Chasing Summits or Go Big Then Go Home

This will be my last post from Uganda. I am writing from the outdoor seating area at the Travellers Rest Hotel, one of my favorite spots near our home here. I cannot even believe that the end is so soon but before I get all weepy about having to leave let me just tell you about my recent experiences.

Last week I returned from my wonderful stay at Lake Bunyonyi. I did some data entry on Tuesday afternoon because last week was the final push. Wednesday morning I was scheduled to go on supervision with Sam and he picked me up promptly at 8am. We went to the villages of Dometiera and Naomi, two of the new village health workers. In Dometiera’s village we spoke with a man who had been seen in the hospital for cirrhosis of the liver and met with two pregnant women to discuss prenatal care and their delivery plans (both will go to the health center near their village). Naomi’s village was very different from the others that I have seen. We train the village health workers to assess the quality of structures like kitchens, homes and latrines and then they assign the structure a grade: A-Highest quality, B-could be improved and C-looks like it could fall over, unsafe. Most of the villages are mostly Bs and Cs but Naomi had all As. She also had no patients for us to visit there, we had gone just to test her on her ability to evaluate the structures (she passed, she will now be certified as a village health worker). So I asked if her community was wealthier than the others. Her response really surprised me. She said that no, most people were farmers, but her community has very low levels of alcoholism. She said that as a result, she does not see many malnourished children in her role as the health worker. This information really surprised me. I know that there are very high levels of alcoholism. I also know that in this area there are very high levels of malnutrition. I had not thought that these things were connected or possibly even a cause and effect relationship. I do think that this would be an interesting thing to explore and if Naomi’s observation reflects the truth/data then it seems like Nutrition clinics shouldn’t just provide lumpy butter (high calorie foods), but they should also provide AA type services. And if alcoholism really is the cause of many problems here it would make sense for more dramatic interventions, right now it seems there is just an AA meeting at Kisoro hospital which last time was attended by 2 people.

Then the rest of the week was data entry time. We did all get up early on Thursday morning to climb Crater Hill and watch the sunrise, but it was cloudy so that was not too exciting. I was going to go again with Sarah on Friday morning but I decided to give my legs a rest before my big hike on Saturday. Which brings me to Muhabura…

Holy hell.

