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