More Pictures from Mtn. Elgon

 
 
 
 

Here are pictures of Mtn. Elgon while driving up, Mbale Clocktower, Moses (guide) and me, and first porter (unnamed) Moses and his sister.

Down the Mountain and off to Hong Kong

 
 
 
 

Ok well my last blog left off during the night before I began my ascent--it also had quite a bit of spelling/grammmar mistakes which was due to the fact that I typed the entire thing on a Palm Treo. But anyways, I went to bed that night with the idea that I would get up at 7:30 and go get breakfast at the hotel restaurant and eventually get into town at 8:30 when the banks open to get more money. In reality I did get up at 7:30 and had breakfast but the bank part became a bigger problem. The hotel flagged a private taxi down to take me into town for money and then eventually to the ranger station at the beginning of the trail (about 15 miles away). I got into town but once again my cards did not work at the ATM, so I had to resort to Traveler's Cheques. Please note, NEVER BRING TRAVELER'S Cheques to Uganda. I went to Barclay's bank and they said come back in a couple hours because they have not received exchange rates for the day....no go. Then I went to Stanbic bank where most Ugandan's leave there money, or at least the ones in Mbale. The place was packed and it took about 30 minutes just to get someone working on my exchange. To pass the time though a group of British kids, around 16 years old, came in to exchange money. They had just finished the mountain and were now preparing to do some community service stuff. The one boy was peculiar and his most random question was, "What do Americans think of the movie Borat?" or "Do Americans make fun of Canada?" Finally after an hour and a half of "processing" they were finally prepared to exchange the cheques. So I got the money which would pay for the park fees, tent rental, and more driving costs--all of which turned out to be a bit more than expected.

I arrived at the ranger station around noon, which was quite late because they recommend to start hiking in the morning so you do not get hit by the rain plus it can take up to 6 hours to get to the first camp. It also did not help that I tried, unsuccessfully,to get a 25% student discount. Finally at around 1 pm I was ready to start hiking. I was introduced to my guide, Moses, and a porter which I never got his name---apparently he was just my porter to the last village before the park entrance because then I got my actual porter who's name was also Moses. The beginning of the hike was fairly easy, we were still outside the park and we were walking through the small villages. The best part was that because the mountain is spread across Uganda and Kenya the people here primarily speak Swahili (because back in the day kids were used to smuggle items across the mountain from each country and so Kenya's language has stuck). I was pumped and immediately started to use some of my Swahili, though most of it was not coming back to me that quickly. Finally we got to the last village before the boundary line between the park and villages. We stopped to have a break, I bought some passion fruits for the journey and also had a taste of a local brew. Basically imagine a really watered down bad beer with dirt and flour mixed into it and thats a local brew. It is pretty nasty and both my porter and guide gulped it down. Eventually we set back off and my real porter joined us. As expected it started to rain and I became very proud of my gear purchases--my backpack came with a waterpoof cover so nothing would get wet plus I had a waterproof jacket on. So I was dry except for my feet. Even with my new hiking shoes they were no match for the muddy mess that was soon to come. Once you get into the park, on the trail we were hiking, it goes up quickly, very quickly. We were not even over 2000 meters and I was getting tired because I had not eaten since breakfast and we were moving rapidly to make up for leaving late. Then we reached, "Dead Man's Wall."

To Be Continued...

In Mbale

well lucky me my cellphone is connecting to the internet without charging me so I am hopefully going to be able to update all weekend while hiking. So I left nkokonjeru at around 9:30 but we have to wait until the taxi is too full to actually comfortably fit people in it. Leaving at 10:30 I was crushed in the back of the taxi with my 20 pound hiking pack sitting on my legs completely blocking my face--the locals were lauging. after about thirty painful minutes driving the taxi just died and broke down. So I needed to be in Mbale before 5 or earlier so I got nervous. After 20 minutes of waiting I was almost ready to call off my trip that it was just going to be too much. Luckily another taxi came and I got to put my bag in the trunk and we headed off to mukono. while riding I made a decision that riding taxis the entire way-i would need to switch to another in jinja on the way- so I decided to go to the bank and get some money and hire a private car. it cost me around 90 dollars instead of 30 but it was going to be the only way to make it the weekend work so I bit the bullet. but I soon realized it was worth the cost, the ride was going to be around 2-3 and I got a nice big back seat and a trunk for my bag.

After two and a half hours we got to mbale and went to the park office. talking to the ranger I realized the lodge I was going to stay at was another hour away and it was a lot farther from the peak than leaving from here. coupled with the fact that I would need more money and mbale was the only place to get money I asked the ranger to get me a hotel in mbale so I can hike from here plus I didn't want to pay the driver to drive anymore. so we headed out to the hotel and stopped at the supermarket to get food supplies for camping. so my hotel is nothing like the lodge I was going to go to--the other was set right next to a 200 meter waterfall. but it has tv,electricity, and my own bathroom with hot water so almost as good. so now just hanging out tonight at the hotel and will leave early in morning.

Out of Water

Well this week has been pretty quiet. Did a few hernia surgeries and one bitubiligation but apparently the person in charge of preparing for the annual water pump repair did not actually do any preparation. So the main water pump that pumps water from a nearby stream to the hospital is off and the main tanks are dry. So that leaves just the rain collection tanks which is not nearly enough to meet the needs of the hospital. So all surgeries have been postponed till Monday---there was going to be a hysterectomy today...oh well. Been working on med school applications and have already finished one and have made head way on some others.