Muhabura means “the guide” in Kinyarwanda and the name makes sense because you can see this volcano from most places near the Rwanda/Uganda border. It is massive, towering above its neighboring volcanoes. I had to do the climb alone because no one had any desire to even attempt it. We had all heard from Katrina that it was not enjoyable and she had gone slowly so at 11am the guide told her she would not make it to the top so she climbed a bit further and then went down. She said she made it around halfway. So I knew I was in for a tough time, but I was grateful that Emma was willing to hike with me because company is essential on these treks. So Emma and I climbed up to the lodge, I had to carry my backpack which contained two large water bottles, sandwiches, snacks, my good camera etc. I was horrified that I was winded by the time we got to the base lodge and thought about calling it quits there. Thanks for coming, lets go home. But I sat through the orientation and saw that Emma and I would be climbing with 3 other Ugandans, a guide, and my porter. Following behind us was a group of 30 college age Ugandan students who were there for a trip. We were told they race so they would blow by us. So we began climbing and I found that the Ugandan men were moving pretty slowly and stopping regularly. I asked the guide if it was ok for Emma, my porter and me to climb ahead because I had this fear of repeating Katrina’s experience. I climb for the feeling of reaching the top so being told halfway that I was done would have been a bummer. So the three of us headed off at a slow but steady pace. We reached the first of two huts and I was feeling good. We stopped, grabbed some water and continued. Then things just went downhill (figuratively of course, this mountain was entirely UPHILL at an incline of 45 degrees or greater). The distance between the first and second hut is 500 meters. This terrain was just rocks, ladders, brutal switchbacks and absurdly fast altitude gain. And I felt every step. I tried to keep drinking water but I think the altitude started affecting me and we had been climbing for 3.5 hours so my legs were really burning. The porter was ahead of me and keeping a pretty quick pace and I found myself needing to stop after each strenuous maneuver (climbing up a boulder, ascending a ladder) and trying to keep up made me feel like I was dying. So when we finally reached the second hut I told Emma I had had enough. I was done. I was tired and in pain and probably had sweat out the 1.5 liters I had consumed and I was cold and I couldn’t tell if my hands were numb from the cold or hypoxia. NOT a happy camper. But Emma said that we had just 1.5 hours left (JUST?!) and that he would be disappointed if I quit. So we regrouped and I asked to lead so I could set my own pace. So I just put one foot in front of the other. We passed students and were passed by students and somehow the trail just kept going but eventually we reached the top! I am not a very emotional person but I sort of get this feeling in my chest when I accomplish something like this hike. I got it when I did the marathon too. It sort of feels like you are about to cry but I always manage to pull it together. It was hard and parts sucked and I still had to make it down but I MADE IT, and in 4.5 hours instead of the predicted 5! We spent some time walking around the small crater lake, passing from Uganda to Rwanda and back. I watched the clouds speed by below and occasionally there was a break so I could see the lands and homes. We ate some food, drank water, took pictures and then we began the descent. Usually I LOVE the downhill. Sometimes I can run, if the terrain allows. This was SO difficult. My fatigued legs were shaking and balancing on the ladders was not something I was capable of at that time so my porter held my hand to help me balance on those. After 3 hours my knees started stinging and I worried that I had torn something in my left one but after a brief stop I realized they were just tired and sore after being used as a breaking system for 3 hours of steep descent. And then we were back at the starting point. 8 hours up and back! And we actually were the first group to return so the students were impressed ;) I am pretty competitive. Then Emma and I went to a 3 course meal at Travellers to celebrate. I am so grateful for his friendship, he has been so helpful all summer and I do not know what I would have done without him.

So this is the end. Tomorrow and Tuesday my peers and I will take the data and turn it into a presentation that we are delivering on Wednesday. Then Wednesday at 5pm we are heading back to Rwanda. Maddie is flying out to South Africa on Wednesday very late (technically Thursday as her flight is after midnight) and Sarah leaves Thursday night. Then I will head to the airport Friday evening and make my way to Amsterdam.

I feel like I should end the leg of this journey with some profound idea or statement. This trip has been unbelievable. I have never been bored here. I learned a lot and saw a lot and experienced so many new things. I am so grateful for everyone who made this trip possible. It has truly been transformative and I hope that I never forget it. I would like to leave you with this quote that popped up on my Facebook under the Gates foundation page (pages suggested for you...thanks Facebook) but I think it summarizes nicely something that I have learned or felt this summer:
“I cannot do everything, but still I can do something; and because I cannot do everything I will not refuse to do the something that I can do”- Helen Keller

Thank you all for following this, hopefully I will be able to continue the blog in Amsterdam and Ireland but in the event that I cannot I hope that you have all enjoyed this journey. I know I certainly have.

Love,
Hope

My Four-Day Getaway

(Actually a 3.5 day getaway but that just didn't sound as good)

Last week was a pretty uneventful week around the hospital. I attended a teaching round where Nori was giving a lesson on examining a patient for elevated JVP. The first patient we looked at was intended to demonstrate a normal finding. In healthy individuals, it can be pretty difficult to visualize the internal jugular vein because it runs in a bundle with the carotid artery and in general, seeing venous pulsations is not an easy task. Then we looked at a second patient who had visibly dilated jugular veins and they could be seen beyond her ear. Then I did a heart exam and felt a rocking motion (there is a displaced PMI and an off tempo atrial kick) and I could hear an irregularity.

