Uganda Love This

Hey everyone-

I promised I would be back! My time home was very refreshing and I’m so happy I was able to be there for my brother’s big day. Still a little confused about the “compassion” award he won, as I don’t think threatening to leave me during carpool or attempting to drown me in the pool when I was younger classifies as that, but nonetheless I couldn’t be more proud (or happy that he didn’t choose OB/GYN).

My trip back to Uganda was a little different this time as it was the first time I wasn’t traveling alone. Alyssa has officially joined our Ugandan team and traveled back with me for her first African experience. Super excited about our adventure, we decided to have a celebratory dinner in the airport and lazily strolled to the line boarding the plane. They then told Alyssa that her ticket had been cancelled and that there was no chance of her getting on the plane….After a long chat with her travel agent and KLM having to call headquarters to “re-open” the flight, we were on our way (and next to each other to boot). Never a dull moment…..and possibly some foreshadowing of how the next few weeks would pan out…

After 24 hours we finally arrived in Uganda (2 hours late since someone mysteriously didn’t get off the plane in Rwanda) but Alyssa’s luggage however, did not. While a bit premature, I’m pretty sure that was the moment I knew she would be okay in Uganda. “The plane is super delayed? Who cares” “My luggage was lost? Can I borrow some shampoo?” You have to learn to go with the flow in Uganda for NOTHING ever goes as planned and right now I can say she is passing with flying colors.

Upon our arrival to Kampala we met up with a large crew from Gulu to celebrate Grace’s birthday before heading to Jinja. Alyssa and I decided to go rafting on the Nile on Friday since most of the group had already gone. While I think almost drowning your new coworker in the Nile might be considered hazing…we had an absolute blast and the group of people in our raft couldn’t have been any more enterntaining. We were both too cheap to buy the extremely overpriced photos but I can paint you a nice picture- Alyssa, me, 2 older men that could barely swim, and our new friends JiWon and Nick, all falling out of the boat with mouthfuls of water….multiple times….We spent the entire day on the water before heading to Nile River Camp to meet up with the 18 person crew that we had from Gulu.

We spent the weekend relaxing at the pool, enjoying each other’s company and eating some great food. About half of the people that came to Jinja left or are leaving this month so it was one final time for us all to be together. I’ve spent the last year with these people, experiencing with them all the good (and bad) that Gulu and Uganda has to offer. I’m very sad to see most of them go but I’m so fortunate for the many amazing memories and friendships I have formed…. and the free places to stay all over the world. I’ve said it over and over again but this experience wouldn’t be the same if it weren’t for the inspiring and supportive volunteer community in Gulu.

After Jinja we headed back to Gulu in what ended up being a 10-hour car ride. We arrived in the dark so Alyssa didn’t get to truly experience all of the beautiful scenes on the way up North. She finally met her puppy Zazu and experienced her first night in the Gulu heat. The next day we headed to the hospital and I couldn’t have been more excited to see my nurses smiling faces. They truly have become family to me over the last year and going to clinic is such a comforting feeling. I was, however, quickly reminded that life here has continued without me and the many lapses in healthcare are still ever present. As I caught up with the nurses they were joking how the hospital cleaning lady was mad that our patients drop crumbs outside our clinic while they eat waiting to be seen. I joked by saying “ah its probably Lakica, she gets more on the ground than she gets in her mouth”. All of sudden Rose just looked at her feet and with tears in her eyes she informed me that Lakica had passed away while I was at home. She had a tet spell on a public bus and was not able to reach help in time. I spent time at home advocating for Lakica’s surgery and genuinely believe that she would have been operated on in the coming year. I’ve strongly advocated for 3 patients while I’ve been in Gulu and wasn’t fast enough to save 2 of the 3. This one hurt, a lot; but serves as a reminder for how we need to keep trying. We’ll get it right.

