, there were patients sitting outside on the concrete steps, waiting for the nurse who staffs the health center to arrive. We were able to tour the grounds. Dr. Welishe had already informed us that this health center needed a lot of work. Apparently 2 American women donated 10K dollars a few years ago to go towards an electric water pump so that it would have running water, electricity, fumigating to get rid of the hundreds of bats that set up home in various buildings, repairing the roofs that blew off in a rain storm, ect. Of the 10K dollars, 2K has been spent, and the other 8K has “disappeared” in the university deans office where it was donated too, basically none of the repairs have been completed. The water source is a hand pump 50 meteres from the health center, and over 300 m from where all the staff live. The maternity ward that used to deliver all the local mothers and have 2 midwives, lost its roof 3 years ago, and they have since not been able to repair it. The walls are crumbling under the amazing African rain storms and domesticated animals roam through where children used to be delivered. With out a maternity ward, the midwives have long since left, and local pregnant women usually deliver with traditional attendants (no formal training) or must travel to Tororo or a health center 4 that is closer, but the doctor is often in Tororo working at his private job.

As we rounded the corner, we ran into 5 2nd year medical students that were living on the grounds during their 6 week “COBES” rotation that aims to put medical students in the more rural environment to encourage them to practice there when they graduate. However, they were staying in bat infested housing, with no running water or electricity, with the nearest trading post 2 km away that they had to walk too, and that had very expensive prices. It was nearly unanimous that this experience was not going to encourage them to come back to the rural setting.

So I have seen the health care in Uganda, from the epicenter in Kampala, Mulago Hospital, to the smaller health care units that you can only get to by 4WD roads. This experience has only further confirmed that I want to do some international work during my career. What that will eventually entail? Stay tuned 

Crystal

oh the pathology

Hi All,
So this is my 4th week in Uganda and my 2nd week in Tororo. We started off the week on Monday in the women’s ward doing rounds. The first patient we saw was a 60 yo women with type 2 diabetes that was initially placed on insulin but had run out and came in with excessive thirst, urination, and neuropathy. It was interesting, because the wards are basically run by clinical officers (like a PA or NP) but there is supposed to be a doctor responsible for that ward and rounding on those patients. At Mulago, we saw the attending physicians coming 2-3 times a week….in Tororo we saw them come barely once a week, and the clinical officer basically does all the work. So, Dr. Welishe was brought to this patient in specific cause it was Diabetes, something the clinical officer was not as comfortable managing. You give the C.O. HIV, malaria, Tb, multiple other infectious diseases, they would have no problems. It is just interesting to see the differences in causes of morbidity and mortality! So Lisa and I had a lot to contribute with the Diabetes patient (ACE-I’s, education on foot care, urine proteins, ect) and we ended up changing her from insulin to metformin (her pancreas can still produce some insulin)

One of the more interesting patients of the day was a young girl, age 8, with anasarca (generalized edema and swelling all over the body). We questioned why this 8 yo was on the adult ward and realized that the pediatric ward was all children under 5 and everyone else goes to the adult wards. Dr. Welishe said that with the huge amount of disease affecting children under 5 and the high mortality rate for <5yo the peds wards are to swamped to take older kids. They don’t even have beds on the peds wards to fit kids bigger than 3 ft  So this poor little girl probably had nephritic syndrome (where your kidney’s can no longer keep protein from draining out of your body in the urine). This rotation has been great, because even the #1 cause of nephritic syndrome in children is different her because of the frequency of infectious diseases. At the same time, she had a huge palpable spleen and renal mass. We aren’t sure yet what the renal mass is, but immediately I thought of a Wilm’s tumor, but Dr. Welishe mentioned that here they also have to think more about Burkitt’s lymphoma.

