Malnutrition

My week at the malnutrition ward has been eye opening to a world that is easily forgotten about when you live a privileged life. The mwanamujimu clinic is one of the happiest looking places I’ve been at Mulago. The walls are painted bright yellow with giant murals on the walls, ranging from Disney movies to safari themes. For as cheerful as the walls are, the children are heartbreaking. There are as many causes of malnutrition as there are malnourished children. Some of the children have been orphaned or abandoned, raised now by family members who cannot afford or do not want them. Some of their mothers have inadequate breastmilk and cannot afford adequate formula supplementation. Many mothers are grossly miseducated: they hear that breastmilk is not best for baby, and begin to feed their young infant matoke (plantains), posho (cassava), potatoes, and soda. Additionally, many of the children come to us with underlying conditions that cause acute malnutrition. Sadly, most of these are HIV/AIDS related diagnoses (diarrhea, pneumonia) or TB.

In the malnutrition clinic, the children are initially evaluated. If they meet criteria for inpatient treatment (a Z score of weight for height at -3 standard deviations or less), they are admitted and worked up for any underlying cause of the malnutrition. They are started on refeeding regimens based on whether their malnutrition is edematous (protein deficiency – kwashiorkor) or non-edematous (total caloric – marasmus). Once they start gaining weight and have had their underlying issues addressed, they are moved to a wing where nurses teach the caregivers how to prepare proper meals. It’s such a welcome change to see education being emphasized and done well! The children are then followed for a few months at outpatient clinic, where mothers are provided with PlumpyNut for the child.

It’s hard to believe that in one week I’ll be getting ready to leave Africa! I’ll be spending this next week on the Infectious Disease ward, then it’s off to Barcelona and Stockholm. I’ll try to get in one more blog post before I head off to the next continent. I’ll leave you with a picture from the malnutrition clinic. This young boy had been a patient for over a month, had been abandoned by his mother, and his father had been arrested. He is just the most precious, sweetest little boy and I wish I could just take him home with me! My heart just melts thinking about him!

Coffee and Waterfalls

This post is going to be a bit longer, but don't worry - there are lots of pictures!!

We left for Sipi Falls around 8am. Here's a map of Uganda - we had to follow the black line from Kampala almost to Kapchorwa. It doesn't look far, right? Heck, when I look at the map it doesn't look far! Let me break down the travel time (and prices) for you - $1=2600 Shillings. 

8am - leave Edge House, walk to catch 1st matatu. Free!

8:15 - Matatu to Old Taxi Park. 500 shillings. 

8:45 - Arrive at Old Taxi Park (see below), chase after man showing us to the right bus. Priceless. 

9:15 - Depart to Mbale. 15,000 shillings

1:45 - Arrive at Mbale. Take a boda (motorcycle) to catch our next matatu. 1,000 shillings

2:15 - Depart Mbale for Sipi. 8,000 shillings.

3:30 - Arrive at Crow's Nest! Finally! 

After a relaxing Friday night, we were ready for our hike! Here's the view from our room with the 3 falls labeled in the order we hiked them.

 Here's the first waterfall as we approach

And close up

Behind the second waterfall

Second waterfall from above

Third waterfall - 100 meters! 

Such gorgeous scenery! 

That afternoon, two of us went on a tour of the coffee plantation and learned about the arabica coffee that is produced locally. It's nowhere near harvesting season, but they keep some of the dried beans around for tourists like us to play with. 

Here are the dried beans with the husks still on going into the mortar

We had to pound the coffee beans for several minutes to get the husks separated

Then we had to separate the beans from the chaff

After the beans were cleaned, we roasted them over a clay oven.

After stirring constantly for about 20 minutes, the beans took on the familiar appearance

Once they were done roasting, it was back into the mortar so we could grind them

This is the hardest I've ever had to work for coffee!!

Since there are no coffee pots, you just dump the grounds into boiling water ala French press and strain it into a thermos. 

Finally got our coffee! Also, the guide said Danielle and I are "becoming Ugandan". He may have been flattering us a bit, but here's some proof - Melissa has been here for one week compared to my 6 weeks.

