Connor and I have been trying a new approach to our hospital schedule- today we went in for the afternoon and evening, because all of the students peace out at about five and then we have more opportunities to ask questions of the nurses. We had a really nice morning! I had been tipped off about some decent instant coffee (star coffee) which I bought yesterday, and so this morning I enjoyed two cups of coffee- my first since Monmouth in London. It felt sooooo good. Connor and I spent the morning doing crosswords on the iPad and went in to the hospital after lunch. We watched two c-sections in the afternoon. The first was for a ruptured uterus, which I had never seen before. The baby was stillborn and the mother's uterus was torn in two directions and looked stiff and dark. It was shaped at that point kind of like a baseball mitt, but the surgeon closed the uterus again despite the high likelihood of future dangerous pregnancies. He hadn't discussed the possibility of a damaged uterus with the mother beforehand, so he felt that he couldn't perform a hysterectomy. Safe spacing is key in situations like this,, as is close and conscientious monitoring throughout pregnancy. The chance that the mother will take these precautions with her next pregnancy is slim, so I can't help but be concerned for her. The second c-section went very well, happily.
After our afternoon tea, we returned to the hospital to help out with labor and delivery. They had delivered sixteen babies between nine and five, and we saw many more mothers there laboring. One mother was laboring in the hallway and had her baby there, unattended. Connor ended up helping nurse Zaki with the mother while I tended to the baby. There was so much going on that it was hard to tear ourselves away for dinner, which is served between nine and ten in the evening.
Wednesday, June 29, 2011
Monday, June 27, 2011
6/27/11
Even as I write this, it's Monday, 6/27.
We decided to take the day off today to make up for working on Saturday, and it's been very nice. We bathed, did our laundry, and spent much of the afternoon catching up on this, our blog. We do it all for you, dear reader, that you may live vicariously through our adventurous spirits.
The power has been out all day at home. I guess it just happens here sometimes.
Anne Marie is just noticing all the typos in my posts.
I hope you've enjoyed the latest installment, and we miss you all in America! Enjoy a tasty cheeseburger for us.
We decided to take the day off today to make up for working on Saturday, and it's been very nice. We bathed, did our laundry, and spent much of the afternoon catching up on this, our blog. We do it all for you, dear reader, that you may live vicariously through our adventurous spirits.
The power has been out all day at home. I guess it just happens here sometimes.
Anne Marie is just noticing all the typos in my posts.
I hope you've enjoyed the latest installment, and we miss you all in America! Enjoy a tasty cheeseburger for us.
6/26/11
After a long day watching circumcisions, we were really excited about a day off. We slept in really late, watched Modern Family and Fringe on the iPad, took extra-long luxurious bucket baths, and generally relaxed hard.
One annoyance that interrupted our otherwise perfect day was a small problem with our host mom. Our house has no running water, but there's a public water source nearby that she and her adult children pay to fill these big water jugs (called "Jerry-cans"), so that we have water to cook, bathe, and wash our clothes with. Except that this week, the water has almost never been there when we need it. It's been a minor problem, it always showed up eventually, but apparently the roommates collectively had heard that she had no money to fill the cans with. The water costs 100 shillings per jerry can (that's about 4 cents), so I'd given her the 16 cents she required to fill our 4 jerry cans, but this prompted the roommates to call Michael, who should be giving her the money... anyway, long story short, he came over and talked with Jessica and us and it was super awkward and now, on Monday, things are still a bit awkward between our host mom and us. Ah well.
But otherwise, we did nothing. Awesome.
One annoyance that interrupted our otherwise perfect day was a small problem with our host mom. Our house has no running water, but there's a public water source nearby that she and her adult children pay to fill these big water jugs (called "Jerry-cans"), so that we have water to cook, bathe, and wash our clothes with. Except that this week, the water has almost never been there when we need it. It's been a minor problem, it always showed up eventually, but apparently the roommates collectively had heard that she had no money to fill the cans with. The water costs 100 shillings per jerry can (that's about 4 cents), so I'd given her the 16 cents she required to fill our 4 jerry cans, but this prompted the roommates to call Michael, who should be giving her the money... anyway, long story short, he came over and talked with Jessica and us and it was super awkward and now, on Monday, things are still a bit awkward between our host mom and us. Ah well.
But otherwise, we did nothing. Awesome.
6/24/11
I think I've been rambling for my recent posts, so I'll be brief.
It's Anne Marie's half birthday, and my 5/6 birthday!
We worked normal hours again, but we really liked our afternoon/evening schedule... we'll be doing that again.
Anne Marie will write about the craziness in Maternity with the mother that died, so I'll not write about that again... except that it really angered me how insensitive the staff was being to the mother and brother of the deceased. They were just being students, not knowing what to do with the body, but as they were screwing around with it they were laughing and smiling... all right in front of these absolutely heartbroken relatives. It really was awful.
I tried to fix the drill in the dental clinic for a few hours today. I took the whole thing apart, and as you can imagine, it was more complicated than I'd originally thought. I knew I was unlikely to fix it, and sure enough I didn't, but I did fix that little suction-y thing that dentists stick into your mouth to clear out the spit! The other stuff was broken beyond repair - plastic broken and such - plus I had no tools or knowledge. The dentist lady was nonetheless extremely grateful.
We got roped into going on an all-day circumcision outreach on Saturday. Woo hoo!
It's Anne Marie's half birthday, and my 5/6 birthday!
We worked normal hours again, but we really liked our afternoon/evening schedule... we'll be doing that again.
Anne Marie will write about the craziness in Maternity with the mother that died, so I'll not write about that again... except that it really angered me how insensitive the staff was being to the mother and brother of the deceased. They were just being students, not knowing what to do with the body, but as they were screwing around with it they were laughing and smiling... all right in front of these absolutely heartbroken relatives. It really was awful.
I tried to fix the drill in the dental clinic for a few hours today. I took the whole thing apart, and as you can imagine, it was more complicated than I'd originally thought. I knew I was unlikely to fix it, and sure enough I didn't, but I did fix that little suction-y thing that dentists stick into your mouth to clear out the spit! The other stuff was broken beyond repair - plastic broken and such - plus I had no tools or knowledge. The dentist lady was nonetheless extremely grateful.
