Oh man, I forgot about this story until just now! Ok, so Christine and I are on our way back from Kumi after finishing our project, feeling contented and satisfied with the world etc….. Well, to get from Kumi Hospital (where we were working and staying) to Kumi town (where the busses to Kampala pick you up) you must either walk 5Km or take a boda boda (small motor bike). Now in Kampala, where large, heavy cars with careless drivers zip through the paved streets at surprising speed, I advise against taking bodas too regularly because in general, human skulls and their valuable innards tend to come out worse-for-the-wear when they’re hit head on by pavement at 30mph. However, if you’re in Kumi where walkers and bicyclers are the main form of traffic on the long dusty dirt road that connects hospital to town then bodas are a pretty good option.
So anyway, Christine and I are on bodas, one each, with our big packs strapped precariously to the rear of our bikes with strips of tire rubber so that when the driver swerves slightly the pack rocks back and forth, threatening to fall off. My boda is in front (this is important for the story).
Now, I usually don’t talk to boda drivers very much while we’re moving because they do this really annoying thing where they turn their head sideways to talk back to you so that you can hear them better, taking their eyes OFF of the road and its on-coming traffic in the process, for FAR too long (any time longer than 0.5 seconds). So when my boda driver swerved abruptly, sending my pack a-rocking, and then turned his head to have a long meaningful conversation in response to my “hey! Be careful ok?” I didn’t really hear what he was saying, it was something like “yeah, you people are afraid of those ones” (most Ugandans refer to any group of caucasians as “you people,” I think its funny) He didn’t say much else because I was like “eyes on the road buddy!” while pointing my finger forward and he shrugged and drove on.
So Christine and I get to town, hop a bus, get back to Kampala, la-de-da and so forth. The next day…. we are walking to dinner with our friend Therese (one of the Swedes) relaying our most gripping Kumi stories when Christine says “oh yeah, and Annie’s boda boda almost hit a Green Mamba on the way back to town!” *** those stars represent the stunned silence that ensued after this statement before I blurted “ha-WHAT?!?!” Now, for those of you who did not study neurobiology with Bill Moody at the University of Washington (go Bill!), the Green Mamba is maybe one of the most dangerous/poisonous snakes in the world! Its not super aggressive, like the perhaps more infamous black mamba (that will chase you down faster than you can run and then bite you if you piss it off) but its venom is rife (yes, rife!) with dendrotoxin, a potent neurotoxin that when introduced into the human body, basically stops pretty much all the neurons it encounters from firing any more action potentials by blocking potassium channels….this includes the handy neurons that, oh, keep you breathing, or the ones that keep your heart beating….all those neurons that go unnoticed day by day until the one day when they stop working. They say that when a green mamba bites you, you’ve got about 7 steps to live….that’s foot steps. Just about enough time to think “ow, what the…..” thud.
So! Holy crap! My boda was actually swerving to dodge a crazy-poisonous snake not just joy-riding! Christine saw the whole thing and estimated that our wheels passed about 12 inches from its tail! “eyes on the road buddy!” oops, I mean “hey thanks for not hitting that deadly snake, I really appreciate it.”
Wednesday, August 6, 2008
Mabira Forest
After being back in the hustle and bustle of Kampala for a few weeks, Christine and I were dying to get out into some wilderness for a bit. I get into a “the world is my oyster” exploratory mode when I’m traveling in a place where cheap lodgings and national forests are abundant and the result is usually pleasing. So, in full oyster mode Christine and I packed a set of clothes and a flashlight and hopped a matatu to Mabire National Forrest, a 300km.sq stretch of jungle that is known for hosting a variety of monkey and butterfly species as well as just being gorgeous.
Our matatu dropped us off in Najembe, a tiny town in the middle of Mabira flanking the road that connects Kampala to the source of the Nile, and since white people are a little more scarce in rural towns than they are in Kampala, we had a little trail of smiling kids following us around within seconds while we walked around asking local women (using mostly hand gestures) where we could get a bite to eat. We stepped into a “restaurant” (a small room with a tin roof, two couches and a small fridge) just in time to avoid the torrential down pour that had been tracking us, and ate Matoke (a local dish composed of smooshed plantain), drank local tea, played cards and had a lovely but broken conversation with the restaurant matron until the rain stopped about a hour later. When we paid her the equivalent of about 2 US dollars for the food and tea she declared “now you are my sister!” and waved us onward, smiling. It was great.
That night, after hiking around a bit and sampling some delicious “chicken on a stick” (seriously, half a chicken….on a stick!) from the market we stayed in a little banda that had two twin beds, a deck that faced the dense jungle (allowing for nice monkey watching around dusk) and approximately 300,000 mildew spores that were waiting eagerly to enter my alveolar sacks and make a nice little home for themselves. I woke up in the morning with a slight cough and burning lungs, as did Christine, so I know that it wasn’t wholly psychosomatic.