After a week of charting and lots of work hours I was ready to get out of Kisoro. On Saturday morning, our guide picked up Maddie and me at 7am. We drove 6 hours, with minimal pit stops, and arrived at Queen Elizabeth park with just time to grab a chapati before our boat tour left at 2pm. While we were waiting for the waitress to bring our food out to us, I looked up and saw a HUGE elephant wandering over to try to grab scraps from the dumpster. Off to a good start. Then, we boarded a tour boat and made our way across the Kazinga channel. The channel acts as a watering hole for most of the large animals so when we reached the other side we were greeted by a large herd of more than 20 elephants, plus a herd of buffalo and several groups (schools?) of hippos. Every once in a while I saw a crocodile lurking in the shallow water by the beach and was worried I would have to witness some animal planet action (buh bye baby buffalo). Fortunately everyone kept their teeth/tusks to themselves so I didn’t have to see anything like that. The tour lasted two hours and we were able to see more of all of the above plus a wide array of birds and several different deer-like animals. Once we made it back to land, we headed on an evening game drive in our SUV. We drove along the grassland part of the park and saw warthogs, more deer things, and a male lion made a brief guest appearance. He was only standing for 15 seconds and spent the rest of the time hiding in the tall grass but it was still very exciting!

When the sun had set and we were losing daylight, we made our way to our accommodations for the night. We had arranged to stay in a large tent in the park. There was a briefing before we could head to bed…something along the lines of: Hippos will be grazing at night, they are aggressive, if you must leave your tent bring a flashlight and do not go near them or they will charge. So of course, at 3am my bladder had had enough and I had to grab my headlamp and bolt for the toilets. Fortunately, there were no hippo encounters. Then we got up at 5:45 for 6am breakfast so that we could meet our guide at 6:30 for another game drive. More of the same but we were lucky enough to see a large male lion just hanging out by a rock. He seemed pretty uninterested in us but I was still nervous having my window down to take pictures.

After a few hours of driving around it was time to hit the road. Off to my next stop…
LAKE BUNYONYI! I had asked other members of my group if they wanted to come, but since this is our last full week, they preferred to stay around Kisoro. I am not one to miss out on seeing/doing things that I want so I had no problems going myself. And thanks to my parents, I had a reservation at the beautiful Birds Nest Hotel. My guide dropped me off at the entrance and then I was on my own. I checked in, dropped my bags in my room, grabbed a book and headed for the hammock. I was walking through the sitting area and I heard someone call out “HOPE!” What the heck? I don’t know people in Uganda. But I turned around and there was Annette, the Australian psychologist that I had done psych outreach with (she and Immaculate are the psych workers here at the moment, Immaculate is here always and Annette is leaving on Sunday). I learned that she and her husband Dr. John (pediatrician) had spent a night at a nearby hotel and were waiting for my friend/driver/tour guide Emma to pick them up. I spoke with her for a bit, and was so happy to see Emma. He was surprised I was alone and actually texted me later that night to make sure I was enjoying myself. Once I was alone again I spent a lot of time outside reading my book on the Rwandan genocide. I would actually HIGHLY recommend it, it is very well written non-fiction and is called “We Wish to Inform You That Tomorrow We Will Be Killed with Our Families” by Philip Gourevitch. Living in Africa for the summer, I felt very ignorant about the governments and histories of surrounding areas so this allowed me to better understand the recent events in Rwanda/Uganda/Zaire now the Congo. So anyways I had my book and my hammock and a beautiful lake view. Then dinnertime rolled around and I tried the highly recommend garlic crayfish and they did not disappoint. Crayfish can be found in the lake but are not indigenous to the area; a foreigner brought them so I learned that older locals will not eat this animal. Then it was time for bed.

When I got up the next day I grabbed breakfast and headed out on a 2 hour tour of the lake. I got to see many of the islands (one had zebras imported by the wealthy owner, another has a hospital and a school). The smallest island at the center of the lake is called “Punishment Island” and up until 80 years ago, community members would leave pregnant unmarried women on the island to die. If a poor man could not afford a wife he could come in the nighttime and take one off of the island but was then forced to move away from his village. Pretty harsh. After more reading, I took the hotel canoe for a spin around the immediate area but the giant dugout canoe proved pretty tricky to maneuver. I ate dinner and then sat by the fire where I began talking to two girls who looked my age. Their names were Emma and Jenny and they are from London. Jenny is a nurse who was working in the north and Emma had left her job and has an open-ended trip here in Africa. They had met in Jinja and decided after their programs ended to just travel around together. It was great to have people to talk to and we stayed up until 11 just exchanging stories about our time here (cue Diane Haddad saying "This one time, in Africa"). They were staying at a hostel just a short boat ride from my hotel and they actually came back this morning to hang out with me while I waited for Emma.

