Uganda Love This

Amy Scheel

Month: March 2015

Rain finally came

Right at the start of our safari!!!!

On Saturday morning we set off bright and early to Kidepo National Park, which borders Kenya and Sudan. Let me tell you-one way to test a shaky stomach; cram as many people as you can in one car and then drive on dirt roads for 5 hours and see if you survive. Add to the mix that our driver had “Greatest Hits-Love edition 1&2” on repeat for the whole drive, and it’ll really test you as a person. I know it’s a classic but if I ever hear “I will always love you” by Whitney Houston again, it’ll be too soon.

Entrance to Kidepo

Entrance to Kidepo

We got there around 10:30, which is much earlier than we had anticipated. Excited by the extra time we would have to drive around and look for animals, we headed straight into the park after a picnic lunch. Unfortunately 2 minutes into our drive it started to rain. And by rain I mean torrential downpour. Visibility was close to nothing so we decided to head to our accommodation and wait for it to lighten up a little. We stayed in bandas that were directly in the safari park. It was awesome because this area wasn’t fenced in at all so wild animals were free to roam in and out of the area, including some zebras! We headed out for about 3 hours at dusk in hopes of seeing some lions but came back at dark after not seeing anything but zebras, buffalo, Jackson heart beast and gazelles.

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Our bandas for the night

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Abdu, Sarah and I before our afternoon excursion

By nightfall the rain had subsided and the campsite we were staying at built a bonfire for everyone. We all gathered round and ate the chicken and rice that they served for dinner (I’ll let you know how it is once I stop chewing….) and enjoyed some of the wine that we had brought with us. Kidepo is absolutely beautiful but I do have to say that this may have been one of my favorite parts of the whole trip. We spent the whole evening laughing and discussing extremely insightful topics such as One Direction, the difference between drunk Americans and drunk Europeans, and if we could invite 3 celebrities to a dinner party who they would be (very serious stuff). I felt like I was at home with all of my girlfriends and its so comforting to know that I have found that here. Knowing we were getting up at 5:30 in the morning we called it a night around 11pm.

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Sunset over Kidepo

In the morning we had a quick breakfast and then headed to the safari vehicle that we had rented for the morning. We had been driving around in the car that Sarah had managed to rent from work but we decided that we should rent a real safari vehicle at least once so that we could get some great pictures. As we were waiting for our guide to show up….it started to pour again. He tried to tell us that we should wait an hour, but we insisted on leaving then and I am so happy that we did. For starters lions are usually only active really early in the morning and 2. We only had 24 hrs in the park and needed to get out on time. The gatekeeper was very lenient when we first arrived but once he found out that Stuy and I were Americans he decided to tell us that we would have a huge fee if we missed our departure time by any amount of time.

We hopped in the car and proceeded to get soaked. To be honest for the first hour or so we all thought we may have made a mistake. The rain continued and we could barely see anything. Then our luck changed and a cheetah ran directly in front of our vehicle!! Cheetahs are extremely hard to spot on safaris. Our guide said that he had only seen 1 other one this whole entire year! We continued on for about 2 more hours and accepted the fact that we probably wouldn’t see any lions. THEN about 20 minutes before we were supposed to end we spotted 2!!! We could not have asked for better luck and they probably couldn’t have been any closer (unless we wanted to die). It was such a cool experience to see lions in the wild and it definitely was one of the highlights of the trip!

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Ready to brave the rain

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some cool cats

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After that we headed back to our vehicle and made the 5-hour trek to Gulu. It was such an awesome weekend and I’m so happy that I got to spend it with such wonderful people! Hope everyone had a great weekend and has an even better week!

Organized chaos

 Sorry for the delay-this week has been absolutely crazy (topped off with a stomach bug last night) so I haven’t had too much free time to type this up.

We saw 30 families this week, which is absolutely amazing! We have been averaging around 10-12 per week and were able to accomplish that number in one day! Organized chaos would probably be the best way to describe the week but nonetheless we were able to pull it off. In addition everything was done properly and efficiently (per African standards) which is an added bonus. The study is definitely winding down and I can see the light at the end of the tunnel. These next 2 weeks will be devoted to perfecting our numbers/matching them with controls and then in 3 weeks I’ll be headed home!

