Poster presentations, whew!

I am very sorry that I haven't posted for a while. I have been very busy, but there really isn't any excuse for not updating my friends and blog readers on what has been going on in my life. We are coming to the end of the quarter now and approaching final exams craziness, but there have been many other events speckling the fall quarter of our second year.

I have now presented my IHOP (International Health Opportunities Program) poster about my project in Uganda twice. Both times I was slightly dreading the experience, but I actually enjoyed it quite a bit. It was nice to talk to people and share some experiences in Uganda as well as talk about some rising health issues in Uganda. Oh, and it also gave me an excuse to dress up in some of my Uganda clothes, which was really fun.

Here are just a few pics from the most recent poster session:

This picture didn't really turn out very well, but I was poster 3.


Here are some of the IHOP participants. Annie and I went to Uganda, but others went to Peru, Madagascar, and India.
Annie and I haven't seen each other as much since going back to school, so it was nice to catch up a little during the poster session.

Here I am with my poster. It was fun.

Brain Flop: Multiple Causes of Chest Pain?

Second year of med school at the UW has a lot of book learning, but the school also does a good job of trying to ramp up our clinical skills in preparation for spending 3rd and 4th year in hospitals on various rotations. The Introduction to Clinical Medicine course is class that tries to guide us on the path to becoming good doctors, and it is through this course that our second year clinical experiences take place. The Medical School has 6 different "Colleges" or sort-of families that students get randomly assigned to when they start medical school. They are:

Denali = my college (which is, of course, the best!)
Rainer
Columbia River
Snake River
Wind River
and Big Sky


Within the Colleges, students also get assigned to a "College Mentoring Group" with about 5 or 6 other students. Your College Mentor is an experienced physician who guides and supports you through you medical school and who plays a large role in your clinical learning in second year. Throughout second year we go to a hospital with our College mentor and the other students in our mentoring group and interview patients and practice our physical exam skills. Each student completes 2 completely histories and physicals a quarter, presents their patient to their group, and completes a write-up about the patient. (It is a lot of work, but we learn SOOOOO much through this experience).

This is a picture (off the school's website) of Sam who is our Denali College Mentor. Sam is awesome. He is really good about giving very helpful feedback, but in a kind and supportive way. (I will try to post an update picture of our entire college mentoring group next quarter. I kept forgetting to take pictures this quarter).

Anyway, towards the beginning of the quarter I interviewed a very nice patient who had been admitted to the hospital because of chest pain. I didn't get through everything, but I finished as much of history and physical as time would allow. Then I presented the case to my mentor and mentoring group classmates. I was really nervous and my mouth was dry and my hands were shaking while I was presenting the case. Then we got to the end and our mentor asked me: "So what are some of the most likely causes of the chest pain?" I froze and I couldn't think of anything to say other than a possible myocardial infarction (a heart attack). My mentor smiled and asked with an inquisitive look if I could possibly think of anything else that could cause chest pain. I swallowed slowly and quickly tried search my brain, only to find that it was completely void of any useful knowledge. In fact, the only thing present seemed to be the word, "uh?" echoing through my skulls empty chambers. I looked at the floor and said that I couldn't think of any other possible causes of chest pain. I was embarrassed then, but it was nothing to how I felt once I got home and looked up "Chest Pain" in my physical exam book. The possible causes of chest pain and almost countless. Just a few that I found were:

-myocardial infarction
-cardiac arrhythmia
-aortic dissection
-pericarditis
-pulmonary embolism
-pneumonia
-lung cancer
-pneumothorax
-pleural effusion
-hyperventilation
-anxiety
-depression
-reflux esophagitis
-esophageal spasm
-peptic ulcer
-gastritis
-pancreatitis
-biliary colic
-cervical arthritis
-costochondritis
-herpes zoster

I can't believe that I couldn't think of just one more from the list. I guess we are still a long way from becoming doctors. Hopefully, we improve a lot this year!

A shameless fundraising plug: EEP - Orphan Sponsorship Program

When I was in Uganda in 2007 I volunteered for a Canadian organization called Working to Empower. One of the activities I helped with while I was there was their orphan sponsorship program. The program helps female orphans attend secondary school which increases their status in society, breaks the poverty cycle and makes it less likely they will be infected with HIV. I wrote a couple articles about the program while I was in Uganda and got to talk to some of the girls going to secondary school. They really are good kids and have a lot of hopes and dreams. Anyway, if you are looking for a good thing to donate to, check it out:


http://www.givemeaning.com/project/wteeep

(GiveMeaning site is hosting the fund raising efforts for the program)

Still some time for some fun...

Although I may spend many hours studying, I still have plenty of fun. In addition to seeing friends and family, I enjoy spending time with my roommate, Melissa, and her cousin.

I thought this picture was pretty funny. Melissa is a fourth year medical student and she made blueberry muffins for her call team that she works with at the hospital. However, she put the muffins in containers too soon after getting them out of the oven, so the next morning the muffins were a little on the soggy/moist side. I was cracking up as Melissa used a hair dryer to dry out her muffins. I think many years from now this picture will symbolize the good times I have had in this house.