Next day we went on a nature hike with a local guide who told us all about the trees and animals we saw including monkeys, coco trees, a lot of birds whose names I can’t remember and (my favorite) “strangler figs” which are trees that, at a young age, attach themselves to an established tree, slowly grow up its trunk and then after a few centuries, engulf it completely leaving a huge fig tree with a hollowed out network of roots near the bottom where the poor host tree once resided before it was basically suffocated by the fig. No, these figs are not my favorite because of their life-sucking nature, they’re just pretty :)
Our matatu dropped us off in Najembe, a tiny town in the middle of Mabira flanking the road that connects Kampala to the source of the Nile, and since white people are a little more scarce in rural towns than they are in Kampala, we had a little trail of smiling kids following us around within seconds while we walked around asking local women (using mostly hand gestures) where we could get a bite to eat. We stepped into a “restaurant” (a small room with a tin roof, two couches and a small fridge) just in time to avoid the torrential down pour that had been tracking us, and ate Matoke (a local dish composed of smooshed plantain), drank local tea, played cards and had a lovely but broken conversation with the restaurant matron until the rain stopped about a hour later. When we paid her the equivalent of about 2 US dollars for the food and tea she declared “now you are my sister!” and waved us onward, smiling. It was great.
That night, after hiking around a bit and sampling some delicious “chicken on a stick” (seriously, half a chicken….on a stick!) from the market we stayed in a little banda that had two twin beds, a deck that faced the dense jungle (allowing for nice monkey watching around dusk) and approximately 300,000 mildew spores that were waiting eagerly to enter my alveolar sacks and make a nice little home for themselves. I woke up in the morning with a slight cough and burning lungs, as did Christine, so I know that it wasn’t wholly psychosomatic.
Next day we went on a nature hike with a local guide who told us all about the trees and animals we saw including monkeys, coco trees, a lot of birds whose names I can’t remember and (my favorite) “strangler figs” which are trees that, at a young age, attach themselves to an established tree, slowly grow up its trunk and then after a few centuries, engulf it completely leaving a huge fig tree with a hollowed out network of roots near the bottom where the poor host tree once resided before it was basically suffocated by the fig. No, these figs are not my favorite because of their life-sucking nature, they’re just pretty :)
Neurosurgery Camp!
Last week Christine and I rotated in the neurology unit at Mulago. I have long harbored a secret desire to be a neurologist, so I found this rotation particularly interesting, though admittedly it was not at all representative of a neuro practice in the US. The patients present with symptoms that are far more advanced than those you would see in the states –Mr. X has left sided paralysis, he has been like this for three weeks, he is HIV positive, when his speech began to slur we decided to bring him in….etc—
Also, in mulago, anyone who is admitted to the hospital while unconscious is turfed to the neuro ward so we saw a fair number of recovering alcoholics and hypoglycemic patients along with many of the expected neurological complications like stroke, meningitis, dementia, brain cancer and bell’s paulsy. In addition, we saw some of the more rare neurological disorders (rare in the US) such as guillan barre syndrome (ascending but often reversible paralysis) and AIDS-associated-toxoplasmosis. Toxoplasmosis is the parasite associated with cat feces, and virtually all of the population has been exposed to it (you’re infected right now!) but under normal circumstances, our incredible immune systems keep it under control. In AIDS patients, however, the immune system is sometimes too weak to fight off this infection and the parasite can invade the brain creating large “ring enhancing” lesions (indicating inflammation around the edges of the lesion, as you would expect in toxo, TB meningitis or some types of lymphoma) that result in a variety of potentially lethal complications. In the US, HIV positive patients are given prophylactic medication to avoid toxoplasmosis infection, but here in Uganda patients do not have the same access to medication and so toxo is unfortunately quite common.
Mid week Christine and I learned that there was a “neurosurgery camp” being hosted in one of the surgical wards by a US medical team from Duke and we decided to seek them out to see if they would let us join in on the fun. I mean, come on! Neurosurgery camp? It sounds like the best camp ever!!! (Who needs s’mores and a swimming pool when you can observe brain surgery?) There was one doctor in particular, Dr. Robert Wilkins, a retired neurosurgeon on the faculty at Duke who made a particular point to teach us about the different surgeries and make us feel at ease. He was awesome. While the surgeries were being performed he would take us from room to room and walk us through the x-rays and CT scans of each patient so that we could better understand the procedures.
We found out near the end of the first day that Dr. Wilkins is actually a world renowned surgeon! He founded the journal “Neurosurgery” (amazing) and co-authored/edited two editions of the book “neurosurgery” a major text in the field. Half the fun of Neuro Camp was hearing about how he managed to start a journal and how the practice of neurosurgery has changed since the beginning of his career. I felt very lucky to be learning from someone who is both so knowledgeable and so patient. All in all a very good week.
