Spring!

Spring is finally here!  It sure is sweet.  Before I left for Uganda the winter was quite bitter - we had a lot of snow this year!  It snowed more in Virginia and Pennsylvania while I was in Uganda sweating away in the equatorial heat.  So when I arrived back in Charlottesville and the trees were just beginning to come into bloom I think I enjoyed it all the more.

I took this one last year at Monticello

Tulips (my favorite) outside the apartment

Dogwood outside the apartment

Of course beautiful flowers in bloom means something else is in the air ...

You got that right.  Pollen.  I have been sniffling and sneezing, and have had a sinus headache for about a week.  I'd been trying to get away with just using my Flonase, but gave in today and went to get some allergy medicine at CVS.  I needed some decongestant along with my antihistamine, but that includes those pseudoephedrine boxes that are hidden away from all the meth-makers behind the counter.  I grabbed the sample paper and went to the counter where the pharmacist gave me a suspicious glance.  I hoped my raspy voice and sniffly nose gave him the proof he needed that I wasn't a drug lord, but he still had to scan my license and make me sign a form.  Crazy what the world's come to...

And, much better than pollen, Spring means that the farmers' market is open!!!!!!  When I was in Uganda buying all my vegetables from the market (and reading a book called Animal Vegetable Miracle) I was inspired to try to only eat local foods when I got home.  Well folks, that's pretty hard.  Especially when you're on call on market days, or the market rains out.  I've decided that a better way to do it (for now at least) is to get everything I can locally, then everything else should be organic, or fair-trade, or bulk.  We'll see how it goes.  So far I have to say I think I've made some pretty good meals!

Local greens, 'shrooms, and some bulk grains from a locally-owned grocery store

Polenta with sauteed spinach and mushrooms

Stu patiently following my chopping directions

Sauteed greens and dried tomatoes (from a layover in Istanbul!) with poached local eggs

Rhubarb and strawberry crisp!

This weekend brought some beautiful weather.  It also brought the Foxfields horse race which, if you can remember, I went to last year.  It was a good experience at least once, but this year a few of us decided to have an "anti Foxfields" gathering at some local vineyards.  We tried some we hadn't been to before: Blenheim (owned by Dave Matthews) and Trump (owned by ... well you can figure that out).  We had a good time with some fellow residents and their gals, enjoyed the sun, and finally an amazing dinner at Mas tapas restaurant.

Sam and Hartke at Blenheim

The whole crew

Internal medicine group: me, Steve, Hartke, Godsey

Favorite Uganda Pictures: Animal Edition

Ankole Cows

Kobs

Favorite Uganda Pictures: Scenery Edition

Tea Plantation

View over Queen Elizabeth National Park

Some peasant farming land outside QENP

Lucky Bean Tree - beans in the red flowers are used for telling fortunes

Hiking through tea plantation

Salt lake in QENP

Acacia (name Kacie/Casey/Kasey comes from this)

Animal Stories

The buffalo we saw in the national parks are also called “African Cattle”.  They, bless their hearts, are quite ugly animals I think and always seem to be wearing a scowl.  They have terrible vision and so live in a large herd in order to protect themselves from predators.  Because they can’t see, they spook easily and will charge almost anything they think is a threat, especially if the buffalo is away from the herd.  If a buffalo gets injured or becomes elderly, it can’t add to the “herd immunity” from predators, if you will, and oftentimes it gets kicked out of the group.  You’ll see these “loser buffalo” as they are called by the safari drivers by themselves appearing rather lonely.  Some of them may have scars from past battles, or perhaps their coats are a lighter color which is what made them stick out from the group in the first place.  But remember their poor vision?  Now that they are alone it’s really hard to fend for themselves and be protected from danger.  When you frequently run across carcasses in the savannah it’s from those lone buffalo.  These are generally the stubborn ones who refuse to band together with other “losers” in order to gain strength in numbers. 

Then there’s the weaver bird.  This was my favorite bird for a couple of reasons:  first is that they have beautiful splashes of yellow on their feathers, and secondly because of this story.  The weaver birds are so named because they weave very impressive elaborate nests.  Actually, the nest is woven by the male in order to attract the females to come mate with them.  Generally the female will come along, check out the nest, and if it’s not made to her exact specifications she will literally shred it – breaking the male’s heart and then fly away.  She’ll come back a day or two later to a new nest, inspect, and shred it again.  Finally when the nest meets her expectations she will move in and begin a family.

The lessons here?  I’m not so sure, but perhaps it’s better to be together than alone – and men better take care of their women!

