Just arrived back from our weekend in Murchison Falls….Amazing.

I felt an overwhelming sense of relief as we left the smog and heat of Kampala early Saturday morning–the chaos and noise of the city dissolving into the intense green hills and red earth of rural Uganda. We zoomed past the familiar scenes of everyday life in Uganda–naked children playing by the side of the road, people pushing bicycles laden with bananas, women standing in line at town water pumps, men laughing in groups under the shade of trees, boys herding cows, women digging in their gardens….

Started the weekend with the boat trip down the Nile to see Murchison Falls. Could not help but doze off in the heat and sun–waking up every once in awhile to catch glimpses of hippos. Only one elephant spotted on the water–a single male whose trunk had been ripped off by a poacher trap. Left behind by the others because of his disability. Very sad. Enjoyed watching Jake’s excitement. Ended the day with a stop at the top of the falls–the power of the water juxtaposed with the peaceful scene of the sun setting over the Nile. Had forgotten how incredibly beautiful Murchison Falls are. Had my first wonderfully hot shower and fell asleep under the breeze of a fan. It was heaven.

This morning started before dawn as we rushed to catch the ferry for our early morning game drive. Picked up a ranger who jumped in our car and immediately directed us to a male lion who was spotted lying under a tree. Our Valentine simba:) We stayed for awhile, watching the lion rest–the sun rising over the savanna behind us, the scent and sounds of morning pulsing around us. It was a perfect way to start a day filled with elephants (including a baby), giraffe, and a rare leopard sighting. Spectacular. An altogether amazing weekend.

Friday. Exhausted. Feel like I have been hit by a ton of bricks. The heat is oppressive here. I don’t remember it ever being this hot. Maybe it feels hotter because I know that I am missing the amazing snowstorms back home. I am a bit homesick today.

Finished our first week at the IDI with an examination, truly my last medical school exam:) The work is not as clinical as I had hoped, but I still think it has been a valuable week. For most of the week, we sat stuffed into a small examination room with four Ugandan medical students learning the principles of ART treatment. It was a crash course in ARV drugs, side effects, and management of side effects. Yesterday, our instructor (whom I shall call Dr. Sublime Steven) saw patients and taught us at the same time. The physician-patient interaction is very different here and sometimes it was as if the patient was invisible. We discussed the patient’s case–personal details of the patient’s life and then we switched to a discussion of specific ART drugs and then we switched to talking about religion (yes, Jake was clearly present)……all of this while the patient sat quietly in the corner. Once again, the patient interviews were cursory and cold. It was upsetting. Although the week was composed of primarily didactic sessions, I did find it to be a valuable learning experience. After the exam today, the Ugandan medical students had to present cases from home visits with patients from the IDI clinic. I was quite impressed by the emphasis on the psychosocial and environmental determinants of health among HIV patients that were presented. The case presentations certainly highlighted the impact of poverty on HIV treatment in Kampala.

Need to head to dinner now…..Big day tomorrow–heading to Murchison Falls for a unique Valentine’s Day weekend…Have much more to say about our first week…stay tuned. No internet until Monday.

Kampala, Uganda
Monday, February 8

Sitting at the Sheraton in Kampala drinking coffee, relaxing in an environment filled with familiar things—much needed after our first day in Uganda (yesterday). Arrived late Saturday night—stepping off the plane, hit by the first blast of smoky, damp air that I associate with Africa—nervous, overwhelmed, excited. Plane filled with the usual suspects—the missionaries clutching the word of god in their nervous, white hands; the post-pubescent adventurers dressed in hippy dippy safari wear clutching the word of lonely planet in their excited young hands; the Ugandans dressed in their finest, clutching a million bags and the tiny hands of children. The drive to David’s in the darkness is an assault to the senses…..dust and darkness punctuated by the beaming lights of erratic taxis and the pulse of club music, the chaos of a Saturday night threatened by the bota-botas zooming in and out of traffic. I think—I am back. Do I want to be here? Do I want to revisit the place that propelled me from adolescence into adulthood in a matter of days? Do I want to revisit the place that nearly destroyed me 9 years ago? I am still unsure. What is it about this place that grabs me and pulls me into the currents of poverty—what is it about this place that makes me feel alive and incredibly lonely at the same time. What is it about this place that challenges every part of me—challenges me to think, to feel, to breathe in the inequalities inherent in life…..that forces me to recognize my privilege and reject or accept it on a minute to minute basis. My identity is tied to this foreign, uncomfortable place in a way that is difficult to describe. It is the place where I first experienced death and true despair and it is the place where I first felt truly alive.

