Tricia’s Blog

Random thoughts

So we are now 1 week away from leaving Uganda. It has been an interesting, mostly good, experience. Though I do not enjoy being a doctor and usually can’t wait to leave when I’m working in the clinic here, it is interesting. I’ve seen lots of things I would never see in the U.S. including tons of malaria, lots of parasites, a woman with a hole in her neck where water comes out when she swallows (unclear cause at this time), abdominal TB, and tracheomalacia. Then there have been many boda-boda accident victims, and I wonder how anyone actually survives into adulthood with the way the driving is here! So random thoughts:

Malaria is like pregnancy. Even if you protect yourself almost every time, that is not enough. It only takes one time to become pregnant. It only takes one bite to get malaria. Mandy responded to my musings on this topic by saying “But it’s different because getting malaria requires the bite of a female.”

Here is a quiz for my doctor friends, this is a question Dr. Stockley asked me one day: What is the name of the scale where you age people by the length of their testicles? I had no idea what he was talking about and told him I was sure we didn’t have anything like that in the US. He informed me later that he’d looked it up and it was the Tanner staging system. Did you all know that?

Here’s one that hopefully won’t offend too many people: There are many Muslims here and 5 times a day they do their prayers which involves a lot of loud noise and sort of groaning or mooing (at least that is what it sounds like to me). So early on, we were hearing that one day, and someone asked what it was. I responded “well, it’s either a cow or a Mormon.” Okay so I was a little mixed up in my religions, sorry to my Mormon friends! But Mandy and Betsy thought it was a hilarious comment and planned to remember it forever.

I have now taken a boda-boda twice in the crazy traffic of Kampala and both times prayed the entire way, (partly because I believe prayer works and partly because that way I could close my eyes…:) and I have made it to my destination safely both times. I didn’t want to take this most dangerous form of transportation, but sometimes there really seems to be no other choice. I am also convinced now that desensitization therapy works. I am a bit claustrophobic. The idea of taking a matatu (15-passenger van used as taxi) terrified me because there are no aisles, just solid seats everywhere that fold up so people can get out. So when the van is full, which is always, the folded seats are down and there is no way to move or get out. Just thinking about it caused me a bit of panic, and the first time I actually did it, though I was seated by the door which is obviously the best possible seat for a claustrophobic person, it still scared me so much that I jumped off the very next time that the thing stopped, no where near our destination! Well, I had to get back on that day, and dealt with it. Since then, I had to sit in the middle of the back row, clearly the worst possible seat for a claustrophobic person. I had a couple of minutes of sheer panic, but then settled down. Now I can generally take one without much difficulty at all. So I’m a big girl now.

Hmm, what else? I love rice and beans, but Mandy and I are not doing a very good job with our food. We have had to throw out quite a lot of fresh produce because it grows ants, bugs, rots, or molds before we get to it. We have been eating avocados, mangoes, and pineapple pretty religiously, which sounds pretty healthy if I didn’t also confess the carrot cake I have every day at lunch and the Reese’s Cups from the US that I keep hidden in my bedroom!

I learned yesterday that there are 6 or 7 people buried under the trees to the side of The Surgery. Apparently some of the refugees have no home and therefore no place to bury their dead, so Dr. Stockley has let them be buried “out back” so to speak. The topic came up because a worker who was trying to install something dug up a body recently! I mean, where else does that happen? Incredible. I assume Mandy wrote about our very sad situation with a baby who died, but I’ll make mention of it too. John was probably about 2 years old, but looked more like 7 or 8 months because of severe malnourishment. He was abused and badly burned, so was coming to The Surgery for dressing changes. One day he was extremely lethargic. Before anyone could figure out what was wrong with him, he had died. The only data we had was a platelet count of 0. So I don’t know what happened, but I know it breaks my heart that in his entire time on earth he was burned and starved, he never knew anything good. Even when he was taken out of the abuse situation and put in the orphanage, he was still in pain because of dressing changes, so all he knew was pain, even though at the end it was pain for his own good rather than to hurt him. I went today to visit the orphanage he came from. It is an amazing place. Not at all as dirty and run down as I expected, rather it’s a bright, cheerful place. They have a 680 gram baby in an incubator who appears to be doing okay so far. They had an 850 gram baby who is now doing well, which is amazing for the resources available here. Still sad though, there are too many babies to give them all lots of love and attention. One little girl, probably nearly 1 year old, toddled up to me, grabbed my legs and wouldn’t let go. They are so hungry for attention. I think instead of being a doctor I should be a baby holder in a place like that. If the hippo thing doesn’t work out, of course…

