Encountering the Nile

May 17th, 2022 by Benton Huang
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Anne and I traveled to Jinja, one of the closest areas to the source of the Nile where we would try out white river rafting. I’ve been spoiled with top-tier scenery in Washington State, but regardless it was cool to see the largest river in Africa. It’s definitely not marketed as a blue, but it seemed calm, had a dull greenish, brownish color to it and supporting nearby green plants and trees. We went with a company called Nile River Explorers, which I would recommend – though totally unsure how it compares to others. If you’re curious, it was $120 for the whole day. We choose the highest difficulty possible, Grade 5 – might as well get the full experience, right? With no prior experience, I had little confidence in myself but the guides were insistent that I would be fine. I then signed a waiver regarding something, something, bodily injury, waterborne illness, death, etc. As the kids say these days, YOLO?

I had brought my wife’s GoPro for exactly this day and strapped it proudly on my chest. (Unfortunately, the footage ended up being terrible). We did some practice rowing and also jumped into the water to practice getting back into the raft. After trying to pull myself back into the raft, reality hit me that my upper body had no meaningful strength, so our guide offered to pull me in. I was in the Nile and insisted that I could do it, but nevertheless my last muscle fiber gave out and I had to be pulled in. It’s okay. I have no shame. We encountered our first rapid which was like a grade 3 in terms of difficulty. We paddled as fast as we could into it and once into the heart of it, took cover inside the raft and did our best to stay upright. We survived and it was much needed confidence booster. In between each rapid, was met with calmness and we coasted along until the next rapid, which we also survived. We had some snacks in between, a freshly cut pineapple blessed with the water of the Nile and some crackers. The extra touch of Giardia really enhanced the flavor.

The sun was hot, the sunscreen that I had applied would quickly wash off with the splashing water of each rapid. There was another raft that was just for carrying supplies and food, and I did my best tor re-apply but my skin had not had this much sun exposure for quite some time and I accepted my inevitable burns. We approached the last rapid. We again paddled as hard as we could into it, and then we braced ourselves as we let our fates be decided by the wrath of the rapids. The first wave hit and we stayed afloat, then the next one hit us so hard that I felt that I was flying, staring vertically up into the sky – I lost complete orientation of my body and was tossed from the raft. I eventually hit the water and tried to find my way above the surface. On our raft, we had a couple where the girlfriend had no swimming capabilities. He quickly spotted her and tried to swim towards her. Over in the distance I see Anne too with a bloody lower face – OUCH! There were designated people in kayaks nearby to rescue her, so I just stayed afloat where I was and let the Nile take me to Egypt or wherever. Eventually I was rescued and placed back on the raft. Anne had a small laceration below her lip (we concluded that a rogue paddle while we were in mid-air probably hit her. It was exciting – I’m happy that we fell over; I felt like I got the whole experience of a rafting trip in the Nile and glad that we got out with minimal injuries. We got back onto the bus that brought us there (it drove down from our initial departure site) and enjoyed some lunch and beer. The rest of day was spent treating my burns and resting. Nice.

No One Likes Potholes

May 8th, 2022 by Benton Huang
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Just as background information, in Uganda, to become a doctor resembles the European system where you can apply to medical school after high school. Their medical school is considered undergraduate level and after completion of a five year program, will earn a Bachelor of Medicine and Bachelor of Surgery (MBChB). Then they start their internship which lasts one year and are then able to practice medicine independently as a “Chief Medical Officer”. Alternatively, graduates can pursue postgraduate training to specialize and earn a Master of Medicine (MMed) similar to our residency training. In regards to payment, very few utilize health insurance, and the large majority (98% of Ugandans); source was potentially questionable but it was the first site to spit out a number!) pay out of pocket. 


During my first week, I got a little taste of inpatient and outpatient medicine. My first day, I worked with Dr. Timothy who completed training in internal medicine. We saw patients in clinic that were all pretty similar to what I would see back in the US. We saw some diabetes, hypothyroidism, hypertension and heart failure management. I’d like to spend some time just sharing my thoughts on one visit which was for hypothyroidism. She supposedly had a large goiter that had some airway compromise and was surgically removed, subsequently developing symptoms of hypothyroidism and then put on thyroid replacement therapy. The patient begins by making payment for the visit. Now every visit was conducted in Lugandan and I could comprehend nothing, but I was able to review chart notes which were all written in English and Dr. Timothy would graciously discuss his findings with me intermittently during the visit. In Kiwoko, this is a limited-resource medical setting and so there are many barriers for patients to receive optimal medical care. It quickly became very apparent how spoiled it was to practice medicine back in Bremerton. 


As background, managing hypothyroidism is fairly straightforward, you place the patient on a dose of thyroid hormone based on their weight and make adjustments to the dose based on their thyroid-stimulating hormone (TSH) level. It is much more challenging to do manage this here. Ordering a thyroid function test had to be done in Kampala which is about 50 km (~30 mi) away. Now this may not sound terrible,but the roads leading into Kiwoko are pothole-laden, dirt roads. In my experience, a trip from Kampala to Kiwoko takes about 2-3 hours. People generally do not own cars and travel by taxi or “boda-boda” (motorcycle). And when I say “taxi”, Ijust want to make it clear that these aren’t the luxurious yellow sedans with a single passenger, this is a van that squeezes 10-15 passengers and makes stops on the way. There’s no Uber or Lyft that will come to you at the press of a button. So, whereas in the states, I would recheck thyroid labs fairly often, this not as routinely done here due to inconvenience. 