Planning to leave tomorrow and travel to Mbale to hike up Mt. Elgon. Got a reservation at this cool lodge right next to a waterfall on the mountain. I have my own banda or grass hut but I think I might just camp since I am renting a tent for the mountain and it is a lot cheaper. Food is included for Friday night and then saturday I am hiking up with a armed guard (not really for my protection but to investigate for poachers), porter/chef. Should actually not be very expensive since I have set it up on my own---the travel agency wanted to charge me $1400, which $900 of that was for my own private car that waited around while I hiked, ridiculous!

The hike will have to be fairly brisk because it usually takes 4-6 days but I want to do it in 3 so I can be back down the mountain on Monday and stay for the night and come back to Nkokonjeru on Tuesday. Then I fly out on Wednesday to Hong Kong at around 3 pm from Entebbe so we will leave Nkokonjeru early on Wednesday.

With the water out and not much going on I could not pass up an opportunity to see more of Uganda on my last weekend. Should be fun and the mountain is over 16,000 feet high, it is actually an extinct volcano but the slopes are not very steep so it is not a technical hike at all. But I am looking forward to the altitude training.

Well it rained tonight and there was a big lightning show. Been awhile since I have seen rain or lightning like this (LA is burning up this year) so I put on my jacket and just walked up the road a bit and watched. It was really beautiful. Made me think about this book I just read on African Elephants. The author travels all around Africa learning about elephants but along the way he struggles with the idea of a developing Africa. In the west we see development as life expectancy or the country's GDP but Africa is struggling to figure out its development. I mean when it comes down to it is the materialism and advancements of the west really a better life than life in a poor country? Each side will argue its own way but I feel it comes down to happiness. Pretty much everyone I have met here, mostly poor, are happy with their lives but sadly my presence and those before me have shown the west to these people. There lives have become torn between the luxuries of the west and their own cultures. So this is how Africa grows, pushing to move forward in western terms but being pulled back and trying not to lose the beautiful cultures and landscapes that make Africa, Africa. I wrestled with the idea but just found myself standing still with the rain pouring down and watching the sky light up the land.

Fixed past blog

 
 
 
 

I realized that the old blog for more photos from last weekend was not working so here it is again:

Here are some more photos from the wedding and then driving in town. The truck in front of us is carrying what looks to be green bananas--which they are but much different from US style bananas. They are called matoke and it is the food of choice here. Basically it is a bland, not sweet banana, that everyone eats and it has little caloric value. Not sure why they love it so much but if it is not served at a meal then it is considered a crime (well not really but thats how they will treat you if you don't serve it). I don't mind it but it really is nothing special.

Ugandan Runners

Well I just finished a run from the hospital. Not sure how far it was--probably something around 2-3 miles away and then the same return leg. I had run a few times before but this one I got my first taste of Ugandan runners. I left when school was letting out so everyone is going home from jobs or school so there are tons of people and kids. Well when the mzungu comes running, I have learned it is fun to run with him or show how much faster you are..... actually I outlasted all the runners which at times I would look behind me and see around a pack of 15! But it was not because I am in great shape but rather they had arrived at their destination or got bored because I was so slow.

Oh yeah and the kids I am talking about are probably between the ages of 6-12....embarrassing. But it was a great motivation. There was one older kid maybe a little older than 12 actually that stayed with me nearly the whole time even when I turned around---he was never breathing very heavy at all and smiling or I think possibly laughing at how hard I was working.....hahah

Well it was extremely fun though and I did congratulate my friend on his running skills.

Back at the hospital and did some rounds today and some ultrasounds yesterday, no surgeries though. I tried to setup to go chimpanzee tracking or even better habituation this weekend (you work with the chimps all day long with the warden and researchers to get them acclimated to humans!) but neither was available, so I am trying to go climb Mt. Elgon---will see what the costs are and if I can fit it. They say it takes 4-6 days to hike the trail but I told the tour guide I am in shape and will make sure to do it in 4 or less....so you can see why I am running today.


Hopefully so more exciting surgeries will come later in the week...all the patients now are pretty much malaria, pregnancies, and burns or complications associated with those.

And an update on my toe from the Nile, well did a bit more than stubbed it, I bruised it underneath the nail so it swelled a lot yesterday and now the nail looks like it might come off....uggh. It really is not bad though...I am running on the foot....but the doc has me on some antibiotics just in case so it does not get infected. So not as tough as Dave's, the Navy Seal (still has not emailed any pictures) injury but I can say that the Nile roughed me up....or better yet I should make up a story about a Nile crocodile trying to bite me but I wrestled it down and all it got was just a nip at the toe.....

Monkeys

 
 
 
 


Some Monkeys that were nearby Nkokonjeru village. There was a bunch but they were vary hard to photograph because they were constantly moving but I got a few good ones.

Photos from the Weekend

 
 
 
 

Here are some photos from the weekend. The first is a truck that looked like it would tip over--apparently in the early morning and during the night these trucks will illegally load too much on them because the cops are not out. I thought it was funny. The others are from the wedding for Dr. Kabuye's cousin---much different than the other wedding. Both families were quite wealthy (Ugandan standards) so the wedding was very elaborate. The other photo is getting ready to raft, waiting on Dave, the Navy Seal guy to send me photos...lets hope he does.

