Intranational traveling

About 4.5 weeks ago I left Chicago for Chinle, AZ. Here is a summary of those 4.5 weeks.

Places

The drive was nothing special. I stayed for one night in Oklahoma City and another night in Albuquerque where I went for a short and miserable run in the Foothills based on the advice of the legendary Jesse McDaniel. The drive through New Mexico and Arizona was significantly better than any drive I’ve made through the endless array of farms and flat land that is Illinois.

Chinle is a small town about an hour into Arizona from the border with New Mexico. The last 30-45 minutes of driving could accurately be described as the middle of nowhere. Also, I hope the movie Tremors was not based on actual events because Arizona definitely looks like graboid territory. Chinle consists of a hospital, a high school with a sports complex that from the outside looks nicer than the entire athletic complex at WashU, ~4 gas stations, 4 fast food joints, 3 churches (catholic, mormon, jehovah’s witness), a hospital, an aquatics center, an arts and crafts store, a grocery store, ACE hardware, bank, about half a dozen restaurants, and a dozen other run-down buildings providing various other services.

People

I work in the PT gym with my Clinical Instructor (CI) Sally, a 2010 graduate from UW’s PT program. The clinic consists of about 4 other PTs, 2 PT administrators, an OT, 2 speech therapists, a PTA, and 3 office workers. Except for the 3 office employees and the PTA, none of the others listed are Navajo. Basically anyone who works here either served a student rotation here or began as a contract worker and decided to stay. I believe the 2 PT admins have been here 11 and 14 years, one PT has been here about 5 years, and the other PTs less than 2 years each. Employee turnover throughout the hospital is pretty high, considering that this is labeled an "isolated hardship" position. Apparently that is the label given to a job that is a certain distance from a city of a sufficient size. In order to live and work in Chinle you have to be fairly open-minded, culturally sensitive, and low maintenance, so everyone gets along pretty well.

My roommate when I moved in, Mike, is a medical resident here for a 4 week rotation. He hails from Michigan. I’ve had a few chats with my next-door neighbor, Pete. Pete is an author of American military fiction who has to get his books cleared by the government before publishing so he doesn’t reveal anything too confidential I guess. He is here because his wife works at the hospital, however of the 3 or 4 times I’ve spoken to Pete in front of our houses, nobody else has ever been around at the time, so it is entirely possible that Pete doesn’t actually exist.

Housing

Student housing is provided about a 10 minute drive from the hospital. It includes 2 bedrooms, a kitchen (with 5 pans and about a dozen baking sheets and mixing bowls, but no pots, can openers, or reasonably sharp knives), a common area that has a TV but no cable, and a bathroom. Internet is not available in the apartment, so days at home so far have pretty much involved watching the TV shows I happened to bring with me or happened to already have loaded on my computer, and exploring the various computer games my laptop came built with (I’ve swept quite a few mines in the past few weeks). I also study or read when I’m sufficiently motivated, but for the most part I lay around thinking of all the things I should be doing.

That’s enough for now. Over the next few weeks I’ll add entries on places I have or have not visited, what it’s like in the PT clinic, and whatever else I feel it will be extremely important for me to remember when I reread this blog in the future to make it seem worthwhile to have written it at all.

The Final Countdown

We have had a shortage of both power and free time this past week, so I'll have to summarize our last week in this post. I would feel guilty, but Anna hadn't updated all week either, and her blog has actually been good. For those of you who aren't UW-PT students, you can read her blog at http://www.anna-uganda.blogspot.com.

Sunday was beach day. For our last weekend here, we had made plans with Chris to visit a beach in Entebbe. Coincidentally, the UW med students had also decided to spend the day at the beach for their last day in Uganda before heading off to the airport. So we joined forces and bussed to a private beach about an hour from Kampala. The first thing we noticed was that any of the Ugandans not going in the water wore fairly nice clothes to the beach, like they do pretty much anywhere else they go. The beach wasn't bad, but was clearly overshadowed by the tourist-style nature of the private hotels that own sections of the beach. At Imperial Beach Resort, the "beach" includes at least one restaurant, a carnival, and a massive dance floor with a DJ playing all day. Since stagnant water poses yet another threat to us visitors, we spent most of the time tossing a frisbee on the beach, which caught the curiosity of any nearby Ugandans, and taking jumping pictures with Doreen. When I say taking jumping pictures with Doreen, I mean somebody there introduced her to the concept and she wasn't satisfied until she had taken a dozen jumping pictures with everybody there. It reminded me of the time my freshman floor-mate from Hawaii saw snow for the first time.

