Question: What do you post on your blog during the holidays when you have no children? Answer: Dogs and other people's children. Above we have a few shots from Christmas in Green Bay. It does not include highlights from the pancake breakfast or the 4 bar slog through Green Bay culminating in (nadiring in?) a club called Confetti's, for which no photographic evidence exists. Thank you, Lord. Coming soon are highlights from Naperville, IL - the illustrious Chicago suburb. For those of you contemplating a trip to Madison, please follow this link from the Chicago Tribune's own Randy Curwen, who opted to impersonate a serial killer/high school chemistry teacher in the photo that accompanies his byline.

Snow!

With three major snow storms since December 1, we have done plenty of shoveling... The storm today dropped about five inches of fluffy snow and tied up traffic all day. I think the December total is about 12 inches. We haven't had snow like this since my first winter of grad school in 2000.



Although Coca gets cold quickly, she enjoys the snow. Her new favorite game is to find the treat hidden in the snow.



We bought two wreaths for our house: one for our front door and one for above the fireplace. To get in the holiday mood, we also set out our favorite ornaments and baked sugar cookies this weekend. Coca is working on her commands, "sit", "stay", and "shy sideways glance".



This is my favorite tree in our yard. Who needs to chop down a tree when we have something so beautiful living in our yard?! I love the way it looks when the snow sits on its boughs.

Trip to Chicago

Coca and I went to Chicago to celebrate Lula's and Jacki's birthdays. Here's a picture of Lula getting ready to eat her peanut butter cupcakes.



Here are the proud dog-parents:



Bella, Lucy, and Coca had a great time chewing on Lula's special birthday-girl outfit.



Susie and Keith made all of Lula's favorite foods. We enjoyed hotdogs, peanuts, biscuits, mango salad, and deviled eggs. They also sent us home with a doggie bag full of treats. Here's Coca curled up with her new favorite toy:




We stayed with the Lamont Grand-pup-parents' house after the dog party. My Mom is healing well after her surgery, in part because of my Dad's excellent care. My parents took care of Coca while I went to Jacki's 30th birthday party, and then Brad came out to the 'burbs for French Toast on Sunday.

Here's a picture of the other birthday girl Jacki, her husband Mark, and her Mom.



One of the highlights was playing beer-pong in Jacki's parents basement. It was just like junior high and high school, except with beer and almond champagne.

More Thanksgiving photos

We received about an inch of snow on Wednesday night. Here's Coca in her reflective jacket trying to figure out this cold, wet stuff falling from the sky.



After all that play outside, Coca needed to warm up inside.



We enjoyed having most of our families together for Thanksgiving. (We missed you Chris, Jeff, Jen, and Simone!) Coca enjoyed all the company, and she took turns napping with each guest. Here she is snuggled up between the two Grand-pup-pas.



While awake, Coca spent plenty of time sniffing the family. That's Brad behind the newspaper and Jazz on Jeanine's lap.





We enjoyed dining at our new table with Liana's grandparents' china.

Home for TG

I've made it back safely for thanksgiving in Madison, for which dinner was made by committee between us and the families. Biggest shock of returning to Madison: daylight that is gone by 5 pm in winter! Close second: it's friggin cold.

Kampala

Safe arrival in Kampala and staying at a hotel in the downtown area. Unfortunately I developed a cold with lots of snot. Here I expected to contract malaria or a hemorrhagic fever or some other exciting disease, and I contracted a cold. It must have been the days spent seeing kids, who are excellent culture media for all the cold viruses.

Kampala is a big complicated city, though staying in the city center where business people and tourists stay doesn't let on. It's very clean and neat. Some of this is likely from the preparations for the upcoming CHOGM event, for which the government has been cleaning up. In particular they have fixed up the airport road to Entebbe, though there was flooding over the weekend that hopefully the queen doesn't notice (or does).

Thursday morning

Thursday morning. I've left no updates recently because the internet has been particularly slow and because I've started preparations for leaving Mbarara. I'm leaving for Kampala with some other doctors tomorrow. The plan is to have a few nice dinners, some shopping for stuff to bring home, and, for me, a rafting trip on the Nile through one of the local hostels. Then my flight leaves on Monday!

Thursday morning

Weekend update

It's been a quiet but fruitful weekend, at least if one lowers the bar far enough. Uganda is filled with cows and goats, and yet it's been impossible to find good cheese - until today. I'm sitting with a half kilo each of parmesan and mozzarella. It's difficult to cook good pasta without a little cheese. Secondly, I finished reading "Special Topics in Calamity Physics," the first book by author Marisha Pessl. The hyper-referenced writing is enjoyable and the plot, essentially a mystery, pulls you along quickly - although you can't help but be conscious of the extended Scooby-Doo moment (without the criminal's confession) as book reaches it's conclusion. Somewhere in the book is a great quote about traveling, but since I don't have the book with me, you'll have to enjoy some other historic travel related quotes.

