August 7th, 2016 by INMED
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Sorry it has been so long since my last post. We have been traveling around Uganda for the past 9 days and Internet was very sparse. Two weeks ago was my last week at The Surgery. I worked through Thursday and then we started our touristy adventure. The last week at the Surgery was very different from the three before. It was fun and I really solidified my tropical medicine knowledge. Monday I worked with Dr. Stockley at The Surgery and then on Tuessay and Wednesday I rounded with the medicine team at the Kiruddu hospital. This is a branch from the national hospital and it is totally different from everything at the Surgery. The wards were all open air, and the rooms had about 20 patient beds in each room. (No one from home should ever complain about a double room again). And the family and friends of the patient do all of the caregiving such as bathing, feeding, etc. They keep all of their stuff under the patients bed and then sit on the tile floor on bamboo mats. It is a very sad place, but the people who are there are so helpful and friendly and just trying to give the patients the best care that they can.

Then on Thursday I also gave the CME talk over lunch. I presented on hypertension and how the guidelines have differentiated between different races and ages. I also wrote down the prices of all of the HTN drugs from the pharmacy so the doctors would have a quick handout with the guidelines and then also the prices of all the appropriate drugs. I think it went well and it was a good way to end the rotation.

Then Friday we started our adventure. We drove up to Murchison National Park and did game drives, a boat tour to Murchison falls, and we hiked up the path to the top of the falls. We saw so many giraffes, elephants, hippos, antelope, etc. it was amazing, and the falls were beautiful. We stayed in Murchison for 3 days and then on Sunday we drove to Fort Portal to stay the night. Then Monday we continued our drive to Queen Elizabeth National Park where we did a boat safari on the Kazinga channel, and two game drives. One in Queen Elizabeth and one in Ishasha sector of Queen Elizabeth. On our first game drive we saw lions just lazing in the sun and then In Ishasha we drove around for hours looking for the “tree climbing lions”. In Ishasha the lions climb the fig trees during the afternoons to sleep and escape the heat, and it also is a good vantage point to scope out dinner. Unfortunately we didn’t see any lions in the trees but that definitely wasn’t due to lack of trying.

After those game drives we drove to Bwindi National Park and stayed there for 4 nights. The first day we just relaxed all morning and thanked God we weren’t in a bouncing safari van any longer. Then in the afternoon we did a small hike to “Top of Heaven Hill” which was close to our lodge and really gave a good view of the surrounding community and of the hilly and beautiful geography. Thursday we went Gorilla trekking. It was 100% worth the money. We hiked out about 1.5 hours and then got to spend an hour with the mountain gorillas. There was a silverback named Rafiki and about 10 other smaller gorillas. At one point the gorilla even started grunting and raised up on his hind legs, beat his chest like they do in Tarzan and made one scary sound as he ran down the hill a little bit. Apparently they do that when someone in the family is doing something that he doesn’t like.

Friday we did a day trip to Rwanda. I knew the East African Visa would come in handy. We drove there in the morning and visited the Kigali Genocide Museum, the Belgium soldier memorial, and also the “Hotel Rwanda” which has now been renamed. It was a very sobering but educational day and I am really glad that we went. Then Saturday we just drove the 13 hours back to Kampala. Thank God most of the way was on Tarmac. But Today (Sunday) we are just running last minute errands and packing, because we go home TOMORROW. It’s definitely bitter sweet but I am ready to see the boyfriend again, and to be able to drive my own car around again. Plus sleep in a bed that isn’t made of foam.

Overall it has been a wonderful 5 weeks and I have enjoyed spending my time here. I will definitely miss Uganda, it is a very friendly and exciting place to live.

July 25th, 2016 by INMED
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Wow! Only one week left of the rotation! I don’t know how time has gone so fast. Week three was a bit different that the past two weeks. Monday I worked with Dr. Stockley and it was a normal day, full of tropical diseases and general practice. Then Tuesday and Wednesday Ashley and I actually took off and went to Jinja to spend two days outside of Kampala. Don’t worry I made up the work days this weekend.

But Jinja was a ton of fun. Tuesday morning we were picked up in Kampala by the Nile River Explorers bus and taken about 2 hours to Jinja. We spent Tuesday white water rafting on the Nile River which was absolutely amazing. Tuesday started off with a general introduction and safety briefing and then we got fitted with life jackets and helmets. Then we were given a Rolex and a bowl of fruit and put on a bus for another 45 minutes and taken to the starting point for rafting. We had an amazing guide, and he let us practice everything we needed to in the calm waters before the first rapid. Then the white water rafting began! As we approached the first of 8 Rapids, we watched another raft go down the first one. They went over this huge wave and then just disappeared and we all panicked because we had no idea how big the drop off was. Then it was our turn. We followed the guides instructions to paddle hard, get down and lean right, paddle some more, and then get down and hold on. We made it through the rapids without losing anyone and once we were passed it, we turned and looked back. Turns out we had pretty much just rafted down a 12 foot rock wall and survived!

