Day 6

Let’s talk about food!

Probably one of my favorite things about traveling abroad is experiencing the culture through food.  I think you can learn a lot about a place via how people eat and share their meals, and obviously I just love to try about anything that’s put in front of me.  At least once.  Probably my best travel cuisine experience thus far has been in India.  I ate seconds (or thirds) at every meal, and had a nice glass of chai tea to go alongside.

I’ve had a fair amount of traditional Ugandan food thus far.  Unfortunately some larger towns you go to, like Mbrarara, seem to cater to visiting Muzungus in that they Americanize a lot of dishes and you don’t get a true food experience.  So far the most traditional food I’ve eaten has been at the hospital.  There’s two “canteens” there where you can get a really filling meal for about 4,000 Shillings, or a little less than $2.  Generally this consists of rice with a lot of other stuff piled on top.  It’s a bit of a carbohydrate overload, but I figure with the amount of sweating I’m doing, it probably burns off.  Anyway, here’s a few of the main food groups I’ve discovered and tasted so far:

Fruit – I love love love fresh fruit.  Sometimes it can be a bit dangerous to eat without preparing properly, but sometimes I find myself having a wild moment and just going for it anyway.  One of my favorites is passion fruit, which we don’t have back home.  Or if we did I’m sure it would be genetically engineered and flavorless.  Anyway, this looks kind of like a cross between a kiwi and ping-pong ball.  It’s hard and green on the outside.  Then you crack the hard shell and the fruit inside is bright yellow, semi-solid, and has these nice crunchy black seeds which are edible as well.  It tastes just delightful – a little more tart than sweet.  Anyway, the hospital cafeteria makes PF juice.  I was about to buy a glass the other day until my co-traveler Anem asked if they mixed it with the water, to which they replied “yes”.  My spirits were crushed.  Delicious passion fruit juice and possible massive diarrhea?  Or no juice and being a little sad for the rest of the day?  I went with the being sad choice.  Otherwise there’s fresh pineapple (which is interestingly a lot lighter in color than ours), delicious avocados, mangos, and bananas literally by the truckload (as in trucks drive down the road piled full of bananas).  So many to choose from!

Matoke (Ma-toe-kay)– this is, from best I can tell, mashed up ripe plantains.  It’s served on the side kind of like mashed potatoes would be in an American meal.  It has a very mild banana flavor mixed with somewhat of a starchy flavor.  I’ve been eating buckets of this at lunch, until I found out there’s a condition here called “Matoke-booty” where you eat too much Matoke and your booty gets real big.

Posha (Posh-ah) – this is maize flour combined with water to make a solid mash-type food.  I’m not really sure why it’s a common food here … if it’s supposed to be something you sop up sauce with, or you just eat it plain?  But it tastes kind of like you would think … like uncooked flour mixed with water that’s firm in texture.  So that’s kind of weird.  Maybe I’ll acquire a taste for it?

G-nuts and G-nut Sauce – this seems to be THE prototypical Ugandan food so far.  G-nut means ground nuts.  They seem to be in the peanut family but are a little smaller than our peanuts and taste somewhat more mild.  They grind them up and mix them with something (?) that gives the sauce an eerie lavender color.  I was a bit put-off when it first arrived on my plate at lunch, but it turned out to taste pretty good!  It’s not an obvious peanut flavor like Thai peanut sauce, but nice and mild and would go with pretty much anything you put it on I guess.

If I find any more fantastic foods, I’ll let you know!  Apparently BBQ Goat is a big deal here, so I’ll try and get my hands on some!

Day 5

I just love our medical students here.  The attendings and residents on the team change frequently, but the medical students are always there and really the best form of continuity for their patients.  They’re expected to know the patient better than the resident does, and also to make sure the patient gets the treatments they need since there are so few nurses available.

This morning we were starting rounds, and Anthony, one of the third year students (here medical school is 5 years) grabbed me and said “Dr Kacie – I’m worried about this patient over in the corner – I think she needs fluids”.  The patient wasn’t even his patient, he was just observant enough to notice someone in distress who wasn’t being attended to.  So I went over with him somewhat hurriedly to evaluate her. Since she wasn’t his patient he didn’t know what her primary problem was, and we didn’t have a time to look through her chart.  She was huddled under blankets and looked very ill.  I checked her pulse rate: 126.  I grabbed a blood pressure cuff and as I tried to uncover her I put my hand down in something warm and goopy … a pile of fresh yellow sputum.  She had been coughing up phlegm into the scarf she was covering up with.  After starting some fluids on her we took a quick peek at the chart – sure enough – her sputum was positive for Tuberculosis.  Thankfully it can’t travel through the skin, but I sure did douse myself in some chlorhexidine I found in one of the lab sinks!