Well, that ends this post for now because I have to go to work. I am making a presentation to the doctors today over lunch about fevers of unknown origin. I’m sure they’ll find it fascinating. Looking forward to seeing people when I come home next week, though I am absolutely sick about going back to work. Oh, and GO COLTS!

I want to be a hippo…

Wow, what a weekend! I know this will all be detailed in Mandy’s blog, but I want to write about it too, so I will. My sister Betsy, Mandy, and I went on safari this past weekend and it was amazing. There are great things to do in Uganda if you are not working all of the time! We left early Saturday morning to drive north to Murchison Falls national park to see animals. We drove in a safari van, which involved a pop-up top so that we could stand up inside and see out. We drove about 4 hours until we made it to the entrance of the park. Part of that 4 hours was driving probably 5 miles along a stretch of road that had a speed bump every 10 meters! There were about 500 speed bumps in this stretch, so we had to go very slow the entire time. We asked our driver what the purpose of these “speed humps” as they say here was, and he answered that the road is under construction and that is their way to ensure that drivers go slow. It definitely worked, but seemed like overkill to then have to remove or build over all of these speed bumps once the road is completed! Interesting. Once we left Kampala and were driving through countryside, we saw what I think of as stereotypical Africa…small mud huts with grass roofs, cows, goats, and chickens in the roads, only dirt roads, etc. It is SO much nicer not to be in the fume- and smog-filled city. Maybe it is nicer because we are not working. Well, for sure it is, but leaving the city helps too.

Anyway, once we made it to Murchison Falls, we had a 72 km drive to our campsite during which we saw several families of baboons. We reached our campsite and found our safari tents. They were amazing tents which were large enough for two beds. However they had very little ventilation, so were extremely hot! We put down our things and then went on a game drive. This involved taking our safari van to a ferry to cross the Nile river to the game park. We drove around for 3 hours, and saw lots of antelope, giraffes, elephants, hippos, and water buffalo. Amazing! That evening we slept in our sauna-like tent, which was hot and steamy but a much needed rest anyway. The camp was full of very large warthogs which reminded us of The Lion King. We were told not to leave any food in our tent because the warthogs have such an amazing sense of smell that they can smell the smallest morsel of food in the bottom of a suitcase and will tear down the tent to get to it. Unfortunately, we had some cookies and we couldn’t find our van driver to open the van and put them inside, so we had no choice but to leave them in the tent overnight (or throw them away, which obviously was not an option). So we wrapped the container in the thick blankets (that we obviously did not need for warmth) to mask the smell as best we could, and spent a nervous night wondering if we’d be attacked by warthogs. In the morning both we and the cookies were safe. The following morning we set out on game drive #2 in which we saw more of everything we’d seen the day before, but added to the list lions and a leopard. The lion seems to be the most coveted creature to see, as that is the one we’ve been asked about over and over since getting back to Kampala. That afternoon we went on a boat to the bottom of Murchison Falls. We saw many of the same creatures along the shoreline, but also saw lots of hippos up very close, and crocodiles. We saw the bottom of the beautiful falls as well. That night we slept in our warm tent again. The following morning we started off for Kampala, but stopped to see the top of the same falls. They are much more impressive from the top, with an incredible roar of water and white spray everywhere. We took lots of pictures. In fact, between the 3 of us we have over 1000 photos and 25 videos of our safari. I have decided the perfect life for me would be that of a hippo. They lounge in the water all day, and then eat all night. I can’t imagine anything better! They also seem to be friends with the crocodiles, as the two were very close several times and did not seem bothered by each other.

