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.