And remember that CXR lecture we gave yesterday?  Every time we would pass a bed today that had a chest film on it, the med students would pick it up, huddle together and try and interpret it using the steps I taught them.  They all did a great job!  It made me proud watching them learn!

On rounds the students get asked questions frequently to test their knowledge base.  The other day we had an elderly female patient who was admitted for confusion.  This is a very bread-and-butter type of admission for the US, and generally the first thing a medicine resident would consider would be a urinary tract infection.  Well, the medical students got asked what they thought might be causing confusion in this nice lady, and they spouted off all kinds of answers like: Syphilis!  Cryptococcal Meningitis!  Toxoplasmosis!  It was humorous hearing their differential diagnosis, but it turns out that common things in America can also be common in Africa, and the lady just had a UTI.

And last but not least, and not related to medical students, it rained today!  Like Forrest Gump rain.  We woke up to the wonderful sound, and it really cooled things off quite nicely.  Unfortunately in the hospital the rain was coming down so hard the power went out – which again isn’t necessarily a strange thing – so we did rounds in the dark!  Gotta love it!

Day #4

Awesome day! 

We had our first weekday formal rounds this morning starting at 8. We did post-take rounds which I mentioned previously.  Probably the most interesting case was a young cabbage farmer who poisoned himself with pesticide.  It’s one of those board questions that you study for but never see in real life – what to do for organophosphate poisoning?  But here was the board question in real life! Fortunately I think he will be safe and hopefully better soon.

Then we proceeded to women’s ward to make rounds.  It was interesting, but apparently rounds here last a whole lot longer than we’re accustomed to in the States!  We rounded from 9am until about 3 pm with no break for lunch!  Afterward we headed to the canteen for some matoke and g-nut sauce.

There was supposed to be a Ugandan resident-lead chest X-ray lecture for the medical students at 3, but since we rounded so late all the residents were busy.  So Anem and I volunteered to give the CXR interpretation lecture on the fly.  I think it was a success since only 1 of the 30 students fell asleep during our hour-long talk.  It was a lot of fun!

Then we came back to our house to study a bit on all these diseases we never see at home.  There’s another crew here from UVA and we planned on going to a dinner tonight with some of the Mbarara University folks.  I expected a regular dinner at a semi-nice restaurant, but to our surprise it was much fancier!  Mbarara used this occasion to honor UVA for all their work here, specifically my mentor Dr Moore who they named an official “visiting professor” of the university here.  They had this dinner at a wonderful Ugandan cultural museum outside of town.  It was complete with Ugandan food, wine, and even tribal dancing!  I sat next to the student body president and we discussed the recently signed law making homosexuality illegal and also banning miniskirts and pornography. Perhaps more on that later!  It was a wonderful night – unfortunately I thought we were just going to a regular dinner so I didn’t take my camera.  Anem took some pictures and videos of the dancing so I’ll post those at some point when I have more bandwith.  Between all the excitement and still not adjusting to my jet lag I’m really tired … hence the short post!  More details later!

Today was our first day in the hospital!  Unfortunately due to that aforementioned speed bump, neither of us slept well enough to feel refreshed.  Nevertheless we headed out across busy Mbarara Road and made our way to the Emergency Wards for “post-take rounds”. 

The medical system here runs quite differently than ours, which may not be a bad thing.  Medical students pretty much run the show – making sure patients’ orders get completed, taking vitals, sometimes drawing labs, etc.  The intern stays around the clock and admits patients – alone – all night long.  They only call to report to their upper level resident if they have a question about management.  Then the upper level comes in the morning to do these “post-take rounds” to see the patients that came in overnight.  They may or may not agree with the intern’s management of the patient.  There may or may not be an attending present at rounds, so the resident advises the team and then calls the attending if he has a question.

Rounds in the Emergency Ward this morning were busy.  There were several new patients: a confused woman with a diabetic foot ulcer, a young lady with malaria, a young lady with HIV and sepsis, a young man with likely tuberculosis and sepsis, an 84 year old man with likely esophageal cancer, and a young lady with vomiting, found to have diabetes and pregnancy (surprise!).  There was also a middle-aged man with confusion, headache and neck stiffness for several months, and we think likely tuberculosis in his brain.  He unfortunately came to the hospital too late for any treatment to likely help him.

