The unforgettable dirt roads, still have the collection ofdust in the seams of my backpack from two years ago...
On the edge of Lake Victoria
Landing in Entebbe
I'm back
The Marabou Stork Flies Again
Sunday, April 5, 2026
Views from the Plane
The unforgettable dirt roads, still have the collection ofdust in the seams of my backpack from two years ago...
On the edge of Lake VictoriaLanding in EntebbeI'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.
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.
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.
MUYU in Gulu
Our team of 5 from the Makerere University-Yale University (MUYU) medical student and resident exchange program made the trip north to Gulu this past week. We’ve spent a lot time together since I’ve arrived, so I figured that I should probably introduce them to you all, or at least show their bright beaming faces again to those of you who do know them. (Note: the best dressed guy in the picture above is Dr. Michael, our team's outstanding liaison at Lacor hospital.)
Ali, a 4th year medical student at Yale, who serves as our
team expert on the methods of staying well hydrated in the
Sub-Saharan heat, as well as our most skilled member in the
art of internet social networking and on-line chatting.
Michael, another 4th year medical student from Yale who ismaking a return trip to Uganda for 6 months. He has proven
to be a Luganda virtuoso who would also risk life and limb
through the African savanna if it stood between him
and streaming highlight reels of Notre Dame football.
Esther, a 3rd year medicine resident from Tufts, is theteam's conscience, keeping the boyish humor always within
reasonable limits. She also adds to the list of awesome
people produced by the state with the greatest awesome
people per capita ratio in the country, that's right you
all know what I'm talking about, Minnesota.
Andy, a 3rd year medicine resident from Stanford, providesthe team with a little bit of California cool on the wards,
while maintaining his tough guy appearance outside the
hospital by eating tropical medicine text books.
The Italians at Lacor
Lacor hospital was founded by Catholic Comboni missionaries in 1959. Two years later, a husband and wife team, Drs Piero Corti (an Italian paediatrician) and Lucille Teasdale Corti (a Canadian surgeon), arrived in Gulu where they spent the rest of their lives developing the hospital into the amazing health care facility it is today (For more on the history: http://www.lacorhospital.org/). In honor of their life work, a Corti foundation was set up in Italy to continue funding the hospital along with the Catholic Archdiocese in Gulu. As a result, lots of Italians come to Lacor to volunteer their services. Currently at the hospital, there are 2 pediatricians, a pathologist, an oncologist, a radiologist, and a number of administrators and technical staff all from Italy. They were all so welcoming and friendly, only adding to our pleasant experience there.
Besides overhearing the occasional "Ciao, Ciao" exchange throughout the wards, one of the other most obvious examples of the Italian presence at Lacor is the food. Throughout the week, our lunchtime meals would range from the classic Acholi malakwang (a peanut sauce mixed with cabbage and greens) poured over sweet potatoes to gnocchi in a Bolognese sauce. For our last evening, Carlo (a Comboni Brother-radiologist and the guy in a white t-shirt sitting next to Dewan in the picture above) made a traditional Italian meal for us, which included an antipasti of grilled eggplant smothered in oil and garlic (which he prepared on a pannini press a day in advance), homemade cheese, sausage from the market, and rosemary focaccia. After carving out avocados and chopping up potatoes for a salad earlier that evening, Carlo assigned me to plucking the rosemary like pine needles from a stem. The kitchen was filled with the aroma of the baking focaccia, an odor that seemed so exotic in this place.
For the main course, we had three varieties of the pizza, with different crusts, mixtures of vegetables, and sausage ...
For dessert, there was a salad made up of the classics from Uganda: passion fruit, oranges bananas, and pineapple...
Besides overhearing the occasional "Ciao, Ciao" exchange throughout the wards, one of the other most obvious examples of the Italian presence at Lacor is the food. Throughout the week, our lunchtime meals would range from the classic Acholi malakwang (a peanut sauce mixed with cabbage and greens) poured over sweet potatoes to gnocchi in a Bolognese sauce. For our last evening, Carlo (a Comboni Brother-radiologist and the guy in a white t-shirt sitting next to Dewan in the picture above) made a traditional Italian meal for us, which included an antipasti of grilled eggplant smothered in oil and garlic (which he prepared on a pannini press a day in advance), homemade cheese, sausage from the market, and rosemary focaccia. After carving out avocados and chopping up potatoes for a salad earlier that evening, Carlo assigned me to plucking the rosemary like pine needles from a stem. The kitchen was filled with the aroma of the baking focaccia, an odor that seemed so exotic in this place.
For the main course, we had three varieties of the pizza, with different crusts, mixtures of vegetables, and sausage ...
For dessert, there was a salad made up of the classics from Uganda: passion fruit, oranges bananas, and pineapple...
More Gulu Photos
The soccer field at St. Jude's Orphanage, which houseschildren abandoned because of war, disease, and poverty.
While there, we got into a pretty serious soccer game with
some of the younger boys, who were sending passes
around us left and right.
While there, we got into a pretty serious soccer game with
some of the younger boys, who were sending passes
around us left and right.
Sunrise from the matatu on our way to catch the bus home.
Morning breaks in Gulu.
Passing a village on the bus back to Kampala, dust andrain collecting on the window add to the blur of smoke
crawling along the grass roofs.
The Nutrition Center
Though I had originally planned to spend this past week rotating with a surgical team, circumstances changed and I chose to spend my time working in a pediatric nutrition center. There were about 40 children being treated in the center, almost all between the ages of 6 months-5 years. To get admitted to the center, a child must have one of these 3 signs of severe malnutrition, 1) an upper arm circumference of less than 11 centimeters, 2) swelling in both feet, or 3) 70% of a normal height-to-weight ratio. In other words, these kids really look sick when they come to the center, and usually present either severely emaciated or completely swollen to the point where their skin breaks down. They also commonly have infections because their immune systems are not functioning well, or are actually malnourished secondary to already having an infection. The WHO estimates that malnutrition contributes to greater than 50% of the mortality for children under 5 years old globally. Though this is a very serious, common illness, it is amazing how proper feeding and antibiotic treatment can transform most kids from being on the verge of dying to laughing and playing again in a matter of a few weeks. Once the kids are discharged, they receive a two weeks supply of "plumpy'nut," which is like a peanut butter paste with some extra fat, sugar and vitamins mixed into it. The idea behind this paste is that it's cheap (about $15 for a months supply), high in calories (about 500 for a spoonful serving), and requires no preparation at home. The kids come back every two weeks for follow up, and then given another 2 weeks free supply of plumpy'nut until they reach 85% of a normal height-to-weight ratio, which is deemed "cured."
There are many causes of malnutrition, and they range from the level of society to the family to the individual. Two reasons commonly given by the center's staff are that a family doesn't have enough food or that parents are not educated on how best to use the food around them to properly provide for their children. One of the most painfully obvious exacerbating factors leading to the high prevalence of malnutrition in Uganda is the country's fertility rate, with an average of greater than 6 births per woman. I met a mother of one our patient's who had 10 children by the age of 33. Not only does she not have the resources to care for all these kids, having pregnancies so close together harms the nutritional status of both the mother and the growing fetus, leading to further health problems in the future. Another common problem with inappropriate child spacing (under 18 months apart) is that mothers will stop breastfeeding their infants out of fear that it will harm the new child inside of them. We had several infants in the nutrition center who were admitted secondary to this phenomenon. The staff members all believe that family planning methods are essential for combating malnutrition, but these efforts are not allowed by the hospital, which as a Catholic institution can only promote calendar and abstinence based methods. In a community where rape has been used as a tool of war for so many years, and women still suffer to have autonomy and authority within a family, these methods seem neither realistic or practical. In order for women to receive education and resources for family planning, they must go elsewhere in the city. Lacor hospital is so well-run, and has social justice written all over it, but it seems like a tragic missed opportunity to intervene for both the sake of the children and their mothers. As if I were back in my Catholic school days, I have found myself engaged again in long conversations with some of the missionary staff on site about the Church as a motivating force in social reform, and its responsibilities in doing so. No agreements have been reached yet, but I'm looking forward to continuing these conversations when I return next month.
There are many causes of malnutrition, and they range from the level of society to the family to the individual. Two reasons commonly given by the center's staff are that a family doesn't have enough food or that parents are not educated on how best to use the food around them to properly provide for their children. One of the most painfully obvious exacerbating factors leading to the high prevalence of malnutrition in Uganda is the country's fertility rate, with an average of greater than 6 births per woman. I met a mother of one our patient's who had 10 children by the age of 33. Not only does she not have the resources to care for all these kids, having pregnancies so close together harms the nutritional status of both the mother and the growing fetus, leading to further health problems in the future. Another common problem with inappropriate child spacing (under 18 months apart) is that mothers will stop breastfeeding their infants out of fear that it will harm the new child inside of them. We had several infants in the nutrition center who were admitted secondary to this phenomenon. The staff members all believe that family planning methods are essential for combating malnutrition, but these efforts are not allowed by the hospital, which as a Catholic institution can only promote calendar and abstinence based methods. In a community where rape has been used as a tool of war for so many years, and women still suffer to have autonomy and authority within a family, these methods seem neither realistic or practical. In order for women to receive education and resources for family planning, they must go elsewhere in the city. Lacor hospital is so well-run, and has social justice written all over it, but it seems like a tragic missed opportunity to intervene for both the sake of the children and their mothers. As if I were back in my Catholic school days, I have found myself engaged again in long conversations with some of the missionary staff on site about the Church as a motivating force in social reform, and its responsibilities in doing so. No agreements have been reached yet, but I'm looking forward to continuing these conversations when I return next month.
