Bonjour mes amis!

Hello from Paris!

Sorry I suddenly failed at posting blogs--I was really busy in Kampala and lost internet access on my computer for a few days.

I promise to play catch up with the final travels and hospital adventures (I delivered sooo many babies in the past week) now that there's a thing called wifi again. Also there are trash cans everywhere! That won't help me write blog posts, but it is comforting to be in a Westernized city again!

Sipi Falls

After the drama of the Nile River Rafting, going to Sipi in far eastern Uganda last weekend was a relaxing treat. Sipi is located on the slopes of Mt. Elgon almost all the way to Kenya. Getting there (and back) was as painful as usual, and we once again had to break our rule of not riding boda bodas in Uganda. Shalina and I decided after this trip that really our rule needed to be amended to "we only ride boda bodas up twisty scary mountain roads where we're less likely to die than in Kampala"

We arrived safely Sunday evening and were too pooped from rafting to do much of anything, but it was great to just sit around and read and drink in the scenery. This is the view from the porch we liked to eat on--you can just make out the three waterfalls that are part of Sipi River's path down the mountain.


We set out with a guide Monday morning to do the hike to the three waterfalls. Our guide was dressed in jeans and galoshes, but was concerned WE weren't wearing appropriate hiking clothing in our shorts and Merrils/Keens. He told us we'd go up to the very top to the third waterfall and then work our way back down to the hotel.

The "trails" we followed were often barely visible, and crossed through people's yards and fields--we were very glad we'd hired a guide for the day. (This photo is from later on when the rain clouds were threatening--it was clear and hot on the way up!)

When we got to the top (after stopping several times to suck air while reassuring ourselves it was the humidity and elevation that was getting to us, not that we were beat up and pitifully out of shape) we loved the close up view of the 60-odd meter waterfall--the smallest of the three!

Since we were already sweaty we decided to go for "showers" at the bottom of the waterfall, and got completely soaked. It was wonderful!

The view from the top was lovely. I love green jungley mountain-scapes! With rainbows!

We hiked down to the top of the next falls, following the river's pathway, pausing often for photo ops. Unfortunately we were soaked and sweaty so we don't look the cutest on any of the close-ups. :)

We paused at the top of the falls for a while for some "classroom time" where our guide taught us about all things local--words and greetings, how to grow and make coffee and local brew, the history of Mt. Elgon, and crazy circumcision rituals. Clearly I was the most excited about the fields of coffee berries!

There were sweet caves under the second waterfall that we didn't go into for fear of bats, rabies, and Ebola, but we got a nice shower from passing underneath it nonetheless. This waterfall was even bigger than the last one--almost 90m and very powerful!


On our way down to the third and largest waterfall our guide decided that since it wasn't raining yet, and since we were such good hikers (such a lie--we'd been slipping and sliding in the mud up and down the mountain all morning while he hopped around safely in his galoshes) we could do an extra leg of the hike to see another pair of waterfalls. We thought that sounded great, but should have asked more closely when he said they were "not far".

When we got there the view was GORGEOUS and we could see for miles across the plains of Uganda and into Kenya, but we all about had heat stroke by the time we reached the vista. (We voted to not actually hike out to them since it had taken us almost an hour in the scorching sun to get there.)


Along this alternate path we picked up lots of kids who rarely saw mzungus. After the usual shy greetings and giggles they would follow us for 1/4-1/2 a mile before giggling more and running off. We were sure they were making fun of us for being so out of shape...or just looking weird in general.

We walked back to our hotel and along the top of the final waterfall. To go beneath it you need to rappel down the cliff, and while that sounded totally awesome and fun we were a) exhausted and b) too poor. Instead we met a boy and his pet chameleon Joseph! They were both adorable.

In all the hike was only 5hrs or so, but we were again so exhausted we were useless the rest of the day. We just hung around the hotel and chatted with all the other people visiting, and then left early the next morning to journey back to Kampala.

Sipi Fall was a gorgeous place to visit, and worth going to for sure. We recommend not going immediately after getting your butt kicked by the Nile and hopefully you'll be far less sore by the time you leave!

Rafting the Nile

When you think of the Nile River, do you think of the slow flowing, flat, lazy river meandering past the pyramids in Egypt? I used to, until I traveled to the source of the Nile out of Lake Victoria near Jinja, Uganda. We mountain girls were skeptical of what rapids the Nile would have to offer, and boy did we find out!

That's right I rode down this. Only part of it in a raft...

Early Saturday morning we left Kampala (after having just arrived the night before from Kiboga) to catch a shuttle to the rafting company's base camp in Jinja about two hours away. We met two Danish boys who were also going to be rafting that day, and before we'd pulled out of the parking lot Shalina and I had silently agreed we wanted them on our raft with us--they were young, fun, strong, and cute, so it seemed like they'd be able to save us from drowning! We also met a group of teachers who were rafting the next day, and randomly we ended up sharing a cabin with them that night.

We got to the base camp, dropped off our luggage, and waited for the 100 other people that were rafting that day to show up. Once we were all together we got some safety instructions, life jackets, and helmets, and loaded up in buses/trucks to head 25km down stream to start the trip. We piled out, abandoned our shoes and everything else we had with us, and hiked down the hill to the Nile. Shalina and I were hesitant to walk barefoot through the mud/river sludge/poop, and listed all the parasites we were catching on the way down the hill. We were listing the parasites we'd be catching from the Nile itself that day when the Danish boys reminded us "Hakuna matata, that's what deworming meds are for." We split into groups, and Shalina and I ended up with four other 20-something guys in our boat, plus our awesome South African guide named Q.

Look at me hanging on like a baller!

We practiced doing commands and drills (like how to flip over and get back in) before we heading down stream for our first rapid (the one pictured at the top). Due to the heavy rains it was rated a 5+, and while we did our best to blast through it we ended up flipping over.



