Fall Break = Spring Break

It is now November and it’s only been about 2.5 weeks since we started classes again after Fall Break. Even so, I can already feel that we have entered the last month of the program. We are currently at La Selva Biological Station, where we have never stayed before, and it is definitely my favorite. But I will talk more about La Selva after we leave, because first I need to talk about what I did with my week off.

Tamarindo

For Fall Break, we were set free to go wherever we pleased. Some people in the program traveled around San Jose and surrounding areas in a small group, others met up with their families to vacation on Costa Rica beaches, one person went home to visit loved ones, and 9 of us pooled some money and made Tamarindo, a beach on the Pacific side of Costa Rica, our destination.

Before I can talk about the actual vacation, it is worth mentioning how unusually and absurdly difficult our trip there became. We had to get there from Palo Verde, the station we had been staying in. So, the course bus took us to the nearest town with a bus station – Bagaces. From there, we just had to take a bus to Liberia, and then take a bus to Tamarindo from there. So, we got on the first bus displaying Liberia on its front. Unfortunately, it turned in the wrong direction – as it turns out, it was coming from Liberia. Fortunately, we noticed after one bus stop. So we got off this bus, had to unload our bags from underneath it, and crossed the highway to the opposite bus stop. There we waited for 30 minutes before a bus to Liberia came, but it did not stop. Then in a little under another 30 min, a bus came going to Liberia. Finally, we got on the bus and made way towards Liberia – but one stop before we got to the bus station there, two people rushed out of the bus, taking two bags belonging to some of the girls in our group. This definitely put a damper on our day. But not as much as when the bus hit a parked car in a rainstorm and we had to sit there for three hours waiting for an ambulance to come and check on the people in the car, and a police officer to write a report. Luckily, no one was hurt, but regardless we still had to wait for all of this to happen, and then we were switched to a different bus. Why this did not occur to them sooner continues to puzzle me, but that’s how it went. After a long day and about 5 hours of unforeseen delay, we finally made it to Tamarindo, and after a little confusion on behalf of our taxi drivers, we finally found the house we were renting.

Tamarindo is like heaven on Earth. The beach is straight out of a postcard - blue waters, hot sun, white sandy beach, palm trees, and a tropical rainforest backdrop in the distance. Behind the line of trees between the beach and the town, you find a small commercial area completely dedicated to the tourism in the area – so dedicated, that almost every sign is written in English and everyone’s prices are in dollars. And much more expensive than anywhere else in Costa Rica, it seems. So while we were getting a great deal on low rent because it was the off season, and the weather was perfect regardless, going out to eat and paying for guided activities seemed a little bit out of our budget. So, each day two of us prepared dinner for everyone and we went to the grocery store and stocked up on breakfast and lunch snacks, and on some days we had lunch or dinner out. Most of our time was spent out on the beach laying out and reading in the sun, swimming in the comfortable Pacific waters, and exploring little shops in town. One day, we even rented some snorkeling gear and kayaks to reach a nearby island. Upon reaching it, we found it was covered in massive shells and conchs, as well as many hermit crabs. The waters around it had many pretty fish which were hard to spot on the somewhat cloudy day and amongst the seaweed – but nevertheless, we saw many and it was one of my favorite ocean experiences ever, having been only the second time I ever snorkeled.

We did run into some trouble in Tamarindo – for example, the bathrooms in the house we were renting overflowed and started seeping sewage – then the landlords brought someone in to fix it, which involved removing the toilet bowl and replacing it – but the next day, the same thing happened. This was the last straw, and so the owner moved us to a bigger, nicer house.

In the Thick of Things

After San Jose, the group traveled once more to Las Cruces Biological Station, where we stayed for another 2 weeks and completed our project proposals and had all the lectures that we would be tested on in our midterms. Following this stay, we spent 3 days in Nicaragua, where we stayed at the charming Hotel Granada in the most wonderful little colonial town of Granada. In addition to having the opportunity to see some of the history of the town, we were able to visit a variety of places related to the health sector of Nicaragua (even in the capital not too far away, Managua), the crater of an active volcano at Masaya, and a sleuth of nightlife hotspots. We then proceeded to spend 4 days in Palo Verde Biological Station, which is a natural reserve of flood plains and other types of wetlands. The first two days there were spent studying on our own for our midterms, and then on the other two days we had a couple of classes and some exciting activities which I have briefly summarized below. Those are activities I STRONGLY recommend you read.

After Palo Verde, we were let loose to go wherever we wanted because it is now our FALL BREAK. Nine of us are currently vacationing in the most wonderful surfer town, Tamarindo, which is full of tourists, expensive food and activities, and days on the most gorgeous beach I have ever seen, perhaps second to Waikiki in Hawaii. Pictures and details to come. It deserves its own entry, for sure. Maybe the best vacation I have ever taken – definitely the best I have ever taken without my family. Oh, adulthood. Although, our trip so far has not been the most fortunate…yeah, that’s another story you’re going to want to read.

Field Trips and Activities

Las Cruces Biological Station

Boruca, a town of the Brunka indigenous community. We spent half a day visiting this indigenous community who graciously agreed to not only give us an opportunity to speak to them and shop some of their most beautiful handicrafts, which is a large part of their community’s income, but also showed us how some of them are made using traditional methods. For example, they create a lot of textiles from cotton and natural dyes. Although the cotton they now use for convenience is manufactured by a company outside of the community, they still dye it themselves and during our visit we were able to participate in the process. The dyes were essentially made by boiling specially selected and prepared plants. Different plants were mixed for different tones and the length of time the cotton was boiled affected the shade or intensity of the color. It was fascinating to see plants which all looked green prior to undergoing the process produce red, blue, and yellow dye. The best color by far was the purple. The Brunka collect this special color once a year in a special trip to the ocean. There, they send men into rocks next to cliffs to seek out and find special snails. When startled (like when they are picked up and blown on by a human, for example), the snails urinate. The cotton threads are soaked in this urine, which at first looks yellow. After drying in the sun, however, the snail urine dye becomes purple!