Will post some more photos of various things, like the monkeys me and Dr. Kabuye ran into while driving.

Sorry for no updates

Sorry for not updating but the internet at the hospital was not allowing me to logon to the Blog, I am at an internet cafe outside of Kampala. Have to be brief but I hope to update more when I am at the hospital---will have to try in the middle of the night when the internet is the fastest.

But it has been a great week, more surgeries (including one that I needed to sit down from because I got light headed, did not drink much water the whole day...but I am fine)also I spent time in the laboratory looking at malaria and TB slides and performing the staining. I can now identify both with no problem. Other than that the week was pretty light, but this weekend has been a blast.

Late friday, Dr. Kabuye tells me he is going to a wedding for his cousin in Jinja on saturday and I should come so I can see the town. Well in Jinja the Nile River begins and there is apparently great white water rafting, plus it is not that expensive. So a quick 10 mintutes later and I am booked for a all day rafting event on saturday and then will meet Dr. Kabuye at the wedding reception.

So to sum it up, I met tons of people---even a USC grad who knew Dannny Friedman. Medical students, bizzare Ex Navy Seals who could not really tell me what they do. Plus we were rafting for about 7 hours through Class 5 rapids--the toughest are Class 6 and we can't do those. We flipped a couple time and I stubbed my finger and toe but it was awesome---one of the Navy seals ironically got pretty messed up, we went down a tougher area than we were supposed to and he got thrown and bang a bunch of rocks, but he had scars from being shot in well who knows where so he was not bothered at all. If it would have been someone else might have been a lot worse, or just more complaining.

Then went to the wedding and met Dr. Kabuye's family. And now I am just hanging out today and heading back to the hospital tomorrow. Going to try and set something else up next weekend too.

One of the Navy Seal dudes, will email photos he took from rafting so hopefully he remembers and I will post them

Update again hopefully soon.

Pictures From the Wedding

 
 
 
 

Here are some photos from the wedding. The first is a picture of Masaka, the town it was located in. The church was pretty much one of those pre fab metal wharehouse structures and it was all dirt floor. But they had a carpet laid down for the procession and some decorations up. Apparently this was an extravagent wedding. The blog only lets me upload 4 photos at a time so have to upload them in batches of 4--I will put another 4 up after this.

Been back at the hospital for the last couple days, not much has been going on because our power has been out. Umeme the power company--which has a monopoly on Uganda--decided after 1.5 years to finally install a bigger transformer at the hopsital so that we could use the new x-ray machine. Everyone is very excited but as usual they work not very hard, but I think today it should be done. Now we just need to hook up the x-ray machine and calibrate it.

On Monday I came home from Kampala pretty late. Christina (I have to apologize I just realized I was writing Katrina not Christina in my last couple posts, not sure how that happnened but I have been calling her the right name in person...) and Teresa ran late with their dental appointments and then they wanted to go get cheesecake from this new cafe that is run by a New Yorker--I think I mentioned before we ate there also that morning for breakfast to eat the bagels. But they wanted more so we went there and had some late lunch. While we were there a father and his two boys, 6th and 8th, graders, form Illinois came into eat some of the only New York pizza in Uganda. We chatted with them and found out he and his wife run a NGO that gives money to families but also works with them to teach them over 3 years how to manage and earn money. Whats remarkable is that they started in Riwanda but got kicked out a year ago. Well if you have ever seen Hotel Riwanda, the guy that the movie is based upon, lives in the US and helped to raise money at a charity drive for this NGO in Chicago. Well the Riwandan government found out and apparently he is seen as a mortal enemy to the government. Because he is a Hutu (i thinkt that is spelled right) and the entire government is Tutsi---mind you this is 14 or so years after the genocide that occurred in the early 90s that the movie portrays. Well the Riwanda government contacted this the NGO and interogated the American man we met and his workers to see if they were supporting the Hutus--there lives were threatened too because as luck would have it the only Riwandans working at his organization happened to be Hutus too so this fueled the fire. The entire group was expelled from the country and as of now 3 of the Riwandans that worked there have been found dead. The Riwanda based manager is also hiding in Uganda and they are trying to get him into the US.

Pretty nuts! But the family and the group keep working and now are doing the same thing in Uganda. The two kids were also fun, they acted just like any other pre/teenager boys. One was even trying to teach me magic tricks so I could amuse the Ugandan kids---he was actually very good.

So after that we were in a rush to get over to the taxi park and make the 6 p.m. taxi back to Nkokonjeru. Christina and Teresa were very worried we were going to get stuck and were flipping out. I was not really worried because I knew the doctor would come pick us up but they were starting to remind me of times during our family trips when everyone just goes crazy...haha I just tried to keep up. We stopped at a grocery store right next to the taxi park and I picked up strawberry jelly, honey, peanut butter, juice, and spaghetti sauce---I was in heaven. And yes we made the taxi with time to spare and there even was another after that---but that did not stop the two women from complaining about how bad things were...arrghh.

The ride back was nice and it was really fast, I think the driver wanted to get to bed or something because I have never seen anyone go so fast over these crappy roads but I thought it was fun.

We got back and I showed the doctor my new goodies, he had never heard of a bagel (I bought a few to go) but I have soon found out that he really enjoys strawberry jelly and honey---sweets are hard to come by usually. So at this rate I will have to pick some more up this weekend.