I desperately want to give a blow by blow of each rapid series we went over, but there were 8 of them and they were all amazing. Luckily our boat and another one of medical students pooled resources to buy both the picture CD and the awesome DVD they made of our trip, so believe you me I will be showing them to people when I get back. I'll just tell two quick stories here.

The first involves a crazy series of rapids ending in "The Bad Place" (the ominous name of one of the rapids). Q told us there was a 95% chance we would flip before we made it out, and to not even try to hold onto our paddles. The nickname of The Bad Place is "rodeo", and he said it'd be just like riding a bucking bronc once we slid into the pocket. And slide into the pocket we did!

You'll have to see the video to appreciate how ridiculous this was, but after two bucks--and two ROUGH landings smashing into people--I decided I would just bail on the next buck up. Apparently everyone had the same idea and most of us bailed on the third round. All of us but Shalina--she ended up in the front of the boat bounced around like a pinball for several more rounds before she escaped out the front of our raft. Apparently our raft stayed in for over 4 minutes, the longest of the day!

While our raft was bouncing merrily around in the rapid I had been dunked deep underwater and hit some underwater currents HARD. I was under water a long time before coming up for a brief gasp of air before I was dragged down, and then up, and then down, many times over. Surprisingly, running out of air wasn't my biggest concern (though it was getting kind of scary before I made it out). My biggest concern was my shorts!

When I'd been launched out of the boat and dragged around a bit my shorts and swim suit bottoms were ripped off very quickly. By some miracle I felt them coming off and managed to catch my shorts with the big toe on my right foot. Only my big toe.

Our boat chillin' by itself in The Bad Place

When you get dumped off the raft in the middle of rapids you're supposed to tuck into a ball and just ride it out, focus on getting what air you can, and swim towards the shore out of the rapids when you get an opportunity. I did not follow these instructions and instead dragged my upper body against the current to try and grab my shorts before they slipped off my toe and ended up in Egypt. I managed to grab them and was surprised to find that my swim bottoms were still inside too! I wouldn't be bottomless the rest of the trip!!

Once I had my shorts in hand I focused on breathing and getting out of the rapids, and as soon as I swam out a helpful kayaker showed up to help tow me back to a raft. As I was still bottomless I refused his help for awhile until I got into calmer water and could pull my bottoms back on (this greatly confused the kayaker and he was very concerned for my sanity). I mostly got them on and accepted his ride to a raft, where a med student friend hauled me out of the water and in the process managed to mostly pull off my shorts AGAIN. Now that it felt like the whole river had seen my bum all I could do was laugh and share the story with my boat once we were all reunited again...and tie my shorts on REALLY REALLY tightly for the rest of the trip!

ALMOST a back flip. Note Shalina's leg-hilarious!

The rest of the trip was a blast, eating lunch on the river, cruising through more rapids, and spending time swimming and goofing around (trying to secretly push each other in, playing games of chicken, wearing river plants, etc) during the calmer bits. By the time we got to the final series of rapids our raft was a pretty tight group, and Q thought we should go for glory on the last rapid, the Nile Special. We decided to shift all our weight to the back and try and hit the rapid just right to pull a sweet back flip and be the stars of the video, which we half succeeded in.

That giant splash in the front left is me!

We made it straight up in the rapid before slamming back down. We lost two people on the first trip up, so then one of the Danish boys and I got dumped out due to the weight imbalance. He somehow (SOMEHOW) managed to hold onto the boat and ended up getting rescued by Q. The four guys left in the boat hammed it up for the camera and ended up stealing the show when the boat stayed in the rapid for several minutes. I ended up downstream again, but at least I kept my shorts on this time!

Overall it was an amazing awesome super fun day, and the barbecue afterwards was delicious and so summery. That night we painfully crawled into bed (while we like to say we conquered the Nile really the Nile kicked my butt--I lost a decent amount of skin and have some MONDO bruises...not from the river, but from being hauled back into the raft a little too energetically and dropped onto the paddles) and were soon passed out. Unfortunately, our night was not over.

Around 2:40am I was woken up by the American teachers in our room. I could hear them talking to each other and there was a flashlight on. Barely conscious, I realized there was another noise in the background as well. I half sat up, turned on my flashlight, and peered through my mosquito net at our vet-student-friend's bunk. I didn't have my contacts in, but I could just see his leg and asked "Is that noise M? Is his leg shaking?" Shalina started to wake up hearing my voice, and one girl said it was M making the noise, and that his whole body was shaking and had been for 5-10 minutes.

I thought I was out of adrenaline, but I was instantly awake and alert. M is a diabetic, and I yelled, "Hypoglycemia! He's having a diabetic seizure!" as I floundered out of my covers. Flashlight in hand I vaulted down from the top bunk, slipped on my shoes, and said, "Shalina? Are you ok?"

"I got it! Go!" she said as she fought out of her mosquito net, her adrenaline kicking in. I bolted out the door into the darkness, hurdled over a couple low hedges, and headed for the bar, hoping there'd still be some staff hanging out. Fortunately there were still guides around, but unfortunately they'd been drinking since 9pm. I had no idea how emergency medical assistance could be called, so I prayed that drunk help would be better than no help at all.

I found Q and another guide, and had to convince them that I was not there to party and flirt, but that we had a medical emergency. Q knew that M was a diabetic, so he snapped out of it and followed me back to our cabin with another guide to check out the situtaion.

While I was wrangling drunk 20-somethings guys (which luckily I've had lots of practice doing as an RA), Shalina was dealing with a seizing friend and two unhelpful, freaking-out teachers. Shalina had to push past them to turn on the lights, and as she was digging through M's things for glucose the power went out. When then finally got flashlights on and M managed to stutter out where his glucose tablets were Shalina quickly popped one into his mouth. She said it was amazing how quickly his seizing calmed down.