Monday through Thursday involved little other than COMBRA, which stands for Community-Based Rehabilitation Association. This is an organization located about 30 minutes from Makerere University, in the town of Seeta, which sends volunteers out to villages to help individuals with disabilities learn to compensate for their physical or functional shortcomings and adapt to their environments. The craziest part is that these volunteers have to pay a sort of tuition to be educated by COMBRA, after which they go to a village and work for free. In a place where money and opportunities are scarce, it is barely conceivable that people can do this.

Monday was basically an orientation, or rather a second orientation, because our first one a few Fridays ago turned out to be a 4 hour lecture on the definition of community-based rehab by Barbara, a woman with no shortage of words. Anyway on this second orientation we discovered that COMBRA vastly surpasses Mulago Hospital as far as patient documentation is concerned. We were introduced to the forms used in which volunteers go door-to-door in each village of each parish of each sub-county of each county of each district to find exactly who has a disability, as well as what kind, what the cause was, etc. The detail is phenomenal.

Tuesday we hit the road. With one year of PT education under our belts and zero experience in home health treatment and assessments, I think we all felt reassured that we would be paired up together and given an interpreter/volunteer for each of our home visits, which is why we are all blatantly terrified on Tuesday morning when William, the COMBRA employee in charge of our experience, informed us that we would each be left at a separate house individually, for a period of about 6 hours. To be honest, I figure that without the supervision of a therapist or the guidance of a COMBRA volunteer or interpreter, I could have lasted maybe 30 minutes on my own. Fortunately Karen, our UW-PT professor chaperoning us on this whole trip, talked William into letting us pair up and only staying for 1-2 hours at each place, insisting we would have nothing to do for a 6 hour stint at each house, but this not before Brett had been dropped off and left at the first house. Fortunately Brett can handle adverse situations and he managed just fine.

I was paired up with Allyssia, and our patient was Emmanuel, a 4.5 year old boy with a form of cerebral palsy induced by an infantile episode of malaria. Emmanuel had surprisingly good range of motion and as of March had learned the ability to roll from supine to prone, but with poor vision, limited responsiveness, and dystonia, he was unable to perform any activities of daily living (bathing, feeding, hygiene) independently. Our time there along with our interpreter Gertrude, a recent graduate from COMBRA with a heart of gold, was mostly spent taking the patient's history and testing range of motion and spasticity as well as assessing his recently built CP chair. After lunch, we all regrouped and saw 2 more patients. Along with Anna, Ryan, and Karen, I visited Onesim, a 20 year old boy with periodic convulsions and significant knee and hip flexion contractures who spends all day every day completely alone inside a dark and smoke-filled hut, unable to feed himself or control his bowels or bladder, while his mother works gathering tea leaves on a bordering estate. This patient encounter involved little more than recording a patient history, as realistically there was little we could do for his body or his or his mother's living conditions. Like much of what we've seen so far in Uganda, it was heartbreaking.

Wednesday morning was spent reviewing the patient cases we had all gathered from Tuesday, after which we returned to selected patient houses to take measurements collect 2 CP chairs that needed modification. Thursday was workshop day. COMBRA has a workshop where they build devices such as crutches, puzzles, standers, chairs, and various toys for the individuals they assess who can afford such devices. We spent the morning sawing and hammering our way to improve the two chairs we had collected on Wednesday, while Anna built a puzzle for 2 cognitively-delayed patients she and Ryan had visited on Tuesday. After doing what felt like our minimal best, we returned to the patient's houses a final time to deliver our goods. We also made a few quick stops at a school for cognitively challenged or orphaned individuals, most of whom are apparently dropped off there after being found abandoned on roadsides, and a school where Gertrude works for deaf, hard of hearing, and mentally disabled children. Both of these visits were highly inspirational and discouraging as far as the standards and conditions we witnessed there.