Ngobe family visit. One afternoon, a traditional healer, his partner, and their granddaughter visited the station to chat with us about their culture, particularly that of medicinal plants and traditional healing, and their handicraft business. They showed us how they make a cocoa drink from fresh roasted beans which tastes very funny until you add lots of sugar (which they don’t actually do), and then it tastes just like hot cocoa. It is very caffeinated and certainly gives you quite a rush. One of the most fascinating parts of their visit was seeing the traditional healer identify and describe the use and purpose of so many of the indigenous plants we had marked in sections of the botanical garden we had sampled earlier for an ethnobiology course activity. He had an incredible wealth of knowledge which really brought the theoretical parts of our course to life.

Social Security offices in San Vito. Paid a short visit to the administrative offices of the San Vito branch of the social security system and made contact with staff that could potentially helps us in our future research projects.

Bioprospecting scavenger hunt. Fun activity we did in the gardens where groups searched for “active compounds” (small trinkets in jars) with medicinal or marketing potential around the grounds of the station. Some groups used the ethnobiological method (simulated by interviewing people around the station) and others did random sampling (aimlessly looked around for the objects). At the end, it wasn’t just about how many each group found, but how many useful ones (only certain trinkets) they acquired.

Nicaragua

Visiting parts of the health system. In a short trip to the capital city, Managua, we visited a couple of the administrative buildings and laboratories of the ministry of health. While no where near the level of those in Costa Rica, they are definitely set up to make a lot of progress in the next few years.

Masaya Volcano. Prior to this visit, I had never been at the mouth of an active volcano. While it was more of a smoky crater, and there wasn’t any lava or anything to see, we were definitely in close proximity to what colonists/missionaries who encountered this volcano referred to as “the mouth of hell.” We were not allowed to stay in the observatory longer than 20 min because the fumes were not exactly good for humans. Amazingly, there are some parrots that have adapted to these dire conditions and they now live in the walls of the crater. I didn’t see any, but there was a display about them in the Park Museum.

Granada carriage rides and colonial hotels. The town we stayed in, Granada, is really old and full of colonial charm as its basically entirely still in the colonial architecture. The hotels and other locales take advantage of this quaint charm and have remodeled and developed this area to make it a big hit with foreigners. For example, we stayed at Hotel Granada, which was once a convent and is now a huge hotel with a swimming pool and a small art gallery. One main street leading to the main square is dotted with bars, hotels, and restaurants. During the day, you can do what we did and take a horse-drawn carriage ride and tour the city to see highlights like old parks, the abandoned hospital, more awesome old buildings, and such.

Granada nightlife. As mentioned, there is a main street with many bars and the like. It ranged from simple bars to grills to even an Irish bar – which happened to have the best happy hour specials, making the highlight of that trip the 50 cent mojitos. Speaking of rum, Nicaragua is famous for their deliciously good national rum, Flor de Caña. Excellent.

Palo Verde Biological Station

Wading through swampland to find snails and dragonfly larvae. To gather data for some biostatistic practice, and to take advantage of the natural wetlands landscape at Palo Verde, we set off on a very wild adventure. Our task was to sample squares of wetland and count and identify snails and dragonfly larvae that we could find attached to plants and floating in the water. We entered the wetland at a level below our knees. By the end of the activity, we were waist-deep in the water. But it wasn’t just water. There were lots of large plants, floating plants, oh – and floating cow dung, and swimming water cockroaches, leeches, other bugs, and God knows what. And yes, my body was in this water, with water filling my rubber boots and pants. While incredibly uncomfortable at first, the rugged exercise eventually became an accepted state of being and it actually became kind of fun to find the snails in the water, although not so fun to find leeches in the sifter 30 minutes later. Regardless, I think I am now more of a real scientist for going through that.

Getting stung by a scorpion. GETTING STUNG BY A SCORPION. One more time – GETTING STUNG BY A SCORPION. OK, if you find yourself in Costa Rica, and if wading through swamplands infested with water cockroaches, leeches, who knows what and floating cow dung is not enough excitement for you, try and see if you can get a scorpion to sting you. Don’t know how? Try this. Stay at Palo Verde. Leave a duffle bag on the floor next to your bed. Leave at least one pocket of the duffle bag unzipped for at least one night (more if possible). On the last day, when you are packing, reach into said pocket. If you feel an instantaneous rush of seriously sharp pain shooting through your palm like someone is jabbing a needle into your hand and it lasts for 30 minutes – then success, you have been stung by a scorpion. Luckily for me, there aren’t any lethally venomous scorpions in Costa Rica (at least not lethal unless you have a serious allergic reaction), so when I was stung and I rushed to my professor who is also a doctor, he made sure I was OK and we worked on relieving the pain without much worry, although he was equipped and prepared to revive me if something more serious happened. Anyway, that was one of the most intense moments of my life. But it is all good.

Lectures and Films

Introduction to Ethnobiology
Biodiversity in Costa Rica
Costa Rican Cultural Diversity
Types of Ethnobiological Research
Chaga’s Disease
Approaching and Learning from Different Cultures
What Makes Plants Useful
Dengue Virus
Quantitative Methods in Ethnobiology
Non-timber Forest Products
Tropical Forest Ecology Basic Concepts
Analyzing Ethnobiological Data
Bioprospecting
Malaria
Tuberculosis
Leishmaniasis
Tourism and Medical Tourism in Costa Rica
Animals in Ethnobiology
Traditional Healing Methods in Shamanic Traditions
RX for Survival Documentary Series
Healthcare in Rwanda and Cuba
Homeopathic Medicine
Foreign Aid
Genetic Diseases
Debating different types of healthcare systems
Nicaraguan Healthcare System
Venomous snakes and snakebites
Biostatistics medley
Malnutrition

It's been a while

In fact, it has been, and I have not written in my blog for quite a
while. I have been busy though, with learning and projects and now
studying for midterms. Next week is fall break so hopefully by then I
will have a) recovered from my 2 week bronchitis which I only got
antibiotics for yesterday, and b) time to work on another entry. For
now, I should add that after our second stay at the Las Cruces
Biological Station, we spent 3 amazing days in Granada, Nicaragua, a
lovely colonial town. Then we moved on to Palo Verde Biological
Stations, in the northern part of Costa Rica, and we shall be here for
a few days until Saturday, when Fall Break starts - an entire week of
freedom! Should be exciting.