This is when I arrived, and the other girls went outside (probably to vomit, but hopefully just to be out of the way). We kept feeding M glucose until he could talk to us and we could test his blood sugar. It was crazy low--under 1/4 of what it usually is. He turned off his auto-insulin pump but said it would keep working for half an hour, so we battled his ever-dropping blood sugar levels with cookies, granola bars, and some soda for 45 minutes before it started inching up.

While Q was good at first in providing a calming focus to the situation, he got distracted after a bit and kept wanting to poke people with lancets and talk about murdering people with insulin. The other guide was trying to be helpful by gathering sugary supplies, but ended up exploding a glass bottle all over the floor and stealing someone's cell phone (don't ask).

Emergency averted, and our last stores of adrenaline depleted, Shalina and I dragged to bed around 4am. I almost slept in her bunk because I couldn't pull myself up to my top bunk, but I finally managed to flop into bed and immediately passed out.

Shalina and I were so extremely glad that we had been sharing a room with M that night--there's a very high chance he would have died without us, or without competent people around to react when he was having a seizure for close to ten minutes. He was fine the next day, and traveled with us to Sipi Falls where we continued to pester him about his blood sugar levels the rest of the weekend, especially during the monster hike we did to the waterfalls.

Sipi is a gorgeous, green, jungly area on Mt Elgon in the far east of Uganda, and I will post pictures from our time there soon!

5 days left in Uganda--eek!

Alive!

We made it through rafting the Nile and some crazy sauce rapids, saving a friend's life in the middle of the night, and doing a way-too-long hike to all the waterfalls in gorgeous Sipi. So many stories!

Back in Kampala now and heading to the hospital tomorrow morning before hanging out with Shalina before she leaves me in 24hrs!

I will post pictures and the epic stories soon!

Goodbye Kiboga!!

We were very sad to leave Kiboga and all our friends at the hospital this morning and head back to Kampala, where I am now. We took lots of pictures and forced everyone to hug us goodbye, even though it's not a Ugandan custom. We Americans like to hug!


I will be working at Mulago, the national hospital and the teaching school for the medical school, but not yet! Need some more vacay time first!

We head out early tomorrow morning to go to Jinja, the source of the Nile River, where we're going on a white water rafting trip down the Nile (up the Nile? the Nile is so backwards). I'm sure I will get soaked and burnt to a crisp, but I'm suuuuper excited!

We're spending the night in Jinja and then heading east to Sipi Falls, where we'll stay two nights before heading back to Kampala on Tuesday. Sipi is supposed to be ridiculously gorgeous (which must be impressive because almost everywhere we've been in Uganda is gorgeous), and we're going to attempt an all day hike on Monday. Shalina and I are still recovering from our Bunyonyi injuries--I think I now have the hip of a 65yr old woman--but we're pumped to be doing summery things!

We're not taking our computers so I'll be incommunicado til Tuesday night. Happy Birthday to all the birthdays I'm missing in the states!!

Dr. Mzungu, Surgeon!

I know I owe a million blog posts, but I have no time after yesterday's 14 hour day. It was our last real clinical day so we wanted to do everything, so we did!

Beyond seeing a million ridiculous cases in maternity like usual, a horrible preteen sexual assault case, watching two vaginal births, and watching two C-sections, we got to assist in surgery!

I was the first assist (and ONLY assistant for Dr. K) on an emergency Caesar that got much more complicated and tricky than had been planned, but despite the sweat rolling down my back the entire time apparently I did wonderfully! Both mom and baby survived, despite lots of bleeding and a long struggle to start breathing (respectively). I was responsible for basically everything during the surgery but cutting and suturing, which is a lot of crazy juggling. I even got to clamp off and cut the cord. It was so so awesome.

Shalina caught the baby on the first surgery, so she got to assist on the second one while I caught the baby. She of course got a nice quick clean case after my messy one, but that meant the baby was super healthy, which was more fun for me!

I held the wiggly screaming baby while they cut the cord, then took her over to the midwife and got to suck out all the goo and tie off the cord neatly, and weigh and APGAR score her. She was chubby and super healthy, but fussy and cold during the rest of the surgery despite the warming lamp. The midwife told me the baby's name was Maren now, so I should hold my namesake while I watched the rest of the surgery. So of course I did. And observing surgeries late at night is made more enjoyable by simultaneously snuggling newborn infants, in case you didn't know.

After the surgeries we were starving and ready to drop, but maternity was blowing up downstairs so we saw some crazy cases for another hour and a half before we escaped (leaving Dr. K still there) and got home at midnight.

A wonderful last clinical day!!

Lake Bunyonyi & the Equator

This weekend we took a much needed vacation after working for two straight weeks and through a weekend on our projects. We escaped to southwest Uganda to gorgeous Lake Bunyonyi up in the mountains outside Kabale. Bunyonyi means "the place of little birds" and did not disappoint; it's also known for it's cooler temperatures so we were excited to escape the heat of Kiboga for the weekend.

The trip there was pretty brutal: We worked Thursday morning in the hospital, bolted down some food, and caught a mutatu out of Kiboga by noon (after waiting only half an hour!). It was a billion degrees or so, with matching humidity, so as usual I kept my head stuck out the window like a dog the entire 2.5 hours.

We needed to take a big coach bus from Kampala to Kabale since the trip is supposed to take 6-7 hours, so we had to face the bus depot again. The first time we'd tried to take a bus to Kiboga we were hassled, lied to, and screwed out of quite a bit of money. The second time we'd attempted to take a bus we got trapped between two buses by a wall of yelling men who wouldn't let us leave without paying ridiculous amounts of money and buying tickets for a bus leaving in 3 hours. We had to actually fight our way through the men--Shalina knocked one over with her giant backpack and created just a big enough hole for me to wiggle through so we could run out of the bus park. So we were super looking forward to dealing with the bus park people again.

