Best laid plans…

So I had this grand idea when I got back from Uganda, that I’d keep up my blog as a way of interacting with my friends and family, and also a way to get my thoughts out onto “paper,” to help me process things as I move through second year of medical school, eventually onto clinical years, etc.

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Get ready to work until we have to put you on a drip!

June 29, 2014

According to Dr. Anguyo, at least (he said this to us on Saturday afternoon as we arrived at another KIHEFO health camp, and it’s pretty accurate to describe how I feel about the last few days. We’ve been pretty busy, and I haven’t much felt like blogging at the end of the days so I figured I’d do a little masterpost of what’s been happening.

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Community health camp, and the difficulties that it brought

June 25, 2014

This was easily one of our busiest days in Kabale so far, but it was also one of my most challenging, and, for a few reasons, favorite. KIHEFO sponsored a miniature health camp in a nearby village, called Kicumbi; it was a smaller version of the larger health camps that KIHEFO runs a few times a year, and we had several stations set up to see patients-general clinic, dental, eye, family planning, and a small laboratory and pharmacy. It was really cool to see several different areas of KIHEFO working together at the same time, even if things got hectic at times (we saw probably a little over three hundred patients in all of the different clinics, in just under seven hours).

The church where we held the health camp

The church where we held the health camp

Patients waiting to be seen at several of the clinics

Patients waiting to be seen at several of the clinics

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Sam, the traditional healer

June 23, 2014

Today unexpectedly was a really long day, so I have a few different things to talk about: grand rounds, a visit to a traditional healer, and nutrition clinic.

Grand rounds with Dr. Anguyo started a little late this morning, but there weren’t as many patients admitted to the clinic as there have been in previous weeks, so it went by pretty quickly. Today’s most interesting case was an older gentleman with an enlarged prostate that had gone undetected for years, to the point that his urethra was blocked and urine had backed up into his ureters and kidneys. We talked with Dr. Anguyo for awhile about renal function testing (shoutout to my daddy here :P) and how, because of costs, they will try to run as few tests as possible; in this case, they tested the patient’s creatinine, and when that wasn’t good, they had to test his urea levels.

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Take only pictures, leave only footprints

June 22, 2014

That’s a saying I remember quite well from Girl Scout camp, and one that was posted all over the national park as we went on our safari this weekend. It’s a fitting title for this post since I mostly have only pictures, and a few stories about our adventure through Lake Mburro National Park, Queen Elizabeth National Park, and the Kazinga Channel.

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Finding a routine

June 19, 2014

I haven’t posted in a couple days because there really hasn’t been much exciting to report, just work at the clinic every day, and occasionally seminars in the afternoons. We’ve finally settled into a familiar routine, with breakfast, rounds, clinic hours, lunch, and seminars, as well as free time. We had a few interesting cases this week, so I’ll probably talk a little bit about them, and we’ve gotten to know Allen, the medical officer at the clinic, quite well over the past few days.

One of the most common things we test for at the clinic is malaria, and I’ve gotten to know the symptoms quite well in just the short time we’ve been working here, because we’ve had several cases of severe malaria already. Many of these cases we admit to the clinic for treatment, because we need to give IV meds and fluids. We also see a lot of bronchitis and pneumonia, which is probably one of the most surprising things I’ve found in the clinic work.

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Waiting room at the general clinic, and some of the patient rooms

We’ve also seen some really interesting cases, particularly this week, several of which are cases that I will probably never see in practice back home in the US. During morning clinic yesterday, we had a 52-year-old woman present with generalized abdominal pain and general weakness, but not much else. When we examined her abdomen, she had what we at first thought was a mass on the left side, but turned out to be her very enlarged spleen. Unfortunately, she was very poor and was unable to afford most of the tests we needed, so we had to settle for just an ultrasound and limited blood tests.

It turned out that her spleen was so enlarged that it crossed over her abdomen to the right side as well as down almost to her pelvis, and she was HIV+. Many people who contract HIV here either don’t come for testing, or can’t afford testing and care, and she had been sick for several years before the pain finally got to be too unbearable and she couldn’t lie on her left side due to the splenomegaly. We have seen several severely immunocompromised HIV+ patients at the clinic, with varying degrees of opportunistic infections and illnesses; her splenomegaly turned out to be a result of her HIV infection, something which only really happens with advanced HIV.

