Cultural Clashes

February 4th, 2010 by INMED
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Cultural clashes—yesterday (Wednesday) I went on home visits in a very poor area.  The families felt that it was sooo important that the muzungus have a place to sit and we not be inconvenienced in taking off our shoes before we entered (even though everyone else did).  My thoughts were, of course, that I want to be as gracious and least a hassle as possible, but given my skin color and occupation, that is not possible.  This also happens in the clinic were others tend to wait on me, and while I love having my tea brought to me everyday midmorning (I still think we need tea time built into our day), I feel soooo lazy and unhelpful.  I guess I’ll just have to be nice to strangers back home to alleviate some of my guilt.


So I think going to Costa Rica as my first real international experience at the wise age of 20 ruined (which isn’t quite the right word) other international experiences for me.  First of all I was there for three months and soooo didn’t want to leave at that time.  But for a developing country it was doing many things right.  Where many post-colonial countries were plagued with civil wars and outside interferers, it wasn’t.  It had peaceful transitions of power.  Thus it was able to pave roads, set up a reliable public transportation network, socialize health care, and build industries (mostly tourism, coffee, and banana).  By the end, things were starting to make sense to me, not that it wasn’t without its problems.  Maybe because I wasn’t in Honduras or here as long, but I still think it would have taken longer for me to try to understand things (but probably not, it’s hard as a gringa or muzungu to accept lack of reliable postal system or banks or roads or random power outages or random farm animals, cows, goats, chickens, etc in the city).  Regardless, this is still a wonderful place to be and I’m glad I’m here (FYI, it’s about 10pm, I’m sitting in my room, window and door open and still sweating; it must have been close to 90 today with considerable humidity; I wish I had a fan or a/c).


The people I saw in the community were quite sick.  At Memorial I’m sure they’d have been admitted to staff medicine (and probably wouldn’t leave the service for at least a week, I may be exaggerating a little, can you tell I’m not looking forward to starting medicine again), but here they were told to keep there clinic appointment on Friday.  One had TB (man I hope I don’t convert, I don’t want to have to have be on INH—nine months with no alcohol; no I’m not a lush) and the other was quite anemic with fever, so I really hope he doesn’t have malaria on top of anemia likely due to AZT.  I was in a community sort of on the outskirts of the city.  They were very poor.  Open sewage, sketchy electricity, who know what kind of toilets, crowded, I don’t know what was holding up or together the buildings.  Yet on the way out of town, a likely three-year-old boy ran after us yelling muzungu quite loudly (it totally made me smile).


Before the community visits, there was a CME on new .  It was a very quick overview, but quite interesting.  Part of me is amazed at the drugs that are available here and the other part of me wishes they had more.  They are quite reliant on the US at the moment for many of their meds and that funding is set to end towards the end of this year. So this is what happens when I walk home by myself…I analyze what I’ve seen!

“Hello! How are you?”

February 2nd, 2010 by INMED
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So life since the safari has had its ups and downs.  I’m feeling a little more confident with which tests to order and what treatment to give.  I’ve seen a lot more malaria.  I saw chickenpox on a child, which was pretty cool (even cooler that I made the correct diagnosis before the attending saw the patient).  I gave a presentation about tracheomalacia because it was thought one of the kids from the orphanage had it but upon further study, he really doesn’t fit the picture.  It seems his abnormal breathing is due to something higher up, so they are going to try to have and ENT see him.


On a sad note, one of the kids from the orphanage who came in initially a few weeks ago with severe anemia, abuse, and burns, suddenly died late last week.  We don’t really know what happened.  He seemed to be more interactive the last time I saw him.  Then they brought him in because of vomiting and diarrhea and lethargy, had a platelet count of zero, and then stopped breathing and died.  It was awful.  This poor child of probably around two years of age, probably never had a decent day.  The days that would have been better at the orphanage were burdened with pain from burns and dressing changes. We had another very sick AIDS male who quickly developed confusion and then lethargy and had to be air lifted to Nairobi.  His family is apparently big wigs in the government here.


On a lighter note, an American patient who’s husband works for the oil drilling companies called back to the clinic after I saw her and invited me out for drinks with oil people.  So random, that never happens in South Bend (and I didn’t go out and drink, I was still working at that time).


I went to an HIV clinic starting on Monday.  They have a holistic approach, not only offering medical care and meds, but education, food, community outreach, helping families pay for school fees.  It’s quite a set up.  I will hopefully get to go on home visits on Wednesday.  Also on the way home on Monday I was in a matatu (shared taxi—envision a white minivan equipped to hold 15 people, but usually more) with lots of people and a chicken.  Today I sat in on an annual report for this program.  They do some really neat work and really try to analyze their results for improvement.  Later I sat with the person who starts patients on anti-retroviral drugs.  They have to go through and extensive education process and even today before giving the patients the medications, she made sure they understood what they were for and that they would need to take them reliably.  I wish we had something similar in the States.


