Friday, September 30, 2016

Luganda Diary: September 29, 2016

It's 5:05am, my stomach is growling uncontrollably now that I've been awake for the last 2.5 hours.  I still haven't adjusted to the different time zone. I have been awake every night between for a least an hour or two 2-4am. It's making for longer days due to fatigue. 

As I lay in bed, I hear the pouring rain for the 3rd or 4th time in the last few hours.  It's relaxing and comforting and I wish it would lull me to sleep.  Instead I'm here trying to decide what was the most interesting or intriguing cases or events of the day. 

There was a woman suffering from HIV and TB, severely wasted, constipated and in excruciating pain. I couldn't bear to look at her suffering too long. The thing that made it so heartbreaking was watching her mother loving tend to her throughout her hospital stay. She comforts, bathed, feeds, and keeps her company. The families take care of the patients. There are no nursing assistants or orderlies handling some of the day to day patient care tasks like we're used to in the USA. The families bring in bed linens, food, drinking water, medication and whatever else the patients need. They also bring a sleeping mat and arrange it on the floor beside the patients bed during the day & night to be available if needed. 

There was another woman complaining of jaw/neck pain due to a mass that appeared to be a cyst or abscess right behind and below her ear. The doctor aspirated and got fluid from the mass. The more striking thing about this woman was that she was one month into recovery after her husband came to her parents house and attempted to kill her. He chopped off her left arm below the elbow, her right thumb, and slashed her face in at least 2 different places. We're not quite sure of the backstory as to why he did such a thing but she said the villagers caught him and killed him in retaliation for trying to kill her. Her scars around the amputations and face are healing well but the emotional wounds are still very raw. 

In stark contrast from the patient encounters, we spent some time in the lab learning more about malaria, filariasis, and sickle cell. We had the opportunity to speak to the techs, learn how they prepare the samples and viewed microscope slides containing the various parasites and sickled blood cells. 

Last night we also had our first official Luganda Language Lesson from the ACCESS Librarian, Irene. She is a great teacher. She was so patient with us. We were introduced to the alphabet, phonetically learning to pronounce the sounds, numbers 1-10, and some simple greetings. As I lay here I remember most of the numbers and only a few of the greetings. 

I'm tired yet wide awake. I need to sleep fast because our compound comes alive between 530-6am. So on that note, good night/good morning. 

Until next time...

Luganda Diary: September 26, 2016

After it rained (think that monsoon type rain again) this morning, we went out into the community to a district health center to speak to women about family planning and the benefits they can reap if they consider birth control. There were close to 20 women in attendance ranging in age from 17 to about 35. They all had at least one child, many had 3 or more. 

There are so many misconceptions the Ugandan women have about contraception methods as I mentioned before. Similarly to the other young adults we spoke with over the weekend, they think birth control leads to abdominal pain, cancer and infertility. Most time is spent educating them that that isn't the case. The remaining time is spent trying to encourage them to consider options to space out their children. 

Two women committed to 3 year implants to prevent pregnancy. After those two, they must have given a few other the courage to consider their options. At least 4 other women got 3 or 5 year implants and a few got 3month Depo Provera injections. The doctor & family planning specialist we were with showed us how to do the implants and under supervision Kendal and I completed a few of them! 

In the community, the clinic, and the hospital, everyone encourages us to participate in direct patient care. They look at us strangely when we say we just want to observe but gladly welcome our input and assistance when possible. 

Until next time...

Luganda Diary: September 25, 2016

Sunday morning in the village. We woke, had breakfast and got ourselves ready to attend a local church service. We walked thru the village with Mama Roona, as many of the village kids & adults call Winnie, and another neighbor, Harriet. 

We went via the short cut, thru an area with many houses (and tons of kids), to the main road, and then down a side road. With 2yo Roona in tow, it was about a 20 minute walk. We finally made it to the church where Praise & Worship was already in full swing. Kendal & I were the only visitors present. The parishioners made us feel very welcome as soon as they saw us. They waved, smiled, and shook our hands. Thankfully, the worship leaders & pastor translated most of the service for us from Luganda to English.  

