The kids of Nyamitanga

I tease Danny that he had an entire social network established in Mbarara before I even arrived, but have to comment on how amazing one of these particular connections has been- The Nyamitanga Kid's Club.




Danny met the kids while out on a run during his first week in Uganda. He came across a field of kids playing soccer. A week later was one of their coaches. A month land a half later he is regular in the village, and spends a few days a week hanging out at the kids club, which doubles as a home for four orphans. I've joined him on a few occasions, including last Saturday, and took a couple of pictures to share.

The kids are incredible. My husband is amazing.

Surviving Malaria

I suppose it was to be expected. When you spend time around sick people, you will get sick. So, yes, I spent most of this week suffering through a nasty upper respiratory infection. A typical virus that came in with a sore throat and left with a stuffy nose. Although, if you ask anyone around here, it could have been malaria...

I survived my cold without any trouble, but got a great insight into how deeply held the common, "catch-all" diagnosis of malaria really is. It makes sense, I guess, if you live in a village where most women aim to have at least 5 kids, as they know that there is a good chance they may lose 1 or 2 to malaria before the age of 5. Although tragic that these women are probably correct with their diagnosis, the subsequent common labeling of every febrile illness as malaria goes undisputed in day-to-day life. The examples are endless. In an article today by the BBC about the violence in Northern Uganda, there were only 2 reported reasons that people died. They were either victims of the LRA, or... "malaria". Another example came from some of the residents in the hospital. These doctors can list every malarial symptom, stage in the parasite's lifecycle and side-effect of the treatments, but still admit to putting themselves on empiric anti-malaria medication at the first sign of just about any illness. Who can blame them, I suppose. The stakes are high, and the treatment is cheap.

In any case, I survived my cold and am feeling much better. But maybe I'll stock our bathroom with some new medication. Just in case.

Runyankole and other mind numbing tidbits

I’m pretty sure “Wasibota” means good afternoon. I was very excited to arrive in Uganda and continue working on the little bit of Swahili I picked up in Tanzania and Kenya. To my dismay, however, it turns out that no one speaks Swahili in Uganda. Several native languages are spoken in Uganda including “Runyankole” which is spoken here in the southwest corner of the country where Mbarara is located. Runyankole is no where near as easy as Swahili appeared to be, hence my confusion in using Wasibota. As a matter of fact, after being here for 5 weeks, I am still not sure exactly which hello to use in the morning, afternoon, night, or in general for that matter. I bought a cheap phrase book in town, but it was useless because it taught me how to say things like “my leg is paining” or “my neighbor is thievery” yet still did not give me a word for hello. Lynn and I have decided to find a tutor to try to teach us a couple of times a week for a month or so to see if we pick it up at all or to at least learn some of the basics.
In addition to trying to figure out the language, we have been very busy meeting new people, expats and locals alike. I already have about 25 contacts in my phone including the kid who promised to ride me on his bicycle any where I wanted to go. The locals here have been great; everyone from the students and teachers to the doctors and medical students at Lynn’s hospital. We have at least one dinner party per week, and sometimes more. Overall, the locals have been very kind and easy to talk to. However, aside from the constant Mzungu…Mzungu (white person in Runyankole and Swahili) we do get the stares from some people which are neither curious nor friendly, but instead say, without the need of words, “What are you doing here whitey?”

School (pictured above) is going well and looks to get more interesting as we progress. There are 10-12 of us in my class and we complete the year in 2-4 week modules. For instance, I just finished my first three week module, which was Intro to Development and now move on to a two week module in communication skills with a different professor. Going to school here is a quite a different experience than when I lived and studied in China. In China I was one of three hundred foreigners from all over the world living and studying together. Here I am the only “Mzungu” enrolled in the entire school. I’m hoping they get bored with that fact real soon. The other difference is that here I am involved in a serious and complicated program, development, which is fraught with myths, perceptions, and misconceptions on both the “developed” and “developing” sides of the issue. Already, after my first three weeks of class and having lived here for five weeks, I have had to totally transform my own definition of “development” and learn that the word can at times be presumptuous and at other times downright arrogant. However, the greatest part of the class is that as a group we get first hand knowledge from each other regarding our respective countries socially, politically, etc… so there are less assumptions being tossed around. Oh yeah, and one other difference, there are no textbooks here; at least in my program as far as I can tell. We get "a" handout or "a" book to look at, but we have to pay to make photocopies for ourselves. The other day my change for the photocopies was paid to me in candy. We love it here!
Well, I could write for hours about the things we are doing here, but I know that no one would come back to the blog if I did......so more later.

Lake Mburo

So, after a rough 2 whole weeks in the daily grind of life in Mbarara, we decided we needed a vacation... We escaped to the beautiful Lake Mburo National Park for a couple of days wildlife watching, hiking, boating and generally enjoying the beautiful surroundings.

Mbarara Hospital

You just have to be comfortable not knowing.

This is the most important lesson I have learned in my first week of work at Mbarara Hospital, and one that I suspect will cause me strife throughout my time here. It's really unnerving to be making important clinical decisions about a patient's care with virtually no hard information outside of my clincal exam. In the US, I frequently didn't even meet my patient until after I had the results of a complete blood count, a renal panel, a liver panel, an Xray, often a CT scan and sometimes an MRI. Things are different here. But let me start at the beginning, by describing the hospital...