Around Makerere and Budo Field Trip
Most mornings Mrs. M drops me off at Makerere where the MUYU team apartment and her office are located. The iconic clock tower building is situated in the center of the university, which started out as a technical school established by the British in 1922, and then became an independent institution in 1970. 
The stairwell to the MUYU apartment, where the rest of the team stays. After a cup or two of instant coffee, we usually make the 20 minute walk to Mulago alongside the crowded roads with asphalt crumbling at the edges and a footpath worn into the red mud. Half-way to the hospital, there is a giant intersection called Wandegeya. There, matatus amass, and their conductors shout out destinations while harassing pedestrians and promising "you come, we go."
Our program periodically has cultural field trips, most recently we went to the site of the Bugandan king's (the Kabaka's) coronation, which takes place in this grass hut. The site is called Budo.
While at Budo, we also visited with a traditional healer, or a "witch doctor" as they are called in the local newspapers these days (video of our meeting will be posted soon). This tree is the sacred site where the healer practices, chosen because it predates the kabakas. He noted how the earth continues to wash away from the tree, and that is why its ancient roots can now be seen. A self-proclaimed Catholic, who still attends mass each Sunday, the healer described for our team how he receives all his knowledge from the spirits of the forest and only treats illnesses that Mulago fails to cure (more details to come with video footage).
At Budo, there are a number of holy shrines that would be easily missed without a guide to point them out. Trees along side this field are thought to be filled with the spirits of ancestors that prepare a new kabaka for his upcoming responsibilities to rule his land. Inside the tall plants at the right hand side of this photo is a rock believed to pour out water when an old king dies and new one is crowned. There are only a few thin tree branches corralling it as a place of significance. 
A produce market in Wandegeya, where you can buy the most amazing avocado for 500 Ugandan Schillings, or about 20 cents. 
One of the many varieties of banana found in Uganda, the famous matooke. Steamed and mashed up with ground nut sauce on top, it's an acquired taste for most foreigners, but a classic favorite amongst the locals. Along the roads and in the villages, it's easy to spot a fearless cyclist powering his way forward with bushels of matooke on the back of a heavy metal bike.
Film and Research Updates
While I’m not busy in the hospital, I’ve been preparing for the film and research projects that will occupy most of my time here. Mostly, I have had a large number meetings with various potential collaborators and persons knowledgeable about logistics for working in resettlement communities for internally displaced persons (IDP) in Northern Uganda. In Kampala, I’ve had meetings with the Uganda Human Rights Commission, HEPS Uganda (an NGO devoted to promoting access to essential medical care), members of the Ministry of Health, and a professor at Makerere School of Public Health, Dr. Orach, whose previous research looked at awareness levels of human rights in IDP camps. He was happy to collaborate on the projects, which means I now have to go through the review board at the school of public health here, which I’m told won’t take more than two weeks so long as my proposal is in the right format. In Gulu, I had a wide range of meetings. I met with a NGO that helps bring medications for HIV to patients homes that are too isolated from care. This was a meeting set up by Brother Carlo, the radiologist at Lacor. The next morning after this meeting, I met with an American evangelical missionary-surgeon working and teaching at the medical school in Gulu. I was put in contact with her through a friend of Mr. and Mrs. M. She provided a lot of information on traveling around the area, advice on maps and data showing medical services for the region, and suggested some possible interpreters. After meeting with her, she dropped me off in her SUV at the United Nations Office of the High Commissioner for Human Rights (OHCHR)in Gulu, where staff informed me about health sector meetings for the region that take place on a monthly basis in the city. These meetings are attended by government agencies, NGOs, health care professionals, and other non state actors involved in health care like the OHCHR). They provide another major avenue for raising grievances about the community’s barriers to accessing essential medical care. I hope to attend these meetings in the coming months. After leaving the OHCHR office, I went next door to the World Health Organization’s local office. Staff there were very helpful and friendly; they even showed me two short documentary films they made about health burdens of IDPs while living in the camps. They also gave me contacts for a number of physicians working in Gulu who may be able to help with making connections in the communities involved with the research. Last quick update, John Binford (another Yale medical student for those who don’t him) will be arriving next Monday to share the fun and work for the next two months.
A Strange Feeling
Over the past two weeks, I have occasionally encountered on the wards a strange feeling, something primitive, like an anxious stomach or restless feet. During rounds at the nutrition center in Lacor, my team (an attending, intern, and myself) came across a 9 month old boy with sunken eyes and twig-like arms, lying in bed under a tattered piece of clothe. When the attending physician removed the piece of fabric away from the baby, I felt a kind of displacement under my chest, and a need to shift my eyes around and take a deep breath. I had seen dozens of emaciated or swollen-limbed kids with their skin peeling off for the past couple of days, but this boy’s situation seemed so far from natural that it couldn’t register. There was hardly more than skin and bone on the bed. He needed a transfusion, and so we needed to type and cross his blood. The intern failed to draw any from his femoral vein, so the attending was asked to help. The boy didn’t even twitch, as the attending took 4 sticks to finally get the sample we needed. I came home to the guest house that afternoon and told Dewan how I thought it was strange that seeing this boy made me feel light headed when I had seen all these other really sick kids and didn’t flinch. The next morning, we arrived at the boy’s bed and I noticed a different mother at the head of it. I asked how the boy tolerated the transfusion, and my intern told me he never got the chance to give it to him. The boy had passed away shortly after we sent off our samples.
This feeling came again the following week, while our team was doing its routine visit to a community hospital in one of the suburbs of Kampala. Though classified as a hospital, the facility could be easily mistaken for a clinic based on the limited resources there. It’s a collection of 3 small buildings with space for about 30 patients, run by a single newly ordained physician, and has a solitary ultra-sound machine as its only diagnostic imaging tool. Despite the lack of resources, however, the staff is able to offer some of the most essential medical care possible, like treating an emergent ectopic pregnancy.
While on rounds there, our team entered a patient’s room tucked away in a dark corner off from the hospital’s inner courtyard. Inside the room, there was a healthy young Bugandan man in his 20s seated on a bench next to the door, and across from him, was a wiry hospital bed where a head of sparse gray hair protruded from a mound of army-green wool blankets. The young man was completely silent, staring at the heap of fabric which roared a waxing and waning gurgle that could be heard from the hallway. The staff physician pulled away the blankets from the head, and underneath was an unconscious, frail 70 year old man who had a stroke a couple of months ago and been hospitalized for the past several weeks with an aspiration pneumonia. I again felt a need to rock on my feet, and began shifting my eyes around the room. But this time it wasn’t what I saw that made me restless, rather it was recognizing the source of the inhuman gurgle, so far from right, that made it so hard to hear. One of our team members asked about suction for the patient, to help remove some of the mucus plugs in his lungs. The staff physician kicked around under the bed, and finally pushed out a little foot-pump vacuum. She demonstrated how it worked before noting it hasn’t made much of a difference. We left the room with the understanding that there wasn’t much that could be done, at least nothing curative. An hour later, while examining a young girl for a skin rash in the outpatient room, a male nurse came knocking on the door. The gurgling had stopped, and he couldn’t feel a pulse. We all hurried across the courtyard and into the dark hallway where we found a gaunt elderly woman, dressed in a bright traditional gown with tented shoulders, wailing outside the patient’s room. We stepped past her, and went to the bedside to do our exam. His heart had stopped, and with it, the breathing. As we left the room, I told Michael that I had that strange feeling again when we saw the patient earlier that morning. He told me the first time he heard the patient two weeks ago, he got the feeling too, and was surprised he lasted this long.
This feeling came again the following week, while our team was doing its routine visit to a community hospital in one of the suburbs of Kampala. Though classified as a hospital, the facility could be easily mistaken for a clinic based on the limited resources there. It’s a collection of 3 small buildings with space for about 30 patients, run by a single newly ordained physician, and has a solitary ultra-sound machine as its only diagnostic imaging tool. Despite the lack of resources, however, the staff is able to offer some of the most essential medical care possible, like treating an emergent ectopic pregnancy.
