Friday

Friday morning Kelly and I FINALLY had a chance to go on the mammogram van!! Unfortunately the van, which Yale and Johnson & Johnson donated, has not worked in over 6 months. There is also a second mammogram van at the Cancer Institute, which is also out of commission.  Mulago Hospital does have a working mammogram machine, but we’ve been told that mammograms are almost never ordered due to their cost, and that ultrasounds and fine need aspirations are done instead.  That being said, we are very confused as to why two mammograms vans have been donated, and furthermore why we were told we’d be traveling on the van as it operates two days a week throughout this rotation, and come to find out it hasn’t worked in six months! But either way, we’ve learned a ton at the Uganda Cancer Institute!  So what did we do on Friday on the van??  Well on Fridays they do screening breast exams, and since they aren’t enough exam rooms, they use the van for extra space.  This seems completely backwards to me, but we went with the flow.  So we performed several exams, and if there was anything suspicious, sure enough a breast ultrasound was ordered, no mammograms.  We also met Josephine, an eleven year survivor, and volunteer every Friday during this “screening” program.  She talks to woman as they wait for their appointment about the importance of self breast exams, she hands out pamphlets, and answers any questions they may have for her.  Meeting her was the highlight of our day :-)

Friday evening our group went to meet a tradition healer.  Traditional healers are very popular in East Africa, in fact many patients will go to one before going to a medical doctor.  This traditional healer explained to us that she is given remedies for her patients in her dreams from her ancestors.  She will then collect different plants to produce the remedies. She also explained that sickness is often due to a curse or a demon, and she can help relieve someone from such troubles.  However if it is a sickness she cannot heal, she says she refers her patients on to a medical doctor.  She has no training herself, other than the gifts she was given by her ancestors.  This was an enlightening session because so many of our patients bring up traditional healers.

Update for the week

So we haven't had internet all week, so here's a post for the whole week...
Monday afternoon we went to Sanyu Babies Home, an orphanage for abandoned babies up to 4 years old.  There were 47 children there, and they can take up to 50. The home attempts to have the children adopted, but in the meantime takes very good care of them with very little resources.  We brought some things to donate, but they need so much more!  Feel free to check out there website, it is http://www.sanyubabies.com/

Tuesday was a very eye-opening day at the Cancer Institute. Kelly and I were attending rounds as usual with our attending physician and about 5 Ugandan medical students when the women who we would have rounded on next, died.  Her two daughters that were with her started wailing.  I of course expected my attending to stop what he was doing, to say something to the family, to "pronounce" the woman as we would have in the states, but instead he and the Ugandan students just went on discussing the previous patient as if nothing was going on. Eventually a nurse came over and assisted the family, putting up a divider to give them a small amount of privacy.  Kelly and I both just stood with our jaws hanging open saying to each other, "did that just really happen?"  We've both lost patients, but we've certainly never seen anything handled like that.  We later wondered if the reactions of the other students was somehow due to the fact that death is so common here.  Life expectancy is 53 years old, more than 30 years less than the US, so are they just desensitized to it??

Tuesday evening we met Matt from Nairobi who was in Kampala for a few days, and he took us out for a wonderful meal at his beautiful hotel.  It really made our accommodations look less than favorable...

Wednesday the streets of Kampala were crazy!! We are still not quite sure what was going on... but we were told some famous evangelist was here, but either way the streets were out of control! You couldn't drive anywhere! People were blowing horns, blasting music through huge loud speakers, large buses or trucks carrying speakers would have someone proselytizing at top volume, and large pick-ups would have 30 people standing up in the back, crammed together, with hats and horns, dancing! At night there were fireworks. I attempted to take pictures or video, but it was so outrageous you had to be careful you didn't get trampled, so I didn't end up getting any. Things have quieted down a bit.

Today we were in the outpatient cancer clinic.  Between patients I decided to look something up on my Iphone, and the other med students were so amazed at my phone and what it could do! They had a good time looking things up in the medical dictionaries I have downloaded to it. It's funny, things we take for granted, they were amazed by.  Tonight we had a group dinner with our MUYU family here, which has become a nice tradition. We went to an Italian restaurant and it was really good.

Tomorrow after the hospital we are going to a traditional healer, which is very popular here in Uganda. Then this weekend (our last weekend here) we are headed to Bwindi National Park, a rainforest, to track a family of mountain gorillas :-)

3-Day Weekend in Kenya

Early Friday morning the three of us flew to Nairobi (a 45-minute flight) and spent the day doing some of the tourist attractions there including the Giraffe Center where we fed giraffes, the Kazuri Factory, and saw the home from the "Out of Africa" movie.  We then went to Ramesh and Matt's home, which is beautiful, and had a lovely time meeting their daughter Shireen. We all went to a delicious Italian restaurant and had real cheese which is something we've all missed!!  We had a very relaxing evening and a fun time with the Cohens!!

