Relaxing Days

So usually when we get here we have to hit the ground running with projects and visits to places, but we actually had some time to just relax and enjoy Uganda life for a bit. We still did quite a bit on Friday but today was basically sleeping off jet lag and Angella and I enjoying life! It was glorious!

On Friday we woke up and after breakfast headed in to Mulago hospital to see our friend Susan. Last year we stayed at Susan's house while she was living next door with her sister who was about to get married. Susan just delivered a baby by C-section on Thursday and we were able to go in and see her! Little Jasmine is a precious little baby and Susan is a proud new mom! She was still a little out of it from all the drugs that she was on for pain and infection, but she was doing well overall! We took a bunch of pictures on Angella's camera that I will post when I get them uploaded. It was great to go to Mulago and not be on our way to see really sick patients, which is often the case. It felt like we were visiting friends in Minnesota in the hospital after they had a baby a couple of weeks ago. Susan was even fortunate enough to get a private room for her recovery! She loved the clothes that my mom and I had bought for the baby and the jewelry that we picked out for her! Way to go mom!

After visiting with Susan, we took boda's to another friend, Gloria's house. She stays with her brother and his family in a two story house that is much bigger than my parents home in Minnesota. I am not used to being here and staying in "real" houses. Usually it's a guest house or we are visiting an orphanage with very small rooms and lots of kids crammed in. Sometimes I forget that people live fairly normal lives right next to the places where life isn't so easy! It was great to see Gloria and I think she was excited to see us too! We went to the Oasis mall for lunch at Java's. It's a favorite spot of Mzungu's....as we were driving up to the mall, I saw more white people than I had seen all day in other parts of town. I guess we all end up flocking to the places that feel most like home!

We left to pick up a SIM card for my phone and then found a place in an area called Wandegeya that sells internet connections. Luckily they were having a sale so I was able to purchase my modem (that looks like a Jump Drive) and a connection package that will last about a month, depending on how much I use it for just about $40. I was a little shocked when they asked for my contact information including a phone and email when they registered my account. I think it's the first time in four years of coming here that anybody has sold me something and cared who I was! I guess Uganda is moving forward!!

By the time we were finished with our errands and visits it was already after 5, and the jam was bad. We tried to take a back road, but that really wasn't much better. Halfway up a small street, we were completely blocked by a tow truck. It didn't have enough power to make it up the small hill. Can you imagine the truck that is supposed to help other vehicles was incapable of even the smallest hill? While we were waiting a boda ran into the back bumper. Not really surprising and luckily didn't do any damage. When we finally got home, I realized I was exhausted and could barely keep my eyes open. Thanks jet lag! I ended up taking a nap for an hour, which is never a good idea, but sometimes its totally necessary! I woke up and ended up talking with Gloria, Angella, Gloria's brother George and his girlfriend Nora. The conversation was all over the place from very serious topics to extremely lighthearted ones, but there managed to be laughter the entire time. I think George has a way with words!

Today was an even more low key day. I had woken up in the middle of the night to finish some MPH assignments. It's not easy to keep up with them and as excited as I was about my Orange internet modem, it wasn't working well at all last night so the excitement went a little south. At 4 am though, it all of a sudden kicked in and now I have decently fast internet! Yay Orange! So I ended up staying up way to late and then sleeping in until 9:30! That's the latest I've slept in ages! We made some plans and some phone calls for where we are going to go each day and hopefully we will be able to make it all work out. Since Angella had bought a lot of vegetables, we decided to have a cooking adventure. We made amazing pasta complete with homemade sauce from fresh tomatoes and all kinds of random veggies. We were quite proud of our creation in the end! We even decided to document the momentous occasion with a picture. I think it's the first time I've been here and cooked a meal in a house. We've stayed at places without great cooking facilities before so this was a nice change!


We ended up spending most of the day watching silly American reality T.V. shows like Wipeout, Next, and some random new one about fixing people's relationships. We laughed a lot all day! I can't imagine what Ugandans think about us if this is what they generally see is "reality" They must think we are all a little crazy!

I convinced Angella that running would be fun and she agreed to go with! I was expecting it to be really hard because of the hills and the heat and I think we are at a bit of an altitude compared to Minnesota. It actually was a lot of fun. You have to really be aware of your surroundings with the traffic and the weird arrangement of the roads. I had to come up with random landmarks because it's not like there were street signs to guide my way! We tried to find another Susan's house, but we were totally not in the right place. On the way back with both saw it at different times and realized we had completely looked past it! I think I was so worried about making it up the hill that I saw in front of me that I didn't look off to the sides! We decided to come back another day and visit instead! Here are our before and after pictures! Haha!