Sorry that I haven't posted for a while, second year is kicking my ______

I am sorry that I haven't posted anything on the bl0g for a while. The only (extremely lame) excuse I can give is that the second year of med school is kicking my______(this word has been omitted in an effort to keep my blog G-rated and family-friendly). I am currently in a state of post-test euphoria so I will spend a few minutes giving you a quick update on my life.

I just started the 7th week of our 15 week "quarter," and we have already completed 2 classes! We have 5 hours of class Monday-Friday and our classes are divided up into quarter-long classes and block classes. Pharmacology and Introduction to Clinical Medicine II last the entire quarter while other classes only last a few weeks. The first class, the Skin System, we completed in only 2 weeks. The second class we just finished was Endocrinology and that class lasted about 4 weeks. Some good news: I passed both classes! Whew! Those of you who talk to me (which we know really means listening to me freak out) regularly know that I was particularly concerned with passing Endocrine. In the end I passed the course and decided that I really liked the material - endocrinology is absolutely fascinating! Now we are studying the Cardiovascular System and the Urinary System as block classes.

The REALLY good thing about second year is that the material we are studying is much more interesting and is directly applicable to taking care of patients which makes studying it more fun. Learning in detail about different aspects of the human body is fascinating and it makes you feel smart too! Therefore the 4-6hours you have to study each day to stay caught up seems much more bearable than the study load last year even though we have more work.

In addition to coursework, I have had a few other things on my plate. My laptop I use to take notes on everyday, gave up the ghost and is currently being repaired (thanks to the Staples warranty). Also, for my trip to Uganda last summer I had to create a poster about the project I conducted in Kumi making shoes for diabetic patients. The poster was due earlier in the quarter, but I will be presenting it at the School of Medicine Poster Session in November.

Here is my poster. It might be hard to read on the blog, but you can probably get the gist of the information. It is a lot of work to try to line up all of the boxes on the poster!


As far as my study methods go, I am probably don't have the most efficient methods possible, but I have been doing anything I can possibly think of to help me learn the material. Recently this has taken the form of using many different pen and highlighter colors with my studying to keep things interesting.

This photograph is the current artistic representation of my life - studying a lot! Featured here are my Endocrinology notes, my pens and some of my highlighters. When I put a full day of studying, I go through an average of a highlighter a day or a pen every other day. I know, I live an exciting life.


Here are the coursepacks for the two conquered subjects so far - Skin and Endocrine. A long time ago I used to have this reverence for textbooks. I somehow thought that it was wrong to write in them, highlight excessively or otherwise defame such a precious source of knowledge. Now I have a completely different approach - textbooks are my slaves! Their purpose in the scope of the universe is to help me learn and therefore should be abused in anyway possible that can help me understand the material. These abuses may include, but are not limited to: highlighting, annotations in the margins, scribbling in frustration, or the writing of sarcastic commentary/mnemonics. In case you were wondering, my highlighting color scheme does have a rudimentary logic: yellow is mildly important, green and blue are moderately important, and orange and pink are extremely important/pay attention! If a figure or concept is very important or hard to grasp I write a summary statement in the margin. Therefore, when it is time to review for an exam I can go through and read the orange, pink, green and blue highlighted text, review figures and read by notes in the margin and come away with a pretty good review. OK, now you probably know way more than you ever wanted to about my study habits...

How do I feel these days? Well, a picture is worth a thousand words... :)

Reentry

Washing machines are amazing. No, really. Washing machines may be one of the best inventions of modern society. This is my third time coming back from east or southern Africa and each time I amazed by how effective washing machines are at getting clothes really clean with minimal human labor required. During most of our time in Uganda this summer we paid a local Ugandan woman to wash our clothes. However, towards the end of the summer she went to a different part of the country and I decided to tough it out and wash my clothes myself. I tried various techniques all of which left my clothes remarkably still dirty and still smelly. My increasing desperation to get my clothes clean climaxed in me trying to perfectly simulate the actions of a washing machine. I pre-soaked my clothes in a large bucket of cold water. Then I boiled water on the stove and agitated my clothes with hand washing soap in a bucket of hot to warm water. I rubbed the soap into each garment paying particular attention to any stained or smelly areas (wash cycle). Then I drained the water and wrung out each garment (spin cycle). Then I actually repeated the warm wash cycle again as well as the ringing out of the clothes. Then I rinsed my clothes with warm water and then once again with cold water (ringing the clothes out in between rinses). I hung the clothes on the line and once they dried I was dismayed to find that they were still dirty. The orange hue of Ugandan dirt stubbornly remained and none of the stains had been removed. It seemed like a physical impossibility. I left about ½ of my clothes in Uganda. However, I decided to bring back some of my particular favorites. The day after I came back to the States I put my (still dirty and stained) Ugandan clothes in our washing machine, put in an appropriate about of laundry detergent, pressed start and 40 minutes later my clothes came out vibrantly clean and stain free. It is amazing.