Moses, our guide for the day. He was pretty excited for the coffee as well. 

The drive back today was considerably less fun than Friday's trip. We had to sit on the bus at Mbale for almost FOUR hours waiting for it to fill up, which it never did, then we made frequent stops along the way. All in all, that 4-4.5 hour leg of the trip took over 8 hours. Such is life, I suppose, and thankfully we didn't have any pressing reason to get back quickly. 

Thanks for hanging in there with me for that long post! Tomorrow I'll be starting at malnutrition clinic - I hear it's a pretty cushy area of the hospital as it is run by an NGO. We'll see how it goes, and I'll be sure to update you! 

You're not dying, you're having a baby

I have officially delivered my last baby as a medical student! While that is an exciting thought, it's tempered by the realization that the next baby I deliver will have lots of associated paperwork with it (and I'll have a couple extra letters behind my name). I have been so incredibly impressed by the majority of the Ugandan women who go through childbirth without making a noise - I whine at the smallest pain, so I can't imagine not having an epidural! This week, though, I had so many women grab me and say "Musawo, musawo (doctor, doctor) I am dying! I am dying! Please take me to theater (for a C-section)!" Four weeks ago I probably would have freaked out, grabbed a doctor, done an exam, tried to find pain meds, held the woman's hand for a long time, and coached her through her contractions. By this week, my response was somewhat more brusque: "You're not dying. You're having a baby. Women do this every day. You don't need a C-section. You'll be fine." I definitely feel more comfortable with managing labor and certain complications now, although it's quite different in Uganda compared to the more modern comforts of US hospitals. I haven't decided what to do with my last two weeks - any suggestions? 

In my last post, I mentioned that I would be going on safari - unfortunately, the night before we left I got really sick and had to spend my weekend recuperating in Kampala. Sorry for the lack of awesome pictures! Tomorrow morning we are headed to Sipi Falls for a nice weekend of hiking and relaxing. I don't intend to get sick, so hopefully I'll actually have pictures to post next week! 

Halfway Home!

Yesterday marked the halfway point in this incredible trip, Europe and all! As life here settles into a routine, there aren't quite as many crazy stories to recount - or at least, the crazy stories are becoming so normal that I don't find them quite as unusual.

It seems as though each week here has had it own emotion attached to it: overwhelmed at the adjustment, shocked at how medicine is practiced in Africa, homesick, sad to say good-bye to friends, and this week I've finally switched to a feeling of gratitude and thanks. Without getting too introspective or emotional, I've come to appreciate so much the friends I've made here, the opportunities for travel, those of you back home who have offered words of support while I've been over here, and mostly, appreciation that I will be able to practice medicine in a setting that encourages patient safety.

Five of us from the house will be headed out on safari this weekend in Murchison Falls- I'll be sure to take some good pictures and post them when I get back!

Apparently gorillas fart a lot...

...though I guess I'd be pretty gassy if I spent 6 hours a day eating leaves and twigs.

Gorilla trekking has definitely been a highlight of the trip so far! We left bright and early Sunday morning to head 6 1/2 hours (according to Google Maps) to Bwindi Impenetrable National Park. Twelve hours later, we arrived at our camp. I guess Google Maps doesn't take unpaved, muddy roads into account when calculating drive times!

We were up bright and early to meet with our guide the next morning to hike this mountain.

Looking at the photo, this mountain seems deceptively small. It wasn't. Either that, or I'm just really out of shape! For the first hour and a half we followed a well maintained path, but then our path turned into this...

It's called the Impenetrable Forest for a reason! 

Thankfully the actual tracking of the gorillas is done by scouts that leave before we do and radio their location to our guides. After about 2 1/2 hours, we found the Mubare family chillin' in the forest and munching on some leaves. 

This is the silverback, Kanyonyi

Malaika in the background

Kanyonyi just chillin'

Kashundwe, a female of the group. She was in heat and didn't appreciate us being anywhere near Kanyonyi.

