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.
Kumi: Week 1
Christine and I started our rural rotation in Kumi, a small town in the Eastern-ish part of Uganda two days ago.
After the first three hours of our Kumi-bound bus ride had passed, Christine and I could be found sitting contentedly in a grassy yard by the side of the road eating fresh chapatti about three miles from the bus park in central Kampala. We traveled these first three miles at a moderate pace, but then our bus driver, who apparently had hit-and-run a small vehicle earlier in the day with the very same bright green bus was pulled over and taken away by the police for questioning. I find this sad and hilarious at the same time. Don’t hit people and drive off, its not ok! But, add another tick mark to the bus-bound adventures list.
When we arrived in Kumi I knew immediately that I would enjoy it here. Kumi itself is a tiny little town made of concrete store-fronts that bake in the dry heat of mid day, but the surrounding land is lush and green and expands evenly for miles. The horizon looks similar to those I naively pictured in my dreams before setting foot on African soil: grassy expanses speckled with tall shady trees. I guess Disney did his homework because it sort of looks like some scenes from “The Lion King.”
One of the down sides of Kumi is that its freaking hot here…and thus my body wants to slip into a heat-induced semi-coma between the hours of 1 and 3 pm, but lucky for me, the whole of Kumi seems to do the same. The mornings are the most productive time of day and things ramp up again around 4pm when the outside world is tolerable.
There is about a 45 minute window of time in the morning when the sun has peaked over the horizon enough illuminate the road way, but has not risen enough to scorch my doxy-induced-sensitive skin, and I have been utilizing this window to run along the dusty red roads of Kumi, much to the amusement of the local people. I hear “Yes, Mzungu! Yes” over and over as they shake their heads and wonder why in the world this sweaty pink mzungu is running down the road. I was going to run along the smaller paths that cut between the corn and peanut fields around our guest house to avoid such a public spectacle, but when I was lacing up my shoes, one of my house mates warned me about the large number of cobras in the fields that don’t really appreciate being taken off guard by a sweaty white girl….so I stick to the roads.
The first day in the clinic was sweet. Christine and I were paired up with a physician who took us on medical rounds in the morning through the women’s ward, then to the pediatric ward to check on a few children and then to surgery. I scrubbed in on two procedures including a laparotomy (sp?), which was really interesting. The surgeon re-opened one of the patient’s fallopian tubes, which had healed shut after an infection and the subsequent inflammation and healing. Thin clear strands of connective tissue splayed off of the swollen tubes like spider webs, which the surgeon tore apart while bathing the organs with hydrocortisone solution in order to reduce inflammation. If all goes well, the patient may regain fertility following the procedure.
Today (day two) Christine and I shadowed the same physician/surgeon/pediatrician in the AIDS clinic. Patient after patient filed into the small room, sat in a small wooden chair and presented their chart. We learned the WHO staging criteria for HIV infected children and adults, which take into consideration the level of patient immunity (CD4 count), the presence of various opportunistic infections and many other factors. Depending on the stage, the doctor would decide weather or not anti-retro-viral medications were indicated and if not, what preventative treatments could be offered. Many of the patients were already on ARV regiments and were visiting the clinic for refills or to report new sx. that were either associated with their low immunity or with the ARV treatment itself, which can have some nasty side effects.
Around 1pm the hospital pharmacy was reaching the bottom of their ARV supplies so patients were triaged depending on how much medicine they had remaining at home and newly-qualified patients were instructed to return the following Thursday, as it is much worse to stop ARV treatment for one week than it is to delay the treatment onset by a week because the former can encourage drug resistance. The shortage of drugs totally took me off guard. Sure, I know that this is a poor area, but this was the first time I’d actually witnessed patients being turned away because the drugs they needed simply were not there. Sorry, there are no ARVs for hundreds of miles, so best come back next week. This incident increased both my sense of respect for the doctors trying to get by with what supplies they had, and my sympathy for patients suffering from debilitating diseases in an area where medical care is well intentioned but often ill supplied and poorly funded. It’s a bit overwhelming.
After the first three hours of our Kumi-bound bus ride had passed, Christine and I could be found sitting contentedly in a grassy yard by the side of the road eating fresh chapatti about three miles from the bus park in central Kampala. We traveled these first three miles at a moderate pace, but then our bus driver, who apparently had hit-and-run a small vehicle earlier in the day with the very same bright green bus was pulled over and taken away by the police for questioning. I find this sad and hilarious at the same time. Don’t hit people and drive off, its not ok! But, add another tick mark to the bus-bound adventures list.
When we arrived in Kumi I knew immediately that I would enjoy it here. Kumi itself is a tiny little town made of concrete store-fronts that bake in the dry heat of mid day, but the surrounding land is lush and green and expands evenly for miles. The horizon looks similar to those I naively pictured in my dreams before setting foot on African soil: grassy expanses speckled with tall shady trees. I guess Disney did his homework because it sort of looks like some scenes from “The Lion King.”
One of the down sides of Kumi is that its freaking hot here…and thus my body wants to slip into a heat-induced semi-coma between the hours of 1 and 3 pm, but lucky for me, the whole of Kumi seems to do the same. The mornings are the most productive time of day and things ramp up again around 4pm when the outside world is tolerable.
There is about a 45 minute window of time in the morning when the sun has peaked over the horizon enough illuminate the road way, but has not risen enough to scorch my doxy-induced-sensitive skin, and I have been utilizing this window to run along the dusty red roads of Kumi, much to the amusement of the local people. I hear “Yes, Mzungu! Yes” over and over as they shake their heads and wonder why in the world this sweaty pink mzungu is running down the road. I was going to run along the smaller paths that cut between the corn and peanut fields around our guest house to avoid such a public spectacle, but when I was lacing up my shoes, one of my house mates warned me about the large number of cobras in the fields that don’t really appreciate being taken off guard by a sweaty white girl….so I stick to the roads.
The first day in the clinic was sweet. Christine and I were paired up with a physician who took us on medical rounds in the morning through the women’s ward, then to the pediatric ward to check on a few children and then to surgery. I scrubbed in on two procedures including a laparotomy (sp?), which was really interesting. The surgeon re-opened one of the patient’s fallopian tubes, which had healed shut after an infection and the subsequent inflammation and healing. Thin clear strands of connective tissue splayed off of the swollen tubes like spider webs, which the surgeon tore apart while bathing the organs with hydrocortisone solution in order to reduce inflammation. If all goes well, the patient may regain fertility following the procedure.