We got roped into going on an all-day circumcision outreach on Saturday. Woo hoo!
6/25/11
Connor dragged me out the a nearby village, Bulamagi, to help with fifty circumcisions that are conducted every weekend day in this area as part of the Safe Male Circumcision outreach program. This project is funded really well by USAID. One of the perks of the whole day for me was getting to drive in a truck out to the village health clinic. Thanks, USAID! This health clinic serves one hundred thousand people. It was the size of a large house here, and had no electricity or running water. Anyway, they did LOTS of circumcisions, which I'm not really very interested in except from a public health perspective. Connor has a relationship with one of the doctors who's in charge of this project, and while we were observing the surgeries the doctors really kept pressuring Connor to perform one. It's actually a very disturbingly common occurrence for the nurses at the hospital to push us to conduct deliveries or perform procedures. I've been assisting on a lot of deliveries,, and I certainly hope that I'll be able to conduct a delivery before I leave, but I'm a little flabbergasted by the constant push to do things outside my comfort zone, which I feel is already pretty wide for a first year medical student. Notable quotes: (from a surgeon standing over a twelve year old boy who was grimacing as a large needle was inserted into his penis) "this man is a coward!" (from the same surgeon explaining why he was giving this boy a hard time) " African men know no fear of death!".
6/23/11
I don't remember much about Thursday.
In the morning, we were told by our host mom Jessica that Michael (our main ELI contact here) had somehow heard that we weren't at the hospital in the morning, and sent Juliette over to make sure we were alright. How on earth the hospital can allow patients to fall through the cracks and be generally unorganized as anything I've ever imagined, and yet realize that we weren't there in the morning, is pretty much a mystery to me. But so it was, I guess.
We went in for a normal day Thursday, and I think I spent much of it in Maternity... in fact, Thursday was the day I assisted delivering a baby! It was very messy.
After work, we went over to Anne Marie's good friend Maria's house to meet her family. Maria was a nursing student Anne Marie'd been working with in Maternity, and who left Iganga to train somewhere else on Friday. It was very nice - we looked at pictures, met her big family, had some Rolex (delicious!) and walked home. Thursday was a good day.
In the morning, we were told by our host mom Jessica that Michael (our main ELI contact here) had somehow heard that we weren't at the hospital in the morning, and sent Juliette over to make sure we were alright. How on earth the hospital can allow patients to fall through the cracks and be generally unorganized as anything I've ever imagined, and yet realize that we weren't there in the morning, is pretty much a mystery to me. But so it was, I guess.
We went in for a normal day Thursday, and I think I spent much of it in Maternity... in fact, Thursday was the day I assisted delivering a baby! It was very messy.
After work, we went over to Anne Marie's good friend Maria's house to meet her family. Maria was a nursing student Anne Marie'd been working with in Maternity, and who left Iganga to train somewhere else on Friday. It was very nice - we looked at pictures, met her big family, had some Rolex (delicious!) and walked home. Thursday was a good day.
6/22/11
Determined to have a better day than we had on Tuesday, we did.
We decided to go into the hospital in the afternoon and evening, rather than the morning and afternoon. There are so many students there during the day that it's hard to be legitimately helpful - it seems like we're just in the way half the time. But at 5:30, the hospital totally clears out. So we decided that's when we wanted to be there.
More dental clinic in the afternoon, and more Ugandans being outrageously stoic. One poor preteen, too old to scream like a child but too young to be anything but terrified, sat in the chair shaking uncontrollably, but not uttering a word. She couldn't anaestetize him, he was shaking so badly... when he came back later he'd calmed himself, and went through it with no complaint. Pretty crazy.
I went to the maternity ward for much of the evening with Anne Marie, and successfully learned a few things about obstetrics - how to determine where the fetus's head is, how it's oriented, how to do a vaginal exam and determine how dilated a woman's cervix is. It was really interesting, and really cool - the nurses in maternity are extremely helpful and knowledgeable, so I really liked that. Before I knew it it was 5:30, and the ward emptied. In fact, we found ourselves in the situation where we were the only people in the whole damn ward, with some ten or more laboring mothers. Catching one nursing student on her way out, we asked who was in charge... "You are!" Wait, what? "If we weren't here, what would happen if one of these mothers started delivering?" "They would scream for help, and probably someone would hear them." By now pretty freaked out, we started running around looking for someone, anyone qualified really, who would be there if one of these women started having a baby. We figured we could deliver a perfectly uncomplicated baby, but what if there was a hemmorhage? A tear? We weren't about to sucher one of these women back together, with no experience (and with no anaesthetic, as is the crazy policy of the maternity ward)! Luckily we found a nurse who came in with us, and normalcy was restored.
It was about now that yesterday's scenario began to replay itself. A woman was in obstructed labor. It was determined that she required a C-section. The surgeon on duty during the daytime was just leaving, and the nighttime duty surgeon was "on her way." For the entire time that we waited for her (well over an hour), I was increasingly nervous and angry. I couldn't beleive that a baby was stuck in this woman's birth canal, a medical emergency(!), and for two days in a row surgery was delayed to the point that disaster seemed inevitable. Finally the woman was carted to the operating theater, and the surgeon (after a painstakingly slow introduction to us and a generally unhurried air) began operating. The baby was removed - resuscitated - and after a few heart-wrenching minutes, began to breathe.
Anne Marie and I were really, really happy. At about 8:00 we left the hospital and grabbed some beers at a bar on main street. Sometimes, it seems, medicine works!
We decided to go into the hospital in the afternoon and evening, rather than the morning and afternoon. There are so many students there during the day that it's hard to be legitimately helpful - it seems like we're just in the way half the time. But at 5:30, the hospital totally clears out. So we decided that's when we wanted to be there.
More dental clinic in the afternoon, and more Ugandans being outrageously stoic. One poor preteen, too old to scream like a child but too young to be anything but terrified, sat in the chair shaking uncontrollably, but not uttering a word. She couldn't anaestetize him, he was shaking so badly... when he came back later he'd calmed himself, and went through it with no complaint. Pretty crazy.