While on rounds there, our team entered a patient’s room tucked away in a dark corner off from the hospital’s inner courtyard. Inside the room, there was a healthy young Bugandan man in his 20s seated on a bench next to the door, and across from him, was a wiry hospital bed where a head of sparse gray hair protruded from a mound of army-green wool blankets. The young man was completely silent, staring at the heap of fabric which roared a waxing and waning gurgle that could be heard from the hallway. The staff physician pulled away the blankets from the head, and underneath was an unconscious, frail 70 year old man who had a stroke a couple of months ago and been hospitalized for the past several weeks with an aspiration pneumonia. I again felt a need to rock on my feet, and began shifting my eyes around the room. But this time it wasn’t what I saw that made me restless, rather it was recognizing the source of the inhuman gurgle, so far from right, that made it so hard to hear. One of our team members asked about suction for the patient, to help remove some of the mucus plugs in his lungs. The staff physician kicked around under the bed, and finally pushed out a little foot-pump vacuum. She demonstrated how it worked before noting it hasn’t made much of a difference. We left the room with the understanding that there wasn’t much that could be done, at least nothing curative. An hour later, while examining a young girl for a skin rash in the outpatient room, a male nurse came knocking on the door. The gurgling had stopped, and he couldn’t feel a pulse. We all hurried across the courtyard and into the dark hallway where we found a gaunt elderly woman, dressed in a bright traditional gown with tented shoulders, wailing outside the patient’s room. We stepped past her, and went to the bedside to do our exam. His heart had stopped, and with it, the breathing. As we left the room, I told Michael that I had that strange feeling again when we saw the patient earlier that morning. He told me the first time he heard the patient two weeks ago, he got the feeling too, and was surprised he lasted this long.
Photos from Mulago
This is the sidewalk that leads from the medical school buildings down to the hospital. From where this photo was taken, turning left would lead down a covered walked way to the a building where the MUYU office is located on the second floor. Turning 180 degrees, there is short set of stairs that leads to one of my favorite places on the grounds, the canteen. The female staff take a little warming up, but once they're your friends, the lunch line becomes smooth sailing. One morning, they even rushed an order for me of a "rolex" (chapati rolled up with a fried egg in the middle, goodness couldn't get more simple) when the cooks hadn't started making them yet. True kindness.
The central courtyard of Mulago. Covered walkways are essential in a city where it rains at least once a day for over half the year. Each floor is a different specialty, the 4th floor (from where this photo was taken) is ID and GI wards. The top floor is for patients who have a little bit of money and can pay for a more private room, as opposed to staying in one of the open-dormitory style wards for the rest of the hospital. 
Before entering the ID and GI wards, this is the scene looking out from the open air walk way. A storm is about to role in, a classic afternoon in Kampala. Calls to prayer from the mosque in the background can occasionally be heard on the floor, a reminder of the city's religious diversity. Many of Kampala's neighbourhoods can be identified by some religious edifice, including the only Baha'i temple on the African continent.
Photos from Weekend in Fort Portal
Dewan and Ali finished up their rotations at Mulago this past weekend, and as a farewell hoorah, we ventured to the city of Fort Portal, which lies at the foot of the Rwenzori mountains that form the border between Uganda and the Democratic Republic of Congo. It has a reputation for being the most beautiful place in the country because of its vast green hill side tea plantations (pictured above), rain forest national park, and crater lakes. Getting there consisted of a 5 hour bus ride through some very turbulent roads while a traveling salesman pontificated for the first 2 and 1/2 hours about the cancer risks of using steel wool to clean dishes at home. He followed up his speech by trying to sell some Chinese herbal tea which could cure both cancer and stomach ulcers. After the salesman got off halfway through the ride, the bus began to play Angelina Jolie's new film, "SALT," on the 12" TV at the front. Interestingly, the film would play for about 30 seconds, and then pause, while a male voice would narrate in the local language what was being said by the characters.
Where we stayed. Though the guesthouse hadn't had electricity for the 4 days prior to our arrival, it kicked in by day 2. Water for the cottages was kept in tanks outside that would be heated with charcoal whenever a hot shower was planned in advance. 
Trekking through the hillsides with the Rwenzoris in the backdrop and the occasional boda boda ferrying passengers from the villages to the trading centers along the main roads.
The crater lakes, so beautiful. Being the good medical students that Yale trained us to be, however, we looked into the most recent studies regarding the prevalence of Schistosomiasis in the lakes before deciding to take a swim. Despite previous theories they couldn't survive in lakes at higher altitude, it appears that the little critters have no problem adjusting. 
These red flowers pop up all over Uganda, like little bursts of rouge that freckle a background. Again, a crater lake can be seen in the distance on the left hand side and the Rwenzoris on the right. The forest here is well known for its large variety of monkeys, including chimpanzees. Though we didn't go chimp trekking, we did see our fair share of monkeys both hiking and while on the bus.
Musawo Muganda
Footage from our field trip to Budo last week. The film was shot by Esther. This is one of the more humorous moments of our meeting with the traditional healer when he discusses what he can do for lonely souls. Musawo Muganda literally means Bugandan doctor in Luganda, but is used to describe any traditional healer/ witch doctor who is not a trained Musawo Muzungu (literally white person doctor, or doctor of western-based medicine). Musawo Mugandas have been getting some very bad press lately because of increasing incidents of child sacrifice. As unbelievable as it sounds, and I even feel somewhat embarrassed talking about it, a number of Ugandans aspiring to great wealth have gone to such lengths as to pay a Musawo Muganda to sacrifice a strangers child with the belief that it will bring good luck. Mrs. M. explained to me that the witch doctors require that children must have unblemished skin for their rituals, so now lots of parents are having their kids' ears pierced at a very young age. Once the kids are found to have imperfect skin, they are usually released unharmed. The reports of child sacrifice in the newspapers were part of the impetus for our meeting with this Musawo Muganda.
Raising the Question
At the beginning of last week a friend emailed me an article from the Washington Post with the title “'Hang them': Uganda paper publishes photos of gays.” Currently, acts of homosexuality are illegal in Uganda and punishable by up to 14 years in prison. This past year, a bill was raised in the Ugandan parliament that would increase the penalty to life in prison. It also proposes the death penalty for a new crime of "aggravated homosexuality,” which is when one of the participants is a minor, HIV-positive, disabled or a "serial offender.” Because of international outcry against the bill, and concern by the Ugandan government that their Western donors would withhold funds, the bill has been tabled for a formal debate at a later time. While the politicians have held off slightly from their crusade, others in the community have taken up the cause in force, such as publicly identifying Ugandan gays and physically terrorizing them (http://www.bbc.co.uk/news/world-africa-11608241).
Uganda’s wide spread discrimination of gays has always been a particular challenge for me to overcome in choosing to work here. The human rights fellowship that I received in 2007 from the University of Minnesota Law School to do my first work in the country was funded by a gay couple in Minneapolis dedicated to promoting the fulfillment of rights around the world. It was strange to me that the same people who made it possible for me to start a men’s health education group in rural Eastern Uganda (which is still doing amazing work to this day) would never be welcomed by the people benefiting from their generosity. This fact bothered me so much that during my first trip, I quietly raised the issue with one of the regional office leaders for the Uganda Human Rights Commission while we were having dinner at a restaurant. As if we were trading State secrets, he responded in a whisper that human rights are based on law and the constitution says it illegal, therefore “they should be run out of the country.” After I tried making the case that human rights should at least protect everyone from harm, he then replied that homosexuality makes the family and society unstable, and that while Uganda is so unstable, it can’t accept it.
Reading about the recent attacks on Ugandan gays lead to another effervescence to say something. The topic had become a particular issue of conversation amongst the MUYU team. Each week the team has a class to learn about cultural practices in Uganda lead by a physician-pastor, who has been applauded for his ability to integrate science and spirituality. During one of these sessions last week, I asked him if he could translate for us the basis of the anti-homosexuality laws in Uganda since everyone on the MUYU team has friends who are gay and even now live in states where gay marriage is legal (except California). He assured us that he was never in support of the death penalty for gays, but explained that homosexuality is against their culture and therefor should not be supported. He reasoned that if homosexuality were permitted by law then young children would be recruited to becoming gay--a common argument not only heard in Uganda, but also the United States. When someone from our team raised the issue that gays should at least be protected from harm by human rights, the physician-pastor responded that he has never personally harmed anyone and then stated that gays always hold public rallies for their rights but you never see heterosexuals doing it. He then exclaimed, “what about my rights?” Somehow the dialogue of culture and rights has backfired in Uganda into a logic for intolerance. During my second stay in Uganda, I examined how legal and medical professionals thought human rights might help gays in Uganda encounter less discrimination when accessing healthcare. Surprisingly, it was common for interviewees to turn my question on me and ask “when are gays going to stop oppressing my rights?” The right being violated, many explained, was the right not to witness their “immoral” behavior.
After our class session had ended, one of my classmates asked me, “how do you think the doctor feels about the African-American rallies in the 1960s? Does he think they should have stopped complaining about their rights?” Just like the civil rights movement in the US, gays in Uganda face a serious threat of discrimination that is both state and culturally sanctioned. And though I can write lots about the sad state of things for this minority group here, equally worthy of note are the wonderful individuals that I’ve met who resist the intolerance. Though few in number, they make it easy to come back.
