A weekend trip to Sipi Falls - one of the most beautiful places in the world

Last weekend Annie and I met up with some medical student friends from Kampala at a place called Sipi Falls. It is about a 2 hour's journey from Kumi and about 4 hours from Kampala. It was so beautiful. A friend of the medical student from the UK said it was the most beautiful place in the world. I think this might be stretching the truth a little bit. The world has a lot of beautiful places. However, I will say that if you are going to spend some time in Uganda or Kenya you should definitely visit Sipi Falls. We stayed in a place called "Lacam," but I am sure that there are many nice places to stay. Some of the highlights or our holiday: Abseiling down a 100 meter cliff next a breathtakingly beautiful waterfall, a day long hike around the area to explore all three of the primary Sipi waterfalls, and a half day hike (the next day) to a viewpoint. Some other good points were awesome food and hot showers! Yes, it was pretty sweet.

Here we are before the abseiling (aka repelling). I was pretty scared.

Here I am going down the cliff next to the water fall. It was a lot of fun after I got used to being scared out of my mind... :) Yes, I am wearing shorts - I figured trying to wear a skirt with the harness wasn't the best idea. It ended up being a lot of fun. Highly recommended for those visiting Sipi Falls.

The view from our dorms. It was much better in real life.

A shot of one of the waterfalls. It was amazing.

Another aspect of the view. In the distance you can see the waterfall that we abseiled down next to.

Pictures of our trip from Kampala to Kumi

Typical road/road side shot. I really love the bright blue sky here in Uganda. You can seek the little "Matatu" taxi minibuses traveling the opposite direction. These minibuses are supposed to hold 14 passengers, but on long journeys they usually hold around 24. The motorcycles are the Boda-boda taxis that I have written about in earlier blog posts. The passenger(s) just ride behind the motorbike driver. The roadside scene in this picture is pretty typical. Little shops and people selling produce. It is very nice.

Kampala bus park. The "No entry signs" are for taxis and other cars. Just tons of people and buses going to various parts of Uganda.

This is right next to the bus park in Kampala. Lots of people and lots of cars. I usually don't take too many pictures because I am worried that if I stand still long enough with my attention focused elsewhere I will get robbed. However, Annie and I took some pictures out the window of the bus which seemed to work out well.

Kumi Town

Welcome to Kumi town and the surrounding area. Here are some pictures that took me about an hour to upload. (But please, no pity. OK, you can send a little pity my way). :)

Lush green goodness of the area surrounding Kumi. It really is beautiful. Just avoid the mosquitoes and it is great.

Here are some few shots of Kumi town. I just shot some pictures from the hip while walking around. Do you like the cow walking down the Kumi main street?

A bicycle taxi (far left) and bicycle water carrying technique. Who knew that bicycles could be used for so many things?

Here are some young people making a few shillings by roasting corn at the side of the road. They gave me permission to take the picture... :)

Yummy! Roasted corn. One of my street-vendor favorites! It is really good and really filling. It is about 200 shillings for one of the lightly roasted cobs. The burned ones are 100 shillings (about a dime or something like that).

Opps. This picture isn't actually from Kumi. This is a picture of a intern doctor I worked with in Kampala.

Sorry that this picture is so dark. It was much brighter on my camera. I promise that we were both smiling in the picture... It is of a little girl named Wendy that I met in town today. I was just standing at a shop asking if they had any envelopes and I saw this streak out of my peripheral vision. This little girl had started at a run and touched my hand as fast as she possibly could while passing me at light speed. I gave her a smile and she ran by again to touch my hand. After a few minutes she let me take her picture (I also got permission from Wendy's mother). Then she started to hug me. It was really cute.

Here is another (brighter) picture of Wendy. She is quite the character!

Today I learned a lot of bad words in Ateso

What did you do today? Today I learned some really bad words in Ateso, the local language of the Kumi area. How did my vocabulary of Ateso curse words expand so quickly? Read on and you will see...