It was youth Sunday, with special focus paid to the children as many are starting a new semester term tomorrow. The kids did a great job ministering: during praise & worship, prayer, & even a short sermon that focused on Love (1 Corinthians 13).  

At one point the Pastor called us up and asked us to introduce ourselves. "Someone", ahem....nominated me to speak for both of us. Letting the congregation know who we were, where we were from, and why we were here in Uganda.  Overall it was really nice being able to experience life as a member of Nakasake Village. 

After church we took a ride to another village (Luwero) in order to tap the ATM and buy a few items that we would need for the week--mostly bottled water & fruit. The drive took about 45 mins along a rutted dirt road. We were finally able to get some cash!! I took out 150,000 Ugandan Shillings! Sounds like a lot but with 3,400 Shillings=$1 US, I only ended up with about $43. Enough to buy a few staple items and hopefully, finally, at last set up my phone so that I'll be able to have more reliable internet. The jury is still out on that. After a registration process that took close to 30 minutes, waiting another 30 minutes for the torrential downpour to slack up a bit, on our way out of the stand, I was told it could take up to 3 days to activate the new SIM card. I'm not holding my breath. We'll see how it goes in a few days. 

The remainder of the evening was spent socializing over dinner & tea with Winnie, organizing my room (now that I'm no longer sharing with Kendal) & was cold tonight! Even more cold than what I started getting used it.  Oh well, it wasn't the end of the world. 

It's now bedtime for me.  Im not quite sure what tomorrow will bring but I'm positive it will be interesting! Until next time...

Luganda Diary: September 24, 2016

It's the weekend in Nakasake! I got to sleep in a little later than during the week which was nice bc this girl loves her sleep :)
We went to meet with some youth from the local villages. We went with the ACCESS Outreach team with the hopes of meeting with a group of young adults to discuss family planning and what types of programs the younger people would like to see offered by ACCESS. We met at one of the local schools and about 10 young adults came to discuss their ideas. 

We learned that many young people are getting into Agri-business here in Uganda: Farming small plots and selling the harvest to help support the family. These young people expressed wanting help getting money to start their businesses and getting to the larger Capital city of Kampala to sell their crops for higher prices than what they can sell for here in Nakasake. 

When it comes to family planning there are so many myths that must be dispelled for many of the males and females to get on board with the idea. Here in Uganda 50% of the population is under 15yo. The goal is to educate young people to better plan their families, increase the time between pregnancies, and hopefully reduce the burden many families face with so many children and not enough resources. 

From what we learned today, there is more work to be done in the community on both determining what the youth oriented program focus should be and dispelling more myths regarding family planning. 

Luganda Diary: September 22, 2016--Part 2

After the super intense storm last night, I was able to get a good 5 hours of sleep. I woke to chickens and roosters and bright sunshine this morning. I felt rested and ready to take on the day. 

Winnie, our surrogate mom/sister and another young lady named Julie prepared breakfast for us. Chapati, sliced bread with butter, watermelon, and tea. As we set off to the hospital, they were already prepping for lunch. 

We went to the hospital with Dr. James, met with the most senior Sister (for a minute I felt like I was back in the UK!), as well as some other doctors and nurses and took a tour. The hospital has a Men's Ward, Women's Ward, Pediatric Ward, Labor & Delivery Ward, an Operating theatre and a trauma receiving area. We spent time with nurses triaging patients as well as the counsellors and doctors during the HIV Clinic that is held on Thursdays.  

There was a constant flow of patients; I'm guessing at least 35 came in while we were there this morning. We had an interactive introduction on HIV in Uganda: The prevalence is high with the most common modes of transmission being thru sexual contact and vertical transmission from mother to baby. We discussed treatment regimes and indications, the stigma associated with having HIV, and what could/should be done to help reduce the spread of the virus. The country is trying to educate the people but it's extremely difficult because no one wants to openly talk about it. It's a very taboo subject. Husbands & wives, partners, family members, & kids often conceal their HIV status from one another for fear of social isolation and the stigma associated with having HIV. 