Uganda’s wide spread discrimination of gays has always been a particular challenge for me to overcome in choosing to work here. The human rights fellowship that I received in 2007 from the University of Minnesota Law School to do my first work in the country was funded by a gay couple in Minneapolis dedicated to promoting the fulfillment of rights around the world. It was strange to me that the same people who made it possible for me to start a men’s health education group in rural Eastern Uganda (which is still doing amazing work to this day) would never be welcomed by the people benefiting from their generosity. This fact bothered me so much that during my first trip, I quietly raised the issue with one of the regional office leaders for the Uganda Human Rights Commission while we were having dinner at a restaurant. As if we were trading State secrets, he responded in a whisper that human rights are based on law and the constitution says it illegal, therefore “they should be run out of the country.” After I tried making the case that human rights should at least protect everyone from harm, he then replied that homosexuality makes the family and society unstable, and that while Uganda is so unstable, it can’t accept it.
Reading about the recent attacks on Ugandan gays lead to another effervescence to say something. The topic had become a particular issue of conversation amongst the MUYU team. Each week the team has a class to learn about cultural practices in Uganda lead by a physician-pastor, who has been applauded for his ability to integrate science and spirituality. During one of these sessions last week, I asked him if he could translate for us the basis of the anti-homosexuality laws in Uganda since everyone on the MUYU team has friends who are gay and even now live in states where gay marriage is legal (except California). He assured us that he was never in support of the death penalty for gays, but explained that homosexuality is against their culture and therefor should not be supported. He reasoned that if homosexuality were permitted by law then young children would be recruited to becoming gay--a common argument not only heard in Uganda, but also the United States. When someone from our team raised the issue that gays should at least be protected from harm by human rights, the physician-pastor responded that he has never personally harmed anyone and then stated that gays always hold public rallies for their rights but you never see heterosexuals doing it. He then exclaimed, “what about my rights?” Somehow the dialogue of culture and rights has backfired in Uganda into a logic for intolerance. During my second stay in Uganda, I examined how legal and medical professionals thought human rights might help gays in Uganda encounter less discrimination when accessing healthcare. Surprisingly, it was common for interviewees to turn my question on me and ask “when are gays going to stop oppressing my rights?” The right being violated, many explained, was the right not to witness their “immoral” behavior.
After our class session had ended, one of my classmates asked me, “how do you think the doctor feels about the African-American rallies in the 1960s? Does he think they should have stopped complaining about their rights?” Just like the civil rights movement in the US, gays in Uganda face a serious threat of discrimination that is both state and culturally sanctioned. And though I can write lots about the sad state of things for this minority group here, equally worthy of note are the wonderful individuals that I’ve met who resist the intolerance. Though few in number, they make it easy to come back.
The CT Scan Part 1
Thursday morning, I woke up with an excruciating pain in the back of my throat. I had developed an esophageal ulcer from a freak accident where my doxycycline pill (antimalarial prophylaxis) got stuck in my throat during the prior weekend in Fort Portal. While I was busy trying to find a good position to swallow my breakfast without the feeling of a knife running down my esophagus, I noticed that Mr. and Mrs. M were not in their usual state of chatting with me about our mutual plans for the day. I thought they might be discontent with me eating only the insides of my morning margarine sandwich and neglecting to finish my African milk tea. While gathering the bread crusts on the edge of my plate, I apologized to Mr. M that my throat hurt and could only tolerate the soft sandwich innards. With a blank stare on his face, as if preoccupied with thoughts far from the breakfast table, he assured me that my new dietary requirements were not a problem.
On the ride to Mulago, the only thing that I could think about was finding some sort of painkiller or antacid to fight off the burning in my throat. Like Mr. M, Mrs. M also seemed much quieter than usual. But unable to deviate from my one track mind, I let the morning drive pass in silence, broken occasionally by the brakes shrieking as we bounced over decrepit speed bumps and weaved our way through pedestrians and livestock congregating in roundabouts. At the hospital, I found the ultimate cure, 2% lidocaine, a recommendation by one of the residents in the MUYU office. A little timid at first of putting a little PPD syringe full of lidocaine in my mouth, and aiming it in the mirror like a squirt gun around my uvula, I was euphoric to find my pain vanish in a matter of minutes (no viscous lidocaine or anesthetic sprays could be found). The freedom from torment, however, only lasted a half hour before I’d sneak away to the bathroom again for another fix.
With my pain under control, and my syringe and vial of lidocaine in my white coat, I made my way to the cancer institute at the top of the Old Mulago hill. I spent the last two weeks rotating there with Dr. Fred, an old friend and former visitor to Yale through the MUYU exchange. While waiting in his office for clinic to start, I got a phone call from Mrs. M. She was down in casualty (the emergency department). There had been an accident and Mr. M’s brother, P., was badly injured. She reported that there was a long line to see a doctor, and asked if I knew anyone that could help. I reported the situation to Dr. Fred and he gave me a letter for a friend down in casualty who he thought could help. I ran down the winding walk way of Old Mulago, skipping over sets of broken stairs, and taking the red dirt path shortcut snaked in between the TB and prenatal care wards.
Once inside the Eastern bloc edifice known as New Mulago, I scurried through semi-lit hallways lined with patients and their family members and down a flight of stairs to the casualty ward. There I found Mrs. M standing on the edge of a row of benches in front of a caged-in reception desk. She told me that P. had just been taken into a room and being seen by doctors. The casualty ward corridor is a series of concrete cells cut off to the outside world by wooden doors, whose opacity is enhanced by the white paint pealing at their edges. Mrs. M guided me to one of them, and unsure of what I would find behind the veneer, I pressed down on the handle and swung it open.
Inside the room I immediately noticed two young muzungu men in white coats and two plain clothed Ugandans struggling to hold down a man squirming on an exam table. They were trying to place an IV, and though P. looked half-sedated with his eyes closed and a swollen contusion across his forehead, he was doing everything he could to throw these guys off him. I shut the door behind me, and moved in closer to the action. The young munzugus were rapidly calling out in German to another young blonde woman in scrubs around the corner. She handed one of them a new IV needle and cannula, as P. began flexing his arm away again, I spoke up, “you want some lidocaine?” One of the German’s jokingly responded, “why, you know where to get some?” I pulled it out of my pocket and handed it to him. With a little bit of the numbing medication, and a big help from some Diazepam, an IV finally got situated in his right arm and P. rested easy on the table.
After the room settled down a bit, I asked who was in charge because I had a letter requesting a certain physician’s involvement. The Germans laughed again and said they weren’t sure who was supposed to be managing the ward. They introduced themselves, Thomas and Marcus, and told me they were senior medical students doing a rotation abroad as well. They advised me to check in the neighboring cell for a doctor who might be able to help me, but I was unsuccessful at finding any physician who could help. I abandoned my plans to find Fred’s friend, and realized these German medical students might actually be P.’s best shot. I returned to his bedside and asked their assessment and plan. Thomas told me P. had been hit by a matatu (minivan taxi) while walking on the street a few hours earlier and came into the ward with a GCS of 7 (severe head trauma, not making any verbal communication or opening his eyes, but localizing pain). He absolutely needed a CT scan, which everyone had written off as impossible because he came in with tattered clothes half hanging off his torso and dirt crusted to his skin. Even if he could afford it, they noted Mulago’s machine is down for at least another week. Next step would then be a neurosurgery consult, but the Germans added that they’re not going to do anything without a CT. I told them that I was a friend of his family’s and we would figure something out.
More to come soon...
On the ride to Mulago, the only thing that I could think about was finding some sort of painkiller or antacid to fight off the burning in my throat. Like Mr. M, Mrs. M also seemed much quieter than usual. But unable to deviate from my one track mind, I let the morning drive pass in silence, broken occasionally by the brakes shrieking as we bounced over decrepit speed bumps and weaved our way through pedestrians and livestock congregating in roundabouts. At the hospital, I found the ultimate cure, 2% lidocaine, a recommendation by one of the residents in the MUYU office. A little timid at first of putting a little PPD syringe full of lidocaine in my mouth, and aiming it in the mirror like a squirt gun around my uvula, I was euphoric to find my pain vanish in a matter of minutes (no viscous lidocaine or anesthetic sprays could be found). The freedom from torment, however, only lasted a half hour before I’d sneak away to the bathroom again for another fix.
With my pain under control, and my syringe and vial of lidocaine in my white coat, I made my way to the cancer institute at the top of the Old Mulago hill. I spent the last two weeks rotating there with Dr. Fred, an old friend and former visitor to Yale through the MUYU exchange. While waiting in his office for clinic to start, I got a phone call from Mrs. M. She was down in casualty (the emergency department). There had been an accident and Mr. M’s brother, P., was badly injured. She reported that there was a long line to see a doctor, and asked if I knew anyone that could help. I reported the situation to Dr. Fred and he gave me a letter for a friend down in casualty who he thought could help. I ran down the winding walk way of Old Mulago, skipping over sets of broken stairs, and taking the red dirt path shortcut snaked in between the TB and prenatal care wards.
Once inside the Eastern bloc edifice known as New Mulago, I scurried through semi-lit hallways lined with patients and their family members and down a flight of stairs to the casualty ward. There I found Mrs. M standing on the edge of a row of benches in front of a caged-in reception desk. She told me that P. had just been taken into a room and being seen by doctors. The casualty ward corridor is a series of concrete cells cut off to the outside world by wooden doors, whose opacity is enhanced by the white paint pealing at their edges. Mrs. M guided me to one of them, and unsure of what I would find behind the veneer, I pressed down on the handle and swung it open.