We arrived back in Kampala on Monday night and stayed at Betsy’s house so that we could take another short trip Tuesday. Tuesday was Uganda’s Liberation Day, so a national holiday here. Betsy did not have to teach, and we had asked for that day off, so we went to visit Mukono, a smaller town about 1 hr from Kampala to visit the Ugandan family that Betsy stayed with during her first semester here in 2008. Once in Mukono, we set off to find her host family’s house. We were told about a shortcut, so we tried it. We did something wrong, because we were walking through banana growing forests, people’s fields, dodging cows, and not finding anything that looked like a road, just tromping through the brush. But we kept walking and asking people where the road was, and eventually we found it, and Betsy recognized that her house was right there where we came out onto the road, so that was lucky. Her host family was not expecting us, (Betsy had tried to contact them but had been unable to) so was surprised, but they were extremely welcoming and very excited to meet “Betty’s” family and friend. It is customary here for the hosts to feed the guests, even if it means leaving the guests alone to prepare food. So that is what happened. The family rushed around in their outdoor kitchen preparing rice and matoke (plantains made like potatoes) and g-nut sauce (a sauce made of ground nuts) and juice for us. They left us in the sitting room alone for an hour or so. Finally the meal was ready and they ate with us. It was very fun to talk with them. I got to see the tiny bedroom that Betsy shared with 3 other family members when she was there, and I got to use the “bathroom” that she used, which was actually a brick-sized hole in the ground that you were supposed to squat over. I discovered my aim is not that great! Overall it was a lot of fun to finally interact with some Ugandans. We made it back to Kampala safely after another hour or so on various matatus (15 passenger vans that are packed with more than 15 people and serve as taxis) to arrive at our destination. A very fun vacation weekend indeed. Wednesday we start back to work, and we have no more days off on the schedule that has been made so far. We’ll see if we have any once the next schedule comes out. I do not anticipate that we will, but there is so much more that I would love to see, I am hoping that we might. So back to the real world. Oh, to be a hippo!

PS: I mentioned before the lack of hypertension in Uganda. I have now found one of my only hypertensive patients: Mandy Schmidt. Luckily she has been taking her HCTZ, but I think she may need a second agent!

Liking Uganda, still disliking doctoring…

We are now finishing our first week in
Uganda. It has not been too difficult in terms of cultural adjustment. Well, easy for me to say, as Mandy was the one squirting out of both ends all day on Monday. But really, we have been well. We have had the usual frustrations of huge amounts of traffic, so driving to and from work tacks a couple of hours onto a rather long work day, lack of internet access, as well as lack of transportation of our own, so we have to really plan ahead to go anywhere, and many times we’ve said “Oh, we’d like to go to that market” but then we realize that it will take us so long to get there and back that we don’t have time to do it. But otherwise, it has been a fairly easy transition. However, I feel that is largely because we are surrounded by Europeans, not by Ugandans. We have not gotten to experience the Ugandan culture hardly at all. We live in a house with Belgians, Swiss, and British people. We work with people from
Britain, and some Ugandans, but obviously more well-off ones. We haven’t even eaten any local food yet, but I just learned today that the cafeteria outside our clinic serves typical Ugandan food, so hopefully we’ll try that next week. We spend our days at the clinic, Mandy and I alternate between the ER and seeing outpatients. We continue to see lots of malaria and abdominal complaints. No more boda accidents since a couple of days ago, but I can’t imagine that is the last one we’ll see, with all of the traffic here.