Yesterday Annie and I watched orthopedic surgeries at Kumi Hospital. They were super cool and most of them were also slightly disgusting to watch. Up on the "disgusting scale" was an older woman with leprosy who had her leg amputated above the knee and a small child that had an infection in her tibia (a bone in the lower part of the leg) and had most of the bone removed and the area cleaned out. I guess bone infections are fairly common here, particularly in children.

This morning we rounded in the orthopedic ward and saw all of the patient who had surgeries yesterday. It was pretty cool. The woman with the amputated leg was sitting up and looking cheerful and happy. Quite impressive.

As we were leaving rounds I saw another physician who said that he was just about to perform a C-section and asked if I would like to watch. I instantly said "Yes!" because I have never seen a C-section and I have really wanted to watch one since I arrived in Uganda. We went down to the surgery theater and I changed into a scrub dress and the physician changed into his scrubs. The patient arrived, but we were waiting for a surgery nurse who was on her way. While we were waiting the physician told me that the had to perform a C-section because the baby was in the transverse position. However, while we were waiting, the physician re-examined the patient and found that the baby had turned and was now in the breech position. C-section deliveries generally more risky than normal vaginal deliveries here, so he told the nurses to take the pregnant patient back to the maternity ward. Slightly disappointed that I wasn't going to watch my first C-section, I asked if I could go back with the woman and watch the natural delivery. It turns out that there was another woman in labor in the maternity ward. So I sat with the midwives and waited for a delivery. We started waiting around noon and I was sure that at any moment a delivery was going to take place.

Labor and contractions are obviously very painful in any culture or country. The women in labor started off just moaning and whimpering when they had a contraction, but gradually the got louder and louder. Soon they were screaming/crying and saying all sorts of things in Ateso. I wanted to go over and hold their hands or rub their backs or do something. However, it appeared to be culturally inappropriate to try to do these things. Both of the women had friends and family (or a husband) present and they were not holding her hand, rubbing her back or anything like that. It is very uncomfortable to watch someone be in pain and not be able to do anything to help. I decided to distract myself by trying to learn some words in the local language, Ateso. Near the beginning of the afternoon a nurse gave a series of instructions to one of the women in labor ('if you walk around, the labor will go faster') and the woman responded by saying, "ebo, ebo, ebo" and proceeded to get up and walk around the room. I asked what "ebo" meant in Ateso and the nurse-midwife told me it means "yes." I was there for 5 hours. I followed the midwives around, watching them give medication, and asking questions about the maternity ward and the surrounding culture. I also continued my language learning whenever someone said a short word in Ateso that sounded like it would be easy to remember. It turned out that the women in labor said words like this frequently. One woman kept saying a word "O****Y! O****Y!" I asked the nurse what this word meant in Ateso. She told me it didn't have a translation in English, but that it was a very bad word that people say when they are in pain or upset that people should say in front of children and that I shouldn't repeat it. I decided this is essentially the definition of a curse word. This processes was repeated again when I asked what another word was that the women in labor were saying and the nurse said responded that it was "another bad word." I tried to block out the words, but every time the women said them, I forced it deeper and deeper into my mind. I was learning bad words in another language all afternoon.

After 5 hours or so of watching the women in labor, the physician came back and decided to do a C-section on the the woman with the breech baby. I scrubbed in again and got to watch my first C-section. It was pretty bloody/messy, but it was fun to watch because it really a happy operation - a baby comes out! They baby and the mom were fine after the surgery.


Me in scrubs waiting for the C-section (the first time). They have these cute little scrub dresses here. They are usually for the nurses, but I wear them sometimes too.

Nausea

This morning Annie and I went to Kumi Hospital which turned out to be a Hospital run by the Catholic Church (at least I think it is the Catholic Church). We arrived early enough to attend devotions in the hospital chapel at 8am. From there we went to the administration office where we showed our letter of introduction and were surprised to find that we were not expected. However, the secretary kindly took us to a very nice doctor who said we could shadow him for the day.

