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
Thursday, April 30, 2009
Wednesday, April 29, 2009
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
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
Saturday, April 25, 2009
"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
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
Wednesday, April 22, 2009
“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
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
Tuesday, April 21, 2009
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
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
Saturday, April 18, 2009
I survived the Nile
Hi All,
So I have a few minutes We of internet access, I am back at the camp of the rafting company we went with. I had an absolutely AMAZING day on the river today. We did Class 5 rapids on the Nile, which is HUGE water!!! The count was 3 flips, 1 dump truck. I am usually really good about staying in the boat, I think I only fell out "swam" twice when i guided, but today, I FLUNG out, then 2 seconds later everyone else flipped. We had pineapple and biscuits for lunch while floating down the river, they actually turned over a kayak to cut the pineapple on top. So I lived! And tonight we stay at there camp which is right on the shore of the Nile, over looking it, not a bad set up at all. I will write again when I get internet access in the next few days.
crystal
So I have a few minutes We of internet access, I am back at the camp of the rafting company we went with. I had an absolutely AMAZING day on the river today. We did Class 5 rapids on the Nile, which is HUGE water!!! The count was 3 flips, 1 dump truck. I am usually really good about staying in the boat, I think I only fell out "swam" twice when i guided, but today, I FLUNG out, then 2 seconds later everyone else flipped. We had pineapple and biscuits for lunch while floating down the river, they actually turned over a kayak to cut the pineapple on top. So I lived! And tonight we stay at there camp which is right on the shore of the Nile, over looking it, not a bad set up at all. I will write again when I get internet access in the next few days.
crystal
Friday, April 17, 2009
Leaving For Jinja, then off to Tororo :)
Hi All,
Since yesterday, I found out that the girl with possible ALL (Leukemia) made it through the night with a few blood transfusions which is great news! We went to bar trivia last night at an irish pub...yes Kampala has an Irish Pub. I had a good time, but I honestly wasn't a huge fan, I am in Uganda, why would I want to go to an Irish pub??? (No offense to the IRISH that are reading ;)
I was in Acute pediatrics again today and I have an absolutely heart wrenching, make you ball your eyes out story from today. I am going to preface this with, this can and does happen anywhere in the world, I just happened to see it first hand in Uganda. Today a 1-2 day old infant was brought in by the police. Her mother had abandoned her and placed her in a pit-latrine. The police rescued her this morning and brought her to Mulago for care while they searched for the mom. When she came in, she was covered in feces, but by the time she came to our room, she had been washed by the nursing staff, but was still really cold. The Ugandian Intern was continuing to wash her off, when we realized...don't read this if you are squeemish...........that there were magets coming out of her swollen eyes and her ears and a few left on her body. I have never had such an awful feeling in my stomach! We got her good and whiped off (I'm not going to lie, the Ugandian intern did most of the maget catching) but there was still alot of pus coming from her swollen eyes. I think being from the cold, we are much more prone to treating hypothermia, so me and a peds resident from Detroit stepped in and worked on getting her warm. Between finding blankets and filling gloves with warm water, we got her all wrapped up and took turns holding her. Just an awful story and way to start of your life! I am worried about her vision, everytime I checked on her today, I would relieve more puss from her swollen eyes, and I kept hounding people for the anti-biotic drops for her eyes, but they haven't surfaced yet. They were also going to feed her through a naso-gastric tube, they don't have any bottles to use. Since the baby otherwise has no reason she couldn't bottle feed, I went and bought one in town during my lunch. A few dollars well spent....that is provided the formula that was promised to me ever arrives on the ward tonight. Every few hrs I keep going in to hold her for a few minutes, otherwise she lays in the crib by herself. Absolutely heart breaking.
I don't think there is anyway to transition well from that story, so I will just make it abrupt. Lisa and I are very excited to get out of Kampala tomorrow! Kampala is a nice safe city, but as put by Dr. Welishe "it is not the true Africa." Like any other city it has horrendous traffic, lots of people, and trash. Surprisingly, it also has alot of Mzungu's (white people). I am not sure if that is just cause I am around the hospital, but I was shocked by how many foreigner's I run into left and right. When I was in Accra, I barely every remember seeing a white person. Kampala is also incredibly globalized. There is a mall "Garden City" where you can pretty much get any western products you would need/want. I even say clean and clear face wash. We lasted about 30 minutes in Garden City (25 of which were eating ice cream) and then we were ready to leave. Also I am continually shocked by the lack of traditional clothing. When I was in Ghana, I would have estimated that > 70% of the people I saw, at least women, had traditional clothing/fabric. In Kampala most people are dressed in western clothing, many of which is brought over from US second hand stores. For instance, Ugandian man walking down the street with a Greenbay packer shirt ;) So Lisa and I are excited to head the "the real Africa" in the words of Dr. Welishe who is our preceptor for the next 2 weeks in Tororo. Kampala and Mulago have been fun, eye-opening, educational, frustrating, and a cultural experience all in one, but we are ready for the next thing ;) Oh, and Dr. Welishe was in Kampala today so we met briefly to discuss what we will be doing for the next 2 weeks. He has a whole itinerary for us. He is getting us into all types of community HIV clinics, "peripheral" or village clinics, ect. I think this will be a great addition to what we have done so far.
So tomorrow AM we leave for Jinja, where we will go class 5 whitewater rafting on the Nile tomorrow ;) Wish us luck! I am hoping to bring my camera since it is waterproof. From there we will stay in Jinja till Sunday afternoon (some of the people we live with are bunji jumping) and then head to Tororo for 2 weeks. I am note sure of the internet situation, so it may be a bit until I post again. I am not feeling the love. Mac is the only one that has called me thus far. I know some of you have calling cards out there. I think mac's is 8 cents a minute. If I don't pick up it doesn't charge you. I am 8 hrs ahead of Wisconsin, so the best time to call is 9pm my time on weekdays...around 1 pm for you, but anything after 5 is usually okay. Miss you all!!