Dr. Stockley is our supervisor, and is a very unique person. I think he is a very good doctor, especially within the resources he has available, but he is also a man with no filter. He says anything that pops into his head. He has asked multiple men when their due date is, letting them know that they are overweight. He told the interpreter to shut up one morning because the interpreter was supposed to be interpreting between English and French, but unfortunately he didn’t seem to know much English. Dr. Stockley also told a girl that she was being given an antibiotic, and she didn’t need to worry about side effects; she could drink beer and get pregnant but he advised her not to do both at the same time, because she’d probably spill the beer. It has been pretty fun working with him, as he teaches us well, and definitely gives us something to laugh at most of the time. There is a lot of HIV here, and we are seeing some patients like that. We have also been seeing children from a local orphanage, and some of them are very sick. One little boy has tracheomalacia (we think) and sounds absolutely terrible, with loud stridor and incredibly deep retractions at all times. He also has TB and pneumonia. Two other little boys were brought in who had been abused, they were completely starving, as in totally underweight, and one had been burned a lot. They were very anemic, probably from malnutrition, with hemoglobins of 3. Very sad case. Mandy and I are hoping to visit that orphanage at some point during our time here.

I am personally becoming corrupted. The girls in the house watch Grey’s Anatomy every night. I always thought I wouldn’t watch that “trash” but I find myself becoming drawn into it the last couple of evenings while eating. Eating is another thing. I love to do it, but I’m not getting enough exercise to keep up my present amount of eating. I did go for a very short run earlier this week, but found it extremely hard for several reasons. First, because it is at a little more elevation than we have at home, second because it is hot, third because it is very hilly everywhere, and the biggest reason of all is because I am completely out of shape at baseline, so even if the first 3 weren’t true, I’d still struggle. Doesn’t look like I’ll have time to run on too many days, but we’ll see.

Today Mandy and I decided to try to find a market that only happens on Friday and is within 1 km of our house. So we left home in the morning (we work afternoon and evening today) and started walking. We knew one way that would get us there for sure, but for some reason we went the opposite way (Okay, it was because I’d run the opposite way the day before and felt quite sure I knew a shortcut). We thought we’d be able to find it, but we were wrong. We walked up and down very muddy, steep hills for about an hour before we decided to just go back the way we knew for sure. Once we did that we made it in only 15 minutes, so that would have been the way to go. Oh well, we needed the exercise. Once we got there, they didn’t have what we were looking for anyway, so we turned around and walked the kilometer back up to the house. Not a very productive morning! This weekend we are going on a safari, Mandy, my sister Betsy, and I. We are looking forward to it, everyone tells us it will be a lot of fun. However, I diagnosed malaria in a guy yesterday who had just been where we’re going, so we’ll have to be careful. Mandy and I have discussed timing our malaria so we get it right when we return to the States, allowing us to miss the first week of our next rotations. That is our goal.

What I have learned here is that I like talking to people, trying to learn about different customs and cultures, and seeing what they are concerned about, but I still don’t like being a doctor. That hasn’t changed since leaving the
US. I was hoping I’d come here and find that I love practicing medicine away from residency, but as I’d feared, it hasn’t happened. I like everything I’m doing here except the working as a doctor part. I think it is official that I made the wrong career choice. Not much I can do about that now.

I have also seen interesting effects of lifestyle. Out of all of the patients we’ve seen in the past week, maybe 2 were here for checks of their blood pressure, one or two for diabetes, I’ve seen one person since I’ve been here who has a history of heart disease. There is just no obesity among the Africans we are seeing, so they don’t have those types of illnesses. It would be nice to walk to work everyday, generally be active, and not have to worry about some of the illnesses that plague most of the American population. That is all I have to report for now, I’ll have to write about the safari sometime next week!