I went to the maternity ward for much of the evening with Anne Marie, and successfully learned a few things about obstetrics - how to determine where the fetus's head is, how it's oriented, how to do a vaginal exam and determine how dilated a woman's cervix is. It was really interesting, and really cool - the nurses in maternity are extremely helpful and knowledgeable, so I really liked that. Before I knew it it was 5:30, and the ward emptied. In fact, we found ourselves in the situation where we were the only people in the whole damn ward, with some ten or more laboring mothers. Catching one nursing student on her way out, we asked who was in charge... "You are!" Wait, what? "If we weren't here, what would happen if one of these mothers started delivering?" "They would scream for help, and probably someone would hear them." By now pretty freaked out, we started running around looking for someone, anyone qualified really, who would be there if one of these women started having a baby. We figured we could deliver a perfectly uncomplicated baby, but what if there was a hemmorhage? A tear? We weren't about to sucher one of these women back together, with no experience (and with no anaesthetic, as is the crazy policy of the maternity ward)! Luckily we found a nurse who came in with us, and normalcy was restored.
It was about now that yesterday's scenario began to replay itself. A woman was in obstructed labor. It was determined that she required a C-section. The surgeon on duty during the daytime was just leaving, and the nighttime duty surgeon was "on her way." For the entire time that we waited for her (well over an hour), I was increasingly nervous and angry. I couldn't beleive that a baby was stuck in this woman's birth canal, a medical emergency(!), and for two days in a row surgery was delayed to the point that disaster seemed inevitable. Finally the woman was carted to the operating theater, and the surgeon (after a painstakingly slow introduction to us and a generally unhurried air) began operating. The baby was removed - resuscitated - and after a few heart-wrenching minutes, began to breathe.
Anne Marie and I were really, really happy. At about 8:00 we left the hospital and grabbed some beers at a bar on main street. Sometimes, it seems, medicine works!
6/20/11 - 6/24/11
Connor has already written a lot about some of his first impressions of the hospital. I think that I've been lucky to have Maria, a really excellent nursing student, teaching me this past week. She will be leaving this week, though, so I'm on the lookout for a new guru. I've also been very lucky to have the maternity ward to work in. There are usually anywhere from ten to fifteen women in active labor, and a baby comes along about every couple of hours. I've already learned so much by participating in these births. This incredibly high volume of laboring women is managed out of a very small room. Women labor outside or in the hallways until they are ready to deliver, and then they occupy one of three delivery beds, which are right next to each other, separated by only hanging sheets and about two feet. Each mother brings in any gloves, medications and blankets that she wants the nurses to use. She also brings a black plastic sheet to lie on while she delivers. The labor suite has one blood pressure cuff, a fetoscope, a handful of suction bulbs to clear the babies' airways and antibiotic eye ointment for all the babies. They also have a very limited supply of oxytocin, pitocin, syringes, and sutures which they reserve for the very, very poorest of patients. Other than the specific c-section which ended very badly with a baby who probably had brain damage and ultimately didn't make it, there are a few other events that really stood out this week.
A baby was found in the town. She had been born just a few hours earlier and abandoned in the street, and she was perfectly healthy and really cute once she'd been bathed. Connor, Jennie and I bought some formula for her and she is being cared for by one of the head pediatric nurses. She named the baby Gift. It was startling that there was no system in place to handle abandoned or orphaned children. If they are not claimed by other family members, the children will be looked after until an orphanage accepts them or a family steps up to take care of them. This lack of protocol pervades all aspects of the hospital's operations, sometimes with devastating consequences. On Friday, a mother came in to the birtng suite (the aforementioned small room with three beds crammed in side by side) to be examined. She said she'd come in a couple of days ago with some fluid leaking and that she had been laboring since then, but that she had vomited a few minutes earlier so she thought she should get it checked out. My friend Maria examined her, but couldn't find her chart anywhere. The charts are all kept in a pile on the table in this room, but they frequently wander off and have to be searched for in other parts of the maternity ward. Maria noted that the mom was two centimeters dilated and was still leaking some fluid, so she ordered the woman to be given a test for malaria and to be observed. Maria was really concerned that this mom had been laboring so long while she was losing fluid- this boded badly for the health of both the mom and the baby. The mom climbed down from the bed, then walked a few feet and then collapsed, convulsing. When the nurses managed to get the mom back onto a bed and check for her pulse and blood pressure, there were none. The mom was gone. No attempt was made to save the baby, whose heartbeat Maria had heard only moments earlier. On fact, the blame for this mother's death landed largely on Maria, even though the nurse who had admitted this mother earlier had failed to register her in the admission book and even though no one had followed up with this mom, in the midst of a complicated labor, for two days. This lack of oversight and management, the complete absence of a system for monitoring mothers at regular intervals, is at least partly responsible for the common deaths of mothers and babies. The babies who die are often kept in a cabinet in the birthing suite until the families come to claim their bodies. I saw four babies either being placed in there or taken from this cupboard. I've only been in the maternity ward for one week.
A baby was found in the town. She had been born just a few hours earlier and abandoned in the street, and she was perfectly healthy and really cute once she'd been bathed. Connor, Jennie and I bought some formula for her and she is being cared for by one of the head pediatric nurses. She named the baby Gift. It was startling that there was no system in place to handle abandoned or orphaned children. If they are not claimed by other family members, the children will be looked after until an orphanage accepts them or a family steps up to take care of them. This lack of protocol pervades all aspects of the hospital's operations, sometimes with devastating consequences. On Friday, a mother came in to the birtng suite (the aforementioned small room with three beds crammed in side by side) to be examined. She said she'd come in a couple of days ago with some fluid leaking and that she had been laboring since then, but that she had vomited a few minutes earlier so she thought she should get it checked out. My friend Maria examined her, but couldn't find her chart anywhere. The charts are all kept in a pile on the table in this room, but they frequently wander off and have to be searched for in other parts of the maternity ward. Maria noted that the mom was two centimeters dilated and was still leaking some fluid, so she ordered the woman to be given a test for malaria and to be observed. Maria was really concerned that this mom had been laboring so long while she was losing fluid- this boded badly for the health of both the mom and the baby. The mom climbed down from the bed, then walked a few feet and then collapsed, convulsing. When the nurses managed to get the mom back onto a bed and check for her pulse and blood pressure, there were none. The mom was gone. No attempt was made to save the baby, whose heartbeat Maria had heard only moments earlier. On fact, the blame for this mother's death landed largely on Maria, even though the nurse who had admitted this mother earlier had failed to register her in the admission book and even though no one had followed up with this mom, in the midst of a complicated labor, for two days. This lack of oversight and management, the complete absence of a system for monitoring mothers at regular intervals, is at least partly responsible for the common deaths of mothers and babies. The babies who die are often kept in a cabinet in the birthing suite until the families come to claim their bodies. I saw four babies either being placed in there or taken from this cupboard. I've only been in the maternity ward for one week.