The rest of the day was a mix of adrenaline pumping Rapids with lots of calm water in between. There were even areas in which we could jump out and swim around. I just couldn’t believe I was swimming in the NIle. And yes, I do plan to get tested for Schistosomiasis in a couple weeks and to take the treatment as recommended, because the Nile definitely has Bilharziasis! We did a total of 8 Rapids and only flipped the raft over 3 times, which I thought was fairly decent since all of the Rapids were between a grade 3 and grade 5.

After a full day of rafting we had a buffet barbecue with drinks and then got on the bus to go back to the lodge. Ashley and I opted to spend the night on the NIle River Explorers river view camp which was this amazing camp site compound right on a bluff over looking the Nile. We stayed in a river view safari tent, and I actually was able to go to a yoga class on a platform over looking the river for sunset. Everything was just beautiful and amazing.

Wednesday we just spent the day in town in Jinja getting some good food and visiting some of the craft and souvenir shops before we caught the bus home. In true African style the 80 km bus ride ended up taking 4.5 hours. Needless to say we were exhausted after a great two days and did NOT want to go back to work Thursday. But we did manage to finish up the week at the Surgery.

Thursday we used Ketamine and set a woman’s leg that she had fractured. I had never experienced ketamine use like that so it was nerve wracking but really cool. Then Friday was just another day with Stockley learning about tropical diseases. Friday we got off a bit early and went to the craft market in Makindye and I loaded up on gifts for everyone back home.

Then I worked this weekend and also prepared the presentation that I am going to give for the CME this coming Thursday. It was nice to work on the weekend because the patient load was less and I got to talk about the cases more with the doctors that I was working with. It is going to make for a long week though because I will be working 8 full days in a row. The worst part of being on the equator is that the sun goes down at 7 every day no matter what. So working till 6 or 7 and then the ride home, means that I am always home after dark so the day consists of pretty much only work and nothing else. It’s hard to get any work done or a workout in. But if that is one of my only complaints, I’m doing pretty dang awesome! So far I have loved it here, and I am so glad I am staying in Claire’ house. There is a great social aspect of the house and we all look out for one another and it really has been on of the best parts of my trip so far.

One of the other things that I have really enjoyed is learned about all the different countries processes in which they train doctors. The US system is about 3 years longer than any other country I have talked about and that is really frustrating to me. It is also by far the most expensive education. In the UK, it is only 5 years after graduation, and only 9,000 pounds a year for those 5 years. That is almost the same price as 1 year of medical school for me. It has been really enlightening to learn about all the different countries processes.

July 16th, 2016 by Carlye Marszalek
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WOW! My time here is going so fast! I can’t believe I have already finished 2 of the 4 weeks of the rotation already. This week went even faster than week 1. We already have our routine down so the days go by so quickly.

Monday – Wednesday I worked with Dr. Stockley and saw a wide range of cases. We had many lacerations which were fun and different to watch compared to the normal office visit. Unfortunately I wasn’t able to repair them because they were both elderly patients with very thin skin and compromised blood flow so I didn’t want to lower the risk of them healing completely. Thursday I worked with Lisanne who let me see many of her patients with me as the lead doctor. She was still in the room but I was able to type the note and lead the encounter which was much more fun than shadowing.

Friday we actually took the day off. We decided to book a tour of Kampala through Walter’s Boda Boda tours. So two drivers picked us up and led us on a 7 hour tour of Kampala. We saw all the main sites, and got many stories of the area and of the city. It was really nice to learn about the areas in which we had been spending all of our time. Some of the things we toured included the Hindu temple, the Ba’Hai Temple, the Gaddafi Mosque, the old taxi park and business center of Kampala, and the Kings Palace and old torture chambers. Along the way we also saw many sites from a far and just got to see a lot of the neighborhoods within the city. It was a great experience and I highly recommend them to anyone visiting Kampala.

To make up for the lost day on Friday, I did work a half day on Saturday. I had intended to work all day, but one of the doctors sent me home early to enjoy my weekend cause students don’t need to come on weekends. I didn’t argue with him!

