Day 1-3

3/9/13

I’m settling into my life in Uganda well!  I live with two med student friends- Eman and Masha- in a nice 3 bedroom/1 bath.  We have some serious luxury – running water, a toilet that flushes, gas stove, a working refrigerator, malaria nets over our beds…and the most amazing….HOT WATER.  We swap waking up 30 minutes early to turn on the water heater for our showers, then Eman and I try to do an Insanity Workout in the AM before we go to the wards.  The last 3 days have been “easy” days- 9am-4:30pm.  Tomorrow we start 8am-7pm, so perhaps the AM workouts will become more sporadic. 

Food options are limited here but great for the vegetarian.  Thank god I brought some rolled oats from home. Oats, raisins and 1 tbsp peanut butter with hot water is a hearty breakfast and can last me until 4pm.  We do have a glorious lunch hour every day (this will not happen in the US!) and we take our translators out to lunch at Beans Place. As you can guess from the title, the main entrée is usually beans with boiled greens.  You get to pick 2 “sides” which are a variety of starches: irish potatoes, matoke (boiled plantains), white rice, or chipati (like fried Naan).  The portions are HUGE and its 1500 schillings which is about $0.60.  We go to this place every day!!  I’ve started taking every other day off (to “deflate” as we joke here) and I just buy a banana from the ladies who sell them on the road.  For dinner we go out to restaurants- they have a nice Indian influence here so lots of curries.  Dinner usually costs $6-8 if you also buy drinks. Lots of beers, gin and whiskey.  Very little wine or vodka.  Most locals drink their homemade alcohols…which can lead to serious intoxication very quickly.  We had an obtunded man admitted today from alcohol poisoning.

The weather is beautiful despite rainy season.  It’s 75-85 degrees and sunny most of the time, humidity like San Diego, except for the crazy rain storms that can last anywhere from 10 minutes to 4 hours.  The trees, vegetation, and flowers are lush and bright green- it makes for a very nice walk to the hospital every day (only 8-10 minutes). 

I’ve been able to see more pediatric patients that I thought – and some CRAZY things.  My first case in the E-Ward (think of a disaster ICU) was a child who refused to walk for the last week, with a 2 mos history of fevers, systemic symptoms, and 2 semi-failed courses of antibiotics.  At first, we thought it was a muscle infection from the way he was describing his pain. However our attending, Jerry, immediately diagnosed the child based on his history and physical exam with Brucellosis, a bacteria we don’t see often in the US.  Its “textbook” timeline is 2 months of “undulating fevers” after which it seeds as arthritis usually in the hip or the sacrum. It can also cause granulomas in the liver or brain (more serious, but rare).  Endemic in the Middle East with the bedoins because they drink raw goat milk, one can contract Brucella by drinking any unpasteurized milk.  My patient comes from a family of farmers and he drinks raw cow milk.  Six months of antibiotics are required to kill the bone infection.

I’ve seen so much amazing pathology (NERD ALERT!).  Today I saw pulmonic stenosis (4/6 systolic, harsh murmur) with secondary tricuspid regurgitation (right heart failure- no left side involvement which is usually the cause of right-heart failure) in a 15 yo girl—something Jerry says we’ll probably never see again in our life.  Perhaps she has congenital pulmonary stenosis or rheumatic heart disease (only 10% of patients will have the right-sided valves of the heart affected- usually it’s the left).  We’ve sent her to a bigger hospital for an ECHO. She desperately needs heart surgery, so we will try to find a sponsor and send her to India (cheap surgery there!) 

My other patient has what looks like amyloidosis presenting as Nephrotic Syndrome (kidney failure)—but usually this disease presents with a cardiomyopathy (heart failure).  My last patient today was a trauma- a 13yo boy who suffered severe 2^nd degree burns from boiling water.  His entire groin, left leg front and back, and penis/scrotum and left butt check were burned so his black skin was pink with large bullae everywhere.   The boy was so incredibly stoic as I applied topical ointment to his burns. We ran out of opioids so we gave him the strongest ibuprofen-type of medicine we had, Tylenol, antibiotics, and most importantly, fluids.  Our little hospital has such limited supplied we thankfully transferred him to a burn unit at a larger hospital by our driver, something funded by DGH (Doctors for Global Health).