Another interesting patient was a young girl, 8 yo also, who had “fits” epilepsy and was brought in with an absolutely awful desquamating rash, with open ulcerations all over her body. As we were seeing the patient next door, see was cuddled up in a ball so small, I first questioned if she was missing the lower half of her body. She shamefully covered her self with her single sheet on the bed, with just a few inches of open ulcerated skin showing. When we finally saw her, you could see that the skin eruption involved her whole body including her eye lids that had sealed her eyes shut and her mouth to the point where she could not swallow and saliva was slipping down the outside of her mouth. The “sisters” nurses informed us that she had improved since yesterday. When questioning the family, we got an unclear history of whether she was treated with anti-malarials or anti-epileptic medications. This was Steven-Johnson syndrome, something I have seen 2 other times here in Uganda, but not nearly this severe. The rash is most likely from an anti-epileptic medication she received.

Some other interesting patients we saw included a epileptic women with 3rd degree burns on her breasts from falling into a cooking fire during a “fit”, a women with HIV wasting syndrome and severe obstructive jaundice and hepatomegaly which we placed on palliative care, a patient with probably typhoid fever, a women with a patellar tendon rupture for the past 3 mos! Interesting physical exam finding for the day was a seropositive women (HIV) with nodular hepatomegally. You could see the edge of her liver and the nodules with every breath and they became even more apparent on palpation.

We also recently saw a patient with herpes zoster (shingles). Immediately when he got shingles they gave him an HIV test, and the man was incredibly distraught cause he had shingles so he assumed he had HIV. When his test came back seronegative, he didn’t believe it. In Uganda, a patient with zoster, has HIV until proven otherwise. We had to convince he that he didn’t have to have HIV just because he had shingles. In the states we usually don’t think twice about shingles, unless there is something else to make us suspicious of HIV.

Some other notes about things I have learned. The hospitals often run out of many of the medications. This includes Tb drugs. Uganda has had no Tb medications since January (I may have mentioned this already) and I think is in the process of getting some more  We talked to one doctor who when he has 3 patients who need Tb treatment, he fudges the numbers and says he has 6….the patients of this doctor have had there medications this whole time. Is this ethical? He is reducing the amount of resistant Tb by providing continuous treatment for his patients, on the other hand he is forging the numbers to get these medications, and this may causes a shortage somewhere else. Interesting ethical dilemma I think! Something else I learned is that when hospitals are out of amoxicillin, it costs 1,500 schillings from the pharmacies in town. This is the equivalent of 75 cents, yet, when the hospital runs-out a good majority of the patients can not afford it. This experience has really taught me the importance of taking to patients about their resources and what they can afford before prescribing medications or recommending certain studies. If you prescribe a medication, but it is to expensive so they never get it, you are really not helping them at all. I have also been noticing the shy nature of the women I have seen on the wards and in the clinic. Women rarely look any of the health care workers in the eye, are very quite, and only speak when spoken too. It is much more of a paternalistic, doctor knows best mentality, than what I am used to in the states. Just an observation.

Yesterday, we spent the day in the antenatal ward, labor and delivery. When we arrived with Dr. Welishe, we were greeted by the many midwifes. We soon learned that the last time the doctor responsible for the ward had rounded with the midwifes was March 18th, yes that’s right, over 1 month ago. Luckily, the midwifes know there stuff, but you could tell they appreciated the rounds with Dr. Welishe to learn more and think outside the box. I won’t talk about this too much, it was a lot of the same things you would see on a maternity ward in the US. It was interesting however to see how they combat HIV transmission from seropositive mothers to the newborns. During the mothers antenatal visits, the are given an antiretroviral for labor (if they are not already on) and an antiretroviral syrup for their newborn to take home with them. 85% of women in Uganda attend an antenatal clinic, however only 30% deliver by skilled mid-wives or doctors. By giving them the medications ahead of time, if they do deliver in the village, they can still do there best to prevent transmission of HIV to their newborn. The other big highlight was seeing a mother who was G13P12, great-grand-multiparous, that means it is her 13th pregnancy. I know that used to not be a big deal, but that was the highest I have seen. Listening and trying to count out the fetal heart tones with the fetoscope, 5 inch long “acoustic device” caused some challenges in comparison to the fancy Doppler heart tones we are used to hearing!