Of course, washing my clothes might be a stupid thing to write a huge paragraph about, however, it does illustrate how insanely easy so many things are here in the United States. It took me all day and probably about 500 Calories to try to get by clothes “less dirty” in Uganda. However, in the States “doing laundry” is something you do on a whim while talking to your mom on the phone and takes very little energy. Just getting water piped into your house is a huge luxury that many of us take for granted here in the States. In Kumi it would take women all morning to pump water from the local well and carry it back to their homes 20 liters at a time for cooking, drinking, washing dishes, bathing, laundry, etc. Reliable electricity? Hot running water? These are privileges reserved for only the wealthiest of the upper class in Uganda. Here they are just expected like people expect the sky to be blue and the grass in their manicured lawns to be green. We really do live in a privileged society.

The day after I came back from Uganda I opened internet explorer on my computer and opened a book to read while I waited for the gmail page to load. I only read a sentence or two before I realized that I was back in the land of technology and highspeed internet! Oh, the bliss of typing in a webpage and having it pop up suddenly! Think of how much time you save with the instant, virtually free, communication and access to information through the internet. It is spectacular. However, there are disadvantages that come with our technology and internet information age. When was the last time you just sat down with a stranger and talked to them for 3 hours? In Uganda, I was able to spend a lot of time getting to know people and hearing their stories because technology, electricity, and internet were so inaccessible. When we were in rural Kumi I got to spend a lot of time with a physician and his wife learning about how they met, the courtship and marriage traditions from their ethnic group, what they thought about Ugandan and US politics, how the Catholic Church was run in Uganda and corruption in the Ugandan medical system. These are conversations and information I might not have gleaned if the internet, electricity and other forms of entertainment had been readily available.

I think my re-entry shock hit a high last week when I was at my pediatric infectious preceptorship in Children’s Hospital. I will be doing this preceptorship all of fall quarter and I think it will be very fun and interesting to compare the infectious diseases we deal with here in the States compared to those I saw in Uganda. Anyway, during the first preceptorship session at Children’s, the physician had to do a lumbar puncture on an infant who was only a couple months old. They placed a path of gel on the baby’s back, there was a whole sterile lumbar puncture kit that had been laid out by the staff, there was a little pacifier with sugar water for the baby to suck on during the lumbar puncture, there was a pack of three iodine swabs to sterilize the area, 3 clean collection tubes, various extra (sterile) equipment, a sterile paper sheet to put the baby on and a clean blanket to wrap the baby in after the lumbar puncture was over. It was such a contrast to the lumbar punctures I had witnessed or helped with in Uganda where frequently there weren’t even materials to sterilize the baby’s back, needs of the correct size or collection tubes available for the cerebral spinal fluid. The Children’s lumbar puncture experience made me marvel all day at the resources we have in the US medical system and how it compares to the needs of so much of the rest of the world. How unjust is it that a child treated in Uganda for meningitis is some much more likely to suffer and die than a child born in the States? It isn’t because of anything the child did or any other reason than that the child was born to parents who happened to be poor and happened to be living in a poor country in East Africa which happens to be at a huge economic and medical disadvantage compared to the United States and Europe. It is not fair, but what can be done?

Camano Island State Park

I am back from Uganda and I spent Labor Day weekend with my family on Camano Island. My brother, Aaron, also came up to visit and it was very fun to see him. Sometimes the exuberance of the house can overwhelm. Since it was fairly sunny one of our favorite activities was to go to Camano Island State Park which is only a few minutes drive from our house. I thought I would post just a few pictures from your walk/hike for you to enjoy and admire the island-lifestyle.

Sarah took this lovely picture of the beach.

The park has lots of educational materials such as this sign which is being highlighted by Aaron. Apparently, "Falling can be deadly." Who knew? I am really glad I went to the park so I could learn this important fact.

This picture was taken by the fabulous Paul. From left to right: Me, Sarah, Aaron, and Kalkidan. We had a lot of fun.

A pic of the loop trail. We went on Roy's trail first and it was super lame - it just led to a RV circle with a bunch of people playing horseshoes. If you ever go hiking in the park stay away from Roy. The loop trail isn't really a loop though, it dead ends on a road and you have to walk on pavement for the last little bit, but it is still fun.

My brother Aaron works as an outdoor educator and so we learned a lot on the hike as he taught us about various plants and animals we discovered.

Window seat adventures, again

I am back from Uganda! It is nice to be home and start seeing family and friends again. I really want to see everyone before I start the second year of medical school (orientation starts Wednesday and classes start in earnest on the Tuesday after Labor Day).

