Women Peace Keepers

I am currently writing this from my new favorite place. I had previously enjoyed the view from the top of crater hill but yesterday I decided to get adventurous and climb hospital hill by myself. This “trail” takes the climber up an impossibly steep face (scrambling is required) and once at the first plateau it is possible to see the three volcanoes, the hospital, and most of Kisoro including my compound. Then you head up another grassy climb and traverse the ridge to find yourself overlooking lake Mutanda. So this is where I am coming to you guys from, sitting on the grass overlooking the lake. It is unlike anything I have ever seen.

If I were more of a poet I could come up with something about how the people in this area break my heart and the mountains put it back together again but I guess I will just tell you about what I have done so far this week. Yesterday, we went back to the Congo refugee camp. When we pulled in I could already see that there were new tents and more people. The population has swelled to nearly one THOUSAND people there. Our assignment was to give talks about STIs and HIV and to discuss safe sexual practices. In the past, after giving this talk, women shared with Andrea (4th year) some horror stories about rape and violence that they had encountered in the Congo. This inspired her work and future projects and she is working to establish a database or something similar pertaining to human rights violations among refugee populations. We did not have a similar experience yesterday, just some of the men asked Maddie (in French) about how they could obtain condoms. When we asked if people had questions for us they raised their hands and asked if we could speed up transports because the camp is too crowded (we cannot control that) or if we could do something about getting sugar for the porridge (again, not our area of work).

Today I went on a psych outreach with Immaculate. Immaculate is a nurse at the hospital who also runs outreach programs and organizes AA meetings and I am sure this does not even cover all of what she does. We drove (in a car!) to a village healthworker’s home where we met a group of about 20 women. Immaculate explained that they had planned on doing mental health talks in the community on various topics but last time they came and spoke about depression, many of the women identified themselves as having this illness and so they were working on turning this into a support group. Today, the Australian psychologist (who is in Kisoro for 3 months) gave a talk about stress and techniques used to reduce stress. When asked about what makes these village women stressed they responded with answers like poverty, not having enough to feed my children, raising children when the husband is away most of the time, fighting in the home and so on. The Australian women talked about healthy and unhealthy coping mechanisms and walked the villagers through some breathing exercises. Immaculate also talked to the women about the importance of supporting one another and discussing problems with people outside of the home, and then she asked them what they want this support group to be called, answer: The Women Peace Keepers.

At the onset of the meeting there had been a bit of a discussion because one of the women of the community had attempted suicide last night. She was currently at the clinic across the street so someone went and got her for the meeting. I kept an eye on her the entire time. When others laughed and joked, she remained so serious. She stayed after so we could talk with her and I learned that she has four children. Her husband has work and money but uses it to pay for prostitutes, he even brings them to his home and forces his wife to sleep on the floor in the common room. She said her children often go to bed hungry and there is no money to pay for them to go to school. She took out loans to pay for land to farm but her husband never bought seeds and now she has no way to repay the debt. I asked how much she owes and it is around 300,000 of the Ugandan currency or roughly $100. Seeds would also cost around $100. My first instinct was to just offer to pay this but I realize this is not a sustainable solution and there are so many people here who need help. In fact, I learned from Immaculate today that suicide rates are at around 30%. I knew that alcohol consumption per capita is the second highest in the world here and that alcoholism is an epidemic, but I did not realize that suicide rates where so astronomically here too. This woman promised that she will come to the hospital for help and I truly hope that she shows up. I really do wish there was more that I or anyone could do to help but I really have no ideas (thoughts I have had: I heard of the Heiffer project, I wonder if they have something where people donate money for seeds and then get back a certain percentage at harvest time? If so, why is that not here? Or in farming communities like this could they have a collective fund so when some people have lots and others have a bad year there is a safety net?). I probably should have taken an ECON class or something…

Updates

Good Afternoon!
I hope everyone is having a nice weekend. All is well in Uganda, and the sun has finally decided to come out. It had been thunder storming every afternoon for the first week or so that I was here but these days have been so nice.
Last week we decided to go back to Mutolere to watch the Dutch surgeon on Thursday. Since my last blog was mostly about procedures I will just quickly summarize what I saw this time. I saw a Casearian section where the placenta was not completely delivered (I have not taken repro or done an ob/gyn rotation so I am not sure what the specific cause of this was..Steph?) so rapid suturing was required to stop the internal bleeding . The other interesting procedure was seeing a transfemoral amputation on a man who had a gangrenous lower leg. I will refrain from providing too many details but it looked like a pretty physically demanding procedure without the use of electric tools. And they did it under spinal block so the patient was awake the entire time.

