Thursday, October 6, 2011

The journey and the destination

Hello readers! You will have to wait a bit for an explanation of the picture attached...

I know that some of you will be disappointed to hear that my travel to Kitgum, Uganda was not nearly as eventful as the last time. No bus fires, hitch hiking, or traveling with stealthy chickens.

I caught a ride north to Kitgum with a staff member from IGF (Irene Gleeson Foundation), who was transporting a refrigerator and a radio transmitter from Kampala in a truck. (No, I got to ride in the cab, not in the back). One funny sign in a village on the way advertised an office for SLAP - Support Least Advantaged People. I almost asked to stop to take a picture of it, but didn't think quick enough. Is that the worst possible acronym you have ever heard of? I cannot imagine anyone even wanting to go into the office to ask for help :)

The ride was more green and lush than the last visit because of the rains - which also meant some washout areas. However it was only a 7 hour drive - with the last segment from Gulu to Kitgum being similar to riding on the inside of a washing machine for 2 hours. Taking the larger bus may have a distinct advantage on this last section. It seemed surreal to see little children walking along the road with large jerry cans of water on their heads, or women with a child tied to their backs and carrying jerry cans in both hands and on their heads. There is pretty much nothing to complain about when you see that.

At the end of the long day's travel there was a beautiful rainbow that seemed to end at Kitgum - a sign for me. Irene was there to greet me, and I finally met Dr. Andrew - an Australian family doc who has been here several times and is encouraging me to partner with him in the medical work here. He is a very warm, compassionate doctor and I am going to be very lucky to work with him - I have much to learn. There is another Australian couple here visiting as well (I am outnumbered by the Australians - I am the only white person without an accent :) He is a mechanical engineer and she is a retired pharmacist - so we are all gainfully put to work here.

After being awoken by roosters at 5 am (earplugs tonight for sure) - I sat down with Andrew to hear about what he has been doing here for the last couple of days. Then he showed me around the clinic area - which is very simple but impressive. Would you believe he even has an electronic medical record system for the clinic? There is still much to do as far as standards of practice/lab testing/ approaches to common problems like fever/cough etc. We have a lot to learn about a whole array of new diseases in the differential diagnosis of a symptom - in other words typhoid and malaria are not usually in my differential at home!

I then was asked to see an "old" man in the hospice ward. Sure - something I might actually have some experience in... When I got there and heard his story - it turns out he is only 55 but looked 80 - very thin and obviously dying. He had AIDS and TB and the question for me was whether the TB meds were the possible cause of his lack of appetite and obvious decline. I spoke with the wife and son, as well as the medical officer (a young man who is the equivalent of a doctor here - but probably more like a good Physicians Assistant in the US) and we talked about the various options. I thought we should give him some IV fluids in case dehydration was the cause of his decline over the last few days. (He was basically unresponsive at this point). He did not seem to have any physical discomfort - which is good because there is not any morphine or other opioids in stock (Note to self - fix this issue before I leave). I'll check on him tomorrow, but I dont think anything can stop his decline at this point... he is in the right place.

I was pulled away again to examine a little orphan boy (whose name is DAVID! ) who had only weighed 2 pounds when he was born prematurely about 5 months ago - now he is about 8.5 pounds. He was doing well except for an inguinal hernia (note picture above). Some of his intestine had gone through a weakness in his abdominal wall into his little scrotum. So I felt like a monster as he screamed and I tried to gently maneuver (or "reduce) his hernia back into his abdomen. No luck. So I packed him up with his "grandma" caregiver from here and we went to the Catholic hospital. We got prompt help and within 30 minutes we were waiting for the anesthetist. The young African medical officer welcomed me into the operating room where I helped a little bit (if holding a retractor is helping) while he did the operation. Good news was that the bowel was not ischemic and pinked right up when he got it out of the hernia opening. He should make a full recovery. It was a great privilege to be part of helping him avoid an early death - especially since they had worked so hard to save him from his low birth weight and prematurity.

It was a busy first day - I have a lot to learn, and a lot of listening to do so I can hope to be sensitive to the needs here, and not just tell them how we do things in the US. Thanks for reading!

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