City Life

I am now back in Las Cruces, the first biological station we visited soon after our arrival in Costa Rica. We arrived here on Monday after completing our 2.5 week stay in San Jose. We will be here for a while (see calendar below for detailed information on when and where I am staying).

Our stay in San Jose was really great. For 10 days, everyone in the OTS program attended intensive Spanish classes at the Costa Rica Language Academy, a small language school within the San Jose metropolis not too far from where we stayed and near the University of Costa Rica, San Pedro Mall, and various restaurants and commercial areas. We had five hours of class each day, and the group was split into a few different classes in which we were placed after taking a placement exam during the first few days of the program in August. My class focused on some common grammatical errors as well as language and culture necessary to conduct basic medical history interviews and to discuss issues in the field. Some activities included mock interviews in person and on the phone, interviewing random students on the UCR campus, and doctor-patient role playing. In addition to a fifteen minute coffee break and one hour lunch each day, the program came with other perks; it included a one day excursion of our choice as well. I went along with a group who chose the “Adventure Combo” which included ziplining the rainforest canopy and whitewater rafting. Both were very awesome experiences and a lot of fun – see pictures for visuals.

While in San Jose, we were assigned to home stays through the Spanish program, which is accustomed to hiring families to host students that they enroll from around the world. I had the pleasure of staying in the home of Sra. Nidia, who is a very sweet, creative, and artistic 74 year old woman living with her husband, adult daughter, and her daughter, who is around my age. I didn’t really get a chance to spend a lot of time other than meals with the family, but Sra. Nidia was a great host and I really appreciated her home. I was definitely able to get a sense of how family dynamics and just routine Costa Rican life works for a home in the suburbs of San Jose. Additionally, her cooking was absolutely delicious, much like all the Costa Rican food I have experience thus far. She has been hosting students for seven years and really enjoys it.

Other than the Spanish classes, the program met up at the Organization for Tropical Studies offices for lectures to continue our studies in other subjects, although our stay in San Jose was mostly about focusing and polishing our Spanish skills. We also had a chance to take advantage of the urban setting to explore another face of the health care system as well as other points of interest. Outside of class, we had a good amount of time on weekdays and plenty of time on weekend nights to explore the town periphery as well as downtown. In groups as well as on our own, we explored a variety of venues from restaurants to clubs to malls. I really enjoyed the freedom and quickly became familiar with the bus system and general layout of interesting hubs around where I stayed – I would definitely say that out of all the places outside of my home countries, Peru and the USA, that I have visited, it was by far the easiest place to feel like I could, with time, call it home. In general, the city is modernized and the presence of globalization is very obvious from the American fast food chains scattered across food courts around the city’s malls to the various international companies in many different markets that have made their way to Costa Rica. There is plenty to do for entertainment, and there are many food options as well. From what I understand, it is the nicest/most modern city in Central America, and it reminded me a lot of Lima, Peru, although it is much smaller. I personally liked it a lot. It had a nice modern-yet-uniquely-Latin-American vibe to it.

Field Trips:

Mercado Central. The central market – a hub of commerce and storefronts. Depending on which part you are in, you can find everything from fresh meat to hardware. We made some attempts at exploring stands specializing in natural medicine and local remedies.

Museo Nacional. The national museum, where we learned about the history of Costa Rica from the first human settlers all the way to modern times. Highlights included ancient pottery, stonewear, giant stone spheres made by precolombian communities, colonial furniture.

Hospital Mexico. One of the largest hospitals in the country, and connected to a center for educating hospital interns and graduate level students.

EBAIS in Vargas Araya. Like the EBAIS units discussed in my previous entry, but in an urban setting. This particular EBAIS is managed by the UCR, which was approved by the national security system to manage the money that would otherwise be managed by their employees to provide services in that area.

INCIENSA. National lab network that focuses on epidemiological surveillance and confirms and characterizes parasites.

Children’s Hospital. While we were not able to tour the hospital given that we might transmit H1N1 to hospitalized children, we received a lecture on the history of smallpox eradication by a major doctor in the hospital.

INBIO. Awesome nature park with exhibitions, trails, and animals run by an organization seeking to document and preserve the biodiversity of Costa Rica.

Lecture topics:

Introduction to Statistics

Introduction to Research

H1N1 and Preparing for the Upcoming Flu Season

Conducting Small Scale Surveys in Spanish

Insect Taxonomy

Diarrheas

Vaccine Development

Epidemiological Surveillance

Health Care in Nepal and Niger

Fun stuff outside of class:

Canopy Zipline

Whitewater Rafting

La Esquina, Bar Rafas, Bahamas, Bar Rio, Bar Cirus, Bar Acapulco, Calle de la Amargura, Nova. After classes and on weekend nights, the group enjoyed visiting a variety of bars and nightclubs like the ones named, and a couple of them were also the sites used for the celebration of Gabe’s 21st birthday. We also watched the much anticipated Costa Rica vs Mexico soccer game in a bar, which CR unfortunately lost.

Castro’s Bar. The best Latin dancing in San Jose, provided by this bar and nightclub, was a favorite haunt for a few of us. I had forgotten how much I love dancing salsa, merengue, bachata, and cumbia (except I don’t really know how to dance cumbia, or dance any other dance nearly as well as Ticos…)

San Pedro Mall. The mall closest to our home stays. Great place for fast food (including American favorites including but not limited to McDonald’s, Wendy’s, Taco Bell, Burger King, TCBY, Subway, Quiznos), great place for shopping (including a bargain clothing store, Pague Menos, which was a favorite amongst the girls), and also the location for the movie theater – I was able to see The Hangover and The Proposal in English with Spanish subtitles while in San Jose.

Museos del Banco Central de Costa Rica: Museo del Oro Precolombino, Museo de Numismática. One of the best museums we visited, the Museums of the Central Bank of Costa Rica include the Museum of Precolombian Gold and the Museum of Currency. The first section of the museum contained samples of currency in Costa Rica through history with nice interactive displays and my favorite feature, lights inside the displays that you can turn on and off depending on how long you are looking at the display to save energy and preserve the samples. There was also a special exhibit on animals and plants featured on currency. The second section was a wonderful museum containing a large amount of gold figurines, jewelry, and other items made by Precolombian people in Costa Rica before the arrival of Spanish colonists. The items were beautiful, masterfully crafted, and many were representative of the animals the people encountered in their natural environment, many of which were from the rainforest. See my pictures, they do not do them justice, but will give you an idea of how amazing the work is.