Yesterday, Saturday, we went to lake Chahafi. I had planned to go on safari at Queen Elizabeth national park but when we realized that this weekend is Andrew’s last weekend we decided to all do something together and I moved queen Elizabeth to the weekend of the 18th. Robert, a guide and friend of our group is also an avid birder so he led us on a nature walk. There were kites, crested cranes, raptors, herons, king fishers and many other birds at the lake. The cranes are still my favorite...they mate for life and if their partner dies they will not find a new mate. That seems such a unique behavior in nature. I also think they are pretty funny looking and seem so large and uncoordinated on land that it still amazes me that they can take off and fly.

Today we are having a bonfire and Katrina has invited over all of the Ugandans that the fourth years have befriended in their time here. We have tried to introduce as many people to s’mores as possible so this will be another opportunity to spread our American ways. Haha.

This week I am going back to the Congo refugee camp on Monday, psych outreach on Tuesday and will probably work on data related tasks for Wednesday and Thursday. Then, we have a three day weekend so I am going to see the gorillas on Friday and am trying to peer pressure Sarah Maddie and Katrina to hike Sabino with me on Saturday. Stay tuned for updates!

Xoxo,
Hope

Surgery!

I think that today has provided me with sufficient evidence to support my theory that surgery is incredible. There is currently a Dutch surgeon visiting/working at the private hospital near Kisoro. The surgeon had met us when he was visiting Kisoro and said we (Maddie, Sarah and I) were welcome to shadow, so today we took him up on his offer. Our day began at 7:45 when we left for the hospital. After waiting outside of the surgical theatre for 15min we were greeted by the surgeon and met up with the Dutch students and Ugandan surgeons. The first case was a direct hernia repair. There is no laparoscopy here so it was an open procedure and they do not use mesh because it increases risk of infection. Instead they use absorbable sutures. The surgeon pointed out relevant anatomy and answered our many questions. Next up was a recurring cyst that I learned was due to abnormal embryological development of one of the branchial/pharyngeal pouches (sorry embryology is NOT my thing so I don’t know which precise arch). Anyways, the patient had had recurring cyst formation due to poor surgical technique. I learned that most surgeons remove only the cyst. But, there is also a tract that is where the fluid is draining from and so this surgeon found this, traced it back to its origin in the hyoid bone, cut the hyoid bone (no adverse consequences from this, I asked) and removed the cyst with the tract. The patient should never have this problem again. We briefly walked across the hall to the other OR and saw the end of a Caesarian section. The next case was a young boy who suffered from osteomyelitis. Treatment here involves drilling holes into the femur and trying to find where pus instead of blood is what seeps from the hole. Then the surgeon used a chisel to open up the bone in the areas where he found evidence of infection. The patient will have to stay in the hospital for some time to allow the wound to drain. After this we watched one surgeon apply casts to a baby with clubbed feet and another surgeon drain an abscess in clinic.

After this very full morning, the Dutch students took us to their compound to eat a quick lunch and then we got back to the OR. A woman had come to the hospital with a profoundly distended abdomen. It felt firm when I palpated. After trying (unsuccessfully) to relieve the pressure using less invasive methods (sorry, I will keep this blog non med friendly so we won’t go there) the surgeon decided to open her up to see what was causing this problem. He made one long vertical incision from below her belly button to between her ribs and then he placed his arms in the incision and pulled out what looked to be an inflated balloon. IT WAS HER LARGE INTESTINES! I was informed that some patients have long colons and these, for reasons yet to be discovered, may twist leading to obstruction. So the surgeon unwound the colon, used suction to remove the air, and placed it back in the cavity. He added some sutures and it was done. The woman had gone from looking 9 months pregnant to very thin in a matter of minutes. I have never seen anything like it!