With so many people infected, the only way I see things changing is by people openly talking about HIV, prevention, treatment and gaining more access to medications. Currently, most patients are started on Antiretroviral (ARV's) drugs once their CD4 T-cell count drops below 500, if they are pregnant, or if they are seriously ill/already immune suppressed. Once patients are started on treatment it continues for life.  All of the drugs are provided free of cost to the patients here. With that being said, the sad reality is that there isn't enough funding to start every newly diagnosed patient on ARV's right away which could potentially increase their life span. The patients that came into the clinic ranged in age from 2-65yrs old. One of the most heartbreaking is one little girl who came in alone with her clinic visit log book & medications, info on drug compliance and any new symptoms she was experiencing.  This is the unfortunate reality for many kids here in Uganda. 

After leaving the HIV clinic we watched a C-Section performed. The operating staff consisted of 2 doctors, Anesthetist, Nurse, a gentleman keeping the room clean, plus the 3 medical students watching. All of the basic instruments needed to operate were present. Notably absent was any electronic monitoring equipment for the patient and baby.  The patient was put under general anesthesia and within 10 minutes a 3.4kg baby boy was delivered. The entire surgery was over in about an hour and we were told the patient would be walking to the antenatal area later this afternoon. Whew! I can't imagine. I don't think many women in the USA could imagine having a C-section and walking themselves from the recovery room to the antenatal section just a couple hours later.  I salute all the mothers that do this each and every day....there are approx 3,000 babies born in Uganda every single day!

Until next time...

Luganda Diary: September 22, 2016

I left home on Monday morning at 4:50am to head to JFK for the long trek to Uganda. We finally reached Nakaseke, Uganda at 6:30pm on Wednesday. A day later than planned after a missed connection in Johannesburg, South Africa.  The delay allowed us to spend the afternoon in South Africa. We went to a Lion & Safari park about an hour away from the airport. Us/We is Kendal and I. Kendal is one of my colleagues from AUC. I think we first met when she was an anatomy TA my first semester. She was ahead of me and we didn't really interact much until finding out we were we both doing a Global Health rotation in Africa at the same time.  We clicked right away. Talking and laughing easily. Taking everything in stride from the very beginning. Agreeing that this was a very wild idea but having no doubts that this would be an awesome experience. We met up at JFK Airport on Monday morning and have been by each other's side since. 

It's 12:49am (Thursday morning), we're sleeping in bunk beds in a room inside a row of 4 rooms within a gated area. This is our housing compound for the next 5 weeks. There's an open air courtyard that holds a large dining table, kitchen sink area, and room to spread out. The toilet and shower rooms are right behind the unit where the family taking care of us stays.  It's a quick few steps thru the courtyard and around the corner. 

We share the compound with Winnie, Ronald & their 2yo daughter Roona(pronounced Rhona).  Ronald works as an administrator with ACCESS.  Winnie cooks for us, looks after us, and makes sure we have the necessities. 

Once we arrived at the ACCESS Uganda campus, we had a brief orientation about the organization we're working with during our stay. What they do. Who they serve. And what our roles would be.  After orientation, our host Winnie, helped us get our bags into our room and served us dinner: fried Irish potato cakes, beef sausages, cabbage/tomato salad and tea. The food was very tasty and by 9pm I was ready to call it a night. I showered, applied lots of bug repellant, & climbed up on my top bunk. I think I was asleep in less than 5 minutes!  

I slept for what felt like all night. At least 6-7hours. Opened my eyes to total darkness and realized I was somewhat tangled in my mosquito net. It's also raining....It's loud against the corrugated metal roof we have....Wait, how could it still be dark after all those hours of sleep? I press the indiglo button on my watch and it reads 12:01am. No way! I just slept for what felt like all night. I must have pressed some buttons by mistake while sleeping and adjusted the time. I look at my cell phone, resting near my pillow to serve as a flashlight and alarm clock. It says 12:01am as well. Ok, so I've only been asleep for just shy of 3 hours?!? And guess what? I've gotta pee!

