I may be belated in doing this but I should clarify for some people what exactly I’m doing. Some of you didn’t really know that I was even coming to Uganda. (Sorry, sometimes I’m not the greatest at keeping in touch with people…). I’m here for two months on what’s basically an exchange program between the division of internal medicine at my university (University of Alberta) and the university here (Makkerere University). I’m working as a senior resident here at Mulago Hospital, which is the referral centre for Uganda and some of the surrounding area. Having lived in developing countries before some things are not as shocking as they might be for someone experiencing all this for the first time but some things are eye opening, that’s for sure.
In keeping with family tradition, when living abroad I must make at least some detailed comment early on about the food. (Sorry – inside joke for immediate family members, if you’re not interested in food you can skip this paragraph). That is why the title of the email. I was never a fan of the low carb craze but after this trip I may decide to take it up as I feel like I have seriously overdosed on the starchy foods already. Let me explain what a daily diet is – at least for me. In the mornings, I eat a banana (if I’m lucky), which is great, some toast (on white bread – yep, jo eating white bread as that’s what there is) and sometimes an egg – although as mom could witness, I’ve never really loved eggs. At lunch time I usually eat at the “Doctor’s Canteen”, which is on the top floor of the hospital and as far as I can tell has the best food of all the places at the hospital – as is evidenced by the fact that a lot of the staff eat there and not just the doctors. This is good traditional Ugandan fare (i.e. starch-o-rama) you get “the mix” or selections from “the mix” plus “sauce”. The mix is a big huge plate of: white rice, posho (ground white corn flour made into a loaf-like texture), matooke (plantains boiled and mashed), sweet potato (more like our regular potato) and yams (purple and very starchy, not like North American yams). The “sauce” is brought in it’s own little bowl and can be beans (which I like and always get if available), groundnuts or g’nuts (actually peanuts ground up into a sauce – quite tasty), fish (always fried tilapia from Lake Victoria, with a tomato/oil sauce), or some kind of meat (chicken, beef or goat boiled in a tomato/oil sauce). The alternative is to get chips (i.e. French fries for you Americans) plus “sauce” or sausages. For supper I either eat out (vegetables preferably) or eat some fruit and crackers, as I’m not usually that hungry after such a big lunch. I haven’t solved the dairy deficiency problem yet but am working on it. I have made friends with the couple staying in the little apartment next to my room and they have a fridge that they say I can use.
Fruit Market
Lake Victoria
Whew, long section – as per usual, I got a little carried away when talking about food, my apologies. I am now well settled in at the guesthouse and am enjoying it. Kampala is a beautiful city (when you live up on one of the hills) and I have enjoyed walking around and exploring a bit. I haven’t been very far really as it isn’t wise to be out after dark but hope to do a little more exploring this weekend with some new friends. Two of the girls who work at the guesthouse and I are going shopping tomorrow. We’ll see how it goes.
I went to church last Sunday and enjoyed it. It was in English so that was really great. They were very kind and I made some friends who were so kind as to invite me over for dinner on Sunday afternoon. They live just on the other side of Mulago hill (Kampala is divided into neighborhoods that are roughly based on the hills). I also met a girl who is an intern at the hospital and lives just next door to me. I also met all the missionaries (who were the only other foreigners at church besides me) and actually took the two elders who work in this area out for dinner once this week. One is from Botswana and the other is a farm boy from, you guessed it, Idaho.
I haven’t mentioned much about the medicine this week. A few people said that my last posting was too medical. It’s kind of hard since that’s really what I’m here to do (and it’s taking a whole lot of my time!) but I’ll try not to make things too unintelligible for the civilians. I’m kind of a little frustrated actually. I feel like I’m not really contributing much. I’m not sure if it’s because I really don’t know very much or that I still sometimes can’t figure out what exactly is supposed to be happening and the language and culture are huge barriers. Maybe it’s a combination of everything.
Part of the problem is that cardiology was never one of my strengths – I’ve probably learned more in the past 2 weeks than I ever did in my 2 months of cardiology rotations at home. I realized how well I know my acute coronary syndrome stuff and what to do (I didn’t realize that I actually knew it so well) BUT how poorly I know the rest of cardiology. Who knew that dilated cardiomyopathy secondary to blown out hypertensive heart was so common? I am seeing a lot of rheumatic heart disease (with lovely mitral stenosis and regurg murmurs) as expected but there’s lots of other stuff. I’ve really had to study pulmonary hypertension and other valvular heart disease. I am looking forward to starting infectious diseases on Monday – although my knowledge will probably be sadly lacking there as well.
Another part of the problem is that the approach to things is quite a bit different here. They are interested in slightly different things and don’t get worried about the same things. Maybe it’s because they can’t do much about them so there’s no point. For instance, there was a gentleman today who’s oxygen sats were 75% (99-100% is normal expected) yesterday and it had been suggested that he move to where the oxygen tank is (there’s only one so all the people who need it have to be clustered around it) but it wasn’t done. Today his oxygen sats were 66% and he was very cyanotic looking and the comment kind of was: “well, when we finish rounds we’ll get the sisters (nurses) to move him to the oxygen.” It’s hard, because at home we’d have called the ICU long ago. I don’t know, the problem is that he’ll probably only get a maximum of 3L of oxygen /minute anyhow so I’m not sure how much the oxygen will help anyway.
Oxygen Tank
I also didn’t realize that all that “patient-centered” stuff in med school sunk in as well. I realized at home that I spend an awful lot of time explaining things to patients and their families. Here I can’t because I don’t speak the language (they laugh when I try to say things in Luganda). I don’t think it’s really done here either, mostly we just write in the chart and on the treatment order sheet and move on – except for telling the patient that they need to take more of that or this pill (Captopril, Furosemide, Propranolol, ASA, Spironolactone, Warfarin and Digoxin are pretty much the only drugs I’ve ordered this whole time). I think it’s a cultural thing – I’m still getting used to it.
I do enjoy the on-call nights (ha ha), mostly because I feel like I’m actually doing something. I don’t pick up on everything (apparently, despite much reading I know nothing about Sickle Cell anemia). I do know some things though and with help can manoeuvre through the intricacies of the system. It’s hard though. They expect me to be an expert on things like stroke and I have to really think. They ask, so, what would you do now and I think to myself: “ummm, page the Stroke Fellow…”. For instance, do I or do I not try to lower a blood pressure of 210/110 when I don’t know if it’s hemorrhagic or ischemic (no CT scan).
Anyway, this is ridiculously long and probably getting boring so I’ll stop. I wanted to talk about the animals - Maribou storks and the monkeys that live next door just for you Alita but I will save that for next time and maybe will be able to send pictures as well. Talk to you later.
Monkey!!
Maribou stork (eating garbage)
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