Uganda Love This

On Monday morning Twalib and I made the long trek up to Gulu. When I arrived late afternoon I received a very big “welcome back to Gulu”. I had been home for all of 5 minutes when there was a loud banging at my door. It was a representative from the local electricity company saying that we owed them money and that they were about to shut our power off. I knew for a fact that my roommate had paid the bill and she even left the receipt for me (honestly bless her for being the organized one). Naturally the office closes at 4, not 5, so I had to cross my fingers that they wouldn’t shut it off before I had the chance to talk to them on Tuesday. Luckily they held off and I was able to get everything sorted out, even though I was convinced that when the power went off on Monday night it was because of them.

This week has been extremely productive but very busy. Neither Twalib nor I were around last week, which means there was a backlog of patients. Tuesdays are probably our busiest day because this is when we see adults (a lot of hypertension cases). On Tuesday we worked from 8-6, with a conference call from 2-3, and I would be lying if I said I wasn’t exhausted at the end of the day. Luckily for me…. my evenings consist of secondary medical school applications so at the moment I do not have too much down time. I’d like to take this opportunity to thank my brother, editor-in-chief, for proofreading my application essays. Even when I know they are ready for submission, something about him proofreading them just makes me feel a little bit better. I am only half way through the applications in my inbox but I plan on hibernating this weekend to get everything done (probably an unrealistic goal but I’ll give it a go). My roommate Jess is away for the week visiting friends in Thailand (casual) which means I probably won’t be going out after dark. Our compound gets locked around 9pm every night and we have discovered that it takes two people to successfully unlock all 3 locks on the gate…and sometimes we even have to call the neighbors to let us in. It’s moments like these that I really miss the simplicity of a garage code.

Wednesday was just one of those days where every child that came into the clinic was extremely sick. We saw a 9 year-old girl who was struggling to breathe and stand. She has severe RHD, which has damaged two of her heart valves. At this point she is in congestive heart failure and struggling to hang on. Extremely distraught by the whole situation I asked Twalib about her prognosis. He said that Wednesday night was the most critical and if she could make it through her rheumatic fever episode over night then she may be okay. This morning I stopped by her room first thing to make sure that she was okay and I am happy to report that she was sitting up (something that she could not do yesterday).

On Wednesday night Twalib and I continued the movie night tradition by watching the documentary “ Call Me Kuchu”. This documentary is about gay rights in Uganda and to be honest I have no idea how we decided to watch this film. It was surprisingly informative and paved the way for some extremely awkward discussions once the movie was over….. A few years ago it was actually a law that if you knew someone that was gay and didn’t report them within 24 hours you could be sentenced to 3 years in prison….something that seems absolutely preposterous after growing up in the States. Although homosexuality is no longer illegal here (socially yes, legally no) the only law they have bans “the recruiting of people to be homosexuals.” I’ll stop this discussion here but I do have to say that we are definitely lucky to live in a society where people accept one another (well, for the most part). What the people in this documentary had to go through and the violence they were subjected to is unfathomable.

This morning I was greeted by a thunderstorm on the way to work. Unlike at home, walking is the only option I have. There are usually motorcycle taxis running throughout the town but when it rains they tend to hibernate. When I reached the office I was dripping wet and was really wishing I had an extra shirt. I am hoping that I will be able to find an umbrella in the market because apparently all of August will be like this.

This morning we will continue to see patients and I will organize all of the Registry forms that the nurses completed while I was away. At first glance I am extremely proud of the work that they did while I was gone and am becoming increasingly confident that this will be sustainable once I am gone. As of today we have 55 patients in the Registry, which means we are about 1/3 of the way there!

Since the first thing people always ask me is what I miss most about home, I figured I would include some things that I have been missing this week; strawberries, good yogurt, and the ability to drink tap water. Oh-and my family but I figured thats a given. 

Hope you all are having a great week!

This cutie was brought into the clinic because his physician heard a heart murmur but luckily he seems to be okay!