After seeing those patients, I and the upper level resident – Sam – moved on to the men’s and women’s wards to see the sickest patients and come up with their plans for the day.  One ward is probably a little less square footage than my apartment, is open-air, and contains 26 patient beds.  If there are more than 26 patients, the rest just place mats on the floor between the other beds and sleep there.  There is only 1 nurse for 26+ patients, so you can imagine it’s impossible for patients to get the attention they need.  There’s also absolutely no privacy, in stark contrast to our HIPAA-ruled western medical world.  Every patient knows what’s wrong with their neighbor, and care of the patient is discussed openly in the ward.  Since there’s so few nurses, patients generally have a family or friend “attendant” that stays with them around the clock.  The hospital doesn’t serve meals, so the attendant is responsible for cooking for the patient in the hospital’s yard, as well as sometimes administering their medicines and cleaning their wounds.  Patients without attendants get worse care, and unfortunately it seems the sickest patients don’t always have attendants.  Also unfortunately here, you have to pay up-front for your medical treatment, so oftentimes patients’ family will decline diagnostic work-up (chest x-ray, etc) because they can’t pay for it.  Supposedly sometimes patients will “disappear” in the middle of the night because their families are afraid of paying for their bills.  Because of this you’re often forced to guess at a diagnosis, and treat just based off the patient’s story and physical exam.  This is challenging and pretty refreshing compared to how just about everyone in an American hospital gets a CT scan.

Generally when I have patients on a general medicine service at UVA, about 1/3 to ½ of them are dangerously sick.  On this women’s ward, every person seemed dangerously sick.  Most were lying in motionless lumps under blankets on their cots with flies landing on them, occasionally you’d hear coughs and cries.  Some women had no one to care for their children while they were sick, so they had their babies in the bed with them.  There were several patients with presumed tuberculosis.  There was a 30 year old woman with kidney failure who couldn’t afford dialysis, so she was being discharged home with hospice.  There was a 15 year old girl with Kaposi’s Sarcoma in her mouth – that is a cancer that only AIDS patients get.  Another 13 year old refugee girl from a nearby camp presented with bloody diarrhea.  Her whole family had it as well after eating a meal, which reportedly was poisoned by someone else in the camp.  She is better now, but the only survivor, and I’m not sure where she will go when she’s released from the hospital.

There’s definitely a lot to be sad about in this hospital, but there’s also definitely a lot of people who can get better here too.  Young people come in with terrible infections, and with some simple antibiotics and IV fluids they are cured.  Others come in with terrible decompensated heart failure and get relief of their symptoms with a few IV medicines.  That’s really wonderful, and combined with racking your brain over diagnostic dilemmas without tons of CT scans and tests really is what I think I went to medical school for! 

Since there were a few depressing stories there, I’ll share some pictures that I didn’t get to put up yesterday.  There’s a few pictures of our house, the giant storks outside, and the busy road. Enjoy!

Day 2

Today we had two tasks: recovering from jet lag and exploring the town a bit.  Yesterday afternoon we took a much-refreshing nap, but unfortunately I had a lot of problems sleeping through the night.  Likely due to my body being confused, but also complicated by the fact that we live about 30 yards from a speed bump on the busiest road in town.    Giant trucks slam their squeaky brakes before bouncing over the top of it, and some don’t brake at all, creating a sound like a small bomb.  There’s also apparently a very hip nightclub close by.  Lots of good sounds to keep you entertained!

Speaking of our house, I must say it’s pretty awesome!  I had imagined living in some sort of dingy studio apartment while here, so we were quite surprised when handed a skeleton key to a beautiful flat – complete with two bedrooms, a functional kitchen, and wall-to-wall windows in our common living area!  There’s concrete floors and high ceilings, but no clocks and no televisions.  Also there’s no air conditioner and the breeze blows through our many windows all day.  Of course as with all houses, this one has its quirks.  Among those are: a family of giant storks living in the tree outside (baby anyone?), a few lizards living inside that scatter when you turn on the lights, toilet paper you can’t flush and water you can’t drink (both common themes of the third world), and electricity that is also bound to go out at least daily (it’s actually out now). 