Today (day two) Christine and I shadowed the same physician/surgeon/pediatrician in the AIDS clinic. Patient after patient filed into the small room, sat in a small wooden chair and presented their chart. We learned the WHO staging criteria for HIV infected children and adults, which take into consideration the level of patient immunity (CD4 count), the presence of various opportunistic infections and many other factors. Depending on the stage, the doctor would decide weather or not anti-retro-viral medications were indicated and if not, what preventative treatments could be offered. Many of the patients were already on ARV regiments and were visiting the clinic for refills or to report new sx. that were either associated with their low immunity or with the ARV treatment itself, which can have some nasty side effects.
Around 1pm the hospital pharmacy was reaching the bottom of their ARV supplies so patients were triaged depending on how much medicine they had remaining at home and newly-qualified patients were instructed to return the following Thursday, as it is much worse to stop ARV treatment for one week than it is to delay the treatment onset by a week because the former can encourage drug resistance. The shortage of drugs totally took me off guard. Sure, I know that this is a poor area, but this was the first time I’d actually witnessed patients being turned away because the drugs they needed simply were not there. Sorry, there are no ARVs for hundreds of miles, so best come back next week. This incident increased both my sense of respect for the doctors trying to get by with what supplies they had, and my sympathy for patients suffering from debilitating diseases in an area where medical care is well intentioned but often ill supplied and poorly funded. It’s a bit overwhelming.
Monday, June 16, 2008
The Stethescope Fiasco
Photos:
City scope, Kampala....craziness. This is a pic of the street next to the bus park.
Market restaruant: this is where the Swedes and I ate the first day I met them. The women cook matoke and beans on coal fires, which makes for a very warm (but very cheap) dining environment.
Puff Daddy: I love this picture. All of the matatus (taxis) here have slogans foiled onto their windows, most reading something like "jesus saves!" or "Have faith" but not this one....no no.
I’ve been told by fellow travelers that it’s a good idea to try and accomplish one major thing every day while in Uganda. Maybe two things, but that could really be pushing it. Seems ridiculous right? At first I thought “oh ho, but I am Annie McCabe, over achiever extraortinaire!” and set out to maintain my uber-productive pace in this slow-paced city, but I was promptly humbled by what I now refer to as “the stethoscope fiasco.”
I, like an idiot, packed my swanky Litman’s stethoscope (compliments of UW alumni assoc, thanks guys) with my various other belongings that are currently residing contently in boxes tucked into the plush burgundy interior of Bessy the Buick in my Aunt Jane’s yard in Olympia, Wa….USA. I realized this just prior to boarding my flight to Uganda, which is quite a ways from Olympia, but figured hey, no biggie I’ll just pick up a stethoscope in Kampala.
Christine, my classmate and cohort here in Kampala who arrived here one week after I did, graciously purchased me a used stethoscope from a 4th year UW student and brought it along. Sweet, problem solved! Oh wait, except said 4th year was a tricky conniving jerk and convinced sweet and trusting Christine that the stethoscope in question wasn’t missing its diaphragm, no no, it came like that, it never had a diaphragm. Lies. Dirty stinking lies, because the large bell doesn’t work at all sans its diaphragm and the style and number is identical to Christine’s diaphragm-having twin Litman’s.
Ok, back to plan A: get a stethoscope in Kampala, no problem.
Thursday. I inquire with Richard, my 5th year med student Ugandan friend, about where to either find a new diaphragm or get a new Litman’s here and we agree to meet for lunch on Friday and sort it all out. Ok, the ball is rolling.
Friday. I’m sitting in the canteen at Makarere U with Christine and Sophie the Swede waiting for Richard at our agreed-upon time and 30 minutes later Richard shows up because A: he’s on Uganda time, not American time and that’s just how they roll here, fair enough, and B: he was waiting for me outside the canteen for a good 15 minutes while I was waiting inside the canteen for him. We get to chatting and he agrees to take me to the repair shop at Mulago (the hospital) where there is a guy he knows (there’s always a guy he knows, its great, Richard is a good friend to have here) who will probably have a spare diaphragm and will be able to jimmy my Sävlig stethoscope into working order. We show up at the repair shop where there is a graveyard of old hospital beds/chairs/desks etc awaiting repair and an impressive collection of engineery-type machinery that I assume is used to cut metal and perform other manly tasks, but “the guy” was absent. Ok we’ll try again tomorrow. “Or,” I assure Richard “It would also be ok for me to find a place to get a new stethoscope.” We then promptly run into one of Richard’s pharmacy school friends (another one of those guys) on our way out who has the low-down on stethescopes and where to get them. He informs us of a few places in town where I can purchase a good scope, the best one being Joint Medical Stores on the outskirts of Kampala in a region called Nsambya, because it sells Litman’s at a good price. After being thoroughly assured by both of them that JMS is open on Saturdays, I thank them and bid them farewell. Sweet, the ball rolls on.
Saturday: I awake nice and early because I don’t know how long its going to take me to find JMS. I could take a special hire (personal taxi) that would deliver me straight there, but its about 10 or 15X as expensive as public transport and I’m a cheapskate while traveling so I decide to brave the matatus and find my way. Armed with Kaisa’s map of Kampala and a good amount of sunblock, I set out. It is 9am.
I board a Matatu to the old taxi park like a pro because I have been there before on our previous get-out-of-the-city weekend excursions, and then ask a few people how I can get to Nsambya from there. One nice fellow guides me across the street and directs me to the right taxi (people are so so nice here when it comes to directions, its great) I get in the taxi, wait for about 15 minutes while it fills to the brim with Nsambya-bound Ugandans and we’re off. The driver assures me that he knows JMS and will direct me when to get off, but I don’t know weather or not to trust him because on our way out of the taxi park when we encounter the always-present hoard of coming and going matatus, bikes and boda-bodas (small motor bikes) he literally almost runs over 3 or 4 pedestrians and nudges the back wheels of passing bikes while aggressively honking his horn in order to pass as quickly as possible through the traffic (it still takes like 30 minutes despite all this). We emerge from the crowded streets of central kampala and start skirting along the dusty side roads leading to Nsambya (I saw some signs with the word “Nsambya” on them intermingled with some Lugandan words that meant nothing to me, so at least I knew we were heading in the right direction…unless the signs were reading “do NOT go this way to get to Nsambya,” which I thought was unlikely J). A few minutes later the driver pulled over and pointed down a road, telling me to follow it for a while and I’d arrive at JMS. Ok. So, I paid my 800 Ugandan Shillings (about 50 cents) and off I went. Lo and behold, a short walk later there was JMS! Sweet! I am a bad ass! Yes, its about 11:30 am by now, but no worries, I made it.