When we got done, one of Angella's neighbors came up and asked her, "Doctor, why does this one not sweat?". Apparently my white skin was hiding all of my sweat! I wiped my face with my hand and assured him that I was not any different, and that I sweat too! I was so glad that Angella came with and that there weren't any falls on the slippery dust on the roads. My poor shoes are a little worse for the journey though! I don't think they will be coming home with me!


We spent the rest of the night watching the 3rd place game of the women's World Cup between Sweden and France! I wish I knew more about the sport! It's not easy to be excited about it when you don't know any of the players and the rules are still a mystery! I think I've picked up on quite a bit though and I was actually excited to watch it! Tomorrow is a must watch game between the US and Japan! I think I know who I'll cheer for in that game!

Okay, so the past two days were a lot of fun and relaxation which I think was needed but tomorrow starts working on a lot of things. We have to confirm contacts with a bunch of the orphanages, go to church (I can't wait for Watoto Church!), hopefully meet up with Troy's other traveling companions (Troy is stranded with Dennis somewhere between Paris, Nairobi, and here until Sunday night), try to meet up with our favorite cab driver, Joseph, and maybe make another trip to see Susan! I feel like I need to start doing the real work so we don't end up stressing out towards the end of the trip when we have to cram a lot into a few days!

I have arrived!

Traveling was different being alone, but I think I managed just fine. The only think I like about coming home from Uganda is that my carry-on is much smaller and lighter. On the way over I pack EVERY heavy thing I can in my backpack and computer case. I look like one of those inexperienced travelers that doesn't know when to stop packing. I had a printer, refills of paper, children's books, reading flashcards, all my electronics, and every other random heavy thing I could fit in my bags. Its was a delicate puzzle trying to get my computer out of its case and then back in again during the short time in security every time......and going through security is a requirement on EVERY flight, even the connections! In Chicago I'm pretty sure the International terminal was in a different city that domestic. We had to leave through security, walk through the entire terminal, take a shuttle, and then go through security again. I just love carrying all my crap on my back. I have probalby said it before, but I feel pretty much like a turtle with my whole life on my back! Oh yeah, and on top of that, I had to put my otoscope and opthalmascope into my really full, perfectly packed backpack and wouldn't you know that all three times through security, they couldn't tell what it was in the scanner! Even when I took it out of my bag in Amsterdam they had to rescan it. At least it gave me extra time to repack my computer each time without too much of a scene!

I was just a little more stressed during these flights because I knew I had a lot of online MPH homework to do while I was traveling. This computer has a battery life of 2 hours if I'm lucky so doing work on the plane isn't really all that productive. It makes me miss my mac! I got to Amsterdam and I had two things on my mind.....take a two hour online biostats test and check my board scores.....both are unappealing and made me sick to my stomach! When I got off of the flight from Chicago and printed my boarding pass from the KLM kiosk, I was baffled to see my ticket didn't give me a seat number and the "attendant" told me I was flying standby! Really? You have to be kidding me! And when I asked her how I could fix it since I was sure I already had a seat assigned, she said I couldn't do anything until I was at the gate and that the gate didn't open until right before security and boarding started....awesome work KLM!

By the time I found a place to connect to the internet, got my stuff set up, and got an internet connection started, I realized I only had 2 hours and 10 minutes before boarding started. I quickly checked my reservation and saw that I was in 16G. I hoped that simply knowing that would fix any problem that might arise. I probably rushed through the test and really all I could do was think about checking my score for boards so I won't be surprised if my biostats test score is less than stellar! When I finished with only 10 minutes left til boarding, I logged in to the email with board scores and started clicking through the website. I know it's not medically possible, but I'm pretty sure my heart was beating so hard that it could have just popped right through my ribs! Waiting for the pdf to open was an eternity! The first thing I saw when I opened it was the best 4 letter word I've ever seen....PASS. I didn't really care much about the details because I had to get to the gate, and honestly I'm still a little worried that I didn't read it right, but right now the webpage is down so I'll just have to assume that I was right! This made the last flight a whole lot more bearable!