Today was Operating Theatre (OR), Lisa has been looking forward to this ;) When arriving to the door of the theatre, you immediately have to take off your shoes. Luckily I was informed of this and had my handy dandy socks with me. From there we were able to change into our scrubs and put on the huge white rain boots that we are allowed to wear in the OR, along with the cloth hats to cover our hair and the cloth masks for our face. The OR has one set of instruments that they have to sterilize between cases, so by the second case, the metal instruments were scalding hot from just being cleaned. Today there was a appendectomy, a hernia repair and a lipoma removal. Lisa, future surgeon, did the lipoma removal with some assistance from Dr. Welishe. I on the other hand, was much more interested in the anesthesia. The available medications included thiopental, succinylcholine, ketamine, diazepam, atropine, and ether as the inhalation anesthetic. I have never seen ether used, so I was eager to learn about it. On the second case I was able to do the intubation, and run the anesthesia. This consisted of hand ventilating through the case since there is not a ventilator  Oh and also adjust the ether…it gave me something to do! By the last case, they had run out of sterile gowns, gauze, drapes, so from there, all other elective cases were put on hold until they could be replaced. It was a good day in the OR.

Well I will try to wrap things up, but I want to leave you with one story. A few months ago, Dr. Welishe was at the hospital when he received a phone call from one of his fellow doctors at the hospital who is responsible for the labor and delivery. This doctor said he was in the labor and deliver ward, and he had a patient with obstructive labor that needed to go to the OR for a c-section. The doctor mentioned that he was not feeling well and that he would appreciate if Dr. Welishe would do the case so he could go home and rest. Being the nice man he is, Dr. Welishe agreed. Immediately after the case, Dr. Welishe traveled to Mbale, 40 km away to pick something up. On the side of the road he saw this doctor waiting for a taxi to take him back to Tororo. Turns out, the doctor was never at the hospital, he had been at a private clinic 45 minutes away all day, to earn extra money and do tubal ligations. When a urgent case came in and he was not there…he called Dr. Welishe and said he was sick. After all this Dr. Welishe picked him up and gave him a ride back to Tororo with out a word.

So I leave you with that. With all the Swine flu, Lisa and I are anticipating an interesting return to the states since we are coming from London, so we will have to follow it closely.

Miss you all,
Crystal

"Haw ar u muzungu"

Hi everyone! Well Lisa and I just got back from a mini vacation  On Thursday we went with Dr. Welishe to the Kumuju Health Center 4. Basically this is a small clinic, that has a very small ward, that is down a dirt road about 25 minutes from Tororo. This center has 1 doctor that runs it, and the smaller health centers (3,2,1) have no doctors, we will see them next week. We spent the day seeing patients, and the highlight of the day was probably when a chicken walked into the exam room as we were examining a patient. No one, besides Lisa and I, thought anything about it ;) Random animals tend to be all over the hospital grounds, chickens, goats, cows, you name it. After clinic, we decided to be brave and go running on a road that leads out of town. Although we didn’t get as much attention as when I went running in Ghana, people definitely looked at us funny and of course, the children would laugh and giggle then try to race us. I have been walking a lot, but that was my first official exercise in a while.

There was also a horrendous rain storm which Lisa and I watched from the comfort of our balcony. At one point a whole fence came out of the ground. The best part about it though was that we grabbed Lisa’s Ipod and listened to Toto “Africa” and sang over and over “I felt the rains down in Africa” over and over while dancing….I think some locals across the street got a laugh out of it.