In a very good mood, I open the big iron door to find a nice security guard, but absolutely no one else in sight. Mmm, mood plummet, what’s going on? “Hi there, I’m here to buy a stethoscope, is the store open today?” No. The store is not open on Saturdays, silly mzungu. (I make a mental note to cause Richard some sort of pain). “Ok, do you mind if I take a look around?” I was not going to give up so easy. The guard concedes to my wandering around with a “its not like you’re not going to find anything” look on his face, but he lets me go anyway. I find an open door on the side of a building, and inside a really nice employee who assures me that no, there is no way of getting into the store house on Saturday, but since I really need to get a stethoscope today because I’m leaving for the rural rotation the following day, he starts calling around Kampala to help me find a place that is open on Saturdays where they sell stethescopes. Yay for nice people, he finds a store (on the way other side of town) that is open and we locate it on the map. Off I go.
I hop another matatu (that was an IHOP pun), weave through the ensuing traffic jam, make it to a place in the city I recognize and jump out. Walk a few winding blocks up to the main road, hop another matatu that’s headed in the right direction, make friends with the fellow passengers who agree to tell me where to get out and in another hour or so, and a lot of directions later, I’m walking up to SinoAfrica Medical Supplies. They are open! They have stethoscopes! Not Litman’s but at this point I don’t really care what brand I get as long as I can hear heart sounds with it. I settle on a nice Chinese model and also purchase a reflex hammer and pen light, all the things I should have brought with me from the states but did not. It takes a while to get the items from the store house, but I’m chatting amiably with the two staff who are helping me and when they find out I’m going to work in a clinic in Kumi they muster up some other supplies that they want to donate and place them in the bag for me to take to the clinic. They were super nice. One of the ladies leads me back to the main road via a short cut and makes sure I get on the right matatu that’s headed back to Bukoto street, where I live.
Ah, all done. The matatu was going to pass all the way back through town (there was no direct matatu back to Bukoto) but it would eventually take me all the way home, I just needed to sit there and bask in my success. Good thing because my blood sugar was really low and all the matatu jumping and traffic and heat was getting to me. I slid over to the far window when a few passengers unloaded so that I could feel the breeze a bit and just zone out while other passengers hopped on and off (if you’re by the door you have to keep moving so that people can get past you). A few minutes later *CRASH* the window where I had been sitting moments before busted into a thousand tiny little pieces and all the passengers (including me) jumped and turned to see what had happened. The conductor had slammed the door with a touch too much fervor and the window had relented. Tiny crystalline nuggets of glass were scattered all over the floor and the back seat. Thank goodness I had moved, it would have scared the crap out of me if I’d been right next to the window. I thought for a split second that someone had shot at us, but that was just a silly gut fear as there’s very little violence here….though the police and guards carry disturbingly large weapons.
The conductor swept the glass from the seats and we pressed on. The traffic was increasing to the point of agony now so we turned around, edging along slowly, and back tracked to take an alternative route. By the time we reached about the half-way point to Bukoto I decided that I just couldn’t take any more of this inch-by-inch progress and got out to walk. I made it home by about 2:30pm, completely exhausted and slightly dehydrated but with a shiny new stethoscope in hand…and it only took 2 and a half days.
I, like an idiot, packed my swanky Litman’s stethoscope (compliments of UW alumni assoc, thanks guys) with my various other belongings that are currently residing contently in boxes tucked into the plush burgundy interior of Bessy the Buick in my Aunt Jane’s yard in Olympia, Wa….USA. I realized this just prior to boarding my flight to Uganda, which is quite a ways from Olympia, but figured hey, no biggie I’ll just pick up a stethoscope in Kampala.
Christine, my classmate and cohort here in Kampala who arrived here one week after I did, graciously purchased me a used stethoscope from a 4th year UW student and brought it along. Sweet, problem solved! Oh wait, except said 4th year was a tricky conniving jerk and convinced sweet and trusting Christine that the stethoscope in question wasn’t missing its diaphragm, no no, it came like that, it never had a diaphragm. Lies. Dirty stinking lies, because the large bell doesn’t work at all sans its diaphragm and the style and number is identical to Christine’s diaphragm-having twin Litman’s.
Ok, back to plan A: get a stethoscope in Kampala, no problem.
Thursday. I inquire with Richard, my 5th year med student Ugandan friend, about where to either find a new diaphragm or get a new Litman’s here and we agree to meet for lunch on Friday and sort it all out. Ok, the ball is rolling.
Friday. I’m sitting in the canteen at Makarere U with Christine and Sophie the Swede waiting for Richard at our agreed-upon time and 30 minutes later Richard shows up because A: he’s on Uganda time, not American time and that’s just how they roll here, fair enough, and B: he was waiting for me outside the canteen for a good 15 minutes while I was waiting inside the canteen for him. We get to chatting and he agrees to take me to the repair shop at Mulago (the hospital) where there is a guy he knows (there’s always a guy he knows, its great, Richard is a good friend to have here) who will probably have a spare diaphragm and will be able to jimmy my Sävlig stethoscope into working order. We show up at the repair shop where there is a graveyard of old hospital beds/chairs/desks etc awaiting repair and an impressive collection of engineery-type machinery that I assume is used to cut metal and perform other manly tasks, but “the guy” was absent. Ok we’ll try again tomorrow. “Or,” I assure Richard “It would also be ok for me to find a place to get a new stethoscope.” We then promptly run into one of Richard’s pharmacy school friends (another one of those guys) on our way out who has the low-down on stethescopes and where to get them. He informs us of a few places in town where I can purchase a good scope, the best one being Joint Medical Stores on the outskirts of Kampala in a region called Nsambya, because it sells Litman’s at a good price. After being thoroughly assured by both of them that JMS is open on Saturdays, I thank them and bid them farewell. Sweet, the ball rolls on.
