Last Week at Kiwoko Hospital

August 2nd, 2016 by INMED
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The Ugandan medical students rotating at Kiwoko found out I hadn’t taken any trips on the weekends so they orchestrated quite the experience for me on Saturday.  One of their friends from Kampala drove up to pick us up and take us to the National Museum and the theater in Kampala, then we went to Entebbe to visit the zoo (my safari) and hit the beach on Lake Victoria.  Against my better judgment, I swam in Lake Victoria, but I picked up some praziquantel at the pharmacy when I got back, so no schisto for me!  We got back around 11 pm.  It was an exhausting, awesome day.  I did, however, feel like the only white person in all of Uganda for most of it.  It has been really eye opening to experience being a minority for a whole month.


Then, Sunday.  I went to church in the morning and had coffee afterwards with the hospital’s medical director, Dr. Rory.  He’s a physician from Northern Ireland that has been the director for some ten years.  It was great to get an opportunity to pick his brain about working here and life abroad.  Later, I was meant to play soccer with some of the guys I play with after work.  One of them told me they were getting together to play somewhere a few kilometers away and that he would pick me up from the hospital.  He showed up around 3:30 and we headed into town so he could round up the rest of the guys and stuff them + his family clown car style into his car, which was kind of a minivan type thing.  We were riding low for sure.  The whole time I was made to feel like an honored guest.


Anyway we get to this pitch (pitch is excessively generous – ‘area with no trees’ would be more apt), pile out, and it’s a legit game.  I had been recruited to play with the Kiwoko team in a friendly match against some young men from a nearby village.  We had full kits, they found me some boots, and they gave me the captain’s armband.  I was pretty moved by it all, honestly.  I promptly twisted my ankle 10 minutes into the game (total mzungu move) and sat out the rest, but all the same it was certainly an unforgettable experience.  The match was a little crazy, and on two occasions the sidelines emptied as men from the village and Kiwoko rushed onto the pitch.  I wasn’t really sure what was going on either time, but the men looked very upset.  Kiwoko won the day, 3-1, we all piled back into the minivan-thing and dropped everyone off.  Then they drove me back to the hospital and I tried to process what had just happened.


Soapbox moment:  Some of these guys can ball.  Two guys especially, Wilson, 21, and Joel, 19, are really good.  There’s at least a handful of other guys that are really good, too.  I can hang with them because I had coaches for 16 years of my life, parents that drove me to practices/games/tournaments (thanks Mom and Dad!), opportunities to lift and run and train in other ways.  i was fortunate enough to play in college, to train a couple hours a day several months out of the year on great, well kept fields (with occasional cone-covered sprinkler heads), and to eat three squares a day in the dining hall.  These guys just play.  All the time.  And they play good soccer – it is fun to watch them.  One touch, two touch, combining with each other, touch like a pro, but in cleats so worn out they’re turf shoes now, and on fields so busted a Land Cruiser would have trouble going end to end.


A handful of them could have played really high level college ball in the States, maybe pro.  They were talking to me about life and football (soccer) in Kiwoko – they said they’re born there, they grow up and play football as long as they can, and they get old and die there.  Occasionally a team from Kampala will come play on their ‘pitch’ (aforementioned D-Day beach), and they play friendlies against villages near them, but who else sees these guys play?  And for that matter, if these footballers are buried out here, in the bush in Africa, imagine all the scientists, physicians, composers, and engineers buried out here.  I once heard a speaker challenge the claim that Rory McElroy (or some such person) was the best golfer in the world because so few people in the world have had the opportunity to play golf.  Maybe he’s the best out of the <1% of people who were handed a set of clubs and given green fees.  I am humbled by my privilege.