Random thoughts about being abroad…sometimes it’s nice being a minority, all the kids (and many adults), run up to me and say something to the effect of hello “mzungu” (white person) (the kids are of course much cuter saying it than the adults).  Memorial prepared me well for this because everyone in the hospital seems to know who we are without me knowing a quarter of them (our pictures are up all over the hospital, often on many nurses clip boards is a copy as well)….The roads in South Bend (or really anywhere in the States) are not bad compared to here.  This major city with a population over a million, probably has more dirt roads than paved and the paved ones have excessive amounts of speed “humps” and large pot holes.


I’m always amazed at people’s generosity and kindness.  This city can be confusing since many of the roads aren’t on the map and there is no such thing as a bus map.  But somehow I manage to get to where I need to be.  Whether it’s a neighbor who’s going the same direction that I am takes me most of the way.  Or it’s a stranger who guides me to the right matatu.  Or a worker at the clinic who brings me tea.  Or a Ugandan doctor who takes time and tries to teach me a thing or two about medicine here.  Or some random person who thanks me for coming here to help, even though I’m receiving more help than giving for sure…I love learning cultural things and wishing I could make everyone do them back home…like tea time (that should definitely be blocked out for in clinic) and when you greet someone here you say “hello, how are you” and actually care about the response.  You have to say this to someone before you ask then a question or they think it’s rude…which I think is great.

Little To Do With Medicine: My Safari

January 28th, 2010 by INMED
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Tricia, the other resident, and I went on a safari this weekend.  It was an awesome experience.  It started on Saturday with our driver, Jeffery, picking us up.  We had about a 3 hour drive to Masindi which is just outside of the Murchinson Falls National Park.  For about another hour or so we drove on red dirt dusty roads (seeing baboons and baby warthogs) until we made it to our lodging (Red Chili Camp Site).  After lunch and finding our tent (and watching warthogs for awhile, Pumba was much cuter than the real things.  Also they have an incredible sense of smell so we weren’t allowed to leave any food in our tent because they would destroy it trying to find it), we crossed the Victoria Nile.


Let me digress into a little geography lesson.  The Nile has several branches.  It starts in Jinja, Uganda as the Victoria Nile coming off Lake Victoria.  Near where we were for safari, it joins the Albert Nile coming off of Lake Albert and reverses its flow and heads north where it meets up with several other branches before dumping into the Mediterranean Sea in Egypt.


After the ferry ride, we saw hippos off to the side in the water and we picked up Emmanuel, our guide for the game tour.  He is extremely knowledgeable about the Park (basically a park ranger).  We started off seeing lots of animals from the antelope family.  (This part is for you, Anita.)  We saw the Hartebeest (apparently a very dumb and forgetful creature that lions like to eat), a Defassa waterbuck, tons of Ugandan kobs, and lots of small antelopes that I don’t know the names of.  We then saw a variety of giraffes and some water buffalo.  Then we went to a marsh area with tons of hippos.  They are odd creatures, extremely fierce in that they kill more humans than any other wild animal, but they mostly lie in the water all day and eat plants at night (they kill humans but don’t eat them).  Tricia decided that instead of being a doctor, she’d rather be a hippo for obvious reasons.  On the way back to the ferry we saw a group of elephants….it was quite cool.  I should mention, the van we were in had a top that could be lift up so we stood up in it and looked around the whole time.  We crossed the Nile at sunset which was amazing.  After dinner and a much needed shower, I tried to sleep but it was insanely hot and kept feeling like I was getting eaten up by bugs despite tons of bug spray.  (Also many of cases of malaria that we had seen the week before, were likely contracted at Murchinson, so that freaked me out a little).


The next morning we had an early start (and I really hadn’t gotten eaten up).  We went on another game tour and this time we saw many of the same things but also lions.  Initially we saw two lionesses and a lion far off in the distance (I’m glad I invested in some binoculars).  Later on, we found another lioness and we played ring around the rosy with it, chasing it with our van around some bushes until it found a way to hide in them.  It was kind of amusing.  The lioness had an extremely annoyed swagger throughout the ordeal.  After that we found a leopard far off in the distance laying in a tree probably stalking its dinner.  After lunch, we went on a boat tour up the Nile towards the falls.  It too was awesome.  We got closer to hippos, and even saw a baby one.  There were lots of different birds.  We went past a family of elephants and saw a couple of different types of monkeys.  The crocodiles and hippos were hanging out together (even crocodiles are afraid of hippos).  Then we got near the falls.  As we approached tons of white foam appeared in the water from the falls.  We were able to see them from a distance and then headed back.  It was another hot night.


