Beautiful Uganda
I had written another dispatch previously but I decided that it was too negative and so filed it away in my journal. I just started venting and decided that it wasn’t appropriate to send that all out. This has been a frustrating week though – probably one of the most frustrating of my life! I have switched over to ward 4A, which houses all the Gastroenterology as well as infectious diseases patients. Unlike all the other specialties, ID is split into two teams – male and female. For some reason, the female side tends to run at about 30-35 patients and the male side more like 20.
I guess I am enjoying ID as I am seeing plenty of pathology – most of it related to end-stage HIV. The stuff I saw on the HIV ward in St. Paul’s in Vancouver was nothing compared to this. It’s heart wrenching, I’m not used to losing so many patients. And I feel like what I can do to prevent it is very limited. I know what to do and I know what would make a difference - at least in some cases - but getting it done is another story. Inadequate numbers of nurses, inadequate nursing care, inconsistent (or nonexistent) access to medications or even basics like IV fluids, very little access to diagnostic services and my struggles with procedures all combine to make things difficult.
The worst was the LPs this week – I was so frustrated with myself. I basically HAVE to get the LP because it’s the only diagnostic test that’s possible or with in the means of the patients (i.e. it’s free) and when the interns can’t get it – I get called. Well, trying to do them on a concave bed with a confused patient, one set of sterile gloves, no drapes (I use the inner glove cover paper as a sterile sheet), sketchy chlorahexidine scrub solution on (maybe) sterile cotton and an IV catheter as my needle (the 18 gauge is just barely long enough in the slender Ugandans) is quite difficult. On top of that, the wind then comes in and starts blowing everything around (ie patient’s clothing/sheets, cotton, sterile piece of paper etc. Great. ….I made one girl move onto this flat gurney because her bed was positively a valley in permanent reverse trendelenberg and prayed really hard – miracle occurred, prayer answered – got the tap.
Actually I’m not sure what this experience would be like without the HIV. It’s so pervasive. They say the statistics are that the prevalence is 10% in Ugandans but it’s probably about 75% in the patients admitted to Mulago. I’d read about the effect of HIV in Sub-saharan Africa but you really don’t understand until you’re here and you see the absolute devastation this virus has caused. And it’s usually in people who don’t really have huge risk factors like we would twig onto in Canada, frightening.
I should say that there are positive things too. For the most part people are very kind too me and I have made more friends amongst the residents – it’s hard because their agenda is very much educational based (they don’t get paid to be on service) but I feel I can’t just leave the poor intern to run the ward herself so I spend much more time on the wards than the rest of the residents. Also, patients are always so grateful – even though I feel like I’ve done nothing for them.
Uganda is a beautiful place. It has rained a lot this week so it’s very green and humid. It rains very hard at night and I often will wake up and listen to it drumming down on the metal roof. The birds are nice too – although there is one black, iridescent species with a long curved beak that makes a terrible noise: a kind of cross between a frightened cat and an angry crow. And then there is the Maribou, a large stork. They are very ugly, large birds that all congregate in tall trees. If you’ve ever seen Walt Disney’s Jungle Book it totally reminds me of those vultures that sit in the dead tree and ask each other “So, what do you want to do?” “I don’t know, what do you want to do?” (Alita – I will try and send pictures so you can look them up in your book).
(This next paragraph is church/Mormon related so those of you not interested could skip it) It was a hard week for the church here too. As some of you may know, President Duke, the mission president for the Uganda mission was killed in a car accident on the Entebbe road early Thursday morning. His wife was injured but is recovering well, at least physically. I forgot to ask about the driver, but should have. They had a memorial service for President Duke so that all the members here could attend and it’s been very hard on all of them. So many of them are new and felt very bereft at his death. One of the other couples that are here (there are several couple missionaries) has been asked to step in for the interim until they call a new president. The missionaries are in shock but coping OK as well.
I have been working pretty much everyday but everyone keeps telling me that I need to see some of Uganda besides the 5 square kilometers that I pretty much have seen. I have been taking walks in an attempt to get more exercise and it’s pretty good as Kampala is basically built on a bunch of hills. The Ugandans think I’m crazy, why walk when you have money to ride somewhere? Whenever I go out walking I’m sure to get honked at every 30 metres or so by either a taxi driver or a boda boda driver (motorcycle for hire) checking to see if I want a ride. I guess most Mzungu (foreigners) are into conspicuous consumption here (at least it seems like it as they have the most gorgeous houses, SUVs and gardens ever) so it’s hard for others to see a Mzungu who’s on a bit of a budget. I don’t think it’s necessary to take a special hire (taxi) everywhere – especially when I want some exercise. Don’t worry though, I don’t go walking around after dusk.
Yikes, this is ridiculously long already so will sign off. Thanks for your letters and support! More next week.
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