Sorry for the delay! This week has been absolutely amazing thus far and I can’t wait to tell you all about it. On Sunday morning I met up with the team from Imaging the World in Kampala and after a few introductions we set off for Nawanyago. Nawanyago is in the Eastern part of Uganda, right outside a big town called Jinja, and was the pilot site for the ultrasound program that ITW has successfully implemented all over the country. Our main objective for the trip was to figure out how we are going to smoothly integrate RHD screening into the existing ultrasound program.

Upon arrival we were greeted by one of the friendliest Ugandans I have met. Sister Angela is a midwife at Nawanyago Health Center III and is the main sonographer for the ITW program there. She gave us a tour of the facilities and then we all sat down for lunch and a lecture on RHD. Besides gathering all of the information we need to successfully launch this program, sonographers from different ITW sites joined us in Nawayanyago to receive training from cardiologists based at Children’s National and UVM.

Sister Angela and I

The team receiving echo training from Dr. Sable

On Monday I helped educate the local Village Health Team about Rheumatic Heart Disease. The VHT system here consists of a director and 2 volunteers for each of the 16 communities that the Nawanyago Health Center serves. You could really see how much the VHTs care about their communities and how eager they were to bring back this information. It is our goal that they will not only spread the word about the cause of RHD but also inform mothers about the echo screening that will soon be available at their health center.

VHTs hard at work

After our afternoon training we were taken into the village by the director of the VHTs to visit some of the patients that ITW has helped in the past. For those of you that are unaware of the Imaging the World model, they have implemented this OB ultrasound program to help discover at risk pregnancies early on so that complications can hopefully be avoided during labor. This way mothers can be referred to a hospital before it is too late. All of the studies that are performed in Uganda are uploaded to a server and are over read by experts in the States. What they have been able to accomplish is truly remarkable and I could not be more excited that I get to work with this team in the upcoming months.

This baby’s mother received an ultrasound through the ITW program while she was pregant

On Tuesday morning I got to experience my first Antenatal Care Clinic day, which was extremely important because it allowed me to get information about a typical day at Nawanyago. Since the introduction of Ultrasound, ANC visits have climbed from 130 a month to over 250 per month! These clinics are super important for mother and baby because mothers receive education about their pregnancy, prenatal supplements and are tested for HIV monthly to decrease the risk of mother to baby transmission.

In addition to the ANC clinic I was able to spend the afternoon with Sister Angela learning about OB ultrasound and was able to watch her perform a couple! At the end of the day the whole team headed to Jinja where we stayed at a wonderful hotel located on the Nile and enjoyed some great pizza.

On Wednesday we returned to Nawanyago for one last day of echocardiography training before heading back to Kampala. About an hour before we left a woman went into labor so I had the bright idea that I would watch-Stupid, stupid mistake. Lets just say that when I walked out of the room, the doctors said I have never looked whiter. I think I can safely say that OB is off the table for this girl.

On Thursday morning I headed to the UHI with Dr. Sable and Dr. Donofrio. There were about 50 patients lined up to see them when we arrived, including some of the children that received surgery in March when I was here with the team from Childrens. A lot of these children have congenital heart defects and Dr. Sable is simply incredible when it comes to finding children sponsors for surgery.

I spent most of Thursday preparing the IRB (for our upcoming project with ITW) for submission. All of the content was already there but this is Uganda which means things don’t usually go according to plan. After some formatting issues, a broken printer, 3 power outages, 5 hours and a close call with a bottle of water, we were able to successfully drop the proposal off to Mengo Hospital. I returned to our hotel around 6:30 to meet up with Dr. Sable and Dr. Donofrio before we headed to Dr. Lwabi’s house for dinner. Dr. Lwabi is one of the pediatric cardiologists at UHI and he is simply a great person. His house was absolutely beautiful and his family was so welcoming. After an excellent dinner and some Ugandan Waragi, we decided to call it a night and head back to our hotel.

I will be spending most of the day organizing the information that we were able to gather on this trip in addition to a few medical school applications that have been neglected this past week. Happy Friday everyone!

