Saturday?

What did I do on Saturday? Well, on Friday night Dr. Troy Lund informed me in front of his team that the pathologists at Mulago Hospital don't report for work on Saturday, but, if I really, really wanted to, his team might let me go to the village with them. He talked it up like it was a real honor,so....
We were up at dawn to get ready and to find a taxi to take us to Dr. Angella's apartment in the Ntinda neighborhood of Kampala. Angella's apartment is very nice but it is also the Supply Warehouse for Medicine for Sick Children











We were met by our transport team and Dr. Angella




















We stopped at the grocery store for the sort of essentials that you might need at a rural African orphanage.









We drove for what seemed forever and stopped only long enough to buy Road Food.









We drove more and, finally stopped at a village so I could use the bathroom.


















Thank you to everyone at Balance Fitness who has helped me to develop the kind of core musculature required to utilize the toilet facilities of rural Uganda.
We also picked up Eva and her friend Sistenda.









Eva is five years old. She was born with an imperforate anus/ano-vaginal fistula. She did not have a bowel movement for the first year of her life. Margaret and Dr. Troy Lund were contacted by one of her village leaders who found them on the internet. Dr. Troy brought her to Mulago Hospital for a colostomy and Margaret and Dr. Angella taught the village women how to care for her. She will need another surgery but Dr. Troy will need to raise the money first. I did mention to Dr. Angella that it looks like Eva will need antibiotics for what looks like impetigo (staphlococcus cellulitis) on her face.









Then we spent the next seven hours weighing, measuring, documenting, listening to children singing, singing ourselves, giving away dresses made by an NYU graduate student, blowing up and giving away balloons, giving away candy, giving away cookies, giving away crayons and coloring pages, giving medical kits, mosquito nets, hydration supplies, and medicines to village orphanage Mommies, educating village orphage Mommies, quizzing village orphanage mommies.
































































I diagnosed a case of scabies which I suspected that Dr. Troy Lund had planted in a remote village as a quiz for me.


















We were assisted by Joseph, who works for Dr. Troy.









We left the village at sunset.










And as complete darkness fell on a lonely rural Ugandan road, the brakes on the van started to fail. But that will require another blog.

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Location:Kisweera

What exactly is Isaac doing?

So what exactly are Isaac and Dennis doing while Dr. Troy Lund and I are trying to be doctors in Uganda? They are working for Margaret and Angella. Margaret Perko is in her second year at University of Minnesota Medical School, Duluth. Angella Kabatooro is a Uganda trained physician. They both work for Dr. Troy Lund's foundation which is

Medicine for Sick Children


Here is a picture of Dr. Lund











Medicine for Sick Children seeks out the orphanages that are Not supported by a Big Church and that lack even the most basic supplies needed to keep children healthy.












They assess and document their needs and then use their foundation dollars and Dr. Lund and Angela's contacts and expertise to obtain supplies
including medicines, vitamins, protein supplements, mosquito nets, etc.












In rare cases they have found "orphanage" situations that are so appalling that they have notified authorities resulting in children being sent to better living situations that they have identified. They are predominantly in Africa but they have responded with aid to an orphanage in Afghanistan that they were alerted to by US military personnel there who found out about the foundation via Google search.
All day, every day while Margaret is here they troop around to the orphanages evaluating and documenting and delivering. There is also shopping, sorting and packaging. In addition, Isaac and Dennis look for things they can fix or improve with tools or paint.











Here are Isaac and Margaret at one of the orphanages -



























Here is Dennis. He took most of these photo's.












Yesterday they thought that they had a casual agreement to meet one of their local adult contacts to learn about African music. They were busy with orphanage visits and showed up two hours after the suggested time (remember TIA?) only to find that the man had lined up FIFTY school children who had waited for TWO HOURS (with teachers, school principle, etc,etc) to perform for them. Apparently everyone was very excited when they did arrive and put on one heck of a show.























And what did I do today? I pushed glass around on a crappy microscope.











Well, only after the cleaning lady let me enter the room...












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Location:Kampala, Uganda

Just like back home...sort of.......

Way back when I realized that I was actually planning to go to Uganda (and not Uruguay or some place else that sounds like it), I asked Dr. Troy Lund what exactly I might do all day here. He assured me that Mulago Hospital is effectively Uganda's Hennepin County Medical Center and that I would be doing here pretty much what I do there. Well I kind of have been doing here what I do there, sort of, except....

Take for instance this morning. I was scheduled to give a lecture in the Cancer Center at 8:30 AM, except,






They needed finish mopping the floor before we were allowed to go in. And Isaac and Dennis needed to fix the projector before we could get started.












I got talked into doing a bone marrow biopsy on an old man that really wasn't necessary except to make a better story for reporting him in a medical journal,






Except, the room was really small and filthy and there were no standard Illinois style needles for the aspiration.

I looked at a lot of malignant lymph node biopsies and bone marrow aspirates,






Except I couldn't make any specific diagnoses because thay can't even do a myeloperoxidase stain here, let alone an immunoperoxidase stain.

Concerned people have donated cool stuff,







Except, Dr Troy Lund says that this vehicle has never left this parking lot because no one here is organized enough to plan things like staffing, fueling and ongoing funding.

So, just like HCMC, but don't forget, TIA, which, in case you have forgotten means This Is Africa!


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Location:Mulago Hospital, Kampala, Uganda

I am introduced

I decided to take my chances and my camera with me to Mulago Hospital.




















They do have a hospital laboratory staffed with pathologists but, somewhat similar to Peru, they are not so up to date with procedures and stuff like keeping stuff organized so you can easily retrieve it at a later date.