Crystal
ps tried to upload pics again...no hope
Since yesterday, I found out that the girl with possible ALL (Leukemia) made it through the night with a few blood transfusions which is great news! We went to bar trivia last night at an irish pub...yes Kampala has an Irish Pub. I had a good time, but I honestly wasn't a huge fan, I am in Uganda, why would I want to go to an Irish pub??? (No offense to the IRISH that are reading ;)
I was in Acute pediatrics again today and I have an absolutely heart wrenching, make you ball your eyes out story from today. I am going to preface this with, this can and does happen anywhere in the world, I just happened to see it first hand in Uganda. Today a 1-2 day old infant was brought in by the police. Her mother had abandoned her and placed her in a pit-latrine. The police rescued her this morning and brought her to Mulago for care while they searched for the mom. When she came in, she was covered in feces, but by the time she came to our room, she had been washed by the nursing staff, but was still really cold. The Ugandian Intern was continuing to wash her off, when we realized...don't read this if you are squeemish...........that there were magets coming out of her swollen eyes and her ears and a few left on her body. I have never had such an awful feeling in my stomach! We got her good and whiped off (I'm not going to lie, the Ugandian intern did most of the maget catching) but there was still alot of pus coming from her swollen eyes. I think being from the cold, we are much more prone to treating hypothermia, so me and a peds resident from Detroit stepped in and worked on getting her warm. Between finding blankets and filling gloves with warm water, we got her all wrapped up and took turns holding her. Just an awful story and way to start of your life! I am worried about her vision, everytime I checked on her today, I would relieve more puss from her swollen eyes, and I kept hounding people for the anti-biotic drops for her eyes, but they haven't surfaced yet. They were also going to feed her through a naso-gastric tube, they don't have any bottles to use. Since the baby otherwise has no reason she couldn't bottle feed, I went and bought one in town during my lunch. A few dollars well spent....that is provided the formula that was promised to me ever arrives on the ward tonight. Every few hrs I keep going in to hold her for a few minutes, otherwise she lays in the crib by herself. Absolutely heart breaking.
I don't think there is anyway to transition well from that story, so I will just make it abrupt. Lisa and I are very excited to get out of Kampala tomorrow! Kampala is a nice safe city, but as put by Dr. Welishe "it is not the true Africa." Like any other city it has horrendous traffic, lots of people, and trash. Surprisingly, it also has alot of Mzungu's (white people). I am not sure if that is just cause I am around the hospital, but I was shocked by how many foreigner's I run into left and right. When I was in Accra, I barely every remember seeing a white person. Kampala is also incredibly globalized. There is a mall "Garden City" where you can pretty much get any western products you would need/want. I even say clean and clear face wash. We lasted about 30 minutes in Garden City (25 of which were eating ice cream) and then we were ready to leave. Also I am continually shocked by the lack of traditional clothing. When I was in Ghana, I would have estimated that > 70% of the people I saw, at least women, had traditional clothing/fabric. In Kampala most people are dressed in western clothing, many of which is brought over from US second hand stores. For instance, Ugandian man walking down the street with a Greenbay packer shirt ;) So Lisa and I are excited to head the "the real Africa" in the words of Dr. Welishe who is our preceptor for the next 2 weeks in Tororo. Kampala and Mulago have been fun, eye-opening, educational, frustrating, and a cultural experience all in one, but we are ready for the next thing ;) Oh, and Dr. Welishe was in Kampala today so we met briefly to discuss what we will be doing for the next 2 weeks. He has a whole itinerary for us. He is getting us into all types of community HIV clinics, "peripheral" or village clinics, ect. I think this will be a great addition to what we have done so far.
So tomorrow AM we leave for Jinja, where we will go class 5 whitewater rafting on the Nile tomorrow ;) Wish us luck! I am hoping to bring my camera since it is waterproof. From there we will stay in Jinja till Sunday afternoon (some of the people we live with are bunji jumping) and then head to Tororo for 2 weeks. I am note sure of the internet situation, so it may be a bit until I post again. I am not feeling the love. Mac is the only one that has called me thus far. I know some of you have calling cards out there. I think mac's is 8 cents a minute. If I don't pick up it doesn't charge you. I am 8 hrs ahead of Wisconsin, so the best time to call is 9pm my time on weekdays...around 1 pm for you, but anything after 5 is usually okay. Miss you all!!
Crystal
ps tried to upload pics again...no hope
Thursday, April 16, 2009
Is it possible to be exhausted and invigorated at the same time?
Hi All,
I am going to start by apologizing for my grammar, I realized I misspell every other word and don't take the time out to correct it or add proper punctuation. I am sure you all understand. I am either paying by the minute for Internet, or praying that I don't loose the connection in the middle of writing. ;)
First, going back to the young 8 yo boy, that had been hit by a care earlier this week, I found out that they found a splenic laceration in the OR, but that they were able to get a CT of his head later that day and he had severe brain injury and died later that day from respiratory depression. They didn't have access to a ventilator for him, but with his brain injury, it probably would not have made a difference.