Saturday: I awake nice and early because I don’t know how long its going to take me to find JMS. I could take a special hire (personal taxi) that would deliver me straight there, but its about 10 or 15X as expensive as public transport and I’m a cheapskate while traveling so I decide to brave the matatus and find my way. Armed with Kaisa’s map of Kampala and a good amount of sunblock, I set out. It is 9am.
I board a Matatu to the old taxi park like a pro because I have been there before on our previous get-out-of-the-city weekend excursions, and then ask a few people how I can get to Nsambya from there. One nice fellow guides me across the street and directs me to the right taxi (people are so so nice here when it comes to directions, its great) I get in the taxi, wait for about 15 minutes while it fills to the brim with Nsambya-bound Ugandans and we’re off. The driver assures me that he knows JMS and will direct me when to get off, but I don’t know weather or not to trust him because on our way out of the taxi park when we encounter the always-present hoard of coming and going matatus, bikes and boda-bodas (small motor bikes) he literally almost runs over 3 or 4 pedestrians and nudges the back wheels of passing bikes while aggressively honking his horn in order to pass as quickly as possible through the traffic (it still takes like 30 minutes despite all this). We emerge from the crowded streets of central kampala and start skirting along the dusty side roads leading to Nsambya (I saw some signs with the word “Nsambya” on them intermingled with some Lugandan words that meant nothing to me, so at least I knew we were heading in the right direction…unless the signs were reading “do NOT go this way to get to Nsambya,” which I thought was unlikely J). A few minutes later the driver pulled over and pointed down a road, telling me to follow it for a while and I’d arrive at JMS. Ok. So, I paid my 800 Ugandan Shillings (about 50 cents) and off I went. Lo and behold, a short walk later there was JMS! Sweet! I am a bad ass! Yes, its about 11:30 am by now, but no worries, I made it.
In a very good mood, I open the big iron door to find a nice security guard, but absolutely no one else in sight. Mmm, mood plummet, what’s going on? “Hi there, I’m here to buy a stethoscope, is the store open today?” No. The store is not open on Saturdays, silly mzungu. (I make a mental note to cause Richard some sort of pain). “Ok, do you mind if I take a look around?” I was not going to give up so easy. The guard concedes to my wandering around with a “its not like you’re not going to find anything” look on his face, but he lets me go anyway. I find an open door on the side of a building, and inside a really nice employee who assures me that no, there is no way of getting into the store house on Saturday, but since I really need to get a stethoscope today because I’m leaving for the rural rotation the following day, he starts calling around Kampala to help me find a place that is open on Saturdays where they sell stethescopes. Yay for nice people, he finds a store (on the way other side of town) that is open and we locate it on the map. Off I go.
I hop another matatu (that was an IHOP pun), weave through the ensuing traffic jam, make it to a place in the city I recognize and jump out. Walk a few winding blocks up to the main road, hop another matatu that’s headed in the right direction, make friends with the fellow passengers who agree to tell me where to get out and in another hour or so, and a lot of directions later, I’m walking up to SinoAfrica Medical Supplies. They are open! They have stethoscopes! Not Litman’s but at this point I don’t really care what brand I get as long as I can hear heart sounds with it. I settle on a nice Chinese model and also purchase a reflex hammer and pen light, all the things I should have brought with me from the states but did not. It takes a while to get the items from the store house, but I’m chatting amiably with the two staff who are helping me and when they find out I’m going to work in a clinic in Kumi they muster up some other supplies that they want to donate and place them in the bag for me to take to the clinic. They were super nice. One of the ladies leads me back to the main road via a short cut and makes sure I get on the right matatu that’s headed back to Bukoto street, where I live.
Ah, all done. The matatu was going to pass all the way back through town (there was no direct matatu back to Bukoto) but it would eventually take me all the way home, I just needed to sit there and bask in my success. Good thing because my blood sugar was really low and all the matatu jumping and traffic and heat was getting to me. I slid over to the far window when a few passengers unloaded so that I could feel the breeze a bit and just zone out while other passengers hopped on and off (if you’re by the door you have to keep moving so that people can get past you). A few minutes later *CRASH* the window where I had been sitting moments before busted into a thousand tiny little pieces and all the passengers (including me) jumped and turned to see what had happened. The conductor had slammed the door with a touch too much fervor and the window had relented. Tiny crystalline nuggets of glass were scattered all over the floor and the back seat. Thank goodness I had moved, it would have scared the crap out of me if I’d been right next to the window. I thought for a split second that someone had shot at us, but that was just a silly gut fear as there’s very little violence here….though the police and guards carry disturbingly large weapons.
The conductor swept the glass from the seats and we pressed on. The traffic was increasing to the point of agony now so we turned around, edging along slowly, and back tracked to take an alternative route. By the time we reached about the half-way point to Bukoto I decided that I just couldn’t take any more of this inch-by-inch progress and got out to walk. I made it home by about 2:30pm, completely exhausted and slightly dehydrated but with a shiny new stethoscope in hand…and it only took 2 and a half days.
Baktanke
I’m learning Swedish. Well, I’m learning some Swedish words….random ones….ones that come up haphazardly in conversation with my three Swedish roommates who I affectionately refer to as “the Swedes.” Here are a few of them for your reading pleasure.
Glap: “gap”, like the infuriating gap that separates the small metal connections between Therese’s European computer charger and the Ugandan adaptor, causing her to sit there and hold it in the wall or strategically place a chair so that it presses against the conglomeration of converters, just so. Now I hear the dulcet tones of Therese from the other room… “angry rapid Swedish words….glap…more angry Swedish”, and I know exactly what’s going on.
Vig: “Flexible” in the bendy sense, not the “yeah sure, whatever” sense. I made my first pun in Swedish with this word because one of the doctors was saying that here in Uganda its good to be flexible and I said “don’t worry, I’m quite vig.” He didn’t get it, but I was laughing on the inside and I told the Swedes about it later J
Genväg blir senväg: “Short cut becomes long cut.” This happens when you’re running in the morning down our street and instead of taking the road, you try to cut through the dirt trail on the other side of the little gutter next to the road and your path is blocked by a cluster of goats and you have to turn around. Short cut makes long cut when the goats are grazing.
Sävlig: “A bit slow” This one comes up a lot around me....I don’t know why.
Jag har en baktanke: This is my personal favorite, meaning “I have an ulterior motive.” I love this phrase and have been announcing to the Swedish-speaking-world that I am not to be trusted ever since I learned it. My friend Sanje (who is hilarious) has learned to say “well, so do I!” (I don’t know these Swedish words) in response to this declaration and we’ve been exchanging vows of dubious secret intentions for the past several days. Fan-freaking-tastic.