We were mobbed as usual and found the right bus with the "assistance" of a crowd of men. The conductor tried to charge an extra 25% to each of us (as a kickback to the gang of men following us around and "helping" the mzungus), but luckily I opened the crumpled tickets he handed us and saw the actual prices we were supposed to be charged, so Shalina just grabbed the extra money back out of his hand. We also managed to force him to tell us an accurate departure time, so we knew we had half an hour to get to the bathroom and back. One of the men who had been "helping" us actually helped us to a public toilet, and then made sure the bus waited for us until we got back. He was so surprisingly nice we tipped him (only 10% of the ticket price, but still a decent chunk of change), which we felt much better about doing since we gave it to him for helping us vs. being screwed by the conductor taking kickbacks.

So off we went on our journey! Except it was extremely long and painful! It took us an 1.5 horus to just get out of Kampala, and later in the trip we were pulled over by the police for an hour while our conductor was arrested. Good times!

At one point of the journey I was standing while we were stopped when the bus driver suddenly floored it so i was thrown down into my spiky metal arm rest. I hit my lower back right on my SI joint, and I'm pretty sure I damaged some ligaments back there. Spraining your SI joint makes every activity super painful--I'm still crazy sore--and I quickly developed a gnarly deep purple bruise right about where my pants sit on my hips. Ouch.

We arrived in Kabale, the big town in the area, around midnight. We had planned on arriving around 9 and taking a taxi up to our hotel on Lake Bunyonyi, but no such luck at that time of night. Our only choice was to ride boda bodas--motorcyles--up a dark, winding, rutted, dirt road in the freezing cold. We had really avoided riding bodas until that night due to the obvious dangers, but we agreed to pay two men a ridiculous price to haul us up to our hotel. We arrived safely, but MAN it was cold. I chose one of the bigger men there just so I could use him as a windshield, and after I almost flew off going over a big bump I was glued to him with both my arms and my legs. We made it to our hotel (which had stayed open late just for us) before 12:30, about 13hrs after we left our place in Kiboga.

So obviously we slept in the next morning, and then got to experience a new kind of hot shower--their hot water heater was a giant vat propped up over a wood fire that hotel staff lights up whenever guests want a shower. The shower room was in a shack, and the water was BOILING hot. At least we scalded all the road dirt off of us!

After we had a big breakfast we headed out to the local market that happens Fridays and Mondays in the local village. It was actually cold out!

Most of the farmers bring in their goods from around the lake via canoe, so it was fun to watch the canoes filled to the brim with fruits and veggies arriving.

We did one walk through and then stopped at a hotel on the shore further down for some real drip Ugandan coffee! So exciting! We meandered back through the market and got some fresh fruit that we ate back at our hotel (with an AMAZING pizza we ordered. It's great being a tourist sometimes).

We spent the afternoon canoeing lazily out on the lake. We didn't really aim to go anywhere so it was very relaxing and nice hanging out in the sun without melting in the heat. Plus we found three crested cranes--Uganda's mascot!--which are totally bizarre and awesome looking.



We ventured out to another hotel/resort for dinner, which ended up taking forever and making us sick. :(

The next morning we feasted at breakfast again and then went out with some new Canadian friends on a motorboat tour of the lake. Gorgeous!! And it's insane how steep all the hills are that local people live and farm on. We saw women and children toting huge loads up the hills on their heads--it made us tired just to watch them from afar.

There are lots of islands in this twisty, fingered lake that fills the valley between hills. This tiny island has a sordid history; it's named Punishment Island. Parents would take their daughters who became pregnant before they were married out to this island and abandon them to die. None of the locals used to know how to swim (it caused a lot of deaths in this big deep lake before lessons began to be taught) so the girls had no means to escape. The one chance for survival was if a poor man wanted a wife but couldn't afford to pay the dowry to get one--he would canoe past the island and pick up a woman if he saw one he wanted. Charming history, eh? Luckily this practice was banned, but not until 1962.

After the ride we decided to hike around the lake for a bit and visit different hotels, and ended up hiking quite a ways to visit a non-profit primary school and orphanage called Heart and check out the crafts they sold. By the time we hiked back we were sweaty and starving, so we put on our swim suits, and laid out by the dock. We had juice and pizza served to us down there (our hotel, like everything in Bunyonyi, is built up and down a steep incline). It was wonderful to swim and lay out like lizards all afternoon! We eventually showered and had dinner and ended up going to bed early.

The next morning we left with our new Canadian friends to catch the bus in Kabale, which came only an hour after it was supposed to arrive. This bus ride was the opposite of the slow torturous ride out to Kabale--this driver went INSANELY FAST over sketchy roads and around hairpin turns. For awhile the woman across the isle from us was pretty constantly puking into the scarf she'd pulled off her head (what a lovely Sunday morning!). After only 5hrs we got off the bus in Mpigi district to hang out at the equator!!

This trip to Uganda is the first time I’ve crossed into the Southern Hemisphere, so it was fun to commemorate the occasion with some goofy photos.







We were super excited to test out the Coriolis effect: would the water swirl opposite ways on different sides of the equator? One of the Canadians had done his research and said you needed to be 50km on either side of the equator for it to work... My dad thinks that it holds true for hurricanes, but not for toilets...

We ponied up a buck each and got to see a demonstration. Maybe we were tricked, but we have video proof of water swirling different ways on either side of the equator, and just draining straight down on the equator! While we skeptics still suspected there were magnets or some shenanigans involved, it was still really fun to watch flowers swirl around pools of water in opposite directions.



After doing some shopping in the craft stores and having lattes at a shop benefiting AIDS orphans we had to hitch a ride the 70km back to Kampala. We tried to wave down some mutatus, but they were all packed. Finally a minibus stopped for us and agreed to a reasonable price, so the four of us piled in for the hour and half ride back. My favorite quote of the day came from Shalina during this leg of the trip, when in exasperation she said, “Maren, the next time you go anywhere you need to just bring a man with you.” I do get a lot of attention here, especially from men who seem to quickly fall in love with me. It came in handy when I needed volunteers to help translate my project into Luganda, but in this instance it was from the conductor’s nephew who asked him if he could get on the bus too and go with me wherever I was going—it didn’t matter where he ended up, he just wanted to go with me. Awkward as per usual, and on a long day of travel Shalina no longer wanted to be my body guard.

