April 10th, 2017 by jasongulati
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I had given my presentation the Thursday before I left, about osteopathic manipulative medicine and how it could be particularly useful in low-resource settings. It went well, although I wish I had given it at the beginning of the month so that my preceptors would give me opportunities to demonstrate its value on actual patients.

On my way out of the city, Jimmy noted that we were going to end up at the airport quite early and that I had time to stop and take pictures of Lake Victoria if I wanted to. Since I hadn’t actually ventured out of Kampala at all, I figured I owed myself at least that much. When I came into the country, it was night time and I didn’t really see anything.

It was a grace on my dry eyes.

While I was there, we met a few guys who turned out to be plainclothes policemen patrolling the area. Apparently I was in a sensitive section of the lake as it is part of the route President Museveni frequents. We ended up having an hours-long discussion about the state of politics and healthcare in Uganda and the US. It was very eye-opening, especially in light of recent events in the news there.

I flew back to London that night, and by luck of the draw I met with a UK Border Force officer who was originally from Uganda–we had the same conversation in a 5 minute window.

Unfortunately, I also brought a second round of diarrhea with me that put a damper on my first few days out… luckily I still had the other half of my Cipro left. Ironically, both times I got sick were from fast food/takeaway. The local cuisine never got me, nor the fresh fruit/veggies.

March 23rd, 2017 by jasongulati
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I feel like I’m just settling in. My body is tired at a normal hour, I’m comfortable hopping on bodas, I have my routine down at the hospital.

Yet I leave on Saturday night.

Part of me still feels like I got here, but I’ve also gotten used to the diseases that were new to me three weeks ago. Bilharzia, malaria, HIV (not new but I see it slightly more frequently here), Giardiasis, chronic Hepatitis B, you name it. What we DON’T see much of in Kampala is sleeping sickness, dengue, or zika. I definitely feel like I got a speed course in tropical diseases here, in addition to your run of the mill colds and aches. I’m sure I mentioned this before but it has also been awesome seeing people from around the world. As it turns out, Kampala is quite a melting pot.

It’s reflected in the food, too. I can log into my food delivery app right now and find Mexican, Thai, Indian (whose influences are deep in Ugandan cuisine), American fare, local, and more. In fact, the best quesadilla I’ve ever had was here. The traditional meals I’ve had here were also fantastic–very carb dense with matoke, rice, beans and a little meat. I’m not sure what goes into making the beans but they’re pretty incredible. That’s just the cooked stuff. The fresh fruit, the avocado, the bananas, the mangoes, the pineapples… I’ll miss it. Such high quality for a fraction of what you pay at home.

And somehow I dropped two or three pant sizes in all this.

I went back to Oweno market with one of my housemates to pick up some clothes I had made. I was super impressed with the result, and of course everyone was super nice even though we were obviously out of place. I’d post a picture but they were neatly folded and closed in a bag for travel.

In a fit of bad news, my phone got pickpocketed while we were out Saturday night. I am normally pretty careful with my belongings but I let my guard down at precisely the wrong second (moving through a busy crowd inside a pub), came through the other end, empty pocket. To be fair, no one warned me about theft here more than other Ugandans and I feel bad bringing it up to people, but it’s come up in casual conversation a couple of times since I don’t have much going on in my life right now. I was pretty upset for about a day since it had some personal data on there and priceless memories. But I got the phone company on board to do a remote disable and notified the police. I don’t expect anything to turn up but I found peace of mind knowing I did what I could. It definitely didn’t sour my overall experience here, which has been just wonderful.

While I’m ready to go home, sign my residency contract (side note, I matched to my #1 choice), and see my girlfriend I’ll miss Kampala a lot. It actually inspired me to buy a motorcycle when I move to Honolulu this summer.

March 15th, 2017 by jasongulati
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I went back to work this week. Yesterday there was a change in schedule so I worked with Drs. Conrad and Scott. I genuinely enjoy seeing the difference in teaching styles and modes of practice. Where Giuseppe had me leading patient encounters, Dr. Scott did more of a top-down style where I shadowed him and he asked me questions. Less hands-on than I’ve gotten used to this year, but I still learned a lot. I observed a deep laceration repair and I&D of a boil. Had I been summoned to do so, I could have done them both solo after spending the past month rotating in the ED. But it was really better to see how they do it here. I noticed a lot more usage of peroxide for wound irrigation, whereas at home we tend to use diluted iodine or just high pressure sterile saline.