Yesterday, Lisa and I had a very....interesting/challenging day on Surgical casualty. As we were arriving in the morning, the Canadian EM doc we had been working with was not around and there was only one practitioner, who was the equivalent of a NP or PA in the US. Soon after, the police brought in a man covered in dirt. We later put together the pieces that he had probably been hit by a car the evening before, fallen in the ditch where he stayed all night in the pouring (I mean POURING) rain. The police then found him in the AM and brought him to Mulago. He was covered in dirt, soaking wet, had obvious cranio-facial abnormalities and step-offs, abrasions all over his chest/abdomen, open fractures in 3 of his extremities, was non-responsive, with labored breathing. Lisa and I sat back for a while to see how this type of severe blunt trauma was managed. During the next few minutes, one of the nursing students worked on an IV and the practitioner looked overwhelmed and noted that the man was cold. Lisa and I tried to tell people that we needed to get the wet clothes off, but everyone looked at us like we were crazy! Almost a direct quote was "this is Uganda, we don't have hypothermia." Well the man's body temp was 32.4 degrees celcius which is moderate hypothermia (<32 is severe) so I guess we disproved that ;) From there, we pushed for the patient to be taken to the rescusation room next door given his condition. Josephine, the resuscitation nurse agreed. However, once in the other room, the practitioner did not follow! Knowing well that Lisa and I were only medical students, he left us to manage the trauma patient. I tried to get him to come help, but he had started seeing another patient with abdominal pain. So Lisa and I did all we knew, started lines, hooked up monitors/got vitals, got blankets and warm IV fluids, started the primary and secondary survey....but quickly recognized that we had been left alone. Early on during our exam, we recognized that his pupils were fixed and dilated, not a good sign with head injury! We knew that there was probably nothing we could do, but who were we to decide that! Luckily I was able to find the candadian EM doc to give us a hand.
We debated given the resources and situation whether intubating and CT scanning his head would be beneficial, and Dr. Martin (candadian) eventually decided to go with it. I got to try to intubate, but all the intubations I have done thus far where on healthy people in the OR. I set up everything I needed, got the laryngoscope correctly positioned and all I could see was blood, even after suctioning. With all the fractures, the anatomy was very distorted. I then gave it to Dr. Martin who tried to reasure me later that he had just done enough that "he knew where to go even without a great view" and it wasn't bad that I wasn't able to do it. From there we started treatment for increased intracrainial pressure, and eventually got him a CT of the head. This showed that he had a subdural hematoma, with SEVERE midline shift, his ventrical was collapsed. In other words, bad news!!! The decision was then made by the ICU doctor that there was no point in sending him to the ICU, that they would give him comfort treatment and put him in the back of the ward until he stopped breathing from his severe brain injury. Lisa just updated me that he died last night on the ward.
Reflecting on this is really difficult for me. I don't know exactly what to think. From lack of resources resuscitation is much different here. The practitioner did not seem to want to do any resuscitation, was this because he was overwhelmed and wanted someone else to deal with it? Or because he knew the outcome was going to be so poor that there was no use wasting resources? I guess I will never know. After seeing his blown pupils Lisa and I knew we couldn't make the decision of whether to proceed, so that is why we pulled in help. But after all this, Lisa and I definately had our first crack at managing blunt trauma on our own by default.
In contrast to this, I spent today in Acute Pediatrics where I was extremly impressed all day with the skill of the residents! I started by shadowing during rounds where I tried to pick up as much teaching as possible on Physical exam and clinical diagnosis without labratory tests and imaging. I then went to the emergency area for medical pediatric emergency, where there is ALOT of SICK kids, I mean really sick, where we may see 1 a day in the ER at UW. Over the course of the day I saw lots of pneumonia, diarrhea, extreme dehydration, malnutrition, HIV, G6PD deficiency hemolysis, ect. One girl we saw had a Hemoglobin of 3.9. In the US we transfuse for anything under 10 pretty much. Here they transufuse at 5. She also was vomiting some blood. Over the course of the day, it was determined that she probably had Acute Lymphocytic Leukemia and she began to have an uncontrollable nose bleed and blood in her vomit. Her platelet count came back later that day at 14,000. Normal is >150,000. We tried to get her platelets, but there were none in the blood bank. When I left today, she was still bleeding, and people were still trying to hunt down platelets for her. It doesn't look good. I talked with the peds resident here about access to chemotherapy for these kids. The government has a certain amount of all resources, including chemotherapy, and when it runs out it runs out. No matter where you are in your treatment. After the chemo runs out, the family would have to pay, which is unrealistic for the majority of the population.
Going back on my last few days, I think there is alot of value placed on youth. I have seen much more resources used and effort placed into taking care of children than I have for adults. I am not clear if this is just by chance, the people I have worked with, or a cultural importance placed on taking care of the youth. Also the medical community is very different here. Doctors in Uganda do not make much money at all, so in order to make a living dr's at Mulago also work at private clinics. As a Ugandian resident put it to me "we have alot more dr's working at Mulago on paper than in person and there is a problem with people taking responsibility" Those are her words, but I could even sense her frustration with individuals not taking responsibility for patient care, the checks and balances to make sure things get done are just non-existent. On the other hand, they are 100 times better at doing physical exams and do much more through histories than we ever do, we rely so much more on labs/tests. So I think it is important to see the positives and negatives of both systems.
On a brighter note, Lisa and I ate the absolute BEST INDIAN FOOD EVER last night!!! We went to "Haandi" indian restaurant down town and for $9 each we had an amazing fancy date :) I am still dreaming about how good the food was. That was our little treat to ourselves for the week, since most nights our dinner costs more like 40 cents to a dollar. From here I will sign off. Miss you all.
crystal
I am going to start by apologizing for my grammar, I realized I misspell every other word and don't take the time out to correct it or add proper punctuation. I am sure you all understand. I am either paying by the minute for Internet, or praying that I don't loose the connection in the middle of writing. ;)
First, going back to the young 8 yo boy, that had been hit by a care earlier this week, I found out that they found a splenic laceration in the OR, but that they were able to get a CT of his head later that day and he had severe brain injury and died later that day from respiratory depression. They didn't have access to a ventilator for him, but with his brain injury, it probably would not have made a difference.