Also, in mulago, anyone who is admitted to the hospital while unconscious is turfed to the neuro ward so we saw a fair number of recovering alcoholics and hypoglycemic patients along with many of the expected neurological complications like stroke, meningitis, dementia, brain cancer and bell’s paulsy. In addition, we saw some of the more rare neurological disorders (rare in the US) such as guillan barre syndrome (ascending but often reversible paralysis) and AIDS-associated-toxoplasmosis. Toxoplasmosis is the parasite associated with cat feces, and virtually all of the population has been exposed to it (you’re infected right now!) but under normal circumstances, our incredible immune systems keep it under control. In AIDS patients, however, the immune system is sometimes too weak to fight off this infection and the parasite can invade the brain creating large “ring enhancing” lesions (indicating inflammation around the edges of the lesion, as you would expect in toxo, TB meningitis or some types of lymphoma) that result in a variety of potentially lethal complications. In the US, HIV positive patients are given prophylactic medication to avoid toxoplasmosis infection, but here in Uganda patients do not have the same access to medication and so toxo is unfortunately quite common.
Mid week Christine and I learned that there was a “neurosurgery camp” being hosted in one of the surgical wards by a US medical team from Duke and we decided to seek them out to see if they would let us join in on the fun. I mean, come on! Neurosurgery camp? It sounds like the best camp ever!!! (Who needs s’mores and a swimming pool when you can observe brain surgery?) There was one doctor in particular, Dr. Robert Wilkins, a retired neurosurgeon on the faculty at Duke who made a particular point to teach us about the different surgeries and make us feel at ease. He was awesome. While the surgeries were being performed he would take us from room to room and walk us through the x-rays and CT scans of each patient so that we could better understand the procedures.
We found out near the end of the first day that Dr. Wilkins is actually a world renowned surgeon! He founded the journal “Neurosurgery” (amazing) and co-authored/edited two editions of the book “neurosurgery” a major text in the field. Half the fun of Neuro Camp was hearing about how he managed to start a journal and how the practice of neurosurgery has changed since the beginning of his career. I felt very lucky to be learning from someone who is both so knowledgeable and so patient. All in all a very good week.
Endocrine Unit
This week I rotated in the endocrinology unit at Mulago because I wanted to see how diabetes was managed in a big city vs rural Kumi. Almost all of the patients in the endo unit are diabetic and they suffer from various ailments, some related to their diabetes and some not. The reason for this is that any patient who enters the gates of mulago who is a known diabetic gets shifted directly to the endo unit regardless of what is wrong with them because it is the only unit that is capable (read: willing) to properly manage blood sugar levels during their hospital visit.
The conclusion that I have reached is that if you get diabetes in Uganda, no matter where you live or how much money you make (to a point) you’re in trouble, because the daily routine of many Ugandans simply does not align well with the proposed treatment plan.
They take good care of you in the unit and teach you about diet/exercise and give you some medication, but once you leave the ward, it is difficult to adopt the lifestyle necessary to slow diabetes progression. The social norms here simply do not align with the suggestions of the physician, so any orders are followed haphazardly at best, and who can blame a patient for ignoring instructions that would so drastically alter their routine? This is assuming you can afford to make said lifestyle changes in the first place.
Ideally, a newly diagnosed diabetic patient (who usually presents with sx that are quite advanced by American standards) should: monitor and control blood sugar levels, alter their diets significantly and begin an exercise regiment, but this is easier said than done here.
Blood sugar monitoring: No patients that I came in contact with (true, I was at a government hospital, so I was exposed to a lower-income portion of the population) owned their own glucometer, so day-to-day they had no idea what their blood sugar levels were. If they were extremely compliant (rare) they attended the diabetic clinic every two weeks and had their blood sugar levels measured and medications adjusted accordingly, but more realistically patients would attend the clinic once a month. So that’s one or two blood sugar reading a month for the average Ugandan who is lucky enough to live within traveling distance to Mulago and willing to sit for 4 hours to get a reading and a refill. Moreover, patients do not really take the blood sugar management seriously (or perhaps are not diagnosed as diabetic) until they have serious sx like neuropathy, visual problems or circulatory problems that cannot be reversed with treatment, so when they try to follow the doctors orders in hopes of “getting better” they are often disappointed. It is way easier to sell a cure than it is to sell “do all of this and you won’t get any worse…maybe.” So this poses a problem for practitioners. We need to catch patients earlier and make blood sugar control more manageable for the average person.
Diet: Soda is extremely popular here. Most people who can afford it drink at least one a day if not more (coca cola has done an amazing job marketing to the Ugandan public) The major affordable staple foods are starchy, often fried and void of protein and the rare teaspoon-sized serving of greens that appears on a plate packed with rice, matoke and cassava has been boiled to a mush…not so many vitamins. So the average Ugandan who seeks medical care at Mulago probably eats something like three servings of starches per day, something fried, something sweet and then if they’re really lucky, a protein source, probably beans, or on occasion chicken! When a doctor tells a poor patient to eat plenty of protein, cut down on the fried foods, limit the sugars and try to eat a lot of vegetables, it is just not a practical change. Vegetables aren’t commonly eaten and they’re more expensive than a plate of matoke (like mashed plantain) that will fill your growling belly much more effectively. The price of food, the foods available, the economic infrastructure, these things all need to change if the poor are to be well nourished, instead of just fed to the point of not starving. The sad thing is, once a poor person who has diabetes gets to the point of neuropathy in the feet, chances are injury (no shoes) and infection (poor hygine) will lead to amputation or other serious complications very quickly and the vicious cycle continues, because who can work with no feet or one hand?