Craft Market. Stopped by and picked up some Costa Rican souvenirs and jewelry.

INKA Grill. Peruvian restaurant that a group of us visited and thoroughly enjoyed. I was very happy to get the opportunity to get some home country favorites in my belly.

Iwaa Sushi. Really cool sushi place with screens at each table to order from, and an amazing all-you-can-eat special on Friday nights.

Terramall. Mall we stopped to have lunch at on our way back to town from a field trip. The main highlight of this stop was the discovery of a new favorite Barcelona-based fashion line, MNG.

First visit to Las Cruces

I have now been in Costa Rica, the happiest country on Earth, for two weeks now. Beginning in San Jose, where the group first met, the 19 students and our two resident professors have progressed through introductions, orientations, and our first lectures. Now, we already find ourselves relatively deeply entrenched in our program here, ready to conquer the semester.

 

After spending a couple of days in the capital, San Jose, meeting and getting to know each other and the Organization for Tropical Studies headquarters in la Universidad de Costa Rica (University of Costa Rica), the group shifted to our first stay in Las Cruces Biological Station (near the rural town of San Vito). Las Cruces is one of three main OTS stations in Costa Rica and home of the Wilson Botanical Garden. It was a mere 6 hour ride to the station, and quite scenic. For more details on that, see my previous entry.

 

We spent about a week in Las Cruces becoming acquainted with the station, surrounding areas, our schedule for the semester, and the new material as well as learning styles we will encounter this semester (oh, and living together all the time J). For example, our four courses, which everyone takes together, are called Preparation for Culture and Language in Costa Rica, Preparation for Tropical Medicine and Public Health, Preparation for Research Practicum and Preparation for Field Ethnobiology. They do not occur on any type of regular schedule. Additionally, it is not always explicitly defined which specific class the material we are covering during an activity is for. We have lectures, presentations, and discussions (both from professors and student-led) in classrooms, but just as often we have planned excursions, field trips, and hands-on activities like laboratories and projects. On any given day, we may have two excursions and a lecture, or perhaps three lectures. Something that is regular, however, is our meal times. While in Las Cruces, we eat breakfast and dinner in the dining hall on the premises run by the station, and on most days, we make an effort to be at the station, or we can order a packed lunch the night before. At this station, breakfast is at 6:30am, lunch at 12pm, and dinner at 6:30pm. Needless to say, these early hours are against my nature, but arguably more productive and healthy in an environment where it rains daily in the afternoon.

 

During our first stay in Las Cruces, we were able to do the following outside of the classroom:

 

• Visits to two local EBAIS. EBAIS stands for Equipo Basico de Atencion Intergral de Salud, roughly translated as "basic team for integral care" . These are the basic units for primary care that are run by the national social security system, which makes it mandatory for all citizens to be part of a public health insurance plan. The goal of these visits was to observe their infrastructure, how people utilize them, and their employees.
  
• Visit to the Ngobe Territory community and EBAIS. Continuing our exploration of the national health care system, we visited this territory, home to the indigenous group Ngobe, to get a glimpse of their lives, the impact of history on their race, and their access to healthcare. In addition to having a chance to walk around their homes and explore their culture on the slopes of some of the many mountains in Costa Rica covered in rainforest, we were asked to take note of a variety of health risks and hazards in the area. A few of us spent about an hour and a half talking to a blind elderly leader who founded one of the major clans living in the territory many years ago. He even played us some of his instruments and sang traditional songs.
  
• Visit to the Caja regional offices and learning from Dr. Ortiz. "Caja" is the social security system. The offices we visited like Dr. Ortiz's conduct research and development projects in many communities, particularly the underserved indigenous territories.
  
• Visit to the border with Panama and housing for immigrant coffee plantation workers. Stopped by, stood on the marker, and saw the meager conditions which many workers are willing to live in for the sake of making a little money picking coffee. We also learned a little bit about how so much of the business exploits the workers and belittles their rights.
  
• Tour of the Wilson Botanical Garden with Resident Biologist Rodolfo. Very cool, thousands of plant species – will have its own entry soon.
  
• Hike to the Rio Java through the rainforest at Las Cruces. After the tour of the garden, a group of us hiked one of the trails at the station which led us to part of a small river nestled in the rainforest.
  
• Laboratory activity, introduction to microbiology. As our first lab, we sampled surfaces of our choosing (mine were the inside of my mouth and my hands after being coughed on), grew them on blood agar plates, and then made slides of the colonies which grew. Everyone saw some bacteria, and some even fungi. I found what I am pretty sure was streptococcus in my mouth and staphylococcus on my hands, both of which are normal flora on those surfaces.
  

 

Topics covered in lectures:

 

• History of Costa Rica
  
• Social security system of Costa Rica
  
• Introduction to Global Health
  
• Costa Rican Health System
  
• Primary Care in Costa Rica
  
• Introduction to Tropical Medicine
  
• Introduction to Microbiology
  
• Costa Rican Lab Network
  
• Introduction to Epidemiology
  
• Research in Health Services
  
• Introduction to Biostatistics
  
• US Healthcare Reform
  

 

Free time activities:

• Card games. Just around the Wilson house, a way to socialize.
  
• Shopping in town. Buying essential school supplies, rubber snake boots, and foodstuffs.
  
• Word games. Another way to socialize/kill time.
  
• Frog hunt. I did not personally participate, but the evening is a great time to search for frogs at the station.
  
• Running. Plenty of inclined paths for keeping active!
  
• S'Lugar. A nice bar with a few cocktails in the town of San Vito for the purpose of starting a good night.
  
• D'Locos. A club in a town about 15 minutes away from San Vito, full of youngsters. Will play a 20 minute segment of American music if you stroll in with 10 Americans.
  
• Pizza. I did not go, but the pizza in this town is supposed to be great because the town was settled by Italian coffee entrepreneurs.
  
• Reading. Plenty of paperbackage seshs.
  
• Computer and wireless internet. The greatest gift of all – although living in the jungle, we have the benefits of a station conducting scientific research.
  
• Music. An absolute necessity no matter where you are.
  