6/21/11
Tuesday was both better, and worse. I had decided that I didn't want to spend all day in the Theater if nothing was going to happen for most of the time, so after waiting there for a little while for a surgery to happen I went over to the dental clinic, which deserves a bit of a description.
The dental clinic is one small room with a chair, a lamp, a drill that's been broken for 10 years and a whole bunch of pliers. The woman who works there is a dentist who's lived in Iganga all her life, and has been working in this clinic ever since she was trained. Long ago, she filled cavities and cleaned teeth here, but when all of the equipment broke she became a one-stop extraction shop. Five patients file in, one at a time, and after a cursory examination of the tooth that's hurting she gives them each 5mL of lidocaine in the gums and sends them back out into the hall. Then the first (hopefully by now anaesthetized) patient comes back in, and she reaches in with some very scary looking pliers, pops out the tooth quick as you're reading this, and sends them on their way (presumably someone outside the room explains what they're allowed to eat and when to wash the clot out and everything, but it sure doesn't happen in this little room!). The sheer quantity of teeth she pulls is staggering.
Superimpose on this two things. Firstly, many of her patients are children, and they often have to be held down as they're shreiking blood-curdling screams in terror and pain. Secondly, her personality is incredibly quirky. After sending these children away, bloody and tear-stained and at least one tooth lighter, she'll often do something like look at the bloody tooth, then look at me, and ask something like "Am I a savage?" All in all, it was a very weird experience.
Just before lunch, Anne Marie and I went to the main operating theater to see a Caesarean section. Just as it was about to start, however, another surgeon insisted that I come with him to see an adult circumcision, so I missed the C-section as my first-ever observed surgery and saw that instead. As a side note, it was here that I discovered that Ugandans are CRAZY TOUGH. As a surgeon later told us, "Ugandans do not fear even death." Because circumcision reduces HIV transmission rates by 60%, they circumcise as many adults as they can find over here... and in an environment in which the patient is all but forced to watch the entire bloody procedure, this guy joked the whole time, and even took a phone call in the middle of the thing!
Anne Marie had mentioned that the C-section had been pretty intense, and we went into the operating theater after lunch to find that the infant had not improved, and some 2 hours later was still being respirated with a little hand pump, the best the hospital has. He couldn't breathe well on its own, but could gasp about once a minute. He clearly had liquid in his little lungs, but wasn't strong enough to cough it out, and we had no way to remove it. He was very much alive, and in the US, would have been fine - placed on oxygen, put in an incubator, he would have finally gotten strong enough to survive on his own. But the hospital had no oxygen - it apparently costs about $25 to refill, and the hospital hadn't the funds or the means to get to Kampala (3 hours away, and somehow, the only place to refill the tanks). And the hospital certainly had no incubator. Just a little hand pump, and finally, a nurse who got tired of trying. I took over with the pump, and got really, really emotionally involved with this baby's survival. It was incredibly hard knowing that he was probably going to die - feeling him get colder, feeling his pulse get weaker and weaker, watching his lips and gums turn white, but all the while seeing him gasp for air between my rescue breaths, knowing that he wasn't dead yet and shouldn't be. About an hour later, I couldn't feel his pulse anymore. I was devastated. I went around back and for the first time in a really long time, bitterly wept.
I really couldn't get over how insane it was that for lack of a $25 oxygen tank, this baby died. It never would have happened the US - the obstructed labor would have been emergency C-sectioned immediately, not 2 hours later, and the baby would've been rescued with some basic oxygen. And yet. Perhaps the worst part was all the doctors and nurses comforting Anne Marie and I (who were certainly the most affected) with fatalisms. The baby had to die. It was God's plan. We left the hospital early, both pretty heartbroken, and for the first time confronted with the dark side of developing world medicine - all the death.
6/20/11
Monday, we went in to work full of excitement and not having any real idea of what we were getting into. Juliette (the woman who picked us up from the airport) walked us the 10 minutes from our house to the hospital, and as we approached the hospital we saw a collection of one story, slightly shabby buildings connected by outdoor pathways. The buildings were the wards - specifically, there's a Male, Female, Pediatric (< 5), Maternity, Operating Theater, and and Outpatient ward... there are also some other smaller miscellaneous rooms for things like dentistry, opthalmology, a minor operating theater, HIV/malaria clinics, etc.
We walked up to the head nurse in charge of the hospital (we've found that despite a huge lack of doctors, there are MANY nurses, especially student nurses). She showed us around, signed us in, and then basically told us to get to it. I had decided I wanted to spend most of my time in the Operating Theater, and Anne Marie chose to go to Maternity.
The Operating Theater is pretty crazy. Like all the other buildings, the ceiling tiles are missing and the floor is hugely stained and dirty looking, but there's pretty good adherance to sterile technique in the most important areas. Walking in, you remove your shoes and put on sandals. The nursing students were all just hanging out in a sort of lounge talking, and I joined them for most of the morning just waiting for something to happen. I met some awesome people though - Barbara and Paul especially. Finally, an anesthetist came in and began scolding everyone for not having a qualified nurse there teaching us things (which didn't seem to me like any of their faults), and after he left the morning continued to drag on much as before... uneventfully. Finally, 2:00 rolled around (lunch time in Uganda) and Anne Marie and I set out for lunch, just as it began to pour. We get soaked on the run home, and realized as soon as we arrived that we'd left the key to our room at the hospital... so after eating lunch soaked the bone, we returned to the hospital to find that all of the surgeries for the morning had already been preformed while we were out to lunch. I hung around for another couple of hours waiting for surgeries that didn't come, and left around 5:30 feeling a bit disappointed that I hadn't seen anything.
