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.