Little Miss Shireen and daddy Matt in their front entrance way

Ramesh and I... friends since undergrad orientation over 10 years ago!!

Saturday morning we were picked up by our safari guide Duncan and we drove out to the Masai Mara which was about a 5-hour drive.  The Mara is a game reserve in South-West Kenya that covers over 580 square miles and crosses over into Tanzania.  On the ride there, we saw the Great Rift Valley, which spans from Israel to Mozambique, and overall the ride wasn't bad, but the last couple hours were quite bumpy!! But once we got there it was just amazing.... On our very short 2-day safari we saw, and I mean were REALLY close to, giraffes, gazelles, water buffalo, lions, elephants, mongoose, zebras, tortoises, wildebeest, jackals, antelopes, hyenas, warthogs, cheetahs, ostriches, and several exotic birds including the bird on the Uganda flag, the grey crowned crane.  Here are just a few a of the hundreds of pictures I took....

A herd of elephants on the mountain

A much closer elephant

An elephant herd walking right in front of the van

Wildebeest

A whole group of giraffes

This giraffe was totally checking us out

A water buffalo, which is the most dangerous of THE BIG FIVE

A female lion sunning herself

Momma lion looking after the cubs

Silly zebra

We felt very lucky to find these cheetahs, as there are only 3 living in this whole side of the Mara

A family of warthogs

Sunset

At our lodge, which was a really nice place if anyone is considering a safari in the near future, they feed hyenas off the back porch at night... the eerie laugh they make was really unnerving! Luckily, they are also guards that walk you to your villas after dark because the wildlife is so close!

The feeding of the hyenas... the video is gross!!

On the second day we visited a Masai Village where we learned a lot about their culture. The Masai wear red cloth and bright beads in order to appear threatening to animals that might be after their herds.  They have cattle and goats, and spend all day protecting the grazing cattle. Their diet consists only of meat, cow's blood, and milk because the land is too dry for them to grow crops.  The older generations also have the "stretched out" earlobes, but they younger generations are not continuing this tradition as it "gets in the way of playing soccer and other sports."  Their huts are made of sticks and cow dung, and you can't believe the flies that are around there!!

Masai teenager showing us how they make fire

The "older generation" Masai

We had an amazing time on the safari!! I would love to go again, and for longer!!
And as an added bonus, on our way back to the airport a baboon crossed the street right in font of us... certainly not something you see everyday!!

Whitewater Rafting Pics

So here are some of the whitewater rafting pics... I decided to put them up, even though we don't have them all yet....

Just before flipping...

That's me in the pink in the back, and Katie and Kelly are the front two

This wave totally smashes us in the face

Preparing to hit a big rapid

This weekend we are headed to Kenya... We are flying to Nairobi early Friday morning and spending a day and the night with my college roommate and close friend Ramesh, her husband Matt, and their baby Shireen who have been living in Nairobi  since, I believe, July 2010.  We are then headed on a 2-day safari to Maasai Mara, and returning to Uganda late Sunday evening. So lots of pics and updates after that!!

Wednesday at Mulago Hospital

Today was I guess "just another day" at the Cancer Institute.  I took some pictures in order to give you an idea of what the cancer institute looks like... the wards are very cramped, there's a mouse living in it, the screens are ripped, and most patients have mosquito nets over their beds. 

After the cancer wards today, Kelly and I decided to stop into the malnutrition unit, which of course feels like a little bit of an oxymoron here where you see so many children on the street that you feel are probably malnutritioned, you sort of wonder how all kids don't end up there.  In this unit, as kids are nursed back to a healthy weight, parents are taught how to add protein and other nutrients to matoke (the banana staple that most kids are fed three meals a day) because it has very little nutritional value.  While we were there, we held and help feed a couple of crying babies who were very small and underdeveloped for their ages.  We then saw a five year old who was no taller than my 2.5 year old niece Hannah, with arms like sticks, no hair, and she couldn't speak, she only made cat-like cries. It was heartbreaking. She had been abandoned, so once she is well, will end up at an orphanage.  She has some serious heart problems considering the amount of wasting, but it seems she was found in time.  Our group is headed to an orphanage next week. We bought a bunch of donations to bring, and are looking forward to spending some time with the kids there.

In the evening, we had a group dinner with all of the Americans that are here, we went for Pizza. It's been good to have the whole group here to talk to and discuss what we see in the hospital and sort of reflect on things.