Inside the room I immediately noticed two young muzungu men in white coats and two plain clothed Ugandans struggling to hold down a man squirming on an exam table. They were trying to place an IV, and though P. looked half-sedated with his eyes closed and a swollen contusion across his forehead, he was doing everything he could to throw these guys off him. I shut the door behind me, and moved in closer to the action. The young munzugus were rapidly calling out in German to another young blonde woman in scrubs around the corner. She handed one of them a new IV needle and cannula, as P. began flexing his arm away again, I spoke up, “you want some lidocaine?” One of the German’s jokingly responded, “why, you know where to get some?” I pulled it out of my pocket and handed it to him. With a little bit of the numbing medication, and a big help from some Diazepam, an IV finally got situated in his right arm and P. rested easy on the table.
After the room settled down a bit, I asked who was in charge because I had a letter requesting a certain physician’s involvement. The Germans laughed again and said they weren’t sure who was supposed to be managing the ward. They introduced themselves, Thomas and Marcus, and told me they were senior medical students doing a rotation abroad as well. They advised me to check in the neighboring cell for a doctor who might be able to help me, but I was unsuccessful at finding any physician who could help. I abandoned my plans to find Fred’s friend, and realized these German medical students might actually be P.’s best shot. I returned to his bedside and asked their assessment and plan. Thomas told me P. had been hit by a matatu (minivan taxi) while walking on the street a few hours earlier and came into the ward with a GCS of 7 (severe head trauma, not making any verbal communication or opening his eyes, but localizing pain). He absolutely needed a CT scan, which everyone had written off as impossible because he came in with tattered clothes half hanging off his torso and dirt crusted to his skin. Even if he could afford it, they noted Mulago’s machine is down for at least another week. Next step would then be a neurosurgery consult, but the Germans added that they’re not going to do anything without a CT. I told them that I was a friend of his family’s and we would figure something out.
More to come soon...
The CT Scan Part 2
In the waiting area, I told Mrs. M the news. P. would need a CT but we would need to venture outside the hospital to find a machine that could work. It would also cost 180,000 Schillings (about $90, and insane amount of money for a population that mostly lives on less than $1 a day). Mrs. M immediately responded that there would be no problem getting the money or transportation necessary for a CT, she just needed advise on the nearest place to go. I hurried back into the casualty room, where P. was still lying on the exam table knocked out from the Diazepam, and the Germans were attending to another patient. They advised me to talk to the senior house officer (SHO), a second year resident, working in the neighboring cell for suggestions on where to get a scan.
On the other side of a cement wall, I found the young SHO talking with a frail elderly man who had collapsed on the street. He stopped his conversation with the patient to field my questions about finding a CT for P. He initially dismissed my inquiry as the result of a classic mzungu mistake; “Don’t worry about it, he can’t afford a scan.” Trying to be sympathetic to his intuition, I kindly explained that despite the patient’s appearance, money would not be a problem for this one. He gave a few names for diagnostic imaging centers in the area, but didn’t know where they were located. Beseeching the nursing staff seated in the corner, they recalled some of the roads and neighborhoods where I could find them. And just as I thought we had a green light, the SHO informed me that the patient still needed a CT request form filled out before he could leave. The hitch, the ward doesn’t have any forms, and the SHO doesn’t have any idea of where to find one. After apologizing that he was new to the ward, the young doctor returned to his interview with the elderly patient, now hunched over the side of the exam table.
Realizing there were no more teeth to pull on this side of the wall, I crossed back over to P.’s cell. I again turned to my new German friends for help. Maybe it was the rare chance to see their triage efforts carryover into definitive care, or the thrill of possibly uncovering a neurosurgical emergency that could save a man’s life, either way the medical students were excited to help P. a scan scan. Thomas went off on a mission throughout the hospital to find a CT request form, and Marcus and I began orchestrating how to transport P. to Mrs. M’s minivan waiting under the main entrance of the hospital.
After about 20 minutes, we acquired one of the few gurneys on the ward, and Thomas returned empty handed. The radiology department had informed him that the hospital was out of forms, but helped dictate one that he could handwrite on a blank piece of paper. With our quasi-document in hand, we started a mannitol drip (a medication that helps reduce pressure around the brain while increasing a patient’s need to urinate, which can be quite an inconvenience when no catheter kits are available), and then transferred P. to a gurney. As we struggled to steer through the throng of urgent care seekers, the stretcher’s wheels squealed incessantly, giving the patients an advanced notice to totter out of the way. When we reached the van, the mannitol had already begun to work its inconvenient magic; we gathered him up in our arms, his jeans sopping wet. We laid him across the two rows of seats folded down in Mrs. M’s minivan, and informed P.’s wife to keep his head elevated in her lap, as her feet dangled into the trunk space. After closing the back door, I turned around to see a large gathering of spectators made up of both staff and patients.
Inside the van, I scrunched up with my back pressed against the rear side of the front passenger seat where Thomas was sitting. With my right arm raised and elbow dangling outside the open car window, I held the mannitol bottle above my head. Our first stop was an imaging center in the neighborhood around Makerere University, which was only a 5 minute drive despite heavy traffic. The center’s machine was down too, so we hopped back into the van drove into the city center. After 30 minutes of getting mixed directions from pedestrians on the street, we arrived at a polished, modern multi-story building near the police headquarters. But again, luck wasn’t with us yet. This center didn’t do CT, their sister branch on the other side of the city had the scanner. So once more, we got back in the van and made our way across Kampala.
As a result of the morning’s non-stop hustle and bustle, I had almost completely forgotten about my inflamed esophagus. But as our make-shift ambulance trotted through the bumper-to-bumper traffic, speckling each other in red dust, I became very aware that my throat was still pissed off at me for the poor choice of taking my Doxy without water. I strangely began craving lidocaine, but found white coat pocket empty, having left the bottle behind for the casualty ward. With some effort, I ingested a handful of antacids and a few painkillers, and then tried to distract myself by naming all the neighborhoods we passed through. Thomas would periodically check-in to see if P. was waking up too much or required any more of the Diazepam that he had packed for the journey. But after an hour from when we had set out from the hospital, we finally found a functioning CT scanner without having to tackle too much restlessness from P.
The imaging center was located in the Beverly Hills of Kampala, known as Kololo. The center kept itself as polished as the homes around it. We were forced to take off our shoes when we entered the scanning room, and the staff was resistant to having P.’s gurney wheeled too close to the machine’s bed. So we again had to get creative transferring P., this time with a bed sheet sopping from Mannitol’s charm. The staff was just as guarded about their work as they were of their scanner. The technician was uneasy about letting us take a copy of the scan to the hospital until after the center’s radiologist gave her reading of it first. In the end, it took another hour and a half for the CT results to arrive at Mulago.
P. had two small isolated bleeds in the front of his brain (right and left frontal lobes) and one in the back (right parietal lobe), as well as a small fracture in his skull and a clear increase in pressure around his brain. He didn’t require emergent surgery, but it took us 7 hours from the time he first arrived in the hospital to figure this out. Compared to the rest of the patients coming into the casualty ward, P.’s is a success story. Back on the wards, he received a protocol of medications that would help prevent seizures, decrease the swelling around his brain, and prophylactically treat a possible infection.
That evening, I learned the fully story of what happened to P. Mr. M, who was needed out of town that day for his work, received a phone call from a relative just before breakfast. The relative had learned by word of mouth that a pedestrian had witnessed P. get hit in the head by the side-view mirror of a taxi van while he was walking on the side of a road on the east end of Kampala. The pedestrian had found P. struggling to standup after being struck to the ground, and then wandering into traffic. The good samaritan had lead him to a nearby health center, but the relative was unable to determine which one. So while I was chewing around the crusts of my margarine sandwich that morning, Mr. M was taking in the news that a relative had heard in rumor fashion that his brother was seriously injured and lost somewhere in the outskirts of the city.
A few days later, Mr. M cited the events of that morning to me as an example of the power of word-of-mouth news in Uganda. I had become frustrated with P.’s wife for repeatedly trying to feed him orally while he was still unconscious (before we could place an NG tube, a story that could take pages to write on its own). Every time I stopped by to see P., I would ask his wife if she tried feeding him again, and she would say yes, prompting me to warn her again of the dangers of aspiration. After days of this happening, I asked Mr. M why she keeps doing this when all the staff, not just me, tells her not to do it. “Doesn’t she get that she could seriously hurt him, if not kill him?” To which Mr. M simply replied, “she’s only doing what her mother tells her, which she learned from her mother, and so-on.”
Notes:
Lots of stories about P.’s stay in the hospital could be written, but so much is happening so quickly here that I don’t have the time to write it all down at the moment, so will try to stay on top of the highlights of current events.
-P is recovering well now, discharged from the hospital yesterday, walking, still some confusion, but very impressive for how he started.
