The Miracle of Life/Passing my first medical exam

While I have not had a chance to write out an entry for my trip to the Lake Mburo Wildlife Reserve or the first week of visiting rural health centers, I had to post the following out of excitement.

Today, I personally witnessed the miracle of life. More specifically, I witnessed the surgical miracle of life. A patient at Mayanja Memorial Hospital delivered her 4th child through her 3rd and last C-section, and the surgeon, Dr. Mugerwa, who is actually an OB/GYN and also the founder of the Mayanja Memorial Foundation and Hospital, allowed me and my teammember Gregory to be present at the surgery. I have been present at one minor surgery before in the US, but never in my wildest dreams did I think I would witness such an intense procedure in person until medical school - and this birth was really quite intense. While I imagine that labour and normal birth is quite an intense process, watching the entire swiftness, aggression, and bodily matter involved in the operation was incredibly fascinating and incredibly amazing. However, its intensity pailed in comparison to the shock and awesomeness of watching the unfortunately breech positioned baby being removed from the uterus by its feet, essentially being yanked out when its head got temporarily stuck in the opening of his mother's belly, and then seeing it breathe and cry for the very first time.
Additionally, I was able to see the mother's entire reproductive system, and then watch the mother lose her fertility for the rest of her life as her tubes were tied.

Talk about an amazing day! Additionally, I feel it marks the passing of my first medical school aptitude test - I did not feel queasy nor did I look away. So blood, fat, babies, umbilical cords, and placenta - check!

First Observations

The view from Mayanja Memorial Hospital, located atop a hill in Mbarara. And yes, the sky looks like that everyday here =).


Once again, this was written a while ago...but I didn't have a chance to access sufficiently fast internet to post until today....

A Home on a Hill

This past week we became familiar with our new home for the next few months, the city of Mbarara. We are living in a large hostel on a hill which usually serves as a housing option for students of the nearby Mbarara University of Science and Technology. Few students are to be found roaming the halls with us, however, because they too are on vacation and only a few have stayed for summer work. For now, I will just say that daily life in Uganda is definitely different than back home, but I have enjoyed the beginning of the acclimation process thus far and I hope to dedicate a later entry on the details about our surroundings and mundane activities.

Holy Family Seminary in Masaka

Before I begin talking about Mbarara and our work here, I should mention that in addition to the equator landmark, we stopped at the Holy Family Seminary, where one of our on-site coordinators, Peter, graduated from in his youth (he is now an ordained priest studying in the Duke Divinity School). The students and administration were all very welcoming and they greeted us with their student band as well as a great meal which we shared. A couple of the older students gave us a tour of their home. The facilities were modest, and yet the boys seem to have a very well rounded and spiritual, healthy life while they study at the seminary. Below is a picture of my new friend Xavier and myself.

Safe Motherhood

Monday marked our first day working with our project community partners, the staff of Mayanja Memorial Foundation and Hospital, who serve the community of Mbarara and surrounding areas as a private health care center and collaborate with government health centers in rural towns surrounding Mbarara. Monday was also the first day, or the launch, of their newest community healthcare intervention, Safe Motherhood. The program started off with a week of free antenatal care services for any pregnant women in the Mbarara municipality who show up to the hospital Monday-Thursday, and it will proceed with over a month of weekly visits to four different rural health centers where similar but not all the services will be provided free of charge to any women who show up, given that there is enough time to see them. The program is supported by various members of local government, the Mayanja Memorial Hospital Foundation, Mbarara University of Science and Technology, and Duke University, particularly the Progressive Healthcare Partnership, the student organization which masterminded this Duke Engage project, fundraised, and acquired grants (everyone on the team is a member through their participation in DE).

All the institutions gathered at a formal launch celebration on Monday where we had representatives from all the different institutions give a short speech (David and I spoke for the Duke Engage students), and there was even a parade held where many of us, the DE students, and members of the other institutions, plus a small marching band, walked into town to spread the word about the program.

The health education tent outside Mayanja Memorial Hospital at the Safe Motherhood week in Mbarara.

As students, our involvement in the Safe Motherhood program this week included observing and sometimes assisting in registration, health education talks, physical examinations, ultrasounds, doctor’s consultation, laboratory work, and counseling during the day, and after lunch we were able to attend some guest lectures on the health care system of Uganda, the prevention of mother to child transmission of HIV, HIV in Uganda, the influence of culture in antenatal care, and the formation of the hospital and foundation. Many mothers were served this week and we hope that this intervention will continue to be as promising.