Still alive, and haven’t killed anyone else either…yet…

Whew, what a crazy few days. I know Mandy will share some of the same stories in her blog, but they’re worth sharing, so I will too…

We are working fairly hard. I was hoping for a bit of a break from residency, but our hours have been similar or worse than back home…I had my first day of seeing patients on my own, but I told Dr. Stockley about all of them before treating them or doing anything to them, so I had a lot of supervision. Yesterday alone we saw 3 cases of malaria, several HIV+ patients, several patients being treated for TB, and lots and lots of people with diarrhea who had amebas or other parasites in their stool. I think the most common complaint here is belly pain and diarrhea, followed closely by “I think I have malaria.” Our clinic sees mostly international patients, as they have to pay to be seen, so we see lots and lots of Europeans, some Ugandans, and occasionally Sudanese or Somalians. Also Australians. Last night we worked until 8 pm, left the clinic about 8:30, and it took us 1 hour to make the 5.5 mile drive home. Crazy. I tell you, the traffic and driving here is amazing. And we were with a driver (Dr. Stockley) who has been driving here for 30 years and knows what he’s doing…we took several very rutted, horrible dirt roads through the bush to get around the deadlocked traffic on the roads.

Speaking of the driving and traffic, I am now convinced not to ride a boda-boda. It is a motorbike used like a taxi here…tons of people use them to get around. Today on the way in to the clinic we witnessed a rather severe boda accident right in front of us. A man was driving his boda boda and another man stepped off the curb immediately in front of him. The boda driver swerved hard to miss him, but couldn’t because he was too close, so he hit the pedestrian (who fell, but then was able to get up and walk away) and crashed his bike so he ended up in a twisted heap beneath it. He hit his head pretty hard, and his leg was twisted around. So since we were driving with Dr. Stockley, we stopped, picked up the unconscious boda driver and put him in the back of the car and took him to the clinic with us. (This clinic is 24-hrs, has rooms like a general doctors’ office, but also 2 ER beds and 2 inpatient beds). We got him to the ER where he woke up rather confused. His leg ended up being okay, despite looking like it was really hurt. He had bleeding road burn all over, but actually came around and seemed okay. I thought he was dead when I watched as his head on the ground right in front of me. So we cleaned up his abrasions and sent him home. Crazy, since at home we would have done a full-body CT scan and kept him around awhile. He got no labs and no studies and no meds. Here they have Tylenol, ibuprofen, and Ultram, I haven’t ever seen any narcotics. No one has come in requesting pain medication at all, whereas that is a routine request every day in South Bend.

We live in a house with 4 other international people, two from Belgium, one from England, and one from Switzerland, as well as the owner of the home and her 14-yr-old daughter. I can’t remember if I already told you that. Anyway, my room, and Mandy’s is in an outside building, very very small, but fine for our purposes. We have a toilet and a shower that we share between the 4 of us, you have to go outside to get to them, but we actually have warm water if the electricity is on. We go to the main house to cook and eat. So far we’ve been making rice and beans or rice and vegebables. We need to go grocery shopping again because we’re running out of food, but our hours have been long and transportation is a problem, so we haven’t. We are off this weekend for our safari, but it looks like we work every other day while we’re here, even Sunday. It’s been fun meeting so many people from so many different places, and overall we’re having a good time, despite the very long drives to and from work (I could often run 5.5 miles faster than we drive it!) and the lack of ability to get places to use the internet or buy food. The people seem very friendly, and even when I walked through town alone I didn’t feel like I had men yelling at me like I always did in Central America. They do greet me with mzungu though.

 28 seconds until my time at the internet cafe runs out…more later!!!

Uganda here we are!

So Mandy and I arrived in Uganda very late on Friday night after many long hours of travel, but happily many delicious meals in the air as well. Actually, all of the food has been great, and it won’t surprise anyone that I am beginning this blog talking about it.

After quite a harrowing ride through the streets of Kampala with my sister Betsy who is here teaching math and was driving on her own for the first time (a trip the wrong way down a one-way dirt street, etc), we made it to The Surgery where we met Dr. Stockley, our supervisor, who has a VERY interesting personality. He informed us that on Monday when we start, one of us will be shadowing him, and one of us will be seeing patients on our own. Mandy elected me to be the one alone, so we’ll see how that goes. Superbly, I’m sure.

Well, I have 55 seconds left on this internet, so I better go ahead and send this. Hopefully I’ll write more later.

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