 

As for now, we have left Las Cruces and begun our home stays in San Jose, where we are currently engaged in a 2.5 week intensive Spanish program at the Costa Rican Language Academy. My next entry will cover our experiences in this city.

Pura Vida

Not having had the opportunity to conclude on Uganda, I will briefly state that the end of the project went well, we presented a good number of data to our community partner, and for now some of us are still working on putting together a report in addition to one we submitted as sort of a description of our work to the university and hospital we partnered with. Then we said our goodbyes to all of our new friends, spent a couple of days in Kampala, and headed home, where we said goodbye to the team in Newark. Most of us are returning to Duke this week, but as for me, I am in COSTA RICA for the Duke Semester Study Abroad through the Organization for Tropical Studies (OTS) !!!

I could not be more excited about being in Costa Rica and everything so far has been great. It is a tropical, rainy place, and I do not anticipate a day without heavy rainstorms, but such is the rainforest!I actually began my journey in San Jose on Monday, August 17th. We spent two nights at El Sesteo Apartotel, and spent our time during the day getting to know our classmates (14 girls, 4 boys, I believe) from universities all around the country, and we had a chance to see the OTS facilities at the University of Costa Rica. We were evaluated on our oral Spanish skills and placed in appropriate levels for our Spanish instruction. Additionally, we reviewed the course syllabi for the semester and were debriefed on the different places we will be visiting. My next entry will review what I have learned so far about how AMAZING this semester will be.

Right now I am seated in the common room of a two story house next to the botanical gardens at the Las Cruces Biological Station. The ride here took seven hours from San Jose, but it was very pleasant. I did feel a little ill for a second as we went up and over gorgeous mountains covered in tropical vegetation because of the somewhat rapid elevation changes, but it was totally worth it because at one point we were even so high up on the lush mountain that we were literally in the clouds. Beautiful. But even more beautiful is the fact that I am literally living in a house nestled amongst the rainforest.

It is, of course, pouring rain, and I don't mind, because I got to use my new raingear and hilking boots. I used it to get from this dorm building (formerly a house belonging to a couple who originally owned the land) to the station’s dining hall, which served a most delicious lunch of beef strips, heart of palm cooked in tomato and onion, black beans, rice, and salad. We washed it down with passion fruit juice and topped it off with a slice of watermelon. Let’s just say it was super delicious and a sign of great things to come. The other food I have had here so far has also been equally tasty.

Also of interest, we got to see a poisonous snake that one of the resident biologists caught this morning not too far from the dining hall. It is called an eyelash pit viper, and the one she found actually has rare coloration and is bright yellow as opposed to dark brown, the more common variation.

Later on we will get a debriefing on what is featured in this station and what not, and then we shall have dinner. Then we will have a talk on risk management. Can't wait to share more!

A Day in the Life

Last Thursday marked the conclusion of our work in the villages. This
week, we will be compiling data and creating documents summarizing the
effect of the intervention and results obtained from surveys, focus
groups, and assessments. (More on focus groups and assessments later).
That means that until Friday, we will be locked up in the MMHF offices
working away on our computers looking at a whole bunch of words and
numbers…

I will take a break, however, to share some stuff about daily life in Mbarara.
The team from Duke Engage, whom I did not introduce earlier, is a
group of 10 Duke undergraduate students; 3 rising seniors (Paul,
Jesse, and David), four rising juniors (Naima, Gregory, Eddie, Josh
and me), and 2 rising sophomores (Marquise and Alex); and two on-site
coordinators hired by Duke Engage (Jacques and Peter). Yes, this does
mean that out of the 12 team members, there are only three girls.
However, the group is actually quite diverse. The group includes every
major race in the USA, a variety of family backgrounds, different
majors, and very unique personalities, each contributing to the
dynamics and grooviness of the group. I feel pretty lucky to have been
able to get to know a lot of the team over the past few weeks, and I
am sure that a lot of long-lasting friendships have been fostered.

Tank Hill Hostel entrance at sunset

The aforementioned team has been living in Tank Hill Hostel during the
last 8 weeks that we have been living in Mbarara. Like I mentioned in
an early entry, the hostel usually houses students from Mbarara
University of Science and Technology, but classes are not currently
going on because the students are on break so we have essentially been
the only ones in the hostel for a long time, with a handful of other
people here and there. It is a fairly large hostel, but luckily we all
live in the same area of the hostel, with all but two of the boys
living on the first floor and the girls living on the second floor. We
have been fortunate enough to get our own rooms – although I should
note that after an unfortunate event involving Marquise waking up with
a grasshopper on her face during the first week, the other two girls
moved her bed to Naima's room and they are now roommates. Otherwise,
each room has two cement desks built into the wall, a bed, and two
small built in closets. Additionally, you will find a mosquito net
over each bed. Also, every room has a window, which is nice, and
Naima's room has a balcony.

In addition to our bedrooms, Gordon, the hostel manager, has allowed
us to keep a fridge in a spare room and a large table, forming a sort
of common room and fruit storage place – if you were to walk in there
now, you would find a fridge stocked with drinks and snacks, as well
as a table with about 5 pineapples and a couple of papayas on it, and
an enormous bag of passion fruit. These three fruits I just mentioned
and also bananas and mangos compose our entire selection of fruits
during this trip. There is also a fruit called jackfruit, but most of
us find it pretty unpleasant, and some have described its smell as "a
cantaloupe that was carried under someone's armpit for hours."
Speaking of meals, the hostel has a nice dining room with many plastic
tables and chairs and a couple of small TVs that are constantly tuned
into National Television or the news channel. We eat breakfast and
dinner in the hostel every day, unless we decide to go out for dinner,
maybe once a week. Breakfast involves one of the following: chapatti,
a flat tortilla-like bread; green onion omelette; sweet bread muffin;
white bread with butter and honey; or samosas, and is accompanied by
either fresh pineapple or papaya, and always taken with either black
garden tea, hot milk, or African tea, which is the black tea brewed in
hot milk. Dinner is buffet-style where rice, matooke (mashed
plantain-like things), cabbage, and beans are always offered and a
couple of other options are rotated daily, such as chickpeas, g-nut
sauce (a mushy sauce made of ground up g-nuts, a small, local,
purplish nut that tastes a lot like peanuts when raw), Irish potatoes,
spaghetti, and on good days, avocado, roasted beef or goat chunks, and
chicken in a broth. Otherwise, the options do not vary at all. I end
up eating rice, beans, and cabbage on most days because I don't really
like most of the other common options. As for drinks, we get to choose
one 300ml of the soda of our choice for dinner every night. In
addition to Coca Cola, 7up, Pepsi, Sprite, Mountain Dew, and Orange
Fanta, Uganda is keen on a couple of other sodas, including Citrus
Fanta, Passion Fruit Fanta, Mirinda Orange (like Fanta), Mirinda
Pineapple, Mirinda Fruity (berries), Krest (bitter lemon, and Stoney
(ginger-flavored soda – much stronger than ginger ale, very strong on
the ginger…). Of course, there is also bottled water.

