Friday, August 6, 2010
Day 24 - July 29
I’m trying to keep the next couple of writing short because frankly I haven’t had much time to keep us since Pamela and Nick have gotten here. We’ve had much more work to do and lots of traveling. It’s more complicated when there are more people. Plus, I’d rather spend free time hanging out with people that I haven’t seen than I would writing about everything we do.
We woke up early to go to Mulago. We had arranged with Jozeph to pick us up at 7:45 so that we could be sure to be on time, even with Jam. It was normal morning traffic, but it does take a lot of time to get there when the traffic is heavy. However, I don’t think it took long enough. We were early to Susan’s office by 20 minutes. I don’t like to be late and I actually prefer to be at least 10 minutes early for any work appointment. That’s just not how it works here. People kept wondering why we were waiting and asking if they could help us. We were perfectly content just sitting outside and waiting, but apparently that makes people uncomfortable. When Susan finally arrived, she said we made her nervous because we were early. When she asked if we were on Mzungu time, Pamela replied that it was Margaret time. I’d rather be known for being early than late! Susan brought us down to the Infectious Disease Unit to follow the doctors there. She made us promise that tomorrow we will be on Africa time. I told her I couldn’t make any promises! I have to plan for Jam and if it’s not there than I’ll just have to be early!
The Infectious Disease wards were totally full with patients. Most of the infectious disease problems are because of HIV/AIDS. The doctor that we were told to follow was trying to do some punch biopsies to confirm Kaposi sarcoma in some of the patients. If that is the case, the patient is in the fourth and highest stage of the disease progression. I was a bit apprehensive about being in on the biopsies. The last time I was observing one, my mind told me I was fine, but my body was trying to stop my from watching by putting me in panic mode, forcing me to sit down and try to keep myself from passing out. Since it was early, I was hot, and hadn’t eaten much, I knew it might be a problem. I started leaning just in case. I’m glad I did because I was feeling a bit clammy even though all that had been done was insertion of the needed to administer the numbing medication. Clearly I need to get over this issue if I’m going to be a doctor! Once the first procedure was done, Pamela and I walked to get more water and I had some of a Cliff bar. I felt much better afterwards. It’s amazing what can happen if your body isn’t getting all the nutrients it needs!
I was expecting to have the next procedure right away, but since the nurses were nowhere to be found, we decided to go through the ward and round on the patients. The doctor we were with tried to explain as much as she could to us. I don’t think she was having an easy time with her patients because she didn’t appear to speak Luganda. She had to keep requesting people to come over and talk to the patients. I can’t imagine how difficult it would be to be trying to take care of that many patients but not be able to speak directly with most of them. She has a hard enough time getting patients to tell the truth and when you add the language barrier, it becomes nearly impossible to get all the necessary information.
After we saw most of the patients, the doctor decided to try the biopsies. The nurse had disappeared and I don’t think she was planning on coming back anytime soon. The doctor asked if we could assister her instead. I’m glad we were at least useful today! She took us on without any warning which I’m sure is a bit uncomfortable and burdensome to have 3 extra people to explain everything to!
The first patient we did, Pamela helped out with. It seemed to go smoothly for everybody and I was ecstatic that I never got light-headed or even close to feeling like I would pass out! Yay! There is still hope for me yet! The third and final biopsy was something I think I’ll never see again in my life. Immune compromised people can end up with some pretty intense infections because their body just doesn’t fight off fungus, virus, or bacteria very well. This man had feet covered in a fungus and they had swelled to at least 3 times the normal size. I can picture them in my head, but I don’t even know how to describe them. I didn’t think it was appropriate to take a picture of his feet, so we never asked. Part of me wishes we could have just to remember what it was. This was the biopsy that I had the pleasure of taking part in. I made it through with not much problem and was able to help out a lot more since his condition was much worse than the first two. I think if I could do that without a problem, I must be getting better. Only time will tell. I’m sure there will be many more things that throw me over the edge, but I’m just going to have to keep trying to push through them!
When we finished, we were supposed to meet up with the sister of a friend from back home named Joyce. She is just starting her third year of medical school here. It was very sweet of her to want to meet us and take us around if we wanted. She was still in class when we finished so we sat in Susan’s office. I’m sure we made her nervous! After a while, I recognized the guy who had come late to the meeting on Tuesday walk in. We talked for a bit. He is a resident from Cornell who is going to start a fellowship in Infectious Disease. It was great of him to take time and talk with us. We ended up waiting for Joyce outside and he was waiting for a cab. He offered to give us a ride on his way since Garden City is easy to get to. It was so great of him. I love when you meet down to earth doctors who are willing to help out those of us at the bottom of the totem pole, aka 10th class citizens as we were once told. Maybe I’ve moved up to 9th class since I finished one year, but still, I think there are way more people in front of us than there are behind. Just before we were ready, Joyce walked up and asked if I was Margaret Perko. I thought maybe it was one of Angella’s friends, but then she introduced herself as Joyce. We thanked Ben for the offer, but ended up getting our own cab to Garden City with Joyce.
Lunch was fun. I think it’s always better to spend time with real people and just not experience the country from the outside. We got to get the perspective of a student in a similar position as us and learn about how she got to be where she is. Even though she’s all the way across the ocean, we seem to have a lot of the same frustrations and struggles.
After lunch, we went back home to meet my mom. She had been with Jozeph all morning visiting a school that her cousin back home has been supporting for many years. When I got home, she was very excited to tell me about the school that takes hundreds of kids and teaches them not only the necessary educational subjects, but also teaches life skills and jobs for those that can’t or don’t want to go to university. Afterwards, Jozeph invited her over to his house to have lunch with his wife and kids! He’s such a great cab driver and just an all around good guy!
It had been an exhausting morning, so we all took naps to get ready for Katanga. We knew we had to get in and out quick at her house because it we had to start later in the afternoon when all of the kids were around and we didn’t want to be there past dark. Luckily, Angella brought Gloria with her to help with translation and explanations. It was mass chaos and the mess was hard to bear. It doesn’t seem to bad when you see all the garbage, but then we you think that this is where they cook, eat, sleep, and where some of the children use the bathroom every day all day long, it’s really overwhelming. I have a hard time sitting there for an hour or two. I don’t know what I would do if I had to stay there for days at a time.