 

Another view of the inside of the clinic

Another view of the inside of the clinic

It’s been a really difficult experience at times, especially when we hear that testing and medications can be around 25,000 Ugandan shillings-the equivalent of ten US dollars. Here in Kabale, though, that is a very large sum, and most people don’t make enough money to pay fees like that, or for school fees. We’ve learned a lot about the villages and local communities, and the economy here is not a cash-based economy, which makes it very hard for people to find money to pay for things like medicine and school fees. Many people farm, and eat the crops that they farm, so subsistence farming is much more common than commerce farming.

A little girl who came to the clinic for treatment-with the balloon friend Marni made for her!

A little girl who came to the clinic for treatment-with the balloon friend Marni made for her!

Some of our group has also been doing village outreaches to conduct nutrition and maternal health surveys with members of the Rubira community; sometime next week we should have the data they collected so that we can come together and discuss the biggest challenges the women in Rubira face, and what strategies KIHEFO can use to help them. I think this is my favorite part of working with KIHEFO, because they want to implement “local solutions to local problems,” in Dr. Anguyo’s words. They pay very close attention to the communities they serve, and they seek to aid those communities in measures they already use.

Other than clinic every day, there isn’t too much to report, sadly. Tomorrow morning at 5:45 AM we leave for safari, and we’ll be gone until Sunday evening. Next week is filled with community and HIV outreaches, so I should have a lot to talk about then!

Until next time,

Lauren

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Rubira and Lake Bunyoni

June 13-15, 2014

So this will be a weekend pseudo-mega post (if my computer battery hopefully holds out-power’s out so I can’t recharge!), and I finally figured out how to add in pictures working with the spotty internet! So this will be fun!

Friday we had our first community outreach to Rubira, a village that KIHEFO works closely with. The clinic was unfortunately closed for the day, but we went to the Rubira primary school to help out with an agriculture workshop. Trina and KIHEFO have started a farmer’s club with some of the kids in P4 through P7 (primary school years 4-7), where they teach the kids how to grow sustainable food crops. They’ve started a garden on the school’s campus, which the kids have built themselves, and maintain.

Friday’s workshop was about different kinds of organic soil, and a demonstration on how to make compost. The kids seem to be really excited about their garden, and about learning from Trina and Alfonse, a farmer who works closely with KIHEFO. It turned out that most of the school wanted to help out, and we had a lot of excited kids trying to get into the classroom while Lillian and Trina were teaching.

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Learning about the differences between organic soil and sand

 

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Agriculture club is very popular at school!

We also had a chance to play with the kids and sing and dance with them for awhile, something they were pretty excited about (probably mostly because it meant they didn’t have to be sitting in lessons!) Several of the older girls tried to teach us one of the traditional Bakiga dances (the Bakiga are the people of the Kabale region we are staying in), and it was so great to see so many of the younger kids wanting to get in on the dancing.

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The older girls trying to teach us the dance

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Lillian and the youngest kids at school-nursery and P1

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Everyone wanted to get in on the dancing!

Though we weren’t really in clinic on Friday (we did go to grand rounds with Dr. Anguyo again, and he gave us homework this time), it was really great to spend some time with the kids at school, because Rubira is a community that KIHEFO works very closely with. We head back there several more times throughout the month to do nutrition surveys, and to work in the small clinic that KiHEFO sends volunteers to a few times a week.

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Her dinosaur hoodie was quite adorable

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Both of these little girls wanted to hold hands for most of the afternoon, and wouldn’t let go even when we sat down.

Friday evening, we headed out to Lake Bunyoni to stay the night, a gorgeous lake very nearby where we stay in Kabale. We watched the Spain/Netherlands game with a group of people from the Netherlands on Friday night, and that was quite fun. Unfortunately, there isn’t much to remark on for the weekend since it rained almost all day on Saturday, and we couldn’t really enjoy much of the lake. I did get some pictures before the weather got too bad, but we mostly ended up sitting up by the café at our hostel and reading. We will get to go back to Bunyoni once more to visit a traditional healer and midwife, probably early next week, so I hope the weather will cooperate a bit more when we go again!

Sign at Lake Bunyoni-Casie swam at her own risk :)

Sign at Lake Bunyoni-Casie swam at her own risk 🙂

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A picture of the lake just before the rain started

Weekends are pretty free and relaxing, which is very nice since days at the clinic can get very long. We tried our hand at laundry today, which involved handwashing all our clothes and hanging them up to dry-the jury’s still out on whether any of us actually managed to get them clean J

That’s all I have for now, so I hope everyone had a wonderful, relaxing Father’s Day, and is enjoying their summer!

-Lauren

 

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