Paul, one of my teammates, practices measuring blood pressure on Jesse, another team member.

Sister Jackie, a nurse at Mayanja Memorial Hospital, and another hospital employee, educate the mothers about antenatal care.

Next week, we DE students will be once again observing the health workers; however we will be in rural health centers. We will also be continuing with more work that is necessary before we can implement a couple of contributions we would like to make to the Safe Motherhood campaign that are in addition to some of the medical equipment and mosquito bed nets that PHP has already been able to donate upon our arrival. One project involves creating, translating, and conducting a baseline community survey that will allow us to assess various factors related to antenatal care issues in this region of the country so that future interventions can be improved and tailored to address any issues that may be found to be of importance for these mothers, and also so that when applying for grants we may have useful and telling information that will allow the institutions to get support for future community outreach. Also, we are looking to possibly use the survey or create another way to assess the effect of the current intervention. Another project involves conducting focus groups with pregnant mothers and other members of the community to have more open ended discussion about antenatal care and related issues (such as family planning). We will also be working closely with a couple of students from the local university, as most of our respondents and participants in these projects will not speak English, instead Runyankole, which is the most common local language in this part of Uganda. In case I had not mentioned this explicitly before, the official language of Uganda in universities, the government, industry and secondary schools, etc. is English (inherited from the time when Uganda was a British colony), but most rural people are much more familiar with Runyankole. As time goes by, perhaps the group will be able to find other useful projects to work on while we are here, but even the healthcare workers can use extra hands in taking down records in order to serve more women daily, so that will be keeping us busy for now as well.

Weekends

Today, Saturday, was a day of rest for the group, and as most weekends will be while we are here, they are very flexible and relaxed. Two of the girls went to visit the hometown of one of our new university friends, Becky, in Kebale (sp?) and they will be spending the night. The rest of us went into town for lunch at an Indian restaurant (a nice change of pace from the traditional Ugandan food), and some of us hung around before we went back to just chill at the hostel. My friend Jesse and I stopped at a park and he was brave enough to invite himself to a casual game of football with some local children.

Jesse playing some football with locals.

Tomorrow, Sunday, most of the remaining students including me will be going to Lake Mburo Park, a wildlife reserve….which I am very excited about. More to come soon…

On its way

Another post is on its way, and I have yet to upload pictures from my camera's internal memory that have more scenery, but until then, I am taking advantage of some unexpectedly fast internet speed and I wanted to post the following pictures.



The view from Mariembe (sp?) Cathedral in Kampala, the capital of Uganda, and my friend and teammate, David.


The equator landmark on the way to Mbarara from Kampala - and yes, I AM standing on both hemispheres at once, all while in my adventurer UPF 30 pants.

ARRIVAL - almost a week later due to the limited access of internet

June 4, 2009

After a long journey totaling approximately 24 hours including about 20 hours of flight time, we finally arrived at the airport in Entebbe, Uganda, on the night of June 3^rd, where one of our On-Site Coordinators, Peter, was waiting for us. The city of Entebbe is about 30 minutes from the capital, Kampala, and we are currently about to spend our second night in the Golf View Inn in Entebbe (sleeping under a mosquito net, of course), where the students, Peter, and another O.S. Coordinator, Jacques, as well as our Faculty Coordinator, Dr. Alex, are staying for the first couple of nights in the country.

Kampala

The agenda for today led us into Kampala for a day filled with visits to many places of interest. Although the surrounding area was not very visible last night, we were able to observe the landscape on the way to the capital. I was not sure what to expect the city to look like, but a few minutes on the road revealed a landscape of lush, rolling land filled with a diversity of trees and foliage, thousands of homes scattered on the hillsides, and a main road lined with thousands of small shed-like stores and houses pressed against one another. Another highlight was the presence of many birds, ranging from small sparrow-sized species to huge stork-like creatures, all of whom were surprisingly more than comfortable hanging out on buildings in even the most crowded and urbanized areas of the city.

The Uganda Museum

After exchanging US dollars for Ugandan shillings at the Forex Bureau at the Grand Imperial Hotel, we proceeded to our first stop, the Uganda Museum. The museum itself was an eclectic mix of exhibits that pertained specifically to Uganda and its history as well as additional exhibits explaining the science or research of topics somehow related to the nature, resources, culture, and life of Uganda. Although not a large museum in contrast to what you may find in large cities of the US, the various halls showcased more than we had the time to see. Out of all the exhibits, I think I enjoyed those showcasing the various tribes and anthropological history of the Ugandan tribes the best, as these exhibits had some of the most fascinating artifacts. Another nice area was that showcasing traditional music, where we even had a chance to try out some traditional instruments.

