One last day in Kampala....

What did I do on my last day working at Mulago Hospital? Well, first I checked out the headlines at the news stand.






Then I checked on the culture plates from the suspected food poisoning
fruit juice in the Microbiology Lab (negative!)


Then I just did what I do on a typical day at HCMC or UMMC-F.....gave a lecture, looked at slides, signed out cases with the residents, said good bye.


Dr. Peter, the Chief Resident in Pathology asked me to give you this message: If you ever think to visit Uganda for safari or adventure travel, please consider coming for even one extra week to teach. The medical students and hospital residents here are taught by other doctors who have trained in Uganda and the people of Uganda have had so little time to make progress in science education since the days of struggle after colonial rule that they have missed so much of what others have been able to gain in the relative peace and prosperity of the US, Canada and Europe.

What did Isaac do on his last day? He rode in a "taxi" (what we call a public bus) into downtown Kampala to find and buy electrical fuses.



He describes a bizaare adventure that included several people suggesting that he give them some money and he could just wait for them to go find and buy fuses to bring back to him (but he ain't that gullible). At any rate, when he finally found a store that actually sold fuses he thought that they were a rip off but he bought them anyways for about US fifty cents each.


He then meandered his way back to Mulago Hospital and found Dr. Lund to so that he could be escorted into the Pediatric ICU.



Then he replaced the fuses in the BiPAP units.



And he had Dr Lund verify that they were in working order.



If you are at Mulago and need a spare fuse there are some taped to the top of the BiPAP's.



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Location:Mulago Hospital, Kampala, Uganda

Poisoned?!

Catchy title, huh? Okay, here is the story. Isaac and Dennis came back early (for them) at 4 PM yesterday afternoon after putting up the newly painted orphanage sign.






Dennis was worried because Isaac had complained of a headache at the orphanage and had vomitted in a vacant lot. Isaac was worried that it was the sign paint. I was worried that it was something from when he fixed the Mulago Pathology Dept projector.






Dr. Troy Lund's preferred diagnosis was E. Coli infection from drinking the tap water. We put Isaac to bed and I took off past the giant storks on the fancy golf course to the grocery store to get hydration fluid.












Please note! Coca Cola is Isaac's preferred hydration fluid, not Dr Lund's! By the time I got back I didn't feel so well myself and I was up vomitting well past 2 AM. I felt so much better by 7 AM that Dr Troy revised his diagnosis to Food Poisoning and hauled off the one thing that Isaac and I had both consumed to the Microbiology Lab (more later!).






Isaac stayed abed today (missing a planned white water raft trip on the Nile), while I felt compelled to go to work. Why this compulsion? I feel so sorry for these pathologists. They are way behind in more ways than one.






Why would anyone not believe that the third world needs US pathologists to volunteer to help them?
So I sat down with Dr Susan Ndidde for a couple of hours at the crappy microscope and pushed glass.






By the way, one of the things that makes this microscope so crappy is the fact that the stage (the metal thing that holds the glass slide) isn't even the correct on for this scope so it doesn't fit and does't hold the slides (which is pretty key if you want to teach folks to look at blood or bone marrow smears). This is what, like a two buck item used? Come on!













We cleared her entire backlog of cases and even (when the clinical physician requested a "second look") revised one of her fellow pathologist's diagnoses from "Inflammation," to "Diffuse Large cell Lymphoma." Not bad for a few hours work in my weakened condition. By afternoon, Isaac even felt well enough to go to work with the Columbia University Biomechanical Engineering guys to fix the BiPAP machines in the Pediatric ICU.

By the way. At the end of our work session today Dr Susan Ndidde said that she had just gotten an e-mail from the CDC offering to buy her a new teaching microscope and that they needed her to tell them what she wants. Unbelievable! DO YOU SUPPOSE THAT THEY HAVE BEEN READING MY BLOG???????!!!!!!!