I will admit that diabetes has typically been labeled as a disease of the affluent. There is some truth to this, but more and more, diabetes is developing in even the poorest of populations. This makes sense when you consider that starchy, sugary or fried food is often the cheapest and most filling.
Exercise:
I love running. I adore it in fact, and yet here in the equatorial heat I have to force myself to get out of bed early three times a week to go jogging through crowded smoggy streets where people stare at me wondering what the heck I am doing. There is no “the pedestrian is always right” rule here, quite the opposite holds true in fact because the law of the road is “biggest thing wins.”
With the traffic risks and the weird stares and the hopping-over-dog-poo-and-waste that accompany any jog within city limits, it is not a stretch to see why running hasn’t really caught on here. Many people walk during the day, but exercise for the sake of it is not really part of daily life (unless you’re a young guy whose mother still cooks for you and does your laundry, in which case you probably play soccer for several hours a day and sport Manchester United t-shirts) Walking is good, yes, but unless walking is already a part of your lifestyle, its hard to integrate it. If you are a 45 year old woman, newly diagnosed with diabetes, chances are you have between 3 and 9 kids and it will be hard to fit 30 minutes of burden-free walking into your day that is already packed with cleaning, cooking and laundry.
Bleak! I know! Diabetes is a hard disease to address here, or in any developing country for that matter. It was so hard for me to see the diabetic patients in the endocrine ward slowly deteriorating, losing a hand or a foot along the way due to injury secondary to the neuropathy and poor circulation characteristic of advanced diabetes. They seemed to have the attitude of “well, I’ll take these pills and we’ll see what happens next.” How do you change something that arises from such strongly established cultural norms? Start small and hope for the best I suppose.
Side note: Christine’s old professor worked for many years in Kenya with an AIDS support organization (how to live a positive life with AIDS etc). One of the things that she would encourage patients to do is eat raw veggies because they have so many vitamins and nutrients. If you have ever been to Kenya (or Uganda) you will know that raw veggies are simply not a part of the every-day diet. People don’t eat a lot of veggies. So, the people in the program started eating raw veggies, and before long there developed a stigma “if you eat raw veggies, you must be HIV positive,” so people were even less likely than before to eat raw veggies for fear of being labeled as HIV positive! It just goes to show that every action you take will have ramifications (both good and bad) that you could never foresee.
I feel that education is the first essential step to addressing the problem of diabetes in Uganda. The more people know about it (how to recognize the sx etc) the earlier it will be caught and the longer the advanced sx can be delayed. However, education is only a first step along a long path. Even if people know all about diabetes, they have to have the means to alter their lifestyle according to the Dr’s orders…this is more complicated as it ties into social, economic and cultural issues. Poverty, of course, is the main problem, just as with many diseases in the developing world. Give the population a means to thrive, lessen the gap between the rich and the poor, educate the populace, give people hope and a sense of stability and diseases will lessen. Man, what a daunting task lies ahead, because diabetes is going to sky rocket here in the next 20 years.
The conclusion that I have reached is that if you get diabetes in Uganda, no matter where you live or how much money you make (to a point) you’re in trouble, because the daily routine of many Ugandans simply does not align well with the proposed treatment plan.
They take good care of you in the unit and teach you about diet/exercise and give you some medication, but once you leave the ward, it is difficult to adopt the lifestyle necessary to slow diabetes progression. The social norms here simply do not align with the suggestions of the physician, so any orders are followed haphazardly at best, and who can blame a patient for ignoring instructions that would so drastically alter their routine? This is assuming you can afford to make said lifestyle changes in the first place.
Ideally, a newly diagnosed diabetic patient (who usually presents with sx that are quite advanced by American standards) should: monitor and control blood sugar levels, alter their diets significantly and begin an exercise regiment, but this is easier said than done here.
Blood sugar monitoring: No patients that I came in contact with (true, I was at a government hospital, so I was exposed to a lower-income portion of the population) owned their own glucometer, so day-to-day they had no idea what their blood sugar levels were. If they were extremely compliant (rare) they attended the diabetic clinic every two weeks and had their blood sugar levels measured and medications adjusted accordingly, but more realistically patients would attend the clinic once a month. So that’s one or two blood sugar reading a month for the average Ugandan who is lucky enough to live within traveling distance to Mulago and willing to sit for 4 hours to get a reading and a refill. Moreover, patients do not really take the blood sugar management seriously (or perhaps are not diagnosed as diabetic) until they have serious sx like neuropathy, visual problems or circulatory problems that cannot be reversed with treatment, so when they try to follow the doctors orders in hopes of “getting better” they are often disappointed. It is way easier to sell a cure than it is to sell “do all of this and you won’t get any worse…maybe.” So this poses a problem for practitioners. We need to catch patients earlier and make blood sugar control more manageable for the average person.