We’re still a little unsure of exactly what JaJa’s relationship to the children is. It doesn’t seem that we know everything about all of the kids. Some of the ones form last year are now gone because a family member decided to take them in. Some of them may be her real grandchildren and there are still quite a few that have no background information and were just dropped off at her house.
Luckily, while we were there, a man named Peter showed up. He explained that he is in a cell group at Watoto church and they have been trying to help JaJa since 2008. They were responsible for the news article that brought the orphanage to Susan’s attention which led to us visiting. They are currently supplying food and helping try to keep things clean. They are also working on projects to help find her land to live on in a bigger space. It was great to know that somebody was working on helping her out. Both Angella and Gloria were worried about the situation and want to do more than just bring the medicine, but they weren’t sure how to help. What are the chances that Peter happened to come at the same time as us? I think God for sure had a plan for us to meet Peter so that we could learn about JaJa and make a contact with somebody who is also trying to help them out. We’re going to try and help out as much as we can and keep in contact with Peter and his friends as they work on improving the situation.
For dinner, we went to Fang Fang hotel and restaurant. It’s pretty much the most expensive place we ever eat, but the good Chinese food is totally worth it. It’s a great outdoor setting with giant red lanterns hanging in the courtyard and wood carvings on all of the walls. I think we deserved a good meal after the long couple of days we just had! Tomorrow may be even busier, with another day at the hospital, shopping, another orphanage, and bowling to end the night!
We woke up early to go to Mulago. We had arranged with Jozeph to pick us up at 7:45 so that we could be sure to be on time, even with Jam. It was normal morning traffic, but it does take a lot of time to get there when the traffic is heavy. However, I don’t think it took long enough. We were early to Susan’s office by 20 minutes. I don’t like to be late and I actually prefer to be at least 10 minutes early for any work appointment. That’s just not how it works here. People kept wondering why we were waiting and asking if they could help us. We were perfectly content just sitting outside and waiting, but apparently that makes people uncomfortable. When Susan finally arrived, she said we made her nervous because we were early. When she asked if we were on Mzungu time, Pamela replied that it was Margaret time. I’d rather be known for being early than late! Susan brought us down to the Infectious Disease Unit to follow the doctors there. She made us promise that tomorrow we will be on Africa time. I told her I couldn’t make any promises! I have to plan for Jam and if it’s not there than I’ll just have to be early!
The Infectious Disease wards were totally full with patients. Most of the infectious disease problems are because of HIV/AIDS. The doctor that we were told to follow was trying to do some punch biopsies to confirm Kaposi sarcoma in some of the patients. If that is the case, the patient is in the fourth and highest stage of the disease progression. I was a bit apprehensive about being in on the biopsies. The last time I was observing one, my mind told me I was fine, but my body was trying to stop my from watching by putting me in panic mode, forcing me to sit down and try to keep myself from passing out. Since it was early, I was hot, and hadn’t eaten much, I knew it might be a problem. I started leaning just in case. I’m glad I did because I was feeling a bit clammy even though all that had been done was insertion of the needed to administer the numbing medication. Clearly I need to get over this issue if I’m going to be a doctor! Once the first procedure was done, Pamela and I walked to get more water and I had some of a Cliff bar. I felt much better afterwards. It’s amazing what can happen if your body isn’t getting all the nutrients it needs!
I was expecting to have the next procedure right away, but since the nurses were nowhere to be found, we decided to go through the ward and round on the patients. The doctor we were with tried to explain as much as she could to us. I don’t think she was having an easy time with her patients because she didn’t appear to speak Luganda. She had to keep requesting people to come over and talk to the patients. I can’t imagine how difficult it would be to be trying to take care of that many patients but not be able to speak directly with most of them. She has a hard enough time getting patients to tell the truth and when you add the language barrier, it becomes nearly impossible to get all the necessary information.
After we saw most of the patients, the doctor decided to try the biopsies. The nurse had disappeared and I don’t think she was planning on coming back anytime soon. The doctor asked if we could assister her instead. I’m glad we were at least useful today! She took us on without any warning which I’m sure is a bit uncomfortable and burdensome to have 3 extra people to explain everything to!
The first patient we did, Pamela helped out with. It seemed to go smoothly for everybody and I was ecstatic that I never got light-headed or even close to feeling like I would pass out! Yay! There is still hope for me yet! The third and final biopsy was something I think I’ll never see again in my life. Immune compromised people can end up with some pretty intense infections because their body just doesn’t fight off fungus, virus, or bacteria very well. This man had feet covered in a fungus and they had swelled to at least 3 times the normal size. I can picture them in my head, but I don’t even know how to describe them. I didn’t think it was appropriate to take a picture of his feet, so we never asked. Part of me wishes we could have just to remember what it was. This was the biopsy that I had the pleasure of taking part in. I made it through with not much problem and was able to help out a lot more since his condition was much worse than the first two. I think if I could do that without a problem, I must be getting better. Only time will tell. I’m sure there will be many more things that throw me over the edge, but I’m just going to have to keep trying to push through them!
When we finished, we were supposed to meet up with the sister of a friend from back home named Joyce. She is just starting her third year of medical school here. It was very sweet of her to want to meet us and take us around if we wanted. She was still in class when we finished so we sat in Susan’s office. I’m sure we made her nervous! After a while, I recognized the guy who had come late to the meeting on Tuesday walk in. We talked for a bit. He is a resident from Cornell who is going to start a fellowship in Infectious Disease. It was great of him to take time and talk with us. We ended up waiting for Joyce outside and he was waiting for a cab. He offered to give us a ride on his way since Garden City is easy to get to. It was so great of him. I love when you meet down to earth doctors who are willing to help out those of us at the bottom of the totem pole, aka 10th class citizens as we were once told. Maybe I’ve moved up to 9th class since I finished one year, but still, I think there are way more people in front of us than there are behind. Just before we were ready, Joyce walked up and asked if I was Margaret Perko. I thought maybe it was one of Angella’s friends, but then she introduced herself as Joyce. We thanked Ben for the offer, but ended up getting our own cab to Garden City with Joyce.
Lunch was fun. I think it’s always better to spend time with real people and just not experience the country from the outside. We got to get the perspective of a student in a similar position as us and learn about how she got to be where she is. Even though she’s all the way across the ocean, we seem to have a lot of the same frustrations and struggles.