On Tuesday afternoon we headed to Gulu Prison Primary School to recruit the last of our controls. Yes I know that this sounds awful so let me clarify. A lot of schools here are “prison schools” because in order to attract workers to the prisons they need to have a school close by for their children. In addition some of the children have parents who are actually inmates in the prison. In my opinion the school was very nice, just much more confined/enclosed than St. Mauritz-guess this has something to do with it being right next to the prison. I think my favorite part about going to the schools is watching Twalib interact with the children. He always pushes them to get good grades and to go to secondary school. I think some of these children have had really rough childhoods and just simply need someone to believe in them.

After seeing 12 families on Wednesday we headed to the Immaculate Heart convent to screen some of the local nuns. Our arrival was even sweeter because the guy that opened the gate for us was wearing a Virginia Tech maroon effect shirt! As I mentioned before, the headmistress at St. Mauritz is a nun at this convent and had asked if we would be willing to screen the other sisters. We happily agreed and were told that there would be roughly 20 nuns to screen. Yea…okay. When we arrived there were 50 nuns waiting in a line to be screened. Although it had been an extremely long day, we all agreed that you can’t say no to a nun. It’s physically impossible. We ended up staying until about 8:30 at night until every nun was seen. Thankfully out of all 50 nuns that we saw only 3 of them had abnormalities. Unfortunately one of the younger nuns has RHD and will have to come to the clinic for monthly injections.

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The holiest echo screening there ever was

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One of nuns getting her blood pressure taken

On Thursday we saw 10 more families, which put an end to our extremely successful week. Unfortunately I must have eaten something bad on Wednesday (although I have no idea what) because I had horrible stomach pains and a fever on Thursday afternoon. When I left work on Thursday I must have been pretty pale since all of the nurses told me “you look whiter than you usually do.” In a setting like this, especially when you have a fever, your mind immediately goes to “ I must have malaria, typhoid etc…” Twalib went into full dad mode and I woke up to 4 missed calls, 2text messages and one of our nurses whom he sent to go check on me knocking on my door. After my dinner of sprite and a single saltine cracker I have to say that I feel 90% better today. Getting sick is inevitable in this environment but I have been extremely fortunate that each time I have been sick it is very short lived.

Tomorrow I will be heading to Kidepo bright and early! Our plan is to get there in time to do a game drive in the afternoon and then to wake up really early on Sunday in hopes of seeing some lions. I’ll let you know how it goes!

Chobe

 

Sometimes in a situation like this, you can’t help but get angry at the world. Angry at how unfair life can be over here. Angry at how guilty you feel for all that you have. Angry you can’t do more to help. This past week was definitely a challenging week and continued to open my eyes to the hardships that the people here face. To add to all of the extremely sick patients we saw last week, I was talking with a family and asked the mother where her other children were. She responded saying that her 7-year-old girl was at another clinic getting her ARV’s. For those of you that don’t know, ARV’s are anti-retrovirals and are prescribed to those with HIV. Unfortunately HIV is extremely common in Uganda. Even if it is “a part of life” here, it is still hard to stomach the fact that a 7-year old will be on medication for the rest of her life when she did nothing wrong. I met a doctor from the UK a couple weeks back named Sophie (who is absolutely great) and she lets me go around with her whenever I have free time. On Friday she was explaining to me that one day she noticed that someone had switched her epileptic patient’s seizure medication for an extremely strong anti-psychotic. When she asked the other doctors why they had done this they responded with “ if we don’t use it all then the government will stop supplying it.” Basically the doctors had been prescribing this anti-psychotic to random patients, without them knowing, so that it would be used up. Prescribing this type of drug to someone who doesn’t need it can be detrimental to his or her mental health. Just another prime example of the challenges people face when it comes to healthcare.

I spent most of Friday working on organizing the data from the last three weeks, as well as putting it into the database. This ended up being an all-day affair but I felt so much better once it was done. Although I mentally knew how far along we were with the project, seeing the numbers in the computer is always reassuring. AND after going through everything, I do have to say that the nurses did an excellent job while we were away. Now that we are back however, they seem to be making the same errors they did before I left which is a bit frustrating.