Free from the loose and inconsistent schedule of our clinical internship, Friday began with a trip to the famed Friday craft market, where the original creators of many of the crafts sold around Kampala convened to sell their products themselves, significantly lowering the prices by cutting out the middleman. With only an hour to peruse the selections due to an unfortunately but unavoidably delayed private taxi, we stormed the market each doing our best to collect as many cheap souvenirs as possible without going completely broke with a day and half left before heading home. There were baskets and drums and sculptures and necklaces galore, and I think I did a pretty decent job displaying will power. I only spent about twice as much as I anticipated.

I would love to write more, but the USA vs. England World Cup game is about to start, and since anybody reading this probably knows me well enough to ask about the events in person anyway, I'll let the game take priority for now. The blog will hopefully resume on Monday or Tuesday after safely returning home.

Down Time

Today is a national holiday: Uganda Martyr's Day. This means that most people have the day off, including all but the bare minimum hospital staff, which ergo vis-a-vis transitive property means we have another casual day off as well. So I'm going to take this opportunity to do some more updating, but since not much has happened since the last time, I'll fill you in on the intangibles, but first thing's first.

Yesterday we returned to Mulago Hospital, and this time I was with physiotherapist William on the burn ward, where Allyssia was during the first week. Having essentially no experience in hospital settings or burn wards or anything that is stereotypically unsettling (other than the cancer and fracture wards I saw during my first week), I was a bit nervous about how I'd handle it. But I didn't pass out, never felt light-headed, and got at least one kid there to return my smile, so I consider it a success. We did rounds, meaning I got to learn a little bit about all of the patients (as long as I could hear what the plastic surgeon leading the rounds was saying, which was not often), but work with none of them. Next I was able to do some brief range of motion and resistive exercises with a few fracture patients and an infant with sickle cell anemia. In the afternoon my PT was nowhere to be found, so I was relegated to the outpatient gym. I saw 3 patients, each with the blanket diagnosis of low back pain. Since starting at Mulago I have "treated" 4 patients in the outpatient gym, and 3 of these 4 have been wearing nothing on top except a bra. There are some interesting standards here.

So now back to basics. Since moving to Nufu House, my 4 PT classmates and I have had a string of house-mates, primarily from the USA but currently there is a professor from Norway as well as a first year medical student who believe it or not graduated from WashU. Small world. Every morning our housekeeper Margaret makes us breakfast, which consists of two pieces of toast, some sort of fruit juice, some type of fruit (usually pineapple now that she knows we love it), and a "main course" of either 2 hard boiled eggs, muffins, omelet, banana bread, and samosas, which are a triangular breaded contraption filled with either meat and cheese or veggies or beans. Several days into the trip we implemented the practice of using the song "The Sign" by Ace of Base to remind us to take our anti-malarial pill, so if you hear anyone sing that song then you know what to do. Speaking of malaria, it appears that virtually everybody here gets it at some point. My first therapist Sam has had it 3 times, and our rafting guide Josh has had it 5. Also a great majority of the peds cases are attributed to it. However a fierce combination of mosquito nets and bug spray have left me relatively unbitten so far.

More about the PTs. Within a day or two after arriving, I finished a respectable 2nd in the "who can avoid their first Ugandan #2 GI contest", losing to Allyssia by a day or so. But the real GI contest was won by Anna, though you might say she was really the first loser. Aside from a few early stomach issues for Anna and Allyssia, a minor cold for me, and Brett's persistent allergies, no one has gotten really sick, though Anna as well as Shweta, our new house-mate from WashU, both fainted on their first day at Mulago Hospital. Ryan and Brett have been putting up a fierce competition with each other in the fart department, and I demolished Ryan in the no-shave contest. He was complaining of itchiness before I had even reached playoff-beard length.

Over the past few weeks, we've tried about a dozen pineapples, papaya, avocados, and a few nights ago one of our Ugandan friends showed us how to make passion-fruit juice. I've eaten goat, matooke (some sort of mashed banana food that is pretty much a staple of the Ugandan diet), posho (a bland starch item), and chappatis, basically a rolled flour tortilla. I want to talk more about driving and traffic in Uganda, but that probably deserves its own separate blog entry. So for now I'll say thanks to everyone who has read my blog, I hope you're all doing well, and I look forward to seeing everyone when I get home in about 11 days!

Safari

Yesterday we returned from a long weekend of animal-watching. Saturday morning we made the 5 hour bus ride with the UW med students to Murchison Falls, a national park/forest preserve in the northwest-ish region of Uganda, near enough to Kampala that it's safe, but far enough that the park is still guarded by soldiers with rifles.