After lunch, we went back home to meet my mom. She had been with Jozeph all morning visiting a school that her cousin back home has been supporting for many years. When I got home, she was very excited to tell me about the school that takes hundreds of kids and teaches them not only the necessary educational subjects, but also teaches life skills and jobs for those that can’t or don’t want to go to university. Afterwards, Jozeph invited her over to his house to have lunch with his wife and kids! He’s such a great cab driver and just an all around good guy!
It had been an exhausting morning, so we all took naps to get ready for Katanga. We knew we had to get in and out quick at her house because it we had to start later in the afternoon when all of the kids were around and we didn’t want to be there past dark. Luckily, Angella brought Gloria with her to help with translation and explanations. It was mass chaos and the mess was hard to bear. It doesn’t seem to bad when you see all the garbage, but then we you think that this is where they cook, eat, sleep, and where some of the children use the bathroom every day all day long, it’s really overwhelming. I have a hard time sitting there for an hour or two. I don’t know what I would do if I had to stay there for days at a time.
We’re still a little unsure of exactly what JaJa’s relationship to the children is. It doesn’t seem that we know everything about all of the kids. Some of the ones form last year are now gone because a family member decided to take them in. Some of them may be her real grandchildren and there are still quite a few that have no background information and were just dropped off at her house.
Luckily, while we were there, a man named Peter showed up. He explained that he is in a cell group at Watoto church and they have been trying to help JaJa since 2008. They were responsible for the news article that brought the orphanage to Susan’s attention which led to us visiting. They are currently supplying food and helping try to keep things clean. They are also working on projects to help find her land to live on in a bigger space. It was great to know that somebody was working on helping her out. Both Angella and Gloria were worried about the situation and want to do more than just bring the medicine, but they weren’t sure how to help. What are the chances that Peter happened to come at the same time as us? I think God for sure had a plan for us to meet Peter so that we could learn about JaJa and make a contact with somebody who is also trying to help them out. We’re going to try and help out as much as we can and keep in contact with Peter and his friends as they work on improving the situation.
For dinner, we went to Fang Fang hotel and restaurant. It’s pretty much the most expensive place we ever eat, but the good Chinese food is totally worth it. It’s a great outdoor setting with giant red lanterns hanging in the courtyard and wood carvings on all of the walls. I think we deserved a good meal after the long couple of days we just had! Tomorrow may be even busier, with another day at the hospital, shopping, another orphanage, and bowling to end the night!
Day 23 - July 28
After a long day, sometimes all you want to do is relax! Too bad we don’t really get that luxury because we have an early morning tomorrow. I think every day from here on out is going to be this busy, but we will hopefully get a great experience.
I woke up around 7:30 as usual and used the quite time to get my thoughts in order and plan for the rest of the day. Lately I’ve been having strange dreams that make me wake up thinking about odd things. I think last night there was some sort of serial killer out to get us and we were hiding out trying to stay alive. The medication we take for anti-malarials called Malarone is what a lot of people blame their strange dreams on while they are in foreign places. I’m still not sure if it’s the medicine or perhaps just the strange environment. In addition, those silly movies may have just found too much room to camp out in my brain! I’m not going to get sucked into another one and hopefully the dreams will be a little less bizarre!
Angella called and said she would be going to the clinic and we could meet her for Evelyn’s appointment around eleven. We weren’t at all ready by then. I think I was the only one that was up before 9:30 and everyone else still wanted to shower before we left the house. We decided to just meet at Mulago around noon.
Once we finally got ready, we called Jozeph to pick us up. Unfortunately, he was busy taking somebody to the airport so we had to call the other Jozeph, who charges more. I understand that his car is bigger, but seriously, he charges way too much! I think the only fair rate that he gave us was for the airport. This time we tried to get him to go for 15,000, but he said that wasn’t enough and that 20,000 was the fare. We finally settled on 17,000. It’s the first time I feel like he actually gave us a somewhat decent negotiation on price.
We stopped by Susan’s office to drop of the crayons, coloring book, and beanie baby we brought for her niece, Clarissa. She really appreciated loved them and I’m sure Clarissa will too! When she found out that Pamela and Nick were here and that we weren’t going to see the hospital, she insisted on setting up a couple of days for them to work in Mulago. I thought Troy had said he talked to this Susan about it and was told we couldn’t, but Susan said she never talked to Troy. Who knows if it was a different Susan or if she didn’t remember him. We’ve met so many Susans that I wouldn’t be surprised if there was another one working in a similar place in the hospital that Troy talked to and thought it was the same person.
We didn’t know exactly where to find Evelyn but luckily Angella knows every area of the hospital so she acted as our person guide. We got to the outpatient surgical ward to find that it had moved to a whole other building for the day. Go figure. I don’t know how people know where to show up for work in the morning and I’m even more baffled at how patients are able to arrive, find their charts, and then head to the proper building to see their doctor. We found the ward but when we got there, behind the desk there were three nurses and a man in white that did not want us to be there. We tried to explain to him the situation from both Angella’s and my own perspective, but they weren’t having it. It’s frustrating because when Troy is back in the states, Deo contacts him about Evelyn’s condition but Deo doesn’t know the exact medical procedures so there isn’t anything Troy can do. All we wanted was to talk to a doctor about what the plan was for her case. In the middle of our discussion with the four gatekeepers of the ward, Deo showed up to tell us where to find Evelyn. We decided that just one of us needed to go in and it wouldn’t be a good idea to try to have all of us inside, especially with the way the nurses were annoyed with the group.
While we waited, Deo brought Evelyn over to see us. She’s such a happy little girl as long as you aren’t messing with her belly! Poor thing has been through so much and she’s just 3 ½! I honestly don’t know how her mother does it! She takes care of Evelyn and her other children along with some of the orphaned kids in Mubende. Evelyn needs to be constantly watched and her bandages need to stay clean all day long. It’s hard enough to do it in a sterile environment with running water but to do the same out in the village with no running water and so much outside work with dirt and garbage all over the place, she must be working non-stop. Evelyn had fun with us for a while and we talked a bit with Deo. After nearly an hour, the nurse called Evelyn, and I was chosen to go with. I entered with Fiona and Evelyn to a patient room with four other patient/mother pairs already in it. Apparently privacy and patient confidentiality don’t really matter. Fiona doesn’t speak English and I’m pretty sure that nobody else in the room did. I did understand that Fiona was telling one of the mothers about Evelyn and then explaining to her that I was Mukwano, which means friend. I wish there was more I could do for them, but unfortunately I don’t have the skills of surgeon and I don’t know anybody else who does.
