Week #5

THE FEMALE WARD:

Monday and Tuesday on the female ward were pretty hectic. A young woman in her 20’s was admitted who was unresponsive and was having seizures every 15-30 minutes. Her attendants had only known her for a short time and knew very little about her history other than that she had regular headaches. The sedative diazepam was not working no matter how many times it was administered. Babak the resident wanted to give the medication via a slow drip. In the US if we were to use this medication via IV drip the patient would be in the ICU with one nurse monitoring her closely for respiratory depression. The anti-seizure drugs Phenytoin and Phenobarbital were only available in pill form. This meant we had to place a nasogastric tube into someone who was actively seizing in order to give the medications that would hopefully save her life.

After well over 24 hours of seizures the young woman came out of it. Amazingly she had no apparent brain damage. We learned that she had been having seizures since she was in grade school and her father was only willing to treat her with herbal remedies believing that she was bewitched. As a young adult she was told that she likely has a brain tumor. Unfortunately, her parents came and pressured her to be discharged prematurely. Although it is difficult to say whether there was much more we could do for her given our limited resources.

This week was otherwise uneventful. The ward had the usual Typhoid, TB, HIV, and Malaria patients. I am learning the different presentations of Typhoid fever versus Malaria fever. With Typhoid, (a life-threatening bacterial infection spread through fecal or urine contamination in food or water) the fever gradually goes up each day. Most fevers cause increased heart rate, but with Typhoid fever the pulse remains slow. Another unique symptom is extreme apathy.

In contrast malaria related fevers rise and fall regularly, and are followed by shivering and sweating. Anyone with these symptoms is empirically treated with Co-artem. If symptoms are persistent then a blood test will be taken to determine if the more aggressive treatment of IV Quinine should be given. This drug often causes temporary loss of hearing, and it is no longer given in the US due to its harmful side effects. Given that tonic water has Quinine in it, drinking gin and tonics in malaria infested areas has been said to be useful as a malaria prophylaxis.

THE VILLAGE:

On Saturday I accompanied Morgen to the Village Mugwata. Morgen and Jay make regular visits to various villages to evaluate the Village Health Workers. They also go along for some of their home visits. Getting to a home involves walking through garden pathways that are all interconnected in a winding maze of foliage. When you pass someone working in their garden it is customary to say, “Wakoze.” This is saying thank-you to the person who is working hard digging and producing food.

Sorghum is being harvested right now and it is a grain that grows as tall as corn and has a beautiful red flower at its tip. It is used to produce local liquor as well as the commonly consumed breakfast porridge. The villager’s houses are more like compounds, usually with bamboo fences. Enclosed are several mud huts with grass roofs. There are always goats lounging about, and there was a chicken laying eggs in the living room of one of the homes. The wallpaper in another room was newspaper, one of which was announcing Arnold Schwarzenegger as governor of California.

We visited a pregnant woman’s home and made sure she was going to the antenatal clinic. After looking at her clinic papers we learned that her baby is in breech position. This was an opportunity to reiterate the importance of having a birth plan, which means a way to get to a hospital once labor starts. This can be difficult especially if they go into labor during the night. The woman reported that she WALKED to the hospital when she went into labor with her previous child. It had to have taken her at least a couple of hours to get there! I just cannot even imagine.

The next home we visited was a villager who was suspected to have hypertension. Her blood pressure turned out to be normal. Since next month the teaching topic for the VHW’s is sanitation we asked if we could look around the family’s house to see if the compound had good sanitation. There were several issues that are common in the villages. First, the latrine was not enclosed allowing flies and rodents to get in. It is not ingrained in the villagers mind how common it is that flies and rodents spread disease. Next, when we asked where the animals sleep at night, we were not surprised to hear that they sleep in the kitchen. It was explained that having animals where the food is cooked can contaminate the food. Finally, the kitchen had no windows, so when they are cooking over the fire there is very little ventilation. Apparently the wife had asked her husband to put in a window but he didn’t see the point. Of course this is the case since he never cooks in the kitchen.