To help you understand: The white and yellow plastic squares in the picture are attached to blocks of wax that contain patient tissue samples that are sliced into ultra-thin sections, mounted on glass slides, stained with dye and looked at under the microscope. The plastic things are numbered so that they can be filed away in case you need to look at the patient's tissue again in the future. This pathology lab has about 20,000 of these blocks per year and they ran out of filing boxes in 2008 so they've been just tossing them into these boxes. Get it?

So, on my first day I was intoduced to the only trained, practicing hematology pathologist in Uganda. Her name is Dr. Susan Nnbibe. She is very nice. She was very happy to see me. She had a list of lectures that she wanted me to give. I explained that no one had told me that I needed to prepare or bring lectures and that I hadn't brought my laptop, just an iPad with just a few presentations in Keynote. HINT: Not a good beginning. I scrounged out a presentation on Hodgkin Lymphoma to give to the pathology residents (all two of them) and had just gotten their crappy kind of broken projector to work ( yes, thanks to Jonathan in Anatomic Pathology at U of Minnesota I had a working iPad projector adaptor)....where was I? Oh, I had just gotten the projector to work when Dr. Nnibibe burst in (really, very dramatic) and asked me to look at a bone marrow smear in the next room...at a yucky microscope without the correct lenses for looking at bone marrow. Why that microscope? Because it had multiple heads and she wanted the residents to look too. Oh and the treating physician was on his way to look as well.





I don't want to sound picky but I do prefer to have well labelled and prepared slides and a good microscope but I decided to be a good sport and make nice. I was pleasantly surprised to look at the slide through the crappy, low-power lens and be able to tell them that it was a case of Acute Meloid Leukemia. Of course I couldn't take a picture for you but here is an example picture:







The thin purple line in the light blue part of the big cell means it is myeloid leukemia. Trust me here--this is what I do. "But," Dr Nnbibe said, this was bone marrow from a child who was being treated for childhood (lymphoblastic) leukemia and, besides, she couldn't even see what I was trying to show her with the crappy low-power lens. Now, I know this might not seem like a big deal to you, but I impressed the holy hell out of these folks by circling the cell under the microscope lens with a pen (requires much practice), putting the slide under a better, single head microscope, and finding the same cell (nailing my diagnosis) just when the treating physician arrived to look through the scope. Huge points scored for me -- not for patient. Much different treatment, much worse prognosis.

So it goes but I must say that since that little demonstration of my powers everyone has been really nice to me and pretty much just letting me do their various jobs for them which is probably what they were planning to do anyways.....



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Location:Mulago Hospital, Kampala, Uganda

TIA

Written 18 July to be posted when I have wireless internet access...

I have now learned that in the local language, "TIA" means, "This is Africa." Other options are, "TIAGUTI" ( This is Africa. Get used to it), and YTLYTTWK (Yo Toto. Like you thought this was Kansas?"). I first learned the term when Isaac figured out that the issue with the internet in the guest house was because we needed to buy a card for internet minutes and that for some reason these aren't sold on Sundays in Uganda. Why? "TIA. That's why."

No worries. The internet can wait. And, hey, I'm learning a new language.

And all will be solved because Dr. Troy Lund arrived at 4 AM this (Monday) morning (with an obsessed-with-getting-into-medical-school Carleton College undergrad in tow) ready and racing to Fix The World.

So, now that Dr. Lund is here I am expected to spend some time at the hospital today.



This is a picture of the sign for the Cancer Institute. I am not working at the Cancer Institute. I am working at the Mulago Hospital. I would like to show you some pictures of the Mulago Hospital but IT IS AGAINST THE LAW TO TAKE PICTURES OF A HOSPITAL IN UGANDA. I am considering breaking this law just to augment the blog but Dr. Lund has already made some jokes today about me getting sent home early so I will just say, "TIA."

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Location:Mulago Hospital Guest House, Kampala, Uganda

Getting there is how much fun?

Written 16 and 17 July to be posted when I have wireless internet access....

Way back when, our mentor/Health Volunteers Tour Director, Dr. Troy Lund from the U of M decided that it was cheaper to fly Minneapolis-Detroit-Amsterdam-Uganda so that's what he booked for himself. When I saw that there was only a one hour layover in Detroit and that the direct flight from MSP to Amsterdam was only US$200 more, that's what I booked. Guess who got to Uganda with no delays and guess who spent a day in Paris and the night in in Nairobi when he was rerouted after a delay on the ground in Detroit?




No worries (oh, bullshit, anyone who knows me knows that all I do is worry). With or without worrying, the guy was there right on schedule to pick up me and my son Isaac at the Entebbe, Uganda airport. I would have taken a picture of him for this blog BUT IT IS ILLEGAL TO TAKE PICTURES AT AN AIRPORT IN UGANDA. The airport hotel was lovely (but don't mess with the monkeys) and they had no problem with shifting Troy's reservation until he could figure out how airlines work.








At 10 AM, Sunday July 17 Josephine Buruchara from HVO Uganda called (she seems to know how to find anyone anywhere any time in this country whether Dr. Troy Lund is there to guide them or not) to tell me that Gerald was on his way to pick us up and take us shopping and then on to the Mulago Hospital Guest House.

But first he had to show us how to exchange dollars for shillings:


And how to buy a Sim Card for our cell phone:



Funny how everywhere I go there is a grocery store that looks a lot like one in Minnesota. This one in Uganda is very fussy about taking shillings. Not dollars. Not credit cards.



Traffic in Kampala is just as awful as other places



The Mulago Hospital Guest House is nice







And nobody tells you not to play with the monkeys




After a little lunch Isaac and I tried to see what we could find by walking around the vicinity which is pretty much as follows:












I am sure that we will see more and better once we score a map (WISH THAT WE HAD BROUGHT ONE), once Isaac gets the wireless internet to work, and once Dr. Troy Lund finally arrives.

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Location:In transit