The nurse called the patients one by one to the room next door where the doctor was waiting. I tried to sheepishly explain why I was there, but the doctor really didn’t seem to mind that I was there nor did she care why I was there. She explained that Evelyn’s case was not the only one and that they just need to get their act together in order to do the procedure. Deo has always made it seem like nobody is able to do the surgery, but after talking with the surgeon, it seems they know what to do, it’s just a matter of getting the resources together. The surgeon said that a doctor from the U.S. was welcome to take over the case if they felt like it, but it seemed to me that she would rather continue the process they are working on, even though it is slow-going. I made the mistake of leaving without asking for contact information. When I got back to the group, I explained the situation but it didn’t seem Deo was totally satisfied. I don’t know who mentioned it, but somebody suggested I get the email or phone number for the surgeon directly. I really didn’t want to and I didn’t think it was necessary, but my mom started to insist that I do it. I tried to walk back to the room again, but the nurse was mean this time and said the doctor was very busy and I could wait until she sees the rest of the patients. There were at least 25 more waiting in main area so I knew it would probably be hours. I walked back the hallway without the number and feeling insignificant after the way the nurse brushed me off. When I got back, my mom said I should ask her new friend, the nurse at the desk who had been cranky earlier. My mom has always had a way of making friends wherever she goes. My mom had asked her if she could take her picture to show her friend Shirley back home because her outfit was similar to the outfits that nurses used to wear in the states. When I learned he name, all I could do was laugh. Margaret Susan! Some day we might find a variety of names for the people that we know, but for now we’re just going to have to settle with know multiples of every name. Needless to say, Margaret Susan was not able to help us. I honestly didn’t think it was an appropriate situation in the first place. I get really frustrated that people expect us to solve every problem just because we are from outside of Uganda. It’s somewhat disrespectful to the nurses and doctors that work here. Many of them are very good at what they do and are competent in their skills, but people in the country tend to not trust the system to work and fix their problems. Part of me doesn’t blame them because the number of people that don’t get what they need in hospital is very high. However, most times it is because the organization is so poor and the resources are so limited. There is a lack of understanding that needs to be worked through so that people will learn to trust the people that are there to help them.
I was frustrated when we left, but I know that Evelyn is in good hands and I am glad to know that we can trust them to take care of her. I followed through on my promise to go to the appointment and figure out what is going on, but I think that’s as far as we should get involved. It’s hard to tell people you can’t really help them more, but truthfully, we can’t and we really shouldn’t in the interest of letting the Ugandan doctor do her job. Angella worked under the surgeon and she said she was one of the best that she worked with at her entire time at Mulago. I trust what Angella has to say and I’m glad that she was able to reassure us about the situation.
After the appointment we stopped by Susan’s office to inform her that we would like to see infectious disease and possibly pediatric or OB/GYN rounds in the next two days. She informed us to come at 8:45 in the morning and she’s have it set up.
We also had to stop down at Katanga to make sure JaJa would be around with the kids when we come tomorrow. I am always a little skeptical when we go down in that area. The people watch everything that we do and it’s so crowded and noisy that it’s easy to get distracted. With the group of us, it wasn’t as bad as I expected. Now that we have found an easy way to find it, there doesn’t seem to be any uncertainty about safety. It was probably good for everybody to see where we were going so they could be prepared for tomorrow.
Apparently the morning had gotten away from us because by the time we decided to get lunch it was nearly 4:00. We took Mtatu’s to Taste Budz in Bukoto. I probably should branch out more, but I stuck to the pizza and a chocolate milkshake. They just taste better than most things here! We still had to get our medicine cabinet’s to bring to the Bukoto orphanage. Since we didn’t want to pay for a taxi, Pamela and I took Boda’s back to the house to pick up what we needed. Pamela had asked about safety on them and I assumed she meant physical safety. I said they should be safe, especially since the roads aren’t too bad. Then she informed me that she was more worried about being taken some place she didn’t want to go. Apparently in Vietnam it was a big concern when you took scooters. I’ve never heard of that being a problem, but once we started riding, I was very careful to watch for Pamela, just in case something happened. We got home and grabbed the stuff. When we came back out of the gates, the drivers were pointing up the hill and laughing. I think they were overwhelmed by how steep and bumpy it is. They were strategizing on how to get up it. This hill has caused more headaches than anything else this trip! My driver got on and when as fast as he could the whole way up the hill. We both cheered when we made it. Pamela and her driver were another story. They started slow and weren’t ever able to pick up momentum. We laughed as they struggled to make it! Thankfully, they arrived at the top without too much trouble, but clearly it was a strain on the bike! I decided I wouldn’t mind giving an extra 1,000 for the ride because of the unexpected hill!
We had to walk to the orphanage in Bukoto. We started walking just as the rain started. There weren’t really any taxis out and none of the Mtatus go where we needed to from that point. We just continued in the rain. By the time we arrived, all of us were drenched. At least the water wasn’t too cold and the weather was still pretty warm so we weren’t miserable.
The mother, Hilda, was super excited to see us again. And the children were jumping up and down in happiness! We got to work filling out information on each child and asking the questionnaire to the two main caregivers and two secondary caregivers. The oldest of the women didn’t speak English, so translating was fun. Hilda speaks English, but some things are lost in translation. There is one question about dehydration that asks what it means when a child cries with no tears or drool. She thought it was hysterical and couldn’t stop laughing about such an absurd idea. It took longer than it should have, and it was pretty dark by the time we finished. Pamela, Nick, and my mom handed out beanie babies that Pamela’s dad had given for the trip. The kids loved them and immediately started running in to show them to us.
Once we finally got all the work done, we were blessed with a song and prayer for the rest of our travels. I’m so happy that we have found this orphanage. I think it could be a really great place to visit in the future and they seem to really try to understand exactly how to use all of the medicine. Tomorrow is going to be a long day, with a visit to the hospital and another orphanage!