Yesterday, Lisa and I had a very....interesting/challenging day on Surgical casualty. As we were arriving in the morning, the Canadian EM doc we had been working with was not around and there was only one practitioner, who was the equivalent of a NP or PA in the US. Soon after, the police brought in a man covered in dirt. We later put together the pieces that he had probably been hit by a car the evening before, fallen in the ditch where he stayed all night in the pouring (I mean POURING) rain. The police then found him in the AM and brought him to Mulago. He was covered in dirt, soaking wet, had obvious cranio-facial abnormalities and step-offs, abrasions all over his chest/abdomen, open fractures in 3 of his extremities, was non-responsive, with labored breathing. Lisa and I sat back for a while to see how this type of severe blunt trauma was managed. During the next few minutes, one of the nursing students worked on an IV and the practitioner looked overwhelmed and noted that the man was cold. Lisa and I tried to tell people that we needed to get the wet clothes off, but everyone looked at us like we were crazy! Almost a direct quote was "this is Uganda, we don't have hypothermia." Well the man's body temp was 32.4 degrees celcius which is moderate hypothermia (<32 is severe) so I guess we disproved that ;) From there, we pushed for the patient to be taken to the rescusation room next door given his condition. Josephine, the resuscitation nurse agreed. However, once in the other room, the practitioner did not follow! Knowing well that Lisa and I were only medical students, he left us to manage the trauma patient. I tried to get him to come help, but he had started seeing another patient with abdominal pain. So Lisa and I did all we knew, started lines, hooked up monitors/got vitals, got blankets and warm IV fluids, started the primary and secondary survey....but quickly recognized that we had been left alone. Early on during our exam, we recognized that his pupils were fixed and dilated, not a good sign with head injury! We knew that there was probably nothing we could do, but who were we to decide that! Luckily I was able to find the candadian EM doc to give us a hand.
We debated given the resources and situation whether intubating and CT scanning his head would be beneficial, and Dr. Martin (candadian) eventually decided to go with it. I got to try to intubate, but all the intubations I have done thus far where on healthy people in the OR. I set up everything I needed, got the laryngoscope correctly positioned and all I could see was blood, even after suctioning. With all the fractures, the anatomy was very distorted. I then gave it to Dr. Martin who tried to reasure me later that he had just done enough that "he knew where to go even without a great view" and it wasn't bad that I wasn't able to do it. From there we started treatment for increased intracrainial pressure, and eventually got him a CT of the head. This showed that he had a subdural hematoma, with SEVERE midline shift, his ventrical was collapsed. In other words, bad news!!! The decision was then made by the ICU doctor that there was no point in sending him to the ICU, that they would give him comfort treatment and put him in the back of the ward until he stopped breathing from his severe brain injury. Lisa just updated me that he died last night on the ward.
Reflecting on this is really difficult for me. I don't know exactly what to think. From lack of resources resuscitation is much different here. The practitioner did not seem to want to do any resuscitation, was this because he was overwhelmed and wanted someone else to deal with it? Or because he knew the outcome was going to be so poor that there was no use wasting resources? I guess I will never know. After seeing his blown pupils Lisa and I knew we couldn't make the decision of whether to proceed, so that is why we pulled in help. But after all this, Lisa and I definately had our first crack at managing blunt trauma on our own by default.
In contrast to this, I spent today in Acute Pediatrics where I was extremly impressed all day with the skill of the residents! I started by shadowing during rounds where I tried to pick up as much teaching as possible on Physical exam and clinical diagnosis without labratory tests and imaging. I then went to the emergency area for medical pediatric emergency, where there is ALOT of SICK kids, I mean really sick, where we may see 1 a day in the ER at UW. Over the course of the day I saw lots of pneumonia, diarrhea, extreme dehydration, malnutrition, HIV, G6PD deficiency hemolysis, ect. One girl we saw had a Hemoglobin of 3.9. In the US we transfuse for anything under 10 pretty much. Here they transufuse at 5. She also was vomiting some blood. Over the course of the day, it was determined that she probably had Acute Lymphocytic Leukemia and she began to have an uncontrollable nose bleed and blood in her vomit. Her platelet count came back later that day at 14,000. Normal is >150,000. We tried to get her platelets, but there were none in the blood bank. When I left today, she was still bleeding, and people were still trying to hunt down platelets for her. It doesn't look good. I talked with the peds resident here about access to chemotherapy for these kids. The government has a certain amount of all resources, including chemotherapy, and when it runs out it runs out. No matter where you are in your treatment. After the chemo runs out, the family would have to pay, which is unrealistic for the majority of the population.
Going back on my last few days, I think there is alot of value placed on youth. I have seen much more resources used and effort placed into taking care of children than I have for adults. I am not clear if this is just by chance, the people I have worked with, or a cultural importance placed on taking care of the youth. Also the medical community is very different here. Doctors in Uganda do not make much money at all, so in order to make a living dr's at Mulago also work at private clinics. As a Ugandian resident put it to me "we have alot more dr's working at Mulago on paper than in person and there is a problem with people taking responsibility" Those are her words, but I could even sense her frustration with individuals not taking responsibility for patient care, the checks and balances to make sure things get done are just non-existent. On the other hand, they are 100 times better at doing physical exams and do much more through histories than we ever do, we rely so much more on labs/tests. So I think it is important to see the positives and negatives of both systems.