Photos:
Therese and I at Sipi Falls, the most gorgeous place on earth...though you can't tell from this picture
Medical student dinner with Diane (Makarere U medical student) and the Swedes.
Me and Kajsa at Mpanga forrest
The Freaking Awesome Intern
Last Tuesday we were escorted to the Medical branch of Trauma at Mulago by Susan, who sicked us on an intern doctor who was rotating there, Dr. Francis Mulindwa. We were to shadow Dr. Mulindwa for a few days in order to get a feel for the trauma ward. The next few days were incredible. Coming from pediatrics where the interns I was shadowing communicated in hushed Lugandan (local dialect), to trauma where Dr. Mulindwa, who doesn’t speak Luganda because he is from the north, conducted all of his patient interviews in audible, clearly spoken English (sometimes with the assistance of an interpreter) was like night and day.
As we approached the first patient, Dr. Mulindwa assured us that we were welcome and told us to ask as many questions as we liked. (side note: they say “you are welcome” all the time here, as they are a very hospitable and kind-hearted people. At first it took me off guard: “um, thank you?” oh you mean that I am welcome here! I get it. Now I love hearing it. I feel very welcome) The first patient was a middle aged woman with a list of symptoms that, as a first year medical student, I recognized as terminology, but I had no experience combining them strategically in my mind and formulating a probable diagnosis. “So, what’s happening with this patient do you think?” asked Dr. Mulindwa after relaying her sx. My reflex response was “um, oh I’m not sure, we’re only first year students.” But he wasn’t having it. “I know you’re a first year. So what do you think is happening here?” It….was….awesome!!! Before long I was throwing out suggestions and, stupid or not, Dr. Mulindwa would tell me why they were likely or unlikely diagnoses and then he would explain his own reasoning and the treatment he was prescribing. He gave Christine and I “homework assignments” to learn about the things we had little experience with and was exceedingly patient with us despite his very large patient load (all of the Dr.s here have huge patient loads, it’s a problem). I learned so much in the two days that I shadowed Dr. Mulindwa (sadly, he transferred to a different roatation, but I’ll shadow him again in future) that even if the rest of my trip is total crap (which it won’t be, because Uganda rocks the house) this whole 11 weeks would be worth those two days.
As we approached the first patient, Dr. Mulindwa assured us that we were welcome and told us to ask as many questions as we liked. (side note: they say “you are welcome” all the time here, as they are a very hospitable and kind-hearted people. At first it took me off guard: “um, thank you?” oh you mean that I am welcome here! I get it. Now I love hearing it. I feel very welcome) The first patient was a middle aged woman with a list of symptoms that, as a first year medical student, I recognized as terminology, but I had no experience combining them strategically in my mind and formulating a probable diagnosis. “So, what’s happening with this patient do you think?” asked Dr. Mulindwa after relaying her sx. My reflex response was “um, oh I’m not sure, we’re only first year students.” But he wasn’t having it. “I know you’re a first year. So what do you think is happening here?” It….was….awesome!!! Before long I was throwing out suggestions and, stupid or not, Dr. Mulindwa would tell me why they were likely or unlikely diagnoses and then he would explain his own reasoning and the treatment he was prescribing. He gave Christine and I “homework assignments” to learn about the things we had little experience with and was exceedingly patient with us despite his very large patient load (all of the Dr.s here have huge patient loads, it’s a problem). I learned so much in the two days that I shadowed Dr. Mulindwa (sadly, he transferred to a different roatation, but I’ll shadow him again in future) that even if the rest of my trip is total crap (which it won’t be, because Uganda rocks the house) this whole 11 weeks would be worth those two days.
Mzungu
“Mzungu!” I hear this word pretty much all the time. Or I hear “blah blah blah, gibberish, mzungu blah blah” which is even better. Initially, I was told that “Mzungu” roughly means “white person,” which I think is hilarious, because people don’t say “Hey mzungu!” like a greeting, no no, they just shout “white person!” as though alerting all non-whitey’s of the presence of a person who not only looks strange, but may, with some coaxing, be willing to pay you money for something or other. Let’s face it, I do look strange to the kids here, and yes I pay people to do my laundry, drive me places and give me bananas, so the logic is not faulty.
When Christine arrived (my classmate who is doing the IHOP with me) she informed me that “Mzungu” actually translates to “person who walks around in circles.” Well, this is even better! Hey! “person who doesn’t know where the heck she is going!” you want to buy some bananas? Why yes I do, wembale ngo (thank you very much).
When Christine arrived (my classmate who is doing the IHOP with me) she informed me that “Mzungu” actually translates to “person who walks around in circles.” Well, this is even better! Hey! “person who doesn’t know where the heck she is going!” you want to buy some bananas? Why yes I do, wembale ngo (thank you very much).
The Scare
Last week in Kampala I rotated through the pediatric ward with Sophie, one of the Swedes who is in her 4th year of medical school (out of five in the Swedish program). It took us a while to warm up to the floor because the attending physicians were not at all concerned with teaching (understandably, as there were sick kids who needed attention and very few doctors), and the residents follow them around astutely while everyone mumbles back and forth to one another in hushed medical jargon (in English and Luganda, the local language) before moving on to the next bed.
After the first half hour I started asking questions and trying to get more involved, this made things a bit smoother and soon I was learning the differential for fever and how to distinguish between meningitis and malaria (this can be tricky, so they usually treat for both until the LP results come back). Two interns were very nice and showed me how to do a lumbar puncture, which was very interesting. They use “as sterile as possible” technique and do a good job of it.
Through the sad event of a mother and child gone missing I learned that there is a superstition here regarding lumbar punctures. This is quite logical from one perspective as only very sick children, who have a heightened mortality risk compared to other patients anyways, are given LPs. So, when the child scheduled for the second LP of the day was missing, the intern explained that the mother probably cut and run, fearing that the procedure would kill her child. I was so sad to hear this because he was quite sick and I don’t think there was a large chance of survival without more medical care, but there was nothing to be done, she was gone.