When we returned to Buhoma, we were invited to children's dance performances at Bwindi Orphans' Development Center. Dancing has been one of the community's way to give the children constructive activities. They also fund the children's schooling through donations. Seeing things like this center cause such inner conflict. You  realize that you are one only person (whose net worth is a negative six figures), but you still want to do anything you can to help. Ughh... we talked a lot about that conflict we all felt, but I don't know that we reached any good conclusions. 

So after one more night in the gloriously cool forest (so cold I had to use a blanket!) we made the 12 hour trek back to Kampala yesterday. All in all, hanging out with the gorillas was expensive, a long drive, and exhausting, but definitely worth it! 

The view from the restaurant at our lodge

Epidurals are Beautiful Things

I have a friend who delivered three of her babies without epidurals. After spending a week on OB here, where epidurals are nowhere to be found, she is my new hero. Also, after one week, I’ve come to appreciate OB nurses SO MUCH!! In the states, delivering a baby is a relatively clean endeavor for the doctor. We put on gowns and gloves, catch the baby, and leave the nurses to do the clean-up. That’s not the case here…

Let me try to paint a picture of how OB works at Mulago: Imagine a long open room with over 20 beds in it. Now imagine women in labor without pain meds on those beds. This room is never quiet. The beds don’t break down like normal labor beds, instead the women deliver on sheets of plastic. Once a baby is delivered, we use a roll of cotton (like a giant cotton ball) to clean up the woman. If the baby needs any sort of resuscitation, there is one small area in the room where we can work on him/her. On days when the ward is busy, woman sit on mats in the middle of the floor while laboring if there are no beds available. 

The ward I am working on is considered high risk. In the few days I've been around this week, I've seen a breech delivery, twins - one with achondroplasia, an omphalocele, multiple postpartum hemorrhages, and a uterine inversion. I'm excited for the next few weeks! 

Four of us head out to look at gorillas at Bwindi Impenetrable National Forest, so I'll try to take some good pictures to put up when I get back! 

Rainy Saturday as I write

Trying to be Thankful

It's been a rough day in the life of the DMU girls here in Uganda. It's not that anything specific went poorly today - I think we are all just hitting the end of that "honeymoon period" where everything is new and fun and starting to get into the day to day routine. Two weeks has been enough time for the novelty to wear off, but not enough time for us to adapt to the cultural differences or being a very obvious outsider to this culture. I am also starting to realize how blessed we are in the US to have the resources that we do. So, in what may be a roundabout way of complaining about life here, I'm putting together a little list of things I'm thankful for in the states.

• Luer locks
• Vag packs (for deliveries)
• Gloves that fit
• Shoe booties
• Doctors who actively engage in your education
• Any size suture I want
• Nurses who do all the dirty work on OB
• Nurses who do all the dirty work in general
• Wi-fi in hospitals/smartphones
• Toilet paper 
• High speed internet
• Did I mention nurses?
• Not having "Mzungu! Mzungu!" (translation: white person! white person!) yelled at me multiple times a day :)
• Friends - I miss all of you back home

And now, for the much harder list today, things I'm thankful for here in Uganda.

• Fika with my new Swedish friends
• The opportunity to travel on weekends
• Having enough wealth to go out to dinner most nights (something we take for granted)
• Being here with some awesome people from DMU
• Constantly feeling outside my comfort zone (much easier to be thankful for when you aren't in the midst of the experience!)
• Improving my bartering skills (45,000 shillings for the painting? No way. 20,000 for a taxi? tsk, tsk, tsk)
• Getting to hang out at a hotel pool over our long weekend
  
  Having some fun with my waterproof camera 
  
  
  Next post will be more upbeat, I promise!

That Intoxicating Baby Smell

Whoever came up with the formula for Johnson and Johnson Lavender Baby Shampoo should be a millionaire. I don't know of any girl/woman/mother/grandmother who can hold a baby, smell that scent, and not "ooh" and "ahh" over the drooling, screaming child in her arms. We spent the morning at Sanyu Babies Home hanging out with the babies there. Technically, we were going to help out doing laundry/feeding babies/etc., but we mostly just played with the kids. Also, when you hold a baby and it falls asleep on you, there's not much to do but sit there and hold him (and by default smell the lavender shampoo mentioned above). Spending time there really makes me want to adopt (not for a while!) - just seeing the smiles on the kids' faces when we held them was so wonderful.