The next day were drove to the top of the falls.  That was incredible.  It’s a very powerful drop with amazing scenery.  Then we drove out of the park.  That was very dusty (I now have a once white shirt that now is more redish brown).  Then we drove back to Kampala, where traffic wasn’t horrible.


Tuesday was a national holiday (Liberation Day) and Tricia and I had today off.  We went with her sister to visit her host family in Mukono, about an hour or so from Kampala.  I’ve decided I prefer being out of Kampala.  Traffic is soooooooooo much better and there are less people.  We had to take a couple of shared taxis today which are cheap but crowded and it meant going to the taxi park which is insane with tons of taxis, people, stuff (lots of stores and people wondering around trying to sell you stuff).


Clinic this week (all of one day) was busy…I got to remove a benign couple of millimeter mass in someone’s forearm…that was fun…I put in two layers to close it.  We keep seeing lot of babies from the nearby orphanage, Watoto, and hope to go there and see the place.  Apparently there are about a hundred of kids under age 2 there.

Two Children From The Local Orphanage

January 22nd, 2010 by INMED
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The last few days have been mostly work.  Yesterday I hung out mostly in the ER.  When I arrived, two children from the local orphanage were here.  Ages unknown but both less than 2.  Severely anemic (Hb ~3), one with malaria and one who had been abused and burned.  Both with marasmus.  It was an aweful thing to see.  one had severe muscle wasting.  there were back today for more blood.  The one with burns is now febrile and a little dehydrated….sad, sad, sad.  Abe with the tracheomalacia has been in and out, had pneumonia, went hypoxic yesterday, almost apnic, who knows if he’ll make it…again sad, sad, sad.  But then there are patients who get better, which is always nice.  I’ve seen lots of malaria, which is interesting.


Today has been slower.  We had the morning off and tried to find the neighborhood market which took way too long because we got lost.  And then of course we went looking for clothes and that doesn’t usually start until the afternoon so after an hour and a half of walking mostly unhill, we came home empty handed. Tomorrow morning we leave for our safari to some falls in the northwest part of the country along the Nile.  I’m hoping it’s not canoes because I always fall out of them and i don’t want to get eaten by a crocodile or hippo.

Everyday Something Fascinating

January 20th, 2010 by INMED
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As I type this, it’s going through my head in a British accent, I’m around more Brits or people’s English is more British style than Americans, as one would expect! Tuesday, with the help of one of the other boarders at our house I made to work.  The clinic was nice. I hung out with one of the doctors, learned about stuff we only read about in the States.  I saw a really sad 14 month old with likely tracheomalacia and TB who sounded aweful.  he came back today with pneumonia and looked even worse.


Today began with us going to work with one of the doctors and us witnessing a pedestrian walking out in front of a boda driver and the driver taking nasty fall.  He got loaded up in the back of the car and taken to the clinic. He actually did okay and we determined that without any radiation (no head CT).  Then I saw lots of patients today, some much sicker than others .


Some random observations…no wonder it takes forever to get from point A to point B when in a city of 1.2million people more roads are unpaved than paved (and many of then with huge potholes or large ruts) and there’s no real traffic rules.  Again i am seeing that in a developing country, something simple like adequate roads can change peoples lives in more ways than imaginable. Also, I often take being able to drink water from the tap or eating uncooked vegetables at a restaurant for granted.

I Made It Here!

January 17th, 2010 by INMED
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So after 30+ hours of bus, plane, and taxi travel, we made it safely to Kampala, along with all of our baggage and in desperate need of a shower and bed. Tricia and I start work at the clinic on Monday. We met our supervising physician (those of you from Memorial, think a British version of Dr. Walsh, not in appearance but in personality/bedside manner) on Saturday briefly. Meanwhile, Tricia’s sister has been showing us around the city. It’s been an experience. Many pot holes, people driving on the left side of the road, bodas (motorcyles) transporting people or really anything including large quantities of long metal poles, crazy drivers (I never want to drive here), warm sun, red dirt, beautiful flowers and views of the city, power outages, mosquito nets, African church service, an outdoor craft market, more ethnic food (non Ugandan or American) here than in the States. Well I’ll try to write more this week and upload some pictures. Next weekend we go on a 3 day safari up and down the Nile. I can’t wait, but I don’t want to run into any hippos.

My First INMED Blog Post

January 7th, 2010 by INMED
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schmidt-amandaHello! My name is Amanda Schmidt. I am a resident physician at Memorial Hospital of South Bend Family Medicine Residency, and I’m starting my INMED service-learning experience at The Surgery in Uganda beginning in February 2010.