We thought after this case we were done for the day but someone came in and announced that a boy had been hit by a motorcycle and that he had an open tibial fracture. We decided to stick around. I am glad I have shadowed in trauma surgery at Jacobi because I have seen some pretty gnarly things. This though was a pretty profound injury and the boy required a blood transfusion when his blood pressure became too low. This surgery took the most time and we ended up leaving right after bandages were applied at around 7:30pm.

It was a very long day. But, while watching the surgeon work I had a lot of time to think. Here is some of what goes on in my head: Surgery is incredible and you can fix so many things! Surgeons also deal with very sick people, and sometimes you cannot fix everything. Today, when we were walking through the SICU, I learned that two children were comatose after being involved in two separate motorcycle accidents. While we were looking at another patient in the back room, one of those children died. I was not at all involved in this patient’s care and I still felt devastated. I actually think that when you are a surgeon, unless you are an OB/Gyn and deliver babies, you are seeing your patient on the worst day of his or her life. They come to you in pain, you and your scalpel inflict more pain. But sometimes, in a short period of time, you can have a profound impact on that person’s life. I watched this surgeon today save a boy’s leg and his life, cure several conditions, and provide interventions that will improve quality of life. And I was there for LESS than 12 hours! So, while I have a long way to go in my medical education and I really have no idea what I plan to do with my career, I do think I will be drawn to an area of medicine where rapid results can be achieved.

Weekend Adventures

Hello All,
Thank you for allowing me some time to recover from my hike yesterday before writing. My arms are fine but my lower legs are still on fire, I guess I spent a lot of time on my toes yesterday. But I am getting ahead of myself, so why don’t we start with Saturday.

On Saturday we woke up and the sun was shining so the crew headed to Lake Mutanda. The fourth years had previously found a hotel right on the lake where they had enjoyed many weekends so they were very nice in sharing their special spot with us. After a very long and bumpy car ride we arrived at the hotel, a bit nauseous but no worse for the wear. The hotel was right on the water and had a porch that overlooked the lake. We spent all day just sitting outside, eating, reading and bird watching. Andrew and Sarah were brave and went swimming but after chatting with dad about schistosomiasis I have decided that lake swimming just is not in the cards for me. When we got home after 7 I loaded up my backpack with my hiking essentials and went to bed.

On Sunday I set my alarm for 5:45 but I couldn’t sleep after 5, I was just too excited. Emma (Ugandan tour guide, picked us up in Rwanda earlier in the trip, now is my favorite person ever) arrived at 6:30, informed me he would be hiking with me as my guide and then we set off to the base of the volcanoes. I was having a hard time choosing between Sabyinyo and Gahinga but ultimately decided to start with the smallest and work my way up. Keep in mind that this smallest volcano still took me to an elevation of 3,474 meters or 11,398 feet OR 2.16 miles above sea level. The top of the mountain is half in Rwanda and half in Uganda. But we certainly have not reached the top yet.
After deciding it would be Gahinga, we had to wait for 2 tourists to arrive for orientation. We met the park guides and learned that the guide in the front would be hiking with a machine gun because sometimes there are wild elephants and buffalo and they need to be scared away with shots fired into the air. Awesome. The two other hikers were a couple in their 50s and they opted to hire the Ugandan version of a Sherpa to carry their bags. I am stubborn so I carried my own pack. If Baby can carry a watermelon I could certainly carry my REI pack that had been designed for hiking! So we started off at a brisk pace. The first 2+ hours took us on a slow, gently sloping trail through fields and two bamboo forests. It was beautiful and I was having a great time, except that I stepped in buffalo poop (in some areas it was just unavoidable). There were some elephant tracks that made the path a bit more difficult to navigate but sadly no animal sightings.
Then we got to the first ladder. Guide: “Now is where we begin the hike/ascent.” Me: “Wait what? I thought we were already climbing? Holy S#*!”.
But fine, I am not a quitter so I got onto the ladder and started the climb. The next hour was a steep scramble through ankle deep mud followed by scaling a sketchy ladder followed by a sequence of switchbacks. At one point I made the mistake of asking Emma how much time was left. He said 50 minutes to the group but when we took a break he took me aside and said there was more than 1 hour 50 minutes left (he said he lied to be encouraging). I calmly explained the rule of restaurant reservations...It is better to overestimate than underestimate. From then on, every 15 minutes Emma would turn around to ask me how I was doing. For some time everything was fine. Then we got above a certain height and balancing on the ladders got very tricky. Putting one foot in front of the other seemed far more difficult than it should. I just told him I could keep going but I needed to go slowly. And eventually, when I was ready to kill Emma for his inaccurate time predictions (I yelled at him for lying to me, he found this hilarious) the trees cleared and we were at the top! It was such a bizarre landscape. I was above the clouds and the crater at the top is now a swamp so there were strange looking plants and trees everywhere. The clouds moved so quickly that in one moment I couldn’t more than a few feet around me and the next it was clear skies and great visibility. Then, after only 15 minutes of enjoying the view, it was time to climb down.