IMPORTANT NOTE TO FOLKS WHO CONTACT ME VIA U of M EMAIL. Since my arrival in Uganda, my U of M email has been inundated with scams. Please don't use, "Hello," or, "My dearest friend," in the subject line because I won't even open it.






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Location:Mulago Hospital Guest House, Kampala Uganda

How things work

Okey dokey readers! The time has come for me to tell you how health care works in Uganda. The International Hospital in Kampala is probably the best equipped and best staffed hospital in Uganda. It is for foreigners or Ugandans who have health insurance or lots of money. I know that Ugandans With Lots of Money exist. I see them when I walk by the big golf course on my way to the grocery store. Then I try to do the math to figure out........if the median annual income for the whole country is $490......





Other than the golf course, Kampala has its own "mega mall" called Garden City.









The rest of Kampala looks decidedly more Third World.









I am told that people who work for the government or who work for one of the large companies here (telecom, mining, etc.) receive health insurance benefits. Supposedly, Mulago Hospital is the next best equipped and best staffed hospital in the country. It is for people who have no money and no insurance. Some people with money and insurance go there to a "private wing" that I haven't been allowed to see but that I hear isn't that much better than the public part of the hospital. I did go to a regular patient ward today to perform a needle aspiration biopsy of a female patient's enlarged lymph node. I wanted to take a picture of it for you but my Internal Ethical Compass wouldn't let me take my camera out of my bag. Please allow me to use words....... Words like "horror movie" and "third circle of hell" are what immediately come to mind. Dr. Helen Towers (the visiting neonatologist from Columbia University) describes the Maternity Ward and the Newborn Unit in similar terms. Interestingly, Dr. Towers is here with a Columbia Professor of Bioengineering (Dr. Aaron Kyle) and his graduate student (Gary Zhang) delivering new "smaller-cheaper-more reliable" devices for newborn care that they have developed in their laboratory. Dr. Towers visited the Missionary Hospital in rural Eastern Uganda yesterday, ostensibly to deliver a device that her team had developed for Newborn Transport. She said that the Mission Hospital, which is owned and operated by the Catholic Church and run by an Irish Catholic physician, was so clean, orderly and well run that she couldn't imagine why they would want to transfer a baby from there to Mulago Hospital in Kampala. Dr. Towers' theory? It's all about administration.








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Location:Mulago Hospital, Kampala, Uganda

Just another day in Uganda

What do I do all day at Mulago Hospital? First you need to understand that Mulago is a colonial holdover. The British established it as a public (free) hospital and teaching hospital (for the Makerere University Medical school) in the 1920's. None of the somewhat dysfunctional post liberation governments have dared to shut it down (it is Uganda's largest hospital). It currently has 1500 beds and a government funded annual operating budget of US $2.7 million, which seems okay in a country with a medium annual income of US$ 490 (as compared to US$ 49,000 for the US) but really (the Kardashian sisters probably spend that much annually on mascara).

So I start my day by saying good bye to Isaac and Dennis making new signs for an orphanage.






Then I walked to the hospital Haematology (love that funny British spelling!) Department. I tried to get there early so I could photo baby Benjamin's needle aspirate biopsy slides for my blog.






Couldn't make the microscope camera work (TIA). Okay. Answer is: NOT CANCER. Infected cyst. Needs simple surgery which they can have done for free at Mulago but it will take weeks to line it up.

Started looking at cases and signing reports with Dr. Susan but got in big conversation with Dr. Susan about the Troy Lund Philosopy of Medical Volunteer Service in Africa, which is, find a small problem that can be solved with little or no money, fix it then come back (or get someone else to go back) a few months later to see if it is still fixed (establish a Metric ). Dr. Susan told me that, as far as she was concerned, the seven or eight bone marrow biopsies done each day in their hospital and clinics were pointless because both the specimens obtained were bad and the slide preparation was bad (unless done by her one assistant, Derek, who has so many other responsibilities that he can't do them all). She asked me to spend the rest of the day showing the Cancer Institute doctors and laboratory staff how we perform and process bone marrow in the US (well, sort of, TIA, you make do with what you have....).