-He did require another CT outside the hospital during his stay, with which John Binford helped me orchestrate
-Hit and run accidents are common practice in Kampala, so strangely, it’s not strange that the driver didn’t stop to help P. after hitting him
-Now in Gulu, stories from the final days in Kampala and travels North will come shortly
On the other side of a cement wall, I found the young SHO talking with a frail elderly man who had collapsed on the street. He stopped his conversation with the patient to field my questions about finding a CT for P. He initially dismissed my inquiry as the result of a classic mzungu mistake; “Don’t worry about it, he can’t afford a scan.” Trying to be sympathetic to his intuition, I kindly explained that despite the patient’s appearance, money would not be a problem for this one. He gave a few names for diagnostic imaging centers in the area, but didn’t know where they were located. Beseeching the nursing staff seated in the corner, they recalled some of the roads and neighborhoods where I could find them. And just as I thought we had a green light, the SHO informed me that the patient still needed a CT request form filled out before he could leave. The hitch, the ward doesn’t have any forms, and the SHO doesn’t have any idea of where to find one. After apologizing that he was new to the ward, the young doctor returned to his interview with the elderly patient, now hunched over the side of the exam table.
Realizing there were no more teeth to pull on this side of the wall, I crossed back over to P.’s cell. I again turned to my new German friends for help. Maybe it was the rare chance to see their triage efforts carryover into definitive care, or the thrill of possibly uncovering a neurosurgical emergency that could save a man’s life, either way the medical students were excited to help P. a scan scan. Thomas went off on a mission throughout the hospital to find a CT request form, and Marcus and I began orchestrating how to transport P. to Mrs. M’s minivan waiting under the main entrance of the hospital.
After about 20 minutes, we acquired one of the few gurneys on the ward, and Thomas returned empty handed. The radiology department had informed him that the hospital was out of forms, but helped dictate one that he could handwrite on a blank piece of paper. With our quasi-document in hand, we started a mannitol drip (a medication that helps reduce pressure around the brain while increasing a patient’s need to urinate, which can be quite an inconvenience when no catheter kits are available), and then transferred P. to a gurney. As we struggled to steer through the throng of urgent care seekers, the stretcher’s wheels squealed incessantly, giving the patients an advanced notice to totter out of the way. When we reached the van, the mannitol had already begun to work its inconvenient magic; we gathered him up in our arms, his jeans sopping wet. We laid him across the two rows of seats folded down in Mrs. M’s minivan, and informed P.’s wife to keep his head elevated in her lap, as her feet dangled into the trunk space. After closing the back door, I turned around to see a large gathering of spectators made up of both staff and patients.
Inside the van, I scrunched up with my back pressed against the rear side of the front passenger seat where Thomas was sitting. With my right arm raised and elbow dangling outside the open car window, I held the mannitol bottle above my head. Our first stop was an imaging center in the neighborhood around Makerere University, which was only a 5 minute drive despite heavy traffic. The center’s machine was down too, so we hopped back into the van drove into the city center. After 30 minutes of getting mixed directions from pedestrians on the street, we arrived at a polished, modern multi-story building near the police headquarters. But again, luck wasn’t with us yet. This center didn’t do CT, their sister branch on the other side of the city had the scanner. So once more, we got back in the van and made our way across Kampala.
As a result of the morning’s non-stop hustle and bustle, I had almost completely forgotten about my inflamed esophagus. But as our make-shift ambulance trotted through the bumper-to-bumper traffic, speckling each other in red dust, I became very aware that my throat was still pissed off at me for the poor choice of taking my Doxy without water. I strangely began craving lidocaine, but found white coat pocket empty, having left the bottle behind for the casualty ward. With some effort, I ingested a handful of antacids and a few painkillers, and then tried to distract myself by naming all the neighborhoods we passed through. Thomas would periodically check-in to see if P. was waking up too much or required any more of the Diazepam that he had packed for the journey. But after an hour from when we had set out from the hospital, we finally found a functioning CT scanner without having to tackle too much restlessness from P.
The imaging center was located in the Beverly Hills of Kampala, known as Kololo. The center kept itself as polished as the homes around it. We were forced to take off our shoes when we entered the scanning room, and the staff was resistant to having P.’s gurney wheeled too close to the machine’s bed. So we again had to get creative transferring P., this time with a bed sheet sopping from Mannitol’s charm. The staff was just as guarded about their work as they were of their scanner. The technician was uneasy about letting us take a copy of the scan to the hospital until after the center’s radiologist gave her reading of it first. In the end, it took another hour and a half for the CT results to arrive at Mulago.
P. had two small isolated bleeds in the front of his brain (right and left frontal lobes) and one in the back (right parietal lobe), as well as a small fracture in his skull and a clear increase in pressure around his brain. He didn’t require emergent surgery, but it took us 7 hours from the time he first arrived in the hospital to figure this out. Compared to the rest of the patients coming into the casualty ward, P.’s is a success story. Back on the wards, he received a protocol of medications that would help prevent seizures, decrease the swelling around his brain, and prophylactically treat a possible infection.
That evening, I learned the fully story of what happened to P. Mr. M, who was needed out of town that day for his work, received a phone call from a relative just before breakfast. The relative had learned by word of mouth that a pedestrian had witnessed P. get hit in the head by the side-view mirror of a taxi van while he was walking on the side of a road on the east end of Kampala. The pedestrian had found P. struggling to standup after being struck to the ground, and then wandering into traffic. The good samaritan had lead him to a nearby health center, but the relative was unable to determine which one. So while I was chewing around the crusts of my margarine sandwich that morning, Mr. M was taking in the news that a relative had heard in rumor fashion that his brother was seriously injured and lost somewhere in the outskirts of the city.
A few days later, Mr. M cited the events of that morning to me as an example of the power of word-of-mouth news in Uganda. I had become frustrated with P.’s wife for repeatedly trying to feed him orally while he was still unconscious (before we could place an NG tube, a story that could take pages to write on its own). Every time I stopped by to see P., I would ask his wife if she tried feeding him again, and she would say yes, prompting me to warn her again of the dangers of aspiration. After days of this happening, I asked Mr. M why she keeps doing this when all the staff, not just me, tells her not to do it. “Doesn’t she get that she could seriously hurt him, if not kill him?” To which Mr. M simply replied, “she’s only doing what her mother tells her, which she learned from her mother, and so-on.”
Notes:
Lots of stories about P.’s stay in the hospital could be written, but so much is happening so quickly here that I don’t have the time to write it all down at the moment, so will try to stay on top of the highlights of current events.
-P is recovering well now, discharged from the hospital yesterday, walking, still some confusion, but very impressive for how he started.
-He did require another CT outside the hospital during his stay, with which John Binford helped me orchestrate
-Hit and run accidents are common practice in Kampala, so strangely, it’s not strange that the driver didn’t stop to help P. after hitting him
-Now in Gulu, stories from the final days in Kampala and travels North will come shortly
The CT Scan Part 2
In the waiting area, I told Mrs. M the news. P. would need a CT but we would need to venture outside the hospital to find a machine that could work. It would also cost 180,000 Schillings (about $90, and insane amount of money for a population that mostly lives on less than $1 a day). Mrs. M immediately responded that there would be no problem getting the money or transportation necessary for a CT, she just needed advise on the nearest place to go. I hurried back into the casualty room, where P. was still lying on the exam table knocked out from the Diazepam, and the Germans were attending to another patient. They advised me to talk to the senior house officer (SHO), a second year resident, working in the neighboring cell for suggestions on where to get a scan.
On the other side of a cement wall, I found the young SHO talking with a frail elderly man who had collapsed on the street. He stopped his conversation with the patient to field my questions about finding a CT for P. He initially dismissed my inquiry as the result of a classic mzungu mistake; “Don’t worry about it, he can’t afford a scan.” Trying to be sympathetic to his intuition, I kindly explained that despite the patient’s appearance, money would not be a problem for this one. He gave a few names for diagnostic imaging centers in the area, but didn’t know where they were located. Beseeching the nursing staff seated in the corner, they recalled some of the roads and neighborhoods where I could find them. And just as I thought we had a green light, the SHO informed me that the patient still needed a CT request form filled out before he could leave. The hitch, the ward doesn’t have any forms, and the SHO doesn’t have any idea of where to find one. After apologizing that he was new to the ward, the young doctor returned to his interview with the elderly patient, now hunched over the side of the exam table.
Realizing there were no more teeth to pull on this side of the wall, I crossed back over to P.’s cell. I again turned to my new German friends for help. Maybe it was the rare chance to see their triage efforts carryover into definitive care, or the thrill of possibly uncovering a neurosurgical emergency that could save a man’s life, either way the medical students were excited to help P. a scan scan. Thomas went off on a mission throughout the hospital to find a CT request form, and Marcus and I began orchestrating how to transport P. to Mrs. M’s minivan waiting under the main entrance of the hospital.
After about 20 minutes, we acquired one of the few gurneys on the ward, and Thomas returned empty handed. The radiology department had informed him that the hospital was out of forms, but helped dictate one that he could handwrite on a blank piece of paper. With our quasi-document in hand, we started a mannitol drip (a medication that helps reduce pressure around the brain while increasing a patient’s need to urinate, which can be quite an inconvenience when no catheter kits are available), and then transferred P. to a gurney. As we struggled to steer through the throng of urgent care seekers, the stretcher’s wheels squealed incessantly, giving the patients an advanced notice to totter out of the way. When we reached the van, the mannitol had already begun to work its inconvenient magic; we gathered him up in our arms, his jeans sopping wet. We laid him across the two rows of seats folded down in Mrs. M’s minivan, and informed P.’s wife to keep his head elevated in her lap, as her feet dangled into the trunk space. After closing the back door, I turned around to see a large gathering of spectators made up of both staff and patients.