Yesterday was not filled with much, saw some patients but power was out most of the time so did not accomplish much. Today is looking like might be the same with power out this morning and might go out in a bit too. Will see.

Well I have less than two weeks left here and it is really flying by, I am enjoying myself but as the days go by I am getting more excited to go to Asia.

Will put more pictures up.

Kampala Weekend

Well I am still in Kampala...hanging out at an internet cafe until Teresa and Katrina get back from there Peace Corps dentist appointments. It has been a crazy weekend but a lot of fun. On saturday we went to the Fase 2 restaurant--I mispelled it before and it was nice to eat some good food--Indian chicken dish and rice plus apple pie for dessert..yum. We were there for a while it was an outdoor restaurant with a waterfall and resort type feel, the stars were out and it was pretty beautiful night. Katrina had her boyfriend type guy come meet her, his name is James and he is a Ugandan from western Uganda. They had not seen each other in months and I don't think they were ever very serious but he was nice, but very quiet. Apparently he was really stressed from work, he works for two non profit groups with orphans and unlike most Ugandans he really works very hard and I guess it is killing him--plus he pays for his two younge brothers education with this money--we were all pretty impressed. After dinner we were thinking of going out to possibly the casino or a club but Katrina and Teresa were very tired and the other peace corp members were not staying the night. I would not have mind to go out for a bit to see more of the town but I drank two Nile Specials at dinner and they are quite strong compared to American beer--7 or 8 %--so I was pretty tired myself. So we slowly meandered back to the hotel and just went to bed.

Yesterday we had to get up early and get something to eat before heading to the taxi park to find transportation to Masaka for the wedding. Nothing was open on a sunday morning other than gas stations so breakfast was quite light. We rode on a bus instead of a taxi--more comfortable but a bit more expensive. The ride was very enjoyable and I slept for a bit and just enjoyed the countryside landscape. Then we got to the wedding which had not started but the sunday service was going on which preceded the wedding. We were the only other white people there and we got special treatment, we stayed with the bride's family in the front of the church--I have lots of pictures I will upload tomorrrow. But the service took forever and it was mostly in Luganda so I did not understand anything. But they love to sing and dance and greet each other--I got swarmed by young children wanting to shake my hand. Then the wedding service started and it took forever. Each member of the wedding party processes in very very very slowly dancing to the music playing. Then the pastor says some blessings and they exchange vows and say some other stuff I did not understand. A strange tradition is that a younger brother is the last person that formally gives her sister away to the husband. This little guy went up and made some jokes about marriage and then literally handed his sister to the man (their names were James and Judith). Then they sing and dance a lot more. At this point the entire thing was nearing 4 hours and we all were starving. So we decided we would not go to the reception because it would mean getting back to Kampala very late. So we ducked out, saying thanks to the families. But before we could leave they demanded we get in for their family photos--once again because we are white and I guess that impresses people. So somewhere in Masaka James and Judith will live through their marriage with a photo from the ceremony with a strange white guy from California standing there---hahah I really want to get a copy and so does Teresa and Katrina.

So then we headed back to Kampala, but before we got on the bus we wanted something to eat and the bus driver--apparently lived in Colorado for some time agreed to find a place for food for us before we left and would wait. We were relieved but the small house that served the food was not very clean at all and the food was cold which is a big problem. We were pretty scared to eat the food and just picked a bit at it then got on the bus. The ride was going great and this one was a greyhound bus and actually cost a lot less. But we soon realized why it cost so cheap--they pack tons of people on the bus. We were crammed in the back shoulder to shoulder and I was sweating profusely but I think everyone was. I fell asleep but woke up and realized we had hit another car and the road was backed up for miles. It was miserable but worst was Teresa got sick and threw up on a plastic bag--it was probably not from the food though she had been feeling bad days before plus I would be the first to go if something was not cooked right. So she switched with a man at the window and just kept her head stuck out the window holding her bag of vomit. At this point the entire bus was restless but there was nothing to do except suck it up and wait until we arrived. Finally after another 4 hours we got to Kampala.

All we wanted to do was go shower and Teresa wanted to go to bed. So after showering me and Katrina went out for food. There is a Nando's chicken here and I wanted to go. It was not very good but they sell the sauce so I want to get some before I leave. But we chatted and I found out she used to row for 1 year at UCSB and I did know she lived in LA for sometime but now she lives in San Francisco. So we talk a lot about LA and then a Harley biker gang came by making tons of noise. Apparently the only one in Uganda. But she used to have a boyfriend who had a motor cycle so she was jealous and wanted to be back in Malibu riding a bike down the winding stretches of PCH. What a small world! I have trouble finding people in the US who know what rowing is let alone find one in Uganda.

So we then went back and went to bed. Now today I am hanging out at Garden City while they go to their dentist appointments. A new cafe opened yesterday called I love NYC. It has authentic NYC bagels, cream cheese, cheesecake, and other NYC food. Had it for breakfast and yes it was just like the US. The lady who runs it is from NYC and spent 6 months figuring out the recipe since we are at a high altitude and the change in yeast, flour, and water. But it was good. Teresa and Katrina enjoyed it more--they have been without something like a bagel for 17 months. So I can only imagine, it has been almost 3 weeks for me, that is nothing. Though it still was very satisfying because once back at the hospital it will be rice, potatoes, and matoke (a banana type food that is not sweet like a banana but bland and has not nutritional benefit but it is the most popular food in Uganda)

So when I get back to the hospital I will upload pictures.