Gregory and Naima participating in two different conversations after dinner (you can also see two empty bottles of Fanta)

As for personal hygiene, each floor of the hostel has community
showers, sinks, and toilets. The water is in fact, cold, so I have
become very accustomed to compartmentalizing my body sections and
showering one part at a time so as to avoid being under a cold stream
for long periods of time. The toilets upstairs are Western-style, but
downstairs they are latrines in the ground, so the boys have learned
to live with that. Otherwise, everything is pretty good. Occasionally
we find a spider, fly, bee, moth, cockroach, gecko, or two in the
showers and stalls when we check them before entering, but things
actually are a lot better than the first two weeks when giant
grasshoppers were dominating the hallways and bathrooms. One insect
complaint I do have, though, is that there is a never ending
population of ants all over the hostel – they generally mind their own
business, unless you regretfully leave a little bit of food out or
even a crumb on the ground. It is amazing, but in less than 30 minutes
ants will smell that out and mobilize to go and collect the goodies,
so by the time you get back to your room there is an entire line of
ants with an unidentifiable entry point into your room (sometimes its
electrical outlets, or other random holes in the walls). Additionally,
ants will get in your laptop and come out when you turn it on and it
heats up, and they are also a big fan of dirty clothes. Oh, and you
have to hang your toothbrush and toothpaste from a clothes hanger in
your closet if you don't want the ants to get to it.

Speaking of dirty clothes, the hostel has staff that washes our
clothes once a week, except for our underwear, which we wash ourselves
in plastic bins with powdered detergent in any of the community
laundry rooms on each floor. The clothes and sheets they wash are
dried in the sun on clothes lines that are set up on a small lawn
behind the hostel.

This entry is getting very long so I will continue later… I hope this
provided some insight into daily life in Mbarara…

Surveys, Focus Groups, and Assessments

A couple of entries ago, I outlined what our work in the field Monday
– Thursday has been and how we have been involved in the Safe
Motherhood program that has been providing free antenatal health care
services to rural women in the surrounding villages of Mbarara through
the Mayanja Memorial Hospital Foundation. With the next few entries, I
want to share more details about some of the other work we have been
doing simultaneously.

Baseline Survey

One component of this Duke Engage Project is a survey that we have
designed and put together for the purpose of learning more about the
women whom we are serving and to identify some of their biggest needs.
It has been translated into the local language, Runyankole. The
information we gather from it will help us and the foundation to
improve and tailor future interventions to help more women and do so
more effectively by targeting key issues in their communities.
Additionally, good data may also help us and the foundation acquire
grants and other financial support from various organizations.

The first section of the survey contains basic questions about a
woman's demographics - age, residence, and education. There are also
many questions on her reproductive history, family life and assets,
occupation, and accessibility to water. Then there is a section on
antenatal care, which asks about the woman's prior healthcare
experiences during pregnancy, what sort of information she received
during any prior antenatal care visits, if she has ever had one, the
drugs she may have taken during pregnancy, how much she would be
willing to pay for an ultrasound scan, and the challenges she
perceives in obtaining or reaching any antenatal care. The following
section is about the delivery and health of the child she gave birth
to prior to her current pregnancy (if applicable). Next is a section
on malaria, which assesses the woman's knowledge of the disease, its
diagnosis, and precautions that can be taken to protect oneself from
getting malaria. The final section asks a woman about family planning,
her preferences on the size and timing of her family, family planning
methods, and a few questions on who makes family planning and other
healthcare decisions in the family.

Our subjects are randomly selected from the women who come to receive
services from the intervention. They are then approached by a
surveyor, who would be one of the four local university students who
speak the local language and have been told how to give the survey.


Bob and Becky, two MUST students who administer surveys, chatting with Gregory, one of the Duke Team who managed survey work for the day.

The first step is telling the woman how she was selected, what the
survey is for, and then she is asked if she is interested in
participating. If she agrees, a very detailed consent script is read,
and if she still wants to participate, the survey is administered,
after determining that she is eligible (she must be at least 12 weeks
pregnant). As recompense, when the survey is over, the woman is moved
to the front of the line to receive the services she came for, and
like every woman who comes to the intervention, she receives a
mosquito bed net at the end of the day to protect her and her fetus.

Once the surveys are administered, students not going into the field
the next day enter the responses into a large database designed using
the EpiInfo software. We are actually having them entered into two
databases so that we compare them later and check the original paper
copy in case there are discrepancies.

The Nile

So this past weekend I took one of the most exciting day trips EVER.

Panorama of the Nile River

It began Friday. After a day of work and meetings at the Mayanja Memorial Foundation offices, all but a few of us from the Duke Engage team grabbed our things and headed to the bus station in the Mbarara town center, where we loaded a Swift Safaris bus to Kampala, the capital. The buses usually don’t leave until they fill up and we were just in time to board the latest one – which meant a few of us, myself included, where stuck sitting in the very back row of a coach bus. For anyone who has ever experienced such a treat, then you know that with every speed bump you fly about 1 foot in the air… in Uganda, you multiply that times 3 considering the quality of the roads.

After a 6 hour bus ride, we arrived in Kampala at night and Dr. Mugerwa, who happened to be in town, picked us up and drove us to where we were staying, Backpackers. It is a cute hostel full of mostly American, European, and Canadian youngsters and a few NGOs/tourists. We stayed in a dormitory room with maybe 8 bunk beds…we just laid our stuff on any empty beds, and at night we ran into some other people sleeping in beds around us. There is a common bathroom and showers, and some of the beds have pillows – overall I would say it’s sufficiently clean and very, very affordable. And they make really good food – I had a grilled cheese sandwich and it was the most satisfying dinner ever.