We stayed at Sambiya River Lodge, a tourist-style campground with bug-ridden huts and no less then a 2 hour wait to be served any meal, for no other reason than because they're just really slow. I stayed in the Simba hut, so you should be jealous. The lodge comes complete with showers, a swimming pool, bar, and warthogs, baboons, and water bucks freely roaming the grounds. The first night I only had to kill one spider in the room before sleeping comfortably in a bed made for someone no taller than 5 foot 10. Anna and Allyssia, on the other hand, had to enlist the help of one of the lodge employees to evacuate a bat from their ceiling before settling in for the night. They also were held up returning to their rooms from dinner the second night because a large water buck had parked itself on the path. This was apparently dealt with by one of the employees throwing stones at it until it moved.

After settling in on Saturday, we headed to Murchison Falls, a series of rough water falls along the Nile River (or River Nile as most Ugandans refer to it). It was pretty cool to see, but not really worth the 2 to 2.5 hours we spent there. One of the highlights came when Ryan took his first major step in overcoming his bug phobia: one of our tour guides found a millipede which Ryan hesitantly accepted onto his hand only after Anna did the same. I think I killed it when it fell off my arm and crashed into the rocky ground a few feet below. Whoops.

Sunday was an early start, heading off at a dark 6am for Murchison Falls National Park, the location of the safari grounds. The safari consisted of about 25 of us (the PT and med students plus professors) on a large bus crawling around a large span of preserve, stopping for photos at every animal sighting. It's funny to think back now about how excited we were at the first sight of one or two bushbacks or elephants way off in the distance, considering how close we got later on. The ride started with some oribe (sp?), bushbacks, and heartbeasts, all of which look somewhat like deer and none of which I can tell apart because our guide, like most Ugandans, was exceptionally difficult to hear at times. As we moved on, we passed families of warthogs, water buffalo, some giraffes, crested cranes (the national bird of Uganda, depicted on the national flag), and a passive lion, which we quickly discovered had a major gash around its waist, apparently due to poachers. We have some fantastic photos, but not from me of course because I have only a disposable camera. Brett was considerate enough to lend me his binoculars so I didn't feel completely helpless.

After another long wait for lunch at Red Chilli, a nearby campsite with more wild warthogs freely roaming the grounds, we divided up for a boat cruise along the Nile up to the falls we had stopped at yesterday. Despite some ominous clouds and a few brief downpours, this was one of the most exciting parts of the weekend. We came closer to scores of hippos than I ever comfortably expected, and saw plenty more elephants, warthogs, water buffalo, fish eagles, bushbacks, and even a handful of crocodiles, one of which set off in our direction before we motored away.

Monday was another early day, departing from Sambiya Lodge for good to do some chimp trekking before heading back to Kampala. At Budongo Forest, we split into small groups and set off into the woods. Under the expert guidance of Sauda, my group began with more of a nature walk as she showed us mahogany trees, strangling fig trees, and explained to us the process by which the chimps continue to fertilize the grounds, eating fruits and dumping out the undigested seeds. About 20 minutes in we could hear the loud calls of the chimps, and 10 minutes later we had our first sighting. Early on we were content to see a single chimp here and there, sitting contentedly in a tree as we snapped photos (and I looked on earnestly through Brett's binoculars once again). As we progressed and Sauda explained to us the movements of the chimps, we soon found ourselves off the beaten trails, watching fearfully as what we described as a chimp soap opera was unveiled. One of the females "presented" herself to one of the males, who performed the customary action of putting his finger in her sexual organ and smelling it to test the waters. Upon finding her unready (her organ wasn't swollen enough, according to Sauda), he rejected her, causing her to flip out and chase him. What happened over the next 10 minutes was both exhilirating and terrifying. The male began beating the female (named Natasha) and was soon accompanied by several more males. From there they continued trying to bite her as she tried to escape, swinging and occasionally falling from trees, making loud thuds on the ground and cackling loudly. Next, the head chimp Maua came to protect Natasha, planting himself below her in the tree so none of the others would approach her. Somehow these positions were lost and the beating and chasing resumed for several more minutes. Side note: one thing you never wanted to hear a guide say is "I've never seen this before. I don't know what's happening." It's a bit disconcerting. When I was watching the chimps in awe, I was doing my best to stay as close to Sauda as possible, while also quickly glimpsing for two places to lay down (the direction given to us should any chimp start to charge us.) Eventually, the chimps dispersed, and Sauda's favorite chimp Jacko, a lower male, finally attempted to have sex with Natasha. Don't worry, we've got some good videos.