On a brighter note, Lisa and I ate the absolute BEST INDIAN FOOD EVER last night!!! We went to "Haandi" indian restaurant down town and for $9 each we had an amazing fancy date :) I am still dreaming about how good the food was. That was our little treat to ourselves for the week, since most nights our dinner costs more like 40 cents to a dollar. From here I will sign off. Miss you all.
crystal
Tuesday, April 14, 2009
Trauma, music, boda boda accident..oh my
So I have officially been in Uganda for just over 1 week and I can not believe how much I have already done, seen and experienced! I gave a quick run through of this weekend in the last post, but unfortuanately I can't post pictures right now cause the internet is so slow it can't upload them. I will have to share pictures when I get home.
Yesterday being a holiday, Lisa and I got to explore Kamapala which is actually a very safe city, much safer than Accra, Ghana where I was years ago. We went to all the craft markets to get an idea of how much they should cost, so I can buy presents right before I leave, and not have to carry them around with me. If there are any specific requests make sure to let me know ;) We also got amazing cappacino, Uganda has amazing coffee and it is a huge export, but they don't drink much of it which I find odd! Later at night we went to the "east african carnival" as part of the easter celebrations. We had no idea what to expect, and it ended up being sorta like summer fest..but with not as much food, and really only 1 main stage, but same kinda feel. We were waiting for the main performer, "baby cool" to come one, but when it got to 11:30 we decided to head out, since we had to work today. On the way out, our Ugandan friend was working on finding us a Matatu or minibus taxi when a guy came upto us 4 Mazungu's (white people) and asked if we needed help cause we looked lost. We started talking for awhile then were told by our Ugandian friend that that WAS Baby Cool!! So I asked him for a personal concert since we had to leave, and told him I would dance if he would sing for me, but it was a no go. But I have a picture with one of the most popular Ugandian artists :) He is mostly reggae.
We were walking back into Makerere campus on the way home when we heard a load noise and I looked over and saw glass/metal peices flying and a car driving away. At first I thought the car hit a garbage, but then I saw that it was 3 people laying in the street that had just been hit by a car! It ended up being that the Boda Boda was hit by the car like 50 ft from us. We ran over and got the people off to the hospital who needed it. I think just some broken bones and concusions. Nothing too major thank god. With all the blood, I just kept wishing for gloves!! That is exactly why I don't ride boda boda's here!!
Mulago is a huge hospital, basically a campus by itself. There are multiple wards and buildings connected by the outdoors. If you have seen "The Last King of Scottland" that is Mulago. Absolutely huge, with little resources. If someone needs an x-ray, there family has to come up with the money/cash before they can go. I am working in Casualty or the first line emergency so I see alot of the awful things that come through. The waiting room is just filled with people. I don't even want to think of how long trauma patients have to wait to be seen. Just a severe lack of resources! They run out of everything from Iv fluids to alcohol wipes to foleys or chest tubes. This week I am working on the Surgical casualty side. Today I arrived to start working on a penetrating trauma patient that was loosing alot of blood from some scalp lacerations and had an abdominal stab wound and evisceration of his stomach out the stab wound! It took the trauma surgeon about 3 1/2 hrs to get him in the OR. I'm not judging, it is just a dose of reality here! In the same small room we then got a 8 yo who was hit by a car yesterday with mental status changes, a blood in his abdomen by untrasound, a rigid abdomen and a proximal 1/3 femur fracture. The day continued with an epileptic, 25% body burn mostly 3rd degree, huge hand laceration that was infected, a child with either osteomyolitis of the spine or spinal Tuberculosis (will find out later), possible basilar skull fracture. I am absolutely exahuasted by the end of the day. I have been working with a Candadian emergency medicine doc, which makes for great learning! Given where I am in my training and the change of enviroment/new medications/ways of managing disease, I feel useless quite a bit, but every once in a while I fee like I help :).
One last thing. I actually really like the food here! We eat alot of matoke which is mashed plantains, ground nut sauce (peaunut), rice, beans, peas, and believe it or not, alot of really good indian food/curries! My other favorite is the "ROLEX" a street food that is flat bread, with eggs, green pepper, cabbage, tomatoe and onion rolled up. It costs about 40 cents and makes for a great dinner! And I haven't got sick yet!!!
Well I will end this extremely long bost, thanks if you have stayed with me. We will be in Kampala till Friday, then Jinja till Sunday, Tororo from Sunday for about 2 weeks, then on Safari for 5 days, back in Kampala for a day then leaving here on May 8th. Let me know how you are!!
Yesterday being a holiday, Lisa and I got to explore Kamapala which is actually a very safe city, much safer than Accra, Ghana where I was years ago. We went to all the craft markets to get an idea of how much they should cost, so I can buy presents right before I leave, and not have to carry them around with me. If there are any specific requests make sure to let me know ;) We also got amazing cappacino, Uganda has amazing coffee and it is a huge export, but they don't drink much of it which I find odd! Later at night we went to the "east african carnival" as part of the easter celebrations. We had no idea what to expect, and it ended up being sorta like summer fest..but with not as much food, and really only 1 main stage, but same kinda feel. We were waiting for the main performer, "baby cool" to come one, but when it got to 11:30 we decided to head out, since we had to work today. On the way out, our Ugandan friend was working on finding us a Matatu or minibus taxi when a guy came upto us 4 Mazungu's (white people) and asked if we needed help cause we looked lost. We started talking for awhile then were told by our Ugandian friend that that WAS Baby Cool!! So I asked him for a personal concert since we had to leave, and told him I would dance if he would sing for me, but it was a no go. But I have a picture with one of the most popular Ugandian artists :) He is mostly reggae.
We were walking back into Makerere campus on the way home when we heard a load noise and I looked over and saw glass/metal peices flying and a car driving away. At first I thought the car hit a garbage, but then I saw that it was 3 people laying in the street that had just been hit by a car! It ended up being that the Boda Boda was hit by the car like 50 ft from us. We ran over and got the people off to the hospital who needed it. I think just some broken bones and concusions. Nothing too major thank god. With all the blood, I just kept wishing for gloves!! That is exactly why I don't ride boda boda's here!!