Since it's Easter weekend, all of us students get a 4 day weekend! We didn't have any big plans, so we've been hitting up some local coffee shops, checked out a market today, and have just generally been lazy! Two of our good friends from Sweden are leaving tomorrow, so tonight we'll go out with them one last time. Next week I'm planning to start OB, so I'll post another update at that point - I'm sure I'll be entirely overwhelmed again!

Until then, happy easter everyone!

Yep, I'm a pretty boring person...nothing better to do than sleep when you hang out with me

Laundry is easier at home

Well today I am happy to report zero deaths. After a 5 year old boy died in trauma yesterday, I needed an easier day. I also have a funny cultural story to share from today... one of the Ugandan interns was taking a history in Luganda at the casualty department, so I was just standing back not really paying attention. At one point in the middle of the history, the intern grabbed me by the hand, pulled me into the conversation, and continued to hold my hand during the rest of the history (still in Luganda). Now holding hands is very much a cultural norm here, and while I realized that it was still a very weird experience to hold hands with a doctor at work. Ha - sorry Brad :)

On a separate note, Danielle and I did our first round of laundry last night. I must say that I will never take a washing machine for granted again. The first rinse turned the water muddy, the "wash cycle" (aka soap) also turned the water muddy, the second rinse was slightly better, and by the last time I ran the clothes under the faucet I had given up any hope of truly clean clothes. I was pleasantly surprised that they had a fresh scent when I took them down from the line today. I don't think that there is any way to keep from smelly musky (musty?) while here, but hopefully I'll at least have decent smelling clothes occasionally!

                                          

 

Me working on laundry in my PJ's and Danielle hanging up her clean clothes

My First Time of Death

Today I shifted from the surgical casualty to trauma - there's really no equivalent in the states since everyone is triaged within the ED, but here you get triaged to medical casualty (abdominal pain, chest pain, etc.), surgical casualty (fractures, sutures, etc.), or trauma (really bad, need to be intubated, probably won't survive). We had one patient that we spent all morning working on, but finally decided to call it around 1:30 this afternoon. This was the first patient that I actually called time of death on. While I've seen patients that have died before, this was the first guy that I was working on and in the room with when he actually died. It really makes you stop and wonder at what point he "died." Looking at the shell of his body, you can't help but feel that whatever made him the person he was had already left his body. It may have just been that I hadn't eaten in several hours, but it was a pretty introspective moment.

On a lighter note, Danielle, Natalie, and I went white water rafting on the Nile this past weekend and stayed at a nice island "resort" called the Hairy Lemon. The rafting was fantastic! Natalie was a bit scared at the beginning, but I think by the end she even had a good time. Some of the other students from the house happened to be staying at the Hairy Lemon for the weekend, so we were able to hang out with them. It was such a nice, relaxing weekend exploring Uganda outside the smoggy confines of Kampala.

Going over a waterfall

Waving for the camera!

Mangu Jangu!!

The last two days have been relatively quiet in casualty - a nice chance to adjust to life in Uganda without work being quite as intense as the first few days. I thought that I would explain a bit about life outside the hospital today. First, I live in a house on the Makarere University campus. It's nothing fancy, but there can be up to about 20 international students here at a time. We are all in health professions, be it nursing, physical therapy, midwifery, or medical students and there are currently students from Sweden and the US living in the house. It's about a 20 minute walk to the hospital from the house each way. At night, the majority of us choose a restaurant (or in the case of us girls that just arrived, we trust what the others decide) and take a taxi, which usually works out to less than a dollar a person. Dinner is also relatively inexpensive, running around 5-7 dollars before drinks if it's a reasonable place. Aside from that, we spend a lot of time talking to each other and on our computers - internet here is like slow dial-up. Everything can be done, but takes MUCH longer.