Update on my health from last weekend

Oh yeah, sorry for not updating it but I did feel really sick last weekend and eventually broke out the Cippro. I was very nervous because I had gotten a fever so my first thought was malaria. This scared me pretty bad but the Cippro made me feel very good real quick and I did not have any other fevers---a good sign of malaria so the doc says it was just probably from something I ate---which by the way I cooked two of my own meals that weekend because I was alone at the hospital. So pretty sure it was my cooking, which was not very tasty to begin with.

I am fine now and feeling great...and have asked for help with cooking from Teresa.

In Kampala for the Weekend

Hey everyone, I am in Kampala for the weekend and at an internet cafe so I will have to be brief. On Thursday, I did not do much because the doctor said he was taking a lighter day so eventually I went running and well...missed pretty much all the excitement. To Dr. Kabuye's dismay several patients came in needing help so he operated several surgeries and I missed them. Finally after dinner another lady came in at around midnight so though I was tired I was happy to go and help. She needed a c section and I went and assisted. The patient was very unusual because this was her fourth baby and all the others were miscarriages so we were performing a c section (which all her others had been) to guarantee the baby would not die...hopefully. Well when we removed the baby we noticed something very strange--she had two uteri. The doctor claimed it was bicornuate uterus, meaning a uterus with two horns. It is very rare and as I pointed out was probably the cause of the miscarriages (the baby did live too so everything worked out). The next day I researched bicornuate uterus on the internet and it turns out that it does cause an elevated risk of miscarriage and pre-term babies--which these were by a few weeks. So I was pretty pumped that my theory turned out to be correct. The rest of the day was the off day that the doctor was hoping for the day before so I continued with my medical school applications.

On an even more positive note I got word from my dad that my sister, Abigail had dropped more time in the 200 butterfly, her best event, to put her about 5 seconds under the olympic trial cut and probably around the top 10 or so in the country!!! I am so blessed to have such a great family and I wish her continued success.

So now I am in Kampala for the weekend, I left with Teresa in the morning to go see the Harry Potter movie, which we just watched (it was good but I am ambivilent over the series). We stopped at the casino in Garden City which is where all the white people are, there are more here than I have seen since leaving the US. We played a few rounds of blackjack just to say we did it and I came out even not wanting to lose anything. I met a lot of other Peace Corp members, they all hang out at Garden City on the weekend and we are all going to hang out tonight. Before that we are going to a restaurant called Phase 2---apparrently it is really good, but slightly pricy.

Will update again on Monday when I am back in Nkokonjeru, going to a wedding tomorrow so that should be interesting.

New Surgeries

So finally I got to see some different surgeries beyond c sections--though these were nothing major. There was a long list of things to do yesterday so the doc had all the nurses setup the surgeries back to back---we would do one in the first surgical theater then immediately proceed to the second theater and start then next one.

Our first was an evacuation of a incomplete abortion. Women go to local doctors to get abortions and they usually just end up with more problems. These so called doctors perform the abortion in the most crude manner and use herbs to treat---sometimes Dr. Kabuye says you will find twigs in there uterus still (which also means the uterus is probably perforated). So we just had to go and suck out remaining membrane material that will make the uterus continue to bleed. It is very easy, you just scrape the uterus walls with a suction device until it feels rough. This means that the membrane is gone and you are down to the uterus wall. We did not find any twigs but the uterus was perforated.

So it was nice to do something else, except I still find myself acting as an OB/GYN and a new area would be nice...

Well I got what I asked for but it did not take much. The next two patients had large swellings of puss---one on their face and the other on his hip (the man had severe HIV and actually had many swellings but he was too fragile to do them all). The procedure is simple, just put the lady/man on anesthetic then cut open the area and drain. Simple and well just nasty. Both of the patients had a lot of puss and it just is pretty disgusting. But I did get to cut with a scalpel, so that was exciting but it fades once the puss starts flowing...

Then we finished up with another incomplete abortion. Same procedure, very simple. Once again no twigs but another uterus perforation.

The last operation was to remove a piece of a twig from a young girl's leg (pretty ironic). This one was even more simple with just a local anesthetic and then cut open and remove--turned out there was just a few strands in the wound and it was just mostly infected.

So yesterday was fun because while the surgeries were simple it felt like a US hospital, running back and forth. Well actually the nurses and the Dr. liked to go a little slower and I found myself moving the heart monitor and tools and such back and forth between the surgical theaters.

Well today was not so busy so will mention it too.

We did another c-section today and I was the only assistant. If you notice in the pictures from before, I am standing next to a younger Ugandan woman in scrubs---her name is May and she is a Ugandan medical student so we usually both assist. So I was happy she was busy because now I was the only one. So with greater ease I helped with another c section. Nothing really too interesting other than this lady bled a lot and so it was pretty messy. However, it just made for a more Gray's Anatomy moment (No I don't watch the show). When I was helping suture up, Dr. Kabuye offered for me to do it by myself but I declined. Not sure why, I should have but she was bleeding a lot and I just wanted to finish quickly. But I will not make that mistake again...