Even though I didn't see any surgeries Monday, I feel like it's as good a time as any to describe surgery in the operating theater. It's nuts. You change from your sandals into big river-wading boots and put on your gloves. The surgeon doesn't scrub in (there's a paucity of running water everywhere in the hospital), but does put on sterile surgeons gloves and has a scrub nurse who puts helps the surgeon into a gown, mask, and cap. The instruments are all well sterilized in an autoclave, but the windows are wide open and dusty air is constantly blowing in. The most common procedure is a Caeserean section, which involves a woman being carted in completely naked and being laid on the one table in the center of the room, atop a plastic tarp. An anaesthetist knocks the patient out with a mixture of ketamine and valium, and sometimes ether. The surgery takes place, and it's a very bloody affair indeed, because there's no suction or anything to clear away the blood (so it just flows all over the patient, surgeon, and floor - hence the river-wading boots). Once the surgery is done, some buckets are filled with water and poured all over the patient to wash off the blood and urine (in C-sections the patient is catheterized, but the tube simply pours onto the patient/floor), and some bleach type liquid they call Jik is mixed in, and poured all over the floor. This is then squeegeed into a drain, and the room is again ready to go. Meanwhile, the patient is carted into a recovery room, where inevitably they wake up moaning or screaming in what appears to be pretty significant pain. Yikes.
We walked up to the head nurse in charge of the hospital (we've found that despite a huge lack of doctors, there are MANY nurses, especially student nurses). She showed us around, signed us in, and then basically told us to get to it. I had decided I wanted to spend most of my time in the Operating Theater, and Anne Marie chose to go to Maternity.
The Operating Theater is pretty crazy. Like all the other buildings, the ceiling tiles are missing and the floor is hugely stained and dirty looking, but there's pretty good adherance to sterile technique in the most important areas. Walking in, you remove your shoes and put on sandals. The nursing students were all just hanging out in a sort of lounge talking, and I joined them for most of the morning just waiting for something to happen. I met some awesome people though - Barbara and Paul especially. Finally, an anesthetist came in and began scolding everyone for not having a qualified nurse there teaching us things (which didn't seem to me like any of their faults), and after he left the morning continued to drag on much as before... uneventfully. Finally, 2:00 rolled around (lunch time in Uganda) and Anne Marie and I set out for lunch, just as it began to pour. We get soaked on the run home, and realized as soon as we arrived that we'd left the key to our room at the hospital... so after eating lunch soaked the bone, we returned to the hospital to find that all of the surgeries for the morning had already been preformed while we were out to lunch. I hung around for another couple of hours waiting for surgeries that didn't come, and left around 5:30 feeling a bit disappointed that I hadn't seen anything.
Even though I didn't see any surgeries Monday, I feel like it's as good a time as any to describe surgery in the operating theater. It's nuts. You change from your sandals into big river-wading boots and put on your gloves. The surgeon doesn't scrub in (there's a paucity of running water everywhere in the hospital), but does put on sterile surgeons gloves and has a scrub nurse who puts helps the surgeon into a gown, mask, and cap. The instruments are all well sterilized in an autoclave, but the windows are wide open and dusty air is constantly blowing in. The most common procedure is a Caeserean section, which involves a woman being carted in completely naked and being laid on the one table in the center of the room, atop a plastic tarp. An anaesthetist knocks the patient out with a mixture of ketamine and valium, and sometimes ether. The surgery takes place, and it's a very bloody affair indeed, because there's no suction or anything to clear away the blood (so it just flows all over the patient, surgeon, and floor - hence the river-wading boots). Once the surgery is done, some buckets are filled with water and poured all over the patient to wash off the blood and urine (in C-sections the patient is catheterized, but the tube simply pours onto the patient/floor), and some bleach type liquid they call Jik is mixed in, and poured all over the floor. This is then squeegeed into a drain, and the room is again ready to go. Meanwhile, the patient is carted into a recovery room, where inevitably they wake up moaning or screaming in what appears to be pretty significant pain. Yikes.
Wednesday, June 22, 2011
6/19/11
We woke up after a delightful night spent in our new pole-less NEMO Meta2P tent, which weighs only two pounds and is incredibly spacious. We walked out the gates of the hostel to get chapatis, a local specialty courtesy of the Indian population here. I had a banana and nutella chapati, and Connor had his with tomato, onion, and an omelet. They come all wrapped up burrito-style and they are delicious. We walked down with Megan to see the actual falls, which were beautiful- there was a guy there offering to take us out onto the Nile in a boat, and then later offering to ride an empty "jerry can" through the rapids "for your entahtainment". Nooooooooo. It's strange to stand out so completely, and to have many people depending upon tourism and your money to make a living. It makes me uncomfortable.
We took a taxi car back to Jinja with Heather, her housemate Chris, and Megan and the five of us roamed around Jinja looking at shops. We had a huge lunch at a local restaurant there and then headed back to Iganga. Jinja is, as Connor said, about an hour ride away from Iganga. It's a much larger but seemingly less crowded town than Iganga, right on Lake Victoria. The best thing about visiting there is probably Chris and Heather's homestay, which has a toilet, a sink, a shower, and a DVD player. Heather's bedroom is also super nice. She has one of those quintessentially safari-like four-poster beds and a really nice dresser area. Now that I've gotten used to our house in Iganga, I'm a little less jealous of this, but still pretty jealous. Let's be real.
We took a taxi car back to Jinja with Heather, her housemate Chris, and Megan and the five of us roamed around Jinja looking at shops. We had a huge lunch at a local restaurant there and then headed back to Iganga. Jinja is, as Connor said, about an hour ride away from Iganga. It's a much larger but seemingly less crowded town than Iganga, right on Lake Victoria. The best thing about visiting there is probably Chris and Heather's homestay, which has a toilet, a sink, a shower, and a DVD player. Heather's bedroom is also super nice. She has one of those quintessentially safari-like four-poster beds and a really nice dresser area. Now that I've gotten used to our house in Iganga, I'm a little less jealous of this, but still pretty jealous. Let's be real.