For the last 3 afternoons, we have had Luganda classes (the language of Buganda, which is the central area of Uganda). I don't remember much of what we learned, but today we came across the phrase Mangu Jangu, which means "come quickly!" I'm hoping I never have to use that phrase, but at least I have it in my vocabulary!

Since I can't NOT talk about some medicine, I thought I'd leave you with a couple of sweet X-rays that have come across the department

A machine fell on this man's hand

Patellar fracture

That Day I Fixed a Tendon

Day #2 started off a bit more quietly in casualty - by that, I mean there was no blood on the floor when I entered the department. Within about 20 minutes, though, a man entered the ED. He had stolen one of the boda-bodas (local, really dangerous motorcycle used commonly for transportation), been caught, had hot plastic dripped all over his entire body, and had been beaten. He managed to escape relatively unscathed compared to many of the stories I have heard, but he had severed his extensor tendon of his right index finger. I called over the attending physician and got a brief "Yes, that is his tendon. You can put it back together if you have time." Because this man was a thief, caring for him did not top the list of the attending's priorities.

Due to the nature of the injury, I had to create a T-incision to search for the tendon that had retracted deeper into the hand. The proximal end was somewhat shredded, so I had to improvise with the suturing to really bring it back together. It was SUCH an exciting moment when I told the man to extend his fingers, and where his index finger hadn't moved before, it extended along with all the others! I couldn't remember how to properly close a T-incision (because of the nature of it, the area where the skin meets can easily become necrotic). So I did the best I could with what I had, then moved on to the other less-severe lacerations the man had come in with.

On a brighter note, I was able to teach another student how to do some basic suturing. I asked about how they would learn otherwise, and the response I got was a shrug. For as much as I complained about the surgery skills course we had in school, I could not be more thankful that we had such great instructors for that course. Teaching is so grounding for me - in this chaotic hospital, it's a chance to totally immerse myself in someone's education. Seeing them take away a skill that they didn't have an hour earlier is such a gratifyig experience. Also, it reminds me that at one point I was just as unsure about myself and the skills that I have acquired, and it reminds me of the mentors who have been so patient with me in my education to this point.

We've been staying up late unpacking and talking the last few days, so I think I'm going to enjoy some extra shut-eye tonight! Good night!

Suturing brain matter

Today I started my 8 week rotation at Mulago Hospital in Kampala. While I had initially wanted to do 8 weeks on the labor and delivery floor, I learned that there are already several students currently on that service. Instead I opted to start with a few weeks of Casualty, or Emergency. Nothing could have prepared me for my first day! While we were touring the hospital, we heard that there had been a big accident in one of the suburbs when a truck lost control of its brakes and crashed into a crowd of cars and pedestrians. I figured it was going to be bad when our tour guide dropped me off and sympathetically said "Good luck, sweetie."

Upon entering the casualty ward, mass chaos ensued. Quickly I donned a pair of gloves and... stood in a corner. Seriously. One of the most helpless feelings you can have is knowing that you have the skills to assist, but not having any idea where supplies are or what you can/should do. Thankfully, one of the Ugandan residents quickly took me under his wing and said "Can you suture? Good, I'll assist you on this patient." After that, I was a suturing machine! One of the attending physicians complemented me, and on the next patient I was asked to teach two Ugandan medical students how to suture. We were directed to a patient with a bandage on his head, so I assumed he just had a laceration. When we removed the bandage, I saw what I thought was a severe depressed skull fracture with some congealed blood over it. I rinsed off the area with some saline, and realized that the "congealed blood" I thought I saw was actually brain matter. It was as if someone had taken a melon baller and scooped out a chunk of this man's head. I'm not sure what happened to him after we sent him for imaging, but that was a scary moment.

Throughout the day, I became more and more thankful for American hospitals. Just as some examples: running out of gloves was a common occurrence, and using sterile surgical gloves was also commonplace when the regular exam gloves ran out. In the waiting area, there was blood on the floor and on the walls, and patients would wait on stretchers in that area after being treated before they could be admitted. The trash cans in the room are metal buckets on the floor, and there is no separation of "biohazard" (anything with blood) from non-biohazard material. The sharps containers are cardboard boxes on the floor with a small hole in the top.