Picture this: A 4 year old girl being carried into the clinic seizing in her mothers arms. She’s had a stroke and is barely breathing. You need epinephrine but you can’t find any in the hospital. You need oxygen but the one tank available is hooked up to a 2 week-old child. She stops breathing all together so you start giving CPR while her mother collapses to the ground screaming and crying. This nightmare was unfortunately a reality for us at the clinic on Wednesday morning.

Lakica is a 4-yr old girl known to have a tetraology of fallot (TOF), a condition caused by a combination of 4 heart defects that present at birth. She has been a patient of Twalib’s for the past 6 months. Her condition was being managed by medication and follow up appointments however the only real solution would be surgery. No one knows exactly what caused these events but I can honestly say that if Twalib had notbeen around the morning that she came in, she would no longer be with us. He knew exactly what to do (and the ward doctors didn’t..), even with a lack of resources and he did it in such a calm and collected manner. It was one of those situations that I felt absolutely helpless in and simply watched from a distance. Its moments like these that remind my why I want to be a physician. I am happy to report that Lakica is alive and breathing on her own as of this morning.

Besides the chaos on Wednesday morning, everything else went fairly smooth this week. We were able to enroll 15 more patients into the registry, which brings us to 40! Things are moving along nicely and I can’t wait to hit the 100 mark. Twalib and I will both be gone next week but the nurses will continue to enroll patients while we are away so hopefully I will be able to report that we have hit the 50 mark next week.

On Tuesday, Twalib and I continued movie night tradition and watched The Theory of Everything, a movie about physicist Steven Hawking. Overall I thought it was a really good movie and I think Twalib did too.

On Wednesday night I got off work in time to join everyone playing volleyball at BJz. It’s such a great way to unwind while being outside and I’ve had a lot of fun both times I’ve played. It was a great way for me to be active before having to sit down and take a two hour personality test….Say what? Yes- one of the medical schools I applied to required me to take a two-hour personality at a prearranged time. The test was set up MMI (Multiple Mini Interview) style and addressed key personality traits necessary for the medical profession. They offered 10 sessions throughout the summer but I decided to take the first one since it was the only time that was not at 1 or 4am (6pm/9pm East Coast time). Fighting a rough Internet connection, a rooster that wouldn’t shut up and the wedding celebrations occurring in our compound, I would like to think that I did well but only time will tell. I am quickly learning that applying to school online while being here is definitely easier said than done-hoping to finish a few more applications before I leave town.

On Saturday morning I will be headed to Kampala to meet up with a team from Imaging the World to solidify details for our upcoming project. ITW has an existing ultrasound program for prgenant women in rural areas and we plan to implement RHD screening into this program as well. Super excited for this collaboration and the chance to see a part of Uganda that I have never been too. We will be headed to Eastern Uganda (Kamuli and Nywanyago) on Sunday morning, where I will be staying until Friday. I promise to give you updates when I can-that’s all for now!

Some adorable kiddos at the hospital

On Thursday afternoon I left the office and headed to the Iron Donkey so I could use the Internet. When I walked in, this little guy greeted me.

His name is Fred and he was rescued by a Mzungu couple living in Gulu. They were keeping him for a few days until the UWA (Ugandan Wildlife Authority) could come and take him back to the wild. Surprisingly, this was not their first monkey and they  treated him just like a dog. They said he slept in the bed with them (not weird at all) and always came back when he was called.

On Thursday night Rhoda and I went to an aerobics class taught by our Ugandan friend Robina, who is honestly one of the most unique people I have ever met. She studied in Cuba for 5 years and then returned to Gulu where she has been working ever since. She is extremely athletic and has played on multiple Ugandan athletic teams. With that being said, Rhoda and I were a little skeptical about what we were getting ourselves into but nonetheless we went anyway. When we walked in we were directed to a patch of grass, next to a chicken coup. We were then joined by 5 middle aged, overweight Ugandan women who told us that Robina’s class was the hardest thing they’ve ever done. The next hour or so was honestly the most entertaining, comical and laugh worthy hour of my life. To say this was an aerobics class is a big stretch. It was more like adult Gymboree. Everyone was flailing they’re limbs all over the place and 2 of the women rolled over proclaiming they were going to die when she asked us to do 8 sit ups. Best $1.25 I ever spent.