It was such a WONDERFUL weekend and I am so glad I had the opportunity to travel around. Now it seems that all that is left here on my Uganda itinerary is work this week and our presentation next week, broken up by my attempt to climb Muhavura (some sites spell it with a B not a V..who knows) on Saturday.

Thanks for following along on this crazy journey. I will update you guys either Sunday (to discuss the hike) or once I am in Kigali on Wednesday the 29th or Thursday.
PS I did my last Humira injection in Africa today (signals I have less than 2 weeks here, which we know since I actually have 1 week as of tomorrow)! Last one for my time abroad will be in Amsterdam.

Love you all,
Hope
Aka Hope (who is now comfortable going) Solo

Sabyinyo

I was feeling better after my medical scare (thanks dad, international sos, Keflex and the inventors of a non penicillin antibiotic) so I decided to join my friends on their attempt to hike mount Sabyinyo. This is the oldest of the three volcanoes and the name translates to mean tooth because it looks like a molar with its multiple peaks. The summit is at 3,645 meters or 11,959 feet (Wikipedia) and at the third peak it is possible to stand in Uganda, Rwanda and the Congo.

So we set off at 6:20 am and arrived at the mountain by 7. We were very lucky in that we were the only group climbing Sabyinyo that day and so we did not have to wait for any other tourists. This time I was smart enough to hire a porter to carry my backpack because schlepping my bag up Gahinga was not an easy task and I heard that this mountain has some difficult ladders near the top.

Here is a brief summary of my inner monologue:
First minutes: Ugh I feel lightheaded. I have not had my coffee yet. Why did I sign up for this? This guide needs to slow down or my friends in the back are going to die

Hours 1-2: Just keep walking, just keep walking. IthinkicanIthinkican. OOOh look at the bamboo. Oh crap, I see peak 3. WHAT ARE THOSE LADDERS?!

Hour 3: They said we were halfway to peak 1 like 30 minutes ago? Why do they always lie about this stuff?

Hour 4: Yay! Made it to peak 1. Now we just have to climb down the other side. Then up to peak 2. Then down the other side. Then up the ladders. Piece of cake :/

Hour 5: Don’t look down. Probably not a good idea to look up either. How is Sarah standing directly over my head?!
And then once I was up the ladders there was a 5 foot narrow path/cliff where I found myself hugging the face of the mountain and inching across. I made Sarah hold my hand after I made the mistake of looking down.

And then we had done it! All four of us, plus our guides and our porters had made it to the top! We stopped for a brief lunch and lots of photos and then it was time to head back down. Sarah and I were in the lead and decided to sing broadway/Disney songs to distract us from the terrifying ladders that somehow were worse going down than up. The others had an even tougher time so we did some waiting but I really did not mind having the chance to rest my legs. So we made it to the bottom of the mountain and then had to make the several mile trek back to the starting point. When we finished it was nearly 5pm and we had spent over 9 hours hiking. So the next stop was the Gahinga lodge for a three course dinner! The girls played banagrams and I called my mom to tell her I was still alive and then I ate a feast! So delicious at the time but I paid for it later when my stomach reminded me that I have been eating a low fat, mostly vegetarian diet all summer. Not fun.

Today, Tuesday, I shadowed at Mutolere again. I saw two Caesarian sections and they let me hold the babies and show the mothers that they had sons! I also saw two hernia repairs and got to help put a cast on a fractured wrist. I really love the OR but it has been hard to only be able to watch here. I really look forward to going home and having more opportunities to scrub in and assist (even retracting is interesting to me and it is less taxing on your back when you can lean into the table/are distracted by the work you are doing).