Then a school girl, around 15 came in with a septic foot. She had fallen about 2 months ago and cut her foot but it had gotten much worse. I have a photo but its on Dr. Kabuye's camera so will try to upload it. Basically, we think some flesh eating bacteria got into the wound and just started going at it. Pretty much the entire top of her foot was necrotic tissue. So we had to anesthetize her and just cut off all the dead infected tissue and then let it heal some--in about 14 days she will get a skin graft. So I did not do much other than chat with the young girl, she was pretty nervous and spoke English. So I found out she wants to be a neurosurgeon, yeah thats right...a neurosurgeon. But apparently she still needs to get over the fear of needles....

Back again soon, going to Kampala this weekend to see Harry Potter with the Peace Corp (there is one movie theater and it is in an area called Garden City where all the mizungus or white people hang out), not my idea on the movie though. Teresa invited me so it lets me get away and see more of the city. Plus I think I might tag along on Sunday too. She is going to a local wedding for a person that works with one of her other peace corp friends. Not sure what it is like but hopefully some tribal dancing?

Tip: Don't take herbal remedies for labor

 
 
 
 

Ok so yesterday was a pretty big day. Dr. Kabuye was coming back to the hospital from his weekend retreat back home to Kampala. I did not do much in the morning, other than begin my obssession with The Office, which Teresa happens to have practically the entire 1,2,and 3rd seasons. Finally after lunch, at around 2 the doctor arrived and we were to begin in the labor ward. There were three patients there and all of them were bad cases. The first lady, which we delivered as c section last week--the one where I helped give oxygen to the baby--had developed a very bad infection. We analyzed her and I learned the types of shock (loss of fluids, neurogenic, and septic--however there is even a more rare one associated with the heart which I read later). It was sad because this infection was post operative and most likely caused by the beds the patients lay in. These beds do not get new linen for each patient and blood or fluids has soaked into them. Basically it is a petri dish for all infections and patients just have to lay on them because that is all there is--next financial year they are hoping to upgrade the beds or at least seal them with plastic.

We then moved on to the two surgeries we had to complete. They were both c sections. In these surgeries I was going to scrub in and help as the surgical assistant. I was pretty pumped and not really nervous because I had seen several c sections by now. The lady had seen a local herbal doctor and she was given an herb that mimicked oxytocin and thereby inducing labor. But to have a proper labor the cervix must dilate to 10cm or more. This lady was at 2 cm but she had contractions as if her cervix was 10 cm. This causes fetal distress because the baby is now constantly being pushed on by the uterus but it is going nowhere. So a c section is required as soon as possible. So we started the surgery and I did not do much: I helped with towels to soak up blood inside and out or the abdominal cavity, I also helped with suturing and giving Dr. Kabuye the right tools. When we removed the baby it was not very good. The first sign is the amniotic fluid is now filled with excrement from the baby because it expels when distressed. Then the baby was puled out and it was very blue. The nurses took it and put it on oxygen but its heart rate was at 198 (should be 130-140) and it O2 concentration was 50 (needs to be around 100). So as the nurses monitored the baby I helped suture up the uterus and abdomen. The baby did improve with its heart rate dropping and the O2 stabilizing around 95. So once again hopefully there is no permanent damage.

Then we quickly moved onto the next c section. I was once again scrubbing in and helping. This lady had refused surgery earlier even though once again she had taken herbal medicine to induce labor--also compounded with vaginal warts which were too numerous to allow the baby to squeeze out. But we had to comply and she now had agreed to let us operate---at this point her membrane had ruptured in the uterus and the baby was severely distressed--or so it was told by the nurses. I performed most of the same functions though with much greater speed and efficiency--I knew the tools names and could follow the suturing very easily. But this operation would turn out to be very bad. When we cut the uterus and Dr. Kabuye went to pull the baby out--it was feet first but then he noticed immediately it was twins. I was excited because I had never seen this. But as he pulled the first one out, things were very wrong. Both babies were dead.

The babies were easily recognizable for being dead because the skin had started to fall off--Dr. Kabuye had said that the babies probably died around 4 days prior. He was very frustrated because in a developed country he could be sued possibly. The babies were preterm (which you would not perform a c section for) and also the nurses had not checked for a fetal heart very well--because if we knew they were dead we would have just gone with a regular delivery because the vaginal warts could have caused problems but it would not have mattered.

It was sad to see these human babies just dead and thrown in a bucket with the placenta but this lady just had too many problems. Apparently malaria might have had a hand in the deaths, plus she had vaginal warts, and used the herbs. But we sutured her up and finished for the night.

So it was kind of up and down. I was happy to have helped and really learned a lot more. But two babies were dead and one had lost several precious minutes without oxygen which might have caused brain damage.

So the tip of the day is don't take herbal remedies for labor.

Also, when we looked at the first patient with a lot of infection Dr. Kabuye decided not to work on her because she was just too fragile and he left me with a very good quote:

"The best surgeon is the surgeon that knows when not to operate."

I have more stories from today but will post them tomorrow, gotta keep a steady stream and not divulge them all at once.

Oh yeah these are photos from the second c section with the two dead babies.

PS. also thanks for listing comments, I do read them and appreciate them. Trout, I can't wait for the Orient.