On Friday morning we came in expecting to go to “theater” the operating room. Dr. Welishe had a hernia repair, appendectomy and lipoma removal scheduled, and Lisa was going to get to do the hernia repair (she’s going into surgery). When we got to the hospital, we got the bad news that there was no water!! Anywhere in Tororo or surrounding. (Clearly we didn’t shower that AM to notice ;) It was amazing to think that there was just no water for a few days! There was a bit of water reserved for fires, and if an emergent surgery needed to be done. This did create yet another brilliant comment from Dr. Welishe, “there is a shortage of everything here in Uganda, besides Pathology.” So, our cases got post-poned and Lisa and I decided to leave for our weekend trip to sipi falls a bit early!

We hoped on the matatu to Mbale, which was crowded as usual with 4- 5 people per row, no dead chickens though! In Mbale, we had to make our way to the taxi park. While I was exploring the map, Lisa’s hand was grabbed by a man who immediately professed his love to her and would not let go, after prying his fingers 1 by 1 off her hand, Lisa was again free and we were on our way. Yet another crowded Matatu ride, and we were in the “town” of Sipi which sits on the foothills of Mt. Elgon, near the border to Kenya. We stayed at a great place that had dorms and bandas that overlooked the sipi valley and sipi falls. It cost about $15 for the two of us, which worked out really well, we had a shower, pit latrine and a dry place to stay. Best of all, the view from our pourch was amazing! From there we met Joseph, who would be our guide for yesterday and today. We went on a 3+ hr hike up and up and up, then finally back down. We wound our way around through small villages that you can only get to by trails, no roads, with a ridiculous number of children screaming at us “haw ur u muzungu” at times we were in the fields or forests so we couldn’t even tell where the little voices were coming from, but clearly they saw our white skin reflecting the sun. The hike was absolutely amazing because we saw the day to day life in the very rural setting, people cooking, women clearing fields with babies on their backs, you name it. Everyone greeted us so warmly, and I even got a stab at saying hello and how are you in the local language ( I learned half way through the hike that the languages had changed and I was speaking the wrong language to a different tribe…oops) Then the hike came through the eucalyptus and acacia trees the series of 3 falls that make up sipi falls. We also wound our way through coffee fields and learned about how they harvest and roast the beans…pretty cool!!! The children would laugh as we would slip and nearly fall in the much with our tennis shoes, then they would have nor problems barefoot. For being a “tourist area” we were the only people around, so we had it all to our selves. At the second falls, I got to go under the falls and take a mini-shower. It was paradise!!

During our hikes we learned that Joseph our guide was 1 of 17 children and that his mother was the first of 4 wives of his father! I asked him if he was going to take many wives, but he assured me that one women was enough!

That evening, Lisa and I went to a nicer hotel to eat dinner. We had the restaurant all to ourselves, and we had told them earlier what we wanted, so that cooked the food especially for us! 2 people later came though as we were eating desert. It was a really good 4 course meal overlooking sipi valley as the sunset…once again we have had our share of romantic dinners. When dinner was complete, it was already dark out, and as we left the restaurant we realized that Sipi did not have power and that it was going to be a dark ride home along the road. I don’t remember the last time I walked so fast, but, I was not a fan of walking along the road in the darkest dark night I can remember, with random animals crossing the road that I couldn’t identify, we had my head lamp, but we were glad to arrive back at the hotel.

This morning, we got up early, read our books as we watched the sunrise over the waterfalls, then took off early for another hike. Our goal was to make it to Mt. Elgon National park and hike in the park some, but when we got to the park, we decided that it would be too expensive and we decided that our hike with Joseph around the park for 4 hrs round trip would have to be enough. Once again, we were meeting people as they tended their fields, walking 2 ft from their mud homes with banana leaf roofs, with children behind laughing at the muzungus…good day! At one point we approached a family in the field, and suddenly a 2 yr old girl screamed, ran away from the trail we were approaching on, was balling and buried herself in her mothers skirt. Joseph then told us that her older brother told her that the muzungus wanted to take her and that we where going to steal her. Clearly we scared her 

We had a very uneventful ride back to Tororo. We were lucky enough to grab a ride to Mbale with a man traveling that direction (of course for a price) so we ended up sitting in the back with 2 school girls (ages 5 and 6) and their chicken…or dinner for that night. The girls where clearly terrified of us, but eventually they warmed up! So now we are back in Tororo and going to church tomorrow morning with Dr. Welishe.

