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