I woke up around 7:30 as usual and used the quite time to get my thoughts in order and plan for the rest of the day. Lately I’ve been having strange dreams that make me wake up thinking about odd things. I think last night there was some sort of serial killer out to get us and we were hiding out trying to stay alive. The medication we take for anti-malarials called Malarone is what a lot of people blame their strange dreams on while they are in foreign places. I’m still not sure if it’s the medicine or perhaps just the strange environment. In addition, those silly movies may have just found too much room to camp out in my brain! I’m not going to get sucked into another one and hopefully the dreams will be a little less bizarre!
Angella called and said she would be going to the clinic and we could meet her for Evelyn’s appointment around eleven. We weren’t at all ready by then. I think I was the only one that was up before 9:30 and everyone else still wanted to shower before we left the house. We decided to just meet at Mulago around noon.
Once we finally got ready, we called Jozeph to pick us up. Unfortunately, he was busy taking somebody to the airport so we had to call the other Jozeph, who charges more. I understand that his car is bigger, but seriously, he charges way too much! I think the only fair rate that he gave us was for the airport. This time we tried to get him to go for 15,000, but he said that wasn’t enough and that 20,000 was the fare. We finally settled on 17,000. It’s the first time I feel like he actually gave us a somewhat decent negotiation on price.
We stopped by Susan’s office to drop of the crayons, coloring book, and beanie baby we brought for her niece, Clarissa. She really appreciated loved them and I’m sure Clarissa will too! When she found out that Pamela and Nick were here and that we weren’t going to see the hospital, she insisted on setting up a couple of days for them to work in Mulago. I thought Troy had said he talked to this Susan about it and was told we couldn’t, but Susan said she never talked to Troy. Who knows if it was a different Susan or if she didn’t remember him. We’ve met so many Susans that I wouldn’t be surprised if there was another one working in a similar place in the hospital that Troy talked to and thought it was the same person.
We didn’t know exactly where to find Evelyn but luckily Angella knows every area of the hospital so she acted as our person guide. We got to the outpatient surgical ward to find that it had moved to a whole other building for the day. Go figure. I don’t know how people know where to show up for work in the morning and I’m even more baffled at how patients are able to arrive, find their charts, and then head to the proper building to see their doctor. We found the ward but when we got there, behind the desk there were three nurses and a man in white that did not want us to be there. We tried to explain to him the situation from both Angella’s and my own perspective, but they weren’t having it. It’s frustrating because when Troy is back in the states, Deo contacts him about Evelyn’s condition but Deo doesn’t know the exact medical procedures so there isn’t anything Troy can do. All we wanted was to talk to a doctor about what the plan was for her case. In the middle of our discussion with the four gatekeepers of the ward, Deo showed up to tell us where to find Evelyn. We decided that just one of us needed to go in and it wouldn’t be a good idea to try to have all of us inside, especially with the way the nurses were annoyed with the group.
While we waited, Deo brought Evelyn over to see us. She’s such a happy little girl as long as you aren’t messing with her belly! Poor thing has been through so much and she’s just 3 ½! I honestly don’t know how her mother does it! She takes care of Evelyn and her other children along with some of the orphaned kids in Mubende. Evelyn needs to be constantly watched and her bandages need to stay clean all day long. It’s hard enough to do it in a sterile environment with running water but to do the same out in the village with no running water and so much outside work with dirt and garbage all over the place, she must be working non-stop. Evelyn had fun with us for a while and we talked a bit with Deo. After nearly an hour, the nurse called Evelyn, and I was chosen to go with. I entered with Fiona and Evelyn to a patient room with four other patient/mother pairs already in it. Apparently privacy and patient confidentiality don’t really matter. Fiona doesn’t speak English and I’m pretty sure that nobody else in the room did. I did understand that Fiona was telling one of the mothers about Evelyn and then explaining to her that I was Mukwano, which means friend. I wish there was more I could do for them, but unfortunately I don’t have the skills of surgeon and I don’t know anybody else who does.
The nurse called the patients one by one to the room next door where the doctor was waiting. I tried to sheepishly explain why I was there, but the doctor really didn’t seem to mind that I was there nor did she care why I was there. She explained that Evelyn’s case was not the only one and that they just need to get their act together in order to do the procedure. Deo has always made it seem like nobody is able to do the surgery, but after talking with the surgeon, it seems they know what to do, it’s just a matter of getting the resources together. The surgeon said that a doctor from the U.S. was welcome to take over the case if they felt like it, but it seemed to me that she would rather continue the process they are working on, even though it is slow-going. I made the mistake of leaving without asking for contact information. When I got back to the group, I explained the situation but it didn’t seem Deo was totally satisfied. I don’t know who mentioned it, but somebody suggested I get the email or phone number for the surgeon directly. I really didn’t want to and I didn’t think it was necessary, but my mom started to insist that I do it. I tried to walk back to the room again, but the nurse was mean this time and said the doctor was very busy and I could wait until she sees the rest of the patients. There were at least 25 more waiting in main area so I knew it would probably be hours. I walked back the hallway without the number and feeling insignificant after the way the nurse brushed me off. When I got back, my mom said I should ask her new friend, the nurse at the desk who had been cranky earlier. My mom has always had a way of making friends wherever she goes. My mom had asked her if she could take her picture to show her friend Shirley back home because her outfit was similar to the outfits that nurses used to wear in the states. When I learned he name, all I could do was laugh. Margaret Susan! Some day we might find a variety of names for the people that we know, but for now we’re just going to have to settle with know multiples of every name. Needless to say, Margaret Susan was not able to help us. I honestly didn’t think it was an appropriate situation in the first place. I get really frustrated that people expect us to solve every problem just because we are from outside of Uganda. It’s somewhat disrespectful to the nurses and doctors that work here. Many of them are very good at what they do and are competent in their skills, but people in the country tend to not trust the system to work and fix their problems. Part of me doesn’t blame them because the number of people that don’t get what they need in hospital is very high. However, most times it is because the organization is so poor and the resources are so limited. There is a lack of understanding that needs to be worked through so that people will learn to trust the people that are there to help them.