Many of you long-term blog readers will remember my window-seat trouble my last trip back from Africa. (To see the previous entry visit: http://christystriptoafrica2007.blogspot.com/2007/08/my-trip-home-emotional-and-frustrating.html )

You may find it entertaining that the window-seat drama continued on this trip. After successfully packing my ridiculous amount of stuff in two 48.5 pound bags (the max is 50 pounds) with the help of Andy's portable scale, I arrived at the Entebbe Airport in Uganda. I made it through the security, etc and was waiting with a room full of people for the Ethiopian Airlines plane to come. It was about an hour late and when the plane landed the airline attendant announced in Amharic (the national language of Ethiopia): "something something something something something something something something something something something something something something... (several more minutes) ... something something something." Then she said in English, "We are now boarding all rows." My first response was that it either takes a lot longer to say a statement in Amharic than in English or that I, as a non-Amharic speaker, had not received all the information that had been recited in Amharic. I stood up and started walking towards the door when I was literally flattened against the wall by a stampede of Ethiopian passengers. The non-Ethiopian-looking passengers were not stampeding and had a bewildered expression. As I was drawing near suffocation from the mass of people pinning me to the wall I thought it was a very good thing that I hadn't fallen over because I might have been killed with the sudden vigor of everyone trying to reach the plane at once.

When I finally freed myself from the wall and started to move towards the plane I noticed there were two sets of stairs going into the plane - one towards the front and one in the very back. My seat was 11L which I thought would be fairly close to the front, so I decided to go up the front set of stairs. However, I was abruptly stopped by an airline attendant who asked if I was First/Business Class. I said I wasn't and he said that I would have to use the back set of stairs. So, I reluctantly joined the shoving throng of people pushing towards the back set of stairs. Once I made it in the back door I started on the arduous journey towards the front of the plane and my seat in 11L. With only the thought of my window seat to drive me forward, I cintinued on row after row after row. I finally arrived at row 11 which is the row DIRECTLY behind first/business class. (Side note: The first set of stairs is actually attached to the plane behind row 11, so it would have made perfect sense for me to use the front stairs, but no). To my horror, a woman was already sitting in my window seat. I politely told her that I thought that I had the window seat, but to my surprise she responded with several sentences of rapid French. I didn't understand most of it, but I thought I got the gist of the message: "This is my seat!" Still speaking French she showed me her board slip which had "11L" clearly typed on the bottom. A flight attendant came over and said, "Oh, didn't you hear the announcement? We had a problem with seat assignments so it is just open seating - sit where ever you want." Apparently "Open seating" was part of the Amharic announcement that they decided not to repeat in English. By this time almost all of the seats in the plane were full and I ended up sitting on an aisle seat in the same row as the French woman. I guess I had it good because apparently they ran out of room for the last passenger - perhaps that was another part of the Amharic message too. I don't know.

I was guardedly hopeful that I might get the window seat for the next flight from Ethiopia to Washington DC, but it was not to be. When I found my row, I discovered an Ethiopian woman sitting in my window seat. With a sigh I decided to start the sad ritual that I knew could not end happily. I said very respectfully that I thought I had the window seat and maybe she could have the aisle. The woman's English was very poor, but she managed to say, "My seat" while point at my window seat she was sitting in. I decided that maybe she just really wanted to sit by the window and that I wouldn't try to fight this battle again. After taking my aisle seat the woman abruptly closed the window so we could see anything and pulled a blanket over her entire head and went to sleep. Thus, I concluded that she was not too excited about looking at the window.

While the final passengers were boarding an American girl came on the plane and stopped a couple rows in front of me. After storing several bags she walked up to a man sitting in the window seat in her row and said, "Sir, I think that is my seat." She repeated the phrase a couple times and seemed dismayed as she could not get the man to budge and let her have the window. It was so similar to my past experiences that I couldn't help laughing - never try to claim your window seat on an Ethiopian Airlines flight returning to the United States!

After I stumbled off the plane in DC, I tried to sleep for a bit and then watched the news to discover that neither Obama or McCain had selected Vice President running mates yet. What had they been doing the entire summer I was in Africa? When I left the big news was that Obama and McCain were the nominees and everyone was trying to guess who their running mates would be and when I came back that was still the top news story. I guess I didn't miss much by not getting to watch the news over the summer!

I boarded my flight to Seattle and was delighted to sit in my precious window seat. I hunkered down wrapped myself in a blanket and prepared for a 6 hour flight of sleeping, looking out the window and relaxing. I was only slightly concerned when a couple and a child passed my row and I feel asleep during the rest of the boarding process. While the plane was taking off, I awoke to a high pitched noise and a shock wave rippling down my back. Confused I opened my eyes and tried to figure out what was going on. Another shock wave hit my back and I realized what had disturbed my slumber - a child of about 4 years of age was seated directly behind me and was screaming and kicking the back of my seat. I decided to try to ignore it, and look out the window. However, several minutes later an announcement came that we were supposed to close our windows so people could enjoy the in-flight entertainment or sleep. I obediently complied with the closing-of-the-window request and resigned myself to a less than perfect flight as the child continued to scream and kick for the duration. I think that little boy probably has a future in sports because that is a long time to continually kick a chair. I thought about turning around and giving the kid a piece of my mind, but the parents were already really embarrassed about the child's behavior and apologizing to everyone nearby so I didn't want to make them feel worse.

Whew! Now you know about my window seat troubles. Perhaps it is better not to request a particular seat...


Window seats -the impossible treasure on international flights with Ethiopian Airlines.

"The Rank Inn" and other pictures that make me happy...