We started out rounding on the patients who were in his section of the hospital. We went through about 30 patients in an hour and half. About 3 of the patients were living with HIV; several had typhoid (yikes! I don’t want to get that again!), and then rest had malaria.

(It was at this time that I remembered the DOWN SIDE of a Lush Green Paradise. It is that if everything is lush and green then it means it rains a lot. If it rains a lot that means there is a lot of water around. If there is a lot of water around there are LOTS AND LOTS of mosquitoes and other bugs. If there are lots of bugs and mosquitoes there is LOTS mosquito born diseases such as MALARIA! Darn!)

After rounding, the doctor asked if Annie and I would like to observe surgeries with him. We said we would love to observe surgeries with him. We went to the surgery theater and changed into scrubs. As we were walking into the operating room, he asked if Annie and I would like to be the assistant for the surgeries. We said “yes” and Annie asked if I wanted to go first. I said sure and started to scrub in. The doctor was across the room while I was washing my hands carefully trying to keep my hands above my elbows so they would be cleaner. It was at this time that I realized that I didn’t even know what the surgery was that I was going to be assisting on. I heard Annie ask the doctor, but they were too far away for me to hear the answer. I then crossed the room, dried my hands with a sterile clothe, and put on double sterile gloves. I walked up to the doctor who had just approached the patient. It was a woman who was already under anesthesia with her legs positioned so her pelvis was available. I approached the doctor (who is not very talkative) and quietly asked what procedure we were going to do. He didn’t appear to hear me, but instead started draining the woman’s urine with a catheter-like tool and then inserted a tool in the woman’s vaginal canal and asked me to hold it placing downward pressure. I asked again what procedure we were going to perform and the doctor quietly said, “An evacuation.” It was starting to dawn on me what that meant, but I still didn’t understand until the physician inserted a loop-like tool into the woman’s uterus and blobs of flesh and dried and fresh blood started falling over my gloved hand holding the tool. It was really gross. I asked if the material was fetus and the doctor responded, “yes, it is the product of conception.” I was very confused. Here I was in the middle of Uganda assisting a Muslim doctor in performing an abortion in a Catholic Hospital in a country where elective abortions are illegal. More blood and tissue kept falling over my gloved hand I started getting really nauseated. I tried to take some deep breathes, but my stomach just got tighter and tighter. As I watched some more tissue and blood drip over my thumb I realized that I was about to either faint or vomit. I then decided to tell the doctor that “I was somehow not feeling so good” and a nurse came over and took my place. The brought a chair for me to sit in and everybody responded by telling me everybody gets a little nauseated at first. I didn’t vomit, but I definitely felt like I was going to for about 5 minutes. Annie very bravely took my place for the next procedure and did an awesome job.

We asked the doctor afterwards why he was doing the abortions. He said that elective abortions are illegal in Uganda (a very conservative country where children are considered a sign of wealth and blessing). However, the women that we operated on today had had incomplete miscarriages due to natural causes and that they had continued to bleed and had developed a fever indicating that the left-over dead tissue had become infected. Thus, cleaning out the remaining tissue and giving the women antibiotics was probably going to save their lives. Therefore the tissue and blood that was falling over my hand was the remains of a fetus or placenta that had incompletely miscarried several days ago. Still, not the most pleasant experience.

We arrived safely in Kumi and now we are staying in ghetto paradise

Yesterday we arrived safely in Kumi! Our travel consisted of about 8 hours of travel interspersed with many delays. One of the delays took 2 hours and was essentially our bus driver getting arrested and making a statement because he had hit and damaged a small car earlier in the day. This did much to increase our confidence in the individual who was driving our bus at approximately 95 miles per hour on an unsafe road and crazily passing other vehicles that were only going about 80 miles an hour.