I was frustrated when we left, but I know that Evelyn is in good hands and I am glad to know that we can trust them to take care of her. I followed through on my promise to go to the appointment and figure out what is going on, but I think that’s as far as we should get involved. It’s hard to tell people you can’t really help them more, but truthfully, we can’t and we really shouldn’t in the interest of letting the Ugandan doctor do her job. Angella worked under the surgeon and she said she was one of the best that she worked with at her entire time at Mulago. I trust what Angella has to say and I’m glad that she was able to reassure us about the situation.
After the appointment we stopped by Susan’s office to inform her that we would like to see infectious disease and possibly pediatric or OB/GYN rounds in the next two days. She informed us to come at 8:45 in the morning and she’s have it set up.
We also had to stop down at Katanga to make sure JaJa would be around with the kids when we come tomorrow. I am always a little skeptical when we go down in that area. The people watch everything that we do and it’s so crowded and noisy that it’s easy to get distracted. With the group of us, it wasn’t as bad as I expected. Now that we have found an easy way to find it, there doesn’t seem to be any uncertainty about safety. It was probably good for everybody to see where we were going so they could be prepared for tomorrow.
Apparently the morning had gotten away from us because by the time we decided to get lunch it was nearly 4:00. We took Mtatu’s to Taste Budz in Bukoto. I probably should branch out more, but I stuck to the pizza and a chocolate milkshake. They just taste better than most things here! We still had to get our medicine cabinet’s to bring to the Bukoto orphanage. Since we didn’t want to pay for a taxi, Pamela and I took Boda’s back to the house to pick up what we needed. Pamela had asked about safety on them and I assumed she meant physical safety. I said they should be safe, especially since the roads aren’t too bad. Then she informed me that she was more worried about being taken some place she didn’t want to go. Apparently in Vietnam it was a big concern when you took scooters. I’ve never heard of that being a problem, but once we started riding, I was very careful to watch for Pamela, just in case something happened. We got home and grabbed the stuff. When we came back out of the gates, the drivers were pointing up the hill and laughing. I think they were overwhelmed by how steep and bumpy it is. They were strategizing on how to get up it. This hill has caused more headaches than anything else this trip! My driver got on and when as fast as he could the whole way up the hill. We both cheered when we made it. Pamela and her driver were another story. They started slow and weren’t ever able to pick up momentum. We laughed as they struggled to make it! Thankfully, they arrived at the top without too much trouble, but clearly it was a strain on the bike! I decided I wouldn’t mind giving an extra 1,000 for the ride because of the unexpected hill!
We had to walk to the orphanage in Bukoto. We started walking just as the rain started. There weren’t really any taxis out and none of the Mtatus go where we needed to from that point. We just continued in the rain. By the time we arrived, all of us were drenched. At least the water wasn’t too cold and the weather was still pretty warm so we weren’t miserable.
The mother, Hilda, was super excited to see us again. And the children were jumping up and down in happiness! We got to work filling out information on each child and asking the questionnaire to the two main caregivers and two secondary caregivers. The oldest of the women didn’t speak English, so translating was fun. Hilda speaks English, but some things are lost in translation. There is one question about dehydration that asks what it means when a child cries with no tears or drool. She thought it was hysterical and couldn’t stop laughing about such an absurd idea. It took longer than it should have, and it was pretty dark by the time we finished. Pamela, Nick, and my mom handed out beanie babies that Pamela’s dad had given for the trip. The kids loved them and immediately started running in to show them to us.
Once we finally got all the work done, we were blessed with a song and prayer for the rest of our travels. I’m so happy that we have found this orphanage. I think it could be a really great place to visit in the future and they seem to really try to understand exactly how to use all of the medicine. Tomorrow is going to be a long day, with a visit to the hospital and another orphanage!
Day 22 - July 27
I hope that Nick and Pamela enjoyed today. We returned to the HIV clinic that I went to at first with Gloria. We were supposed to meet her at 8:00 to go to the meeting for failing patients at IDI. Jozeph came to get us in the morning, but he was a little late and then the jam was more intense than usual so we ended up being almost a half hour late! I don’t know if I can really say late. Since everybody works on African time, it’s almost impossible to ever start anything when you are supposed to. The traffic is awful in the city so some days it can take an hour or more to go a distance that should take 15 minutes. We walked into the meeting late, but the person in charge waved us to some seats in the front.
I was surprised at how much more I was able to figure out what was going on today. The last meeting I went to, they might as well have all been speaking Luganda, because I wasn’t catching any of the points they were making. After spending a couple of days with Gloria and talking about HIV/AIDS and all of the complications, I was actually understanding what they were talking about with each patient. I felt like I had learned some relevant information that I will be able to take with me as I learn more in the future. The world probably learns a lot from the data that comes out of the IDI center about infectious disease. There are not many other places outside of Africa that have the number and high concentration of HIV positive patients. Each patient is put into a profile and then given treatment based on guidelines set up here. The biggest problem is the sheer number of patients. The CDC has a set budget on what money is available to purchase ARV drugs to give out to patients for free. The more patients that show up, the more money they need to spend. In order to try to cut costs, they patients are being started on the medicines later and later. This means that the patient’s immune system may be very weak by the time the drugs are started so they will end up with more complications. It’s so unfortunate to see that there are drugs that will prevent severe sickness, but they are not being used because there is not enough money to make them go around.
At the clinic, I decided to help out with the triage of the patients which is basically taking weight, height, temp and blood pressure. Being a first year medical student and working at the HOPE Clinic qualified me to be able to do it! However, I think the most important factor was that I have my own BP cuff, which is a limiting factor for the number of people that are able to take blood pressures. Pamela and Nick split up with Gloria and her friend Joane, who works with management of pregnant woman and children who are at risk or have HIV.
I tried to help call out the names of the patients that were waiting as the files were placed on the table. When I called out the names in my English pronunciation, nobody really paid attention. There were three nurses and a counseling student at the table, and they didn’t seem to interested in helping me at first. I knew it was going to be a really rough day if I wasn’t able to make a connection with them. Lucky for me, I had resources to help me out! The best was the tiny beanie babies. Our neighbors our extremely generous and had given us over 400 of the little toys to pass out wherever we saw they would be appreciated. We decided to hand them out to the children at the clinic as they went in to see the doctors. I never got the student’s name, but he was my biggest help. I wasn’t sure how to use the thermometers. Everybody here takes temperatures under the armpit. It might be a little less invasive and more sterile than anywhere else, but I don’t really think they are that accurate. Most of the patients were 35 degrees Celcius or less, which means that they are a whole 2 degrees below the average normal temperature. I just have a hard time believing that everybody is that low. Maybe there is something I don’t know about people in the country and core body temperature. I’ll have to try to figure it out some day.