This is Annie making a piece of rubber talk. We were waiting for the tire shoe guy to make a pair of shoes in Kumi and Annie entertained all of us by making various inanimate objects talk or make random noises.

This infinity media sign makes think of calculus and Buzz Lightyear.

This is the chapati man across the street from our apartment making a Rolex. A Rolex is eggs with cabbage, tomato and onion that are rolled up inside of a chapati. It is cheap and delicious.

Her is another shot of the chapti guy and his Rolex stand.

This is the fruit lady named Rhoda. She has a small shop in the little market area near Mulago Hospital. She picks the best fruit from the market and then sells fruit salad and fresh fruit juice from her little sand. I stopped by a couple of days ago for my last fruit salad and took this picture. Rhoda is extremely nice and likes to talk while she is making the fruit salad. She says she really wants a white husband and offered to marry my older brother if he would take her to America.

"The Rank Inn." This sign makes me smile almost every day. We pass it on our way to the hospital in the morning. A couple of days ago I decided to walk to the hospital so I could get a picture of the sign. I wonder what the Inn is like. Would you stay there?

Babies!

Now that Annie is gone and I am all by my little lonesome, I am playing catch-up from past pictures and stories. I really wish that I had taken pictures of the babies I delivered in the OB ward. However, the night before Annie left we visited a friend that we met in Kumi and his wife that had a 7 day old baby. He was so cute! I decided to post a few pics from this visit to stimulate your imaginations on how cute little newborn Ugandan babies are.

This is our friend's week old baby. I didn't deliver him, but imagine some slightly smaller babies that are just as cute, and that is what the babies looked like.

Ahhh... Here I am holding our friend's baby again.

Two of the midwifes from the delivery ward. They were so nice to me and taught me a lot about the delivery process.

Today I went and said goodbye to all of the lovely midwives at the maternity ward. It was really nice to see them again and we snapped a few pictures. This is the head midwife and she watched me deliver my first baby. Good memories...

A mean prank

How is the summer treating you? Are you bored? Tired of life? Do you want to go on a road trip, but can't afford the gas? Have you completed all of your 1,000 piece jigsaw puzzles, and don't know what to do next? Do you delight in the inconvenience of others? Are you just itching to play a vicious prank on a sort-of friend? If so, this is the blog entry for you! Follow these simple steps and watch your friend/acquaintance agonize for weeks and loathe your name.

Note: For the purpose of this entry, we will call the person on whom you are playing the prank, "The Victim."

Prank Day 0 (Planning stage): Go to a local store and buy several large bags of candy. Any kind will do, but preferably it would be small, individually wrapped and easy to distribute to large numbers of children. Also, make a time schedule of when the victim is usually away from home.

Prank Day 1: When the victim is gone (consult time schedule), go to the victim's neighborhood and conduct some activity to attract small children. This could be playing a game of soccer in an
area next to the victim's house. Once a large number of children are gathered, ask them if they would like some candy/sweets. Of course, the children will say, "Yes!" Next, GO TO THE DOOR OF THE VICTIM'S HOUSE (This is a very important step) and proceed to give out 1 or 2 pieces of candy to each child present while still standing outside the victim's door. When the children call their friends, give them candy too.

Prank Day 2: Repeat the process. The sports activity won't be necessary. The children will be ready to run to the door of the victim's house to receive their piece of candy bliss.

Prank Day 3: Go to the victim's door, but don't give out candy. Tell the children that you don't have candy EVERY day, so they have to keep coming back even if they don't get candy for a couple days.

Prank Day 4: Go to the victim's door and give out more candy.

Prank Day 5: Give out tons of candy at the victim's door! Get rid of what ever candy you may have left.

Prank Day 6 - infinity: Relish the misery you have inflicted on the victim as every child in the neighborhood hounds them with,"Give me sweets! Give me sweets!" as they go to and from his or her house.

The worst part of it, is that the victim will feel so bad having to say, "No, I am sorry, I don't have any sweets" to cute little children every day. You also have the perfect cover if you get caught giving out candy - just say that you really like being nice too kids.
________________________________________________
I am sure that you have already guessed from the bitter nature of this entry that someone did this very prank at the our apartment in Kampala. I don't think the individual was consciously trying to be vicious. However, the end result was the same. We also know who did it because Annie caught him red-handed as he was giving out the last of a huge bag of candy to small children outside our door. The individual was a friend of one of the Swedish medical students and for some he thought it would be a good idea of give out candy at the door of our house for 6 consecutive days.

For the first week after the candy was distributed, every time Annie and I came home we would be mobbed by at least 4 children yelling, "Mzungu (white person)! Give me sweets! Give me sweets!" We would respond by saying that we were sorry, but we didn't have any candy/sweets to give. They usually left and would try again the next day, but one time they actually laid on the ground and kicked the door of our apartment screaming, "Give me sweets! Give me sweets!" They have gradually thinned, but there are still 1-4 children who follow me to the door of our apartment asking for candy.