Last Day =(

For some reason it seems appropriate that our last two days in Uganda have been marked by a deluge of rain.  The past week or so we’ve been riding on the cusp of the rainy season and now, it seems, we’re here.  Oddly I’ve been waking up approximately 10 minutes before rain starts the past few nights, and it’s such hard rain that it keeps me awake.  I can’t say that I mind, though. Of course I start thinking of the chorus of “Africa” by Toto in my head every time.  The rain is quite similar to the rain scene in Forrest Gump and honestly sounds like you’re sitting underneath a waterfall.  Somehow the birds still chirp through it.

This morning we trudged through the downpour to the hospital.   Ugandan time was even more delayed this morning as no one wanted to get out in the rain.  When we arrived in the emergency ward for post-take rounds, there was a young man slouched over on his friend, unresponsive.  Allison and I grabbed him and (literally) carried him into triage.  His friend couldn’t tell us what happened – just that he had found him unresponsive.  We started pumping fluids into him and serendipitously when I poked his finger with a (unfortunately large) needle for a random glucose level, he woke up!  He could speak English and told us he’d been vomiting blood all day.  Then about that time he started having it from the other end as well … never a good sign.  We call this a “brisk upper GI bleed” back home, and it requires immediate intervention.  Unfortunately endoscopies here are only done on Wednesdays, and surgeons don’t “have the ability” to repair stomach ulcers by sewing over them.  So as we resuscitated this young guy we got on the phone with the doctor who does endoscopies and convinced him this one needed to be emergent. 

Once Allison and I felt secure enough that the patient was stable, it was time for my last Kotogo breakfast and then on to rounds.  It was still pouring, and I dodged puddles and near sink-holes of mud to get where I was going.  I made my usual morning pass by the three year old who mops the floors of the hospital with his dad and is always wearing a snow suit.  He gets so excited when he sees my pale skin that all he can seem to figure out to do is scream and wave his arms around.

No attending showed up on rounds today, so I and one of the PG’s, Adrian, were attendings and taught the medical students while seeing patients.  I’m going to miss being called “Doctor Kacie” so much that I might have the embroidery on my white coat altered.  Today on rounds was a 20 year old with a miscarriage due to currently untreated leukemia, two ladies vomiting blood, one lady with tuberculosis meningitis, another 20 year old with fungus in her brain, and a lady with PML – a late-stage complication of AIDS … among other various and sundry patients.  Another patient on the other side of the ward died during rounds, and I had to log roll one of my patients sleeping on the floor so that the gurney wouldn’t roll over her when it came to get the body.

After rounds it was time for lunch, and I walked down through the mud again to my last meal at the canteen.  Fortunately by that time the rain had stopped.  I had a plate piled high with rice, G-nut sauce, cabbage, and dodo – which are basically boiled greens.  I enjoyed the company of my muzungu friends as well as Amir, the PG who I will be working with when I come back in September.  After lunch we hung out at the medical lab with Robert, the technician who has been kind enough to teach us some lab work.  Today was “stool day” and he tried to stump us with microscope slides of various and sundry parasite eggs.  I’m a big parasite fan – so it was a fun session!

Before the day was done I headed back to emergency to check on my bleeding guy.  He had his endoscopy a bit prior and was looking much better, and after seeing him and staying bye to the interns on call, I headed through the campus and across the street to our house for the last time.  At least until September.

Tonight we celebrated (not sure that’s the right term) our last night here with a “fancy dinner” at a motel called Ajip in town.  It seems to be more of a muzungu hangout than anything, and as a result their menu has everything from pizza and pasta to chicken tikka masala on it.  The most interesting thing was that the menu said “Welcome Y’all!” on top.  I found that most amusing as I obviously used the word frequently here and no one knew what I was saying.  I went with the tikka masala and some watermelon juice, and it was pretty good.  Perhaps I’m partial to the g-nuts?  After a few minutes of sitting down at dinner Allison and I remarked “what’s that sound” and then realized it was a television.  I haven’t heard a television since I’ve been here, and it’s been quite refreshing.

Since Ajip was a bit far for a walk we hired a taxi driver I won’t name here for his protection (not that anyone important in Ugandan politics reads my blog, but I digress).  I say that because he’s openly gay and having to leave the country next month so as not to get arrested under this “anti-gay bill” passed by President Museveni.  He’ll be leaving his 17 siblings as well as his parents and the only hometown he’s ever known.  Meanwhile as he’s been planning to go, his very nice taxi business has dwindled down because customers don’t want to support him.

We talked to him on the way home about these things, and then got dropped off at our gate.  The short walk back to our house was lit up by a billion stars in the sky, and now I’m lying on our couch feeling the cool rainy season air come through the windows while listening to cars on the road and the sounds of the nearby dance club floating on the breeze.

Tomorrow morning we head out around 930.  We’ll drive through the capitol of Kampala to see a few artisan markets, then spend a short night in a hotel to fly out around 3am.  Our layover is in Istanbul for a few short hours, then I’ll be back in Charlottesville Friday night God willing.