As we were leaving this house one of the young women slyly reached out and brushed her hand against my arm and then jumped back and laughed. The interpreter relayed to me that she wanted to discover if my skin felt the same as hers. I asked the young woman if it felt different and she replied, “No.” It was one of those magical moments where we all jabbered and marveled at how much the same we really are. This is aside from the glaring fact that the countries that we each happened to be born in allow us an inequitable difference in opportunity.

As we were walking back to the van, we peered into a compound where the people were working hard at what looked like beating grass with a stick. Morgen stepped inside the compound and inquired as to what they were doing, and asked if we could try. I soon found myself beating what turned out to be beans from their pods. It was super fun and tiring participating, for a short time, in the daily activities of a villager. Of course the families loved watching the Mazungus try and do their work.

As we headed back to the trading center, (small business center of the village) we were summoned by another VHW to go and visit a home. Apparently a woman had given birth at home to her 6th child a few weeks prior. It broke my heart to hear that a few minutes after the baby made its first cry it died. If that wasn’t enough the mother began to hemorrhage and was taken to the hospital after she became unconscious. We were asked to visit this woman because, after being discharged from the hospital, she was continuing to have dizziness, weakness, and lower extremity edema. There was not much we could do for her but to encourage her to eat iron-rich food such as millet and greens for her anemia, and to elevate her legs for her edema. Although it wasn’t an appropriate time to mention it, this was an unfortunate example of the potential dangers of having too many births, and also why it is so important for women to have a birth plan in order to give birth in the hospital.

FUN THINGS:

Last Sunday was the day I attempted to climb Mt. Sabinyo, (Old Man’s Teeth) which is a 3 peak climb that begins at 2364 meters and ends at 3635 meters. The final peak you are on the border of Rwanda, Congo, and Uganda at the same time. You are not allowed to hike in Mgahinga National Park without at least two guides, one of which totes an AK47. We were told it was to protect us from the dangerous water buffalo, but we couldn’t help but wonder if it was because we were going to be on the border of the Democratic Republic of Congo

The beginning of the hike was a beautiful walk through bamboo forests. Along the way we discovered wild pumpkins, also known as “elephant beer” due to the fact that it makes elephants intoxicated. As we began our steep ascent into the magical draping moss forest land, I began to experience symptoms of acute mountain sickness due to the rapid elevation gain. The nausea, dizziness, and shortness of breath were unlike anything I have ever experienced on a hike. After climbing many ladders and stopping to rest way too frequently, I managed to make it to the first peak. It was a gorgeous misty mountain view. Suddenly all of our cell phones began to beep at different intervals. It was a text message from Rwanda, welcoming us to the country! I took a nap in the sun on the first peak, while the others continued on, except for Julius, the gun toting guide, who was there to protect me from I don’t know what.

After about an hour we began to hear the rumble of thunder and see the clouds rolling in. I texted the group that I was descending early to avoid the rain. This was at the recommendation of a Polish mountaineer who had been climbing peaks in the rain for the past two weeks. He explained that it was treacherous. Sure enough it began to rain, no actually hail. It was a muddy slippery climb down, and I fell countless times. I don’t know how my guide managed with his rain boots that had absolutely no traction at all. At one point I landed on some stinging nettles. After Julius picked the nettles out of my hand he told me how they usually whip thieves with these painful little plants.

The rain eventually stopped, and I was completely soaked. As we neared the trailhead, I saw two people and a dog run away into the bushes. It was poachers! Apparently they were illegally hunting the water buffalo. I was sure my guide was going to run off and chase them or shoot his gun. Fortunately, he stayed with me.

While I waited for the others to return at a small canteen outside of the park, I ran into Sandra. Sandra is from the UK and has been in Uganda for the last 7 years studying the endangered Golden Monkey. She has been spending the last 5 months attempting to habituate the monkeys. This means getting the monkeys used to humans so they don’t run away, making it possible to study them. She had a successful day in the jungle, where she was able to sit and watch the primates for over an hour without minding her presence. If anyone ever wants to hang out with these cute little guys, Sandra is always looking for volunteers.

That’s it for another great week in Uganda! Now I am off to lunch at my interpreter Penninah’s house.