If you have read some of my earlier blog entries, you may be confused - I always talk about how much I love children and how cute they are. This is true, and I do love children, just not when they are stalking me for candy. Also, please don't be under the impression that these are starving children. They are actually the children of quite affluent families who live around us (we live in a fairly nice area of Kampala) and the children are fairly spoiled by Uganda's standards. But yes, in general, I do still love children.



"Give me sweets!" I took this picture today, almost 3 weeks since the last day of candy distribution at our door. There were two small children waiting outside my door today. They are still cute, even if they are getting on my nerves a little bit.

Pics from Kumi Hospital

Here are some pictures from Kumi Hospital that I have been meaning to post.

This is some of the equipment in the orthopedic surgery ward.

Here is the surgery table.

This is Annie and me with Dr. Ekure. He is very talented and an excellent teacher.

Here we are with the surgery staff. They were all so nice.

pics - kids are cute

At home my little sister Monica (5 yrs old) likes to put a ball under her shirt and pretend that she is pregnant. Yesterday I met the cutest little Ugandan girl who likes to tie a bundle of blankets on her back and pretend that she is carrying around a baby. I guess it is the Ugandan equivalent of pretending you are pregnant. I thought it was so cute that I asked the mom if I could take some pictures.

Here she is showing off her bundle/pretend baby. I love kids. I forgot to mention that I am wearing my Ugandan dress that I had made in Kumi. It is a little bright, but I got a lot of compliments on it from Ugandan women who enjoy seeing a crazy white person dressed in their style.

She was a little shy so I had trouble getting her to look at the camera. Although she was shy, she did shake my hand and wave goodbye to me when I left.

I am still not sure what I want to do for residency, but I think it will probably come down to a choice between pediatrics and family medicine. We will see what the future holds.

pics of the hosptial!

Here I am sporting my Ugandan dress outside the med school.

The outside of the hospital.

A visit to Mabira forest and a renewed faith in humanity

Last week I was slightly discouraged about the state of the medical system in Uganda as well as the attitudes that seem prevalent in some aspects of Ugandan society (women not being valued as highly as men, etc). Also, Annie and I seem to continually be faced with people who want to rip us off/cheat us out of money or anything else just because we are white. We decided that we just needed to get out of Kampala for the weekend. Annie and I both like nature/hiking so we decided to visit the Mabira Rainforest. It is one of the biggest rainforests in Uganda (about 300 sq. kilometers) and the guidebook rated it highly. We made our way to the old taxi park and found a mini bus that was heading toward Jinja (Mabira forest is between Jinja and Kampala). A nice Ugandan man in the minibus knew the road between Jinja and Kampala very well and he told us that he would tell us where to get out. It was so refreshing to have someone volunteer to help us without asking for anything. We got out of the minibus and were surrounded by a delightful little market and lush forest. About 30 second after leaving the transport it started pour down rain. It made sense - it probably RAINS a lot in a rainforest. We ducked into a little restaurant and ordered some tea. It was run by a older woman and her entire family (children and grandchildren) lived in the adjacent room separated from the restaurant by a little curtain. She seemed delighted to have us as customers and was particularly thrilled when we ordered some matoke (cooked green bananas) and beef stew. She was so nice and welcoming and charged us a very fair price even though we had to sit there for over an hour while it rained. We explored housing options and found the most affordable option was to stay at the housing provided by the park itself. We were shown to a delightful banda/house that was surrounded by lush forest. Although there wasn't running water, a woman very kindly brought us warm water to bathe with. The park director found out that we had been working/studying in Uganda for over 2 months and gave us a small discount off of the normal tourist fee for staying in the banda and hiking in the forest - a very refreshing change from the norm.

After a refreshing shower and watching the monkeys swing from the trees around our banda Annie and I walked to the road-side market. We were able to purchase grilled bananas and chicken that we ate with a plate of delicious beans. All for a price much cheaper than Kampala. We finished off with some fresh pineapple for dessert.

The next day we hired a guide and had a delightful hike through the forest. We saw lots of birds and fascinating botanical specimens as well as hundreds of butterflies. Our guide stopped us towards the end of the walk - a cobra had been lying across the pathway. Fortunately, it slithered away and didn't bother us.

Here are some pictures from our awesome weekend:


Here is the view (away from the forest) on the top of a nearby hill.

Here are some children that were carrying firewood to their homes. They were really cute.

Annie and I in front of the a field of sugar cane. The pictures from inside the forest are a larger file sizes so I didn't try to upload them.

This picture exemplifies one of the highlights of our trip. There was this little craft shop run by the women of Najembe (the road town of Mabira Forest). I poked my head in the little shack and found this woman making a basket. It was a heart warming sight to see someone actually making the crafts that they were selling. Apparently, there is a lot of the plant that they make baskets out of growing around the forest. Annie and I noticed that her baskets weren't as Fancy as the ones available in Kampala, but I told Annie that I had a very good feeling about this woman and wanted to by something from her. We picked some of the baskets she had made and asked how much. She gave us a very fair price and we bought several. She was so happy that we bought the baskets that when we stopped by later she gave a taste a a sweet potato paste she was making. She indicated she sold it by the road and we were confused if we were supposed to give her money or not (she didn't speak any English). We decided to give her a couple hundred shillings and she came after us with a huge banana leaf filled with sweet potato mush indicating that this is what we paid for. It was so refreshing that she didn't try to cheat us. Anyway, now I have a huge simple basket that I bought from this woman. It is very special because the woman who made it was so nice!