This should be an interesting trip. It marks the end of a journey that has lasted over 14 years. I have visited this place, this country at every critical point in my life’s journey from adolescence into adulthood and it has shaped me through the wonder, the guilt, the confusion, the horror, the anger, and the joy that it inspires inside of me. Can I say that I love it here? I cannot. But I can say that this place changes me every time I come.

We are spending the first 2 weeks working at the Infectious Disease Institue in Kampala. We are staying (for now) at the Makerere University Guest House and are in the company of at least six other American medical students. On our first day, we trekked down the road to the hospital—the other students walking confidently in their ridiculously white short white medical coats through the sea of Kampala city life—weaving through the crowds of people, trying to avoid inhaling the dust and exhaust, the garbage and sewage. Almost marching in single file, pretending that we are inconspicuous, that we belong somehow. Pretending we are doctors. But pretending is futile here—I learned that long ago.

We enter the IDI, unsure of where we are going and who we are supposed to meet. We are almost immediately taken to the IDI clinic, where at least 80 patients are waiting on benches on either side of a long hallway. None of the patients are talking to each other—they all sit staring. It is strangely quiet for a cavernous hallway filled with so many people. It is a place of serious business.

IDI, Kampala
February 10, 2010
Kuwaala Health Center (Health Center #3)

Fell on my way to the hospital today and finished the intense trek to the IDI with blood running down my hand—thoughts of tetanus running through my mind. The sight of my own blood mixed with the tension I feel weaving through the rush hour morning traffic led to an exhausting morning. Hopped into van heading to Kuwaala Health Center, one of the IDI-KCC clinic sites. The IDI-KCC is a capacity building partnership between the IDI and the Kampala City Council designed to improve access and tracking ART treatment in the community. At this point in time, the IDI-KCC partnership at Kawaala and 6 other government health sites provides free ART treatment to 2,000 patients and is currently funded by the Global Fund, PEPFAR, and the Ugandan Ministry of Health. The partnership was supposed to end at the end of March 2010, with the hopes that the Ministry of Health would be able to fully support the ART program. The partnership has failed to build enough capacity to continue without emergency funding through the Center for Disease Control. According to the young physician I was paired with for the day, the Ministry of Health has claimed that the IDI pays the IDI physicians that staff the clinics at an unfeasible rate. At this point, the Ministry of Health will not distribute ART treatment to patients without the availability of a 3-month supply of ART drugs. Currently, there are hundreds of patients who are on waiting lists for free treatment.

We pulled up at the clinic and I was slightly surprised to see at least 100 patients sitting on benches waiting for us to arrive. The crowd looked much like the crowd waiting at the IDI clinic at Mulago—however, there were at least 8 physicians staffing the IDI clinic on a daily basis and today there is only one. We set up space in a consultation room, the physician and I sitting on one side of a desk and the patients on the other, separated by a huge stack of colorful paper charts. Our first patient was a 29 year-old woman who presented in tears. She told us her story—she lost her husband three months ago and was ostracized by his clan secondary to her HIV status. Her care was transferred from other part of the country to the Kawaale clinic, but she was having difficulty accessing her much-needed ART treatment. The physician looked at her with pity—there was not much he could do for her. The encounter lasted less than five minutes, followed by at least 60 more patients with various physical and psychosocial complaints. The interviews were conducted in Lugandan, the local language, making it nearly impossible to understand what was being verbally communicated. The clinic morning ended with a cold chapatti, a warm orange soda, and a lot of questions about the feasibility of delivering ART treatment in a clinic like Kawaale without the massive influx of foreign money.

This is my first experience with blogs, having previously vowed to never, ever write one……In any case, here goes nothing……