Miss you all.

Crystal

“Lisa, Where does a fish start rotting first?” “Your sons will curse you”

Last night Lisa and I had yet another romantic dinner together. Somehow we are still coming up with things to say at the table, despite that we have been together for 2 and a half weeks straight…almost. In Kampala we had amazing food options, ranging from thai to Indian to Chinese and “American” but now in Tororo are options are basically all local food. We don’t have a kitchen, so basically every meal we have to eat out. Luckily a plate of roast chicken and “chips” (fries) is about $2 and local ground nut sauce ( peanut sauce) with rice/matoke/chapatti is about $1. We are gradually making our way through all of the restraints in Tororo that would be recommended for us to safely eat at and what we are noticing is that although each menu has lots of items, in reality there is usually 3-5 choices for dinner. We usually ask if they have a couple things we want, then just ask what they do have. Last night we decided we wanted pasta for dinner and ordered spaghetti napoleon. They agreed but said it would take 15 minutes. 45 minutes later, after watching our waiter go out and buy the tomatoes and spaghetti, we had a delicious spaghetti to eat  For lunch we are usually fine with eating on the go, but since we learned it was rude to eat on the street or while walking we have opted for more relaxed lunches. Basically everything is more relaxed here!

Today we spent the day at a private hospital in Tororo. I am continually amazed by the hospitality of the people here! We are continually greeted with smiles and “you are welcome” by the hospital doctors and staff and by huge grins and waves from the children that run out to see the muzungus. Even in the market and things, people bend over backwards to help us find things…of course they try to sell us lots of things too. Back to St. Anthony’s the private hospital where we spent today. Dr. Jute, the hospital administer showed us around all the wards and basically gave us free reign to experience how things work. The hospital is government and church subsidized, however patients still pay for the services they receive. There is a cashier’s office where patients go to pay before they have labs drawn. In contrast to Tororo hospital which is government funded and free, the private hospital has some more resources, I would not say a lot though. After our grand tour, of the amazing grounds with a view of Tororo rock ( a huge hill that stands apart from the flat surrounding), and the crowded shared wards typical of all the hospitals in Uganda, Dr. Jute set us free to work with Dr. Patrick who was running a chronic medical condition clinic.

This was the first time I had really encountered Hypertension, Heart disease, and Diabetes as chief complaints! I am sure that some of the patients I have seen have had these issues, but as they there hypotensive from sepsis, it is not at the top of the priority list. A lot of this is because I have spent most of my time at Mulago in casualty where the sickest of the sick are brought in, literally on deaths door. So it was interesting to see how some of these chronic diseases or “diseases of affluence” are managed. A huge priority is placed on deciding medications that patients will be compliant with based on cost and how frequently they must take the medicines and number of medicines. Dr. Patrick is a general practitioner, and it was nice to be able to weigh-in on management of heart disease since we have so much experience living in the US ;) For instance we had a very interesting conversation on the use of Beta blockers in patients with heart failure to prevent remodeling of the heart. One other interesting thing from today is that we saw a women with lots of small marks over her abdomen. I asked Dr. Patrick what they where and he told us that they were “therapeutic marks” or small cuts placed on the body by traditional healers to try to cure disease. I found this interesting. I didn’t get a chance to ask her if it worked.