We got off the bus at Kumi and no one was there to meet us (which was expected). We were immediately surrounded by boda-boda drivers (a boda-boda is a motorcycle taxi). We got boda-boda’s to take us to the Kumi Hospital Guest House who we called in advance and who we thought knew we were coming. The boda-boda ride through the Kumi country-side was amazing. All shades of lush green surrounded us. We passed mud huts and people going about their daily lives. Occasionally a cow or goat would meander across the road. However, no beauty surpassed the Kumi Hospital Guest Houses themselves. They really weren’t houses, but adorable quaint cottages that were perfect in every respect. They looked well-made and comfortable. They were surrounded by beautiful old trees and the ground was covered in vibrant wildflowers. It was like a piece of paradise. This is where people come to volunteer – it is where you should come merely to enjoy the beauty. Sigh, it was almost too good to be true. Hahaha – I bet you know that is coming, don’t you?

Wait for it…


wait for it…


Yup! You guessed! It was too good to be true. A scheming Ugandan woman appeared who told us that the guest houses are for staff and not students and that the houses were also full. She then took us to a very run down looking building. It looked old and un-welcoming, very unlike the cottages we had just bonded with. This old building was definitely not surrounded by wildflowers. The woman took us inside and told us all the rooms were full, but that Annie and I were welcome to stay in the storage closet. We looked in the storage closet and sure enough there was a bed off to the side underneath all the various items. She told us she would put another bed inside the closet and that Annie and I were welcome to stay for “only” 31,000 Ugandan Shillings PER NIGHT (That is $20 each)! With out another alternative presently available, Annie and I decided to stay there last night and pay $40 to share the storage closet. Oh, and I forgot to mention that this run-down guest house doesn’t have electricity (but the cute cottages do).

Today Annie and I went to the hospital and this afternoon we are going to Kumi town to try to find a more affordable place to live and use the SSSLLLLOOOOOWWWW internet for a few minutes.

"Bring Your Own _______" pictures from the hospital

I took my camera to the hospital today. Unfortunately, because of confidentiality reasons I can't currently post pictures of patients. However, I took some pictures of the empty hospital beds and some of the nurses and doctors I have been working with this week. You may be wondering why the ward looks mostly empty in these pictures - as there is never enough room in the hospital and an overflow of patients, etc. The way the emergency ward works is that patients come in for a maximum of 24 hours. They examined and a history is taken so that tentative diagnosis and treatment plan can be produced. Then the patients are either discharged (sent home with the hope they will get better) or they are transferred to a department in the hospital. (The last very sad option is that the patient dies in the emergency ward which seems to happen at least once a day). That way the emergency ward clears out once a day and is cleaned up and all of the beds are wiped down. It was during this cleaning period is when I took the pictures below.


This is me with the head nurse. She is pretty nice once you get to know her, but radiates a sort-of "stern' aura. She works really hard everyday and is very concerned for her patients. She also helps instruct a stream of nursing students (who wear blue dresses instead of white) who are continuously flowing into the ward.

Here are some of the interns I have been working with this week (several others unfortunately aren't in the picture). The night intern is sitting at the desk filling out discharge and transfer papers. There was a death certificate to fill out, but apparently the senior consulting doctor has to fill it out.

This is a small section of what the emergency wards. There are a number of rows of beds similar to this. When the beds get full sometimes they just put a mattress or mat on the ground. The hospital is definitely an example of "Bring your own ________." Patients need to bring their own sheets, bedding, clothes, food, personal care attendant (family member or friend), etc. The personal attendant does basic nursing care for the patient, feeds the patient, etc. The personal attendant in turn needs to bring bedding to sleep on the floor next to the patient's bed and enough food and clothes for several days. There is water outside to do laundry for the patient if the clothes or bedding get soiled. There is also a place to cook outside so the people staying with the patient can eat and bring food for the patient.

The personal attendant also has to be prepared to take the patient for tests (X-ray, blood draws, etc) which must be paid for in cash (although I don't think they are the full price that you would have to pay in the States if you didn't have insurance - I think it is about $90 for an X-ray). Any medicines that the emergency ward doesn't have, must also be purchased at the pharmacy.

Here I am sitting in front of the desk of honor with one of the intern doctors.

