Views from the Plane

The unforgettable dirt roads, still have the collection of
dust in the seams of my backpack from two years ago...

On the edge of Lake Victoria

Landing in Entebbe

I'm back

Mulago Hospital Week 1

Most of my time in the hospital this week was devoted to the infectious disease ward. As I noted in my email update, most of the cases that I have seen so far involve opportunistic infections secondary to AIDS. The most common diagnosis on the service has been cryptococcal meningitis, or un-affectionately known to all the staff as CCM. Our morning team usually consists of 5 Ugandan medical students, 2 senior house officers (3rd year residents who pay to work for an extra year in the hospital), and a consultant ("attending" in our vernacular). The wards are overcrowded with patients and their companions taking up residence in any vacant space that they can find on the ground. Men and women are placed in two separate large rooms on the ward, and each room is further divided into three sections with two rows of metal hospital beds, with little paint left to peal and from circa 1960, running the length of each one. In between the rows of beds, I tiptoe my way around the heads and hands of patients lying on the floor in order to keep up with our team's soft-spoken consultant as he demonstrates over and over again another unfortunate patient's stiff neck.

One of the most challenging cases that I saw this week was a 50 year old man being treated for CCM with deep bed sores on his torso, buttocks, and thigh. He has been barely conscious after 3 weeks of treatment with anti-fungal medications and anti-retrovirals, but developing more muscle strength in response to being disturbed, leading our consultant to note "he's doing well." I can't help but think, however, that if this man survives his meningitis, it would be such a tragedy for him to succumb to another infection from his sores simply because there wasn't enough staff able to rotate him every two hours while confined to his bed. In the middle of the week, I was also given an assignment to follow a 19 year old man with CCM, who was recovering quite nicely after a week of treatment. During his workup, however, he was diagnosed with pulmonary and abdominal TB. Though it's only been a week in Mulago, I'm already developing the suspicion that there is usually something lurking around the corner for these patients as they try to make their way out.

On a positive note, I am learning a tremendous amount from the staff and students here, as well as found a useful role for myself in reviewing what I've learned in medical school with them. Blumenfeld would have been proud yesterday morning, I had to demonstrate the complete neuro-exam for the students on rounds. On Monday, I head to Gulu for a week long rotation on surgery at the famous Lacor Hospital.

My Room in Kampala- A film test-run

I found my Flip Mino camera in my duffel bag and filmed a little bit of my room as a test-run for uploading video footage. Blogger only allows 100 MB clips, around 1 minute long, and they take about 20 minutes to load. Looks like it worked, hope you enjoy.

Independence Day

Last Saturday, Uganda celebrated its 48th anniversary of independence. The significance of the day seemed to have gone unnoticed for most of the country as there was hardly any mention of it in the newspapers until the following day. Even then, the journalists only reported on a relatively small gathering in Kampala where the president gave a speech to boost nationalist pride. Beyond that, most of the op-ed columns were about the wasted benefits of colonialism since the day the Union Jack was taken down. Reading theses pseudo-defenses of the colonialist days, I couldn’t help but think these authors would be viewed locally as heretics. I naively expected that it would be taboo to note anything positive about this period of oppression, especially on the anniversary of Uganda’s reclamation of the dignity of seeing its own people lead the country. Most of the op-ed writers, however, commented on how the British had at least provided strong public institutions and services (i.e. schools, hospitals, roads etc.) when they exploited Uganda’s natural resources and suppressed the population’s ability for self-determination. They also noted that Ugandans now are too tired and worn out from poverty and years of civil war to give up any of their free time for celebrating the birth of a nation that still feels like it’s being born. Interestingly, Michael Dewan (a classmate from medical school for those of you who don’t know him) was asked to take part in an information session for Makerere medical students applying to do a 6 week rotation at Yale next year. During the session, one of the Ugandan medical students, who just returned from doing a rotation in New Haven this past summer, noted to him how strange the 4th of July seemed to her; it was unbelievable that Americans have so much pride in their country that they put on giant firework displays and host barbecues in its honor.

My host parents (who wish to maintain some pseudo-anonymity on this blog so will be called Mr. and Mrs. M) honored the day at their Baptist church. Mr. M was asked to give a sermon on the role of independence in political and spiritual life, in which he also described some of the perks left over the from the Brits including the English language, Christianity, and the country’s judicial system. In the bible study group that I attended with them, there was a long debate about verses in the book of Peter regarding submission to civil authorities. In brief, the passage states that God smiles on those who are submissive to their leaders, even when the authorities are irrational. Not to get into a debate about Christian theology, but I felt this palpable tension in the room between the text and its readers. These were all devout Christians sitting around the table, who had lived through both Amin and Obote’s regimes, trying to find wisdom from a statement so hard to accept on its own. Though it wasn’t quite hot dogs and sparklers, debating how to live with a contradiction intact felt like a very appropriate way to celebrate the day nonetheless.

Photos from Week 2

The water tower at the gates of Lacor Hospital in Gulu, where our MUYU group has been for the last week. The hospital is famous for overcoming the Ebola virus in 2000 and being a safe haven for children during the government's war with the Lord's Resistance Army.

Crossing the Nile River on our way to Gulu.

Roadside Cooking. At major roundabouts on Uganda's highways, vendors come up to bus and car windows selling a variety of grilled meats, fresh produce, and roasted plantains.

Flip Footage from Week 2

A little clip from our program's bus ride to Gulu from Kampala. It shows some of the city's amazing diversity in color, architecture, and wealth living in such close proximity.




Here is a little footage of Dewan buying peanuts (which were raw not roasted a little to his dismay) at one of the road stops just before crossing the Nile. Baboons in the background picking up scraps left behind by the vendors.

More Flip Footage from Week 2

This was taken while riding in a matatu (a minivan taxi that is normally packed with 15-20 passengers). We hired this one for our group visit to St. Jude's orphanage nearby Lacor hospital. The erratic pendulum swing of the rear view mirror is pretty telling of how the ride feels inside a matatu cruising down the village roads.



Outside Lacor, as our team is about to board a matatu. The road that runs in front of hospital is the country's major route to Sudan, whose border is about 65 miles further north. Across the road is a cluster of small shops, restaurants, and bars, where we found ourselves playing billiards during some of our down time. In front of these, there is also a group of guys hanging out on dirt bikes, the famous boda bodas. They're another taxi service option, especially popular with the late night crowds and those light on cash.