Tonight is Saturday and it’s “Mandatory Jerry Fun Night,” so we all trudged to dinner at Golden Monkeys.  Food takes literally 2 hours to make after you order. I guess on the good side its fresh and gives us time to get a good buzz going (for me at this altitude = 1 drink).  Nice to have an attending physician who isn’t all business! He supposedly will even go dancing with us.  This is the same guy who “cured himself of lunch” during his intern year because it slowed him down and prevented him from working.   Ah, Jerry. 

3/10/13

Today was better as far as feeling comfortable on the wards.  My new admission was a 14yo female who had 5 days of viral-like symptoms (headache, dizziness, sore throat).  In Uganda there is an unfortunate belief that when your tonsils become very swollen, those tonsils can be the source of your death.  This is called “Gapfura.”  Similarly in our culture, for many generations, people have had their tonsils removed if they had strep throat a few times.  But recently there have been studies which suggest the tonsils are actually much more important than we thought, and a tonsillectomy should be a last resort (i.e. patient must have 5-6 episodes of strep pharyngitis/year to warrant tonsillectomy).  In any case, this patient with a sore throat and enlarged tonsils went to her “local doctor” (she is from the highlands—deep villages, hours walk away), where they put a stick from a tree between her teeth, then with two fingers reach back and squeeze and scrape her tonsils until they “break.”   Sometimes they even try to yank them out.  A) that is PAINFUL (no anesthetics used)  B) Imagine the bacteria on a rural man’s hand, and C)  My patient’s tonsils were bloody, therefore at risk for a super-infection from the bacterial flora of the human mouth (quite dirty!) and from whatever was on this man’s hands.  Luckily they don’t use a metal tool, otherwise tetanus prophylaxis would be necessary.  In any case this poor girl was feverish (102F), tachycardic, orthostatic, and with a horrible headache.  We gave her an IV for fluids and some strong antibiotics.  Hopefully she feels better soon…

Today we hiked “Hospital Hill” (see pics below) with our discovered guide, Habati, a 12 yo local village boy with a soul beyond his years.  He helped show us the best path to take, and for that we bought him a soda.  Many of the children here learn at a young age to ask for money from “mizungos” (white people), often they don’t even know what it means.  Habati did not ask us for money. He just wanted to hang with us.  Definitely a cool kid- I mean check out his white jeans and Timbalands (pic below)!  In Brooklyn he’d be a hipster.  The hike was a good 30 minutes and VERY uphill. Good workout and we rewarded ourselves with a Stoney soda (delicious ginger soda—much more gingery than Ginger Ale) and watching the sunset.

Off to do some reading as I feel as if I know nothing most of the time! I think my doctor friends will sympathize with me on this sentiment… especially being in a foreign hospital with no resources.  Amazing experience and only 3 days in!

Miss you all and lots of love,  

Vanessa

At the equator! From left: Jerry, me, masha, eman, will

The sign that reminds me to turn right to find our house!

Miraculous that these boxes made it intact-- they hold lots of medical supplies-- (Thank you Julie Crosby!) and 50+ binders that we use to do community talks

After a 1 hour rain- floods!  Everyone drives a motorcycle...

Me- first day on wards. Notice hand sanitizer hanging off my pants...we must carry all our own equipment- BP cuffs, thermometers, Pulse-Ox, tongue depressor, alcohol swabs, gloves, masks etc.  

Local kids hanging out with us

Sunset- this is the road we walk along to get to hospital.

Me at top of Hospital Hill, Lake Mutande in background and Congo behind

Sheperds tending to their goats

View of Kisoro Hospital from hospital hill (blue roof, center)

Sunset over Kisoro