My first day back in clinic with Twalib and Alyssa’s first day seeing patients was eventful to say the least. The first patient laid on the bed, starting seizing and then began expelling “fluids” from every orifice of his body. He finally made it to the lawn where he began seizing again. We had to carry him to the ward because no other health professionals could be found. Like I said, Alyssa just went with it and had both his arms in her hands. After we had him stabilized we returned to the clinic to attend to the 38 patients that had lined up to see Twalib. As we began the echo of the first patient, our trusty echo machine died on us. Sure it could have broken in May so Andrea or my mom could have brought a new one, or while I was home so I could bring a replacement but nope- the very first day I’m back. We then started using Vscans (handheld echos) but the quality/effectiveness for anyone that is not RHD is not very good. This will unfortunately be our practice until we get a replacement in July.

On Saturday I held the 6^th and final support group (for the research pilot) and was thrilled to see how many of the kids came out for the final one (and how many had come to every single one). I’m still working on the data but for the most part it seems very positive. While I’ve been apart of multiple amazing projects while I’ve been here, this is the first project that has truly been in my hands, allowing me to use some creativity as I designed the plan for each session. I’m so happy that my hard work seems to have paid off for the kids were begging us to continue the groups and I have been able to see a lot of friendships within the group grow. In a country where feelings are considered taboo, I’m glad these children are able to support each other as they face the many challenges associated with a positive diagnosis. We even made them a video of pictures and clips from the support group, which had them all laughing, and smiling (especially at the photos of Twalib dancing). I’m super excited to be able to continue the groups, especially with Alyssa’s help and next time I’ll know I need to bring a first aid kit…but I won’t go into the details of that little misfortune.

On Sunday night, my roommates and I were curled up on the couch catching up on the Bachelorette (yes, it’s possible to stream trashy TV in Uganda) when we started hearing what at first, sounded like fireworks. It was in fact gunfire and it continued for roughly 25 minutes. My house is a mile away from where it started but it felt so much closer. Long story short a “group” (also termed thugs by the local newspaper) wanted to break a “friend” out of prison and showed up to the police station with AK47’s (which they had stolen from the military armory weeks prior) and opened fired. It soon became a running battle in the streets of Gulu before everything was shut down 30 minutes later. While this group wasn’t targeting civilians, I’m not going to sit here and say it wasn’t scary-it was. At the same time it appears that the threat has been managed and I don’t feel any less safe than I did a week ago. There has definitely been more gun violence in the USA in the past year than there has been here in the last 4. This event did however force us all to think about plans if this were to happen again, which is ultimately a good thing. Most organizations were on curfew all week to see how everything played out and Travis, Austin and Arthur spent the night at our house so we could all be together. Alyssa and I ended up leaving for Kampala on Thursday morning and we are planning to be here all week. The good food, hot showers, gym and constant electricity have been really rough on us but somehow we are surviving. I will be taking Alyssa to the ITW sites for the first time this week and I’m very excited to see our teams at Kasambya and Nawanyago. June has flown by!

Hi everyone,

I’m back!! Sorry for the longest delay to date but I promise I have lots of exciting (“exciting”) things to fill you in on-bear with me! I have been back in Uganda for 2 weeks as of today and I promise that I will have a recap for you all very soon. Look forward to a post full of power outages, broken machines and bullets (already told my parents so I feel like that’s okay to say now…). Maybe after you read it you’ll understand why it has been a little hectic here.

My trip with my mom was absolutely amazing and I am so blessed that I was able to share this experience with her. Because she is so amazing she even wrote a recap of our trip together for me so I could remember all of the details. I’m not sure how but we managed to not take a single photo together the entire trip….there’s a first time for everything…..Below is an abridged version of Uganda through my mother’s eyes (don’t worry I cut out the embarrassing stuff). Thank you so much Mom! You being here meant more than you will ever know. 

 

My dearest Amy,

I look at your blog daily and have noticed that it has been awhile since your last post. Now that I have seen you in action in Uganda, it is easy to see why this may not be your first priority. I have never considered myself a “helicopter” parent but I could not resist the temptation to jump in so that everyone would know about my amazing week in Uganda.