I'm sure my time in the ED will make me more confident in many procedures, but above all I don't think I will ever be able to complain about medicine in the US again!

Getting to Uganda

Greetings from Uganda!
Wow - talk about culture shock. It's been 4 years since I've been in Africa, and while everything is similar to Tanzania, I had just forgotten how different it is. I'll admit I felt a bit overwhelmed this morning, but after meeting up with a classmate, Natalie, and having lunch with some girls that have been here I've been reassured that these 8 weeks are doable!

To backtrack a bit, let me rewind to this morning. I arrived in Kampala around 0430 and proceeded smoothly through baggage claim and customs. I was amazed at how well the day had started, but that all ended when my ride didn't show up. After being accosted by several cab drivers, I made my way to a bench with another Mzungu and hestitantly asked "Waiting for your ride, too?" Thankfully, Benjamin also spoke English and I found out that he had been unable to reach his girlfriend, who was supposed to be picking him up from the airport. We sat together for close to 3 hours, debating whether to cab into town, wait for his girlfriend, or wait until 9 when Danielle, another classmate of mine, was supposed to get in. At one point I jokingly asked him "Have you ever seen Taken? How do I know you aren't a serial killer or looking to abduct me?" We both had a good laugh, but a little piece of me was still slightly hesitant to share a cab with this stranger. Literally right as we decided to head to the cab line, his girlfriend called to say that there had been an accident with a taxi and she would be there shortly. He turned out to NOT be a serial killer with an incredibly sweet girlfriend, and they didn't charge me for the cab ride! So thankful for good-hearted people in the world.

On the plus side, I did get to see this gorgeous sunrise from the airport!

I hope everyone is having a wonderful St. Patty's Day! 

T-minus 1 hour til the Match!

I was planning to take a nap to kill the last bit of time until the NRMP has their big reveal. Who am I kidding? There's no way I can sleep right now, and no way I'm leaving this computer until I know for sure! Hopefully writing this blog will do the trick.

The internet was terrible yesterday, so here's a quick summary: got to the Vatican right at opening time - very smart move on my part! No waiting in line for tickets or security, which was wonderful! I didn't realize how extensive the Vatican Museums are. The closest thing I can compare it to is the Louvre. Like the Louvre, you have three options: 1. Blow through everything quickly without really admiring much; 2. Research ahead of time, find out what you want to see, and spend the most time there, or; 3. Spend the entire day looking at everything. As I have very little appreciation of fine art, I chose option 1, then ate lunch in St. Peter's Square. At 1, I toured the Necropolis. This tour was by far the highlight of my day. For anyone unfamiliar with the Necropolis (like me a month ago), it is the burial site of St. Peter and the reason that St. Peter's basilica is located where it is. Also, for anyone who likes Angels and Demons by Dan Brown, it's the location where the antimatter was hidden (anyone? anyone?). Excavations have been going on for several decades, and an entire mausoleum has been uncovered. It's so cool to see this link back to Biblical times and the first few centuries AD. The basilica and the square are also impressive sights to see and again, there is really no adequate way to convey the grandeur of either.

Today I headed to the Colosseum bright and early, and was again rewarded with NO line! I highly recommend dragging yourself out of bed early to get to sites - you save so much time and have the place to yourself (kind of) for the first 45 minutes or so til the rest of the tourists really start rolling in. I loved the Colosseum! If you close your eyes, you can really imagine what it was like back when the place was first built. Granted, it was rather barbaric, but still a sight to behold. As I strolled to the Roman Forum, I realized that today is the Ides of March (the day Julius Caesar was assassinated), and sure enough, there were a LOT of people gathered outside the temple of Caesar. With Rick Steves podcasts as a guide, I felt pretty well informed of the history of both the Colosseum and the Forum.



Thanks for reading along with me! Next post I'll share match results!!

Pros and Cons of Travelling Alone

Overall, taking on Italy alone has been wonderful! I’m so glad to have this opportunity. Throughout the past few days I’ve thought of several times I’ve been happy to be alone, but also times I wish I had someone else along. So, for anyone thinking about travelling solo, here’s my two cents.

