Uganda Love This

Hi everyone, sorry for the delayed post. Friday was an extremely busy day and I think I needed some time to take in everything that has happened over the last few days.

I’ll go ahead and jump right to Opio’s surgery because I know that is what everyone is interested in. Opio’s surgery went extremely well and he came out of the OR extubated and was talking within an hour. I was able to watch the entire pericardiectomy standing by his head and I have to say it was an absolutely amazing experience. I have been able to see a couple of heart surgeries over the past few months, however Opio’s was special because I was able to witness it from start to finish. In addition, this is the only heart surgery I have seen where the patient wasn’t put on bypass and the heart beat normally throughout the operation (how cool!).

Morning of surgery-love this kid

Opio has been such a trooper throughout this entire experience that sometimes I have to remind myself that he is only 8 years old. On Friday morning he walked himself into the OR, saw the surgical table, and hopped right up (an image I will never forget). None of the surgeons or nurses in the OR spoke Acholi so he was not able to understand anything they were telling him. My small Acholi vocabulary finally came in handy when they were trying to get him to make a fist to put in a cannula. “Me che matak” means “make a fist” in Acholi and once I said it, he immediately made a fist. I’m not sure who was more surprised that it came out of my mouth-me or him.

Dr. Tom working on Opio’s heart

As I mentioned before, the surgery went really well and the surgeon did not come across anything unexpected (which is a good sign.) It was amazing to see the heart expand as the fibrous pericardium was removed piece by piece. Post-surgery Opio was suffering from hypoalbuminemia (low albumin), which is common for someone who has been suffering with his condition, but surprise-there was no albumin in the hospital. Twalib and I ran around Kampala for about 90 minutes fighting traffic, trying to find a pharmacy that sold albumin. I realize I’m still in Uganda however it blows my mind that even in a developed, western-supported hospital that there would be a shortage of important medication, especially since right on his chart (which I saw after surgery…) the pre surgery notes clearly state “ at risk for hypoalbuminemia.” I could probably write a whole post about shortages within the Uganda health care system but I’ll save that for another time.

On Saturday I spent most of the day with Opio in the ICU so that his father could have a break. When I arrived he looked great, his albumin had increased and his urine output was sufficient (which was another one of the doctors concerns). He spent most of the day sleeping but I was there for whatever he needed, which consisted of water and moving his bed up or down so that he was comfortable. I also divided my time with Mabel, a patient of Twalib’s, whom I met in March when the surgical team was here. She is in congestive heart failure and needs treatment in the US. Luckily she is currently in the process of being adopted by a family in the states who will hopefully arrive this Wednesday. She is such a sweet girl who has been dealt a very crappy hand . She doesn’t have any biological family members to take care of her, which is especially challenging with a serious medical condition. She has been supported by an NGO here in Uganda but what she really needs is constant love and support. She has been admitted to the hospital so many times that I think every time she dreads it even more. Although there wasn’t too much to do, I just sat on her bed and chatted with her for a while. Her face lit up when she started talking about her new family and the necklace they gave her. My fingers are crossed that everything works out because she truly deserves the chance to be happy.

blowing balloons to get his lungs moving

On Sunday I took advantage of the opportunity to sleep until 9 and then headed to the hospital to check on my kiddo. When I arrived he was sitting up, eating, and looking for something to do. At this point his biggest problem is that he is bored and wants to get out of bed. If that’s the biggest obstacle he is facing right now- I’ll take it. I then went to check on Mabel and was extremely discouraged to find her shivering and dripping in sweat with a fever of 103 degrees. She said she had been trying to get someone to come look at her for over 40 minutes but so far nothing. It’s times like these that I become so frustrated that I do not have a medical degree and that I can’t personally help her on my own. I finally called her pediatrician, who has taken a special interest in her case, and she came to hospital right away. Mabel’s malaria test was negative and she was but on antibiotics to fight whatever infection she is suffering from. When I left last night her fever was already going down and she said her headache was fading. She has gone through more than anyone should have to in one lifetime and my heart simply aches for her. The hope is that she will be in the US within the next 10 days, which would be absolutely amazing.