Inside the van, I scrunched up with my back pressed against the rear side of the front passenger seat where Thomas was sitting. With my right arm raised and elbow dangling outside the open car window, I held the mannitol bottle above my head. Our first stop was an imaging center in the neighborhood around Makerere University, which was only a 5 minute drive despite heavy traffic. The center’s machine was down too, so we hopped back into the van drove into the city center. After 30 minutes of getting mixed directions from pedestrians on the street, we arrived at a polished, modern multi-story building near the police headquarters. But again, luck wasn’t with us yet. This center didn’t do CT, their sister branch on the other side of the city had the scanner. So once more, we got back in the van and made our way across Kampala.
As a result of the morning’s non-stop hustle and bustle, I had almost completely forgotten about my inflamed esophagus. But as our make-shift ambulance trotted through the bumper-to-bumper traffic, speckling each other in red dust, I became very aware that my throat was still pissed off at me for the poor choice of taking my Doxy without water. I strangely began craving lidocaine, but found white coat pocket empty, having left the bottle behind for the casualty ward. With some effort, I ingested a handful of antacids and a few painkillers, and then tried to distract myself by naming all the neighborhoods we passed through. Thomas would periodically check-in to see if P. was waking up too much or required any more of the Diazepam that he had packed for the journey. But after an hour from when we had set out from the hospital, we finally found a functioning CT scanner without having to tackle too much restlessness from P.
The imaging center was located in the Beverly Hills of Kampala, known as Kololo. The center kept itself as polished as the homes around it. We were forced to take off our shoes when we entered the scanning room, and the staff was resistant to having P.’s gurney wheeled too close to the machine’s bed. So we again had to get creative transferring P., this time with a bed sheet sopping from Mannitol’s charm. The staff was just as guarded about their work as they were of their scanner. The technician was uneasy about letting us take a copy of the scan to the hospital until after the center’s radiologist gave her reading of it first. In the end, it took another hour and a half for the CT results to arrive at Mulago.
P. had two small isolated bleeds in the front of his brain (right and left frontal lobes) and one in the back (right parietal lobe), as well as a small fracture in his skull and a clear increase in pressure around his brain. He didn’t require emergent surgery, but it took us 7 hours from the time he first arrived in the hospital to figure this out. Compared to the rest of the patients coming into the casualty ward, P.’s is a success story. Back on the wards, he received a protocol of medications that would help prevent seizures, decrease the swelling around his brain, and prophylactically treat a possible infection.
That evening, I learned the fully story of what happened to P. Mr. M, who was needed out of town that day for his work, received a phone call from a relative just before breakfast. The relative had learned by word of mouth that a pedestrian had witnessed P. get hit in the head by the side-view mirror of a taxi van while he was walking on the side of a road on the east end of Kampala. The pedestrian had found P. struggling to standup after being struck to the ground, and then wandering into traffic. The good samaritan had lead him to a nearby health center, but the relative was unable to determine which one. So while I was chewing around the crusts of my margarine sandwich that morning, Mr. M was taking in the news that a relative had heard in rumor fashion that his brother was seriously injured and lost somewhere in the outskirts of the city.
A few days later, Mr. M cited the events of that morning to me as an example of the power of word-of-mouth news in Uganda. I had become frustrated with P.’s wife for repeatedly trying to feed him orally while he was still unconscious (before we could place an NG tube, a story that could take pages to write on its own). Every time I stopped by to see P., I would ask his wife if she tried feeding him again, and she would say yes, prompting me to warn her again of the dangers of aspiration. After days of this happening, I asked Mr. M why she keeps doing this when all the staff, not just me, tells her not to do it. “Doesn’t she get that she could seriously hurt him, if not kill him?” To which Mr. M simply replied, “she’s only doing what her mother tells her, which she learned from her mother, and so-on.”
Notes:
Lots of stories about P.’s stay in the hospital could be written, but so much is happening so quickly here that I don’t have the time to write it all down at the moment, so will try to stay on top of the highlights of current events.
-P is recovering well now, discharged from the hospital yesterday, walking, still some confusion, but very impressive for how he started.
-He did require another CT outside the hospital during his stay, with which John Binford helped me orchestrate
-Hit and run accidents are common practice in Kampala, so strangely, it’s not strange that the driver didn’t stop to help P. after hitting him
-The esophageal ulcer stopped ruining my life after 10 days
-Now in Gulu, stories from the final days in Kampala and travels North will come shortly
On the other side of a cement wall, I found the young SHO talking with a frail elderly man who had collapsed on the street. He stopped his conversation with the patient to field my questions about finding a CT for P. He initially dismissed my inquiry as the result of a classic mzungu mistake; “Don’t worry about it, he can’t afford a scan.” Trying to be sympathetic to his intuition, I kindly explained that despite the patient’s appearance, money would not be a problem for this one. He gave a few names for diagnostic imaging centers in the area, but didn’t know where they were located. Beseeching the nursing staff seated in the corner, they recalled some of the roads and neighborhoods where I could find them. And just as I thought we had a green light, the SHO informed me that the patient still needed a CT request form filled out before he could leave. The hitch, the ward doesn’t have any forms, and the SHO doesn’t have any idea of where to find one. After apologizing that he was new to the ward, the young doctor returned to his interview with the elderly patient, now hunched over the side of the exam table.
Realizing there were no more teeth to pull on this side of the wall, I crossed back over to P.’s cell. I again turned to my new German friends for help. Maybe it was the rare chance to see their triage efforts carryover into definitive care, or the thrill of possibly uncovering a neurosurgical emergency that could save a man’s life, either way the medical students were excited to help P. a scan scan. Thomas went off on a mission throughout the hospital to find a CT request form, and Marcus and I began orchestrating how to transport P. to Mrs. M’s minivan waiting under the main entrance of the hospital.
After about 20 minutes, we acquired one of the few gurneys on the ward, and Thomas returned empty handed. The radiology department had informed him that the hospital was out of forms, but helped dictate one that he could handwrite on a blank piece of paper. With our quasi-document in hand, we started a mannitol drip (a medication that helps reduce pressure around the brain while increasing a patient’s need to urinate, which can be quite an inconvenience when no catheter kits are available), and then transferred P. to a gurney. As we struggled to steer through the throng of urgent care seekers, the stretcher’s wheels squealed incessantly, giving the patients an advanced notice to totter out of the way. When we reached the van, the mannitol had already begun to work its inconvenient magic; we gathered him up in our arms, his jeans sopping wet. We laid him across the two rows of seats folded down in Mrs. M’s minivan, and informed P.’s wife to keep his head elevated in her lap, as her feet dangled into the trunk space. After closing the back door, I turned around to see a large gathering of spectators made up of both staff and patients.
Inside the van, I scrunched up with my back pressed against the rear side of the front passenger seat where Thomas was sitting. With my right arm raised and elbow dangling outside the open car window, I held the mannitol bottle above my head. Our first stop was an imaging center in the neighborhood around Makerere University, which was only a 5 minute drive despite heavy traffic. The center’s machine was down too, so we hopped back into the van drove into the city center. After 30 minutes of getting mixed directions from pedestrians on the street, we arrived at a polished, modern multi-story building near the police headquarters. But again, luck wasn’t with us yet. This center didn’t do CT, their sister branch on the other side of the city had the scanner. So once more, we got back in the van and made our way across Kampala.
As a result of the morning’s non-stop hustle and bustle, I had almost completely forgotten about my inflamed esophagus. But as our make-shift ambulance trotted through the bumper-to-bumper traffic, speckling each other in red dust, I became very aware that my throat was still pissed off at me for the poor choice of taking my Doxy without water. I strangely began craving lidocaine, but found white coat pocket empty, having left the bottle behind for the casualty ward. With some effort, I ingested a handful of antacids and a few painkillers, and then tried to distract myself by naming all the neighborhoods we passed through. Thomas would periodically check-in to see if P. was waking up too much or required any more of the Diazepam that he had packed for the journey. But after an hour from when we had set out from the hospital, we finally found a functioning CT scanner without having to tackle too much restlessness from P.
The imaging center was located in the Beverly Hills of Kampala, known as Kololo. The center kept itself as polished as the homes around it. We were forced to take off our shoes when we entered the scanning room, and the staff was resistant to having P.’s gurney wheeled too close to the machine’s bed. So we again had to get creative transferring P., this time with a bed sheet sopping from Mannitol’s charm. The staff was just as guarded about their work as they were of their scanner. The technician was uneasy about letting us take a copy of the scan to the hospital until after the center’s radiologist gave her reading of it first. In the end, it took another hour and a half for the CT results to arrive at Mulago.