Mbarara Hospital is a public hospital, meaning it is funded by the Ugandan Ministry of Health and general care in the hospital is free. It is affiliated with the medical school (MUST), one of only 2 med schools in the country, and so the hospital is staffed by med students and residents. The med students are good, and the residents are really excellent.

There are a few different wards in the hospital: a pediatric ward, an OB ward, an emergency ward, a surgical ward, and our medical ward. The medical ward is split into a men's and women's side and there are a total of 56 beds that lie in 2 rows about 2 feet from each other. Despite there being 56 beds, the ward is usually over capacity with many patients in spaces on the floor. There are 2 nurses for the whole ward, and very few other staff.

One of the most unique aspects of the hospital that struck me on my first day and continues to astonish me as I go to work everyday, is the presence of "attendants". Every patient is expected to have family tend to ALL their non-medical needs. This includes feeding, toileting, laundry, providing bedding. Everything! As you can imagine, a hospital full of patients creates the need for many, many attendants, and so the grass outside the ward is filled with women doing laundry or preparing food, other family members sleeping, and many just sitting. Waiting.

As a place to work, the hospital is great, but this is in part due to the rather sad dichotomy between the well-read, very intelligent, hard-working med students, interns and residents and the stark lack of resources, medications, and investigative abilities of the hospital. For my purposes of trying to gain broader clinical experience, my past 2 weeks have been the richest of my short career, but the tragic disparity between the impressive brain-power that you find in a good clinical training program such as this and the lack of tools available is apparent everyday, with almost every case. Having said that, no one here sits around complaining! They are creative, resourceful and able to provide impressive quality of care to the whole ward for the cost of a single ER visit in the US...

So what do I actually do? I am formally a volunteer teaching attending in the department of medicine (Yes- I actually have my Ugandan Medical License- can't wait to put that on a CV!), and am assigned to one of the 4 medical teams. It is surprisingly like any other residency program in the US or the UK, in that we have post-call intake rounds every morning, and I lead a combination of bedside teaching rounds with medical students and work rounds with the whole team when we see every patient together. The resident I work with is wonderful, and steers me back to Uganda when I fly off on a diagnostic tangent that is feasibly impossible.

As I said, you just have to be comfortable not knowing exactly what the diagnosis is. Be thorough. Make your best guess. Then treat, treat, treat!

Holy Thunderstorms Batman!!

I had to write a quick comment as I sit through (one of the few I haven't been caught in) our third or fourth consecutive, unrelenting, afternoon downpour. I have never lived anywhere before that actually had a "rainy season." Uganda has two. This one officially started yesterday, but it really started three days ago. It's pretty wild as each day starts out very nice, then gets hot in the middle of the day and then, sure enough, each afternoon between 2-4 you see a dark cloud coming in from the east and within minutes it's dumping sheets of rain....enough in each storm to drown Santa Barbara, but doesn't even phase Mbarara. It will rain, thunder, and lightening for 30min to an hour and then clear up beautifully in time for me to head off to school. You can imagine how green it is here and we will never have to worry about water conservation. I also get to use umbrellas for the first time in my life, which my Scottish wife thought was totally obnoxious.

Life in Mbarara

After a week here in Uganda, it is surprising how much today felt like any Monday anywhere. We had a great weekend, with no work or school for either of us, and spent time shopping for our house, playing soccer with the girls in the local village of Nyamatanga, eating out with a couple of our neighbors on Saturday night, and lounging by the pool at a “fru-fru” hotel just out of town on Sunday afternoon. It could have been Santa Barbara- well, almost…

For anyone we haven’t bored with our pre-trip lectures… Mbarara is a bustling town on the main road between the capital of Uganda, Kampala, and the Southwest regions of the country, and Rwanda. The presence of the university and medical school, means that there are plenty of students around, although the vast majority of Mbarara’s population of 100, 000 has no tie to the university, and outside of the immediate city center, life is very rural and centered in small villages. Thanks to these local farming villages, there is an absolutely amazing vegetable market where we are able to fill our bags with huge avocados, tomatoes, eggplant, bananas, cucumbers, papaya and bell pepper for less than five US dollars total!

We are living on the campus of the university (Mbarara University of Science and Technology) in a set of houses reserved for visiting ex-pats to the university. By East African standards the houses are great with running water, toilets and a reasonably well-equipped kitchen. The location is fantastic, and my “commute” to the hospital is a 50 yard walk, while Danny’s development classes are held in a building 50 yards in the other direction. We are about a mile from the center of town, so also have easy access to shopping and the market. Our neighbors are wonderful, and although we feel well and truly submerged in African life, the presence of a few fellow-Mzungus (Swahili word for “whitey”) has definitely made the adjustment easier!

Despite being virtually on the equator (check out Mbarara on Google Earth and you’ll see what I mean!), the climate is really quite pleasant. The middle of the day is usually in the high 80’s, but most of the time the temperature is in the 60’s or 70’s. And yes, most importantly, I am able to sport my Yater hooded sweatshirt in the evenings! The region is at an altitude of around 4500ft which helps keep things cooler, as well as reducing the number of mosquitos- although they still seem to find poor Danny, and I never seem to get bites. (For all my teasing I’m sure I’ll be the one who comes down with malaria!) As for rain, we are now entering the rainy season and have had a few spectacular afternoon thunderstorms, during which seemingly impossible quantities of rain seem to come from the sky. Okay, maybe not much like Santa Barbara afterall…