Well my first full week is finished and it has been great. Have been at the hospital the entire week and for the most part I have been just observing patients with Dr. Kabuye. There has been several very fascinating things that have gone on. The first is I have been able to watch two C sections. Both were emergency lower c sections. The first one, the lady had obstructed labor and needed the baby removed. It had not been too long so the baby was not distressed. The entire surgery takes about 20 min for Dr. Kabuye and it is fairly simple--I have all the steps written and memorized. It was the first time I had ever seen a baby take its first breath and I was speechless for a few seconds. Then this thursday we ran into another problem. Dr. Kabuye and myself checked on a younger woman who was having her first baby at around noon. She was only 8cm dialated and needed to be 10cm. So the doc said we would give her another 2 hours to dialate but since it was her first her knew it might take longer so 4 hours was the max. Well the day continued and the doctor did not go check on her again but rather was waiting for a nurse to tell him that it was time. The nurse showed up at around 10 pm and I guess it was both the doctor, myself, and nurses fault for not being on top of things. We rushed in to now remove the baby because it was obstructed and at this point it had fetal distress. The young lady was put on anesthestia--by way of ether, the doc said he would pay me money if I found another ether machine in the states! The surgery went fine until the baby was removed, the young girl was entirely blue and did not start crying after removal--a very good sign that the baby was not healthy. The nurses took the baby and the doc was ordering to put her on oxygen and beat on the chest and warm her. The entire time I am just watching and not feeeling very confident the baby will make it. An O2 conc. machine was put on the baby at it was registering at 87---it needed to be around 100, and it even dropped to the lower 80s. The baby was still blue, though the face was improving. I continued to watch but became very frustrated because the nurses, I felt did not understand the severity of the situation and werre fumbling around with the oxygen and not really administering it. I could not continue to sit idly and I rushed in and grabbed the oxygen machine and a face mask and immmediately made sure the baby's airway was open--it was not and I ordered for a tounge depressant, but at this time was using my fingers to keep her mouth open. I stayed there for the next 15 min as slowly the O2 went to 91/92 but it was still not doing enough, because the extremities were still blue. However it was breathing fine and the oxygen was attached so I left the baby to the nurses and the surgery finished up. (Since then the baby has been fine, and we think it does not have any permanent damage.) I was fairly proud of myself, but also nervous that I overstep my boundaries and should have just watched, but no one said anything and the doctor seemed to be impressed---but I still felt bad that the nurses here are in such short supply that they just have not had the proper training. But all seemed fine and I headed to bed.

On Friday, Dr. Kabuye, a nurse, and me were going to take the hospital truck to go do spot checks of the health centers for the district--this hopsital is the head of all these smaller clinics. I was very excited because we were going to Lake Victoria and I would be able to ride in a truck offroad.... We went out at around 10 and we were not back until around 4/5. We saw three health clinics. Two were next to the lake and another was closer to our hospital. The two by the lake were functioning ok. They obviously did not have enough workers or supplies but that is just the way it is. However, they were doing the best with what they had. The problems were they were not keeping good records, and they were not testing for HIV and TB enough. If a patient comes in with either symptoms both should be tested because they come hand in hand. However, the tests for HIV were always more frequent. The last, closer, was actually a full hospital. It was brand new and was funded by the Czech government. It was amazing to see a hospital in this good of shape. There were several czech workers there too so it was strange to see a lot of white people too. The hospital was doing everything right, actually it was doing things too good. It was being run like an American hospital but since it is still heavily funded that is not a problem (basically they had specialists for different surgeries) This is great but the Czech government will not fund it forever and at that point they will not be able to afford so many doctors and nurses. Dr. Kabuye tried to explain to them that they need to get used to stretching there resources and the Ugandan doctors needed to be doing c sections and other surgeries instead of a gynecologist. But if the new equipment just donated to the Nkokonjeru hospital was at this hospital it would resemble an American facility so it was reassuring that money and help is coming in.

We came back to the hospital and did not do much after that, Dr. Kabuye was going to go home to Kampala and I decided to stay because there is more I can do here with electricity and water. Plus he was going to a family function on saturday. So Teresa and Katrina, the peace corps members, would be staying I was planning on hanging out with them, there would also be about two other hospital administrators staying too.

So saturday came and I really did not do much, read books, worked on some of my seconday medical school applications. Until the evening. I was haning out with John, the accountant for the hospital, watching TV--which sadly I might have ruined his love for the WWF, it came on and I said it was fake and did not know that he loved it and thought it was real...oops. Then a nurse came rushing in saying a man was very badly cut and could I stitch him up. Well....the answer was no I probably could not but if it meant leaving him to bleed to death or for me to at least help, I decided to at least check out the man. I put on my doctors robe and rushed over---this was probably the best part because I did get to feel like a real doctor. However, once I arrived my glimmer of hope that I might be able to help the man faded...actually it was destroyed. The man had been macheted in the forest by a man who was attempting to steal his timber (I learned this today). From his upper lip to his chin was split open and his front jaw was also cracked. To make matters worse he also had a deep cut on top of his head which was squirting blood. Now I was very nervous. I tried to stay calm and thought about the situation, mean while ordering for his blood pressure checked--which turned out to be fine, as did his pulse. I told John that I really could not help his jaw but probably could stitch the mouth, though they would have to take it apart to fix his jaw later. I ordered for the nurses to clean and bandage him and to apply pressure to his head to slow bleeding. I then decided to try and get a hold of Dr. Kabuye, which at first failed. This made me even more nervous because I did not want to do nothing but I also feared doing something wrong. I tried also to get a hold of Poppy or my parents but this also failed. Luckily though the doctors phone went through and I did talk to him. He said that I did not need to do anything, just put him on antibiotics and fluids--the srugical nurse could stitch his mouth, but nothing could be done about his jaw. They would also stitch his head. So everything seemed fine but I was severly shaken. I felt that I was inadequate and that it was embarrassing to not be able to do anything. But I finally talk to my parents and calmed myself down, in another situation I think I would have done the same thing, I made sure the man was stable, I called a superior, and offered as much help as I knew would not harm. So I headed to bed, once I knew the nurses were taking care of him but it was hard to fall asleep. I feared the man had internal bleeding in his head and possibly internal swelling.