On Friday night I ended up going to the Indian restaurant with Sarah and Sophie. After Kampala I vowed to not eat Indian for at least a month but what can I say-its just too good. We all had a pretty long week and decided to call it a night after dinner, especially knowing we had exciting plans the next day.

On Saturday a group of 7 of us headed out to Chobe lodge, which is in Murchison Falls National Park. It’s about 2 hours away from Gulu and it was absolutely gorgeous. The lodge is located on the Nile and is part of the safari park, so there were wild animals everywhere. We saw at least 20 giraffes on our way into the park and an elephant bathing right next to the lodge (so cool!). To spend the day at the lodge and use the pool was $20 and I have to say, it was totally worth it. While in the pool you could look directly at the Nile and see hippos and crocodiles. In addition to the lovely scenery, the group we had was such a blast. Besides Sophie and Sarah whom I already knew, I met 2 other doctors (Matt (UK) and Sinead (Ireland)), Frankie (Matt’s girlfriend from the UK) and Lea, a Danish student working on the same project as Sarah. Most of them are here until June/July but I can definitely see myself hanging out with them a lot more before I leave (and not only because I’m obsessed with their accents).

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some the giraffes we saw on our way in-for those that dont know, they are by far my favorite animal!

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the amazing pool at Chobe lodge

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found right next to the lodge

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view of the Nile at 5pm right before we left

I spent most of my Sunday morning at the Iron Donkey working on a personal narrative that an online journal in DC asked me to write (don’t worry I’ll let you know when there is a finished product). In the afternoon I headed to the gym at Bomah with Sarah, which was much needed. After begging the owners to turn on the generator so that we could use the treadmills, I finally got a long run in and boy have I missed that! I do however have to keep reminding myself that I am not running 6 minute miles and that the distance is in kilometers…..a girl can dream. The power seems to be going out a lot more than usual and I am not really sure why. I have heard that during rainy season it goes out all the time but trust me; there is no rain here.

This morning I went to St. Mauritz to finalize our list of controls for the week. The whole process took about 2 and a half hours but I think it is going to be worth it. Some of the children’s parents even came in to talk to us about the project and their response seemed really positive. I am trying to mentally prepare for the chaos that will probably ensue if all 10 families we invited show up tomorrow BUT the more the merrier, right? Right.

I am currently planning a trip to Kidepo National Park this weekend with Sarah, Sinead, Sophie and Sarah’s friend Stuy. It is 6hours north of here right on the border of Sudan. Apparently the wildlife is absolutely amazing, so it’s definitely something to help get me through this week! Happy Monday everyone!

Melting

It is actually quite possible that I am going to melt. Rainy season was supposed to start at the beginning of March but SURPRISE they’ve had record high temperatures this year and no rain. I use to not drink a lot of water at work because there is no bathroom. This isn’t me being a princess; there is literally no bathroom and if there is a hole somewhere, I haven’t found it yet. Now I can drink about 3L (newest member of the metric system here) of water and go 10 hours without even thinking about a bathroom. Slowly turning into a camel….

This week has been really hectic and very tiring (partly due to the heat) but we were able to get 8 controls, which I’ll take for our first week back. On Monday morning I came to the hospital to check in with all the nurses and look at all the data that was collected while I was gone. The forms being filled out correctly was probably my biggest concern while being away. The concept of research is not really a thing here, especially the idea of research being published. The nurses don’t seem to understand why everything needs to be filled out completely when they can take shortcuts BUT at first glance everything looked great. I plan on going through and organizing the data this weekend, as well as uploading it to the database, so I’ll let you know if I have a change of heart once I really start looking at it.

Since Twalib was gone for the last two weeks, patients were lined up out the door when we arrived on Tuesday morning. Not only that, most of these patients were extremely, extremely sick. The 18 year old that I mentioned previously who was in heart failure (due to her severe RHD) came back because she had a stroke. Her speech was still slurred and you could tell that she is not going to last much longer. In addition another boy around her age came in with the exact same symptoms and the exact same prognosis. Unfortunately the rest of the day was spent giving people more bad news as well. Not exactly the “homecoming” I was hoping for. It did how ever bring me back to reality and re-motivate me for the final leg of the project. Hopefully one day no one will have to hear this type of news as a result of a preventable disease.