Beyond that, medicine has been interesting.  Clerked a patient on Friday with AIDS and pneumonia, and today I evaluated a stroke patient and an AIDS/tuberculosis patient with a spontaneous pneumothorax.  Sick dude.  The ‘normal’ pathology out here is stuff fit for case reports in medical journals.  I have just a few days left – hopefully tomorrow I’ll be able to join the community team and see some of the public health outreach activities.  I’ve also got one game left to play for the operating theater team in the “Kiwoko Chase” tournament.  Rolling right now with 3 goals and a couple assists in the last two games, but feeling properly beat up.  At home if I found a rock on the field I would carry it to the sideline – here I just try to make a mental note not to fall in certain areas.


Tonight one of the male nursing students I have become friends with made me some ‘posh-o’ (dunno how to spell it) for dinner.  I think it’s corn mashed into something I thought was mashed potatoes + beans.  It was really good, but I had just finished playing and they say ‘hunger is the best sauce’.


That’s all for now – probably won’t post again until I have been back a day or two and had an opportunity to think about what I have learned this month.  Thanks for reading!

Week Three

July 28th, 2016 by INMED
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I’ve spent 3 days on female ward and 1 day in the HIV clinic this week.  From a medicine perspective this has probably been my favorite week due to the variety of pathology.  Also, before coming here I had never actually encountered any HIV+ patients.  The HIV clinic is quite busy and seems to provide great benefit, as most of the patients we saw where just checking in for regular lab draws and med checks.  The majority of them have undetectable viral loads, which is great.  I was working with Dr. Timothy, who has been an excellent teacher, and also gets flustered randomly in kind of a hilarious way.  The female ward is basically a general medicine ward for ladies.


In addition to time in the clinic I have been working on a project for Dr. James, my supervisor.  He wanted to know the reasons for which patients are referred to larger centers, so I have been going through a notebook with entries for each of the referrals over the last year.  It seems the most common reason for referral is a head injury or stroke and subsequent need for a head CT to evaluate whether or not the patient has intracranial bleeding.  I have come across some pretty exotic diagnoses in my time in the referral book, however, including Kaposi sarcoma, TB meningitis, Brucellosis, and cerebral malaria, to name a few.


I’ve spent more time the last week with two Ugandan students just starting their third year of training, Damian and Zam Zam (for real, Zam Zam).  They asked me a bunch of questions about life in America, for which their only source of information is American television.  They think all medical professionals in the US are extremely attractive, then I showed up and confirmed all their suspicions (just kidding).  We talk about medicine quite a bit, too, differences in training, and life generally.  At night the girls in the guest house and I have been kicking it with the six year-old son of the medical director, Gideon, and his eleven year-old buddy, Agre.  They sneak around our house while we’re reading on the porch and try to jump out and scare us.  Usually I can hear or see them coming.  Usually.  Last night I tried to teach them how to make fart noises with their armpits.  They thought it was hilarious.


A couple nights ago I played in a hospital soccer tournament with the crew from the operating theater – they have uniforms and everything.  They take it quite seriously, and I’m basically out there in skates on my vans.  If only I had packed cleats!  I’m beginning to seriously crave some creature comforts.  I haven’t taken a warm shower in 3 weeks, and I miss pizza like a caged bird misses flight.  Freedom is pizza.  All in all, though, I have enjoyed the simplicity of life here.  It has eliminated a number of frivolities, and the lack of distractions forces me to read quite a bit (I knocked out Anna Karenina in two weeks, which, other than some of the Harry Potter books and the Bible, is probably the longest book I’ve ever read). I’m learning plenty, about medicine, life, and mission.  It will take me a while to process it all once I’m home, but I’m quite glad for the experience!  Thanks for following along!

Babies. Vaccines. Soccer. Rolex.

July 20th, 2016 by INMED
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Halfway through week 2!  Today I watched a C-Section, sat in on the GYN clinic, and then there was another C-Section after lunch.  I have been on the maternity ward this week with a Dutch OBGYN who has been working here for 4 years and a Ugandan medical student named Fred.  Today, we were joined by a Ugandan physician – she was the one that performed today’s sections.  All the Ugandan students are expected to be competent at C-Sections when they graduate, so I saw Fred do a good chunk of two sections earlier in the week.  The maternity ward is pretty steady – plenty of business.  The hospital has a midwifery program and the midwives handle most of the vaginal deliveries, while the physicians round on patients and handle the surgeries.  They also oversee deliveries from time to time.  For the most part OBGYN is the same over here as back home with some caveats, namely less prenatal care, HIV prophylaxis is something to consider more frequently, there is no cautery for surgeries so they can be quite bloody, and the women have more children.  Like way more children.