Next to a shot of some good, habit-forming narcotic, there is nothing like traveling alone as a “builder-upper.” - Robert Benchley

So far as my experience goes, travelers generally exaggerate the difficulties of the way. Like most evil, the difficulty is imaginary; for what’s the hurry? - Henry David Thoreau

The uses of travel are occasional, and short; but the best fruit it finds, when it finds it, is conversation; and this is a main function of life. - Ralph Waldo Emerson

Friday morning

Friday morning and things are well. Yesterday I spent with a local hospice unit that I alluded to in previous posts. They are funded by USAid and a charity org from Ireland. The highlight of the day was doing home visits for some of the patients they follow. Most have advanced cancer or advanced HIV, or both, as HIV predisposes to certain malignancies. There are a number of patients with tumors called Kaposi sarcoma, which originates with Epstein Barr Virus – the same virus which causes infectious mononucleosis in healthy individuals.

The hospice organization has a good stock of medications including liquid morphine, which they aliquot into bottles which, to me, resemble a new flavor of Gatorade. Their organization is pretty much the sole source of narcotic pain medication in the area.

I’ve also included a photo of a popular mode of transportation known as a boda-boda, aka BB. They are cheap, convenient, and a popular cause of death on the road in Uganda. Some of the drivers have helmets (for themselves, not the passengers).

Wednesday

Wednesday afternoon and all is calm. I give a medical student lecture this afternoon and I will be trying to use Skype to call LL tonight. The main factor limiting its use here is that the internet connection is slow. I met up with Denis, the Ugandan doctor who has visited the UW and helped me set up this visit. We will try to see if we can get Skype to work at his office. Ideally there is a video function that can be used with a webcam when making a phone call, but I'm not sure how well that will work with the limited bandwitdth of the internet here.

Medical ward rounds today consisted of a few rarities, including probable tuberculosis of the spine, but also a refreshingly familiar case - alcoholic cirrhosis with full-body edema and ascites. It almost makes a person homesick to see such familiar pathologies.

Rain and Larium issues

The planned outing to the pool of the local posh hotel was cancelled due to inclement weather. An alternate date is currently being arranged. This was not rain but rather like the pouring of water out of a giant pitcher onto the city. Each house has a cement gutter (see visual aid above) running 'round it to shuttle away rain during the downpour.

In other news, I've developed a reaction to Larium, generic name mefloquine, which I take for malaria prophylaxis. This pill is taken weekly starting two weeks prior to arrival in the country. After taking Sunday's dose I felt very anxious and agitated, a little confused. You can get hallucinations and psychosis but fortunately I was spared of those effects. It seems to me that mefloquine is a good name to use when referring to the anti-malarial properties of the drug, wheras Larium connotates well the psychosis-inducing aspects.

Lights out!

Saturday morning in Mbarara and the electricity is out. There have been many brief power outages since I've been here but most only last a couple of hours. Apparently, if you wake up to no electricity, as we did this morning, it's a bad prognostic sign. It could be out for all day or longer. Fortunately, most businesses downtown have generators, so I'm able to blog today.

Quite a few people are gone traveling this weekend, so the expatriate section of housing around the hospital is quiet. This means most of the day will be spent reading or working on my lectures. If the weather's nice David and I may head over to the nice hotel in town - the Lakeview - which reportedly has a swimming pool and good liquor.

In case you missed it, the Ugandan president Museveni recently met with president Bush in the U.S. It's hard to find much press on the visit, though. The papers here report that there was talk about trade, HIV, and the small but persistent rebel presence in north Uganda, the Lord's Resistance Army. Bush and Museveni have much in common - they are both cattlemen and they both have preserved their position via questionable elections.

That's all - have a good weekend!

Thursday afternoon

Thursday afternoon, blogging after medical students failed to show up for previously-arranged tutorial. There seems to be some laxity with regard to time here. It doesn't help that I have no phone to be contacted by if there needs to be a schedule change.

I've included a picture of the house where I'm staying as well as the building that houses the general medical ward. I just realized they look disconcertingly similar. The house I live in is also occupied by two Belgian medical students and David, who is an epidemiologist from Glasgow. It's basically like student housing with a shared kitchen and two shared bathrooms. It's not ideal, but you can't complain when it's free.

I went on rounds with a British pediatrician today, just to see what was happening with the little people here. The child mortality rate is high, and most die before they could get health care. Most births are home births - which is fine - but most of them are completely unattended. Jason, the pediatrician, basically runs the NICU, which right now contains 6 babies, all 1-2 kg in weight, several born at approximately 30 weeks. They are doing well though, since mostly they just need breast milk via a nasogastric tube and occasionally antibiotics for infection. One baby probably has a ventricular septal defect based on his exam. The problem is the ultrasound machine is not good enough to see that small of a defect. The plan is to let him get a little bigger, then hopefully refer him to somewhere that can do surgery to close the defect for free.