We have been met with some resistance with control families simply because they know that their kid is healthy and believe that the rest of their kids are healthy as well. Because we want families who are interested and enthusiastic about this program, we went to the school on Wednesday afternoon and simply asked for volunteers that were the same age/gender as our cases. We went classroom to classroom and it was so much fun to see all of the kids in this environment. Their school day is 8-5 and I give them A LOT of credit for such a long day. I’m pretty sure I would have protested if they tried to keep me past 3 when I was younger (Not that leading my whole pre-school class out to the playground when the teacher wasn’t looking was a protest or anything). They sit 3-4 people per bench, when it should really have 2, and it is extremely hot in their classrooms. I’m pretty sure my brother would have had to sit on the floor if he were born in Africa…We were able to recruit a bunch of families and most of them jumped out of their seat and were screaming hoping that they would be picked. We even had a 15-year-old boy who was crying run after our group begging for us to help his family. Good news- they came this morning and they are all fine. We have 30 families on the schedule next week (when we’ve been averaging 10) so it should be a very, very busy week.

Some of the kids in P3 at St. Mauritz

Some of the kids in P3 at St. Mauritz

On Wednesday night a bunch of us went to a pizza place outside of town since my friend Amanda is leaving today. I had pretty much boycotted pizza in Uganda after my last experience but this was absolutely delicious. Pretty sure my dad would have even liked this pizza. It was really sad to say goodbye, especially since she was one of the first people I met when I got here. She was also talking about all the things she planned on doing when she landed and it honestly got me so excited to see my friends and family in just over a month!

 

Found a husband in Uganda!!!!

Found a husband in Uganda!!!!

Back to Gulu

 With a full heart (and stomach) I made the 6-hour drive back to Gulu this morning. I loved every second of my time in Kampala and was sad to see it end. I am truly blessed that I was given the opportunity to be a part of such an amazing week and to witness so many life changing procedures. Thank you to everyone for being so welcoming and making the last two weeks so special! Although I will miss the team from CNMC and everyone at UHI, even with the scorching heat, luke warm water and constant power outages, Gulu still feels more like home to me.

On Friday afternoon the remaining volunteers and I went to a local market so they could do some souvenir shopping. I didn’t buy much just because I knew I would be going back to Gulu and didn’t feel like trying to cram things into my bag. We got a little more than we bargained for when a local man face planted down the hill of the market and proceeded to have a seizure. Medically minded all of us rushed to his side where we were told “ don’t touch him this happens all the time.” I understand that we looked like a bunch of foreigners trying to intrude but the poor man was lying on his back and choking on the blood and dirt that had accumulated in his mouth. They proceeded to put a tarp over him until he “came to”. Unfortunately this was just one of those times where you have to respect cultural boundaries and honor their wishes, no matter how much you may disagree. Don’t worry though, he was up and “moving”, when we left.

Friday evening the 4 remaining doctors/nurses and I went to Ndere cultural center and had an awesome time. It was set up dinner theater style with coliseum seating. The show lasted about 2 and ½ hours and showcased dances from every region of Uganda, as well as Rwanda and Burundi. The dancers were absolutely INCREDIBLE and so much fun to watch. The pride they have for their culture and their country is truly inspirational. They taught us some “courting rituals” and marriage dances as well. Thinking I may need to bring some of those back to the US. At this point I’m thinking it can’t really hurt.

 

Dont worry...Kampala has a way of reminding you you're single

Dont worry…Kampala has a way of reminding you you’re single

In addition, instead of being paid, all of the dancers are guaranteed school tuition. In Uganda you’ll find that a lot of tourist attractions will charge a lot more than they should yet pay the actual tour guides/ entertainers next to nothing.

It was nice to know that our money was going toward a good cause and furthering an education. The food they had was absolutely delicious as well, and I even tried goat for the first time. Not sure if it was because I hadn’t eaten in about 12 hours or not, but I thought it was really good! I know I shouldn’t have been eating meat on a Friday during lent but I honestly find it hard to keep track of what day it is here. Hoping the big man will cut me a break since I’m helping children in Africa….I’ve decided not to give up anything for lent this year simply because, in my opinion, its always lent in Gulu. I can’t really think of anything that I could give up that I’m not forced to give up anyway….