If the ladders were tough on the way up they became nearly impossible going down. I actually decided to try one backwards, the way Pompey Merrill instructed me to do on the boat. With three points of contact at all times I felt very secure and was able to go down much more quickly than the people who were trying to balance. Eventually, even the guides adopted my method and any time there was a steep ladder the guide would say OK time for the Hope method. I found this very amusing. There were a few very slippery portions of the trail and at these points Emma went ahead of me, held my hand, and allowed me to use his boot to break my slide. I was so thankful for his assistance and the hike down was uneventful, likely due to Emma making sure I didn’t fall/slip/slide off of the mountain. Finally, after what felt like forever but was really 6-6.5 hours of nearly constant climbing it was over. My shoes were soaked through, I had mud up to my ankles, and some random scrapes on my arms but I was so excited that I had done it! Since he had been so ridiculously helpful (and because I felt bad for yelling at him...even though he DID lie to me) I took Emma to dinner and drinks. We had a good discussion about his family (his parents are Rwandan, his brother stayed there during the 90s and is now still in the military) and his life in Uganda. I am very lucky to have such a knowledgeable and friendly guide, he is actually going to be the one to drive us back to Kigali at the end of the summer and he has offered to stay over in Rwanda so that on Friday, before my flight, he can take me around the city and through the genocide museum.

Tomorrow Maddie, Sarah and I have arranged to go to a different hospital to shadow the Dutch surgeon that is here until the end of the week. Should be interesting to see how things are done here, it seems like it would be impossible to prevent postop infections in some of these rural settings but I am looking forward to learn about how they attempt this task.

New Places

I went with Sam yesterday on a supervising visit. Sam has a degree as a PA and an additional degree in public health. His role with Doctors for Global Health is that he visits the village health workers and examines the patients that they have assessed during the week/month. What this actually means is hiking up mountains and through fields to very remote homesteads in the hopes of finding people who may or may not have already left home for work that day. He then may advise patients on pertinent topics and then provides medications to the village health worker each Friday which they then distribute to their own community. Needless to say, it is a tough job. The first village we visited was a farming area. We checked on a newborn and the baby’s mother. We visited a man who had 4 wives and more sensitive illness that I am not going to discuss on a blog. As we strolled through the rows of potatoes and wheat I could not help but notice that most mothers were accompanied by their very young children. I learned from the village health worker that her area had a great deal of poverty, malnutrition and alcoholism. It is in areas like this where the village health workers seem so useful. These individuals are part of the community and are able to help their peers and so I think it is a very effective model (as opposed to having outsiders come in or forcing people to travel long distances for healthcare).