On Thursday night a group of us headed to BJ’s for the weekly pub quiz. Unfortunately, I have no comical questions to report. To be honest, the questions this week were actually really difficult and our team struggled a bit. We ended up placing 4^th but most of us ended up leaving before the results were announced since we had to get up early for work.

On Friday I went to the office to work with the nurses on their computer skills. Before my time in Uganda I most definitely took my technology and computer training for granted, not realizing that not everyone has grown up typing on a laptop since age 15. My goal is for them to be typing with  more than one finger by the time I leave, but that’s definitely up in the air. They have however, mastered excel and are able to create weekly reports for Twalib which I am really happy about.

On Friday my medical school application was officially verified, which meant I received multiple emails to complete secondary applications minutes later. Unfortunately, I spent all of Friday night and all of Saturday working on applicant bios and essays. The good news is I was able to submit a few, however I still have a long way to go. I am leaving for Kampala on Saturday so I am hoping to to finish a few more by the time I leave.

On Saturday afternoon I took a break from essay writing to play volleyball with a group of people I met at the Iron Donkey earlier in the day. I found myself channeling my soccer goalie days which meant I spent a lot of time diving for the ball.  Minus the bruises on my arm and the bloody knee cap, I would say it was a success. I honestly had an amazing time and it was a great way to meet some new volunteers. Luckily most of them will be staying until December so I am glad that I am beginning to make new friends. They are planning on playing every Wednesday night so I am hoping that I can leave work in time to be able to make it. 

On Sunday morning I headed to a local hotel to attend the Northern Ugandan Village Health Outreach Project (NUV HOP) Conference which was put on by my friend Job, a medical student at Gulu university. This outreach will be occurring this week and is being led by a team of Belgian and Ugandan medical students. Although I will not be taking part in their outreach, Job asked me if I would attend and I simply couldn’t say no. Even though some of the information was specific to their project, I felt like a lot of the information carries over to my projects as well, including lectures on cultural sensitivity. Overall it was an informative day and well lets face it, it was better than writing essays. 

Tomorrow I will be heading to the hospital bright and early to help the nurses prepare for the week. Hope everyone had a great weekend!

On Monday, the nurses and I prepared everything for the week and made sure that we had enough enrollment forms to get us through. Thank god we did because we were able to enroll 16 patients this week, which is awesome! There are roughly 180 RHD patients eligible for enrollment in the Gulu district and we have already reached 25, which is really promising progress. We are hoping that we will be able to transition all of these patients into the registry by December but at this rate I am hoping it can be sooner.

This week was just one of those weeks that was overwhelmingly busy. We saw roughly 75 patients between Tuesday and Wednesday, in addition to the ones that we enrolled into the registry. I thought I was exhausted but I can only imagine how Twalib felt, echoing and diagnosing all of those patients. I am slowly picking up how to identify certain heart abnormalities and will be practicing echos with the nurses on days that Twalib is not around. Twalib keeps telling me that I have to be a cardiologist because it’s “in my blood.” I am going to take it one step at a time and work on getting into medical school…..

On Tuesday a 2 year-old child came into the clinic that clearly had severe mental disabilities. He could not support his neck, sit on his own let alone stand, or speak. He had apparently been to 3 other doctors yet it took Twalib about 30 seconds to diagnose him with cerebal palsy. I can’t imagine how hard it must be to have a child with a mental disability but it has to even worse to know that there is something wrong and not being able to get a diagnosis. His parents were honestly shocked learning that he may never speak and would never be capable of life without full-time care. It is obviously hard no matter what the situation however there is something about a culture where you are usually married at age 14 and living on your own, that makes everything a little harder.

On Tuesday night Twalib and I continued our movie tradition and watched The Book Thief, a movie set during the Holocaust. My roommate Jess and I thought it was pretty subpar but Twalib really liked it. Jess got the full “Twalib movie experience” when he starting asking us a million questions about the Holocaust and Germany after the movie. I have to say, in that moment, I fully regretted not taking him to the Holocaust museum when he was in DC.