On Saturday morning we headed to Mulago to check on the patients one last time and then said our goodbyes. It was sad to say goodbye but incredible to witness how much progress all of our patients have made. We even brought all of the open-heart surgery kids out into the courtyard for a photo shoot. Our fearless leader Roel was moving everyone around and asking bystanders to move. Something only he could pull off without receiving an eye roll or a flat out no. Below you’ll find some of these photos! Some are mine but the better ones are Roel’s!

 

 

Christian! Talk about someone who was dealt a rough hand. Hoping for someone to adopt him!

Christian! Talk about someone who was dealt a rough hand. Hoping that someone will adopt him soon

All the open heart surgery kids and their moms/grandmoms

All the open heart surgery kids and their moms/grandmoms

Roel doing his thing

Roel doing his thing

Precious- doing much better and preparing for her flight to Jacksonville next week for her second open heart surgery

Precious- doing much better and preparing for her flight to Jacksonville next week for her second open heart surgery

I know I'm no doctor but I'm pretty sure that's not how it works...

I know I’m no doctor but I’m pretty sure that’s not how it works…

Off to the hospital tomorrow to check in with our nurses and all of the amazing work they did while I was away! Can’t wait to see them!

And that’s a wrap

 

And just like that the surgical camp is finished! I had such an amazing time with the team from Children’s National and the team from UHI and seriously learned so much. Most of the team left last night but there are 5 of us that are still here until Sunday. I do not have too much to do except coordinate rides to and from the hospital for the nurses/icu doctors that are still here. Other than that I plan on enjoying my “luxurious” lifestyle in Kampala, which translates to writing my medical essays that are due by Monday in the air conditioning.

the general feeling by the end of the trip

the general feeling by the end of the trip

On Tuesday morning a 7yr old girl named Ciarra finally got her heart surgery! Her surgery had been moved 2 times prior, the Saturday we only did one case and Monday because she had a fever, and you could tell that her family was so relieved when she finally went back. She had a procedure done to fix her doublet outlet right ventricle (DORV). This condition means that both the pulmonary artery and the aorta arise from the right ventricle, when in a normal heart, the aorta would arise from the left ventricle to carry oxygenated blood to the rest of the body. This procedure is probably the most complex one I was able to see while I was here. I got to watch for about an hour and was once again blown away.

In the afternoon I walked up to the children’s ward to help find a patient that needed to come to UHI. I don’t think I realized the extent of the condition of the rest of the hospital, simply because we have been sheltered in UHI, which is in great condition in comparison. On this walk I passed by the children’s HIV clinic, which is just hard to stomach in general, and also learned that the mortality rate for incoming emergencies is over 3%, which is really high. Once I arrived to the children’s ward, my heart sank. This “ward” is just a big room with tiny twin beds extremely close together, with multiple patients lying in agony for everyone else to see. They only move bodies in the morning, so if a child dies during the day they simply place a sheet over their body until the next morning. One of the nurses who came last year told me she went up to the PICU and they had placed an infant in an islet with a dead infant because they were running out of room. Thank god I wasn’t there to witness that because I think I would have lost it. Moving on from this heart wrenching scene, we found the patient with pericarditis we were looking for and brought him back to UHI. He had a pericardial effusion, a relatively simple procedure, to remove the fluid that had built up around his heart. And with his procedure, we were finished!

I think all in all, the doctors would call this week a success. Not including the cath cases, they performed 5 open-heart surgeries even though they had scheduled 7. The reasons the others were not performed were out of their control but I know medicine tends to attract people who are perfectionists (hey paul). Not that they need my two cents BUT I thought they did a great job. You can really tell how passionate the doctors and nurses who came on this trip are for their jobs and this program.

On Wednesday morning I went with Dr. Sable to meet with a team from Imaging the World (check it out). ITW has been conducting screenings of pregnant mothers in rural areas throughout Uganda to help detect any complications that can arise during pregnancy and it is our plan to collaborate with them to screen these mothers for RHD as well. The team showed us their technology and how they upload their images, which was very insightful. I am hoping to help implement some of their techniques back in Gulu because right now we have to copy images onto a hardrive, which takes longer than you could possibly imagine. Speaking of Gulu, I talked with one of the nurses that I work with yesterday and she informed me that they screened 16 families while Twalib and I were away! Could not be happier with this turnout and I am super excited to return (minus the drive) on Sunday to help complete the project. I can’t believe that I am leaving in a little more than a month! Time flies.