Coming Up:
This Saturday Maddie and I are going to Queen Elizabeth for safari. We are sleeping in tents near where the hippos graze and Robert has planned several different safaris/boat trips/ drives for us to see while we are there. Stay tuned for pictures.
Also, next week is my last full week in Uganda. This summer has FLOWN by and I am still having a hard time believing that it is already July. Most of the other students are taking the last week to hang out in Kisoro but I see it as my opportunity to get in any last minute trips. So, I booked a nice hotel room by lake Bunyoni for Sunday and Monday night and will have some quality time to myself. The hotel overlooks a beautiful lake and there are really interesting islands that you can tour. There is also free wifi, good food, a pool and canoes so I am sure I will enjoy myself (and I promised the other students I would bring patient charts so I can get work done too…lets hope I can stay motivated with all of these great distractions).

Still on my to do list:
I have climbed 2/3 of the volcanoes in Uganda. All that is left is that monster Muhabura. I could adopt the medical school approach..65% is passing and I have climbed 66.67% of the volcanoes. But I am so not ok with that, so I plan to spend one of my last weekend days attempting to climb this last one. I also would love to do a sunrise hike of crater hill. I would like to get back to lake Mutanda but it is ok if that doesn’t happen (Bunyoni is like the bigger better version). Deus promised to take us on the coffee tour so I plan to do that too. And if he can find a free morning I really want Deus to teach me how to drive a motorcycle.

So that is it for now. I will probably not blog until next week because I am really just trying to enjoy every second that I have left here because frankly, it is just not enough.
I hope you are all well!
Love,
Hope

My Return to Kisoro

Oh my goodness I cannot even begin to tell you how happy I am to be back in Kisoro! I don’t think I truly appreciated this place until I was nearly forced to leave. Sure it has its problems, we have had no running water on several days this past week and I sometimes get tired of the limited food options, but I really cannot recall a time when I have been more carefree and content.

To ease back into a schedule after feeling so crappy I started with two days of data entry this week. We are trying to take the patient records from the chronic care clinic and amass data with the goal of presenting our findings and making suggestions about improvements by the end of the summer. On Wednesday, I was able to shadow Dr. Nori in clinic. I saw a diabetic foot ulcer, listened to a diastolic rumble on a teenager with rheumatic heart disease (I opted to have Nori give him the penicillin shot-I am allergic and we didn’t have gloves available so I was a bit nervous), took blood pressures and saw many other cases in the 5.5 hours of clinic. I even figured out how to do a urine dipstick and read it on a patient with a nephrotic syndrome (found 3+ protein still but he seems to not be getting any worse and his creatinine is going down on prednisone..mom this is a different case from the one I called you about, clearly if you ever feel like traveling the world there is a great need for nephrologists here). One more unfortunate incident was that an elderly patient decided that she did not feel safe taking a motorcycle to clinic (costs 2,000 or less than $1), so she used all of her money and paid 50,000 ugandan to get her to clinic. But, she did not have the money to get home. She has a history of asthma and just needed a med refill so it was foolish for her to even have come, she could have sent a younger relative for the prescription. Even more frustrating was the fact that the clinic only carried one of her three medications so she would be forced to pay for the others at a pharmacy. Again, the money for the ride could have been much better spent elsewhere. So, she ended up needing to stay over at the hospital, probably on the floor since the women’s ward was at capacity and had to wait for the people of her village to find the money to send for a car to pick her up. Oy.