The nurse sitting across from me was especially stern. She was probably in her mid thirties but you could tell she was in charge of what was going on. She was always telling people what to do and grabbing things away from people in disapproval. Any time I even reached for a file that she wanted, she would shake her head and give me some other file. I realized after a few patients that she had a system and I was interrupting it when I took the files that I was told to take by the man bringing them. Once I figured that out, things went much more smoothly. The nurse was even calling out the names of patients and directing them to me! While we were sitting around waiting for more patients, the stern nurse picked up my pen to figure out how it worked. I told her she could have it and she grinned ear to ear! She was finally happy and it was directed at something I had done! Ross had taught me on the first trip that “pens make friends”, especially when it comes to nurses who are generally in short supply of them. I think he was right. From then on, she was even more friendly and was helping me out more with patients.
In the 4 hours that I was there, I must have taken at least 50 blood pressures, and the other two nurses did even more. Partway through the day, I stopped and thought about the patients and I was amazed at the fact that every patient that I had touched was HIV positive. When am I ever going to be in a place that 100% of my patients have such a complicated disease with such a serious prognosis? When I was with my preceptors in Minnesota, I don’t think that I saw any HIV positive patients. In a day we would maybe see 15 patients, but most of them had high blood pressure or an acute injury. There were only a couple each day with really complicated histories, but very few of them had anything that would compare to HIV.
High blood pressure must not be that big of a problem. People here are generally not overweight and their diets are very healthy. The only two patients that I had that were overweight both had very high blood pressure. I remembered the first man because he was the first person that actually filled up the chair when he sat down. When I took his blood pressure, I thought that I heard the first noise around 185, but I wasn’t positive until about 175 (the normal should be about 120). It ended up being 175/120 that I wrote on his chart. A little while later, a counselor/nurse interrupted me to borrow my cuff. When I looked over, she was re-checking the blood pressure on the man that was really high. All I could think was that I had taken it wrong and they were trying to fix my mistake! Then another nurse went over and took his pressure again. They were gone with my cuff for 20 minutes. When the nurse, Sylvia, brought it back I asked her about the patient. She said she got it as high at 190. I think back home somebody would have sent him to the ER. Instead, the nurses set him up with counseling about his high blood pressure and hopefully got him started on ways to reduce it.
I finished a little earlier than Pamela and Nick so I joined in on a counseling session with Gloria’s friend Sylvia. She is the one who had given me a tour last time. She is so feisty and very expressive when she talks. When I sat down, they were speaking Luganda, but I could tell she wasn’t happy with the patient she was speaking with. There was a man sitting in front of her and a women next to him. Sylvia was asking him questions and he kept avoiding them. She stopped to explain to me that this man had stopped coming to the clinic about a year ago because he felt better and didn’t think he needed drugs. Then he started getting sick so he wanted to come back. She was trying to explain that he needs to stay on the medicine all the time or else he would keep getting more and more sick. It was interesting that even though I didn’t understand the words, I still understood the conversation. At one point, after the man refused to answer the questions to her liking, Sylvia sent him away. The woman remaining was his sister who generally helps out with his care. She was trying to explain to her the importance of the drugs and then get more information about the man’s social history. He had claimed he left his wife because of his HIV, but it didn’t make sense to Sylvia, so she wanted to know more about other women in his life. Before I could find out the conclusion of the story, Gloria came and informed us it was time to go! I think Sylvia probably talked to the patient for a lot longer after I left. She wasn’t going to stop until the whole situation was sorted out and sometimes that means spending an hour with one patient!
There was more jam on the way back, but probably not anywhere near as bad as the morning. Gloria dropped us off at a mtatu stand and we got a ride back to Ntinda. Since I haven’t walked anywhere long in a few days, I convinced them we could walk back home. I was hungry and hot, but I figured it would be better to walk now and then take a shower and nap when we got home. It sounded like Pamela and Nick had learned a lot and enjoyed the experience at the clinic.
When we got home, my mom had just finished with some laundry and cleaning at the house. Even though we are guests here and there are cleaning people that come to the house, she still wants to do all the work she can to contribute to the clean house. I wonder if that’s something that happens when you become a mom or if I should already have the urge to clean all the time. My philosophy is that if there is already somebody doing it, I shouldn’t take their job away from them, so I haven’t really cleaned at all since I’ve been here. Hopefully that’s not too upsetting or offensive to anybody.
We ate some snacks and took naps and just relaxed for a while around the house. We called Jozeph 2 to come and get us and bring us to Javas for dinner and so we could use the internet. It’s hard to keep up with all of the emails and messages from home, but I really don’t miss them! I like not having the expectation that I can be contacted any time by anyone and be expected to reply within 24 hours. Sometimes it’s nice to just work on things at your own pace and be able to get them done when you can. I will be happy to have the internet back on a regular basis and I’m sure I’ll find a million and one ways to waste time on it, but for now, I’ll be content without it!
I was surprised at how much more I was able to figure out what was going on today. The last meeting I went to, they might as well have all been speaking Luganda, because I wasn’t catching any of the points they were making. After spending a couple of days with Gloria and talking about HIV/AIDS and all of the complications, I was actually understanding what they were talking about with each patient. I felt like I had learned some relevant information that I will be able to take with me as I learn more in the future. The world probably learns a lot from the data that comes out of the IDI center about infectious disease. There are not many other places outside of Africa that have the number and high concentration of HIV positive patients. Each patient is put into a profile and then given treatment based on guidelines set up here. The biggest problem is the sheer number of patients. The CDC has a set budget on what money is available to purchase ARV drugs to give out to patients for free. The more patients that show up, the more money they need to spend. In order to try to cut costs, they patients are being started on the medicines later and later. This means that the patient’s immune system may be very weak by the time the drugs are started so they will end up with more complications. It’s so unfortunate to see that there are drugs that will prevent severe sickness, but they are not being used because there is not enough money to make them go around.