Mulago is a huge hospital, basically a campus by itself. There are multiple wards and buildings connected by the outdoors. If you have seen "The Last King of Scottland" that is Mulago. Absolutely huge, with little resources. If someone needs an x-ray, there family has to come up with the money/cash before they can go. I am working in Casualty or the first line emergency so I see alot of the awful things that come through. The waiting room is just filled with people. I don't even want to think of how long trauma patients have to wait to be seen. Just a severe lack of resources! They run out of everything from Iv fluids to alcohol wipes to foleys or chest tubes. This week I am working on the Surgical casualty side. Today I arrived to start working on a penetrating trauma patient that was loosing alot of blood from some scalp lacerations and had an abdominal stab wound and evisceration of his stomach out the stab wound! It took the trauma surgeon about 3 1/2 hrs to get him in the OR. I'm not judging, it is just a dose of reality here! In the same small room we then got a 8 yo who was hit by a car yesterday with mental status changes, a blood in his abdomen by untrasound, a rigid abdomen and a proximal 1/3 femur fracture. The day continued with an epileptic, 25% body burn mostly 3rd degree, huge hand laceration that was infected, a child with either osteomyolitis of the spine or spinal Tuberculosis (will find out later), possible basilar skull fracture. I am absolutely exahuasted by the end of the day. I have been working with a Candadian emergency medicine doc, which makes for great learning! Given where I am in my training and the change of enviroment/new medications/ways of managing disease, I feel useless quite a bit, but every once in a while I fee like I help :).
One last thing. I actually really like the food here! We eat alot of matoke which is mashed plantains, ground nut sauce (peaunut), rice, beans, peas, and believe it or not, alot of really good indian food/curries! My other favorite is the "ROLEX" a street food that is flat bread, with eggs, green pepper, cabbage, tomatoe and onion rolled up. It costs about 40 cents and makes for a great dinner! And I haven't got sick yet!!!
Well I will end this extremely long bost, thanks if you have stayed with me. We will be in Kampala till Friday, then Jinja till Sunday, Tororo from Sunday for about 2 weeks, then on Safari for 5 days, back in Kampala for a day then leaving here on May 8th. Let me know how you are!!
Monday, April 13, 2009
Back from Safari
Hi All,
As I mentioned before, Easter holiday goes from Friday through Monday here, so we took advantage and went to Murchison Falls National Park over the weekend! We went with many of the med students that stay in the same house we do. We left Friday morning, Driving north where we had lunch in Musindi, then entered the park. We hiked around the top of Murchiso falls which was absolutely beautiful!!! We camped in the park with our group and the next morning we did our "game drive" through the park. We saw lots of types of antelope, my favorite being the oribe ? on spelling. But also waterbuck, kobs, buffalo, giraffees, elephants, no lions or leapords unfortunately. To get to the north side of the park we crossed the Nile river by a Ferry. It was AMAZING to see all the animals. At one point we could look over the Nile into the Democratic republic of the Congo. That afternoon we took a boat up the nile surrounded by hippos and crocodiles to Murchison Falls and saw the falls from the bottom, it is alot of fast moving water!! Oh and we also drank a "Nile" beer while on the Nile river :)
It rained and rained that night, but luckly our tent held up pretty well, some of the people we were traveling with were not so lucky. We couldn't have food in the tents because of the warthogs that are all around the campsite...in the US we worry more about bears ;) The next day we drove to Bugando Forest and went "chimpanzee tracking" which was AMAZING!! We hiked for about 2 hours in the rainforest following the "calls" of the chimpanzees to one another. Finally we got to watch a group of about 8 communicate with each other through the trees up above, then come down to the ground about 50 ft away!!! Last, we headed back to Kamapala and our Safari was over, tear. Back to work tomorrow. I am almost out of internet time will update tomorrow! Miss you all
As I mentioned before, Easter holiday goes from Friday through Monday here, so we took advantage and went to Murchison Falls National Park over the weekend! We went with many of the med students that stay in the same house we do. We left Friday morning, Driving north where we had lunch in Musindi, then entered the park. We hiked around the top of Murchiso falls which was absolutely beautiful!!! We camped in the park with our group and the next morning we did our "game drive" through the park. We saw lots of types of antelope, my favorite being the oribe ? on spelling. But also waterbuck, kobs, buffalo, giraffees, elephants, no lions or leapords unfortunately. To get to the north side of the park we crossed the Nile river by a Ferry. It was AMAZING to see all the animals. At one point we could look over the Nile into the Democratic republic of the Congo. That afternoon we took a boat up the nile surrounded by hippos and crocodiles to Murchison Falls and saw the falls from the bottom, it is alot of fast moving water!! Oh and we also drank a "Nile" beer while on the Nile river :)
It rained and rained that night, but luckly our tent held up pretty well, some of the people we were traveling with were not so lucky. We couldn't have food in the tents because of the warthogs that are all around the campsite...in the US we worry more about bears ;) The next day we drove to Bugando Forest and went "chimpanzee tracking" which was AMAZING!! We hiked for about 2 hours in the rainforest following the "calls" of the chimpanzees to one another. Finally we got to watch a group of about 8 communicate with each other through the trees up above, then come down to the ground about 50 ft away!!! Last, we headed back to Kamapala and our Safari was over, tear. Back to work tomorrow. I am almost out of internet time will update tomorrow! Miss you all
Thursday, April 9, 2009
Boda Boda ??