Eric, who was our first patient on friday, is doing great! Precious is being flown to the US next week to receive an operation

Eric, who was our first patient on friday, is doing great! Precious is being flown to the US next week to receive an operation

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Grace my favorite nurse! She was such a big help these past ten days. In this picture she was visiting her brother who has sickle cell. She informed us that she has lost 4 siblings to sickle cell but thankfully she does not have the condition

 

 

Jambo

On Friday I got to watch most of Eric’s surgery, which was such a cool experience. Eric had a heart condition called tetralogy of fallot. This is a congenital heart disease which causes low oxygen levels in the blood and leads to cyanosis. One of the factors of TOF is a ventricular septal defect (VSD), which is a hole between the right and left ventricles.

I was able to watch everything up close, including the placement of the patch that fixed the hole, and even got to go up to the chest cavity and see his beating heart at the end of the procedure. Freaky. He did really great right after surgery but unfortunately starting bleeding in the middle of the night and had to be reopened around 3am. They couldn’t find any problems and he is doing great now, so that’s all that matters.

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Surgeons repairing Eric’s heart

Because the surgical team had to come into the hospital really early Saturday morning and the first of the two cases we had lined up was a 2-month-old baby, which would take more time, they decided to only do one case. I didn’t go into this surgery simply because it felt a little tense and the last thing I knew they needed was me in there taking up space. I helped the doctors screen the patients that had come into the clinic in the morning and then got to head back with some of the team early afternoon, which was a nice change of pace. Because we finished so early we had time to make dinner reservations and decided on a restaurant called Mediterraneo (Italian), which is the number #1 ranked restaurant in Kampala. The restaurant was absolutely gorgeous and had such amazing architecture. I am my father’s daughter because of course I flocked directly towards the pizza. It was good, especially for Uganda, but I would be lying if I said I wasn’t excited for some pizza back home. Dinner was spent talking raises, hospitals, and different programs at different hospitals, sooooo I didn’t have too much to contribute ( I brought the average age down by about 25years). Some of the team here has nicknamed me “ study abroad” because they like to joke that I’m 19 and still in college. They all ordered a beer the first night and then looked directly at me and said” are you even of age?”

Sunday was the designated day off so I helped organize a trip to Jinja, the source of the Nile River. Jinja is about 90 minutes away and home of the supposed “ Bujagali Falls”. What we didn’t know was that a dam was completed about 2 years ago so by falls they actually mean completely still water. We ended up being suckered into a motorboat ride, which took us up and down the Nile. We thought the 2hr ($20) ride was going to be a scam but it was actually an awesome way to learn about Jinja and see some of the people and houses along the river. And yes for you Mean Girls enthusiasts, they actually say Jambo here as a greeting. After our boat ride we went to a restaurant called the Black Lantern, which had been recommended in many guide books. I had tilapia wrapped in banana leaves and it was absolutely delicious and I know it was fresh. I don’t eat fish in Gulu because a. you see the fish sit on the side of the road all day covered in flies b. it is about 5 hours away from any fresh water c. im not trying to die. I have to say that I have been spoiled by the food here in Kampala and we have been to some really great places. I have also eaten at the Indian place 4 times in the last week and am pretty sure that I am about to turn into chicken tikka.

Overlooking the Nile

Overlooking the Nile

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Laundry day on the Nle

 

After lunch, we headed to a place called “all terrain adventures” and went on an ATV tour. It is probably not the most culturally sound way to explore Jinja but it took us through a bunch of the villages and it was a fun way to see some of the houses there. Most of the houses I saw were small but were actual houses as opposed to the huts that they have in Gulu. I was a tad nervous during our tour because the ATVs were my idea and we had our cardiac surgeon with us. All I could picture was something happening to his hand and him not being able to operate (slowly taking after my mom…). Long story short we were all safe, and had an absolute blast (minus being completely covered in dirt for our 2 hr car ride back).