Now what if the thyroid test was slightly abnormal? Typically we type in another dose of medication (typically in increments of 12.5 – 25 mcg) into our electronic medical record and our pharmacy will take care of the rest. Here, they only carry 100 mcg tablets and so as you can imagine, it can be very challenging to make small adjustments. Her most recent TSH levels had been elevated, indicating inadequate thyroid replacement and this patient should have an increased dose. Our solution for this patient was having her cut a pill in half and taking 150 mcg daily. Another alternative plan was to take this new dose only 5 or 6 days of the week for a lower effective dosing increase. At the end of the visit, the doctor will write out a prescription and then the patient will walk it over to the nearby pharmacy to fill it. The doctor then scribbles some notes down into the paper chart which the patient will keep and is expected to bring this to every visit. (If only our patients could be that responsible!)


But generally, I was impressed with the medical practice here in the outpatient setting. It was more sophisticated than I thought it would be. There were still several things that I would have approached differently back in the States that I’ll write about later, but having a better understanding of how life worked in this specific area helped put me at ease.

First Impressions

May 6th, 2022 by Benton Huang
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What a long journey that was, but I finally made it from Bremerton, WA to Kiwoko, Uganda. I took my first steps in Africa around midnight and immediately enjoyed the warm, humid air after some frustratingly long cold stretches in the Pacific Northwest. I showed my proof of a negative COVID test, yellow fever vaccine card, e-visa and passport to the customs officer and was on my way to staying at a hotel in Entebbe overnight, then waiting for a private ride to Kiwoko that following morning. 


In a jet-lagged sleep, I got around 3 hours and was ready to experience my first morning in Uganda. After what seemed to be a nice sunny, blue-skied day, seemingly out of nowhere it began pouring and I was rudely greeted by the first thunderstorm in three years when I lived in the Midwest. When it struck, I admit I was startled and spilled a little bit of the coffee at their complimentary breakfast, but I think it played it off cool. My ride came, and my driver, Davie, greeted me and we stopped at an AirTel cell phone service store where I purchased a data bundle – an absolute must – and checked my social media and played my daily NYT Wordle game to stave off withdrawals. Motorcycles (boda-bodas) were everywhere, traffic was messy, odd-looking birds overlooking the city, and pedestrians doing their best impressions of Frogger – it was a great change of scenery from the calm monotony I had been accustomed to in the States. After a couple turns and several stretches of some asphalt-paved roads we left the city and transitioned to these orange-brown, dusty, bumpy roads. Local kids greeted me with waves and big smiles as I drove past with the window down – I only had 260 instagram followers and was a bit surprised to receive the reception I did – but I played along and returned the greetings. There were stalls everywhere with neatly stacked tomatoes, avocadoes, potatoes, mangoes, watermelons, bananas and pineapples. Davie expertly turned left and right dodging goats, chickens, kids, and potholes and we eventually arrived early afternoon at our final destination at Kiwoko Hospital. I unpacked my things and moved into “The Guest House” that was on campus. I met Anne, the only other occupant of the house who was a medical student from Jena, Germany and met the house’s two housekeepers, Rose and Winnie who both warmly greeted me. 


Laureen, the hospital’s business manager, gave me a tour of the campus and we walked through the male and female wards, maternity, pediatrics, NICU, outpatient departments, HIV clinic and behavioral health clinic. My quick impression of the facilities was simply that “this is different”. The inpatient wards were essentially two large rooms with metal-framed beds that were lined up nearly side to side, separated between communicable and non-communicable illnesses. A special wooden door was in the back with “T.B. ISOLATION, staff only, do not enter” painted in blue. The maternity ward was separated in three large rooms by communicable illnesses, antepartum, and postpartum complications. A separate area for labor and delivery was in the back with a single room with one bed for “high risk obstetrics”. The unit gave a very unusual calm presence and I think it was partly due to the lack of the annoying beeps from IV pumps and the loud thumping doppler sounds that would echo throughout the L&D unit back in Bremerton. The NICU was impressive and absolutely packed with patients. Some infants were reported as being born 500g, some receiving ART therapy for HIV. There were maybe 40 newborn warmers and it was immediately apparent that this department had the most technologically advanced equipment, which nearly all were donated by the German and Irish governments. I walked to the other outpatient departments but it was a quick glance and didn’t really notice much out of the ordinary except that their was a single inpatient psychiatric bed was in an isolated building that looked like an outhouse with a padlocked door. We passed by some other administrative buildings and that was the end of our tour.


I walked around town and bumped into Anne again who invited me to a game of volleyball with locals. I only observed today as the court was full, but the competitiveness, energy, and athleticism was great. Nearby were small kids recovering stray volleyballs and a group of teenage girls playing basketball. The game eventually stopped after sunset around 7:30 PM and I introduced myself to them. The players were all so welcoming, not to mention the hospital staff, the driver, all those kids that I drove by on my way to Kiwoko and it cemented my first impression of Uganda that Ugandans were as nice as advertised. I walked back to the Guest House, resting for a bit before calling it a night and feeling optimistic about the next four weeks that I would spend here.

Introducing Myself

April 22nd, 2022 by INMED
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Hello! My name is Cecile Dinh. I am a resident at Northwest Washington Family Medicine Residency, and I’m starting my INMED service-learning experience at  in Uganda beginning April 2022.