The second and last visit (time constraints) was up in the mountains. We had to park the motorcycle in the nearby village and hike until we met Jane, the village health worker from her community. Jane is a warrior (not actually, but this woman is tough). She is 52 years old, has 9 children (6 boys, 3 girls) and 3 grandchildren. And she is influential enough in her village that she got over 40 people to sign up for the insurance plan that the hospital offers (provides transport to hospital, reduced price for meds/free meds when possible). I thought when we reached Jane that was the end of the hike. Wrong. So wrong. We climbed about one mile and met a man who had been gored by a bull and had received surgery to remove several ribs. The surgical incision was oozing pus…not good. Sam informed this man that Jane would bring him antibiotics on Friday. Then so much more climbing. At the edge of the community, right by the wall that marks the beginning of the national park (think elephants, gorillas, large cats etc) we checked on a newborn and her mother. Sam also tried to discuss family planning with the men at this homestead. One of the guys has 8 children but he said in his own family he was baby number 10 so if his dad had considered family planning he would not be alive. Tough logic to reason with. Sam told the men that they marry for love and if their wives have 10 children it means they have less love or time for the husband. I am not so sure about this but it seemed to get the men to actually consider family planning as an option so sure why not. Then we descended the mountain, saw a few more patients and took the long, bumpy, rocky, hilly ride home (not my favorite motorcycle day).

Today we visited the Congo refugee camp. Whoever settled this continent and made the country lines really messed up when it came to the Congo. It is a HUGE country with no stable government and lots of resources. This has lead to regular emergence of rebel groups claiming areas for their own and has forced entire villages to flee. The camp that I visited is a short-term camp. People stay for 5 days-3 weeks and are then transferred to the more permanent camps. In 2013 the rebel fighting resulted in the camp housing 8,000 refugees in the month of March. There are currently around 200 people there but the numbers change on a daily basis. I was not permitted to take a picture but it was just several large white tents where people sleep, one larger building where there were 8 children in “school” and a hut where meals were being prepared. We walked in to the building where the children were and I watched as they built towers out of blocks. The person leading the tour pointed to a sign on the wall that listed activities for the week, which included singing and dancing. We were told that they try to have activities to distract the kids and adults from the difficult situation that they are in, though I am not so sure how successful these efforts have been.

I was there around breakfast time and watched as people took these orange plastic cups (look like our baking measuring cups) and received one cup full of porridge. Residents receive 3 basic meals per day. We were able to speak with the nurses at the camp and I learned that the 5 major illnesses that are seen are 1. Upper respiratory infections 2. Malaria 3. Diarrhea 4. Skin problems 5. Chronic illnesses. There is also a very high rate of malnutrition among the refugees. I didn’t really have the opportunity to speak with anyone who is staying there but we are returning one week from Monday so I will have more stories then.

When we got back we got to shadow in the chronic care clinic and are now working on database entry.

As I am now settling into a routine I will probably be blogging less often but I will make sure to keep you updated with any interesting stories.

Til next time,
Hope

Motorcycle Diaries

It has been a few days but there had not been much to report. We are familiarizing ourselves with the charting method here so that we can attempt to create a computerized database so that has taken up most of the time (this is the main project and is my job for the summer). After work yesterday Sarah and I climbed crater hill. We are all trying to get in shape so that we can climb the tallest volcano here (>8 hour hike). I don’t think I am quite there yet.

MORE EXCITING THINGS
Today was my favorite day so far. I was assigned to do community outreach with Jerome. This program involves visiting the more rural villages and checking in on patients who were discharged from the hospital but did not show up for follow-up appointments.
The trip took us along the mountainside and above lake Mutanda so the views were spectacular. We stopped first on the near side of the river to speak with a woman who had been seen for hypertension. I learned through the interview that she did not go to clinic as often as she was told because it was expensive to get a ride in from the villages. There had been times where she had managed to make the 2 hour trip down from the mountains to clinic and the clinic had already run out of her pills. When this was the case, she had been told to purchase them on her own. This was not something that she could afford. When asked about what she believed to be the cause of her hypertension she said “I lost many children.” This is something that I really struggle with here. On the one hand, if you have been following my Facebook photo uploads, you will see that everything is BEAUTIFUL. But that is really just one side of the story here. From an outsider’s perspective, it looks like life can be very difficult here. Children die and this is not a rare occurrence. In the more rural areas I see people walking around without shoes. Jerome told me that he got his first pair of shoes when he was 11 and he said that without shoes his feet would freeze in the morning and burn during the dry season. I also learned that the best schools here cost a lot of money and that these students do the best and then receive government scholarships to college. In the rural area that I was in today there was only one school between 12 villages. If education is the key to a better life, it seems like there is very little opportunity for social mobility here (ie. Wealthy parents send their kids to the best schools, these kids get to go to college on government scholarships and get better paying jobs).