This morning I had plans to take the 8am bus back to Gulu but when I arrived at 7:45am the bus had already left. Now I have been in Uganda for almost 7 months total and I can confidently say that I have never been to a meeting/event that started on time. How this bus managed to leave 15minutes early is beyond me. I got out my phone to see if I had contacts of anyone who might be heading back to Gulu and saw a post on the “Ex-pats in Gulu” facebook page from a contractor who was heading back at 9am. Kind of skeptical, I gave him a call and scoped out the situation. I messaged someone who knew the guy and he reassured me that he was a good guy. So, after 3 of my friends had his name, number, and license plate number (just looking out for myself-you’re welcome mom), Jatu, the 55-year-old Indian man, and I set off for Gulu. I can’t help but laugh when I think about the last 7 hours because I honestly can’t make this stuff up. He speaks very broken English but I was  able to learn about the Hindu religion the entire trip up while listening to classical Indian music. I now know all about traditional Indian foods and how “the cow” is considered the mother of Hindu people. Halfway to Gulu he asked if he could stop to buy some bread for his “friends”. I was kind of confused why he wanted to stop in an extremely small town but then again I thought maybe the bread was really good. 20 minutes later I finally understood as he started opening the packages of bread and chucking pieces at the baboons and monkeys on the side of the road. We then had about 15 baboons running after the car as each of us tossed bread out the window. Apparently by “friends” he meant the primates that he feeds every week when he comes up to Gulu….. He honestly was such a nice guy and it was very sweet of him to give me a ride. Not convinced that I’ll do it again but I’m safely back in Gulu so that is all that matters.

Very excited to see the nurses tomorrow at the hospital. I’ve definitely missed them! Have a great week!

xoxo

Emmy

Deep down I knew I would experience “it” during my time here and I knew it would be hard. I realize that death is an unfortunate aspect of working in the medical field but that doesn’t make it any easier. Baby Awor was 2 days old when I watched him take his last breath this past Thursday. He was born pre-maturely at 33 weeks, with underdeveloped lungs and multiple other complications. The medical students, who were in charge of running the neonatal ward, brought him to Dr. Aliku as their last hope. Extremely bradycardic, Dr. Aliku was able to get his heart beating at a normal rate but this success was short lived. He passed away about 20 minutes later-an image that will be ingrained in my head forever. I’m not medically educated to say whether I think this child would have survived in a different setting. What I can say is that the lack of available oxygen, medication and personnel did not help his chances. What struck me even more was that medical students were in charge of running a ward completely by themselves and brought the baby to Dr. Aliku simply because they couldn’t get in touch with their superior. They were out of options and knew where to find him. Although some would say that medical students in the U.S have “their hands held” throughout their training, it is safe to say that the students here could use a little more of that.

On a less depressing note, Opio successfully arrived in Kampala on Thursday and was admitted to the Uganda Heart Institute on Friday! I will be heading down on Thursday night so that I can be present for his surgery on Friday. Although I am very nervous for this little guy, I am also extremely hopeful.

some kiddos I met on the way home from work

On Thursday night a big group of us headed to Bjz for Jess’s last quiz night. She will be flying out on Thursday so we decided that we have to do all of our favorite things before she leaves. We ended up having a huge group attend and were extremely confident that we were going to win. The questions were all logos that our team needed to identify. We ended up with a 29/30 but sadly that was not enough. We still had a really great time and met some great people whom we ended up hanging out with for a majority of the weekend.

On Friday, our group which consisted of a few of our Ugandan friends, our friend Katie and 3 guys from the US army ( I was not even aware that you could get deployed here) that we met on Thursday continued to check things of Jess’s bucket list by going to the Ethiopian restaurant for dinner. Surprisingly I still can’t get enough of the stuff and will most likely be going one last time before Jess’s departure.