Above you can see some traditional recreation tools from a variety of Ugandan tribes.

Mulago Hospital

Our next stop was Mulago hospital, one of the best and largest government-funded hospitals in the country, where over 800 patients were being treated in a facility designed to care for 600. After getting lunch in a small restaurant in the hospital, one of our community partners, Dr. Ben, led us through a tour of the facilities. The various healthcare workers we met through the tour showed us around various departments of the hospital and told us about the most common health problems of their patients, including malaria and diabetes. We also had the opportunity to look into a couple of wards where many patients lay in beds close to one another, without much privacy, while family members provided individual care which the hospital does not have the manpower or resources to give its patients, such as meal preparation, cleaning, and such assistance. The wards, however, do not have enough beds for all patients, and many of them were in beds in the halls or on mats on the floors, accompanied by family members who were either with them during visiting hours or camping out on the floor of small lobbies while doctors and nurses made their rounds. At the end of the tour, we stopped by the sixth and highest floor of the hospital, where patients who are able to pay for their healthcare can stay and be treated in private, cleaner, more attentive areas during their hospital stay.

Makerere University and the Bull with a Leg Growing Out of Its Back

Following the hospital visit, while 4 members of our group spoke to leaders in the Ministry of Health about our project proposals, the rest of us went to Makerere University, where we visited the computer and information technology department as well as the veterinary faculty, which housed departments of veterinary medicine, microbiology, molecular biology, wildlife management, and others. There we spoke to some students researching Trypanosome, the protozoan responsible for sleeping sickness, which is spread by the Tsetse fly. We were even able to visit some of their labs, where despite the limited resources they have for conducting biomedical research, the staff is making important contributions to the understanding of the protozoan’s biology in order to better identify particular strains of the pathogen and to isolate proteins that are necessary for its survival. This will ultimately increase the surveillance, prevention, and treatment of the disease. Additionally, we visited a lab researching and contributing to the surveillance of H5N1 influenza, the avian flu, which has not actually ever been observed in Uganda, but serves as part of a task force created in response to the outbreak in Southeast Asia a few years ago. This lab was significantly more modern and better equipped, which may be explained by its funding from the Walter Reed Foundation. While at the university we were also able to see the surgery theaters for small animals and pets, as well as look at the area where experimental animals were kept outside from a distance. This was the home of the most fascinatingly bizarre animal I have ever seen, an Ankole bull with AN EXTRA LIMB GROWING OUT OF ITS BACK.

There are two schools of thought as how this came about – either another fetus in its mother’s womb merged with him and became incorporated into its body, or it might be due to a genetic or developmental defect. Either way, it is awesome.

Finally, we also visited the largest Anglican cathedral in the country. It was interesting to hear during the short tour of the cathedral was the influence of history and colonialism in the spirituality and religiosity of the protestant sector of Ugandan society and to observe the impact it must have today.

Well, tomorrow we leave for Mbarara, the city where we will actually be working in for the summer. Until next time, I hope to find some internet source so that I can actually post this entry. But please feel free to comment and ask any questions or let me know what kind of things you want to be hearing about. I realize this was a long entry but there was so much I didn’t want to skip. I hope you are all well!

Quick update.

I am now in Mbarara, Uganda, where I will be for the next two months with the Duke Engage cohort. So far we have been very busy around here for the past few days and prior to our arrival to this city we were in Kampala, the capital.

This is my first chance to get online since my arrival in Uganda so I apologize for not posting, but I have written some blog posts on my laptop and I will post those as soon as I get direct access to internet from it. Right now I am at an internet cafe.

Let me assure you that our stay here so far has been incredibly nice and this is due to the kindness of our hosts. Everyone is safe, healthy, and happy.

I hope anyone following this is having a great time in their respective homes or current locations!

And beyond

Welcome to my travel blog, which begins today as I prepare to embark on my journey to Uganda through the Duke Engage program.
I hope to that as I learn through my travels, I will be able to publish interesting and reflective posts that will preserve memories, organize my thoughts, and contribute to my global education and hopefully that of my readers.
I also hope to keep posts as short as they can be without compromising the stories and thoughts.
Thanks for stopping by!