Our second stop required us to park the bike on the side of the road and scale a mountain to reach a small hut. Jerome had asked around for directions and actually met a family member of the patient we were trying to see. So this elderly woman (I am guessing 80-90 years old) led us up a steep slope. Jerome kept turning around to see how I was doing with all of the hiking and I felt pretty winded but there was no way I was stopping. That elderly woman kicked my butt and did it without shoes on. So we met with the patient and his wife promised to bring him to the hospital this week. We then headed on our way, hiked around a bit, got lost a bit more and eventually we had to skip the last two patients and just head home. After such a long day (6 hours on that motorcycle!) I asked Jerome if he would have dinner with me. I was very grateful for his help with translating and for making sure that I felt safe on some pretty rough terrain. I really love when I have the opportunity to talk with the local Kisoro clinic workers, they always have very interesting life stories and introduce me to new ideas. Hopefully I will have the chance to get to know more of them with these outreach trips.
But yes today was my favorite day. Any time I get to be outside is the best and I spent all of today hiking and motorcycling around some spectacular settings. Please do check out the photos, they don’t do it justice but I really tried.

White Knuckles and Skinny Babies

I didn’t blog yesterday because it was a pretty uneventful day. Went to the hospital to watch the village health workers interview the standardized patient (we do this at Einstein as part of our training too) and then Sarah and Maddie peer pressured me to go for a run. I told the girls that Deus told me the road we were on lead to the Congo border and when I got back we realized I was right. Had we all been in better shape we could have found ourselves in a pretty interesting situation (sorry mom!).

Today (Saturday) was our first day out in the community. It was also my first time on the back of a motorcycle and the roads here are terrible. Since this is going to be a necessary mode of transportation here, I am not going to vent and scare my mom but please ask me about it when I am home and I will gladly share all of the terrifying details. Needless to say, the white-knuckle component of the title was inspired by my trip today.
So, Katrina (fourth year), Deus and I took a 30-minute ride toward the volcanoes and out into the more rural villages. We were seeing patients that are part of the chronic care management program so patients met us for medication refills and to be examined. We made three stops and each clinic location was truly different from the others. The first was held at a very nice farmhouse in a rather large town. Most of the patients at this location suffered from asthma, diabetes and hypertension. I got to take blood pressures and listen to some interesting lung sounds and observed as Katrina and Deus instructed patients on proper medication schedules. I kept getting distracted by all of the farm animals but I don’t think anyone noticed or minded.
The second clinic was located outside of a small home in a more rural setting. One of the patients at this location was a woman who had lost sight in one eye as a child. Last year she lost sight in her other eye so she was functionally blind. Katrina described this woman as having a very poor quality of life. BUT thankfully, Jerry’s program was able to provide the funds for this woman to see the eye doctor and later to have cataract surgery. She is now able to see and I was able to meet her and her two young daughters. It was great to see what a profound effect medicine can have in a person’s life here.
The last stop was the most difficult for me. We headed even further out of town and ended up at the base of the volcano. Some background information: malnutrition rates in children in Kisoro are at around 50%. Illnesses related to malnutrition like Kwashiorkor occur at rates of 2%. The interesting thing is that it is not clear if the malnutrition is due to lack of food/money or if it is due to lack of knowledge about what the right foods to be eating are (there are lots of carbs available but protein is hard to come by here). The home where the last clinic was held was built out of mud with a tin roof. I entered the room and first noticed that there was no electricity so it took my eyes some time to adjust. Then I looked around and saw that most of the patients were young women with babies on their backs. Katrina explained that in this village there is a high rate of malnutrition so screening would be a large part of our time there. Thankfully, most of the babies had gained weight since their last visit and most looked great. One child though did not appear well. He was two years old and looked severely underweight. While his MUAC was within the normal limit, there was just something wrong with his overall appearance, he was so small. While the other kids squirmed around and interacted with their environments, this boy remained stationary and seemed to struggle to keep his eyes open (lethargic). His mom had a cough and a two month old child that she was nursing while we examined the boy. The mother informed us that her son had been coughing for one month and that she had been struggling to get him to eat. He had visited the nutritionist in May and been given the nut butter weight gain compound we use here but she said he wasn’t eating it. His respiration rate was fast for his age group. In the US this boy would have been sent to the emergency room to be evaluated. Since it is Saturday here there is no one at the hospital to see him so he will have to wait until Monday. I really hope that he gets the medical help that it seems he needs.