After a few days on the pediatrics ward, “the nice attending” as Sophie and I called him took me to the pediatric intensive care unit so that I could shadow another physician there and see how things were run. After the first few hours of office visits we began to follow around some interns in order to get a feel for the run of the place. We went to the blood lab where they do smears for malaria and saw Plasmodium Falciparum trophozoites (if you know this term, you’re a dork…if you’re not one of us dorks, this is the form of malarial parasite that is found locally which resides inside of red blood cells) under the scope. It was totally cool. After this Sophie went home but I decided to stay and see a few more procedures before calling it a day.
I met Dr. Chris, a very nice Ugandan intern who was manning the pediatric ER while he was caring for a severely dehydrated/anemic child that had just been brought in. He pulled down the child’s eye lids and lifted his lips to reveal staunchly white gums and palpebrae, indicating anemia. The child needed a blood transfusion but first we had to blood type him. Chris drew about a ml of blood and we headed to a “lab” (read “room with a fridge and running water”). To figure out his blood type Chris would put three drops of blood on a white tile and then add some antibody that would react with different RBC antigens, revealing what type of blood would be accepted correctly by his body. A few minutes had passed between the time the blood was drawn and the time he was performing the test, so the blood had become a bit clotted….can you see where this is going? When Chris placed the syringe on the tile the blood wouldn’t budge, so he applied more pressure, logical right? Sure. Except he pushed a bit TOO hard and *ffftt!* a tiny splatter of blood hit my abdomen, and strangely, at the very same time, the entire world stopped spinning for a few seconds….or at least that’s how it felt to me.
The next hour or so was probably one of the worst I have experienced, not because there was any real chance that I had gotten splashed with blood in the eye (absolutely none, don’t worry), but just because I was so frightened by the unexpected risk involved in such a mundane and seemingly innocent procedure. I was totally taken aback by this sudden, miniscule chance of exposure. One moment I’m just standing there, and the next moment I’m calculating the probability of a rogue blood particle had breaking the laws of physics to leave its brothers behind and swerve cork-screw-like around my glasses and onto my cornea. Insane, I know, but I just wasn’t used to being around so many HIV positive patients and the sounds of screaming babies paired with the heat just all added to this sense of panic and there you go. I excused myself from Chris and went to the mirror to check my chest and face for blood and get a grip. There was none.
All of the members of team “let’s keep Annie from getting HIV” will be pleased to know that I’ve upped my safety precautions to the point of hilarity now. Anyone who has spent more than three minutes in a room with me knows that I can be crazy about sanitation and safety, particularly regarding infectious diseases, (I can do sterile tissue culture for goodness sake! And you have to have a touch of OCD to pull that off) but now you will find me in goggles whenever there is blood around, even if its just a simple procedure. Because damn, you never know when someone will apply too much pressure and *fffft*
Post Script: the next weekend I was sitting high over the source of the Nile on a balcony drinking instant coffee and milk when I received a text message from Dr. Chris, who had tested the child for HIV despite the nil risk of exposure, informing me that the child was HIV negative. Even though I had fully calmed down by this time it was still a wonderful bit of news and it closed the lid on any little whisp of anxiety that had been lurking around in my subconscious. I know that I’m being a touch over dramatic here (que soft violin music) but I had one of those “new perspective on the world” moments and all of the crappy little things that had been weighing on my mind in the previous weeks seemed miniscule under the weight of this new optimism. Yes, I forgot my swimming suit, so that’s a bit annoying, but hey! I have not been exposed to HIV! Woo hoo! Its the best “don’t sweat the small stuff” lesson I’ve ever had.
Post post script: Later that week my friend Richard (5th year medical student at Makarere) invited me to the Uganda football game the following Saturday. We were walking from the engineering yard where we were trying to locate a new diaphragm for my spare Litman’s stethoscope when he saw his friend who would be giving us a ride to the game. As we approached I thought to myself “where have I met this guy?” and being nowhere near shy I walked up to him saying “hey, I’ve met you before, where do I know you from?” He gave me this funny knowing smirk that made me hesitate, a bit confused. Right then Richard says “This is my friend Dr. Chris, he’ll be taking us to the game.” And it hits me. Holy crap this is Dr. Chris of the blood splatter incident! I was SO embarrassed! Not only for forgetting his face, like a jerk (I had only interacted with him for about a 15 minute period and had been actively blocking the whole day out of my mind ever since) but also because I had so thoroughly freaked the crap out over a tiny drop of blood, in such perfect silly-little-mzungu fasion. I felt about 8. When I realized who he was I apologized for being such a drama queen and he assured me it was alright, he too was once new to this whole medicine business and has over reacted once or twice. The game was fantastic, Uganda won 3-0 and now Chris and I are pals.
After the first half hour I started asking questions and trying to get more involved, this made things a bit smoother and soon I was learning the differential for fever and how to distinguish between meningitis and malaria (this can be tricky, so they usually treat for both until the LP results come back). Two interns were very nice and showed me how to do a lumbar puncture, which was very interesting. They use “as sterile as possible” technique and do a good job of it.
Through the sad event of a mother and child gone missing I learned that there is a superstition here regarding lumbar punctures. This is quite logical from one perspective as only very sick children, who have a heightened mortality risk compared to other patients anyways, are given LPs. So, when the child scheduled for the second LP of the day was missing, the intern explained that the mother probably cut and run, fearing that the procedure would kill her child. I was so sad to hear this because he was quite sick and I don’t think there was a large chance of survival without more medical care, but there was nothing to be done, she was gone.
After a few days on the pediatrics ward, “the nice attending” as Sophie and I called him took me to the pediatric intensive care unit so that I could shadow another physician there and see how things were run. After the first few hours of office visits we began to follow around some interns in order to get a feel for the run of the place. We went to the blood lab where they do smears for malaria and saw Plasmodium Falciparum trophozoites (if you know this term, you’re a dork…if you’re not one of us dorks, this is the form of malarial parasite that is found locally which resides inside of red blood cells) under the scope. It was totally cool. After this Sophie went home but I decided to stay and see a few more procedures before calling it a day.
I met Dr. Chris, a very nice Ugandan intern who was manning the pediatric ER while he was caring for a severely dehydrated/anemic child that had just been brought in. He pulled down the child’s eye lids and lifted his lips to reveal staunchly white gums and palpebrae, indicating anemia. The child needed a blood transfusion but first we had to blood type him. Chris drew about a ml of blood and we headed to a “lab” (read “room with a fridge and running water”). To figure out his blood type Chris would put three drops of blood on a white tile and then add some antibody that would react with different RBC antigens, revealing what type of blood would be accepted correctly by his body. A few minutes had passed between the time the blood was drawn and the time he was performing the test, so the blood had become a bit clotted….can you see where this is going? When Chris placed the syringe on the tile the blood wouldn’t budge, so he applied more pressure, logical right? Sure. Except he pushed a bit TOO hard and *ffftt!* a tiny splatter of blood hit my abdomen, and strangely, at the very same time, the entire world stopped spinning for a few seconds….or at least that’s how it felt to me.
