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.
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