Here are some of the differences I have noticed from the Surgery compared to work at home:

1. The role of the nurses. In the ER and acute care they are very similar compared to home, but in the out patient clinic, they really only work in phlebotomy. The doctor has to call back the patient, do the vitals, take them to lab, get the results and then get them the meds from the pharmacy on site. To me this is very different from home because at home the nurses in the office generally room the patient, do a nurses consult note and log the vitals, saving the doctor a lot of time, and allowing them to focus on the problem at hand.

2. The patients wait for the lab results. At home everyone gets the labs done and goes home, and the doctor or the nurse will call them with the results and the updated care plan based on the results. Here at the Surgery, the patients wait the hour or 2 for the lab results, and then the doctor calls them back in to the room to give results and the new plan. This seems to un-streamline the process because each patient ends up having to wait to see the doctor twice, making the average time spent at the clinic probably 3-4 hours.

3. LOTS of bilharzia (schistosomiasis) We seem to test everyone for the disease and with Stockley we treat probably at least 5 people a day. When you travel to foreign places everyone worries about malaria…but in reality, here malaria is rare if you stay in Kampala, but is more common if you leave the city. But Bilharzia is EVERYWHERE.

July 10th, 2016 by INMED
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So I am finally posting in the blog about my trip to Uganda. I am working at The Surgery in Kampala and I have just finished my first week of the 4 week rotation! I am loving the experience so far. We arrived last Friday, July 1st in Kampala and spent the weekend getting settled in and meeting everyone who lives in the house with us. We are staying at Claire Infield’s house in Makindye. It is a bit out of the way but I love it here. There are 7 other people living in the house besides Ashley and I so it was a great way to instantly meet other like minded people and to have a group of friends. The first night we arrived the entire group was cooking a mass amount of chili for a house dinner so we were immediately included. It is really nice living with the group of people. We still have our private rooms but then can socialize as well. It completely remind me of living in the dorms at college. Private room but all communal common spaces so it’s been a really fun week.

We spent the weekend getting settled, figuring out transportation and running errands to prepare for the week. Monday morning we started working at the Surgery. Where we were suggested to live is actually 10km from work so we had to leave plenty early to try to get there on time, because the traffic is very crazy, especially on weekdays. I was told when we booked the rooms that Dr. Stockley, one of the main doctors I would be working with lives near Makindye so I may be able to get a ride from him to work most days. But on contacting him he actually bikes or runs to work most days so we decided to take Boda bodas from the Boda stand near our house. I briefly contemplated running to work with Dr. Stockley, but then immediately discarded the idea once I got here and saw all of the hills and dust, and how confusing all of the roads are. There is a Boda stand near our house, and Geoffrey is a great Boda driver who coordinates most of the rides for all the people in the house. He sort of runs the stand near us, and all of the other drivers look to him. Even though we were just taking bodas to work, 10 km is pretty far, and it takes 25-30 minutes and costs 11,000 shillings so the transportation cost will add up quickly to about 6$ a day on work days. Good thing my loan money came in on Monday!

At the Surgery we were introduced to all of the doctors and the staff and given a tour. There are 7 consultation rooms for regular office visits, along with a 24/7 Emergency room with 3 cubicles. There is also 3 inpatient rooms for people needing to stay overnight, along with a fully functioning laboratory for blood, stool, and urine tests, and X-Ray and Ultrasound. The quality of the facility really impressed me because it had most of what any clinic at home would have. There was also a Pharmacy inside to get all of the medications that were prescribed at the office visits. There are a good number of physicians that work there both foreign doctors, and local doctors. It seems to be about half of each. Usually there are 3 or 4 working at a time so that a lot of patients can be seen everyday.

One other thing that surprised me was that the clinic seems to be mostly ex pats who are visiting or living in Uganda, as well as Ugandans who have either private health insurance, or employer health accounts. This is because they charge for every aspect of care. The consultation, the laboratory tests, and the medication. This was a different patient population and situation than I was expecting, but definitely accounts for how the clinic has so many resources and such a high quality of patient care. For the first week I mostly spent my time shadowing and working with the physicians. I saw most of the patients with the Doctor, but took part in the physical exam and history taking. I am hoping to gain some more independence as time goes on, but for the first week I was completely content helping and observing. It takes some time to get used to new clinics and also to see how the visit differs from home because this clinic is almost a mix of family practice, and urgent care. There are many established patients, but we also see lots of visitors who have gotten sick while in Uganda.

Overall, it has been a great first week in Kampala and I look forward to continuing to practice my family medicine and tropical medicine knowledge, while still exploring a brand new foreign city, and making new friends the entire time!

June 21st, 2016 by INMED
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Hello! My name is Carney Marszalk. I am a student at AT Still University/Kirksville College of Osteopathic Medicine, and I’m starting my INMED service-learning experience at The Surgery in Uganda beginning in June, 2016.