On a brighter note tomorrow is Sunday and will be our first full day off since getting to Kisoro. I think we are going to head to the lake because the view is supposed to be spectacular.

SIDE NOTE: Please see facebook for my photos, my internet is too slow to post them here.

Umezute (Hi How are you)

Hi friends,
It has been a busy time since I last left you so I will try to cover as much as possible without boring you.
Yesterday, our driver Emma met us at the hostel and brought us to Kisoro. The trip was a short three hours and the view was spectacular all along the way. One of the funnier moments on the road was when we got stuck behind a truck that was carrying cattle so all we could see were these bobbing cow heads in front of us. Also, people on bikes hang off of the back of trucks to make ascending the hills easier…not sure how safe that option is. Once we got to Kisoro, Emma took us on a tour of the town and showed us where we can buy groceries, how to exchange currency, and then he brought us to a good place for lunch. I have already learned that the diet here consists mostly of fruits, vegetables, rice and beans so I am sure I will be eating a lot of that during my stay. When we finished with these errands it was only 5pm so Sarah, Maddie and I decided to go for a walk around our neighborhood. It is just so beautiful. We live near three volcanoes that can be seen from anywhere in the town. The first two traverse the Rwanda/Uganda boarder and the third is in Rwanda/Uganda/the Congo. It sort of feels like being in the middle of everything, all of these places are so close together. We plan to hike the largest of the three volcanoes at some point but I have heard it is a challenging 8+ hour hike so we may wait until we are more accustomed to the altitude.
When we got back, the fourth years had returned from clinic so we got to hang out and inundate them with all of our questions. They have been here since September so they are extremely helpful. I stayed out until about 9pm but then I was struggling to keep my eyes open so I went to bed.

Today, Deus, another Ugandan who works with Dr. Paccione (Gerry) met us for orientation. The first stop was a tour of the hospital. We were led around the entire facility and got to meet a lot of the staff. When walking through the inpatient ward I noticed that a lot of the beds were empty or missing mattresses. Then Deus pointed outside and said that most patients spend the days laying outside in the sun and that you know when someone is really ill because those are the people who stay in bed. Not something you see in the states. After the tour we headed to the large outdoor market. Every Monday and Wednesday here there is a huge market where we can buy fresh produce. If anyone can figure out how I can send pineapples back to the states please let me know, they are so much better here. We then headed back to the hospital to shadow the fourth years in the clinic.

MEDICAL THINGS (feel free to skip this section if this is not something you are interested in): The first patient we saw was a woman who was 11 weeks pregnant and had presented with edema in one leg earlier in her pregnancy. She had suffered a DVT and I learned you can’t use warfarin during pregnancy so she was prescribed heparin. In the states, a person would receive this treatment for the duration of the pregnancy. This woman received 3 days worth because that was what was available. She was at her return visit and her leg looked fine and her pulmonary exam was normal (you worry about pulmonary embolism in someone who has had DVT) but they will continue monitoring her and she was educated about the symptoms of DVT and PE so she knows to come back should she find herself with any of these problems. The second case we saw was an elderly woman who had come in because of chest pain. She was being seen by the 4th year to be discharged after having been in the hospital for 10 days. On gross exam she appeared to be emaciated and when she removed her shirt so we could listen to her heart and lungs it was possible to see her entire ribcage. She was actually so thin that her PMI could be seen (usually this is something you feel). When we listened it was possible to hear a diastolic murmur that was the loudest in the middle of her sternum. Her formal diagnosis was heart failure and there was also a finding of hepatomegaly, which I learned can be a finding in individuals with heart failure. I am really excited to have the opportunity to shadow the fourth years in the future, they have told us that the clinical findings here are unlike anything we will see in the US.