6/18/11
Before starting I'd just like to add a few Uganda impressions. Like Anne Marie said, it's very dusty and crowded, with lots of mud huts and everything - this is kind of what I expected. I didn't expect all the ads and posters. They have posters of their president and other political figures EVERYWHERE. There are those billboards and ads that she mentioned, mostly for the same five companies, plastered all over. The roads are truly something to see - they're busy and loud, with drivers making frequent use of their horns for safety - with all the pedestrians and bikes on the road, a van coming up at 60 mph ought to blare its horn to be sure they'll get over! The lanes are very much suggestion-only, with drivers passing each other all the time, and no-one blinking at very close calls in which a vehicle in the wrong lane seems to barely miss an oncoming vehicle, making it back into the appropriate lane just in time. The bikes and pedestrians seem to accept that the cars will rush by them with very little space to spare, and on top of it all (if you're us), we have to remember upon hearing these horns to get to the LEFT, not the RIGHT. All in all, it's pretty crazy. There is fruit and food for sale (for cheap!) everywhere, and it's very good. The people are all incredibly friendly, especially the children, who never seem to tire of seeing white people and yelling "MZUNGU!!" and running up and hugging you, or holding your hand as you walk, often for a pretty far distance. We didn't know this coming in, but English is not the main language here. In Inganga, it's Lusoga, though different tribes in different parts of the country speak different Bantu dialects. Lusoga is pretty hard to remember, but many people (and almost all educated people) speak at least some English.
Anyway, we woke up early to catch a Matatu to Jinja, where we'd be white water rafting. We met Emily there, who's volunteering in an orphanage with ELI, but in another part of Iganga. Matatus are awesome - vans that have about 15 seats but never seem to have under 20 people in them. The aisle to get to the back is obstructed by a folding chair to fit even more people in. Everyone takes them everywhere, and they're among the most common vehicles on the streets. It was about an hour ride to Jinja, and we paid 2000 Ugandan Shillings each for the ride (less than a dollar). There we took Bodas to the rafting headquarters where we'd start our journey (Bodas are motorcycles-for-hire that one sits on the back of to get around within a city, and are also very commonly seen on the roads). In Jinja we met Heather (another ELI volunteer).
The rafting itself was very fun, and very touristy - it was almost entirely white people (MZUNGUS!!). After feeding us and taking us where we'd be starting at the source of the Nile, we began our adventure. Sadly our ELI group got split up, and Anne Marie and I ended up with five very strange people volunteering with another group in Kampala. We had a great time though - the rafting was probably slightly less intense than the New River in West Virginia, but we were on the NILE! It was very beautiful - lots of amazing views, and tons of birds everywhere. Our guides were about half Ugandan and half South African, and were in general very fun. We had a delicious lunch of biscuits and the best pinapple I've ever eaten, and after lunch our raft got flipped in one of the rapids - excellent!
When we finished we were fed an amazing barbequed dinner, and given free beer. This turned out to be extraordinarily cruel, as we then got put on a bus for over an hour as we made our way back up the river - by the end, the bus was nearly in revolt as we begged for the opportunity to go to the bathroom (Anne Marie was leading said revolt). Once pacified, however, we found ourselves at a delightful little campsite and hostel at Bujagali Falls. Anne Marie and I set up our tent, and we all met up at a little pavillion-turned-club for drinks and second dinner. The pavillion was pretty strange, but fun - they had loud, mostly American music blaring as we ate and drank until inevitably, some people started dancing and singing along. Anne Marie and I were pretty tired after only one night's sleep, so we went to bed early... though the incredibly loud clubbing music kept Anne Marie awake long into the night.
Anyway, we woke up early to catch a Matatu to Jinja, where we'd be white water rafting. We met Emily there, who's volunteering in an orphanage with ELI, but in another part of Iganga. Matatus are awesome - vans that have about 15 seats but never seem to have under 20 people in them. The aisle to get to the back is obstructed by a folding chair to fit even more people in. Everyone takes them everywhere, and they're among the most common vehicles on the streets. It was about an hour ride to Jinja, and we paid 2000 Ugandan Shillings each for the ride (less than a dollar). There we took Bodas to the rafting headquarters where we'd start our journey (Bodas are motorcycles-for-hire that one sits on the back of to get around within a city, and are also very commonly seen on the roads). In Jinja we met Heather (another ELI volunteer).
The rafting itself was very fun, and very touristy - it was almost entirely white people (MZUNGUS!!). After feeding us and taking us where we'd be starting at the source of the Nile, we began our adventure. Sadly our ELI group got split up, and Anne Marie and I ended up with five very strange people volunteering with another group in Kampala. We had a great time though - the rafting was probably slightly less intense than the New River in West Virginia, but we were on the NILE! It was very beautiful - lots of amazing views, and tons of birds everywhere. Our guides were about half Ugandan and half South African, and were in general very fun. We had a delicious lunch of biscuits and the best pinapple I've ever eaten, and after lunch our raft got flipped in one of the rapids - excellent!
When we finished we were fed an amazing barbequed dinner, and given free beer. This turned out to be extraordinarily cruel, as we then got put on a bus for over an hour as we made our way back up the river - by the end, the bus was nearly in revolt as we begged for the opportunity to go to the bathroom (Anne Marie was leading said revolt). Once pacified, however, we found ourselves at a delightful little campsite and hostel at Bujagali Falls. Anne Marie and I set up our tent, and we all met up at a little pavillion-turned-club for drinks and second dinner. The pavillion was pretty strange, but fun - they had loud, mostly American music blaring as we ate and drank until inevitably, some people started dancing and singing along. Anne Marie and I were pretty tired after only one night's sleep, so we went to bed early... though the incredibly loud clubbing music kept Anne Marie awake long into the night.
6/17/11
We suffered through another red-eye and arrived in Addis Ababa, Ethiopia early the next morning. From our plane, we were shuttled to another terminal, where we waited in some weirdly long, slow lines to get through security and into the gate. There, we were trapped without water or a bathroom for a couple of hours waiting for our flight to leave for Entebbe.
Happily, it did leave! We arrive in Entebbe noonish and filed into passport control. Oddly, the line for Ugandans was much longer, slower, and pushier than the line for other passports. At passport control, we were asked for money for our visas, which we were expecting. What we were NOT expecting was to be asked for it ($100 for both of us) in $US cash. They actually sent us by ourselves out through security and customs to withdraw cash in Ugandan shillings, which we then had to get changed to $US, and then we waltzed freely back through security without so much as a glance from the guards (who all had AK-47s). It was surreal.
