Experiences of a med student with an incurable travel bug.

Lyantonde, Uganda

So we’re finally back in Kampala after two weeks in rural Uganda. You already heard about our time in Kabale, so I’ll pick up at the end of our stay there…

We left Kabale on Monday morning, taking a matatu to Lyantonde. It was pure chaos getting one; a lot of buses and matatus turn around in Kabale, so there are a lot there and every driver is competing for the business. Dozens of people were shouting prices and destinations at us, fighting with each other when we’d start to go to someone else. With the help of Elias, we finally escaped into a matatu for a reasonable rate. What’s a matatu, you ask? Only the worst form of public transportation known to mankind. It’s a van, not quite full size but not really mini either, with four rows of bench seats and fold-out seats crammed behind the driver’s row. Three people can comfortably sit next to each other on each row, which means there are always at least five people jammed into each row, more if you’re lucky. What’s really great about long journeys, like the five hour trip from Kabale to Lyantonde, is that everyone has baggage too, which is all piled on your lap. Then, if you’re really lucky, you happen to end up in one that distributes newspapers, so in addition to screeching to a halt every few kilometers to pick up more people you get to stop even more frequently to pick up and distribute huge bundles of papers. The matatu’s seem to have the same motto as Irish families – there’s always room for one more. After we had 20 people plus bags and newspapers loaded in, I was certain we had to be full. Nope. We got at least another four people in there, maybe more but it’s hard to count when you can’t see everyone that’s being sat on. Really, it’s awesome, you should try it.

After arriving in Lyantonde, we went to our friend Lillian’s house, a contact of ours through Village Health Project, and spent some time with her and Anna, another Wisconsin student who’s staying there for a month. Anna will be helping Lillian conduct interviews with the Family Care Workers of the Community Based Integrated Nutrition (COBIN) group that we also work with. We found out that since they were busy with the interviews, there wasn’t really much we could do with the water projects or COBIN at the time. Instead, we would be able to shadow doctors at the Lyantonde District Hospital, which we had hoped to do as well.

Working at the hospital was very interesting. Each day we got to work in a different area, though primarily with the same doctor.

Day 1: HIV Clinic. Molly helped distribute meds with Hiral, the closest person they have to a pharmacist. I sat in on appointments with the doctor. One of the patients was a six year old girl who looked about three as the HIV had stunted her growth so much. None of the adults that we saw weighed more than ~95 lbs, most of them were significantly less than even that.

Day 2: Antenatal (aka Prenatal in the US). We spent the day with the nurses/midwives in the antenatal clinic. We sat in on an education session, of which we understood nothing as it was in Lugandan, but we got the Women’s Health Passport that they give to the women, so we just went through that for the info. It’s a booklet issued to each patient that has info on everything from their own health records (each pregnancy is documented in the book) to what they need to bring with them to the hospital to give birth (sheets, food, gauze, etc as the hospital has virtually nothing). The patient keeps this booklet and brings it with them to each visit. We then went to the exam room and watched the check-ups. General health is checked, and each woman is tested for HIV if her status is unknown. We were able to check the blood pressure and listen for the fetal heartbeat in some patients, and to feel the abdomen and locate the fetus’s head in others. Listening for the fetal heartbeat was very difficult; they just use this small black cone pressed against the abdomen as they seldom do ultrasounds (this hospital may not even have the equipment).