Today was filled with lively conversations. The first of which was with Dr. Patrick. After telling us that we should have read the entire 600 page tropical medicine book I had in my hand before I came to Uganda, he also wanted to talk about us being women doctors. He made mention of how busy we will be with Lisa as a surgeon, and me going into emergency medicine and continued to say “your sons will curse you” and talk about how he resented his mother for being a school matron. We tried to investigate his feelings a bit further, but it was clear that he did not think it was fair for women to be professionals work a lot and have families. He is definitely the exception here in Uganda, I have met many female medical students and been welcomed by most other doctors. We politely ended the conversation with “that is why we will have husbands to take care of the children” ;) wink wink

Yet another interesting conversation occurred with Dr. Welishe and Dr. Jute. I have found that when you put Ugandian Dr’s together, they tend to vent their frustrations with corruption, and lack of resources. At one point while they joked, Dr. Welishe turned to Lisa and asked “Lisa, where does a fish rot first?” This was met with a confused look on Lisa’s face and a prolonged, uhhhhh. Meanwhile I sat trying to scientifically make a decision about what part of the fish rotted first. The two Dr’s laughed histerically at our reaction and said….”from the head”….stating that corruption starts from the top and spreads down through the rest of the “fish.” Definitely, the highlight of the day. I later commented that if they rotted from the head, the current US health care system was rotting from all over. My personal opinion I guess. The conversation was continued at lunch over fanta and biscuits. Actually a very interesting conversation with Dr. Jute comparing and contrasting the Ugandian and US medical systems. I think Dr. Jute was suprised to hear how messed up we thought the US health care system was. Maybe even relieved to hear that even US doctors (or future doctors in a few weeks, hehe) have frustrations too.

Well, that concludes my day of intersting conversations and learning about managment of "diseases of affluence" in Uganda. Besides that, Lisa and I wondered aimlessly around Tororo trying to find the craft market that apparently does not exist, or we just can't find it. The only other excitement is the amazing afternoon rains. The last few days at about 3 pm there has been just rediculous down pour! Today we watched it from the comfort of our hotel room pourch and watched it take signs of buildings, pick up a fence with metal and wood steaks and through it across the street. When we re-entered our hotel room, there were puddles everywhere from the water that came underneath the door. I have never seen rains like this...not even in Ghana ;)

Goodnight for now, mom just called me...she has a free calling card??? I am paying for internet by the minute, so she is calling back in a few...look forward to hearing how that works!

Crystal

Tororo!!

Hi All,
Well, Lisa and I are all settled-in in Tororo. Saturday night after rafting, we enjoyed a barbeque and a few Ugandian beers at the campsite overlooking the Nile. The next morning we woke up early to see the sun come up and read our books on the overlook of the Nile. Life doesn’t get much better ;) Next to the campsite they had amazing street food! A Rolex which I have talked about before with avocado for breakfast at 60 cents!! Also chapatti bread with nutella and bannanna rolled up for dessert….mmmm. The matatu ride to Tororo was…interesting. Definitely not traveling in luxury. The “mini-bus” taxi left from Jinja and took about 2+ hrs to get to Tororo. The seat the conductor put us in had just enough leg room for me, my knees were touching the seat in front and Lisa had to sit sideways. Somewhere along the drive we just kept adding more and more people, until Lisa and I were basically hugging. Overall though, it was painless. I just kept telling Lisa that we were lucky there were no chickens next to us or funky smells, so we couldn’t complain.

Our hotel in Tororo is basically everything we need. This time we actually have a shower that gives us warm water, and a balcony with a view of Tororo rock. We also have a restraint in the hotel that we get free breakfast at so that works out well. One thing I do have to say though is that Ugandians know how to party!!! The street is always bumping till at least midnight to 1 am and when “football” or soccer is on TV, you can forget about sleep, you’d think it was new years, with dozens of people hanging out on the street trying to take a peak into the few tv’s there are in bars and restaurants.