On Saturday we all headed to the pool for a gorgeous day. I think every Mzungu in Gulu had the same idea since it ended up being a pool party of about 30 ex-pats from all over the globe. My new roommates were also there and I was able to finally solidify that I will be moving in during the first week of September. I am going to miss Jess so much but I am very excited about the group of people that I am moving in with (and the puppy that they just got last week.)

On Saturday night we all headed to BJz for one final hoorah even though it was pouring rain. We figured that since it was raining it would be fairly empty….wrong. It was more packed than I have ever seen it. I think this probably has something to do with the fact that the power was out for about 3 days and Bjz is one of the only places that constantly uses a generator. Nonetheless we all had a great time and just ended up dancing in the rain because it was too packed inside. I know I say this a lot but Saturday was by far my favorite night in Gulu up to this point. I guess it’s a good thing if I say this every weekend, right? Right.

Improvising for the walk to Bjz

Me, david and Jess

On Sunday Jess and I lounged around like we do most Sundays and did not do too much else. We went over the events of our weekend and I’m pretty sure that I haven’t laughed that much in a very long time. I am so fortunate that I got to cross paths with such an amazing person and while I am very mad at her for leaving me, I am super excited that she will be in DC only an hour away from me when I’m home. 

As for this week, I spent Monday in the office with the nurses trying to organize a list of kids that have not returned for their follow up visits. It is our hope that we will be able to track these children down when school starts up again on September 7^th, but we definitely have a lot of work to do. Today was extremely busy and we even enrolled 9 patients into the registry, which brings us up to 97 patients! As I mentioned we had hoped to get to 100 by the end of August and I am confident that I will be able to report that we have surpassed this target come Friday.

Tomorrow a team from the UHI will be visiting our clinic in Gulu to search for potential surgical candidates. This does not happen too often so I am very excited that some of our patients will get this opportunity. We often refer our patients to the UHI so that they can have a “first look” appointment to be placed on a list, however most of them cannot afford the transport to Kampala. By having the team come to us, hopefully these patients will successfully be given a surgical slot and will only have to pay for transport once.

That’s all for now. Next update will be with Opio in Kampala!

I’ve decided that if we were to merge the American mentality regarding health with the Ugandan mentality, then we would be in a very good place. I feel like Americans tend to worry about every minor thing that is wrong, including the common cold, and jump to the worst conclusions. We go from having a headache to being terminally ill with brain cancer in a matter of seconds thanks to our good friends WebMD and Google. In Uganda they have the exact opposite problem, which is one of the main reasons why RHD is so prevalent. Illnesses such as strep throat and the flu are shrugged off simply because they are not considered severe. On Friday one of our RHD follow-ups came to the clinic for a routine check up. I noticed a large growth on her neck and asked her mom a few questions about it. I realize I am not a doctor, however I have taken a basic anatomy class and thanks to my wonderful professor TGills, I know the ABCD’s to look for. Her mother said that it started very small but has been growing over the past two years (another red flag). She says it doesn’t hurt so they never bothered to have anyone look at it. We sent her to the skin clinic after her appointment and I’m honestly praying that I was wrong.

On Friday I started the weekend by going to “fajita night” at a friends house. Everyone was required to bring a food or drink item and we ended up making it a celebration for one of our friends who headed back to the States on Tuesday. She called it her “funeral” and asked us to wear all black. The food was absolutely wonderful and I got to meet a bunch of new people, which is always great. OH- in case you were wondering about the cat-sized rat. Yes, it actually does exist. On my way to fajita night, it ran right in front of me as I was leaving our compound. I’m honestly still in disbelief at how big it was. That and the fact that “bush rat” is a delicacy in some parts of Uganda.

On Saturday I finished my LAST secondary application and I feel like a new person. I don’t think I realized how much they were stressing me out until I was done, but I have to say it feels great. On Saturday evening Jess and I went to the Ethiopian restaurant for dinner and then headed home for a quiet night in. Jess leaves in a week so we’ve decided that we have to eat Ethiopian at least 2 more times before she leaves.