Once this was all dealt with, we picked up our bags and walked easily through customs to meet our guide, Juliette in the arrivals area. She and a driver escorted us on the long haul from Entebbe, through Kampala, several other towns, Jinja, and then finally to Iganga.
The drive only took three and a half hours, but it was really, really crazy.
Our driver was probably crazier than the average Ugandan taxi driver, which is itself already crazy-craze. It really reminded me of Manaus in Brazil, except that instead of going forty miles per hour in the city there, here we were flying across opposing lanes of traffic at close to 90 miles per hour. Connor was actually helplessly asleep during much of this harrowing drive, having slept NOT AT ALL on any of our previous flights.
So, for first impressions of Uganda. This is very difficult to describe. Connor's first impressions were of all of the garbage in the cities, lots and lots of red dust, and of people everywhere all along the roads. I was struck by the fumes and dust as well, and by the cottage-industry/farming that predominates everywhere. Instead of contained shops and businesses, everything spills directly out into the paths and streets- metal-workers in Kampala were all crowded together next to people repairing motorcycles, those driving past, and pedestrians. It's just a sensory-overloading mash of people and activities in any of the more urban/town-y areas.
We were really impressed by the fruit and vegetables for sale everywhere, and by the lushness of the landscape, which is actually undergoing a draught right now but is still very green. Cows, chickens, goats and turkeys roam plentifully and freely.
Most of the buildings are made from the same local bricks, which seem to also be made in giant kilns in a cottage-industry fashion. Some of the buildings are painted, but the ones that are tend to be painted by businesses advertising in very bright colors. The most common colors are yellow for MTN (the national phone service) red for Crane Bank, and Blue for a couple of other businesses.
We found that Iganga is a bigger rural town, bigger than we were expecting. We drove off of the main road, which is paved and really well maintained, to the dirt side paths leading to our homestay. Our house is quite large and extremely basic, all on one floor with a front courtyard and an inner courtyard, all concrete. We were very surprised to discover that we are actually staying in a homestay with three other ELI volunteers, Jennie who works at the hospital with us, and Anna and Megan, who work in microfinance a short taxi drive away.
Connor and I are staying in a room with a mosquito net over a very basic wood-frame bed with a thin mattress over it (his back hasn't been appreciating this very much, so we're going to try putting our Thermarests down as well). Other than the bed, our room has a concrete floor, a light, and an outlet. In the back courtyard, there are latrines with deep "pits" that you squat over, and two areas for bucket-bathing. Our host mom is called Jessica, and she has two young adult children, Winifred (Winnie) and Herman. The living room where we take our meals has a couch, a chair, a coffee table, and a tv. I really didn't expect to appreciate the tv, but it turns out I do. It's really nice to watch AlJazeera for news every morning and feel like I have an idea of what's going on outside Iganga.
We were expecting to be able to sleep in the next day, but were made an offer we couldn't refuse...white-water rafting on the nile with the other volunteers.
Happily, it did leave! We arrive in Entebbe noonish and filed into passport control. Oddly, the line for Ugandans was much longer, slower, and pushier than the line for other passports. At passport control, we were asked for money for our visas, which we were expecting. What we were NOT expecting was to be asked for it ($100 for both of us) in $US cash. They actually sent us by ourselves out through security and customs to withdraw cash in Ugandan shillings, which we then had to get changed to $US, and then we waltzed freely back through security without so much as a glance from the guards (who all had AK-47s). It was surreal.
Once this was all dealt with, we picked up our bags and walked easily through customs to meet our guide, Juliette in the arrivals area. She and a driver escorted us on the long haul from Entebbe, through Kampala, several other towns, Jinja, and then finally to Iganga.
The drive only took three and a half hours, but it was really, really crazy.
Our driver was probably crazier than the average Ugandan taxi driver, which is itself already crazy-craze. It really reminded me of Manaus in Brazil, except that instead of going forty miles per hour in the city there, here we were flying across opposing lanes of traffic at close to 90 miles per hour. Connor was actually helplessly asleep during much of this harrowing drive, having slept NOT AT ALL on any of our previous flights.
So, for first impressions of Uganda. This is very difficult to describe. Connor's first impressions were of all of the garbage in the cities, lots and lots of red dust, and of people everywhere all along the roads. I was struck by the fumes and dust as well, and by the cottage-industry/farming that predominates everywhere. Instead of contained shops and businesses, everything spills directly out into the paths and streets- metal-workers in Kampala were all crowded together next to people repairing motorcycles, those driving past, and pedestrians. It's just a sensory-overloading mash of people and activities in any of the more urban/town-y areas.
We were really impressed by the fruit and vegetables for sale everywhere, and by the lushness of the landscape, which is actually undergoing a draught right now but is still very green. Cows, chickens, goats and turkeys roam plentifully and freely.
Most of the buildings are made from the same local bricks, which seem to also be made in giant kilns in a cottage-industry fashion. Some of the buildings are painted, but the ones that are tend to be painted by businesses advertising in very bright colors. The most common colors are yellow for MTN (the national phone service) red for Crane Bank, and Blue for a couple of other businesses.
We found that Iganga is a bigger rural town, bigger than we were expecting. We drove off of the main road, which is paved and really well maintained, to the dirt side paths leading to our homestay. Our house is quite large and extremely basic, all on one floor with a front courtyard and an inner courtyard, all concrete. We were very surprised to discover that we are actually staying in a homestay with three other ELI volunteers, Jennie who works at the hospital with us, and Anna and Megan, who work in microfinance a short taxi drive away.
Connor and I are staying in a room with a mosquito net over a very basic wood-frame bed with a thin mattress over it (his back hasn't been appreciating this very much, so we're going to try putting our Thermarests down as well). Other than the bed, our room has a concrete floor, a light, and an outlet. In the back courtyard, there are latrines with deep "pits" that you squat over, and two areas for bucket-bathing. Our host mom is called Jessica, and she has two young adult children, Winifred (Winnie) and Herman. The living room where we take our meals has a couch, a chair, a coffee table, and a tv. I really didn't expect to appreciate the tv, but it turns out I do. It's really nice to watch AlJazeera for news every morning and feel like I have an idea of what's going on outside Iganga.
