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!