Pros:

• ·         You can accomplish more in a shorter period of time
• ·         You set the schedule and no one complains about it! Aka, you can nap whenever you want!
• ·         No worrying about whether the other person/people are enjoying themselves
• ·         Placing yourself in photos doesn’t seem as important, so less asking strangers to take pictures
• ·         You don’t feel guilty when you want to stop at another gelatteria. Or when you get a medium instead of a small. Again.
• ·         You can dart across the street without warning your travelling companion.
• ·         You can practice phrases in all the languages you know and when you mess up, no one is the wiser! Seriously, today I butchered Italian, German, and Spanish.
• ·         When you go out for a nice meal, get seated next to an older American couple, and chat with them, they often feel compelled to help pay for your meal. In fact, any parent/grandparent aged couples, regardless of nationality, take you under their wing for whatever time you happen to be with them.

Cons:

• ·         You can’t let your guard down.
• ·         You really shouldn’t have a third glass of wine when you’re out to eat.
• ·         You drink that third glass of wine in your hostel. Alone.
• ·         No one in the hostel speaks English or any language you would attempt to converse in.
• ·         You can’t strike the same pose as a ridiculous statue/bust that you walk by and have your photo taken. I mean, you could ask a stranger, but that is slightly awkward.

All subways smell the same

While riding around the metro today, it hit me that all subways smell the same. Three continents, many cities, same smell.

Today I spent a LOT of time in transit. I was at the train station in Manarola for an 0855 train hoping to get into Rome around 1300. Turns out that train only runs on holidays - whoops! I got into rainy Rome around 1630 (shortly after the new pope was elected!) and ended up wandering up and down this street looking for my hostel, turning a 5 minute walk into a 40 minute walk. Now usually I'm a fairly adept traveller. I don't really freak out and I usually enjoy getting lost (adventura, as Stephanie would say). However, in the rain, toting this heavy pack all day, and not having eaten for several hours all took their toll on me and it really took all my fortitude to not start crying in the street! Luckily I was able to get it together and FINALLY found the tiny house number (and really, how is #70 across the street from #45???). Hostella Female Only is rather adorable, and as it is only women it smells quite fresh! After a quick minute to get myself gathered and unpacked (and grab a fruit bar), I set off on my next adventura!

Walking around Rome instills you with a sense of awe, and also, a good idea of how insignificant you really are in the world! After a quick stop at Trevi Fountain, I proceeded to the Pantheon. WOW. I tried to take so many pictures to convey the vastness of the Pantheon, but there are just no pictures to do it justice. This is the best I could do. It is one of the more incredible man-made sights I have seen.

After stops at Lo Zozzone and Piazza Navona, my next (and highly anticipated) food stop was Giolitti, this AMAZING gelato place. After pondering my insignificance, this gelato made me feel pretty OK about it. 

 

I had planned to do a Rocky style run up the Spanish steps after Giolitti, but that turned into 10 minutes of taking pictures from the bottom before convincing myself to trudge up to the top. I did sing the Rocky theme song in my head in slow motion as I trudged, and that made me feel a bit better! 

Tomorrow starts bright and early at the Vatican! It will be so exciting to be there the day after a new pope has been elected! I'll also be going down into the Necropolis and can't wait for that! 

Arrivederci for now! 

My Liquid Diet

That's right, friends - today I opted to try out a liquid diet. First I had a nice breakfast of foccacia con pesto - both of which are native to the Ligurian region (where the cinque terre is located). From that point on, I dined solely on coffee, wine, and gelato (and water, but pssh, who counts that?). I know you are thinking "What fortitude! How did she do it?" It was hard, let me tell you, but every time my stomach started to growl I would shut it up with one of those. I finally broke my fast at Trattoria locanda il porticciolo: grilled swordfish, veggies, and prosecco. Mmmm.

