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!