We made it back to Kampala, made it to the taxi park, and caught a mutatu back to Kiboga, arriving home around 9pm. Including our stop at the equator it was a 12.5 hour trip—rough, especially considering Shalina had twisted her ankle pretty badly the day before and I had almost dislocated my knee cap (more great bruises, don’t worry) on top of my lower back injury, so we were a sad pair hobbling home at the end of the weekend.

It was still completely worth it though! Hanging out and relaxing by a lake in the mountains, and being slightly cold half the time, was very homey for both of us Northwest girls. A lovely weekend trip, and now just this last week left in Kiboga!

I'm alive I promise!

Whoa it's been over a week since I posted! I've been super busy with my project and worked all last weekend and last week, and now I've been on a weekend vacay trip.

We left Thursday for a 12hr horrible trip to the southwest of Uganda (almost to Rwanda) to lovely gorgeous Lake Bunyoni which is lovely and gorgeous. I had very good intentions to write two posts this weekend, but this is the first time we've had internet fast enough to load anything but very basic html gmail. We're leaving just after breakfast for our long trip back, and we're stopping at the equator on our way---will water really flow straight down the drain???

Pictures and posts soon!

Week 4: Cases of the Week

Two hospital posts in a row--lucky you! Week 4 was very light on the clinical side, especially after week 3. We had to put in a lot of hours to finish the next step in our projects, and we left Wednesday afternoon for our safari, so we only spent two mornings in the clinic. Always great cases though!

***Bug of the week--Leaf bug!
There are always creepy crawlies about the hospital but they're usually gigantor moths and beetles, so it's exciting to see cooler bugs like the praying mantis last week and the leaf bug this week! This not-so-little guy was hanging out on one of the windows in the maternity ward, and after the furtive whispering and poking and pointing between Shalina and I Dr. K paused and asked us if we'd like to get a picture so we could move on with rounds. He knows us so well now!


***Burst Abdomen--Guts on the Outside: This case was as dramatic as it sounds. Remember the two C-sections from the Friday of the previous week, where nothing seemed to go right? Well this case was the second of those Caesars, the woman who was operated on around midnight by a different surgical team.

We rounded on her Monday morning and were pleased to see that she and her baby were alive and recovering well (her baby was very pale after the prolonged labor, so there were several jokes cracked that she had somehow given birth to a mzungu baby). She had developed a cough since the surgery, but since it was likely due to the anesthesia she was prescribed a cough syrup and we moved on.

A while later a sister (nurses=sisters here) discretely came up to us and said that the patient in Bed 6 needed help. When asked what's wrong the sister quietly said that the patient was...bleeding. When pressed for more information she just again quietly said "She is....bleeding....from her....wound," and said she should be seen by the doctor. Though confused, we went with Dr. K back to the front of the ward and had the patient uncover her abdomen. That's when we saw not blood seeping through her dressing, but a large softball-sized amount of bowel coming out of her abdomen! It was pretty shocking for all of us, since it was not what we'd been expecting. The woman was varying between staring at us and staring at her intestines, and Shalina and I could not believe that she wasn't going into shock.

The coughing would have had to rupture through at least three layers of stitches for her guts to come out, which seemed very unlikely for the mild cough the woman had. Dr. K demanded to see her chart again to see what doctor had operated on her, and immediately started calling people for an emergency surgery. Since we'd experienced "emergency surgeries" before I decided to look at my watch and decided to time how long it took to get this woman into the theater. It was 11:18am.

We finished rounds and came back to check on her before we left, around 12:30pm. No progress had been made on readying the OR, though sisters were still trying to track down theater staff while doing their other duties. The patient was trying to keep a gentle but firm hand on the sheet covering her extruded intestines, and trying really hard not to move or cough, but perfect immobility was impossible and more bowel had slipped out since we last saw her. Lots of other women in the ward were stopping by to encourage her and help her and her baby out, and hopefully that helped keep her somewhat calm.

Shalina and I left for lunch and to work on our projects around 2:30pm, and the woman was still nowhere close to getting into surgery. We had hoped to come back later for the surgery, but it wasn't until after 8:30pm --over 9 hours later--that she went into surgery, and Dr. K didn't have a moment to call us once he'd corralled everyone into the theater. Dr. K told us that by the time they started operating almost all of her large and small intestines were outside her body. Completely insane.

He did a thorough wash, sterilization, and repair, and miraculously the woman has not gotten sepsis. It's especially lucky considering her HIV+ status. Unfortunately her cough has gotten worse (don't worry! Dr. K used an extremely tough suture technique so nothing has come out again), and the sisters mistakenly cut her sutures after only 6 days instead of the 10-12 days Dr. K had ordered. Now we're waiting to see if she has tuberculosis (which is super great since she's been coughing around us for two weeks now), and Dr. K re-repaired her outside layer of stitches this past Wednesday.

We never found out if it was a medical error that cause the original 'burst abdomen', but some external sutures have blown on two other patients the same doctor has operated on... We wish Dr. K was available for every surgery!

Me and the most awesome peds nurse, Sister Grace!

***Convulsing Infant: As we were leaving the pediatric ward on Tuesday we were bombarded with several urgent cases. The first one was a day-old infant who had been fine until he was taken to the immunization clinic for his first round of shots. On the way back he started having full-body convulsions, so his mother brought him straight to us. Upon examination we saw that he was having convulsions predominantly on one side, and that they would last for a few minutes and fade away, and then another round would start. Disturbing him too much would set off rounds of convulsions, but they would also start without any stimulus at all. Additionally the baby had a large lesion the size of a quarter on the side of his scalp that was semi-crusty but would ooze fluid if it was poked or squeezed. The mother said he been born with it, and that it didn't seem to bother the baby.