I left what you call “the land of good coffee and reliable internet” voluntarily on a Sunday night with my colleague, Andrea. As most readers of the blog already know, Andrea is Amy’s mentor for her RHD projects in Uganda. As a mother I could not have picked a better mentor for my daughter. Andrea is the complete package: smart, energetic, and productive with a great personality and a sense of humor. She also has her priorities right – meaning her family always comes first.

We arrived in Entebbe and were taken to the Case Western House in Kampala where I finally got to see you, my “Emmy”. It had been five months since I last saw you and I think this was the longest I have ever been apart from you but nonetheless you looked great and happy. After a quick dinner of beans and rice, it was bedtime since we had an early morning- we stayed up talking anyway….

Tuesday we woke up early and started the several hours long drive to Kasambya. Like all of our travels that week, we were in a van driven expertly by Picho. For this leg of the journey, there were eight of us in the van plus our luggage and supplies for the clinics- a little tight and definitely your father’s idea of a nightmare….

The purpose of the visit to Kasambya was to see if there were ways to identify more pregnant women with rheumatic heart disease and figure out ways to follow them up after delivery. Rheumatic heart disease is often not well tolerated in pregnancy and often the women will be sicker after delivery than they were pre-pregnancy. Each pregnancy brings more risk and this can be devastating in a country where most women have many pregnancies and birth control is the exception not the rule. It’s hard to believe that the burden of this disease remains so high in the developing world after we have seen it nearly eradicated in the US.

At Kasambya, I was amazed at how easily you related to the people there. You met with the Village Health Team leaders to explain the purpose of the study. You treated everyone with respect and answered their questions thoroughly. I don’t have your way with words and am not sure I can accurately describe the clinic. I have been in a lot of rough and rudimentary places but this is one of the worst I have seen. The outhouses were concrete walls surrounding a hole in the ground mere feet from the clinic where women were in labor and delivering. They had no roofs and were frequented by all sorts of insects that I could not identify and I did not stay long enough to try. Birds that looked somewhat like a stork, appropriate I guess, were everywhere as were many other animals as the children ran around mostly barefoot- reminding me that improved living conditions and clean water is what is most needed in many places. We left the clinic and headed back to our two star hotel where we enjoyed dinner and attempted to sleep admist the birthday party that occurred into the wee hours of the morning.

The next morning we finished up at Kasambya, once again loaded the van, and headed to Jinja. After arriving in Jinja and checking in we had a delightful dinner at the Jinja Sailing Club sitting next to the Nile. For this part of our journey we were joined by Rob from “Gift of Life” an organization that helps fund cardiac surgery teams to operate in many parts of the world that would otherwise not have access to open heart surgery. Along with Rob was Grace who is the head of the program here in Uganda. She is also the first patient that had surgery through the organization …..over 40 years ago. They traveled with us to Lira and Gulu- fortunately they had their own car……..the van was already a little tight.

The next morning we headed to Nawanyago Health Center III to meet with the village health team there and to follow up some suspicious cases. I met Sister Angela and I agree with you that she is the sweetest Kenyan nun that ever lived although I must confess I have not met many. I got many hugs just for being your mother……….a little different than the reaction I got from the preschool or elementary teachers for being your mother……but I digress.

One of the follow up studies that we did in Nawanyago was on a woman who was 20 weeks pregnant with her third child (having lost the first two). She had supposedly had surgery before for restrictive pericarditis- the same kind of surgery that Opio had. Unfortunately, when we looked it was clear that she had restrictive cardiomyopathy, which means that the muscle was affected. The only real treatment even in the US is a heart transplant- definitely not an option in Uganda. To make matters worse she was in an abnormal heart rhythm where the atria flutters making it even more difficult to get blood into the heart so that it can be pumped out. In the US we would have immediately arranged to shock her into a normal rhythm and given medicine to keep it there. Of course in Nawanyago, we had nothing. She had probably lost her first two pregnancies because of this disease and would likely lose this one and eventually her life because of it. The physician there also explained to me that she will likely lose her husband if she is unable to bear children. I have treated many patients that I could not help as a heart transplant physician but I don’t remember ever feeling quite so useless and powerless. I did get a chuckle from the Ugandan physician when I asked if we could cardiovert her…………….might be possible if we had the machine but then we would not have the medicine we needed to keep her in the right rhythm…………..perhaps all of the critics of the American health care system should do some traveling……..I am not saying that we don’t have some issues but I think we are pretty lucky ….anyways…..