Wednesday was simply not my day. I am one of those people that like to be on time and if I’m not, it throws me off. I can probably thank my super cool, calm and collected older brother for threatening to leave me every morning on the way to school growing up…. but either way, that’s how I’m programed. My phone shut itself off during the night on Tuesday so I woke up at 8:15, when I’m usually at the hospital by 7:45. To make matters worse, it was penicillin day, the one day a month that we start super early. I was able to reach the hospital by 8:30 (completely uncaffeinated) but I still felt horrible that I was late. To cap off the day I learned that the registry business is a “dangerous” one. I was filing away some of the intake forms when I contacted the metal clip on one of the folders in such a way that I sliced open my finger. It was one of those cuts that was relatively insignificant but produced a lot of blood. The nurses went into panic mode acting like I was about to die…meanwhile there was a patient with sickle cell on the bed struggling to breathe (something wrong with this picture.) They essentially soaked my entire hand in iodine, like I was about to undergo major surgery, and wrapped some gauzed around it. I’m happy to report, I think I am going to survive.

hey mom- when was my last tetanus shot?

On Wednesday night I went to the Ethiopian restaurant with Jess, Rhoda, Aaron and a new arrival, Philip. It was honestly great to get out of the house/ hospital setting and relax. Since 3 of them are doctors I didn’t really escape the medical scene though since we ended up talking about medical cases all dinner long. Fun fact-Aaron claims that an Italian surgeon will be doing a “head transplant” in 2017. I thought it was the beer talking BUT I looked it up, and it’s actually a thing- not exactly sure how I feel about that.

More exciting news- I was able to find a sponsor for the constrictive pericarditis patient! His surgery is planned for August 17th and I honestly couldn’t be more excited for the little guy. 

On Thursday we continued to see patients and ended the week with a total of 6 people enrolled into the registry! I was very pleased with how the week went and with the difference I saw in the enrollment process by the nurses from Wednesday to Thursday. We obviously have a long way to go until everyone is enrolled but we’re off to a good start.

Twalib saw multiple patients on Thursday and I once again helped him scribe, learning all of the cardiac lingo as I went along. Unfortunately 3 of the 4 patients that we enrolled into the registry were completely new patients, meaning that their RHD was caught relatively late, after they were already symptomatic. Although I see RHD patients almost every day it is still hard to grasp that so many people are affected even though this disease is preventable. Two of these patients were my age and I honestly can’t even imagine being fine one day and waking up a month later with severe chest pain to be told I was in heart failure.

We were also able to see the little boy with the constrictive pericarditis on Thursday. They drained 6L (SIX LITERS!) from his abdomen, which I was able to watch without passing out (giving myself a pat on the back for that one). This poor guy is honestly so uncomfortable and I simply cant wait for him to get his surgery. Twalib was able to get him an appointment at the UHI in August so I have made it my personal project to get him sponsored so that his surgery can go off without a hitch. I’ll be sure to keep you posted.

Before draining the 6L. He is always open to us taking picture s because he “hopes if the doctors see him, they will help”

On Friday I spent the day at the hospital organizing the penicillin books (easier said than done) to make sure that our data is ready to go. I was able to enjoy a Friday afternoon workout on our front lawn, since our homeowners left a bunch of free weights behind. I am 100% positive that our neighbors think I am absolutely nuts. As if a white girl walking around Gulu wasn’t enough…a white girl doing burpees on the grass in the hot sun is definitely something for them to talk about.

On Friday night I had dinner at the Indian restaurant with my friend Emma. It was the first time that we were able to really catch up since I’ve been back and we ended up chatting for about 3 hours. We called it an early night to get ready for our 4^th of July festivities.