Here is another nurse who is whiping down the beads with a bleach/soap solution. She is also really nice and helpful.

Anyway, now you all have a little more of a visual image of what my life is like here in the hospital. Now it is off to Kumi for 4-6 weeks!

On your checklist for your next soccer game: a goat skin drum

So this weekend we found out our departure to Kumi was delayed for a couple days because the Ugandan students haven't received their stipends yet. So some of us med students decided to go to the World Cup Qualifying game in Uganda. The game was Uganda versus Angola and Uganda hasn't been doing well so far so if they lost this game they would be out of the competition for the World Cup.

We packed into Uganda's Mendela National Stadium with thousands of Africans and some foreigners to support the Ugandan National Team called "The Cranes." To our surprise, the Ugandan team did very well. They creamed Angola 3-1. Uganda had several very exciting goals and the crowd had great energy. (Just in case you didn't know already, Soccer or "Football" is a very big deal in East Africa).

One of the best things about the game for me was how several fans in the crowd had giant goat skin drums that they would beat (or let other people beat) during the game. If they thought you were cheering really well, they would come up to you and tell you to hit the drum. It was pretty fun. I kept thinking - what would a crowd in the United States do if you asked them to hit a drum at a soccer game? :)

Some of the soccer playing action. Uganda was in Yellow and Angola was in white.

One of the fans behind us. I took this during a less-exciting time early in the game that is why they are actually sitting down. Towards the end pretty much everyone was standing up cheering, shouting, blowing whistles and, of course, beating on drums!

The half-time show consisted of holding a giant sheet with a cellphone company title on it in the middle of the soccer field. Pretty enthralling.

A shot of the crowd.

Here are the us three medical students enjoying the game. (Actually, the girl on the right, Grace, just finished her medical degree in the UK so she is actually a doctor). We had a lot of fun.

Off for a Rural Rotation in KUMI (on Monday)!

A map of Uganda with Kumi highlighted.

A on-going trend in medical education is the concentration of physicians in specialities and in urban areas. The University of Washington has programs to encourage medical students to experience medicine in rural areas in the United States. It turns out that the Medical School in we are at in Uganda also has a program like this. It is called the COBES program (see blog posts in the spring). It is allows Ugandan medical students can go to a rural area in Uganda and experience medicine there. We were invited to go on a COBES rotation for 4-6 weeks. We have selected our location which is Kumi, a town of about 12,000 people. Kumi is about 300 kilometers from Kampala, the capital where we are staying now. Apparently, there is a private hospital in Kumi along with smaller rural clinics that we can work at. There is a guest house next to the hospital that Annie and I will be staying it. The hospital has Uganda's leprosy treatment center which should also be very interesting to observe.

For a University of Washington requirement, I have to complete a independent investigative inquiry project. I think I will try to complete the project during the 4-6 weeks I am in Kumi. Hopefully it goes well!

More pictures...

After an enjoyable day at the hospital, I went to the market and got some fruit salad with one of the Swedish medical students. From there caught a minibus back to the flat and decided to spend some quality time at the Internet place. Although the Internet is slow, my boredom while waiting for the pages to load is alleviated by being able to watch Uganda's version of C-SPAN. Yes, literally, there is a TV channel of the Uganda Parliament playing in the Internet place. What is weirder is that there is a group of people watching it. So far it has been a 3 hour debate on whether or not to increase the tax on cigarettes.

Anyway, here are some pictures that I decided to up load during my Ugandan government political education is taking place.


On my minibus ride back to the flat, our minibus (called a "Matatu") ran out of gas. We had to wait in the minibus which was stopped in a busy Kampala street while the driver ran with a container to get some gas. While the bus was stopped I tried to practice some of my butchered Luganda greetings which got some smiles and then asked if I could take pictures. This is the picture of the woman and her daughter who were sitting next to me. She didn't speak any English, but I said her daughter was very cute and I think she understood. (The little girl doesn't look that happy in the picture, but she was smiling for most of the ride).