Global pulse, photo essay

Just in case you are interested, some of the pictures I took during my last trip to East Africa were recently published in "Global Pulse," the American Medical Student Association International Health Journal.

The web address is: http://www.globalpulsejournal.com/

Scroll down to an article entitled: An African Essay.

shock, anger, blah

Yesterday I was filled with the most shock and anger I have experienced during this trip to Uganda.

Soon after arriving at the delivery ward, the third year medical student asked me to assist her for a delivery. I helped prep and got a clean sheet ready for the baby. The third year student did an expert job of delivering the baby. This was the young mother's second baby and she didn't tear at all. I helped hold the baby on the mother's stomach while the third year student tied off the umbilical cord. The baby was very healthy and beautiful baby girl and she let out several strong cries immediately after delivery. After the cord was cut, we showed the sex of the baby to the mother. One of my favorite parts of delivery is when you show the baby (including the sex) to the mother and she gets a huge grin across her face. However, when we showed the baby to this mother she glanced at the baby and looked away in absolute disgust. Confused, I tried to show her the baby again and said, "Congratulations mama! you have a beautiful baby girl!" The mother continued to look away with contempt and refused to look at me or her child. Still confused I took the baby, weighed her, cleaned off her face, examined her toes and back, etc. She was looked perfect - she had all her toes and fingers, she was actively moving and breathing/crying very well. I wrapped the baby up in several sheets and went back to the third year student to ask what was going on. The third year student told me that the mother doesn't want the baby because it was a girl. The young woman's first child was a girl and she wanted a boy because their family needs a male child. The third year medical student then spent about an hour telling me of how common a problem this is. Many women, if you do not show them the sex the the child and get a witness will later accuse the staff of replacing a "less valuable" female child with the male child they claim to have delivered. Apparently, boys are seen as a way to wealth and security, but girls are seen more as a liability in some aspects of Ugandan culture. It was so sad. This beautiful baby wasn't wanted because she was a girl.

I asked the third year student what we were going to do. She said that there really isn't anything you can do besides give the baby to the mother and hope she will care for it. The third year student said that she would hope that mother would have some counseling and someone would make sure she wasn't suffering from post-pardum depression, but the facilities/resources just weren't available there. After the woman was cleaned up we placed the baby next to her. I watched in horror as she apathetically stared at the ceiling while the baby screamed next to her and she made no attempt to console or breastfeed it. What is wrong with the world? Something seems so inherently wrong in a mother not wanting her newborn baby. I calmly tried to maintained my self control despite the feeling that if I could shoot lasers from my eyes everyone in the room would be a singed skeleton, and talked to Annie over lunch. It is great that we have each other to talk to!

Unreasonable fear

This week was awesome. I asked to be placed in the delivery ward of the hospital for uncomplicated cases (there is another ward where complicated cases, such as breach presentation, hypertension, twins, etc are referred) with the hope that I might be able to assist in some deliveries and perhaps deliver a baby (supervised, of course) at the end of the week. The week was by all accounts a success, but it was definitely stressing at times. I got to watch so many births. There weren't any doctors in this delivery ward, but there were about 5 or 6 midwives and a third year medical student. About a couple hours after I arrived in the ward, the third year medical student let me watch while she delivered a baby. She was really good about explaining every step and helping me understand why they did things certain ways. Apparently, one of the most important things to do during the delivery process is to give a shot of oxytocin within 1 minute of the delivery. The third year medical student also taught me how to deliver the placenta with continuous cord traction. She also taught me the basics of delivery and how to minimize tearing and what position to hold the baby. Did I mention it was amazing?

The delivery process itself is surprising fluid-involved. By "fluid-involved" I mean that every fluid that could possibly come out of your body comes out during the delivery of a baby. [Warning: Don't read if you are eating lunch]. First the expectant mother must urinate and empty her bowels to allow maximum room for the baby to descend. The delivery process may or may not be accompanied with vomiting from the mother. Then the delivery itself is accompanied by large amounts of blood and amniotic fluid. Profuse sweating also takes place by the mother while she is pushing. The baby usually defecates as well sometime during the process, making the circle of bodily fluids complete. However, despite these many possibly offensive odors, I found the delivery ward a surprising pleasant place to spend time in and birth a miraculous processes.

Anyway, sorry about my rambling. You might be wondering why I have entitled this entry, "Unreasonable fear." I have entitled the entry thus, because of an experience I had on my third day in the delivery ward. Early on in the morning, a midwife assigned me to monitor a woman who was HIV positive and on HAART (Highly Active Anti-Retroviral Therapy). I looked forward to monitoring this woman and possibly being present while she delivered. I was not concerned about her HIV status as many women in the ward are infected with HIV, and just noted to myself to be extra careful to wear double gloves anytime I had to contact bodily fluids.