My fears were not realized in the morning today. Apparently the man had stabilized and was trasported to the main hospital in kampala for surgery on monday. I felt relieved. It was tough not knowing anything but at the same time this makes me want to be a doctor even more--so that I am never in that situation again.

The rest of today, I have not done much. My stomach has been upset and I think it might have been triggered by both eating something not great and the trauma in the night. Waiting to see if it gets better, or I might have to break out the cippro.

But while it has been a little crazy, I have learned so much. Never would I have an experience similar to these in the US, and while I am inexperienced I am helping to some degree so I guess it works out best for both parties.

Will try to update more frequent but the internet here is just so slow that it is frustrating to use.

Even More Photos

 
 
 
 

More photos

 
 
 
 

Settled Down

 
 
 
 

Ok so things have finally settled down! Saturday we got my luggage--just in the nick of time. The KLM offices were closing when we arrived but nevertheless I have all of my stuff---thanks to Linda for all your help! Also, I have figured my cell phone out and exchanged money...so I am set.

I stayed at Dr. Kabuye's house over the weekend outside of Kampala and we came back to the hospital yesterday. The first thing I realized is that they work a lot less hard here. Doctors in the US are always struggling to find time to relax but here life is slower. We got to the hospital at around noon yesterday (after stopping in Kampala to check for prices on trips, will talk about that later). We then spent a couple hours working on the computer. I worked to finish up my AMCAS application for medical school (which I just submitted). Then at around 2 we had lunch...still no real work. Finally around 3 we did rounds and talked to each patient. This took about 2 hours and then we were done.

I got a little nervous that the trip would be kind of boring, but luckily I got to meet one of the two peace corp members working at or next to the hospital (YES I do have americans to hang out with). She said that it is common but I was reassured that I could always hang out with her or Katrina the other girl, who I have yet to meet. The best part is she has lots of books to read, I already finished one of the two I brought and I was waiting to start the other one until things really got slow...but now I have a lot more.

One of the patients that really struck me when we did rounds yesterday was a man with prostate cancer, or that is the best diagnosis of his problems. He came in with back pain but since he cannot afford a PSA test all we could do is a back x-ray to see if there are any signs that he indeed has prostate cancer. If it turns out true then the only treatment for him, that he can afford is castration. Removing...them....will stop the production of testosterone which will eliviate most of his pain. However, it only lasts for 2 years and at that point there is nothing else but pain kilers which he cannot afford on a regular basis.

What is really neat is how good Dr. Kabuye is at making diagnosis. He is limited to barely any tests that he can perform to confirm diagnosis so he must be able to view the problems with his eyes. I have not met that many doctors but in my opinion he really has an eye for spotting small clues, which is probably the only benefit for not having adequate medical resources.

Finally, today was pretty much similar. We conducted more rounds in the patients but also we did ultrasounds on female paitents--this is one of the new machines. One lady had pain in her throat which turned out to be an iodine deficiency enlarging her thyroid. One lady had an incomplete abortion that needed completed, which is quite disturbing. Others did not really have anything wrong. They just like having an ultrasound because the machine is big and impressive and they can see the screen--I am pretty sure Dr. Kabuye does not charge for it.

Also just late today, a man I saw yesterday with pnemonia and HIV had just passed away. His x-ray was very disturbing--he had lost his right lung and pretty much most of the second. Also a child died in the morning in the town and Dr. Kabuye had to do a post mortem analysis to see the cause of death. The child was apparently fine yesterday but the lady that was taking care of her because her grandmother left town(her parents are dead) claimed a piece of chalk choked her to death. Apparently it was suspicious but it turned out to be true. I could not come in to the morg because Dr. Kabuye said it was too unclean for me--I don't have the antibodies and the place is apparently not even 5% the cleanlieness of a US morg according to Dr. Kabuye. But I got to see the photos he took after and the chalk piece had lodged in her trachea and killed her.

But that about sums up the last two days. Oh yea, not sure if I will be able to go visit any national parks. Found out to just track gorillas, the permit itself is $500. They know most tourists are very wealthy and they capitolize on this. But the Teresa and Katrina, the peace corps, are trying to figure out something. Hopefully I can tag along with them if they do anything.

Here are some more pictures I have taken. The banana type plant is actually matoke. Similar to banana but not as sweet. It is the most prized food here. The hole in the ground is the toliet I use at Dr. Kabuye's house on the weekends. The hopsital has much nicer facilities so it makes me want to just stay here on the weekends. The other photos are just random, some are picures of traffic in Kampala.