Also, the boy had six digits on each hand! He had extra fingers growing out of the middle of his pinky fingers, so while we were waiting to see if the seizures progressed or abated Dr. K tied off both digits tightly with sutures and said they would fall off in less than a week. He said this was decently common in Kiboga District (which was super surprising to us!), and then asked the mother if she had been born with extra digits. She held up her hands and we saw that she had small bumps of flesh on the outside of both pinkies--the remnants of her extra digits.

During all of this the side having most of the convulsions switched! Most of the diagnoses on our differential diagnosis didn't fit, and we were left with thinking it was a reaction to the immunizations (which had been our first suspicion anyway). The other option left was that the lesion was communicating through to his brain and allowing bacteria to enter. The boy was admitted for observation, but since we didn't return to the hospital this week we never found out what happened to him.

***Two tongues: One last weird case was a six-month old infant who appeared as we were walking out the door. The mother, nurse, and Dr. K got quite excited discussing the case in Luganda, and we could tell Dr. K was teasing the mother. When he finally turned to us he said that the boy was really a snake--he had two tongues! When we pried open his tiny mouth to examine him he did indeed appear to have two tongues. But unlike a snake's split tongue this boy had two tongues on top of each other--very bizarre! The mother said the boy had no problems swallowing or breathing, so while Dr. K wrote a referral to Mulago he told the mother not to take the boy until he was five years old or so, unless he developed problems before then.

With these two cases this week, the boy born with no arms the week before, and a couple other cases we feel like we've been seeing lots of weird birth defects. Dr. K says we've seen only a few, and that there are lots lots more. When we tried to press for more details about what he thinks is causing them he didn't really have an answer for us. More unsolved mysteries in Kiboga!

Safari Palm Tree says, "GO STANFORD!"

Week 3: Cases of the Week

Yes, yes, I know it's now week five, but such is life in Africa. Here's the long update from week 3!

This week was a doozy. We did four full clinical days, which lasted 10-12hrs each (with an hour break to escape and eat something...anything!) and included a trip to the OR every day. It was amazing, and soo exhausting. We also had meetings crammed in here and there and everywhere for our projects, but with long hospital days and no electricity at night, we didn’t get very far on actually writing our next assignment…oops! Luckily it got finished the next week so we didn’t have to feel guilty about our clinic time!

The post is long but hopefully not as graphic as the last one, though with medical cases and surgeries there will be some details that may make some squeamish, so again feel free to skip to the next post.

***Praying Mantis: Okay, so this more of a hospital story than a medical case, but there was a praying mantis on the door to the labor suite on Wednesday! It was giant! Shalina and I were shocked and amazed! The locals thought we were bananas, as usual, and found it hilarious that Americans bother to round up bugs and put them on display at zoos (we told the staff that’s the only place we’d seen them before). Later we learned that not only do mantises roam free here, they FLY, and it can be quite distracting when a giant green bug zooms past your head as you’re trying to focus on a woman in labor.

***Surgeries: This week we saw four surgeries—a hernia repair, a circumcision, and two Caesars.

The hernia repair was on a 20yr old man who’d had an indirect scrotal hernia for over 5 years. The man had spent 400,000 Ugandan Shillings on traditional herbal methods of healing with no luck (obviously—I’m not sure how herbs could push bowel back up inside your abdominal wall…) and so finally scheduled the surgery during his school break. Shalina and I thought the hernia was pretty big to leave unattended for so long as it was 6-7” long, but Dr. K said he’s seen indirect hernias the size of basketballs—insane! The hernia was completely manually reducible—you could push all of it back up into his abdominal cavity though his external inguinal ring, but it would all just slip back out again (this is all under his skin of course) after you removed your finger. Pretty crazy. The surgery was awesome to watch since the whole anatomy of the abdominal wall, inguinal canal, and spermatic cord was integral, and Shalina and I were sweating getting ‘pimped’ with all of the questions Dr. K threw our way.

I was also really not feeling well this day, and at one point I had to bolt out of the theater, strip off my sterile layers and galoshes, find my shoes, and rush/stumble to the toilet to puke. When I was finished I chugged some water and wondered if it would be a poor medical decision to return, but I could hear Dr. K calling for me so I got back into all my layers of gear and entered the OR to find everyone staring at me silently. Dr. K calmly called me over to the patient’s side and asked me to describe and identify the different pieces of the spermatic cord he’d just un-entangled from the intestine. The surgery continued on like nothing had happened…

The circumcision on another 20-something year old man was also very interesting. Typically only Muslim men are circumcised in Uganda, and men in a few tribes in Eastern Uganda (in a crazy, painful, un-sterile, HIV-spreading ritual---yeesh), but with the advent of HIV and the studies proving efficacy more men are choosing to have elective circumcision to reduce their risk of contracting and spreading HIV. Though all the men in the room teased the patient that he was “Hadj” now (the Ugandan nickname for all Muslims, whether they’ve made the pilgrimage or not), the patient stood up to it and recovered well.

The first C-section we saw was a sad case. A woman came to the hospital early in the morning  after laboring for 48hrs under the care of a traditional birth attendant in her village. Upon examination it was discovered that the baby was lying obliquely in the abdomen, and so the forearm was being delivered first out of the cervix, wrapped and tangled in the umbilical cord (which was what was causing the obstruction). When Dr. K examined her at 9am there was no umbilical pulse; the baby had already died. He told us it was a "forearm prolapse" but when we saw her in the OR at 1pm (the quickest the OR could be prepped and the staff recruited) the entire arm was out of the woman's body, along with a foot or so of umbilical cord. It was very disturbing-looking and much more extreme than we'd expected. The surgery went well considering the murky state of things inside the uterus, and miraculously the woman recovered without developing sepsis (several women in the maternity ward did not receive their prescribed antibiotics this week, and two did develop sepsis likely because of it, but this woman at least had some small good fortune).