On Sunday I laid by the pool and read Mountains beyond Mountains. I would tell you what else I did but honestly that’s about it. All in all it was an excellent day. I haven’t been to the pool in Gulu since I arrived in June and it was such a relaxing way to end my weekend.

On Monday, I met up with the nurses to clean up our office and enroll any patients that came for RHD follow up. We threw an alarming number of expired drugs away, organized all the registry files, and even saw a cockroach as big as my hand….not too sure what’s going on but I have seen more “creatures” in the past week than I have in my lifetime. Really hoping this trend doesn’t continue because after the extremely poisonous spider that made itself at home on our front porch, I think I’ll be good for the rest of my time here.

On Tuesday and Wednesday we continued to enroll patients into the Registry and had a record high of 9 patients in one day! Not only did we have 9 patients, but the whole process was extremely smooth and efficient and I could not be more happy with how our nurses handled everything. We still have a little ways to go in terms of them filling the forms out correctly 100% of the time but I’m confident in their abilities. In addition to the Registry patients, Opio came for his last visit! The time has finally come for him to head down to Kampala. He will travel tomorrow afternoon and stay with family until he is admitted to the Heart Institute on Friday. I just want to thank everyone who reached out to me about his case and supported his journey. I know they say don’t become emotionally attached to your patients but with Opio it was simply impossible. I care so much for this little boy and I am keeping my fingers crossed that everything goes smoothly next week. As of now my plan is to head to Kampala next Thursday afternoon so I can be there when he goes into surgery on Friday. I will keep you all updated on how everything goes. If you want to read more about his story you can click here.

Opio and I- we’re still mastering the whole picture thing

Lastly, I want to give a huge birthday shout-out to my wonderful grandmother! Happy birthday Mom-mom! Although she may not understand why I voluntarily moved to a place with cold showers,  and “creatures” she has always been nothing but supportive. I wish I were there to celebrate and I hope you have a great day!

On Monday Dr. Onek, our neighbor, greeted Jess and I and proceeded to ask us if we had seen a rat. Not just any rat- a rat so big that it has been eating their chickens….we are now convinced that there is a cat-sized rat roaming around our compound waiting to attack at any moment. Oh the joys of living in Africa.

We are hoping our “guard dog” will find it and kill it, but in reality Donkey (yes that’s his name) is probably as useful as a 3-day-old kitten. He barks when he sees someone new, then puts his tail between his legs and runs over for them to pet him.

On Monday the nurses and I prepared everything for the week and enrolled a few patients into the registry. Wednesday was the scheduled penicillin injection clinic, however many of the students had final exams this week-they all starting showing up at different times on different days, which definitely kept things interesting. On Monday afternoon our nurses went to their first official computer class. The teacher seems great and I am really hoping that they learn a lot. If anything, they are super excited about learning, which is already a positive.

Rose and Agnes ready for computer class!

Tuesday was once again a very personal day for me, but in a good way this time. Opio came in for a visit and he looked the best he ever has since my time here. He was much more stable and you could tell that it is starting to become a reality for him that he will be leaving for the Heart Institute next week. Obviously surgery can be unpredictable, but I am crossing my fingers for this little guy. This week he had his abdomen tapped again so I set him up with “Frozen” on my laptop. He doesn’t know any English but I think it is safe to say that it is probably one of the only movies he has ever seen and he loved it. His surgery is scheduled for the 28^th and he will be heading down to Kampala next Friday- please keep him in your thoughts!

On Tuesday afternoon Noelle, a 3-year old girl from Gulu, came into the clinic for a checkup after her PDA closure in Kampala. I have seen her in the clinic at least 10 times since I have been here and even once at the Uganda Heart Institute in March. She is one of the few children that are not afraid when they see “the white girl” and always runs up to me to hold my hand. Her mom is such a sweetheart and has been trying to get her sponsored for 2 years! Unfortunately, a lot of charities will not sponsor kids with Down Syndrome because their surgeries are usually high risk. Her moment finally arrived last week when Chain of Hope sponsored the catheterization procedure she needed. Everything went flawlessly and she is as spunky as ever. Getting kids from Gulu sponsored and down to Kampala is definitely a challenge due to how far away we are. I am happy to report that we have already had 2 kids in the past month that have had life-changing surgeries/procedures.