Other things I notice here:

• Patients are usually told to wait in the waiting room for lab and imaging results that the doctor will then discuss with them shortly after completion. At home, we usually say we’ll call if anything is abnormal and let them leave. I wonder if there have been issues with patient follow-up in the past that prompted this, or if there is something else at hand.
• And the relationship with nursing is very amicable, but the responsibilities delegated to them are fewer. Nurses in the US have an increasing role at home, especially those with experience in their respective units. I was talking to a German medical student who told me the relationship is far more adversarial there.
• Docs here have far less restriction in how they practice and document here. At home, everything revolves around ticking boxes for the EMR. Here, as long as it’s documented it’s fine, and because consultations are flat rate there is no drive to expand the number of systems checked on exam/review of systems. As I’ve gotten used to the rigor of heavy documentation, Giuseppe has had some laughs about the amount of detail I enter even though we did the same set of exams on a patient. I’ve also enjoyed explaining my usage of acronyms eg CTAB, RRR, EOMI etc.
• It’s also been real interesting seeing the number of “small world” encounters I’ve had with patients… I came all the way to Kampala and I’ve met people with close connections to Detroit, Lansing, AND Ann Arbor. And I saw someone wearing a Texas A&M shirt. As a graduate of the University of Missouri that normally causes a muted eye roll, but when you’re on the opposite side of the world little glimpses of home are always appreciated.

Overall, I like the workflow here. I’d definitely consider coming back here to work as an attending. I think that’s a pretty glowing review having only been here 1.5 weeks. It feels like I just got here but I’m already halfway done. It’s a strange sensation.

View from behind The Surgery, with a solid representation of the spring weather

March 15th, 2017 by jasongulati
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Made a full recovery thanks to the Cipro my travel clinic sent me with. As an aside, no travel clinic is the same and a good one is worth its weight in gold, while others will leave you feeling robbed. As a matter of professionalism I won’t name the clinic in question, but when approaching a travel clinic ask to know their available services up front before the consultation. If they don’t offer everything you’re going to need, keep looking. If the provider appears unsure and is just reciting CDC guidelines (that you can find yourself online), keep looking. Otherwise you’re going to have to go through a brand new consultation elsewhere for the rest. And while pre-travel services are rarely covered by US insurances, ask anyway. I was surprised to discover most of my consultation and prescriptions were covered in my plan.

Anyway, moving on. I had heard textiles were a big deal here, and went in search of fabrics and a good tailor on the advice of my housemates. I got a ride down to Channel St. and tried to find the shop she mentioned. However, this part of Kampala is extremely population-dense and the shops all look a bit similar. I also made the error of wearing shorts for the first time–not uncommon among Muzungu but I had entered an area pretty devoid of them. At that point I had been here a week and that is absolutely the most I’ve ever heard the phrase hollered at me in a single day. Except for one passing boda driver, it never made me feel that unsafe but it was certainly uncomfortable. And embarrassing. When I finally reached the shop, I think the owner took custody of me as though I were a lost child… it was interesting being on the other side of this dynamic after observing it comfortably in Thailand. Interestingly enough (to me), Muzungu is used in the same way we use Falang. Anyway, it took the whole afternoon and she had to lead me all over the district, but we got it all sorted. I’m excited to see the results on Saturday, the fabrics were gorgeous and the tailor sketched the design out right in front of me.

 I hope things still fit right by then. I’ve dropped almost two belt sizes since I’ve been here and while part of it was being sick last week, I know I have just been eating less than I do at home. As I tend to eat a little excessively at home, I’m hoping this habit continues after I return home. I exercise at home but it’s more anaerobically focused… very lacking in cardio. Already now I feel much lighter on my feet.

March 9th, 2017 by jasongulati
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I’m currently laid up at the house in Makindye recovering from some kind of intestinal bug. I developed some loose stools on Saturday but it was all pretty manageable until it took off yesterday. The rest of the house got something too, it might be a two-in-one infection. So I took the day off and enjoyed some bland noodles with broth. Figure while I’m down I could write an update.