Our house is in somewhat of an apartment building of about 4 houses, which sits on the far end of a gated compound of houses for Muzungos (white people) visiting the university.  Apparently there are some Peace Corp workers in the building here now, but we haven’t met them yet.  There’s a front gate that leads across the busy street and to the hospital, and there’s a back gate guarded by the cutest little man named Deo I think with whom we’ll become fast friends. The back gate leads to a dirt road paralleling the main road. On it is a mysterious fancy gated building with a 24-hour armed (aka machine gun) guard, a soccer field/golf course, and a supermarket/restaurant/nightclub combination.  The supermarket has pretty much all we could need, and the restaurant is actually quite good and sometimes has free wireless internet. 

Further down the dirt road, you intersect the main road, and that leads into town.  That’s where we ventured today.  Unfortunately to get to town you have to cross the street, which is probably the most competitive of sports I’ve taken part in in a while.  The good news is when you have shockingly pale skin most people slow down to stare and that affords the opportunity to run across the street.  About a mile down the road the “downtown” starts.  There are so many people!  People going to work, sitting and talking, haggling in storefronts, waiting on busses.  There’s smells of fresh-fried samosas, baked chapatti, and what seems to be a very popular choice – fresh popped popcorn.  There’s other not so pleasant smells I won’t describe here.  One of our professor friends we’ve made so far drew us a rudimentary map last night which was quite helpful; however, we wound up taking a rather circuitous route to get where we wanted to go.

The first thing we found was a bakery, the name of which currently escapes me.  There were lots of pretty cakes that looked somewhat stale, and other treats.  Anem got a g-nut cookie, which tasted like a mild version of a peanut butter cookie, and I got a veggie samosa which is turning out to be my new favorite treat.  With a little help from the store-keeper, we managed to find this giant multi-level Americanized supermarket where we wondered around a while.  We found another pair of Muzungos perusing the aisles and asked for their help finding the main city market.  They were a super nice couple celebrating their retirement by living a year in Uganda – not a bad choice!  They gave us directions, and after another harry street crossing, we found the market!  This is definitely a “local” place … hidden behind store fronts with steps leading down into the main market.  First you pass stands with household tools, clothes, and THEN, over to the left is the most giant display of fruits and vegetables I’ve seen!  Rows and rows and rows of pineapples, avocados, mangos, beautiful multi-colored beans, bunches of bananas, tomatoes.  All accompanied by the people that grew them who seem to be wondering (1) what is this muzungo doing here and (2) how much can I convince her to buy?  One lady came up to me and gave me a hug in order to convince me to buy some of her bananas.  I was eyeing a pineapple and another lady said “1500 shillings!”, grabbed it, chopped off the top, and put it in a bag.  I really had no choice but to buy it at that point!  But for around 50 cents it wasn’t a bad deal!  We left with the pineapple and two giant mangos. There were so many beautiful things/people to take pictures of, but I haven’t gotten quite comfortable enough in my surroundings to snap pictures of these lovely Ugandans yet.   And of course before we left we (unfortunately?) ran into the meat stands where dozens/hundreds of animal carcasses were hanging from the ceilings in the heat being butchered to order.  I think I’ll just eat vegetables for a while now …

The walk back home was nice because we were a bit more confident in our directions.  Every few feet someone said, “Muzungo!” or “welcome to Uganda!”, so that was pretty entertaining.  We made it back safe and sound in time for a nap, and then went to dinner with one of our attendings (Professor Tony, a neurologist from Britain) at a local restaurant.  The food and company was good, and the night was brought to a perfect close by a cat walking into the restaurant with a rat in its mouth!  Better he eats it than I find it later I guess!

Tomorrow, our first day in the hospital!  Sorry no pictures today - not enough power behind the internet tonight!

Uganda, Day 1!

We’ve finally arrived here in Mbarara after about 30 hours of traveling by taxi, plane, and personal driver! 

Mine and Anem’s journey started out by taking a taxi from C’ville to Dulles airport.  Other than getting slightly carsick, the ride wasn’t too bad.  Once at Dulles we flew out on Turkish Airlines, which I must say is the nicest airline I’ve ever flown.  We were greeted on board by a chef (in full attire!) who served the three meals we ate – all of which were pretty decent!  We also were spoiled by hot towels, free socks and sleeping masks, and Turkish delights pre-flight.  We flew straight from Dulles to Istanbul – a 10 hour flight!  Not to worry my medical friends - I took a full-dose aspirin for DVT prophylaxis. 