At the clinic, I decided to help out with the triage of the patients which is basically taking weight, height, temp and blood pressure. Being a first year medical student and working at the HOPE Clinic qualified me to be able to do it! However, I think the most important factor was that I have my own BP cuff, which is a limiting factor for the number of people that are able to take blood pressures. Pamela and Nick split up with Gloria and her friend Joane, who works with management of pregnant woman and children who are at risk or have HIV.
I tried to help call out the names of the patients that were waiting as the files were placed on the table. When I called out the names in my English pronunciation, nobody really paid attention. There were three nurses and a counseling student at the table, and they didn’t seem to interested in helping me at first. I knew it was going to be a really rough day if I wasn’t able to make a connection with them. Lucky for me, I had resources to help me out! The best was the tiny beanie babies. Our neighbors our extremely generous and had given us over 400 of the little toys to pass out wherever we saw they would be appreciated. We decided to hand them out to the children at the clinic as they went in to see the doctors. I never got the student’s name, but he was my biggest help. I wasn’t sure how to use the thermometers. Everybody here takes temperatures under the armpit. It might be a little less invasive and more sterile than anywhere else, but I don’t really think they are that accurate. Most of the patients were 35 degrees Celcius or less, which means that they are a whole 2 degrees below the average normal temperature. I just have a hard time believing that everybody is that low. Maybe there is something I don’t know about people in the country and core body temperature. I’ll have to try to figure it out some day.
The nurse sitting across from me was especially stern. She was probably in her mid thirties but you could tell she was in charge of what was going on. She was always telling people what to do and grabbing things away from people in disapproval. Any time I even reached for a file that she wanted, she would shake her head and give me some other file. I realized after a few patients that she had a system and I was interrupting it when I took the files that I was told to take by the man bringing them. Once I figured that out, things went much more smoothly. The nurse was even calling out the names of patients and directing them to me! While we were sitting around waiting for more patients, the stern nurse picked up my pen to figure out how it worked. I told her she could have it and she grinned ear to ear! She was finally happy and it was directed at something I had done! Ross had taught me on the first trip that “pens make friends”, especially when it comes to nurses who are generally in short supply of them. I think he was right. From then on, she was even more friendly and was helping me out more with patients.
In the 4 hours that I was there, I must have taken at least 50 blood pressures, and the other two nurses did even more. Partway through the day, I stopped and thought about the patients and I was amazed at the fact that every patient that I had touched was HIV positive. When am I ever going to be in a place that 100% of my patients have such a complicated disease with such a serious prognosis? When I was with my preceptors in Minnesota, I don’t think that I saw any HIV positive patients. In a day we would maybe see 15 patients, but most of them had high blood pressure or an acute injury. There were only a couple each day with really complicated histories, but very few of them had anything that would compare to HIV.
High blood pressure must not be that big of a problem. People here are generally not overweight and their diets are very healthy. The only two patients that I had that were overweight both had very high blood pressure. I remembered the first man because he was the first person that actually filled up the chair when he sat down. When I took his blood pressure, I thought that I heard the first noise around 185, but I wasn’t positive until about 175 (the normal should be about 120). It ended up being 175/120 that I wrote on his chart. A little while later, a counselor/nurse interrupted me to borrow my cuff. When I looked over, she was re-checking the blood pressure on the man that was really high. All I could think was that I had taken it wrong and they were trying to fix my mistake! Then another nurse went over and took his pressure again. They were gone with my cuff for 20 minutes. When the nurse, Sylvia, brought it back I asked her about the patient. She said she got it as high at 190. I think back home somebody would have sent him to the ER. Instead, the nurses set him up with counseling about his high blood pressure and hopefully got him started on ways to reduce it.
I finished a little earlier than Pamela and Nick so I joined in on a counseling session with Gloria’s friend Sylvia. She is the one who had given me a tour last time. She is so feisty and very expressive when she talks. When I sat down, they were speaking Luganda, but I could tell she wasn’t happy with the patient she was speaking with. There was a man sitting in front of her and a women next to him. Sylvia was asking him questions and he kept avoiding them. She stopped to explain to me that this man had stopped coming to the clinic about a year ago because he felt better and didn’t think he needed drugs. Then he started getting sick so he wanted to come back. She was trying to explain that he needs to stay on the medicine all the time or else he would keep getting more and more sick. It was interesting that even though I didn’t understand the words, I still understood the conversation. At one point, after the man refused to answer the questions to her liking, Sylvia sent him away. The woman remaining was his sister who generally helps out with his care. She was trying to explain to her the importance of the drugs and then get more information about the man’s social history. He had claimed he left his wife because of his HIV, but it didn’t make sense to Sylvia, so she wanted to know more about other women in his life. Before I could find out the conclusion of the story, Gloria came and informed us it was time to go! I think Sylvia probably talked to the patient for a lot longer after I left. She wasn’t going to stop until the whole situation was sorted out and sometimes that means spending an hour with one patient!
There was more jam on the way back, but probably not anywhere near as bad as the morning. Gloria dropped us off at a mtatu stand and we got a ride back to Ntinda. Since I haven’t walked anywhere long in a few days, I convinced them we could walk back home. I was hungry and hot, but I figured it would be better to walk now and then take a shower and nap when we got home. It sounded like Pamela and Nick had learned a lot and enjoyed the experience at the clinic.
When we got home, my mom had just finished with some laundry and cleaning at the house. Even though we are guests here and there are cleaning people that come to the house, she still wants to do all the work she can to contribute to the clean house. I wonder if that’s something that happens when you become a mom or if I should already have the urge to clean all the time. My philosophy is that if there is already somebody doing it, I shouldn’t take their job away from them, so I haven’t really cleaned at all since I’ve been here. Hopefully that’s not too upsetting or offensive to anybody.
We ate some snacks and took naps and just relaxed for a while around the house. We called Jozeph 2 to come and get us and bring us to Javas for dinner and so we could use the internet. It’s hard to keep up with all of the emails and messages from home, but I really don’t miss them! I like not having the expectation that I can be contacted any time by anyone and be expected to reply within 24 hours. Sometimes it’s nice to just work on things at your own pace and be able to get them done when you can. I will be happy to have the internet back on a regular basis and I’m sure I’ll find a million and one ways to waste time on it, but for now, I’ll be content without it!
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