Later in the week, I went to teaching rounds. The case presented was a 14 year old girl who had low exercise tolerance and complained of vomiting blood. There were signs that this was a more chronic process-she came in with a fever of 100 but said that she was not ever febrile and she did say that she would wake up drenched in sweat (signs that this fever was occurring on a cycle, breaking at night). She also had ascites, when she was admitted the resident asked if she could be pregnant. I don’t know much about tuberculosis but I know it is common here and coughing blood I know is a symptom so I asked if she had been tested for that. The resident told me to wait until we did review of systems. Eyes- conjunctiva and sclera were pale, likely indicating anemia. Lungs- both percussion and auscultation revealed that her right lung had been compressed upward and there was a dull sound, it was possible to discern a line where the sound went from being resonant and normal to dull. Auscultating abdomen-normal bowel sounds. Percussing abdomen- soft, not tender. Then we saw an X-ray that showed most of her right lung had been whited out and it was possible to see the bronchioles in some places, or the white material that lined them. I learned that all of these findings do point to a diagnosis of extrapulmonary tuberculosis. TB usually begins in the lung and can spread either via blood or orally to other parts of the body, so this likey has TB in her gut which is causing her to vomit blood. They will do further testing. I also asked the patient how many siblings she has-answer is 7, so the whole family should be screened. Nori said that in a recent study in Malawi they found that 1 in 4 children from an infected home will require treatment for TB at some point so I am hopeful that if we do confirm TB in this patient, the rest of the family should come in to be examined and tested.

Today (Saturday) I went on the mental health outreach again. Today we talked about suicide prevention. I learned that 3 young people had come to the hospital this week after trying to kill themselves so this was a very relevant topic to this community. So, Immaculate and the Australian psychologist lead a discussion about warning signs and possible interventions. Immaculate also used the gathering as an opportunity to talk about the “Gafura” procedure, which is a health concern here. Basically, if a child has a headache, cough, cold etc, they can be taken to an elder and their tonsils are scraped. It is not a precise procedure and it can lead to infection. So Immaculate showed a video of a procedure being done on a child and told the group that only 3 days later, the child in the video had died. The women in the community looked HORRIFIED and I am thinking based on the reactions that Immaculate was very successful in conveying the dangers of this horrific practice.

Other than work not much has gone on. There have been some good meals (banana pancakes at travelers lodge!) and a lot of quality time hanging out and making smores by the fire at night. Tomorrow we are ALL going to attempt to hike mount sabino together. This volcano has 3 peaks, the third allows you to stand in Uganda, Rwanda and the Congo simultaneously and the views should be great. I always just feel very triumphant when I get to the top and so I hike for that feeling of fulfillment. I am sure if I make it tomorrow it will feel even more proud of myself, in light of recent health issues/obstacles.

Hope everyone is well and sorry for the scare.
Love,
Hope

The Pros and Cons of My Chronic (Crohns-ic?) Life

I did not plan to write this post, in fact I really hoped it could be avoided. But alas, it is the time so here goes.

I was diagnosed with Crohn's disease when I was 15. I was terribly ill then and then got better quickly and enjoyed 7 years of remission mediated by some relatively benign medications (minus prednisone, I hated that and would not wish it on my worst enemy..I don't look forward to having to prescribe it for others). Then, after college I had problems again and the old medications no longer worked. This was followed by several very difficult months of trying a new treatment, feeling better, developing hepatitis from this treatment , going back to square one and trying something new, feeling slowly better and finding a way to maintain that. It was a brutal time but I have been very happy and healthy on Humira for the past year. But my new miracle med is also a pretty terrifying drug with some less than desirable potential side effects and it leaves me immune suppressed, so what may be no big deal to someone else can become a crisis for me.

Which brings me to today...

Crohn's Con:
I had been feeling a bit under the weather this week. It started when I woke up with a red eye on Monday and that improved with antibiotic eye drops over the next 3 days. Later this week I felt a bit tired and had a fever and headache one night. My other housemates have been sick with various things since coming to Africa so I didn't think much of anything. But this morning I woke up and my right cheek was swollen above my sinus. I have said this before, Kisoro is a beautiful place for healthy people. It is freaking terrifying if you are sick. So I texted my dad (it was a reasonable hour at home) and asked if I should be on antibiotics. This led to a conversation about potential causes/complications and so I woke Sarah up and she calmly advised me to call international SOS. I chose to call the South African branch, they are close enough and their accents are so wonderful I figured it could only be a pleasant interaction. They shared my father's concerns, that if this were something like an abscess and with my immune system and geographic location, things could become very bad very quickly. They wanted me to get to somewhere to be seen and get a CT scan and would prefer if that location had a major airport. SO my friends were kind enough to cancel their hike and they let me borrow our guide, Emma and Andrea joined me for the trip. We packed our things quickly and headed off for the 3 hour drive to Kigali (negotiated down from the 10 hour drive that international SOS wanted me to take to Kampala...no way jose). Once at Kigali, Andrea was very helpful at explaining the situation and what I needed. The Doctor I met with was an overworked resident who just wanted me to take an antihistamine and some blood tests. But we prevailed and I got a CT with and without contrast and we even lucked out and there was a radiologist there to read it. No abscess, no fluids, nothing that looked concerning. I just need a course of antibiotics.


