Monday, July 2, 2007

Uganda Report number one

As promised, here is the first installment of "The Uganda Report", I think I will try to stick in a picture here and there as well to illustrate it. I apologize to those of you who were not on my email list (part of the problem is that I'm not the greatest at keeping up with people and so didn't have some emails ready at hand....) Anyway, this was originally sent out on April 27, 2007.

Greetings all, I just thought I’d drop you a line to let you know how things are going here in Kampala, Uganda. I arrived 5 days ago and thus far am really enjoying myself and learning a lot at Mulago Hospital. I don’t feel like I’m contributing much yet so I hope that will come.

Getting here was a long flight but everything went so smoothly, it was a miracle – no lost luggage, no late flights, no visa troubles, nice shuttle bus drivers etc etc. BUT, of course, life is an adventure and I did have some troubles with accommodations when I first got here. There was some mix up at the Mulago Guest House where I was supposed to be staying. The hostess, Sara, had me down as coming this next weekend and not last Sunday so there was no room for me until this next Saturday. When I think about it, I’m not surprised, as every time I talked to her before coming the phone connection was absolutely terrible. All is well however. Sara is a very kind lady and she helped me find a hotel close by to the hospital (about a 10 – 12 minute walk) where I am staying this week until I can move into the guesthouse tomorrow. It’s been just fine, however there are two pubs/bars very near to right under my window and given that there is some East Africa International Football (Soccer) tournament going on this week – and Uganda has been doing quite well – things have been a little loud. Fortunately, I brought earplugs and now that the jet lag is subsiding I am sleeping quite well.



View from my window, overlooking the bars


My little room - pretty nice!!

Africa is as lovely as I remember from Madagascar. I sort of worried that I was remembering things with rose-tinted glasses but things are good. In fact, Uganda is much more prosperous with less overt poverty than Madagascar had – at least several years ago. Granted, I really was right in the middle of real life in Madagascar and haven’t been much around Kampala yet. I’m sure there are areas that can compare with the slums of Antananarivo. I had forgotten though, what it’s like to be completely visibly different from everyone else. I’d forgotten what it was like having all the kids yell “Vasa” (Madagascar) or “Mzungu” (Uganda) as I walk down the street. (i.e. “white person” or “foreigner”) and not understanding the intricacies of language – verbal and non-verbal.


Beautiful Africa

I think I may be a bit odd, even for a “mzungu” though, as it doesn’t seem like very many other foreigners walk as much as I do. I never see any other foreigners walking anywhere – although, come to think of it, this being Africa, you really have to watch where you’re walking, especially in the rainy season as the potholes, puddles, mud and rough patches can jump out and grab you. So maybe, I’m watching where I’m walking and not everyone else. Another thing – pedestrians DO NOT have right of way. This is fairly obvious on crossing main roads but sometimes I forget when crossing driveways (or when I cross a patch of sidewalk some one has decided looks like a promising spot to park a taxi or a boda-boda). I nearly got run over by a very large SUV and boda-boda at the same time because I looked the wrong way (they drive on the left side of the street). For those of you who haven’t been to Uganda, boda-bodas are motorcycles, you can hire one of the drivers to ride you around (if you have a death wish) and they are EVERYWHERE. They swoop in and out of traffic and as far as I can tell, are the leading cause of non-infectious disease related morbidity and mortality in East Africa (I have no evidence to back that up however, just observational data)

Mulago hospital is a neat place. It’s a sad place though, because the people who work there are great and the building itself looks like it was stunning at one point (and the grounds still are beautiful) but there are very few resources. People in Canada should stop complaining about the gurneys in Emerg (almost all my patients in Canada do that – except the unconscious ones), as the vast majority of the so-called beds at Mulago are not as nice as those gurneys. Every time we want to order a test or give a drug we have to consider very carefully cost and availability. An example for you medical types: I’d never really used captopril before I came here (most of the teaching I got in Canada was: why go with a multiple dose drug when you can take a once a day one) but the cost of the other ACE inhibitors is prohibitive.


Mulago Hospital


gurneys on one shocking day when this ward was empty

I should explain why I’m talking about ACE inhibitors. It turns out that there was some sort of problem on the ID ward (too many learners (elective students from Germany) / grumpy staff etc etc – I’m not clear and I didn’t press the issue) so they wanted me to go on to the Cardiology service for my first two weeks and then go onto the ID ward after that. Please note, there is NO general medicine ward – only specialty wards and they all share things – it actually seems like a pretty good system overall. (I won’t pontificate here about it but could go on for a long time about pros and cons of our system compared to theirs.) It does mean that the ID service gets a little overworked as they take at least 25-30% of the admissions but given that this is a relatively new system for them they are still working out the kinks.


A cool echocardiogram - any guesses?

Anyway, I am on the Cardiology ward (or firm as they call it here) and am really enjoying it. Shocking – I can’t believe I wrote that given my feelings about cardiology at home. (Sorry Jon). The range of admissions is very broad and very interesting AND the teaching has been phenomenal. As I said, I don’t feel like I’m contributing much yet so I hope that will improve. In fact, most of this week has been spent with me running around asking everyone questions (probably stupid ones) about where I should be, when I should be there and what I should be doing while I’m there.