So, here in uganda there are a few ways to get around, on foot....public large buses...mini buses...and boda boda's. Boda boda's are motorcycles that you can hop on for pretty cheap and they will take you anywhere. A few of the drivers have helmets for themselves, but more commonly they do not. They weave in and out of traffic almost running over pedestrians left and right. You will often see women sitting sideways with their dresses, with children in there lap. For me and lisa, this is a no brainer, spend the extra few bucks to not have to ride on one of these death traps! But I am amazed by how many med students from all over the world don't think twice about it. We are definitely the odd ones to not ride them. I think Lisa and I have made a smart decision.
I have worked in Medical Casualty for 3 days now, and I have gotten to see alot of interesting cases and pathology. I have been keeping a list, so I remember all the things I have seen. Tuberculosis is everywhere! Both Miliary and pulmonary. I have been trying to avoid patients with Tb, no one wears the masks, so instead of being the only one wearing it, I try to avoid contact. Also, the national average for HIV is somewhere around 5-8%, however, being at the hospital it seems higher here. The "Medicine casualty" is the first line work-up of non-surgical patients. There are 2 tiny rooms with 2 beds each that the intern or general practitioner bounces back and forth between doing the initial work-up of the patient and admitting them to "emergency" where they stay for 1 day until it is determined what is going on and which ward of the hospital they should go to. There are just not the resources for really sick patients, for example where in the US we may intubate a patient, put them on pressors, do CPR, cardiovert...none of this done here. I have heard that they have 3 working ventilators. It takes some getting used to when patients die in front of you and your used to lots of people doing everything they can to bring them back, vs. knowing that the right thing to do is to move on to the next patient.
Yesterday I caught up with some med students from the US that had come with there attending who is a critical care pediatrician, so I rounded with them at night to see some interesting cases. I saw a patient with parylitic rabies, cerebral malaria, Pott's disease or spinal TB and alot of other cases that I would not see in the US.
With easter this sunday, Friday and monday are holidays for many, obviously not in the hospital though. Lisa and I are leaving tomorrow morning to go on a trip to Murchison Falls where we will take a boat trip on the Nile, go chimp tracking, see a bunch of animals and get up to the falls. It will be nice to see some of the countryside, since we went straight into Kampala after we arrived and Kampala is a big city with LOTS of people, cars, and trash. There is a 25 minute walk to and from work every day that is dealing with alot of traffic, trying to avoid getting hit by cars and boda boda's so it will be nice to be out of the congestion for awhile. I am just not a city person!
I will try to post pics when we get back, but we will see if it is possible! Until Monday.
I have worked in Medical Casualty for 3 days now, and I have gotten to see alot of interesting cases and pathology. I have been keeping a list, so I remember all the things I have seen. Tuberculosis is everywhere! Both Miliary and pulmonary. I have been trying to avoid patients with Tb, no one wears the masks, so instead of being the only one wearing it, I try to avoid contact. Also, the national average for HIV is somewhere around 5-8%, however, being at the hospital it seems higher here. The "Medicine casualty" is the first line work-up of non-surgical patients. There are 2 tiny rooms with 2 beds each that the intern or general practitioner bounces back and forth between doing the initial work-up of the patient and admitting them to "emergency" where they stay for 1 day until it is determined what is going on and which ward of the hospital they should go to. There are just not the resources for really sick patients, for example where in the US we may intubate a patient, put them on pressors, do CPR, cardiovert...none of this done here. I have heard that they have 3 working ventilators. It takes some getting used to when patients die in front of you and your used to lots of people doing everything they can to bring them back, vs. knowing that the right thing to do is to move on to the next patient.
Yesterday I caught up with some med students from the US that had come with there attending who is a critical care pediatrician, so I rounded with them at night to see some interesting cases. I saw a patient with parylitic rabies, cerebral malaria, Pott's disease or spinal TB and alot of other cases that I would not see in the US.
With easter this sunday, Friday and monday are holidays for many, obviously not in the hospital though. Lisa and I are leaving tomorrow morning to go on a trip to Murchison Falls where we will take a boat trip on the Nile, go chimp tracking, see a bunch of animals and get up to the falls. It will be nice to see some of the countryside, since we went straight into Kampala after we arrived and Kampala is a big city with LOTS of people, cars, and trash. There is a 25 minute walk to and from work every day that is dealing with alot of traffic, trying to avoid getting hit by cars and boda boda's so it will be nice to be out of the congestion for awhile. I am just not a city person!
I will try to post pics when we get back, but we will see if it is possible! Until Monday.
Tuesday, April 7, 2009
I have a cell phone...weird
Hey everyone,
so just an FYI I have a cell phone in Uganda which is way more than I expected. It doesn't cost me anything if you call me, so if you have some good cheap phone cards, you can give me a ring, remembering that I am 8 hrs ahead of you and only have my phone sometimes. The number is +256781448003 If I call out is is something like 33 cents per minute, but I also have texting options so you can send me a message that way. Just thought you would like to know, incase you need to get ahold of me.
so just an FYI I have a cell phone in Uganda which is way more than I expected. It doesn't cost me anything if you call me, so if you have some good cheap phone cards, you can give me a ring, remembering that I am 8 hrs ahead of you and only have my phone sometimes. The number is +256781448003 If I call out is is something like 33 cents per minute, but I also have texting options so you can send me a message that way. Just thought you would like to know, incase you need to get ahold of me.