Rambling comments without a picture

It's Wednesday morning here and I'm downtown to pick up a chicken that I "reserved" at the market yesterday afternoon. It was still living and moving when I left it. Hopefully today it is de-feathered and at quartered. The plan is to make chicken curry tonight in our little kitchen.

So far most of my medical activities have been spent on the ward rounds of the general medical ward. The ward has about 60 beds total - though people will sometimes be on the floor if it is crowded. There is a male and female side. There are four teams that split up the patients, each consisting of an attending, a post-graduate, and intern, and a bunch of medical students. For the intern and students, scutwork consumes most of their lives, usually to detriment of learning. The attending formally rounds on M-W-F and I try to join one of the teams on those days. I have minimal practical input to provide but try to add someting useful. Unfortunately many of the best cases (sick patients where we don't know what's going on) have often died by the time I round again.

I spent yesterday in the general medical clinic, which was interesting. It's a combination of "our" diseases - hypertension, diabetes, etc, and "their" diseases - TB and HIV. It's good to see that low back strain is ubiquitous in the world. A younger woman had fairly severe rheumatic heart disease, which is uncommon in the U.S. these days. In some ways this is similar to the UW hospital, in that many patients are referred, often from private practitioners, because they can't figure out what's going on or they need tests done. The hospital itself is connected to MUST - Mbarara University of Science and Technology, so there's a lot of other students here. Mbarara generally is a well-off area. Most students are relatively economically advantaged, and there is a fair amount of economic activity here, including a Coke bottling plant.

Tomorrow I hope to round on the pediatric ward with a pediatrician from the UK. Otherwise at the hospital there is a TB ward, an OB ward, surgery ward, diabetes clinic, HIV clinic, ER, ICU (3 beds). There is also a hospice organization that comes to the hospital and does home visits. It's funded externally and so is sometimes the only source of morphine. Ironically, we referred a gentleman to hospice so they could pay for chemotherapy for his Burkitt's lymphoma. Of course most people still die here before they even come to get medical attention, much less a referral to hospice. I'm hoping to visit the hospice office next week.

Have you stopped reading yet? If not, then I'l continue with one more factoid. I bought local wine yesterday, made from fermented banana and pineapple. And to tchris : No, I haven't found a wine store yet.
Bye!

Weekend in QENP

I’ve included some photos from the weekend spent at Queen Elizabeth National Park in Uganda. Reportedly the queen will visit that park as part of her visit to Uganda for Chogm which is upcoming (www.chogm2007.ug). The country has a well-organized park system, though I think it’s less visited than Kenya or Tanzania. We stayed at a hostel - which was cheap - but spent dinner and evenings at the Mweya Lodge - which charges over $300 per night. They serve western food, but the highlight of the dinner was a hippo that walked up next to the dinner patio to eat grass – not a rare event according to our guide.

The dark thing in a tree is a chimp that we found after 3.5 hours tracking through the mud. These chimps are habituated to humans from years of being studied by researchers, otherwise they would be nearly impossible for a guide to track with a bunch of tourists in tow. Otherwise there’s a caveful of bats and an elephant, of course. It’s a beautiful park. Since we frequently see images of these animals on TV and in books, the photos don’t come close to conveying the experience.

It's Thursday evening and I've headed downtown to find an internet cafe. Above are some sights from around the city. Motors here seem to run on equal parts petroleum and oil. The above cloud was created by a petroleum tanker. I think I may include that photo in my upcoming lecture on asthma. The other picture shows a street scene. In the background is a statue of a bull at the entrance to the city. In the foreground is meat, no doubt someone's supper tonight.

Arrival

So I've safely arrived and I'm a couple of days into my trip. I had some doubts as the plane landed when it rolled by the wreckage of a small plane next to the landing strip. It was also raining. Apparently the crash happened a few weeks ago and there was still some investigation going on.

Mbarara is the name of the town I'm staying in. I have a bungalow in near the hospital where other visiting students, lecturers, etc also stay. Most of my time has been spent on the inpatient medical ward. The illnesses are dominated by HIV and TB. There is quite a bit of meningitis - bacterial and cryptococcal, also TB. Today I saw a case of rabies, which I will probably never see in the states. Diagnostics are limited to basic blood tests and plain xrays. Antibiotics are available but of a limited assortment.

Departure

So I'm sitting and writing this during my 10 hour layover at Heathrow Airport in London. For some reason the german version of blogger.com came up so I'm not sure how this will come out. Here is a photo of me and Liana, saying goodbye at the Madison airport.