Diet: Soda is extremely popular here. Most people who can afford it drink at least one a day if not more (coca cola has done an amazing job marketing to the Ugandan public) The major affordable staple foods are starchy, often fried and void of protein and the rare teaspoon-sized serving of greens that appears on a plate packed with rice, matoke and cassava has been boiled to a mush…not so many vitamins. So the average Ugandan who seeks medical care at Mulago probably eats something like three servings of starches per day, something fried, something sweet and then if they’re really lucky, a protein source, probably beans, or on occasion chicken! When a doctor tells a poor patient to eat plenty of protein, cut down on the fried foods, limit the sugars and try to eat a lot of vegetables, it is just not a practical change. Vegetables aren’t commonly eaten and they’re more expensive than a plate of matoke (like mashed plantain) that will fill your growling belly much more effectively. The price of food, the foods available, the economic infrastructure, these things all need to change if the poor are to be well nourished, instead of just fed to the point of not starving. The sad thing is, once a poor person who has diabetes gets to the point of neuropathy in the feet, chances are injury (no shoes) and infection (poor hygine) will lead to amputation or other serious complications very quickly and the vicious cycle continues, because who can work with no feet or one hand?
I will admit that diabetes has typically been labeled as a disease of the affluent. There is some truth to this, but more and more, diabetes is developing in even the poorest of populations. This makes sense when you consider that starchy, sugary or fried food is often the cheapest and most filling.
Exercise:
I love running. I adore it in fact, and yet here in the equatorial heat I have to force myself to get out of bed early three times a week to go jogging through crowded smoggy streets where people stare at me wondering what the heck I am doing. There is no “the pedestrian is always right” rule here, quite the opposite holds true in fact because the law of the road is “biggest thing wins.”
With the traffic risks and the weird stares and the hopping-over-dog-poo-and-waste that accompany any jog within city limits, it is not a stretch to see why running hasn’t really caught on here. Many people walk during the day, but exercise for the sake of it is not really part of daily life (unless you’re a young guy whose mother still cooks for you and does your laundry, in which case you probably play soccer for several hours a day and sport Manchester United t-shirts) Walking is good, yes, but unless walking is already a part of your lifestyle, its hard to integrate it. If you are a 45 year old woman, newly diagnosed with diabetes, chances are you have between 3 and 9 kids and it will be hard to fit 30 minutes of burden-free walking into your day that is already packed with cleaning, cooking and laundry.
Bleak! I know! Diabetes is a hard disease to address here, or in any developing country for that matter. It was so hard for me to see the diabetic patients in the endocrine ward slowly deteriorating, losing a hand or a foot along the way due to injury secondary to the neuropathy and poor circulation characteristic of advanced diabetes. They seemed to have the attitude of “well, I’ll take these pills and we’ll see what happens next.” How do you change something that arises from such strongly established cultural norms? Start small and hope for the best I suppose.
Side note: Christine’s old professor worked for many years in Kenya with an AIDS support organization (how to live a positive life with AIDS etc). One of the things that she would encourage patients to do is eat raw veggies because they have so many vitamins and nutrients. If you have ever been to Kenya (or Uganda) you will know that raw veggies are simply not a part of the every-day diet. People don’t eat a lot of veggies. So, the people in the program started eating raw veggies, and before long there developed a stigma “if you eat raw veggies, you must be HIV positive,” so people were even less likely than before to eat raw veggies for fear of being labeled as HIV positive! It just goes to show that every action you take will have ramifications (both good and bad) that you could never foresee.
I feel that education is the first essential step to addressing the problem of diabetes in Uganda. The more people know about it (how to recognize the sx etc) the earlier it will be caught and the longer the advanced sx can be delayed. However, education is only a first step along a long path. Even if people know all about diabetes, they have to have the means to alter their lifestyle according to the Dr’s orders…this is more complicated as it ties into social, economic and cultural issues. Poverty, of course, is the main problem, just as with many diseases in the developing world. Give the population a means to thrive, lessen the gap between the rich and the poor, educate the populace, give people hope and a sense of stability and diseases will lessen. Man, what a daunting task lies ahead, because diabetes is going to sky rocket here in the next 20 years.
Friday, July 18, 2008
photo ketchup
Photos! Now that I am back in Kampala (where internet is tollerable, here are some pics.from the top....
1:Kumi hospital kids ward...this is what it looks like sans patients (for confidentiality purposes)
2: Sophie the Swede and I in Kampala
3: Sipi three! the third waterfall in a series of three....we absailed down this cliff right next to the waterfall. It was awesome! if you look super close you can see people getting ready to absail in this pic
4: Campfire at Sipi falls, complete with s'mores!