Once I got to the ticket counter, I tried to get the attention of any of the 5 people at the desk but they all seemed to not even care that I, or any of the other passengers were there. I just wanted a seat on that plane! Finally a guy behind me pushed his way to the counter and told the desk person that he needed a boarding pass and informed her that I did too. Thankfully I was given a boarding pass immediately. It the awesome location of 22F. Awesome. Not an aisle seat like I was expecting, but it would do just fine. Oh yeah I forgot to mention that we had a stop in Kigali, Rwanda. It's really great when you book a flight through an airline and it shows all of your destinations but fails to mention you will be stopping to drop of passengers and pick up some more. Just another hour or two of sitting on a plane and not even going anywhere. It's not the first time it's happened. There was the stop in Sudan last year and a side trip to Tanzania a few years ago. I'm just going to assume from now on that we won't have a direct flight anywhere when KLM is taking us somewhere in Africa.

Luckily along the way I met some nice people. In line in Amsterdam, two women from South Carolina started talking to me about their trip to Kigali. One of them is a pastor's wife and the other is her friend. They were on their way to Kigali to help start a church with a local man who has been traveling around giving sermons but doesn't have a base to hold a service in. It was encouraging to hear what they are doing and the excitement they had. Before they got off the plan in Kigali, we exchanged information and offered to be praying for one another. It's really great when you can make a connection with somebody had feel like you are invested in the work they are doing even in just a very brief meeting! I was smashed between two people who happened to be a little bigger than their seats, so I tried my best to stay upright with my hands folded so I didn't take up more than my seat. I didn't really mind though. After an hour or two of sleeping, the first meal came around and it sparked a conversation with the man next to me. It turns out he's been living in Uganda for 3 years and his wife and children still live in Michigan. He travels home when he can, but it's only a few times a year. I can't imagine what it would be like to live her and have your family so far away! He made the time pass quickly as we shared stories of the city, past travels, and we ended up having a connection because his son also just took his boards! Ali gave me his contact information, offered I ride to Kampala if Angella didn't show up at the airport, and assured me that if I were in a pinch for any reason, I could stop by and he'd help me out. I'm always a little cautious of people offering to take me places, but he genuinely just wanted to offer a hand if I needed it. I hopefully won't need his help with anything major, but it's nice to know there is a connection if you need it!

At the airport, I waited in line to purchase a VISA. A man directed us to different ticket counters. I had the misfortune of getting to a window behind a woman and her three boys. By the time they were finished, half the people in the line behind me had made it through other counters. I just have to say, TIA. Stuff happens when it happens and waiting is pretty much a way of life. I found my bags pretty quickly and then waited in another line to put my bags through a security check and walk through a metal detector. I didn't quite understand it. Some people just pushed their bags through and walked around it. I never saw a single person stopped and I went through the metal detector with my backpack and laptop. Clearly they were not actually looking at anything!

When I got outside, there was the usual crowd of taxi drivers. I had no idea where Angella and Pat would be so I just slowly looked around. Then two taxi drivers came up to me and asked if I wanted a ride. Right after I told them know, I saw Angella pop out and say "boo"! You can't imagine how excited and relieved I was to see her! Between her and Pat the excitement was at an amazingly high level. We laughed and joked the whole way to Entebbe. We counted at least a dozen polic trucks on the ride, which is honestly a bit of a comfort. They can often stop people for no reason and ask for money, but I think that things have changed so that they are out to be more of a presence and intervene if anything happens at night, especially since there is always a flight coming in at 10:15 pm with people traveling on to Kampala.

Angella's new apartment is great. It's on the second floor so there is a lot less dust and the bathroom actually has a separate room for the toilet and the shower! The water heater works and the refrigerator holds a lot of stuff! Although there were still craters in the road and noisy dogs and roosters making noise all night, it feels more like a home than any other place I've stayed! I didn't sleep much because I was worried about an assignment that I knew was going to be late because the internet wasn't working and I was suffering from the usually jet lag and time change. I'm pretty sure I only really slept for a few hours, but at least I was in bed pretending to sleep form about 2 am until 7. We started to day with a breakfast made by Angella....amazing eggs, toast with nutella and pineapple! It was much more than I am used to, but it was delicious!

Now that I've written a novel about the boring travel stuff (btw it's like 5 am here and I am not sleeping because I wanted to finish an assignment that is due at midnight Minnesota time which is 8 am here. I had finished it before bed, but the internet was not working all night, so I kept waking myself up to check until finally it worked at 4 am! Haha.....luckily I'm still kind of on Minnesota time and had a hard time going right back to bed so I decided to take advantage while it's still working! It's actually Saturday here, and we did a lot of random things on Friday, but I'll have to save that for my next post! For now I think I'll try to get a few more hours of sleep!