We then took the long bus ride back to Kampala, stopping only for lunch and once more when our tour guide James decided to inform us how bricks were made, much to the restless chagrin of everyone on the bus. Another quick side note about James: he happened to be a part of our chimp trekking group and for some reason deemed it acceptable to walk around pressing buttons on his phone, completely oblivious to the noise it created. He also began our 5 hour bus ride home with a "brief" 30 minute history of the region we were passing through, even though about half of the bus was asleep. He means well.

Back in Kamapala, we have an easy day of laundry and grocery shopping before heading back to Mulago Hospital for the remainder of the week. This morning we went for a run and did a few hill repeats, which was a huge mistake and left me laying light-headed and breathless on the floor of my room (and briefly the toilet) for the next 30 minutes or so. Which brings me to my final thought. Here is my top 5 list of things I most look forward to when we return back to the USA, in no particular order:

1. Hot showers with decent water pressure

2. Breathable air

3. No mosquito nets

4. Good food (although unlike most of the others in my group here, I eat pretty much anything they give us here)

5. Family and friends.

Nkokonjeru

Quick recap: Sunday was spent doing laundry by hand, which means when I get home I'm going to give my washing machine a big bear hug (and let's be honest, there's really no other way to hug a washing machine, those things are huge). We also got to attend a cultural show with dances, songs, and music from the various regions of Uganda. I tried goat meat. It wasn't very good. The highlight was when the emcee invited people onto the stage one nation at a time until all of the guests were down there, then we all danced together.

So, we returned from the small rural village Nkokonjeru last night, and it was one of the best experiences we've had yet. Situated about 2 hours from here on some pothole-infested roads where the matatus (taxi/vans), trucks, bodabodas (passenger motorcycles), and bicycles like to engage in games of chicken, Nkokonjeru is filled with some of the friendliest people we've met this far. We stayed at Providence Home, a home run by nuns where disabled children live and go to school and can receive therapy. Providence Home is also the home of a bakery, which smells amazing. The last thing I did before leaving the village was buy several of their delicious products.

Upon arriving, we were treated to a song and a few dances performed by the children from the home, and I probably didn't make it more than a few seconds into the song before the waterworks came. Sitting in a disabled home in a rural village in Uganda while its residents sang to us to thank us for coming and welcome us to their community and family is one of the most amazing experiences of my life.

Providence Home consists of a boys and girls dorm, a therapy gym run by the occupational therapist Nelson (who we all agreed is basically a saint), a workshop, convent, elderly section, a pig sty, goats scattered around the campus, and a few gardens. Our rooms were noticeably smaller than those @ Nufu House, and the first night we discovered an unexpected roommate, but after about 10 minutes and at least as many failed attempts as well as no shortage of high-pitched screams that were probably heard all over the home, I finally succeeded in killing the spider with one of Brett's shoes, with the other PTs behind me cheering and recording some worthwhile videos. We also had to get rid of a couple cockroaches the following night, including a baby one in Ryan's bed, but all in all the bug and lizard situation wasn't as bad as I had expected. We had a pit toilet, and to shower we had to fill a few small tubs with water and pour these over ourselves, but Ryan and I discovered this much easier when you shower together.

The gym was the focus of our stay. We worked with Nelson, who is great with kids, and one time he loaned the mother of one of the children 60,000 shillings (about $30 USD) to start a business so she could afford to pay for her child's therapy. (PS that's no small sum here). Wow.

Though most of the patients we saw had pretty similar cases, it was still highly interesting and educational for me, having had no pediatric experience before. Karen and Nelson are great teachers and great role models. One of my favorite patients was Geraldine, a young girl with severe dystonia who virtually never stopped smiling and laughing and never stopped trying to get into or out of her wheelchair independently no matter how long it took or difficult it was.

Before leaving, the children performed another dance, which we naturally joined in on, and we gave them two radios and a bunch of inflated soccer balls, which they seemed to love.