5: Kumi sunset
6: Water pump near Kumi Hospital. There has been no running water for about a month in Kumi because the district pump is broken so everyone would get water from this well...all day.
Git 'er Done!
Its not that I’ve really figured out how things work here (to truly accomplish that would take years and something other than the pasty white Irish skin that so loudly proclaims that I am outsider), but I am finding that I am learning how to accomplish things without going crazy, which is great. The more time I spend here the more my feelings of affection toward and comfort in Uganda develop. Combine this with all the other little things that I love about Uganda (Masala tea/Nescafe in the morning, the little lizards everywhere, the way that people lead you by the hand along busy streets to your destination when you ask for directions) and the mixture begins to resemble something that feels like a home. I'm even getting used to taking bucket baths....I don't love it or anything, but I've come to expect it. Taking bucket baths also appeals to my feelings of being hard-core, which is very reinforcing, but these feelings are snuffed out immediately when I see the types of conditions most people are living in here. Bucket baths be damned, I'm eating three meals a day, I'm a freaking princess by some standards.
Ok, back to the original point, I am learning that if you want to get something done in Kumi, or Mbale or any town in Uganda for that matter, there are a few things you should keep in mind in order to “Git ‘er done” as they say in Moscow, Idaho (go Vandals!).
First: Throw aside any and all notions that rapidity equates success.
The whole idea that faster is better simply doesn’t exist here, much to the chagrin of many a western type-A-personality. I have no doubt that the flow of time and urgency that I am accustomed to will return to me abruptly when I set foot back on American soil, (some ways of thinking are engraved into me too deeply to be erased by a summer void of any real responsibility) but for now, I have become comfortable (enough) ambling along at the pace of the region. Ok, time is thrown aside. Done.
Second: Find a woman (not a man) to get any sort of advice or direction.
I hate to generalize so shamelessly, for there are indeed exceptions to this rule, but I have learned the hard way that it holds true in almost all situations. If you’re a lone white girl in a new dusty town and ask a man how to find the taxi park, he will give you a vague or completely false answer, smirk at you, try to sell you something, ask if you’re married, then dismiss you abruptly to gaze in the other direction when you assure him that yes, you have a fiancé back in the states who is a thick muscled, jealous type. Ask a woman for help, however, and she will grasp your hand and lead you down the road to where the taxi park is hiding, or if she doesn’t know the way, she’ll take you next door where her second cousin or aunt or mother lives and a gaggle of smiling, shy women will direct you where you need to go while they tell you how beautiful your light (pasty-ass white, despite the African sun) skin is. Christine's MO, which I have adopted whole heartedly, is to find a tiny little shop where a woman is selling fanta in every town you enter, then buy said fanta, ask how many children she has etc and you'll have a buddy who won't try to cheat you when you need to know where in town to buy shoe laces or face soap, or you just want to sit and chat for a lazy afternoon. In Africa, women pretty much rock :)
Third: Get used to traveling to another city to find what you want.
If its not here in Kumi, then baby, it ain’t here. You want peanut butter? Well, its not in this supermarket, and its not in the supermarket down the street, which carries an almost identical assortment of non-perishable foods, flip flops and plastic table ware, so you can pretty much forget about it. There is peanutbutter in Mbale, so either hop a Matatu for the 60Km ride to get it or just learn to do without. (note: Christine found some local-made “G-nut paste” (Ground-nut paste = peanutbutter) in little baggies at the open market a week after our initial search….I mean come on! It had to be here, I walk through freakin’ peanut fields watching the sunset every few days, they can’t ALL be exported! I guess sometimes it just pays to know the local lingo: G-nut paste? Oh sure, it’s at the market. Peanutbutter? Nope, sorry, never heard of it.
Fourth: When necessary, be a stubborn Mzungu jerk.
This one works alright for me because when I’m getting nothing, I can usually disguise my stubbornness in the non-threatening “oh, but I’m just a little girl, and I’m just so overwhelmed here in this big city, can’t you help me please?” attitude that is surprisingly effective. At first, my shy don’t-want-to-inconvenience-you way of doing things left me frustrated at the end of the day when I’d run around like a fool on faulty suggestions, but when I started being more stubborn (easy for me) and pressed just a little harder for information, I found that most times people did know someone who knew someone else who had exactly what I needed, and yes, of course they would bring it to me if I’d promise to buy three of them. Sweet, I’ll wait here ok? Why yes, I’d love some tea, that would be wonderful.