A series of super boring pictures of our flat (now I don't know why I spent so much time up-loading them):

Our beds, protected by mosquito nets. I am trying very hard not to get Malaria this time. I share a room with two of the med students from Sweden.

Kiasa, one of our housemates. She is very nice. You can see our kitchen in the background. It is a little small, but it very sufficient.

Here is our dinning room. I am sorry that this picture is a little blurry, I didn't realize until after I had spent about 10 minutes uploading it. The sweet mac belongs to Theresa, one of the Swedish students.

This is our view from our flat. It is of an identical apartment building! We live in a pretty nice area.

HIV = The disease-which-must-not-be-named

Today was our 3rd day in the Emergency/Trauma ward. It was almost as amazing as our first two days in the ward. Our intern doctor we shadowed for the first two days moved to a different department today so we got a new intern. He is also really nice and helpful. He lets us help and doo some patient histories. However, our new intern speaks Luganda (the local language) so sometimes he talks to the patients in Luganda and only translates small parts of the histories for us. It is still good and we are learning a lot.

About half of the patients who come into the emergency ward are infected with HIV. However, in the patient chart and when they are discussing the patients with us and each other, the physicians and medical staff always say, "This patient is known to be ISS positive." ISS stands for "Immune System Suppressed" which means that the patient has HIV and their immune system is compromised. Apparently, this system was originally put in place to reduce stigma towards people who are living with HIV. However, everyone knows that ISS means HIV so it doesn't really help protect the patients. Our intern was telling us that now the medical community is beginning to think that calling HIV by all of these fake names is INCREASING stigma. They said that calling it ISS is sort-of placing HIV in its own special scary class because nobody ever says the true diagnosis. The Ugandan physician said that it has been compared to the bad wizard, in the Harry Potter books who almost everyone calls "He-who-must-not-be-named" because they think he is so scary/bad that his name can't be mentioned. Then not saying the name makes people even more scared of the bad wizard. The intern docotor says that in this way it is possible that the medical system in Uganda is making stigma towards people living with HIV worse, because they refuse to say the name. The doctors don't even say the word "HIV" when they come across a very sick patient that they think has AIDS and want them to get tested for HIV. They don't say, "I would like you to have an HIV test." Instead they say, "We would like to draw your blood so we can find out your serostatus. Is that OK?" (Serostatus is another euphemism used in the hospital for HIV).

However, after all that discussion, we still use "ISS positive" every day in the hospital instead of actually saying the words HIV and AIDS.

First day in a hospital in Uganda, First time to be in the room when someone died

I decided that this deserved its own blog entry, because I really thought it would be different the first time I was in the room when someone died.

Today we saw a lot of really sick patients. One of them was a very sick Ugandan boy. He came in while we had been there for a couple of hours and he was etremely anemic. He was immediately given a unit of blood and started on an IV of saline. Through the history from the father we discovered that he had had fevers on and off for the last 3 months. We were at lunch when the intern did the intial admission interview and exam on the patient, but we returned when the intern presented the patient to his attending physician. The physician asked Annie and I what we thought the diagnosis was. We guessed Malaria as a cause of the symptoms. However, the physician said that the boy had been referred from rural health center that had already tried treating him for malaria. The physician said that the long duration of the fever and the anemia and neutropenia made him think of leukemia. He said that unfortunately, they aren't able to do much for leukemia patients. He prescribed another unit of blood for the boy and told the nurses to put him on a broad spectrum antibiotic.

We continued to round on the next patient who was just a few feet away. I turned to look back that the boy a few minutes later and saw he wasn't moving and two nurses were silently placing a blanket over his body and rolling the bed away. No one said anything and no one cried. No one was even holding his hand while he died or telling him they loved him. It was really strange. I turned to Annie and said, "I think that the little boy just died." She said, "Are you sure? I think they must just be moving him to another room." I turned to the intern and asked him if the boy had just died, and he said in a very matter-a-fact detached voice, "Yes, he died." It was so strange. No one seemed upset or worried about trying to comfort the family (who were no longer present). I guess the death of patients is so common that staff can't be upset and grieve over every patient.