The second C-section we saw was one of two women who needed Caesars on Friday. Both women had arrived early in the morning after laboring for several days in their villages—the woman we operated on had been in labor since Monday! Horrible. Both women were spiking very high blood pressures (understandably—their bodies were not handling the stress of labor well after so many days) and so could not be operated on until they were lowered. Many doses of bp-lowering drugs were given before the anesthesiologist would accept either woman, and by the time our first woman’s came down and the OR was prepped her baby had died. The woman had developed a very high fever and she was heading for septicemia and a coma or death, so she was operated on first around 6pm. Her surgery did not go well; the woman bled too much and petocin, a drug to stop peri- and post-partum hemorrhage was mistakenly not given until the very end of the surgery when the bleeding could not be stopped (it should have been given as soon as the baby was delivered). Additionally the scrub nurse assisting Dr. K was sick, and she couldn’t even stand to complete the surgery. Tempers were running very high in the room.

After the surgery, even though the second obstructed labor patient was waiting, the electricity was cut, it was now completely dark, and the scrub nurse refused to do another surgery. Then the anesthesiologist left to get dinner and would only return if all of the problems were resolved. Dr. K was in a very dark mood, and after ranting about how screwed up the system at the hospital was (totally understandable) he tried to convince me to scrub in on the next surgery and assist so the woman could be delivered as soon as possible. There were a million reasons why this was a bad idea, and luckily Shalina and I had already discussed them during the previous surgery. I was torn--what if I agreed to help on the surgery but made a mistake or acted too slowly and the woman died on the table? Or worse, what if I refused to help and just let the woman and her baby die downstairs while waiting for surgery? The woman was also HIV+ and the OR was short on protective equipment; another factor to consider. Additionally the woman's family was too poor to afford a transfer to another hospital, so it was here or nowhere. I was basically ready to cave in despite all the arguments against it, but since there was no electricity, not enough sterile equipment, and no anesthesiologist Shalina and I just went home. We later learned that Dr. K spent several more hours fighting the system to get this woman her operation, and she was finally operated on by another doctor and team around midnight. She and her baby both survived, but she became a case of the week the following week, so stay tuned…

Don't fret! We're still cheerful at the hospital!

***87yr old mystery man: It’s extremely rare to see someone over the age of 60 in Uganda (the mean age of the population is 14yrs, and the life expectancy is around 50), so when we were called into the male ward to see an 87yr old we had to ask if we heard the age correctly. The man came in with his granddaughters who explained he’d been feeling poorly for a while but had staunchly refused medical care all his life. Now he was too weak to resist, though he still had some fire in his eyes even has he remained silent in protest during the whole exam. There were very cool physical exam findings, so we got to use all our new skills! There was crepitus across his right rib cage—air bubbles trapped under the skin that feel totally crazy, kind of like popping tiny bubble wrap. There was also fluid in his belly that was only present right below his rib cage (our mad percussing skills narrowed down the area). His lungs sounded funny as well, but we knew he had emphysema among other problems there. Lots more positives were found throughout the exam, as would be expected in an elderly man (it was much more exciting than doing full exams on healthy medical students!)

So the debate began: is this a lung problem or a liver problem? Pneumothorax? Liver abcess that had ruptured? Obstructed/perforated bowel? Without more certainty Dr. K didn’t want to push a needle into the man’s side to see what came out, and with no imaging options available we had to transfer him to Mulago, the national hospital in Kampala. It was so frustrating not to be able to just send this guy down for a chest and abdominal CT scan and get the answer within a few hours. The radiologist had gotten married the previous weekend so there weren’t even ultrasound or chest x-rays available. Now we’ll never know what was wrong with this man (sigh).

***Pediatrics: Though we only spent one day in peds this week there were still too many notable cases to talk about. Cerebral palsy, severe malnutrition, a possible thalidomide case in a boy born with no arms… One case in particular though stands out in my mind.

There were two adorable toddlers who seemed well recovered from their bouts of malaria and kept escaping from their moms to come play with us as we progressed around the ward doing rounds. We saw them eventually, and both were due to be discharged later that day. One of the moms came back to us half an hour or so later and said her boy was convulsing. We went to go look at him and indeed he was having small tremors all over his body. The staff didn’t seem too concerned, and Dr. K suggested an anti-seizure drug. Half an hour later Shalina and I wanted to check on him on our way out since we felt uneasy with the previous visit; the boy had come in for malaria, which can cause both high fevers and hypoglycemia, both of which cause convulsions in toddlers. We saw he was still convulsing--more severely now--and he hadn't even received the previously stat-ordered meds. So we bullied and nagged Dr. K until he spent time to re-examine him and ordered more appropriate treatment, which quickly stopped the convulsions. Though the case was minor Shalina and I both felt like the boy may never had received correct meds and wouldn’t have stopped convulsing for hours unless we’d intervened. This case made me apprehensive of how many other cases on the busy, overcrowded ward were being overlooked due to harried staff and soft-spoken young mothers…If this kid hadn’t been totally adorable and charming before I might not even have noticed his rapid decline and fought for him to receive appropriate treatment, and who knows what damage would have been done.