We arrived in Istanbul’s airport right on time for our layover.  The airport there was a bit, how shall I say, disorganized?  Mostly on our parts as in the hub-bub of the airport we were trying to figure out how to get free wireless and how to make our international phone work … unsuccessfully.  But we did manage to enjoy some hot tea and lemonade before disembarking again to Africa.  Interestingly our flight took a brief detour to Rwanda to stop and pick up some more travelers – so I guess I could say we had a layover there as well.  Our travel marathon finally came to a close (at least for the airplane part) in Uganda.  I don’t think I’ve ever been so happy to step off a plane!  This is the first long trip I’ve taken in several years, and unfortunately my body can tell I’m a bit older this time around.  I have a cramp in my shoulder from sleeping in weird positions, and halfway through the first flight I had to stand up because my knees were getting stiff!  Oh well.

Once we landed in Entebbe, Uganda, I felt the first humidity and heat I’ve had in several months, and also caught my first whiff of Africa.  Memories of Tanzania came flooding back instantly!  Africa, or these two countries at least, have a distinct smell to me.  I can best describe it as a mixture of two smells: one being how the Earth smells after a summer afternoon rain, and the other being how my dad’s backyard trash pile smells when it’s burning (which is a good smell, I promise).  We went through customs and got our visa – which I’m pretty sure we got overcharged for.  Unfortunately arguing a price is not something I felt comfortable doing with a customs officer!  Our luggage arrived safely and then we exchanged our dollars for shillings.  $1 = 2,400 Ugandan shillings.

After changing our money we went to find our driver.  Unfortunately since we had been unable to use our phones/wireless until that point, we weren’t able to communicate with him to ensure he was picking us up.  A very slight panic set in, and then we realized that – miracle of miracles – the Ugandan airport had free wireless!  Moses (our driving company) had emailed me and said he would be a bit late due to unsafe driving conditions in the dark (our flight arrived at 4am).  So we enjoyed some breakfast at the Crane Airport Café – fried egg sandwich and super milky hot tea – and listened to Kenny G and gospel hymns be played over the airport loudspeaker while we waited.

Our driver, Lucas, arrived a bit earlier than we expected, and we hopped in his Toyota 4WD to make the 5 hour drive to Mbarara.  Honestly the drive should probably take about 2-3 hours, but due to the poor condition of the roads it takes much longer.  We drove briefly in the dark, dodging folks on motorcycles (bodabodas) and bicycles, and lots of children setting out early to walk several kilometers to school.  Once the sun rose we had a beautiful view of dawn over the Ugandan hills, and an unfortunately close view of crazy third-world traffic.  Needless to say I could never drive successfully here.

Our trip was interrupted three times.  Once for a stop at the equator, where we of course took pictures.  Another time was for some mango juice and fresh-made veggie samosas (Ugandan version of a hot pocket) at a road side stand with a militant-appearing armed guard.  I considered taking a potty break there as well, but alas there was no TP and only the “toilets” that are a hole in the ground with foot pedals.  I figured I could wait.  Then lastly, we stopped on the side of the road to view some ZEBRAS(!) that were just roaming around on the side of the highway!  We also got a complimentary African massage during our journey – unfortunately not as relaxing as one might think.  That’s a joking term for driving on a dirt road full of potholes and speed bumps.  Our driver took a detour down one such road to avoid the traffic in Kampala.  It was fun, but a bit jarring to say the least.

And finally we arrived in Mbarara.  It’s definitely a hustling and bustling town and so far we seem to have everything we need here…. But more on that tomorrow!

Colder Weather

It seems yet another snowstorm is upon us.  The first snow of the year was pretty exciting. Pax was fun because it was the most snow I've seen at once and I got to walk "a mile uphill in the snow" to work.  But then yesterday it was warm with a nice rain and I was getting ready for spring.

Alas, today the snow is back.  The good news is that Stuart and I are here, and we're enjoying our French Press coffee while watching the storm out the window.  It's going to be a nice day for relaxing and making a beef stew - so that's what we plan on doing!  

In case you weren't aware, I'll be shipping off to Uganda with my friend Anem in TWO DAYS!  We'll be there for a month working at Mbarara (Em-ba-ra-ra) Regional Referral Hospital, and doing some research as well.  I'm sure there will be a few elephants and zebras along the way, and if we have time perhaps some hiking.  And, oh, the weather there is about 90 degrees.

Until then, here's some cold weather pictures.  First is a few days after Pax, when Stuart and I went to my favorite vineyard, Pippin Hill.  I hope to one day have a backyard that looks like this!

Next are some pictures from my curling team (yes, curling team), the Alabama Dreamboats.  Dad was kind enough to take some photos to document our athletic prowess.  We are undefeated!  Unfortunately I'll be in Uganda during the Bonspiel (curling championships), but I wish my team the best of luck!