Another of my favorite parts from the village was the hour run Ryan and I took Wednesday morning that led us over some honest hills, incredible sunrise views, and tons of friendly and curious onlookers wondering why there mzungos in their town, and what they were running from. That's another thing. The people in the village were so friendly, and I wish we could have spent more time with the kids in the village taking pictures and teaching them to high-five.

Back in Kampala, we have a pretty easy day of shopping at the markets, and one of the therapists from Mulago Hospital offered to take us to dinner tonight. Then this weekend we start our 3 day safari and chimpanzee-tracking adventure. I can't wait.

A Week in Review

Holy hiatus Batman. We're supposed to be heading to a small village for the week but our ride is late, so I'm going to try to summarize a long week in one short post.

We started the week with some orientation/Luganda lessons with the med students given to us by Doreen and Susan. Doreen and Susan are basically international student liaisons and they are AWESOME. They take care of everything we need and pretty much see to it that we don't get run over or robbed while we're here.

Tuesday through Friday we worked at Mulago Hospital, each of us assigned to a different physiotherapist to shadow for the week. I was assigned to Sam, the spine ward PT, although apparently spine ward also entails cancer, orthopedics, and pediatrics with a small dose of surgery ward thrown in. Despite moving at a generally slow pace and rarely working what could be considered a full day, we all finished out each day feeling pretty mentally and emotionally exhausted from everything we saw. However the public forum being what it is, I'll have to spare the details for now.

Saturday we went white water rafting in Jinja, or more specifically we rafted a Class 5 Rapids at the source of the Nile. Seriously. Having never rafted before in my life, and seeing as how Class 5 is the highest commercially navigable rapids, I was pretty darn nervous (but fortunately so was Anna so I didn't have to feel like the lone coward of the group). But for all my nervousness I sit here two days later completely intact save a few miniscule bruises and tolerable sunburn. Our raft only flipped once, possibly the best of the 5 rafts on the river that day, and we saw only one snake! For lunch they served us sandwiches with salami, green peppers, carrots, onions, tomatoes, lettuce, guacamole, pineapple, and potato salad, without a doubt the best meal we've had since getting to Uganda.

In other news, we've spent most of our free time scouring the nearby markets for fruit and other cheap souvenirs and trying to avoid what Anna dubs the 'thunder down under', though to date she's the only one who has suffered that catastrophe.

Our driver is almost here! More to come.

World Travels Round 2: Uganda

Welcome back. So let's get the boring stuff out of the way. As a PT student we are required to do a 4 week clinical internship, and one of the options was surprisingly in Uganda, Africa (as a means of reference, the rest of the internships are spread throughout the USA, primarily in Wisconsin) My interest in world travel being what it is, I sit here typing this from Kampala, the capital city of Uganda. This entails shadowing a physiotherapist at Mulago Hospital, the primary hospital here in Kampala, as well as doing the same out in a currently undisclosed rural village. More on that later.

My classmates Ryan, Brett, Anna, and Allyssia and I started with a 10 hour layover in London. Some fish and chips and about 10 tube rides later, we were back on the plane for the 2nd overnight 8ish hour flight. We arrived in Entebbe, Uganda early Sunday morning, tired and smelly and headed for a day of tours. First of all, the descent into the airport was fantastic. Entebbe is situated on Lake Victoria, which forms the southeast border of Uganda, and is beautiful to see from above on a sunny morning. Next up was the ride from Entebbe to Kampala. Anyone who complains about Chicago drivers or otherwise should spend a single car ride in Uganda. If any traffic rules exist, you wouldn't know it. The roadside along the way was filled with various sorts of markets, ranging from women's dresses to raw meat to furniture, all of which were situated in small, rundown shacks.

But back to the driving. We were in a mutato (sp?), which is just a large passenger van, but all around us and all throughout Kampala are what are called boda bodas. These are smallish motorbikes that serve as taxis where the passengers sits sideways on a small pad behind the driver. I haven't met a single person yet who hasn't strongly recommended against using these, because aside from the instability of the vehicle and the shoddy road conditions, the drivers are inexperienced and generally reckless. But we all made it into Kampala intact with no luggage lost, arriving safely at the campus of Makerere University where we will be living for the next 4 weeks.

Our first day was far from over, but I'll explain more next time, as well as give an introduction to some of the valuable people we've met.