Crohn's Pro: So for anyone else this ordeal would have been overkill. But for me and my immunosuppressed self it is considered necessary medical protocol. In fact, when it looked like a radiologist may not be available, International SOS was ready to fly Andrea and me to South Africa to be seen by a doctor there. We reached a compromise. I wanted to just go back to Kisoro after we realized it was not a concerning finding. They wanted me in South Africa. We settled on me staying in Kigali for the night, seeing how I feel tonight, marking my swelling and seeing how things go and deciding in the morning. What this then meant was that International SOS had to provide housing for Emma, Andrea and me. I asked for the name of the hotel and couldn't understand the woman on the phone so I asked her to spell it...hotel d e s m i l l. Emma stopped me as I was repeating the letters "Hotel des Mille Collines?!" Me: Uh yeah that seems to be where she is going with this. Andrea: that is the hotel Rwanda hotel! SO without my asking, this insurance company has put us up in the fanciest hotel in Kigali. There is a pool. And free brunch. And a great shower and clean linens and oh man it is amazing.

So sometimes having a chronic illness can be a big pain in the butt. I have had more colonoscopies than most 60 year olds. But some days, like today, there can be some pretty wonderful silver (or five star) linings. So Thank you international SOS for providing me and my family with peace of mind in a pretty difficult situation and thank you for the wonderful accommodations :)

Xoxo,
A recovering Hope who is a happy camper in her white bathrobe

(Photo taken Sunday morning, clearly looking less puffy/red and much happier)

Gorillas!!!

If you read the first post then you know how excited I was for this part of the trip. I LOVE animals and I was beyond thrilled to have the opportunity to see an extremely rare animal in its natural habitat. Despite having a fever the previous night (not confirmed with thermometer but at this point I can usually tell), I was not sure if hiking to see gorillas would be feasible. After deliberation and speaking with Emma I decided I was well enough to hike and I didn't want to put off the trek. So at 7:15am we headed to the base of mount Muhavora (the big volcano in all of my photos). I met the two guides and the one other tourist on the trip (a 22 year old South African guy who was on break after finishing college) and we began to walk. We had to cross through village fields and climb over a wall and then we were on these tiny dirt "trails" making our way through a rainforest. After 1.5 hours of getting cut up by thorns and pointy leaves I was told we were near the trackers and to get my camera out. I was pretty cranky at this point but Once I rounded the corner and saw a GIANT silverback male I forgot about the fact that my arms looked like I had an encounter with an angry cat. The first gorilla was pretty obscured by the trees but then we saw a 6 year old female who came very close to us. Her name was Machete and she was quite a character. She sort of seemed to recline against trees and pose for photos. Then when we moved along to the next gorilla she would follow us quite closely. I took a selfie standing several feet in front of her and then I heard a roar and some chest pounding and turned around to see her only 2 feet from my face. OY! The guides explained this was her way of playing. I still was not so sure about the proximity. We saw two more silverback males (this family group has 5 males! This is rare, they usually fight so it is pretty cool). Then there was a mom and her 2 year old baby and because she liked the human attention, Machete came over and played with her little brother. Great photo op. After the hour was up and on the hike back I still could not believe what I had just had the privilege to experience. There are only several hundred mountain gorillas left in the world, they can only live in the wild and efforts to have them mate or live in captivity have been unsuccessful. But getting to hang out with these gentle giants in their home for a day was so amazing/terrifying/awe inspiring.