I started working on Monday. I must admit I was a little apprehensive upon discovering that The Surgery is a private hospital that caters largely to expats and privately insured Ugandans. I had told myself and others that I was coming here to help the needy.

But it’s been so far a fantastic experience. Because while I am serving more affluent people, the diseases that show up are still the same. Tropical diseases don’t discriminate by income. And the dynamic of this kind of facility was something I had always planned to investigate down the road in Thailand.

The patients and the physicians at The Surgery come from all over the world, which has provided a lot of unique experiences over just a few days. I’ve been working with Giuseppe, an Italian physician, and together we’ve seen patients from all over Europe, Asia, Africa, the Middle East, and all the way back to the US. We see as much hypertension management as we do bilharzia (it’s so common I’m honestly planning on getting tested for it before I leave, especially in light of the new symptoms). There is no shortage of zebras either, as we had a patient walk himself in only to discover he was in the acute phases of a malaria, cirrhosis, and a GI bleed with background HIV. In working with this doctor, there has also been a lot of comparing/contrasting between how things are done in the EU, the US, and here. Made for some interesting story sharing.

March 4th, 2017 by jasongulati
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I arrived late Thursday night, a decidedly bad time to arrive if you haven’t set any internet up yet and you promised your girlfriend you’d let her know you were safe. I ended up borrowing a housemate’s computer the next afternoon to send her an email…

But I did arrive safely, and the driver recommended by my host was a master of trade. The road from Entebbe to Kampala completely changes at night, he told me. It was like nothing I had ever seen outside of some videos online, and levels above what I had seen in the likes of Chicago, Atlanta, or even Bangkok. Stretches of roadways were packed with cars and bodas (motorbike taxis), and they seemed to interweave in a chaotic harmony just inches from each other. Yet I witnessed zero collisions, zero road rage, certainly less than I see on an average day in Detroit.

Having no internet and arriving to a house full of sleeping guests, I opted to go to sleep. I was anxious about my sudden change of environment but the roaring thunder was comforting–I slept for 14 hours.

The next day, I took my first boda ride and it was unforgettable. I white-knuckled the support bars for life as the driver seamlessly navigated between car after car. I was impressed, I know if I tried the same thing I would be laid up in the hospital right now. That being said, like seat belts at home helmets are highly recommended.

As I navigated the shops to get myself connected, supplied, and fed, I found nearly everyone I asked for help to be very friendly without any hint of disingenuity. Honestly more than I experience at home some days.

I am hoping to start the medical side of things on Monday morning. In the meantime, I am quickly getting more comfortable in my surroundings.

March 4th, 2017 by jasongulati
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My name is Jason Gulati, I’m a fourth-year medical student at AT Still University in Kirksville, Missouri (located right in the beating heart of Middle America). I’m finishing my clerkships in metropolitan Detroit, Michigan, once the bustling capital of the auto industry now racked with poverty as the industry collapsed and the inhabitants were abandoned. My experiences there serve largely as my basis of comparison as I head into Uganda in March.

Why Uganda? I would be lying if I said this had been my first choice, and let me be clear that this statement is not a slight at what has so far been a wonderful place to be. I have been carefully exploring the idea of ethics in medical outreach and the importance of cultural competency for participants. As a first-generation Thai immigrant, In had hoped to be in Thailand where I am significantly more familiar with local customs, language, and culture. But as luck sometimes goes, the site was full and they graciously offered to take me at The Surgery, located here in Kampala. Despite best efforts to research what I was getting myself into, I knew almost nothing about this country, or even the region. But, having never been on the African continent before, I figured my luck drew this way for a reason.

I have a lot of experience in medical outreach projects at home and a lot of experience traveling the globe. I have also assisted other students in finding outreach projects that matched their interests. But this is my first time leaving to participate in another nation’s healthcare system. My hope is to come away with a great sense for Ugandan culture and learn about their healthcare delivery systems. I would like to think I can learn things that I can apply back home, and in turn impart useful and sustainable practices here. I intend to continue exploring issues in global health into my residency and afterwards (global health and general outreach opportunities were a huge part of my rank order list creation for residency… the results of which I will receive while I’m here in Uganda).

February 23rd, 2017 by INMED
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Hello! My name is Jason Gulati . I am a medical student at A.T. Still University, and I’m starting my INMED service-learning experience at The Surgery in Uganda beginning in February 2017- March 2017.