***Mulluscum contagiosum or Varicella?: A women in her second trimester of pregnancy was in an isolated room off the labor suite when we stopped by to visit her with no inkling of why she’d been admitted. We walked in the door and saw a women covered from head to toe in pox. Shalina and I have both had chicken pox, but we’re in the middle of nowhere in Africa, and we both took three steps backwards to flatten ourselves against the wall as soon as we saw her. Not super proud of that, but the pox looked extensive and weird. We were laughed at by the staff who assured us it was probably chicken pox. We crept a little closer to examine the woman and noticed that many of the pox were umbillicated (look like cheerios) across her abdomen, so we threw out Mulluscum contagiosum for the differential diagnosis, and asked about her HIV status. Dr. K was pretty sure it was chicken pox, despite the weird presentation, and was pretty unconcerned with any dangers to the fetus, though we were told in detail about the dangers of varicella to the fetus in microbiology class. She was treated with calamine lotion and antibiotics and while she remained the only person in her room she wasn’t in isolation and wandered out around the other pregnant women quite frequently. We haven’t seen an epidemic break out since then, but we still were uneasy with this whole pox case….

***Leprosy: We didn’t see this in the hospital, but like the mycetoma foot the week before we saw a man with very advanced lepromatous leprosy begging in Kampala. It didn’t look like he’d been receiving treatment, so we were glad we were just passing by in a mutatu (though you need a lot of contact to catch the bacteria). It was pretty crazy to see such an advanced case--it looked just like the textbooks!

You made it to the end! Giraffes say thanks!

Murchison Falls Safari & Nile Cruise

I think Shalina and I took 500 photos between the two of us over the few days were were gone, all of which are amazing (of course), but I'll try and put of some of the best ones here. I need to start a site to share all my photos, but we'll see if that happens before I'm state-side again...

We left Wednesday afternoon from Kiboga to head to Kampala, where we feasted on coffee treats and had dinner with friends. The safari company we used, Red Chilli's, has a compound outside of Kampala and so we stayed there Wednesday night before leaving early in the morning to start the drive up to Murchison Falls National Park. We got there kind of late and there weren't enough beds for our group so we got a free upgrade to this huge fancy house! It was wonderful, and we had lovely hot showers. Perfect start to the trip.

Thursday we met our safari group (in total there were 7 of us Americans and 1 Welsh guy) and then spent most of the day driving. We got to the park around 4pm, and to the basecamp in the park near the Nile around 5pm. Even though most of the wildlife lives across the Nile we started seeing animals as soon as we entered the park! Warthogs, baboons, and various antelopey creatures were pretty brave and barely moved out of the way for our vehicle. This family of warthogs lives at the basecamp and searches for any food left out or ventures inside tents for snacks...

We wanted to stretch our legs before dinner so five of us hiked down the short hill to the Nile (and were told we shouldn't be wandering around without guns...eek) to see our first hippos!! We saw millions more the next day (only a slight exaggeration), but it was very fun to start the safari early.

We also saw more hippos late that night--outside our tent! The hippos come out of the water at night to feed, and apparently the grass at the basecamp is super delicious. They warned all of us extensively to steer very clear of camp hippos, so it's pretty unnerving when they are close enough to touch through your tent wall. They are also SO. LOUD. when munching on grass two feet away from you!

The next morning we were up before sunrise to hop in our sweet pop-top mutatu to get on a ferry across the Nile and start our safari! We had a ranger join us to help us spot and ID the animals, and also carry a terrifying automatic weapon "just in case" (BTW, not the weapon I was imagining when they said he'd have an "elephant gun"...)



So safariing we went! Like I said it was the best time I've ever had before 8:30am--we'd seen at least one group of every animal by then. And by group, I often mean animals dotting the landscape as far as the eye can see--it was totally unreal.

Here are some of my favorites, like Uganda's national animal--the kob!

Lion! Eating a warthog!

Me and some giraffes! There were soooo many giraffes!

And we were so close to them! And all the animals really--almost uncomfortably close sometimes.

Elephants! This guy was super handsome, and I got my wish to see some baby elephants before we left the park--sooo cute.

Many more animals, and many more pictures--too many to post. After the game drive in the morning, we went back to camp for lunch and a quick nap in the scorching heat, then boarded a double-decker boat to cruise up the Nile to Murchison falls.

The breeze on the boat was lovely, and we got to see most of the animals again as well as new water animals and tons of birds!




Here's me and a family of elephants!

Zoom in on the elephants

Nile crocodile! They were very hard to get a good pic of since they'd dive under water when we got too close, but were so huge and were awesomely green and black. So sweet.

Soooo many hippos. I didn't know there were so many hippos! They dig tunnels in the shallows so it looks like they're all floating in deep water, but when one stands up you can see that the water is barely up to their chubby hippo knees. I really enjoyed talking about hippo tunnels the entire trip--don't they sound like fun places?

We got to climb out of the boat near the falls and take photos on rocks before cruising back down to base camp. A lovely lovely afternoon.

We paid a little extra to do a wine and cheese sunset tour of the Nile, which was a wonderful $20 spent. We got waaaay too close to all the animals in our tiny boat with our brave captain who liked to bellow back at the male hippos who tried to warn us off from their 'schools' of females.

The next morning before we did the long drive back to Kampala (on which we got two different flat tires) we got to hike up to a view point of Murchison Falls and it's sister waterfall Independence Falls (it appeared in 1962 after a flood and is only around certain times of the year, so we were very fortunate to get to see both of them in all their glory!

We then hiked down some cliffs to visit the top of the falls. Me being me, I managed to jump down hard on a clump of soft dirt that was posing as a rock and starting sliding down the cliff! I tried to get my footing but just kept finding dirt and sliding further. Luckily I found a teeny tree root to grab, and pulled myself back up before anyone else had reacted to what had happened. The dirt is super soft and rich in mica, so while I was covered in it after my little fall I wasn't scratched at all, and I glittered the rest of the day! (My shoes are still filled with sparkly mica, so all my socks will get sparkly too...)

I have a billion gorgeous photos of the falls that I am pretty sure I could sell as postcards. Here's me at the end of a rainbow leaning on what used to be a precarious footpath across the falls.

The trip was AMAZING AMAZING even though we didn't pay extra (and spend two more days) to see the rhinos and the chimps. It was a wonderful break from work and worth every cent we spent! :)