Super strong after her PDA closure!

On Tuesday night Twalib, Jess and I watched Invictus, a movie about Nelson Mandela and the 1995 Rugby World Cup in South Africa. After watching Life of Pi last week, I have decided that we will be sticking to movies based on historical events from now on. Twalib did not seem too amused by a fictional boy befriending a tiger……He has already requested Pearl Harbor for next week so I am mentally preparing for the 3 hour film.

On Wednesday I helped with the injection clinic and then continued to work on Registry enrollment. We are up to 70 patients already, which is excellent! I am hoping to have 90-100 by the end of the month.

On Wednesday night I played volleyball with the regular Wednesday night crew, then went out for Indian food. I never thought I would say this but I think I’m a little tired of Indian and don’t foresee myself going back anytime soon. I guess when there are only 4 food places to choose from this is bound to happen….

On Thursday night I finished 2 of my secondaries, leaving only one left! I ended up adding another school last week and just received the secondary on Monday. I honestly think there needs to be a box that says “ I overcame obstacles trying to fill this out in Africa-please take this into consideration.” I honestly never anticipated how stressful this whole process would be but I am very happy that it is pretty much over. Now the waiting game…..

Tonight I will be heading over to a friend’s house for fajita night, with the whole crew that was at the Silent Disco last week. Hope everyone has a great weekend!

On Thursday I spent the morning in the office with our nurses organizing files and rearranging the clinic room. I love getting to spend time with them when we aren’t in clinic with patients because I get to hear about their lives in the villages and it is honestly fascinating. Rose keeps asking me who cooks for me at home. Apparently cereal and peanut butter sandwiches don’t count as cooking so she has decided that when her daughter gets home for break she will send her to come live with me for a few days to teach me the tricks of the trade. I tried explaining that when my mom offers to cook when I’m in Baltimore my dad and I are in the car with our seatbelts fastened within 10 seconds, ready to go virtually anywhere but our own kitchen. Lets just say one Thanksgiving we gave my mom “dessert duty” and she lit the oven on fire…

  Homemade G-nut butter Rose made for me convinced I’m going to starve

Passion fruits picked from Rose’s tree

Rose continued to tell me about a man that has been going around burning grass thatch houses in her village. In Rose’s words “ he had a sugar mama but the village decided it was inappropriate so the woman told him to leave but he refused. She then moved her belongings to different friends houses and the man followed and burned them all.” Unfortunately they do not have the “reliable” justice system we have in the US so if someone denies a crime and they are not caught red handed, there is nothing legally the police can do. I think I’m equally concerned that A. sugar mama is part of the Acholi vocabulary and B. that someone would burn another person’s house for revenge.

On Friday I spent the day working on med school secondary applications (I’m sure you’re sick of me saying that) BUT the good news is I am almost done. I gave myself until August 15, which is this Saturday, and I am confident that I will be able to meet this goal. Most of these applications are not hard, they are just extremely time- consuming, especially since I am much more effective when I write small sections at a time. I can only imagine how great it is going to feel when I get to submit my last one.

On Friday night I went to Absynnia, the Ethiopian restaurant, with a few friends. As much as I hated Ethiopian food when I first arrived, I have to say that it is definitely growing on me. Fun fact: Abyssinia means syphilis in Acholi…..We spent a majority of the dinner talking about the upcoming elections and what it will mean for us come March. I think the good news is that Gulu is so far removed from the capitol that there shouldn’t be too much resistance or rioting. Luckily I have good friends in the Peace Corps so if they are evacuated I will be getting in the car with them.

Traditional Ethiopian food

On Saturday, I spent the day working on some more applications and then relaxed in the sun with a book. I should have never started a new book while working on these applications but “Mountains beyond Mountains” was a suggestion from a friend and I have to say I love it so far. It is about Paul Farmer, an infectious disease doctor, who works in international health, which is obviously right up my alley.