A couple hours later, the woman in the bed next to my patient started pushing and a midwife told me to quickly draw a syringe of oxytocin. The oxytocin are in little glass vials that each contain 1 dose of the medication. The women bring their own gloves, cotton, syringes, plastic sheets to deliver on and clothes for the baby. I quickly got a dose of oxytocin from the supply cupboard, put on a pair of clean gloves and used a piece of cotton to break open the vial of oxytocin. Then I opened a package with a sterile syringe and needle. However, while I was trying to un-cap the needle I accidentally stuck myself with the tip of the needle. I instantly froze and my pulse went up to about 250 beats per minute as I started to feel a small trickle of blood go down my finger inside my glove. I was so scared. I had just stuck myself with a needle! It didn't matter that it was a clean, sterile needle and my hand was clean and covered with a clean glove. All the secret fear of a needle stick came to me in a flood. What if I had just finished giving the injection to my HIV positive patient when I accidentally stuck myself? For the first time since Annie's blood-splash scare, I was glad that the UW made us bring HIV prophylaxis with us. I took a couple deep breaths, and then dropped the contaminated needle/syringe in the sharps container. With slightly trembling hands I successfully filled a new syringe with oxytocin and handed it to the midwife. I then excused myself and washed my hands about 5 times and called Annie (who was rotating in endocrinology) and asked if she wanted to have lunch.

During lunch Annie was really nice about listening to me and was very reassuring when she told me that a needle stick with sterile needle into a clean gloved finger is actually safer than cutting yourself in the kitchen with a knife. I am now fine and completely calm. It was just rattling to realize how easy it would be to stick yourself with an infected needle.

The week's tally...

Whew! I just finished one of the busiest weeks so far during my visit to Uganda. I spent this week in the obstetrics ward for uncomplicated deliveries at the large hospital in Kampala. It was tiring, but so much fun. I have a lot of good memories from this ward that I will share shortly. I just wanted to give you a summary of my week to start off the entries:

Deliveries observed/assisted on: 13

Guided deliveries (a midwife put her hands on top of mine): 1

Unguided deliveries: 2

Placentas delivered: 4

Newborn babies named after me: 1

Scary experiences: several

Adrenaline rushes: countless

A Green Mamba Story

As Annie and I were leaving Kumi we saw one of the most poisonous snakes in East Africa - the Green Mamba. It is a thrilling tale, but unfortunately I don't have any pictures to accompany my story so I have taken one from the Whozoo website in addition to some interesting facts.

Green mambas are very poisonous but are less aggressive than their relatives, the black mambas. (Black mambas will hunt you down if you make them mad and they will probably be successful in their attempts to kill you as they can travel as fast as a human can run, climb trees and swim). Anyway, green mambas don't get upset as easily but they are still very dangerous. There was a joke in Tanzania that the "medicine" for a green mamba bite is this: you see that you have been bitten by a green mamba and then you get out a piece of paper and and a pencil and write a quick note, "Mom and Dad, I love you." You then have just enough time to put the piece of paper back in your pocket before you die.

Back to the story: Annie and I had just packed our bags and were taking two motorcycle taxis to catch the bus when Annie's motorcycle, which was riding in front, swerved drastically on the dirt road. Annie asked what was going on, and the driver said something about not to worry because it was "a green one" and the motorcycle didn't hit it. My motorcycle also swerved to miss a 5-6 foot long snake that was bright green. The motorcycle driver told me it was a green mamba and that they are, "Very common" in the area. He said it that he was very good that we didn't run over it or make it mad. Anyway, that was my second close-proximity story to a poisonous snake in East Africa.

Shoe project...

I posted earlier about the projects that Annie and I are trying to do in Kumi. They are going well and I thought I would give you some update pictures:

First some of the posters we made:

One of Annie's posters in English.

Translated into Ateso. For some reason some of the letters went funky when I tried to convert it into a JPG and upload it. The Ateso posters aren't the final drafts either, but you get the idea.
My poster in English. Essentially just trying to get people to wear shoes and advertise the reduced prices I was able to get for diabetic patients.
Then also translated into Ateso. Once again, not the final draft, but you can get the idea.

This is another poster and Annie made (I helped a little, but she was the mastermind).

Now some pictures of the tire shoe guy making shoes. We made 48 pairs of shoes in 2 weeks! Whew! Hopefully, he will continue to make shoes.

The guy is cutting the tire. He has dismember the tire before he can make shoes out of it.

The diabetes focal person. She was very very nice and extremely helpful.

The shoe guy is fitting a patient for a pair of shoes with the leather straps for a diabetic patient.

A pair of happy feet. One of the women we made shoes for had never worn shoes before and she had to practice several times before she could put her foot through all of the leather loops at once.

Our shoes! They have leather straps instead of rubber to make them more comfortable. The tire shoe guy is making them for us for slightly less than $2 US a pair. A pretty good deal. They also look nice which makes the patients very happy.