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Ready for some ATVing

On Monday morning Twalib and I were scheduled to have a meeting with the Joint Clinical Research Center (JCRC) at 9:30 to discuss the next project that will be happening in Gulu when I return in May/June. We left at 7 to avoid traffic and ended up arriving at 730. After a quick power snooze we finally met up with someone from the JCRC at 9 and she proceeded to show us the grounds. The JCRC originally supported HIV/AIDS research but they are starting to focus on other areas as well. The grounds were beautiful and sat on top of a hill, which gave us a great view of Kampala. We waited and waited for the person we were meeting with until about 10:45 when she finally called. She was in a completely different district and wouldn’t be back until 1:30. I have come to find that there is US time and there is African time. African time is always about 2 hours after you say something will happen, which if you know me, you know this drives me nuts. They offered to drive us to the hospital which ended up being a waste since, after traffic, we were only there for about 45 minutes before having to go straight back. Once we arrived a second time, we ended up waiting another 90minutes for our meeting. Although we were both a little grumpy after waiting all that time, the meeting was definitely a success. It finally became real that I will be coming back for an extended period of time and I am super excited for this project to launch in the summer. It’s hard to believe that I only have a little more than a month left here during this first trip. That’s it for now! Hoping to get to see another surgery tomorrow so I’ll keep you posted.

Not that she’s counting or anything BUT Stryker would like to let you know that I’ll be landing in 42 days.

tetralogy of what?

The wireless network at the hospital has a reputation of messing with computers and I was no exception. Luckily their IT guy has been helping us restore our computers with minimal loss.

This week has honestly been one of the most educational weeks of my life. I have been able to witness so many amazing things that continue to strengthen my desire to become a physician. On Tuesday morning Dr. Sable walked in and said, “ have you scribed before?If not you need to learn in the next 10 minutes because I need you.” So needless to say I attempted to learn their database and the art of scribing in those few minutes before the first echo. My 2 years of making it to the finals of the spelling bee obviously did nothing because I feel like I was second-guessing the spelling of every word. But don’t worry; I was given an easy first sentence pronounced at rapid speed- “tetralogy of Fallot with large anterior malaligned ventricular septal defect.” Uh..could you repeat that?

Although this week has been designated for cardiac catherizations, Dr. Sable is in charge of echoing children that need surgery or a catheter procedure and need to be placed with an organization for sponsorship. As I mentioned before, the cath team here is relatively new and only focuses on less complex cases. This means that there are many problems that cannot be fixed in Uganda. There are organizations (Samaritan’s Purse, Chain of Hope, Gift of Life) that sponsor children to go abroad to receive operations. To be accepted there are many steps involved including an echo detailing findings and heart anatomy. The first day there were about 35 patients waiting outside the door to be screened. It is both rewarding and heartbreaking knowing that some kids will receive the chance of a lifetime while more than half will probably never be accepted into one of these programs because they are too sick or too high risk. Some of the patients even mentioned that it was their 3rd or 4th year in a row coming back to UHI hoping to be sponsored.

 

potentially the most adorable child in the world

potentially the most adorable child in the world

If I were to shadow a cardiologist in the US (not that I know any…), I would probably spend a lot of the day seeing children, brought in by worried parents for no reason, who are completely normal. Unlike at home where we are all convinced by WebMD that we are dying for some reason or another (I’m guilty too) and unnecessarily head to the doctor (or in my case my parents room), here you only come to the hospital if you are very sick. I have been able to see so many unique and complex abnormalities this week, including a child with only one ventricle (you should have 2), a child with trisomy 18 (Edwards syndrome), and a child with a Holmes heart. Unfortunately, there was also a child brought in with severe RHD that will probably not make it more than a year. I think in my head I tried to tell myself that if those in Gulu were near a well-equipped and capable medical center then they might be okay. This RHD case was a reality check and made me vocalize what I already knew; once you are in the severely symptomatic stages of RHD there is not much you can do. These children would need valve replacements, which are extremely tricky as well as expensive, and not really an option in Uganda.