Jess and I were able to convince our Ugandan friend David to throw a party for the 4^th of July. He has a pool and a very large courtyard which is conducive to having a lot of people. Minus the fact that there were people from all over the world and that Europeans and Ugandans outnumbered Americans, it was exactly the type of celebration we would have had in the states. We ordered pizzas instead of cooking out and spent the afternoon in the pool with some cocktails and “American music” -I swear I need to burn all of the Justin Bieber CD’s in this country. David was even able to find us an American flag in the market so that was proudly displayed in the front of his house. There were a bunch of people that I had not met before as well so it was a great opportunity to make some new friends. There is definitely a video of us singing the national anthem somewhere so I can’t wait for that to resurface.

Katie, Jess and I in David’s pool

On Sunday I went to the Iron Donkey with Jess and started working on some of my secondary applications for medical school. I only have a few right now but unfortunately all of the schools I applied to send a secondary to all applicants, which means essays upon essays. I should be getting those within the next two weeks and I’m sure that they will take up all my spare time. 

Hope everyone has a great week!

If you ask my friends, they will tell you that one of my biggest fears is the possibility of never getting married (doesn’t have to be anytime soon…but it needs to happen). After spending the afternoon with one of my favorite nurses, Rose, I realized how different the concept of marriage is here and how miniscule this fear would probably seem to her. Rose’s guardian died when she was in 8th grade, leaving her poor and without any remaining family members. She moved to Lacor, the local missionary hospital, where she lived in extreme poverty for 2 years. During her time there, she met a man who offered to pay for her to go back to school if she married him in return. And just like that, she was married. I’ve seen it time and time again here but when it is someone that you are really close to, it definitely hits home. The concept of the loving relationship that we have engrained in our westernized heads is essentially non-existent. Many marriages are business arrangements and nothing more. Knowing you may not have enough food to eat tomorrow or knowing you can never get a good job because you cannot afford to go to school-real fears. Never getting married?- unfortunate and the butt of every Scheel family joke, but nothing to lose sleep over.

I have also come to find that the range of emotions that it is possible to go through in one day here is simply indescribable. I started my Tuesday morning waiting outside the clinic when I felt a small hand clasp mine from behind. Now normally when a small Ugandan child sees me, they are speechless and continue to stare at the amazing spectacle that is a white person. That or they immediately start screaming and crying and hide behind their mother. Hint: its usually the latter. The fact that this boy just came out of nowhere, grabbed my hand, and simply wanted to play put me in such a great mood that I honestly thought nothing could bring me down. Unfortunately, my mood did a 180 as I was getting ready to leave the hospital for the day. As I was walking out the main gate, a young girl (probably no older than 15) ran up to me saying “Doctor, Doctor” and handed me the forms in her hand. Unfortunately she didn’t speak any English (besides her broken “Doctor, Doctor”) so my attempts to tell her that I actually wasn’t a physician were unsuccessful. I then examined her forms hoping that I could direct her to the correct department. After a closer look I realized that she not only had medical forms but an attached police report detailing her sexual assault-she was there for a Rape Kit. Its moments like these that you are just mad at the world. My heart is honestly still breaking for this young girl, who was obviously terrified. I know that sexual abuse is extremely common in Uganda but seeing a victim firsthand really made all the statistics a reality for me. As horrible as that situation was/is, it provided me a small glimmer of hope that the police department was actually going to take action.

Moving away from depressing topics, in terms of work this week, everything has been going great thus far. The cardiac clinic officially started up today and surprisingly there was not an overwhelming number of patients. Don’t get me wrong- it was definitely more than normal, however considering that today was the dreaded June 31st , I had expected it to be a lot worse. We were able to officially launch the Registry by enrolling 2 patients! This may not seem like a lot, because in the grand scheme of things it isn’t, but it was the perfect number for the nurses to perform their first consents without too much added pressure. Overall, I think they did a really great job and we are definitely moving away from memorizing the intake forms to understanding the forms. If I have learned anything during my time here, it is that patience is a virtue. Next week is the RHD penicillin clinic so I am hopeful that we will be able to recruit multiple patients on that day. Other than helping with the Registry, I have been acting as a scribe for Twalib when he performs patient echos. I really enjoy this part because I love getting to know the patients on a personal level by hearing their stories through their medical histories. Usually once they get started and realize that someone is actually listening, they give me every.single.detail. Off to see more patients tomorrow!