Over the weekend I went with Dr. James, a surgeon and my ‘supervisor’, to vaccinate a bunch of chickens.  I mean a BUNCH.  I originally thought they were owned by the hospital, or that it was a public health measure (they were flu vaccines, bird flu, I dunno), but turns out they are just Dr. James’s chickens.  He raises them and sells them for meat to supplement his his income and help a young man who also tends to the chickens.  It was kind of surreal and hilarious.  He would say, “Come here, chick-un, do not be afraid, it is just your vac-see-nay-shuuunn.”


I finally made it down to the soccer ‘pitch’ outside the hospital compound.  Men that work at the hospital and men from the community come play soccer in the evening, and I had heard about it but didn’t venture down that way till yesterday.  I showed up in the pants I wore around the hospital, a T-shirt, and my Vans feeling like Woody Harrelson from White Men Can’t Jump, minus that sweet mid-range jumper.  Honestly, I had no idea what was going on for a while.  The ‘pitch’, first of all, is a scene from the D-Day beach storming in Saving Private Ryan.  It is sloping in more than one direction with paths running through it, rocks, and dirt mounds ready to rob you of your feet at any time.  On top of that, we were just playing on one half and the goals were bricks that had been set up, one on either end of the half.  So the object, I assumed, was to hit the brick with the ball.  Literally no one was going for goal.  The other team would get the ball 10 feet from our brick and just play the ball back, switch it, dink around with it, and I was defending a brick no one was attacking.  I finally figured out they basically just play keep-away.  They play really good soccer (football).  There are a couple of guys that can ball, for sure, and it’s all one and two touch – very impressive.  I think they’re warming to me, too – yesterday I was mzungu (pronounced mih-zoon-goo, means white guy), and today a few of them were calling me Scott.  I have even been invited to play with some of the staff from the operating room this weekend in a hospital tournament.


I got some company in the guest house after a week of solitude.  Two Portuguese nurses who were serving at a hospital north of here came to see the NICU, and two nursing students here to rotate – one German and one Brit.  We all wandered outside the compound last night to sample the local fare – ‘Rolex’.  That’s what it sounds like to me, anyway.  I think it was ‘rolled eggs’ at one point, but it all just runs together now.  It’s like a mini omelette with tomato inside a tortilla type wrap.  Worth the shillings.


Otherwise, just grinding on the daily.  reading, asking people to repeat things several times, and trying to learn from the experience.  It has been quite humbling in a number of ways – not being familiar with the language spoken by the majority of the patients and struggling to understand the English spoken by the hospital staff has made everything harder.  It’s tough to rotate in a new place because the way they do everything takes a little acclimatization, but here that is compounded by the differences in the culture, the demographics, served, and the limitations of the facilities and equipment available.  It has made me think a lot about what serving in a place like this would be like as a physician (read ‘grown up’).  Hungry for greater perspective and more Rolex.

First Few Days In The Clinic

July 13th, 2016 by INMED
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A rundown of the daily routine:


8:15 – 9:00 AM Worship and Prayer with a short message.


9:00 – 10:00 AM Doctor’s meeting. Doc on call from the night before does sign out and then we move into education.


10:00 – 1:00 PM Rounding. I was in the Pediatric ward the first day and the NICU the last two days. The NICU, I’m told, is one of 6 in Uganda, and it is packed. One physician rounds on something close to 30 babies, though not all of them are in dire straits – some just need a dose of antibiotics and the all clear. I have been with Dr. Becca, a Welsh physician, and Brian, a Ugandan medical student.