What I wanted to “git done” last week was the printing of several large, good quality, color copies of the posters that Christine and I have designed to aid us in our respective projects regarding diabetes education and foot care in the Kumi district. We asked the local health official (who has been fantastic to us, making it possible for the posters to be translated from English into Ateso, the local dialect…..In Ateso “Diabetes” is “Adeka Na Esukaali” or “disease of sugar”) where we should get the posters printed and he along with his office staff assured us that Soroti (probably) or Mbale (definitely) would have a big color printer. So Christine and I set out to Mbale in a little matatu with big hopes, and three days later (or four? I forget) I returned to Christine from Kampala (capital city, a 5, or sometimes 9 hour bus trip away....depending on whether or not your bus breaks down) posters in hand! It is a long story, which I won't bore you with here, but in short: Git 'er Done!!! and I did. It was awesome. It seems like a small feat, I know, but the act of getting to Kampala on my own, scurrying around town to find a descent printer, not being ripped off and getting back with apparent ease was just great.
The posters are now resting proudly on the walls of two local hospitals, a smaller medical center and the local health office, woo!
Ok, back to the original point, I am learning that if you want to get something done in Kumi, or Mbale or any town in Uganda for that matter, there are a few things you should keep in mind in order to “Git ‘er done” as they say in Moscow, Idaho (go Vandals!).
First: Throw aside any and all notions that rapidity equates success.
The whole idea that faster is better simply doesn’t exist here, much to the chagrin of many a western type-A-personality. I have no doubt that the flow of time and urgency that I am accustomed to will return to me abruptly when I set foot back on American soil, (some ways of thinking are engraved into me too deeply to be erased by a summer void of any real responsibility) but for now, I have become comfortable (enough) ambling along at the pace of the region. Ok, time is thrown aside. Done.
Second: Find a woman (not a man) to get any sort of advice or direction.
I hate to generalize so shamelessly, for there are indeed exceptions to this rule, but I have learned the hard way that it holds true in almost all situations. If you’re a lone white girl in a new dusty town and ask a man how to find the taxi park, he will give you a vague or completely false answer, smirk at you, try to sell you something, ask if you’re married, then dismiss you abruptly to gaze in the other direction when you assure him that yes, you have a fiancé back in the states who is a thick muscled, jealous type. Ask a woman for help, however, and she will grasp your hand and lead you down the road to where the taxi park is hiding, or if she doesn’t know the way, she’ll take you next door where her second cousin or aunt or mother lives and a gaggle of smiling, shy women will direct you where you need to go while they tell you how beautiful your light (pasty-ass white, despite the African sun) skin is. Christine's MO, which I have adopted whole heartedly, is to find a tiny little shop where a woman is selling fanta in every town you enter, then buy said fanta, ask how many children she has etc and you'll have a buddy who won't try to cheat you when you need to know where in town to buy shoe laces or face soap, or you just want to sit and chat for a lazy afternoon. In Africa, women pretty much rock :)
Third: Get used to traveling to another city to find what you want.
If its not here in Kumi, then baby, it ain’t here. You want peanut butter? Well, its not in this supermarket, and its not in the supermarket down the street, which carries an almost identical assortment of non-perishable foods, flip flops and plastic table ware, so you can pretty much forget about it. There is peanutbutter in Mbale, so either hop a Matatu for the 60Km ride to get it or just learn to do without. (note: Christine found some local-made “G-nut paste” (Ground-nut paste = peanutbutter) in little baggies at the open market a week after our initial search….I mean come on! It had to be here, I walk through freakin’ peanut fields watching the sunset every few days, they can’t ALL be exported! I guess sometimes it just pays to know the local lingo: G-nut paste? Oh sure, it’s at the market. Peanutbutter? Nope, sorry, never heard of it.
Fourth: When necessary, be a stubborn Mzungu jerk.
This one works alright for me because when I’m getting nothing, I can usually disguise my stubbornness in the non-threatening “oh, but I’m just a little girl, and I’m just so overwhelmed here in this big city, can’t you help me please?” attitude that is surprisingly effective. At first, my shy don’t-want-to-inconvenience-you way of doing things left me frustrated at the end of the day when I’d run around like a fool on faulty suggestions, but when I started being more stubborn (easy for me) and pressed just a little harder for information, I found that most times people did know someone who knew someone else who had exactly what I needed, and yes, of course they would bring it to me if I’d promise to buy three of them. Sweet, I’ll wait here ok? Why yes, I’d love some tea, that would be wonderful.
What I wanted to “git done” last week was the printing of several large, good quality, color copies of the posters that Christine and I have designed to aid us in our respective projects regarding diabetes education and foot care in the Kumi district. We asked the local health official (who has been fantastic to us, making it possible for the posters to be translated from English into Ateso, the local dialect…..In Ateso “Diabetes” is “Adeka Na Esukaali” or “disease of sugar”) where we should get the posters printed and he along with his office staff assured us that Soroti (probably) or Mbale (definitely) would have a big color printer. So Christine and I set out to Mbale in a little matatu with big hopes, and three days later (or four? I forget) I returned to Christine from Kampala (capital city, a 5, or sometimes 9 hour bus trip away....depending on whether or not your bus breaks down) posters in hand! It is a long story, which I won't bore you with here, but in short: Git 'er Done!!! and I did. It was awesome. It seems like a small feat, I know, but the act of getting to Kampala on my own, scurrying around town to find a descent printer, not being ripped off and getting back with apparent ease was just great.