Wow this post got pretty long so I will leave it there. Was planning on including pictures but my internet is pretty temperamental.

Xx,
Hope

Have Courage and Be Kind

Just a brief post because the only thing that has happened so far is that I took a 7.5 hour flight from NY to Amsterdam and then a second, 10 hour flight that stopped in Kilimanjaro and then arrived in Rwanda. The flights were uneventful, I watched 3 movies on the first flight and slept for most of the second. Thank you Bella for recommending that I watch 50 shades of gray on a crowded plane, wasn't awkward or anything (sarcasm). The title of the blog post is actually a recurring line in the new Cinderella movie and I thought it was good advice for me going forward this summer. But, it is now nearly midnight here and I am tucked under my mosquito net at my hostel in Kigali so I think it is time for bed. I will catch up with you guys as soon as I have internet access in Uganda.

xx,
one very grateful traveler (YAY ALL OF MY BAGS MADE IT!)

Uganda Summer 2015!

Hi friends, family, random person who stumbled upon this,
I am currently in my apartment in the Bronx surrounded by luggage that may or may not include a uv water purifier and a personal mosquito head net. Yes that is the official term, I looked it up. In ~30 hours I will be leaving for 8 weeks in Uganda followed by one week in Ireland. Less than 48 hours ago I was preparing for my last final of the first year of medical school. Needless to say, it has been a hectic time. A quick note on MS1: I am SO glad I decided to go to Einstein, I cannot say enough positive things about my classmates. It is going to be so strange to be away from everyone for so long but I am sure there will be great stories come August when we all reunite. I think I will use this space to address some recently posed questions regarding my summer plans:
1. Why Africa?
2. What about ebola/boko haram/any other dangers?
3. What are you most looking forward to?
4. Are you nervous?

Answers:
1. I wish I had some eloquent and well thought out answer for this one. The truth is, I am on Humira (adalimumab for my med school friends who took pharm) and it requires refrigeration, so that limited my travel options. I am interested in learning more about global health and I attended a panel where the second years discussed their completed summer projects. Those who traveled with Dr. Paccione to Uganda seemed to have had a good learning experience and the program sounded very well organized. These factors guided me to pick this specific program.
2. Different coast/country/ I read the international SOS warnings. That last part was actually pretty comical because I am traveling to both Uganda and Ireland and International SOS/Einstein emailed me the travel warnings for both countries. The page on Uganda looked a bit like the warning label you see on a drug commercial (caution: may cause malaria, rabies, yellow fever etc.) There are no warnings for Ireland. I had a long chat with my GI doc about my summer plans and we reached the conclusion that obviously the safest thing to do would be to not go. Having acknowledged this point we then moved on to discuss how I could travel and do so in the safest way possible. So, I have prepared and packed and purchased as many things as are necessary for me to feel that I am undertaking this trip in a responsible manner.
3.GORILLAS. I am so excited to get to see how the clinic works there and to get to travel to the various villages to learn more about how people with chronic illnesses manage symptoms in this setting. I cannot wait for all of the hiking and it is amazing that I will get to explore one of the only places where you can find gorillas in the wild. I feel like a rebellious teenager because I get to ride a motorcycle to work some days and this has been forbidden here (Dad works in the ED...too many horror stories). Oh and did I mention the gorillas?!
4. Yup. I could lie to you and say that I only have positive feelings about going to Uganda for 2 months. But honestly, it is a bit terrifying. Full disclosure: my immune compromised self cannot get the yellow fever vaccine (I got a waiver) and so, warranted or not, this is something I will worry about. I am also not sure what I will encounter in the villages or at the hospital or in the Congo Refugee facility and, for someone who likes to be prepared, this uncertainty is not an easy thing to deal with.

Anyways, I have a very long to do list that I need to get started with if I plan to make it to Natalie's graduation party on time today. I will do my best to keep up with this, even if it is only for myself to look back on later.

Xoxo,
Hope