The next hour or so was probably one of the worst I have experienced, not because there was any real chance that I had gotten splashed with blood in the eye (absolutely none, don’t worry), but just because I was so frightened by the unexpected risk involved in such a mundane and seemingly innocent procedure. I was totally taken aback by this sudden, miniscule chance of exposure. One moment I’m just standing there, and the next moment I’m calculating the probability of a rogue blood particle had breaking the laws of physics to leave its brothers behind and swerve cork-screw-like around my glasses and onto my cornea. Insane, I know, but I just wasn’t used to being around so many HIV positive patients and the sounds of screaming babies paired with the heat just all added to this sense of panic and there you go. I excused myself from Chris and went to the mirror to check my chest and face for blood and get a grip. There was none.
All of the members of team “let’s keep Annie from getting HIV” will be pleased to know that I’ve upped my safety precautions to the point of hilarity now. Anyone who has spent more than three minutes in a room with me knows that I can be crazy about sanitation and safety, particularly regarding infectious diseases, (I can do sterile tissue culture for goodness sake! And you have to have a touch of OCD to pull that off) but now you will find me in goggles whenever there is blood around, even if its just a simple procedure. Because damn, you never know when someone will apply too much pressure and *fffft*
Post Script: the next weekend I was sitting high over the source of the Nile on a balcony drinking instant coffee and milk when I received a text message from Dr. Chris, who had tested the child for HIV despite the nil risk of exposure, informing me that the child was HIV negative. Even though I had fully calmed down by this time it was still a wonderful bit of news and it closed the lid on any little whisp of anxiety that had been lurking around in my subconscious. I know that I’m being a touch over dramatic here (que soft violin music) but I had one of those “new perspective on the world” moments and all of the crappy little things that had been weighing on my mind in the previous weeks seemed miniscule under the weight of this new optimism. Yes, I forgot my swimming suit, so that’s a bit annoying, but hey! I have not been exposed to HIV! Woo hoo! Its the best “don’t sweat the small stuff” lesson I’ve ever had.
Post post script: Later that week my friend Richard (5th year medical student at Makarere) invited me to the Uganda football game the following Saturday. We were walking from the engineering yard where we were trying to locate a new diaphragm for my spare Litman’s stethoscope when he saw his friend who would be giving us a ride to the game. As we approached I thought to myself “where have I met this guy?” and being nowhere near shy I walked up to him saying “hey, I’ve met you before, where do I know you from?” He gave me this funny knowing smirk that made me hesitate, a bit confused. Right then Richard says “This is my friend Dr. Chris, he’ll be taking us to the game.” And it hits me. Holy crap this is Dr. Chris of the blood splatter incident! I was SO embarrassed! Not only for forgetting his face, like a jerk (I had only interacted with him for about a 15 minute period and had been actively blocking the whole day out of my mind ever since) but also because I had so thoroughly freaked the crap out over a tiny drop of blood, in such perfect silly-little-mzungu fasion. I felt about 8. When I realized who he was I apologized for being such a drama queen and he assured me it was alright, he too was once new to this whole medicine business and has over reacted once or twice. The game was fantastic, Uganda won 3-0 and now Chris and I are pals.
Photos:
1: Christine (USA), Sophe (Swe), Therese (Swe), Me and Grace (UK) at Jinja.
2: The view from our guest house deck: the source of the Nile river in Jinja
3: Not a great pic, but on our way home we saw this boda boda, note the fish hanging from the back. This is how dinner is transported 'round here.
Catching up
Photos:
80's explosion! This is me and two of my med school buddies, Heidi and Summer decked out before one of our parties last year....man we're hot.
White coat ceremony: Summer and Me, the epitome of sharpness!
80's explosion! This is me and two of my med school buddies, Heidi and Summer decked out before one of our parties last year....man we're hot.
White coat ceremony: Summer and Me, the epitome of sharpness!
Hey there friends and family--
A note of warning: the computer that I am using at the moment has spell check only in Swedish, so prepare yourself for some pretty horrid mistakes that will go un-noticed on this end as pretty much every other word is underlined in red.
I recently finished my first year of medical school at the University of Washington. Confusingly, I spent this year in Moscow, Idaho and Pullman, Washington with 39 other brilliant souls as part of the WWAMI program. All five states that feed into the UW Seattle campus have an on-site program for the first year and then send their local budding intellectuals to Seattle for the following years of medical training. It’s a pretty sweet deal really as we were able to get to know our faculty very well and our fellow class mates a little too well….making for a nice transition into the craziness that is medical school. A few weeks ago (which seems like an eternity) I completed my final examinations and am now officially a second year medical student. Phew. It took me a while to adapt to the ammt of studying that is necessary, but I got into a groove with the help of my friend Summer who is the world´s greatest outliner, and kicked some medical butt, so to speak. Retaining the information is a different matter, we´ll see about that come August.
This summer I am participating in the IHOP (international health opportunities program…not the pancake house…though I do love me some pancakes) where I am completing a public health project and a few clinical rotations here in Uganda over the next 11 weeks. The majority of my time in Uganda will be spent at Mulago Hospital in Kampala, the capital city. Mulago is associated with Makarere University, which has the top medical training program in Eastern Africa. This relationship allows me to rotate with Ugandan medical students and interact with local and foreign doctors in Mulago.
I arrived in Uganda on the 28th after a 24 hour layover in Amsterdam. I had only ever been in transit through Schipol (?) airport in the past, so it was great to spend a day in the city. The excellent train system made this easy and I wandered around the street severely jetlagged but thoroughly enjoying the architecture and mindfully avoiding the throngs of young, stoned and obnoxious foreigners (mostly American and English). I walked along the canals for hours, drank overpriced coffee in outside cafes and made friends with some other travellers at my guest house. My favourite part of the day was 20 minutes or so of conversation with a group of Dutch street cleaners who I met outside of a cathedral while taking a break. They told me all about the history of the city and explained that the buildings all leaned slightly forward so that furniture etc can be easily (sure) hoisted to the upper floors with ropes and pulleys. I witnessed this later in the day as an apartment was undergoing renovation and it was totally amusing to watch. Even small spray bottles and tools were transported to the top floors on the rope.