The posters are now resting proudly on the walls of two local hospitals, a smaller medical center and the local health office, woo!
Pictures:
Kumi kids: self explanatory and adorable. There was a group of kids that would often follow me home from the hospital asking "how are you?" over and over again....cuuuute.
Scrubbin': this is my hotty nurse surgical outfit that I sported while in the orthopedic surgery
Tire Shoes: This is the awesome tire guy that Christine and I cooperated with to provide good affordable footwear for diabetic patients in the Kumi district. He cuts the soles out of old tires and uses rubber or leather for straps and he is a total bad ass.
Saturday, June 28, 2008
Kumi: week 2
This week Christine and I wandered onto the hospital campus with one of the doctors who is staying in the guest house with us (he’s sort of like an intern, and will start a masters program for orthopedics at Makarere in the fall) and ended up rounding with his mentor “hard core doctor” as we call him, a fantastic orthopedic surgeon who handles literally 15 – 20 cases per day in the OR. During rounds he would approach each bed for an average of 30 seconds, check the wound, talk to the patient in their native tongue, snap orders at the nurses, make a joke and then move on. It was awesome. I could tell he was not someone to trifle with, but that I could learn a lot from him.
On Tuesday of this week I shadowed HCD in the OR from 8am until 4pm and we did….guess how many…19 freaking surgeries! I was about ready to fall on my face at the end of the day. I, having learned the germ theory of disease from a young age (which made me a total freak for a number of years, but primed me to be a bad-ass in the OR) was in charge of tying on the surgical gowns of the two surgeons, adjusting their goggles and keeping their supplies of sterile normal saline and alcohol topped off while HCD shot questions at me and then explained to me why my answers were wrong. He would sometimes tell me the correct answer, but more often than not would set topics for me to study that evening via the painfully slow internet connection in town.
I have learned so much. Some of the procedures I’ve seen are:
--club foot correction: severing the Achilles and then setting the feet in casts for rehab.
--hip replacement and repair.
--limb amputation: mainly in patients with leprosy or diabetes who have severe progressing sores on their feet and legs, but also in cases of malignant melanoma.
--sequestrectomy: this is my shiny new word of the day, it is the term for the removal/cleaning of dead and infected bone in patients who have osteomyelitis, a condition that you rarely see in the states which usually results from a systemic bacterial infection that gets caught up in growing bone and then flourishes for a long period of time. It is usually seen in kids because A: their immune systems are not quite as developed, and B: their bones are still growing fast and contain little twisty systems of capillary beds that are easily clogged up with bacteria (usually staph aureus) if it happens to be flowing through the blood. It is very sad to see, but as long as there is a portion of living healthy bone to leave behind in the limb, the prognosis for recovery is quite good.
--Debreidment: removal of dead or infected (often gangrenous) tissue
--Bone stetting: we had a patient today with an open fracture whose tibia was completely snapped in two. Another reminder not to ride the boda bodas (motorbikes)
I have concluded that orthopedic surgeons have very strong stomachs and are pretty darned awesome.
On Tuesday of this week I shadowed HCD in the OR from 8am until 4pm and we did….guess how many…19 freaking surgeries! I was about ready to fall on my face at the end of the day. I, having learned the germ theory of disease from a young age (which made me a total freak for a number of years, but primed me to be a bad-ass in the OR) was in charge of tying on the surgical gowns of the two surgeons, adjusting their goggles and keeping their supplies of sterile normal saline and alcohol topped off while HCD shot questions at me and then explained to me why my answers were wrong. He would sometimes tell me the correct answer, but more often than not would set topics for me to study that evening via the painfully slow internet connection in town.
I have learned so much. Some of the procedures I’ve seen are:
--club foot correction: severing the Achilles and then setting the feet in casts for rehab.
--hip replacement and repair.
--limb amputation: mainly in patients with leprosy or diabetes who have severe progressing sores on their feet and legs, but also in cases of malignant melanoma.
--sequestrectomy: this is my shiny new word of the day, it is the term for the removal/cleaning of dead and infected bone in patients who have osteomyelitis, a condition that you rarely see in the states which usually results from a systemic bacterial infection that gets caught up in growing bone and then flourishes for a long period of time. It is usually seen in kids because A: their immune systems are not quite as developed, and B: their bones are still growing fast and contain little twisty systems of capillary beds that are easily clogged up with bacteria (usually staph aureus) if it happens to be flowing through the blood. It is very sad to see, but as long as there is a portion of living healthy bone to leave behind in the limb, the prognosis for recovery is quite good.
--Debreidment: removal of dead or infected (often gangrenous) tissue
--Bone stetting: we had a patient today with an open fracture whose tibia was completely snapped in two. Another reminder not to ride the boda bodas (motorbikes)
I have concluded that orthopedic surgeons have very strong stomachs and are pretty darned awesome.
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