The next morning at around 7am, a shuttle from the Nile River Explorers, the rafting and adventure company that two friends of the group also doing Duke Engage in Uganda chose for the day’s activities, picked us up from the hostel and took us to Jinja, a town approximately an hour and a half from Kampala. In addition to being the home of Nile Breweries, the town is located beside the source of the Nile, which comes out of Lake Victoria. Not too far from the source, the Nile has a series of rapids ranging from Class 2 to Class 5 rapids. From my understanding, quite a few companies exist that make use of the river and offer whitewater rafting, kayaking, bungee jumping, and other activities, but the Class 5 rafting full day trip is supposed to be one of the best in the world. When we got to Jinja, the shuttle took us to the main offices of the Nile River Explorers, and we signed in to our reservation. The company provided a good breakfast, briefed us, and then gave us life jackets and helmets, and we got on another shuttle which took us to the launch site. There we divided into teams of about 8 and a guide for one raft, and began our amazing journey.

I have never been rafting before, but after this amazing experience I expect I will not be easily impressed. We spent over 5 hours in the water, at times tackling rapids with names such as “Silverback,” “50/50” (as in a 50% chance we would flip over), “Chop Suey,” and others, and then at some points we were just paddling in smooth water. While our crew was pretty lucky and did not flip over on many of the most treacherous rapids, we purposely flipped on one of the last rapids, and then were completely dominated by the very last rapid that the company takes you through. While flipping over and struggling to hold on to the side of the raft with one hand and a wooden paddle with the other is pretty difficult, particularly during the few startling seconds that you find yourself completely submerged in water and looking for a way out from under the raft, falling in can be sort of fun. The water was at a perfectly cool temperature, and usually rapids are followed by still water so there is time to recuperate and get everybody back on the raft. At one point, the guides let us just swim around in some of the calmer parts of the river. Something cool about the calm time is that the company has figured out how to feed people during the day so as to make full day trips on the river (which cover a distance of 30 km) possible. The company has a gear boat that leads all the raft crew, and strapped to it are bags full of pineapple and biscuits that they distribute to us around lunch time while we are on calm water, in addition to first aid equipment, repair kits, extra equipment, and air pumps. As for our thirst, we just drank the Nile water. And impressively enough, no one in our group got sick from it. While there were a couple of bumps and scrapes and helmets crashing, everyone came out of the majestic Nile in one piece. At the end of the trip, the company puts you back on some other shuttles and they drive you to their campsite, where you can stay the night for a very cheap price in addition to the included barbecue which we all partake in – which was composed of grilled chicken, pork, and a myriad of fantastic sides to accompany the feast. Oh, it also included two free beers. We of course chose Nile Special beers, which cost the same as the other most common beers in Uganda but come in 500ml bottles.

We returned to Kampala after dinner via the company shuttle, and that night a few of us met some peers in Backpackers and we went out with them to a club/bar/hostel called Iguana Lodge, and we danced the night away on a small dance floor with a surprising number of foreigners. The next day, we went to the mall in Kampala and bought a variety of small things ranging from souvenirs/handicrafts, books, Chinese food, and gelato. Yes, gelato. Only in Kampala…

Our Work

Unfortunately, I have failed to write in this blog frequently, but now that I have the time and dedication, I want to share more about our work here.

If you remember my first entry about the Safe Motherhood Program, then you know that the team of Duke Engage students here (10 of us, ranging from incoming sophomores to seniors) spent the first week of work assisting in the Safe Motherhood intervention that provided free antenatal care services, such as physical examinations, sonograms, and drugs, to mothers from the Mbarara municipality who were able to come to the private clinic at Mayanja Memorial Hospital during the week. The next week we began a longer leg of the program, which will not be completed until the end of July. These last few weeks we (the Duke Engage students, a few paid students from Mbarara University of Science and Technology, and Mayanja Memorial Hospital and Foundation staff) have been taking the intervention's services to government-run health centers in rural areas around Mbarara. Each week, we visit a different health center every day; on Mondays we go to Kashongi, Tuesdays to Kikyenke, Wednesdays to Rubindi, (all of which are about an hour and a half away from Mbarara town center) and on Thursdays we go to Kikagate, which is the furthest one, requiring about a 3 hour drive on very poor dirt roads (the town happens to be right next to the Tanzanian border).


The health centers we visit are designated as health center III's by the Ugandan Ministry of Health. My understanding is that they are supposed to be equipped to handle common diseases such as malaria and STIs by providing free drugs and treatment by a couple of nurses, HIV counseling, family planning, antenatal care check-ups (basic minimum, not including sonograms) minor emergencies, and uncomplicated deliveries usually managed by a midwife. Anything they cannot handle they usually refer to higher level health centers or regional referral hospitals (also government-funded). The health centers are usually two buildings: one building has a large room with maybe 10 beds, a small lab room, and a wash room, then the other has a small pharmacy, an office space or two, and some more beds, maybe a labour ward.
A typical day in these health centers, "in the field" as we say, is as follows: first, pregnant mothers arrive at the clinic in the morning and wait for the team to arrive (we leave Mbarara town at around 8:45 am except on Thursdays, when we leave at 7:30). In the first weeks we got upwards of 100 women on some days, but more recently the number is about 50 per day. The women come from the area served by the health center, and while some live a 5 minute walk away, we have spoken to some who have walked 4 hours (an extraordinary feat for a pregnant woman). Then as the ultrasound tech and the rest of the team (6 students each day and frequently also one of the on-site coordinators) get the different stations set up, a team nurse or midwife will gather the women outside and deliver a health education talk, where she tells mothers about pregnancy, the possible complications they may see, the danger of not seeking healthcare if these complications arise, and the importance of delivering at a health center. I believe sometimes she also mentions family planning methods, prevention of mother to child transmission of HIV, and nutrition.