Back to Work on Monday

So Monday we went back to St. Stephen's, the smaller hospital, where we saw a couple of children with malaria and couple pregnant woman who were sick, no deliveries though. We also saw a 9-month old who was being brought in by his single, teenage mother because he had been very sick for a month. The child was so weak he could not even hold up his own head, and was unresponsive except to painful stimuli. On the one hand I was frustrated that this mother waited a month for her son to get this wasted, possibly to the point of no return. But on the other, you realize that the reason she didn't come in is because she was afraid she couldn't pay for the care, and that she would be turned away.  In the U.S. I wonder if this would be considered neglect....

We then went on two home visits, first to a middle class house of a family with several cows and chicken coups, who greeted us with sodas and insisted we sit and chat with them.  And then to a little old lady's mud hut who is looked after by her grandkids. Here is a pic of her talking to our attending....

Monday evening we went to the National Theater which is a stage for all sorts of performing arts. It was "open mic" night, and some local talent sang and played music, everything from covers of U.S songs to Luganda reggae. It was a lot of fun!!

Jinja for the Weekend

We had a wonderful weekend in Jinja, which is about 50 miles east of Kampala and has the Nile River running through it. We were a bit adventurous Saturday and did extreme whitewater rafting down the Nile (pictures coming soon!!!), which was highly recommend to us by our flatmates and a couple previous classmates. I had never done rafting before, but consider myself a decent swimmer, but I must say they really do mean EXTREME! These were level 4 and 5 rapids, our whole raft flipped twice, and we got a bit bruised up and a bit sunburned, but it was a lot of fun!!

We spent the night and the next day at a beautiful resort called the Jinja Nile Resort. We had this beautiful villa overlooking the river.

This was our view from the villa.

The resort had these adorable vervet monkeys running around all over the place. They were playful and causing all sorts of trouble for the staff, but for us it was so much fun to watch.

There was also a beautiful pool with a swim-up bar which we relaxed by today after the beating we received from the river yesterday.

You will regularly see these nets in this area of Uganda which are blue to attract the tsetse flies, known to cause African Sleeping Sickness. They are similar to horse flies, and cause a febrile illness, often mistaken (and mistreated) as malaria, which worsens to a coma state, hence the term sleeping sickness.

So back to reality tomorrow... We are off to the smaller community hospital again, St. Stephen's Hospital, and hopefully some more home visits...

Cancer Institute and Dance Show

Today was a tough day at the cancer institute (as I'm sure all days are!) So if you only want the light stuff, please skip ahead now... We saw a woman with breast cancer where you actually saw her cancer, not her mass through the skin, but the tumor had eaten away all the tissue around it and you saw her tumor directly.  She was only in her forties and her lungs were speckled with mets. To think how someone could present this late in the disease course just baffles me. We then went over to the child cancer center where we met a 3 year old boy with Burkitt's Lymphoma, a form that only exists here in East Africa where the tumor appears in the mouth or jaw, and doubles in size every eight to sixteen hours!! If a patient presents after four weeks, there is no hope for survival as it will eventually spread to the abdomen and brain.  There is no understanding as to why this disease only affects patients here, and with such little money in healthcare, I don't know if research is a top priority.  Both of these patients had such poor prognoses, and I felt very powerless when spending time with them today.

On a brighter note, we went to a very fun traditional Uganda dance show. Performers did dances from all different parts of the country, and musicians played traditional instruments, and singers chanted along. It was a lot of fun!

Uganda Cancer Institute

Today Kelly and I started at the Uganda Cancer Institute which is part of Mulago Hospital up a big hill. There is a mobile mammogram van- which we are hoping to get to spend some time on, a Child Cancer Center, an inpatient center, and an outpatient center. Today we met Dr. Fred our attending who we are going to spend the next few weeks with and he seems to really want to teach so that's gonna be great. There are several medical students from Uganda on the team and 2 from Kenya who are from a dermatological school.  We rounded for several hours today and we saw patients with kaposi's sarcoma (a malignancy found mostly in HIV patients), MASSIVE lymphomas, breast cancer, penile cancer, colon cancer, and prostate cancer.  Many of these patients presented with very late stage tumors, so many are undergoing palliative care only.  Radiation therapy is so expensive that no one in the area could afford it, therefore it is covered by the government and some foundations, and offered to patients at no charge.

What was interesting was as we walked down the hallways of the hospital, several family members and patients greeted us, went out of their way to wave to us, and several children said hello to us and sort of followed us, and we often heard the term mzunga being said.  We later learned in our cultural lesson that it is very rude in the Uganda cultural to walk past someone without greeting them, and that mzungas is a term for white people, and that it is not derogatory, just their way of describing us.

After this long, sort of draining day at the cancer institute, us three mzungus found an Italian Restaurant and had pizza and calzones, and even found that they had a breast cancer month fundraiser... what a nice surprise :-)