P. had two small isolated bleeds in the front of his brain (right and left frontal lobes) and one in the back (right parietal lobe), as well as a small fracture in his skull and a clear increase in pressure around his brain. He didn’t require emergent surgery, but it took us 7 hours from the time he first arrived in the hospital to figure this out. Compared to the rest of the patients coming into the casualty ward, P.’s is a success story. Back on the wards, he received a protocol of medications that would help prevent seizures, decrease the swelling around his brain, and prophylactically treat a possible infection.
That evening, I learned the fully story of what happened to P. Mr. M, who was needed out of town that day for his work, received a phone call from a relative just before breakfast. The relative had learned by word of mouth that a pedestrian had witnessed P. get hit in the head by the side-view mirror of a taxi van while he was walking on the side of a road on the east end of Kampala. The pedestrian had found P. struggling to standup after being struck to the ground, and then wandering into traffic. The good samaritan had lead him to a nearby health center, but the relative was unable to determine which one. So while I was chewing around the crusts of my margarine sandwich that morning, Mr. M was taking in the news that a relative had heard in rumor fashion that his brother was seriously injured and lost somewhere in the outskirts of the city.
A few days later, Mr. M cited the events of that morning to me as an example of the power of word-of-mouth news in Uganda. I had become frustrated with P.’s wife for repeatedly trying to feed him orally while he was still unconscious (before we could place an NG tube, a story that could take pages to write on its own). Every time I stopped by to see P., I would ask his wife if she tried feeding him again, and she would say yes, prompting me to warn her again of the dangers of aspiration. After days of this happening, I asked Mr. M why she keeps doing this when all the staff, not just me, tells her not to do it. “Doesn’t she get that she could seriously hurt him, if not kill him?” To which Mr. M simply replied, “she’s only doing what her mother tells her, which she learned from her mother, and so-on.”
Notes:
Lots of stories about P.’s stay in the hospital could be written, but so much is happening so quickly here that I don’t have the time to write it all down at the moment, so will try to stay on top of the highlights of current events.
-P is recovering well now, discharged from the hospital yesterday, walking, still some confusion, but very impressive for how he started.
-He did require another CT outside the hospital during his stay, with which John Binford helped me orchestrate
-Hit and run accidents are common practice in Kampala, so strangely, it’s not strange that the driver didn’t stop to help P. after hitting him
-The esophageal ulcer stopped ruining my life after 10 days
-Now in Gulu, stories from the final days in Kampala and travels North will come shortly
Binford's Arrival
After launching his pedicab project (http://www.yaledailynews.com/news/2010/nov/08/yalies-start-pedicab-business-to-support/), Binford made the great journey east to Entebbe via Istanbul. I picked him up from the airport last Monday, and the way there negotiated with the driver, Akra, to be our driver for next month in Gulu. Akra had been my go-to taxi driver in Kampala, and coincidentally the driver Mr. and Mrs. M use for their children when they can't pick them up in school. Knowing how reliable he was, I was certain he would make a great addition to our team, even if he's a little unfamiliar with The North (or as he put it, "Being here is like when you travel from the US to Uganda). Akra has only visited a few other cities outside of Kampala, a for a few hours each.
Since John arrived, we have been acting as primary care doctors for Mr. M's brother, working hard to get an expedited review of our film and research proposal from the Makerere School of Public Health, and making arrangements for our projects in Gulu. Lots of success stories, will tell in the coming posts...
The Eritreans
While visiting Kampala in 2007, I ventured across the street from the Human Rights Commission to do some shopping for souvenirs at a crafts market that benefited local organizations supporting women in need. While visiting one of the stalls, a female vendor, who looked East African but not Ugandan, asked me where I was from. I said the USA, and she followed up with, "Which state?" I replied, "you've probably never heard of it, but it's the greatest of them all, Minnesota." To which, she said, "My sister lives there." This is how I met Yordanos. She is an Eritrean refugee who has been living in Kampala since 2003. At the time that I met her, she had two sisters living in the US (Hizbawit in Minnesota, another in Colorado), two sisters left in Eritrea, and one sister with her in Kampala, Sehin. During my previous stays in Uganda, Yordanos has invited me and fellow travelers to her apartment in Old Kampala for amazing Ethiopian/Eritrean lunches on Sunday afternoons when she is not working in her shop. This year, I found her again in the same craft market, and once more she invited me and my friends to her place to enjoy her native cuisine and hospitality. On the way to her place, Binford was captivated by the scene of a man carrying the back door of a matatu while riding a boda boda. 
A lot has changed for Yordanos since I last saw her in 2008. First, she spent most of last year working odd end jobs in Juba, Southern Sudan, where she raised enough money to now be able to rent half of a stall in the craft market where she can sell goods she directly buys from suppliers. This still doesn't provide her with enough income, she works at another stall selling crafts for her landlord. Secondly, Yordanos's mother was granted permission last week to come to the US and live with her sister in Colorado. Her mother had been a refugee in Nairobi for most of the past year with Yordanos's younger sister, Emuna (which means Hope), who is 20. Both have recently relocated to Kampala, Emuna now works in Yordanos's craft shop and the mother will be leaving for the US in two weeks. The last big change for Yordanos, however, has to do with her sister, Sehin.
When I found Yordanos sitting in her shop two weeks ago, I immediately asked about her sister Sehin, to me they were inseparable. Sehin is younger than Yordanos by a couple years, and speaks nearly fluent English, which always came in handy during our lunches. While sitting on tiny, wooden tripod stools on her half of the craft shop, Yordanos pulled out a large blue annual planner from a low lying shelf, and told me that she has concerning news about her sister. She opened the planner, and on the inside cover was a world map, with black pen lines drawn from Kampala to Dubai, Dubai to Ecuador (a shaky tracing across Europe with some scratch marks over Turkey), Ecuador to Columbia, Columbia to Honduras, Honduras to some where in the middle of Mexico. After 7 years, Sehin had grown tired of being a refugee in Kampala and set out to make some money in Dubai. While there, she met a handful of other Eritreans intent on reaching the US and applying for asylum. Their journey began two months ago, and Yordanos only receives a phone call from her sister when she arrives at an immigration office kind enough to let her call her family. Yordanos last spoke to Sehin when she had arrived in Honduras two weeks ago. The conversation lasted for only a few minutes, but Yordanos learned that Sehin had to walk 5 days straight in Columbia without rest and with little food, had to cross by paddle boat to Panama, and was now on her way to Mexico. No one in the family has communicated with Sehin since Honduras, but we recorded video messages from her sisters and her mother on my flip camera that will be posted online for her to see for whenever she gets access to the internet again.
The story of Yordanos and her family is closely tied to the land they come from. The mother is Ethiopian and the father is Eritrean. After over 30 years of conflict and a mutual disdain for people born on the other side of the border, the family has been torn apart. The youngest sister, Aday (which is the name of a yellow flower that only blooms in September) had been living with her father in Eritrea until this past September when she secretly crossed the border with some friends to defect to a refugee camp in Ethiopia. Aday is 16. Above: Yordanos and her mother relax while roasting coffee beans after our meal. The hospitality of this family cannot be praised enough. In this video, Michael, John, and I are wowed by their traditional technique of making coffee.
John, Emuna, Mother, Michael, Me, and Yordanos
Headed North
Akra with our ride on the highway north. We traded his car for his dad's for the month. We lost a pretty nice radio, but gained a lot more reliability and security in the rest of the car's functions. It's about a 4 hour drive from Kampala to Gulu, but ours had few delays...
Road accidents are a pretty common site in Uganda. We came across this accident an hour and a half into our drive. A matatu collided with a lorry carrying timber. We stopped to offer help.
Binford put his emergency medicine skills to good use for this American on board the matatu, heading towards Murchison Falls for a safari. The collision caused his shoulder to hit the seat in front of him with considerable force. Luckily, he broke no bones and John made sure the pulses, sensation, and motor functions were intact in his arm. His shoulder, though, caused him immense pain with any movement, so Binford fashioned a little sling with a T-shirt, a skill he picked up recently with some Wilderness Medicine folks in Connecticut. I, on the other hand, relied on my pre-med training to be of assistance. A mzungu came over to our car and typed into a little hand-held device, which then produced short English phrases on its screen. "Can you call my friend?" "Tell him I'm okay." "I have no minutes." While we tried to communicate in English, it became clear he couldn't understand us very well, nor produce much of any language from his mouth. I asked, "Where are you from?" That one he understood. A strained "France" came out of his tightly pursed lips. So I put my French to use, he would respond on his machine, and in the end, we got him a ride on another matatu taking him back to the French Embassy in Kampala.
After our work was done there, we continued on our way, crossing the Nile while baboons chased along side our car for food, and reached a small town just north of the river where the election fervor was taking hold. Yellow is the color of the ruling party, the National Resistance Movement (NRM). And dried banana leaves are another symbol they commonly employ. Note on the back of the matatu, it says "School Fees." Not sure what to make of this phrase, but big decals saying all kinds of phrases like "God Will" or "Jesus is Lord" are routinely pasted on the rear windows of buses and taxi vans.
Museveni on a T-shirt. Elections will be held this February. With so many candidates running for president and the opposition parties fragmented, public opinion is that there won't be much trouble for the ruling party.
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