So......I spent the next seven hours running up and down the hill from the hospital to the Cancer Institute. Past the Medical Illustration Dept.






Past the guy selling snacks and Obama shopping bags.












Past the Hospital Laundry.






Past the crowded parking and No Parking signs to the Cancer Institute where I tried to teach some Ugandan staff physicians (who kept being called away to look at other patients) and some sketchy looking Italian medical students (who couldn't understand English) how to correctly perform the procedure, whilst simultaneously showing six Uganda lab tech's ( who were very attentive and very receptive) how to make direct smears, touch imprints, concentrate smears and particle crush smears.






























I even found a box of Pasteur pipettes for making the concentrate smears.







If Dr. Troy Lund is correct, the quality will improve temporarily while I am here and disappear when I do. I wonder if I can get another Hematopathologist to come down here (Tony? Nancy? Katy?)


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Location:Mulago Hospital, Kampala

Not Free But Well Worth the Price

The show wasn't free but it was well worth the Uganda Shiilings 15,000 (US$6.00) price. The Ndere Cultural Center is just about the nicest place in Kampala.






They moved the show inside because of the rain.






But then they announced that the rain had stopped and asked us to carry our chairs outside.






But it was raining so they asked us to carry them back in.






No matter (TIA!). The show was brilliant.



















And there was surprisingly excellent Ugandan food too!












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Location:Ndere Cultural Center, Kampala, Uganda

Day of rest?

When you last read of our intrepid travelers, they were hurling (pretty much) down a twisted ribbon of Ugandan highway enveloped by inky darkness and suffering from the knowledge that the brakes on their vehicle seemed to be failing. But that was before they ran out of gas and the battery died.

Oh, whatever, TIA (yes, it means, THIS IS AFRICA). Joseph (remember him from Saturday?) our driver/guide/translator/diplomatic envoy to rural Ugandan orphanage mommies, just kept on managing as if this was all business as usual for Uganda (which, I suppose it is). Round about 11 PM when I needed to get out of the van so they could jump the battery (the battery being housed somehow under my seat in the van and needing to be connected with another battery that had been brought by motorcycle from another car) Joseph turned to me and said, "my son has something on his neck. Can you and Dr Troy look at it?" What the heck was I supposed to say but, "Of course!"

Sooooooo, Sunday, my day of rest, I got myself up for an early run, quick trip to grocery store and breafast then waited with Dr. Troy and Dr. Helen Taylor (a newly arrived pediatric neonatologist from Columbia University) for Joseph to arrive with his wife and seven month old son, Benjamin.







Benjamin had a crusted lesion overlying a swelling on his otherwise incredibly adorable neck.












Dr. Troy and Dr. Helen's differential diagnosis, based on the physical exam and clinical history of an enlarging lesion, lateral to the midline of the neck of an infant, was that this was either a branchial cleft or thyroglossal duct cyst that had become infected. They wanted to aspirate it and have a pathologist (that would be me) make smears for cytology and microbiology staining and review. So that's what you do on your day off here.


















I think that I have figured out how to take pictures through a microcope here for the blog so more about the diagnosis later.

By the way, Benjamin's daddy, Joseph, arranges safaris as well. His email is

Balix2002@yahoo.com

Go ahead and tell him that I sent you.

I did find time to go to the Uganda National Museum.






How much one might enjoy this museum might depend on what one's expectations might have been prior to entering. Suffice it to say that it is conveniently located and only costs about US$1.00 (unless you want to take photographs in which case you are charged extra; please note absence of museum photo's on this blog page).

My evening's amusement consists of a Free Cultural Performance. Which may or may not be cancelled due to rain. Photo's will likely follow, but I will leave you with one of my current favorite US cast-off t-shirt sightings:






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Location:Mugalo Hospital and Guest House, Kampala, Uganda