I am so happy to be in a smaller city than Kampala. It is nice to not have to wait 5 minutes or fear for your life when crossing the street. In Kampala we had to watch out for the Boda Boda’s weaving in and out, here you can pay someone to hope on the back of there bike and get a ride where you want to go. We tend to see the same people, and since we are almost the only 2 muzungu’s, people are starting to recognize us. From our hotel, it is just a ten minute walk to the hospital which has absolutely beautiful grounds. Many of the wards have been built/donated by the Japanese, and are newer buildings, but are still one large room that is severely over crowded. The hospital has a total of 6 wards, but only 4 doctors to run the entire place. Much of the care is then provided by medical officers, similar to NP or PA’s. When talking to Dr. Welishe, is seems to be a huge problem to get doctors to work in the more rural areas such as this. The resources are few, the patients are many, and the pay is poor. Also, it is not secret that there is a huge “brain drain” as many people call in from Uganda. With the limited number of resources and poor pay, Uganda has a very hard time keeping there doctors in Uganda.

On Monday morning, we were greeted by Dr. Welishe with a huge smile!! He is a family practitioner that works technically for Makerere University, but has chosen to stay in more rural Uganda where he feels he is needed more. He is incredibaly helpful and is a great teacher. He has set it up for us to visit a bunch of different types of clinics in the community. On Monday we started off with meeting the Tororo hospital administration and staff, and doing rounds on the female ward. There is some drastic pathology and physical exam findings. We then spent the afternoon trying to hook up an ECG machine that had been donated to one of Dr. Welishe’s friends and fellow doctors. We got it ready to plug in, but it was an American cord, so we didn’t have an adapter. It was amazing though how much they thought we helped, when lisa and I thought we just plugged in a few cords and explained a few things. Talking with them though, we recognized that since they didn’t do many ECG’s they do not get trained in it, so hopefully next week, when the electricity is working, we will be able to sit down with them and do some teaching. Weird to think that we would have anything to offer the Ugandian doc’s who have been out in practice for years, but it is kinda nice ;)

Today we spent the morning in the Pediatric ward. The ward is basically run by sister Dorothy who is a medical officer. When we arrived they were cleaning the ward, so the estimated 50+ children with there mothers were waiting outside the hospital ward. They then were brought in to a large room for a teaching session on anemia. It was great to see the mothers being educated on signs of anemia, what causes it and how to prevent it. Since there are not enough beds in the ward for all the children, they are seen one by one with Dorothy, and those who are going to stay admitted are allowed to enter the ward. Even after this, the beds will still have 2 children per hospital bed. A huge problem is actually that children contract other diseases/problems during there stay. For instance, a child with pneumonia may get malaria while in the hospital from the large amount of mosquitoes or diarrhea from the child next door who has gastroenteritis. We also learned that the most common cause of death, 3 children in the last week, is severe anemia secondary to anemia. There is very limited blood for transfusions, and children are not brought in until they are very sick.

This afternoon, we went over to Taso, The Aids Support Organization, which is one of the main organizations responsible for the successful HIV/AIDS prevention and treatment programs in Uganda. It was amazing to see there counseling support, drum/singing group used for community education, medical support, and everything from aromatherapy to art therapy for HIV/AIDS patients. The organizations provides all these services and anti-retroviral medications and other medications free of charge to there patients. This amount of resources is like nothing else I have seen in Uganda. One of the patients we saw today was actually a women, recently diagnosed with HIV who had hemiparesis from toxoplasmosis.

The difference between the lack of resources for the Pediatric ward and malaria this morning and the vast amount of resources for HIV/AIDS seems odd to me. It truly does appear that the HIV/AIDs as a cause receives much more foreign aid, however malaria is actually a larger cause of morbidity. Dr. Welishe spoke with us about this yesterday, his main frustrations come from the inequality of where the money goes and the government coroption when it comes to donated resources or money. He estimates that less than half of the money donated reaches those that need it and that the rest ends up in someone’s pocket. “If you are going to do something, build us a building, we can’t sell that and pocket it, well not easily” according to Dr. Welishe. This is clearly a huge frustration for a lot of the medical community.

Well I will no sign off. Miss you all.

Crystal