4th time is going to be amazing!

I can't believe that it's been a year since the last time I was in the land I call my second home. It's been a pretty crazy year full of ups and downs and I'm hoping that this is going to be another high point. Let's be honest though, within the next 3 weeks there will likely be lots of highs and just as many lows. It's just a matter of taking it all in stride and continuing to work with what we've got! Since the last time I was in Uganda, I finished my second year of medical school including taking Step 1 of the USMLE boards. It's amazing how many clinic encounters I've had since then. I fell like I've already experiences an amazingly large number of patient interactions but I haven't even touched the tip of the iceberg when it comes to my medical knowledge! I started working on my Master's of Public Health degree the day before I took my board exam and unfortunately I will have to work on some online classes while I am away. The program is only a year long but luckily the whole summer is online classes. I'll be spending the next year in the classroom learning about how to treat entire communities rather than the individual science of disease. I know that this new degree is going to help me when I work in small towns and as I work on projects in Uganda over time. I hope I can start applying when I know on this trip.

Okay, that's pretty boring. The last year in Minnesota has been not all that exciting for most people to hear my drone on about how many hours we study. I have realized I've become quite a nerd and get excited about the pathological basis of diseases and all kinds of little details that most people really don't care about. At least it confirms that what I'm doing is what I'm supposed to be doing and that I'm excited to be learning all of it!

The trip this year is going to be a new experience for me......i'm traveling alone to Entebbe and Angella and her friend Pat will be meeting me at the airport. I'll stay with Angella for the next three weeks and work on more of the orphanage projects delivering medicine and educating the caregivers on how to administer the types of medications that you would normally keep in your medicine cabinet at home. In the end we hope to see a decrease in the need for hospital and clinic visits for the orphans that we are providing medicine for. Dr. Lund and two students will be joining me 4 days after I arrive. I think their names are Isaac and Dennis. It's going to be a different experience working with people I've never met until they arrive! Hopefully I will be able to give them a great experience.....but seriously, it's Uganda.....how can it not be amazing?


This picture is from Ross' first trip to visit the Woolies. It's amazing that the boys were so little. Angella introduced Ross and Ross introduced our family and friends to the kids. Although they are the original "woolies", we have added to the number that we visit every year! Every time I have left the country, I feel as though I'll never be able to have a heart big enough to love any more kids, but every time I get back to Uganda, it seems my heart has grown a little bit more and we find a bunch more to love!



Here's a picture of the original Woolies as they were last year.They have grown so much!


I'll try to be better about posting pictures this time! It's difficult because I usually have to write a blog and then eventually find an internet connection and upload it before it times out! It's almost like back to the days of dial up! This year I am going to try to get internet Orange which is pretty much like a USB port that acts like a wireless modem from anywhere. I'm really hoping it works out because on top of working at the orphanages, I will need to work on all of my coursework for my MPH classes! It's going to be really tough to concentrate on them!

So anyways, I guess that's just a very brief intro to the trip before I leave! I'm currently completely packed. I had to come down and stay at a friend's house in the Twin Cities (thanks Emily, Ashley, and Brandee!) I have a love hate relationship with packing! Two suitcases at 50 pounds each is not enough when you want to load them up with as many toys, books, and games as you can! I basically have a huge box of things at my parents house that my mom has been collecting and I just crammed as much as I could. I take up every last nook and cranny of my backback and computer case with all the heavy stuff and then just hope that I won't have to take anything out of my checked luggage. The only good part about leaving Uganda will be the fact that my suitcases will be significantly lighter.....but I don't want to think about that because once I get there, I usually don't want to leave!

Anyways, I think sleeping before the trip is a great idea! I hope you all enjoy the random commentary I will have about the trip! If you have any questions about what we're doing or random questions about the kids.....or maybe you've never heard of a "wooly"..... feel free to ask! Sometimes I'm positive my parents are the only ones that read this blog and they hear me talk about the trip a lot already!

ps.....I really am going to miss having my mom or my brother or sister-in-law on this trip......oh yeah, and Pamela and Nick, you guys were great travel buddies too! At least I have my "sister from another mother", Angella to take care of me.

Day 25 - July 30

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!

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!

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!