Its raining. Raining is kind of an understatement; It sounds like a monsoon outside of our room. We both have to use the restroom. It's the darkest I've ever seen. The power is out. The only thing illuminating the outside of our window is the brief lightening flashes every so often. The bathroom is in another building, only a 15 second walk around the corner inside of our housing compound. But the rain outside....It's a torrential downpour that's been going on at least 45minutes. 
We each have a bucket meant for bathing. If the rain doesn't let up soon, it just may have to serve a different purpose tonight....until next time. 

Saturday, September 10, 2016

Where to next?1?

Hello good people!

Its been such a long time since I posted anything. The summer has been SUPER BUSY! I was in New York (Bronx, Queens, then back to the Bronx) since the end of May.  I had Family Medicine and Psych rotations. I was in the thick of my Psych rotation last time we chatted.  

Psych turned out to be a very interesting rotation.  To my surprise, I liked it much more than I initially thought I would. The patients were interesting, the Psych ER kept you on your toes, and there were lots and lots and LOTS of Psychiatry Consult requests.  My fellow Med Students & I were mini experts on "capacity to participate in medical decision making" consults.  We all worked really well together and kept each other from going insane...believe me, there were a few days that we thought that just may happen!

The summer was also spent taking my Step 2 CK & CS Board exams and the ancillary tests associated with them.  Boy am I glad they're over.  I had so many new grey hairs and extra pounds sneak up on me this summer it's unbelievable. But its all good because guess what??? I don't have any more exams during Medical School!!!  I don't know if I've fully grasped that idea myself...NO MORE EXAMS until Residency.....ayyyeeeeeeeee!!!!!!!!!

So, with all that craziness now behind me, I had 2 weeks off to catch my breath, soak up some sun, and attend the most beautiful wedding of one of my Med School Besties in Orlando!!!!!! The last 2 weeks made the hellish summer seem like a distant memory!

Now as I get into the home stretch of school, I can spend the next few months absorbing as much as I can during my rotations without the worry of studying for an end of rotation exam! yay!  That makes things so much better.  Studying will be on my terms based on the pathology I've seen during the day in clinics or on the hospital floors.  I may also have a bot of a social life again. That's actually a really exciting prospect.

Enough celebrating about no more exams...time to be excited about what's next.  As you all know, this has been one gigantically, crazy international adventure for me.  I have taken full advantage of the various international clinical experiences that were available.  So it's only fitting that I keep it up right??? My next rotation will be nothing like anything I've experienced so far...

                               I'M GOING TO UGANDA!!!

Seriously! I'll be doing a 6 week Global Health rotation thru an affiliation program my school has with Western Connecticut School of Medicine.  I can't even begin to express how excited I am!!! Of course there are some butterflies going on because I'll be out of my comfort zone but I have no doubt it will be an amazing experience! 

Many people think of Idi Amin and Warlords when they hear Uganda.  Things have changed quite a bit in the last 15 or more years in Uganda.  Uganda has so much more to offer!

  • Its one of the starting points for the Great Nile River and Lake Victoria
  • Queen Elizabeth National Park allows guests to see Elephants, Lions, Hippos, and Migratory birds up close
  • Kebale National Park is known as the best place in Africa to see Chimps
  • Blind Forest (known as the Impenetrable Forest) is home to half of the worlds Mountain Gorilla population

I'll be in a village called Nakaseke in Central Uganda about 1.5 hours from the Capital City of Kampala. The 2 of us going will be working with a program called ACCESS, the African Community Center for Social Sustainability.

"ACCESS is a community-based organization in Nakaseke district, Uganda, which is dedicated to working with vulnerable groups in resource limited settings through medical care, education and economic empowerment. ACCESS cares for and supports people living with HIV-AIDS together with orphans and other vulnerable children."

We'll be working at the ACCESS Lifecare Center Clinic as well as the Nakaseke Hospital.  

I'm sure this will be an experience I'll not forget anytime soon.  

I leave next weekend but I'll be sure to keep you guys updated as much as I can while in Uganda.   In the meantime, please keep me in your prayers :)

Until Next time...