Day 3: SURGERIES! Probably the most interesting day of the week. We were right in the OR with the surgeon, so we had to scrub up. You wouldn’t think that putting on scrubs would be all that difficult, but when the top is roughly the size of a circus tent and each pant leg could comfortably house a family of four, it suddenly becomes quite the project. I was lucky enough to have a drawstring in my pants that, after considerable wrenching, pulling, shifting and shuffling I was eventually able to utilize. Molly, however, only had what must have once been an elastic waist and was now a limp opening the size of a hula hoop, which she ended up tucking into her underwear in order to keep them up. Once we put on the white rainboots, we felt, and undoubtedly looked, distinctly like Oompa Loompas. I assure you, it was the pinnacle of style. We also got scrub caps and masks, completing the outfits. In the morning we watched a Cesarean section. It was very bloody and the doctor said the surgery usually wasn’t so messy, but the fetus was in distress so they had to work quickly. The baby seemed huge when he pulled it out, we’re guessing around 10 lbs, and it was blue from lack of oxygen. It took a while, but they were able to resuscitate her. She was then wrapped in a blanket and left wailing on a bed in another room while they finished working on the mother. Molly and I got to hold her, easily the youngest baby I’ve ever held at less than an hour old!

That afternoon we watched a hysterectomy, which was a much cleaner surgery. The only anesthetic they have at the hospital is (frequently expired) ketamine, so the patient’s aren’t totally out during the operation. Both women would move their arms or legs on occasion, and their gut was never calm. During the hysterectomy the woman’s eyes were open for nearly the whole thing, and clearly not all of the pain was blocked, but they usually don’t remember it after waking up. There’s virtually no equipment or staffing available to do anything remotely high-tech, so there’s no suction, no monitoring equipment, and the patients have to breathe entirely on their own. It was crazy; we had more equipment and drugs when I worked with monkeys than they have here for people.

All in all, it was a really great day. I didn’t have any trouble watching the surgeries; I wondered how it would go but I didn’t have to sit down or take a break or anything. Still, as awesome as it was to watch, I’m not sure that it’s something I would want to do all the time; parts of the procedures can get pretty physical, which I wouldn’t enjoy. Very interesting to observe though! I’ll save the blood and guts details, though.

Day 4: Pediatrics. We did ward rounds in pediatrics where nearly every kid had malaria plus pneumonia, anemia, or malnutrition. There were two families on every bed, some families with multiple ill children, plus extra mattresses on the floor – overflowing, to say the least. We also went through the women’s ward to check up on the patients from the surgeries; it was here that we saw someone with a terrible case of Herpes, a common opportunistic infection for those with HIV. This woman looked like she had been horribly burned and skinned; the skin was gone across her right shoulder, the top of her chest and back, and up her neck. I’m sure you can find similar pictures on google if you want a visual, but it was awful, I can’t imagine the pain.

That afternoon we both helped Hiral distribute meds again. We’d just count out pills in lids or on the counter with our bare hands, put them in plastic baggies, give them to the patient, sign the chart, and then start counting the next batch. All of this would be highly illegal and against health code in the US, but they were just happy to have people who could count to 30 and were willing to help since we made it go faster. After finishing Hiral took us to see the Muslim clinic his mother runs, which was run with a great deal more organization than the district hospital, though I’m sure that’s easier with a smaller clientele.

Each night that week we went over to Lillian’s to hang out with Anna. If the power was on, which was fairly unpredictable, we’d watch movies. Here you can get one DVD with 6-8 different movies on it, usually with a related theme. We were lucky enough to have a J.Lo one, so we had quite the J.Lo marathon. I had no idea she had so many movies and most of them I’d never normally watch, but it was nice to have a little piece of home like that. If there’s power and a tv, the only thing that’s ever on is futbol or terrible Nigerian movies, so it was nice to have something familiar.

Saturday morning we headed back to Kampala after a delicious breakfast; we bought fresh chapatti and a pineapple from the street vendors, all for about $0.80. mmmm. Then we tackled getting a bus. It was a bit less chaotic, but this time we were all on our own. We finally made it onto a bus (we weren’t doing a matatu again!), but only after getting past the matatu drivers who were physically blockading us from getting on. After we got on they decided to change a tire, which took a solid hour but at least we had a bus. Then the tire blew about 30 km outside Kampala; luckily they didn’t stop to fix it, otherwise we would have been delayed even longer. Though it was a far superior journey to the matatu escapade, it was a relief to arrive and go back to Kampala City View, where we’ll be staying until Thursday when we leave for Cape Town!


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