Onto Lira Regional Hospital, the final stop before we got to your home away from home, Gulu. Physically, this may have been the most modern structure that we saw on our journey. Unfortunately, behind the walls, the major gaps in care were very apparent. We saw the pediatric ward with beds packed in one next to the other with less than a foot in between. It was enough to break your heart-because of the volume, you are only considered pediatric until you are 5, not 18 years like here in the states. Most of the diseases are infectious and diarrhea and dehydration remain life-threatening illnesses. We met the hospital administrator, Robert, who was doing as much as possible with what he had available to make things better. This was the first place that I saw residents in training but just like in Gulu, the doctors charged with training them often do not have enough time to care for the volume of patients let alone teach a new generation of physicians. Safe to say they have never heard of resident hour restrictions here……

Finally, on to Gulu! The road was paved and therefore our journey was much shorter than the one you first had to make. There were many interesting things to see along the way. A Petrol truck had turned over and some how word spread and people were running and driving bodas in hoards to come steal the Petrol. The police were parked by the side of the road lazily watching…….We were even stopped on the way to be searched for guns………….luckily, I left mine home (just kidding for those that don’t know me, Amy knows I hate guns). When we arrived in Gulu , it rapidly became clear to me that this was indeed your home now. You knew everyone in town and when we toured the hospital, everyone knew you and respected you. The second day here was the most exciting as I watched support group #5 in action. The kids loved dancing around and learning about heart disease from you. I kept myself busy with my favorite activity…….taking pictures and making up for the restraint I hade shown at the other sites. You then gave them a chance to listen to their hearts and you even picked up an innocent venous hum on a sibling of a patient………..I have many residents that cannot do that and I would like to take credit but cannot- these are skills that you have clearly developed without my help! I also met Opio, his father and his uncle. They had brought his report card with them. We could not communicate very well but I could tell they were bursting with pride at what he had accomplished.

I got to stay at the 31 Bits house where you are living and it was one of the highlights of my trip. I was not happy to see that you had a helmet since that could only mean you were taking bodas but at least you were protecting your head. Now that I have been there I understand why they are necessary to get around, but after your bus accident and seeing the driving in Uganda, there are some things that a mother just does not need to know……… Saturday night we had all (or most) of your friends over for pizza. This was definitely the highlight of my trip. In the US, there is a lot of talk about the entitled members of your generation. I would like to invite anyone who thinks that all young people feel entitled to spend some time with your friends in Uganda. They are an amazing group of people. First there are the ladies that work for 31 Bits. They are running a jewelry company that employs Ugandan women, many of which experienced firsthand the events of the LRA. Truly an amazing concept, as is the company being run by your friend Molly that refurbishes bikes to help Ugandans have a mode of transportation. Then there are your friends in the medical specialties, OB and emergency medicine to name two, that are spending significant time there trying to make a difference rather the usual 2-3 months. These are all young people giving their time and themselves to make Gulu, Uganda and the world a better place. It was a magical evening.

Then began the long journey home. Fortunately you were coming with me so that you could attend Paul’s medical school graduation! I am sorry that I left you to go to business class but these old bones don’t do coach very well any more…….

I did not see any elephants this time in Africa but there is still one elephant in the room. You continue to wait for that elusive med school acceptance……no matter what happens, just remember to follow your heart and never give up on your dreams. Dad and I just want you to find what you love doing for that is true success. We will always love you and we feel like the luckiest parents in the world to have you and Paul as our children.

Love you to the moon and back,

Mom