An Awesome Day in the Emergency Ward

Today was our first day in the emergency ward due to all the senior doctors being off for the holiday yesterday. It was pretty amazing.

We started off with another orientation-type meeting with the dean for the school of medicine. It was fairly interesting. Apparently, Uganda has changed its medical system so that the nurses, doctors and other medical personnel all have class together for the first year of medical school. This was done so there would be better collaboration between the different "classes" of medical care professionals. It sounds like a great idea and the dean says so far the students really like it. The dean also talked about his home for exchange programs in the future, etc, etc.

Next we were taken to the Trauma Ward where we were introduced to a really nice Ugandan intern doctor (first year resident after medical school). He was really nice to Annie and me. He asked us to take histories on patients, take vitals and practice some of our physical exam skills. He also kept asking us questions about what we thought the patients had and what could be causing their symptoms. Then he would try to lead us in the right direction with additional questions and he would give us homework when we didn't know the answer.

For example, there was a patient with HIV and TB who had neurological signs and symptoms of meningitis. Our intern had us examine the patient and take a history and then he asked us what we thought could be causing the symptoms we discovered. We listed meningitis and possibly TB that had gone to the brain and some other random disease possibilities. He final led us to his hypothesis that the patient had a toxoplasmosis infection that had reactivated and formed lesions in the brain because of the patient's immunocompromised status. Annie and I both remembered some of the information about toxoplasmosis which we just studied in microbiology: "women should clean the cat litter box while they are pregnant." Then after a breif review we both remembered that Toxoplasmosis infections can reactivate in immunocompromised patients.

Our intern gave us homework assignments to look up the things we didn't know while we were at the hospital. One of the patients was being treated for HIV and among many symptoms had a very unusual distribution of fat deposits - she had very thin arms and legs, but more visceral fat around the stomach and chest. Our intern asked us what this was called and what could be causing it. Annie and I together are quite the brain-power force so we were able to come up with that it is called 'lypodystrophy' or something like that and it was probably caused by her HIV antiretroviral drugs. Then our intern asked us which class of antiretroviral drugs causes lipodystrophy. This totally stumped us. However, tonight I have been doing some searches on the Internet and have discovered a study to help me answer the question tomorrow: It found that 3TC (Lamivudine) and D4T (Stavudine), nucleoside analog reverse transcriptase inhibitors, caused lipodystrophy but protease inhibitors did not. Whew. one question down, about 10 more to go. If you have any more information, feel free to email me!

When we first arrived at the trauma ward we were a little surprised that it wasn't more about car accidents and severe injuries (as the word "trauma" brings to mind). However, throughout the day it became clear that it was pretty much like a normal emergency wing - it is where really sick people came and were admitted and shuttled off to other areas of the hospital. Most of the people we saw today were actually people with infectious diseases or chronic problems that had suddenly had a deterioration of their condition. A lot of the patients had HIV and others had chronic problems see in the US, but that receive less preventative care or that the Ugandan medical system didn't have the resources to treat.

As we were going home, Annie and I discussed that this could possibly be one of our best days of medical school so far. It was incredible even though it was sad at times. We learned so much! We felt helpful (although we definitely slowed things down) and welcomed by the staff.

pictures... (maybe)

Some of the Chapati and eggs cooking action. Daren and Jennifer (from the Global Health Resource Center), if you are looking at this blog entry, yes, I did get permission before I took the picture.

A breakfast joint we ate at in Jinja. It is essentially like Denny's only the food was way better. We got a really good egg, tomato, and cabbage chapati for about $0.66, yes, yes, I know you are jealous.

Me waiting in Kampala for a minibus. Good times.

The fabulous Annie in our minibus on a day excursion to Jinja to see the source of the Nile.

Me in the back seat of the minibus with two of the Swedish Medical Students - Sofi and Theresa. They are really nice and lots of fun. The Swedish medical education system is different from ours. But Sofi and Theresa are 5th year medical students so they are essentially first year residents in the US system.