We were expecting to be able to sleep in the next day, but were made an offer we couldn't refuse...white-water rafting on the nile with the other volunteers.
6/16/11
Today we woke up bright and early, only slightly grumpy not to be sleeping in (mostly me, I guess) but nonetheless excited for a thrilling day of adventuring in London. We had a tasty breakfast with Susie and her mother (who come in to take care of Kit, who is outrageously cute by the way) and hopped on a bus with Sam as he went to work. After dropping off our luggage at his office, we were ready to explore downtown London!
Unfortunately, no sooner had we stepped out into the streets of London than it started pouring. But no amount of rain could quench our spirit. We started at a little coffee place that Anne Marie knew called Monmouth, then went across the street to Borough Market, a really awesome open-air market. We got some breakfast and some snacks for later at the airport, as well as a delicious beef pasty.
We then wandered up the Thames to the Tate Modern, where I realized that I was still really tired from the sleepless red-eye. I forced myself to enjoy the art nonetheless, which was actually really amazing. We considered taking the Tate boat up the Thames to Tate Britain, but decided we'd have more time for such things on the return journey.
It eventually dried up, and we spent most of the afternoon walking the Thames and seeing the sights. We walked through St. James Park, saw Parliament, considered getting on the London Eye... and eventually found ourselves at the National Gallery. It's been a long time since I've been to London, so I'm not sure if I've already seen them, but I really enjoyed the beautiful art at the National Gallery.
We finally grabbed some dinner at a neat little pub, where we split a meat pie and got a free beer (woo London!), and said goodbye to Sam. After an hour long trip through the underground to Heathrow, we were ready to go to Africa.
Our flight out of Heathrow was at 9, with Ethiopian Airlines. I'd just like to say here that while we were worried about the comfort/service/safety of an African airline compared with US airlines, Ethiopian Air was WAY better than Delta! More leg room, better service, and neither crashed. I wish Ethiopian Air was in the US!
Getting excited for Uganda....
Unfortunately, no sooner had we stepped out into the streets of London than it started pouring. But no amount of rain could quench our spirit. We started at a little coffee place that Anne Marie knew called Monmouth, then went across the street to Borough Market, a really awesome open-air market. We got some breakfast and some snacks for later at the airport, as well as a delicious beef pasty.
We then wandered up the Thames to the Tate Modern, where I realized that I was still really tired from the sleepless red-eye. I forced myself to enjoy the art nonetheless, which was actually really amazing. We considered taking the Tate boat up the Thames to Tate Britain, but decided we'd have more time for such things on the return journey.
It eventually dried up, and we spent most of the afternoon walking the Thames and seeing the sights. We walked through St. James Park, saw Parliament, considered getting on the London Eye... and eventually found ourselves at the National Gallery. It's been a long time since I've been to London, so I'm not sure if I've already seen them, but I really enjoyed the beautiful art at the National Gallery.
We finally grabbed some dinner at a neat little pub, where we split a meat pie and got a free beer (woo London!), and said goodbye to Sam. After an hour long trip through the underground to Heathrow, we were ready to go to Africa.
Our flight out of Heathrow was at 9, with Ethiopian Airlines. I'd just like to say here that while we were worried about the comfort/service/safety of an African airline compared with US airlines, Ethiopian Air was WAY better than Delta! More leg room, better service, and neither crashed. I wish Ethiopian Air was in the US!
Getting excited for Uganda....
6/15/11
We arrived in London in the middle of the day, and I confidently led Connor down to the Underground to top up my Oyster card and buy him a new one. Mysteriously, our debit cards and credit cards were callously rejected by the Oyster top-up machine. Our confidence fell dramatically. We wisely tried a very very small amount on the machines, which was accepted. This has been the only instance of our cards being rejected so far...and I can only offer a gentle criticism of the Oyster machine at Heathrow- many or most of your customers are tourists. Get it together! It's a bit disconcerting to arrive, red-eyed, and have your main form of money turned away.
We expertly navigated our way to Sam's office, had a quick coffee with him, and then headed over to his house to sleep off the pain. We woke up rewarded by Kit's happy bath gurgles, and spent the rest of the evening talking with Sam and Susie and enjoying a delicious dinner. As you might expect, our conversation took a political turn...
We expertly navigated our way to Sam's office, had a quick coffee with him, and then headed over to his house to sleep off the pain. We woke up rewarded by Kit's happy bath gurgles, and spent the rest of the evening talking with Sam and Susie and enjoying a delicious dinner. As you might expect, our conversation took a political turn...
6/14/11
Today Anne Marie woke up in Columbus and was super helpful by getting all of my stuff together.
Meanwhile, I woke up in Florida and caught an early flight to Columbus, through Baltimore. After a few hours of mad scrambling in Columbus we headed to Ben and Julie's house to say goodbye to everyone. We had a few delicious beers, and the girls surprised us with a fun chalk picture of us on a plane to Uganda! Patrick even came over from work to say goodbye with Owen and Catalina.
Julie, Mandy and the girls all drove us to CMH, where we flew to Altlanta, had a short layover, and got on the red-eye to London! Woo hoo!
Meanwhile, I woke up in Florida and caught an early flight to Columbus, through Baltimore. After a few hours of mad scrambling in Columbus we headed to Ben and Julie's house to say goodbye to everyone. We had a few delicious beers, and the girls surprised us with a fun chalk picture of us on a plane to Uganda! Patrick even came over from work to say goodbye with Owen and Catalina.
Julie, Mandy and the girls all drove us to CMH, where we flew to Altlanta, had a short layover, and got on the red-eye to London! Woo hoo!
Monday, June 13, 2011
Getting Ready
Hey all!
Not much to say here, just wanted to test out the blag - the most awesomely excellent way to hear about the most intrepid adventures of Connor and Anne Marie.
Dear reader, when we're fighting off the lions in the Savannah, you'll be the first to know. When we're trekking for gorillas or climbing Kilimanjaro, you'll hear about it. This blog will make you laugh, and it will make you cry; it will inspire and terrify you; you should probably just set it as your home page now.
We leave tomorrow!
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