1:00 – 2:00 PM Lunch. Some women who work for the hospital/community prepare a feast for me/whoever is in the guest house during the week. They are excellent cooks! Typically I eat what’s left over for dinner. Pretty sweet deal.


2:00 – 5:00 PM Reading, waiting for admissions. I have seen just one patient in this time frame the last 3 days – a one-year-old with malaria on the Peds ward.


5:00 – bed Reading. I usually alternate between study materials and leisure reading.


The worship and prayer has been my favorite time the last few days – the worship is so rich and lively. Yesterday there was a great deal of excitement as the Archbishop of the Church of Uganda visited the hospital, so that time was more or less dedicated to him. All religious leaders wear funny hats.


Other notable stuff:
• I won the rematch with the help of one of the boys’ fathers, but thanks to some creative scorekeeping we ‘tied’. No punishments were performed.
• On the admission slips in the Peds ward there is a space for ‘Occupation’ – it often says ‘child’.
• The NICU does not have ventilators, but it does have some clever ‘CPAP’ machines made of air compressors, tubing, and Nalgenes. I spent 10 minutes staring at one and trying to figure out what it was before Dr. Becca let me in on the secret.
• The family that was staying in the guest house with me has left leaving me all to myself. I’m due to receive some more company in the form of additional medical students in a few days, though.
• No one really goes for a firm handshake. They just kind of hold their hand out there. I’m not accustomed to crushing hands, but I generally lead off with a baseline squeeze that I can adjust based on what I’m given. Here it’s mostly it’s cooked spaghetti noodle. There are a hundred little things like that I am picking up on, and it is making me hyper aware – I’m sure there are a hundred more things I do without thinking that give my hosts a bit of pause.
• Despite everyone being very welcoming and hospitable, it’s still quite easy to feel isolated, culturally or otherwise. I am gaining a new level of empathy for people who uproot and transplant themselves in cultures not their own – and for foreign medical grads!

Day One

July 10th, 2016 by INMED
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I arrived in Entebbe last night around 11 I think. We’re 7 hours ahead of Eastern Standard Time in the States, so I have been a little off-balance the last few days. Mostly there has been two times – day time and night time. Hitched a ride to Kiwoko this morning – rode on the back of a motorbike with some chickens and part of a sofa most of the way, then walked a while before a pickup took me the rest of the way. I was in the back with a goat and part of what I assumed to be an unrelated sofa. Just kidding – I had a ride, arranged for by the hospital, from my hotel in Entebbe to Kiwoko, but I know my Mom is going to read this and it is fun to imagine her reaction. I bumped into two medical students from the UK and a family in the guest house upon arrival – the students departed shortly after lunch, but the family is hanging around till Monday morning. Played soccer with one of their boys and the boy of another doc working here. Final score was 13 – 9 bad guys, rematch scheduled for tomorrow. They said if I lose tomorrow I have to ‘poo and wee’ in the front yard for all to see, at which point I went all Drogo from Rocky IV – “I must break you.” Planning on running up the score to send a message.


Tania, the staff person I had been in contact with via email, gave me a tour of the grounds and facilities. Some things that are quite different from back home: no private rooms, lots of open air, and patients are cared for (with regards to bathing, feeding, etc) by family members. Alliteration aside, I’m sure I will encounter myriad more differences Monday morning. Came back after the tour and bummed around a while, unpacked my things, ate some cereal for dinner, then had some tea and ginger snaps while I studied. Will probably get some more studying (and ginger snaps) in tonight. Looking forward to a pretty low key weekend with plenty of reading, coffee, and soccer. Go France! Speaking of…


Quote of the day: “Alfred De Musset was a Frenchman, a poet, and he lived in the 19th century. Hence, he had all the major risk factors for acquiring syphilis, which he compliantly did.”

Introducing Myself

July 2nd, 2016 by INMED
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biggerstaff-scottHello! My name is Scott Biggerstaff. I am a medical students at AT Still University / Kirksville College of Osteopathic Medicine, and I’m starting my INMED service-learning experience at Kiwoko Hospital in Uganda beginning in July 2016.