In other news, the main hiking trail (the blue trail) is closed due to mud/rock slides. I was incredibly bummed because half the reason I came to the cinque terre was for the hiking. Initially I settled on train-hopping from village to village; however, on the road to Corniglia I saw a sign for the upper trail (red and white, less travelled, rougher terrain). What is it that Yogi Berra said? "When you come to a fork in the road, take it" or some variation of that? Well, Yogi, I took your advice and started an hour and a half detour. It was AWESOME hiking! Such amazing views of all the villages I couldn't have gotten from the coastal trail and hills that make the one I complained about last night seem paltry.

I managed to get to all the villages today, but spent the majority of the afternoon at Monterosso al Mare. While it didn't have the most character of the villages (I'd give that to any of the three middle towns), it is the biggest and has the most area to explore. I found another red and white trail to Levanto and hiked that for a few km right after a large glass of sciacchetrà (shh-kay-tra), the local sweet wine. While one part of my brain really wanted to go the whole 10 km to Levanto, the wine-y party of my brain said "Dude, that wine was really good. Why hike up more hills when you could hike downhill and drink more wine?" Needless to say, that part of my brain won out.

Tomorrow I have my last morning in the cinque terre, then it's back to Rome! This time tomorrow, I should be out partying with some bello italianos tucked asleep safely in my female-only hostel, Dad! Promise ;-)

Here's a final picture from today- sweaty me when I decided to get more wine! More to come on facebook!

Holy Hills, Batman!!

27 hours after my flight left Des Moines, I've arrived safe and sound in Manarola, Italy. I knew the place would be hilly, but WOW! I had forgotten what real "hills" are. When I made this reservation, the website talked about "gorgeous views from the top of the village" and I thought that sounded pretty nifty. However, carrying a 50 pound pack up to the top, I realized that I should be doing more cardio!

I'm settled in my hostel (Hostel 5 Terre) and as of right now, I'm the only person in my 4-man room - bonus! I also had the chance to explore Manarola a bit and snagged this shot just after sunset - SO GORGEOUS! This makes all the hills worth it, and hey, I get to feel less guilty about all the gelato and wine I'll be imbibing on in the next few days. Speaking of which, it's dinnertime here, so I'm going to head to Trattoria dal Billy for some of the best food in town! More to come later!

Ciao, Iowa!

After arriving two hours early for my flight (WHEN will I learn that you NEVER need two hours to check in at the Des Moines airport??), I’ve got some time to kill, so I figured I’d try to be good about writing. As excited as I’ve been about this trip, I have to admit I freaked out a bit this morning. 2 ½ months is a LONG time! When I think about all that has happened in my life in the last few months, I can’t believe I’ll be out of the country for that same chunk of time. Also, I find it hard to believe that I’ll actually be a doctor just 5 days after I get back to the states.

In the immediate future, I am so excited for this trip to Italy! I’ll arrive in Rome at 0920 Monday morning and immediately head to the Cinque Terre. I’ll be staying in one of the smaller villages – Manarola, and spend a couple of days hiking along the coast and drinking some a lot of the local wine. For anyone not familiar with the 5 Terre, here’s the Wikipedia link. http://en.wikipedia.org/wiki/Cinque_Terre

Wednesday afternoon I head back to Rome and spend 3 days exploring. I was a huge fan of Angels and Demons a few years ago, so I’m pretty thrilled to be there during conclave. I didn’t plan this, but I’ll be hitting 3 of the 4 main sites from the book AND I’ll be going down into the Necropolis.  While I doubt that the camerlengo is behind the pope’s resignation and bent on becoming pope himself, a girl can hope!

On Saturday, I’ll fly down to Kampala and get ready to start 2 months at Mulago Hospital. http://en.wikipedia.org/wiki/Mulago_Hospital I’ll send more updates along the way! Ciao, Iowa! 

Getting Started

The next three months of my life are going to be some of the most exciting thus far in life. In ten days I take off for Italy, spend 6 days there, then head to Uganda for 8 weeks working in the hospital there, followed by another 10 days roaming around Europe! I can't wait for this adventure to begin, and I figure this will be the most efficient way to inform everyone of my adventures. Internet connection isn't fantastic, so I can't promise I'll be updating frequently, but be sure to check back occasionally for pictures and stories!