I arrived at Entebbe Airport the next day and have been in a rush of heat and commotion ever since. This is one of my favourite things about travelling: two days ago I didn’t know anyone in Uganda and had no idea what to expect, and today I am sitting in my new flat, drinking coffee and writing to you fine people without a worry. Within the span of these two days I have: Wandered around the city of Kampala with my friend/guide/3rd year student at Makarere U, Diane, in matatus (cheap van-taxis), dined and talked with medical students and doctors from all over the world, shadowed an intern in the cardiac ward of Mulago, met three cool Swedish medical students (also rotating in Cardiology), hopped a bus to Mpanga forest reserve with said Swedes and spent the day trekking through some butterfly-thick jungle, decided to move in with said Swedes, got a ride back to town with Father Remi of the Leopard Clan (a local Catholic priest), attended a prom-like celebration dinner with 200 Ugandan medical students from Makarere U (I won a raffle prize half way through the night, which never happens to me by the way, and the officials couldn´t understand why this white girl was walking to the podium until they realized that I was Annie McCabe of ticket number 007…and no, the irony of this number is not lost on me J. I won a lunch for two at a local restaurant. Sweet.) and drank many many cups of Nescafe instant coffee, which I would never touch in the states, but is somehow delicious here. Woah. Yeah its even more ridiculous on this end.
I start my first real rotation on Monday and then its game-on. I´ll be writing verbose emails such as this relatively regularly, though I can´t promise that I will be very efficient at replying to individual emails because the connections here are so painfully slow that it takes hours to send off a note with a picture or two.
In a flurry of selfishness I would like to request that you write to me as much as you want/can despite the fact that I won´t be great at returning the favour. I would absolutely love to hear from you.
Yours,
Annie McCabe, 007
p.s. To Rachel, Anthony and Julia, my favourite punners: My new friends from Sweden are pretty nice so I´ve decided to term them “Sweet-ish”
A note of warning: the computer that I am using at the moment has spell check only in Swedish, so prepare yourself for some pretty horrid mistakes that will go un-noticed on this end as pretty much every other word is underlined in red.
I recently finished my first year of medical school at the University of Washington. Confusingly, I spent this year in Moscow, Idaho and Pullman, Washington with 39 other brilliant souls as part of the WWAMI program. All five states that feed into the UW Seattle campus have an on-site program for the first year and then send their local budding intellectuals to Seattle for the following years of medical training. It’s a pretty sweet deal really as we were able to get to know our faculty very well and our fellow class mates a little too well….making for a nice transition into the craziness that is medical school. A few weeks ago (which seems like an eternity) I completed my final examinations and am now officially a second year medical student. Phew. It took me a while to adapt to the ammt of studying that is necessary, but I got into a groove with the help of my friend Summer who is the world´s greatest outliner, and kicked some medical butt, so to speak. Retaining the information is a different matter, we´ll see about that come August.
This summer I am participating in the IHOP (international health opportunities program…not the pancake house…though I do love me some pancakes) where I am completing a public health project and a few clinical rotations here in Uganda over the next 11 weeks. The majority of my time in Uganda will be spent at Mulago Hospital in Kampala, the capital city. Mulago is associated with Makarere University, which has the top medical training program in Eastern Africa. This relationship allows me to rotate with Ugandan medical students and interact with local and foreign doctors in Mulago.
I arrived in Uganda on the 28th after a 24 hour layover in Amsterdam. I had only ever been in transit through Schipol (?) airport in the past, so it was great to spend a day in the city. The excellent train system made this easy and I wandered around the street severely jetlagged but thoroughly enjoying the architecture and mindfully avoiding the throngs of young, stoned and obnoxious foreigners (mostly American and English). I walked along the canals for hours, drank overpriced coffee in outside cafes and made friends with some other travellers at my guest house. My favourite part of the day was 20 minutes or so of conversation with a group of Dutch street cleaners who I met outside of a cathedral while taking a break. They told me all about the history of the city and explained that the buildings all leaned slightly forward so that furniture etc can be easily (sure) hoisted to the upper floors with ropes and pulleys. I witnessed this later in the day as an apartment was undergoing renovation and it was totally amusing to watch. Even small spray bottles and tools were transported to the top floors on the rope.
I arrived at Entebbe Airport the next day and have been in a rush of heat and commotion ever since. This is one of my favourite things about travelling: two days ago I didn’t know anyone in Uganda and had no idea what to expect, and today I am sitting in my new flat, drinking coffee and writing to you fine people without a worry. Within the span of these two days I have: Wandered around the city of Kampala with my friend/guide/3rd year student at Makarere U, Diane, in matatus (cheap van-taxis), dined and talked with medical students and doctors from all over the world, shadowed an intern in the cardiac ward of Mulago, met three cool Swedish medical students (also rotating in Cardiology), hopped a bus to Mpanga forest reserve with said Swedes and spent the day trekking through some butterfly-thick jungle, decided to move in with said Swedes, got a ride back to town with Father Remi of the Leopard Clan (a local Catholic priest), attended a prom-like celebration dinner with 200 Ugandan medical students from Makarere U (I won a raffle prize half way through the night, which never happens to me by the way, and the officials couldn´t understand why this white girl was walking to the podium until they realized that I was Annie McCabe of ticket number 007…and no, the irony of this number is not lost on me J. I won a lunch for two at a local restaurant. Sweet.) and drank many many cups of Nescafe instant coffee, which I would never touch in the states, but is somehow delicious here. Woah. Yeah its even more ridiculous on this end.
I start my first real rotation on Monday and then its game-on. I´ll be writing verbose emails such as this relatively regularly, though I can´t promise that I will be very efficient at replying to individual emails because the connections here are so painfully slow that it takes hours to send off a note with a picture or two.
In a flurry of selfishness I would like to request that you write to me as much as you want/can despite the fact that I won´t be great at returning the favour. I would absolutely love to hear from you.
Yours,
Annie McCabe, 007
p.s. To Rachel, Anthony and Julia, my favourite punners: My new friends from Sweden are pretty nice so I´ve decided to term them “Sweet-ish”
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