Annie and I in our sunglasses enjoying the view of the Nile and relaxing a bit.

Update:

Today Annie and I went to the hospital for what we thought would be our first day observing in the trauma ward (we were prepared for an exciting and scary day). However, it turned out to be a national holiday ("Hero's Day") and all of the senior medical personnel took the day off. Note to the wise: DO NOT get injured in Uganda on a national holiday! Our coordinator at the Hospital met us and introduced us to some medical students from Northwestern University. We got a short tour of the hospital and a motherly talk from the coordinator about safety in Uganda. This talk included a Strong emphasis on if we wanted to "enjoy ourselves" in Uganda to be sure and use a condom because there is lots of HIV and STIs here. It was pretty funny. Don't worry, I don't plan on "enjoying myself" in Uganda that way. However, it seems like the coordinator has had some experience with students who have. I guess sometimes travel abroad students don't make the best decisions.

Birthday pictures

The afternoon before I left for Uganda I got a surprise birthday party at my house from some of the girls in our first year medical school class. It was so nice! They called me up and asked if it would be OK if they stopped by for a minute to say goodbye and it turns out they had a whole party planned! It was a welcomed distraction from my packing mania.

Don't worry Mom, we are drinking lemon soda, not alcohol. :) From left to right Julia, Maria, me and Amy. Julie was taking the picture and Nelly was just off to the right.

Julie even made me a homemade chocolate birthday cake. It was so sweet. They gave me a signing card a some things to take to Uganda with me. Thanks everybody! It was so nice!

I am in Uganda!

About 4 hours ago I landed safely in Uganda (via an Ethiopian Airlines flight from Addis Ababa, the capital of Ethiopia). Annie, the UW med student I will be working with in Uganda, and a driver picked me up at the Entebbe airport. We drove about an hour to Kamapala (the capital of Uganda) and put my luggage in the flat we will be staying in. Annie and I will be staying in a flat with 3 medical students from Sweden. They are all really nice and lots of fun. We have cold running water and electricity most of the time. We are about a 30 minute walk or a 5 minute mini-bus ride to the Hospital where we will be working.

Starting Monday Annie and I will be observing in the Trauma ward of the hospital. (Sort-of like the emergency room in US hospitals). I guess it gets a lot of car accidents and things like that. I will tell you more after our first couple of days.

After a week Annie and I will start our rural experience (called a COBES rotation) where we will be observing the Uganda health care system in a rural clinic. As part of the UW medical student program I will have to come up with a project to implement in the rural area during our 4-6 weeks in the rural area. I think it will be lots of fun!

Whoo! paying $9.99 for 2 hours of internet

I am currently waiting in the DC airport. I have already have had 5 hour flight from Seattle to Wa DC. My next flight is to Rome. his flight continues on to Addis Ababa (for a total flight 16 hours). I will then stay overnight in Addis and take a flight to Uganda in the morning. Since I am relatively behind on my email and other computer/internet to-do list items, I decided to pay for the internet during my 2 hour layover in the DC airport. I a slight case of sticker shock - it is costs $9.99! Yikes! That is my new way of passing judgment on airports I visit - whether or not it costs money to use wireless internet. It costs about $8 in Seattle and apparently it is even more expensive here. However, it was free in the Portland airport. Apparently Oregon is even more generous than its lack of sales tax.

It is interesting how the introduction into East African culture begins even before you get on the plane. Sitting in the waiting area there are numerous individuals of Ethiopian origin who are waiting for the flight. There is a very beautiful older Ethiopian woman sitting across from me who is dressed in the traditional clothing. (I guess Ethiopians frequently dress up for the flights). She has a little red sign hanging around her neck that says, "Please Help. I don't speak any English. If I am by myself, help me find where I should go or someone who speaks Amharic." However, I don't think this woman has much of a chance of getting lost, as she is surrounded by about 5 younger Ethiopians who are talking to her and bringing her things. I think it will be a fun flight. :)