First post from Uganda
Hi everyone! I arrived safely in Uganda yesterday morning. The trip here was pretty uneventful. Me and Lisa found each other in the huge Heathrow airport, by pure luck! We had arrived at different terminals. We then had about 6 hours to take the tube into London and walk around. We did alot of the tourist stuff like Big Ben, Buckingham Palace, Westminister Abbey, ect. After we borded the plane in London they found some technical problem, unfortunately this was after I had already taken my "sleeping medicine" so we had to unboard the plane and wait 2 hrs for a new one...I slept the entire time in the terminal, poor lisa had to look out for me cause I was all drugged up :)
When we arrived on Monday morning in Entebbe, our ride was waiting for us, and we got settled in at our boarding house on the campus of Makerere University, visited the Mulago Hospital, and got shown around by a medical student. It was nice to get our sense of direction around the city, although lisa is much better at that than me. Our room that we share at the edgehouse is nice, they have mosquito nets for us, there is a dribble of warm water that you can take bucket type shower/baths with. I am just happy for warm water! After walking around all yesterday afternoon, we went out for dinner with some of the other med students staying at the edgehouse and picked up some groceries from the market.
Today was my first day in the hospital. I am spending the next few days on "Casualty Medicine" which is the tiny room where they first bring the non-surgical emergency patients. From there they go to "Emergency" for 1 day then the to hospital wards. I was shy at first, because the diseases are very different and many of the patients do not speak english, and I often have a hard time understanding the Ugandan accent, but after a few hours I started seeing/admitting patients. Already I have seen the worst ascites, had a patient die in my care of septic shock, treated/diagnosed cerebral malaria and the list continues...in other words I am going to learn alot! But it is definately hard when the treatments I know we would give are not available. Mulago is the 1 government hospital in Kampala.
Well lisa is back at the house, so I am going to catch up with her. Hope someone actually reads this ;) And I will work on getting pictures uploaded at some point
When we arrived on Monday morning in Entebbe, our ride was waiting for us, and we got settled in at our boarding house on the campus of Makerere University, visited the Mulago Hospital, and got shown around by a medical student. It was nice to get our sense of direction around the city, although lisa is much better at that than me. Our room that we share at the edgehouse is nice, they have mosquito nets for us, there is a dribble of warm water that you can take bucket type shower/baths with. I am just happy for warm water! After walking around all yesterday afternoon, we went out for dinner with some of the other med students staying at the edgehouse and picked up some groceries from the market.
Today was my first day in the hospital. I am spending the next few days on "Casualty Medicine" which is the tiny room where they first bring the non-surgical emergency patients. From there they go to "Emergency" for 1 day then the to hospital wards. I was shy at first, because the diseases are very different and many of the patients do not speak english, and I often have a hard time understanding the Ugandan accent, but after a few hours I started seeing/admitting patients. Already I have seen the worst ascites, had a patient die in my care of septic shock, treated/diagnosed cerebral malaria and the list continues...in other words I am going to learn alot! But it is definately hard when the treatments I know we would give are not available. Mulago is the 1 government hospital in Kampala.
Well lisa is back at the house, so I am going to catch up with her. Hope someone actually reads this ;) And I will work on getting pictures uploaded at some point
Wednesday, April 1, 2009
Getting Ready, T-4 days!
Hello everyone! This will be my first ever blog posting. I was hoping to create a page to allow people to track what I am up to during my up coming trip to Uganda. We will see if this works, no promises on how often I will update!
Over the next 5 weeks, from April 4th to May 9th I will be working in and traveling around Uganda. I will be traveling to Uganda with Lisa Hamilton, a good medical school friend of my, for those of you who do not know her. We both have arranged a 4 week medical rotation through Makerere University. We leave O'hare this Saturday evening, have a nice long lay over in London during which we plan to do some site seeing, then on to Uganda. We finally land in Entebbe, Uganda (outside of the capital Kampala) at about 7 am on Monday morning.
During the 5 weeks in Uganda, I will be doing a 4 week medical rotation. Although the details are not going to be finalized till we arrive, the general plan is for me to do 1 week of Emergency Medicine in the capital Kampala at the large hospital there, Mulago Hospital. The remainder of the time, I will travel to a smaller city, Tororo which is near the border with Kenya and work with a doctor there. My understanding is that he has a clinic in Tororo and also does some traveling clinics to smaller villages throughout the area. We will see what ends up happening!
At the end of our rotation, Lisa and I have set aside 1 week to do some traveling and site seeing. We are hoping to get permits to go "gorilla trekking" in Southeast Uganda. The endangered mountain gorilla is only located in a pocket of land shared between Uganda, Rwanda, and DRC and very few permits are availabe to see them, so Lisa and I are going to keep our fingers crossed that we can make it work. We are also hoping to do some Class 5 rafting on the Nile while there.
Keep posted for updates of my travels :)
Over the next 5 weeks, from April 4th to May 9th I will be working in and traveling around Uganda. I will be traveling to Uganda with Lisa Hamilton, a good medical school friend of my, for those of you who do not know her. We both have arranged a 4 week medical rotation through Makerere University. We leave O'hare this Saturday evening, have a nice long lay over in London during which we plan to do some site seeing, then on to Uganda. We finally land in Entebbe, Uganda (outside of the capital Kampala) at about 7 am on Monday morning.
During the 5 weeks in Uganda, I will be doing a 4 week medical rotation. Although the details are not going to be finalized till we arrive, the general plan is for me to do 1 week of Emergency Medicine in the capital Kampala at the large hospital there, Mulago Hospital. The remainder of the time, I will travel to a smaller city, Tororo which is near the border with Kenya and work with a doctor there. My understanding is that he has a clinic in Tororo and also does some traveling clinics to smaller villages throughout the area. We will see what ends up happening!
At the end of our rotation, Lisa and I have set aside 1 week to do some traveling and site seeing. We are hoping to get permits to go "gorilla trekking" in Southeast Uganda. The endangered mountain gorilla is only located in a pocket of land shared between Uganda, Rwanda, and DRC and very few permits are availabe to see them, so Lisa and I are going to keep our fingers crossed that we can make it work. We are also hoping to do some Class 5 rafting on the Nile while there.
Keep posted for updates of my travels :)
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