Then the mothers are registered by one of the MUST students or another staff member (actually for the most part I believe mothers have been registered prior to the talk), two students set up a station where we measure the women's blood pressure, height, and weight, two others assist the nurse in setting up a bed where she does physical exams, and two others assist the ultrasound tech in setting up a bed where a portable ultrasound machine allows the intervention to provide the mothers with a sonogram examination. Then once the health education talk is over, the mothers proceed to get in line for the services.


Once they pass through every station, they check out at the bed net table, where if they do not own a mosquito bednet to prevent them from getting malaria through mosquito bites while they sleep, they receive one for free. The nets they receive are provided by the funds raised by the Progressive Health Partnership, the student organization at Duke which began the foundation for this Duke Engage project.
Almost every mother who comes to the intervention brings with her a mother's health passport or antenatal card which the health workers give them and their formats are standarized by the ministry of health with blanks and charts to fill in about their personal health record and their antenatal care visit results. If they don't have these, they will usually have thin notebooks where we write down their results throughout the day. They will usually also bring a purse with personal items and will almost always bring a ketenge, a large piece of cloth with multiple purposes. When they go through the blood pressure/weight/height station, we record the measurements in their books or cards. Then they get in line to see the midwife/nurse. She performs palpitations (meaning she feels around on their bellies and wombs) and determines the position of the baby, estimates the gestational age, listens for the fetal heartbeat, and predicts any complications. She also prescribes antenatal drugs including iron and folic acid supplements, drugs that can both prevent and treat malaria during pregnancy, antibiotics, and deworming tablets, and examines the inside of the mother's eyelids to see if she may be anaemic. Then the mother is seen by the ultrasound tech, who determines the health of the maternal organs, liquor amii, the position and echo grade change of the placenta, the position of the fetus, the femur length, gestational age, and expected date of delivery. If the child is an embryo, slightly different information is gathered, and if it is a multiple pregnancy then she determines how many placentas and sacs are present and information for each fetus. If the mother requests it, she may be able to determine the sex of the fetus by checking to see if a scrotum is present, but unlike in the US, most of these mothers have never had an ultrasound examination, so they are not usually shown the screen so that they can see the baby, nor do they get a print out of their child. The results are recorded on a special form and given to the mother, as is done in the physical examination, and some of the information is entered into large registers for the nurses' personal records.


I mentioned that all the students help set up in the morning, but during the day in the field not
all students are always assisting in record keeping, blood pressure/weight/height measurements, and moving women along. Two students each day are responsible for conducting a focus group with a different group and type of community members each week, and two are engaged in conducting an assessment out in the community in the homes of mothers who we had seen in the prior week. One of the students who assists directly in the intervention simultaneously administrates the MUST students who conduct the survey that we developed in order to do a baseline assessment of the antenatal health and related subjects of the community, which we hope to use in the future to guide future programming. I will explain the details of these three projects more in a future entry, because they are a large component of the work the team is doing here.


When the day is done, usually because a) we have seen all the mothers who came, 2) we run out of battery power for the ultrasound and the power is out in the building, or 3) we run out of bed nets (which only happened recently). Then we pack up all our stuff and ride back to the hostel, usually arriving at around 6 pm.
The rest of the team, 4 students each day, who do not go into the field, spend the day shadowing at two hospitals. Two students will spend the morning doing rounds with the doctors at Mayanja Memorial Hospital. Two others observe the labour ward and surgery at Mbarara Referral Hospital, and after lunch the four students will work back at the hostel entering data and completing other tasks, usually on the computer, related to the project. We rotate every day, so for example I spend Mondays at MMH, Tuesdays in Kikyenke Health Center III conducting a focus group, Wednesdays in Rubindi supervising surveys, and Thursdays at Mbarara Referral. On a Friday like today, most of us go to the Mayanja Memorial Foundation Offices and have meetings to debrief on the results we gathered during the week from our three side projects, enter data from surveys into our database, compile notes from focus groups, discuss the scripts for the next week's focus groups, and work out any problems we want to discuss. On a day like today, we will work for a half day and then begin our weekend journey - this weekend we are going to a town called Jinja, which is next to the source of the Nile River. We will be lodging in Kampala, the capital of Uganda, and on Saturday morning we will be picked up and driven to Jinja (approx. an hour away) and we will spend the entire day on the Nile. I am excited about the trip to Kampala - we will be riding on a public bus.

Thanks for reading, and once again, I will write more about the project after I get back from the Nile....

Queen Elizabeth National Park

Cottages at Kingfisher Lodge, where we spent two nights during our visit to QE.

One of many buffalo at QE

Pelicans and other birds at QE

One of the many adult elephants getting a drink from the channel in Queen Elizabeth National Park

Three baboons on the road through QE

A herd of Ugandan kob in the park

Adult elephant feeding at QE
Male kob at sunrise

Mgahinga National Park

Pictures from Mgahinga National Park

Two of the three mountains at Mgahinga NP

The third mountain, named "Old Man's Teeth" in the local language.

Half of the crew on the hike/climb up to the gorge at Mgahinga ... which was about a 7 hour "walk," as they called it.

The team stops for a break at a clearing on the way to the gorge. On this trip, almost all of the Duke Engage team plus a couple of our community partner staff members spent 2 nights in Kisoro, the nearest town to the national park, and engaged in both the gorge walk and a visit to a cave formerly used by the Batwa tribe (pygmies) as a living space. I didn't get pictures of the cave walk, but others did. Sorry!

Paul looks for birds or possibly monkeys in one of two bamboo forests on the way to the gorge.

Lake Mburo National Park

For now, I only have time to upload some pictures from a couple of our weekend excursions into amazing parts of Uganda...next time I get a good opportunity to use the internet, I will go into detail about the work we have been doing here =).


Ankole cattle on the way to Lake Mburo

Hippopotamus in Lake Mburo

Papyrus in the swamps of Lake Mburo

Me on a boat in Lake Mburo

African Fish Eagle at Lake Mburo

Black-faced vervet monkey at Lake Mburo NP

Can't remember the name of this antelope relative...

Isn't he cute?

A herd of impalas at Lake Mburo NP

Zebra running away at Lake Mburo NP

Me and a warthog by Lake Mburo

The dock at Lake Mburo NP

The landscape on the way to Lake Mburo NP

A plantation of matooke (relative to the plantain) on the road to Lake Mburo NP

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…