In addition to helping screen these children and scribing for their echos, I was able to watch some of the procedures happening in the cath lab. For those of you that are not familiar with cardiac catheterization, they can be done for many different reasons and involve placing a flexible tube (catheter) in a blood vessel, usually the femoral artery, and threading it to the heart, which avoids having to crack the chest (hopefully). They are performed as a diagnostic tool or can be done to fix a less complex problem such as a PDA. Because you don’t crack the chest, there really isn’t too much to see by watching one of these procedures, however I was still grateful for the opportunity, especially because Twalib performed one of the caths I was able to see.

 

 

Twalib performing a diagnostic cath on a 7yr old girl

Twalib performing a diagnostic cath on a 7yr old girl

Tomorrow begins the start of “surgery week” and I am really excited about the potential to go into the OR and watch some of these procedures. In addition, a 14 year old boy (Eric) whom we echoed on Wednesday and has been coming to the clinic for 4 years to get sponsored, was chosen to have surgery weekend and I am super excited for him! Most of the children that receive procedures happen to be fairly young and do not fully comprehend what is happening. Eric, however, came in this afternoon grinning from ear to ear; fully aware of the amazing gift he is about to receive. I’ll be sure to keep you posted on how everything goes!

 

You can end up waiting for 8hrs for an appointment here so many people tend to lay outside

You can end up waiting for 8hrs for an appointment here so many people tend to lay outside

The Uganda Heart Institute

 

Well, after 6.5 hours, one fender bender and 2 yelling Ugandan men…I made it to Kampala safely. Just so my mom doesn’t start calling me, I’ll elaborate on this little fender bender now. About an hour from Kampala we stopped for gas and a car backed up into us. Now in the US the amount of damage done would have been at least $500, if not more. Here they don’t want to involve the police (ever), so the other driver gave my driver $20 and drove off…not exactly sure if this is the best system but my driver seemed content with the business deal.

By the time I arrived at my hotel it was around 4pm. I feel like a Ugandan princess at this place. There is AC, wifi in my room, cold drinks AND I get my own queen bed (which isn’t as hard as a rock). My room was the last room that was booked, which made the group number odd, so while all the other doctors and nurses have a roommate, I, the youngest and only person without an advanced degree, get my own room. I know my parents are rolling their eyes right now.

Last night a group from World Children’s Initiative (go like them on Facebook) arrived in Uganda and I accompanied them to Mulago Hospital this morning. For starters, I was very impressed with the hospital. It is by no means like anything we have in the US but it is far more advanced than anything in Gulu.

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Mulago Hospital

The Ugandan Heart Institute, where we will be working, was just built within the last 2 years. Starting tomorrow, the WCI team will be performing 10 catheter procedures on children who would not be able to afford their operation if they hadn’t been sponsored. I like the structure of the WCI program because it is education based. They have been coming here for the last 5 years, and through all of the stories I have heard, the Ugandan doctors have come a long way. Instead of the American team coming in and cranking out 30-40 procedures in a week, which they could do, they bring the number down to make it more realistic of what the Ugandan doctors will be able to do on their own. After the first year that WCI was here, the Ugandan team performed 3 solo surgeries in a year. The next year it was closer to 10 and now, 5 years later, they are reaching to perform roughly 80-100 in a year. To see how excited all the Ugandan doctors were about their progress was truly inspiring.

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The UHI team!

Today was reserved for a lot of administrative meetings and organizational tasks to get everything ready for tomorrow. With that being said there was not much for me to do, so I tried to keep myself occupied as best I could. One of the nurses gave me a tour of the ICU on the cardiac floor and I then sat in on his lecture on post-catheter procedure care. The most exciting part of my day however was accompanying Jattu to meet with the 3 patients who will be receiving operations tomorrow. These patients are 5,6, and 16 years old. Although only 1 of the families spoke English, you could tell how excited and grateful they were for this opportunity and I honestly couldn’t be more excited for tomorrow. The surgical team arrives tonight and my main role during my time here is to help them in any way that I can. I have no doubt that I will be kept busy for the rest of the week.

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Moureen is one of our patients tomorrow! She will be having a procedure to fix a PDA (patent ductus arteriosus). PDA’s are very common in infants after birth but they usually close on their own. In Moureen’s case it did not, leaving her fatigued and short of breath. Too excited for this sweetheart

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