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