On Saturday night I went to the 31bits house for a much overdue night out. As I have mentioned before, 31bits is a company from the states that empowers local women through jewelry. I am hopefully moving in with them come September when I have to move out of my current house. I love everyone that I have met within the company and it would be great not to have to live alone (fingers crossed).

About 20 of us spent the evening playing Scattergories, which was played by candlelight when the power went out. We then proceeded to have a silent disco, which was hysterical. For a silent disco everyone downloads a prearranged playlist onto their phone and listens to it with headphones, so only you know what part of the song you are at. I can’t dance even when the music is loud so I’m positive I embarrassed myself in one way or another. Not pass out on your grandmother while dancing at your cousins wedding embarrassing…. but pretty close.

Scattergories

Hope everyone had a great weekend!

I honestly didn’t know it was possible for my heart to hurt this bad. On Friday afternoon when Twalib and I left the hospital, Florence, the 8 year old girl with severe RHD, was not doing great but she was stable. On Monday morning when I arrived at the hospital, she was not in the oxygen room where I normally find her. I thought that maybe she had been transferred to the ward because she no longer needed oxygen support. The attending doctor soon informed me that Florence passed away on Saturday morning due to congestive heart failure. I immediately thought “How could this happen?” She was one of the lucky ones who were brought to a hospital with a talented cardiologist. She had a supporting family who cared about her treatment. I realize that there are times when there is nothing that can be done but I hate it; hate that its reality and hate that this preventable disease took the life of an innocent 8 year old child.

Although Florence was all I could really think about on Monday, I continued my day by visiting a bunch of places that offer computer skills classes emphasizing Microsoft Word and Excel. I sometimes forget how lucky I am to know how to use a computer and it’s extremely vital that our project nurses learn these skills. I have made a deal with them that if they go (to a course/teacher I approve of) then I will pay half of their tuition. I think the total is around $30 for 60 hours of training (what a steal) so it will cost me less than $50 to have all 3 of them attend. They are surprisingly extremely excited about the course and I’m even more excited because we will be able to use our time much more efficiently.

On Monday night my roommate Jess finally returned from a trip to Thailand with her friends from college. Her trip sounded absolutely amazing but her trip from the Airport to Gulu- not so amazing. After her driver gipped her out of some money and drove her all around the city running his personal errands before they left, her driver was driving recklessly and flipped the car when she was about an hour outside of Gulu. Luckily no one was hurt in the accident, minus a small cut on her hand, but all of the windows were shattered and the car obviously totaled. Luckily we have some amazing Ugandan friends, one of which jumped into a car the second he heard, to go retrieve her and our friend Tony, who was also in the car. Her whole trip took over 13 hours and sounded like an absolute nightmare. I think its safe to say she enjoyed the glass of wine that was already poured for her when she walked in the door. As nice as it was to have some alone time this weekend to work on my applications, I definitely missed her. It’s so nice to have someone to share your day with or simply have a meal with. I think I would go crazy if I lived alone.

On Tuesday morning my heartache continued when Opio, the little boy with constrictive pericarditis, came into the clinic. He will be leaving for Kampala sometime next week and I am so excited that he has the opportunity to get this surgery. With that being said, it is so hard to witness how much pain he is in. Today we discovered that he had a 2 pleural effusions, which needed to be tapped. He is such a champ dealing with everything he has been through however no 8-year-old child should have to be stuck with a needle like that without any type of numbing medication. He was crying so hard and was in so much pain throughout the procedure that he actually started vomiting. Now my friends will tell you I am not a crier; they sometimes even question if I have emotions at all. This, however, was a lot for me to handle and I actually had to step outside of the room for a minute. I am so hopeful that his suffering will be over within the next month and can’t for the day that he comes to the clinic with a smile on his face, happy that he can go back to school.

Currently deciding on a movie for tonight. Happy Hump Day!