Sunday, May 11, 2014

First Aid Response Training in Mbrarara, Uganda.

Arriving in Rwanda

After a 3 yr hiatus, I am getting back on the road (or plane if you will). Last time I was abroad, I was so anxious to one day be able to go back into the world with a little knowledge under my belt. My year abroad taught me so much, but it was frustrating for me to not have the medical experience to be able to give back. I was a little medical student following the Senegalese/ Laotian resident around. I am now returning as an MD. A little baby MD with training wheels still on, but a Doctor nonetheless.  I am very excited but also nervous to get back on my travel horse. Although I have traveled a great deal, it is still scary to jump on a plane to a unknown land and culture. Here we go once again!

 May 2, 2014

 I started of my adventure with a 21 hour journey from Boston to Uganda (Boston -> Amsterdam -> Rwanda- > Uganda), which was followed by another 13 hours on the ground until I reach my final destination of Mbarara, Uganda. I arrived into Kampala, the Ugandan capital, at 10pm. It was a surreal experience to be setting foot in Africa again. My first hour here, from the airport to the hotel, was one giant flashback. It made me truly miss Senegal. I have kept Senegal very close to my heart since I left. It will forever be my first time in Africa and first time I went out into the world completely on my own. Uganda had big shoes to fill. As I walked out of the airport, all I could see and hear were the Senegalese taxi drivers yelling to get your attention in French and Wolof. I remembered those butterflies in my stomach, the sweat in my palms, and the feeling of my heart racing that I felt when I first landed in Dakar 3 years ago. I was so scared back then. All I kept thinking was to keep walking forward and seem as calm as possible, when all I really wanted to do was crawl in to a little ball and be teleported back home with my Momma. This time it was different. I knew what to expect, and my appearance of calm was not a facade but reality. It made me a little sad.  You only get to have your first kiss once, and you only get to be a 24yr old girl during her first time in Africa once too. As I looked up and saw the million stars in the sky, I smiled and thought to myself, “ Hi
Africa, I’m back!” Uganda is very beautiful. Senegal is in the middle of the Sahara, so it was nothing but desert and Boaboa trees. Uganda is dead center on the equator. It is about 80 degrees year round, so it is very green, a little humid, and filled with valleys.  All the nervous feelings I had as I prepared for my trip disappeared on my way to the hotel. It was like riding a bicycle. I immediately adjusted to the stores on the side of the road, the aluminum roofs, and old concrete or brick. The familiar smell of 1970s cars mixed with fresh air and old world was all around me. I was thinking of how wonderful it was to be able to come back to such a beautiful part of the world, when we arrived to the hotel gates with a security guard holding a machine gun the size of a small child. It was reality reminding me of where I was in the world.   

May 6, 2014
It has barely been 2 days, and I already feel like I have been here a week. Right away it is very obvious that this trip is unlike any trip I have taken. I have always gone abroad to study or work on a project.  Yet, my trips have always been focused on me learning. Even when I have gone abroad to complete a project, no one was depending on my results for anything. The expectation was that I get out as much as I could out of the trip and my experience in order to further my knowledge that specific field or topic. This trip is different because I have very real responsibilities. There are both Ugandans and Americans that are depending on my work and the results I obtain. It feels like the first trip of the rest of my life and career. I feel like my previous trips were done in preparation for this trip and the work I will do from now on. It is both daunting and very exciting.

May 7, 2014
A&E = Emergency Department

Working in the A&E ( accidents and emergencies), which is the Ugandan version of the emergency department is going to be such an incredible learning experience. I have been working hard these last 2 years as a resident to learn as much as I could and gain as much experience as possible as a clinician. It has been a very steep learning curve. Going from an oblivious little intern to now an up-coming PGY-3, the difference in my skills as a doctor are incredible.  On my first day of residency, it took me an  hour and a half to see and complete the evaluation of my first patient. I still remember his face, the room he was in, and his chief complaint. I was so scared to prescribed Tylenol because I knew that if I put in the order, the nurse would actually give it. It wasn’t like medical school, where everything is practice and things have to be approved by your senior resident or attending. Although I had plenty plenty of support and help if I needed it, my orders for medications and interventions would actually be given. Anyway, so I went from getting butterflies from prescribing Tylenol  to being able to confidently treat septic patients,  
Procedure Room
strokes, doing intubation, placing central lines, and ordering medications that could rapidly and drastically alter someone’s physiology as well as having the ability of being responsible of as many as 15-20 patients at the same time on my overnight shifts. I still have a lot to learn, but the difference is mind-boggling. 

Type and Crossing
 Well, I came from that back to step one again. Being here in the Uganda A&E, I don’t know where any of the medications are, how the system works, the extent of the capabilities of the department, or how to simply write a note. My first day, it took me 2 hours to complete the evaluation and admission of 1 patient. Obviously, some of that had to do with how the system works, but the intern had to talk me through how to write a note and work up a patient. I felt like a day 1 intern all over again. I was learning more from the Ugandan doctors and interns than they were learning from me. Me, the American doctor being trained with “advanced” techniques and was here to teach them a few things! Because they do not have the tools and technology we have available to us in the west, they rely mostly on their skills as clinicians and physical exam. It is an art that is quickly fading in the west due to our growing reliance on technology.  
Blood Bank
I needed it, my orders for medications and interventions would actually be given. Anyway, so I went from getting 

It reminded me that I have to always be paying attention. There is no difference between me and the 13yo boy I say in the A&E the other day, who was hit by a boda boda. He came in with a head injury, cuts, and a very large open wound that involved the entire left side of his abdomen. He was lucky because it didn’t involve the part of the body that keep your organs and intestines inside. He was sutured up and discharged home later in the day.

May 8, 2014
I wake up at 630am-7am every morning and have not been able to go to sleep until about 11pm every night, not much difference than my days back in the US. Well, I little different. I don’t think I will have to take-on strings of days/weeks of getting 5-6hrs of sleep per night.

I have already had two amazing experiences. On Tuesday, I tagged along with a field team who deliveries HIV medications to rural communities. We drove out about 1 hour from Mbrarara into the tiny huts and houses that are in the middle of banana plant fields and miles from anything remotely modern. It was awesome!! I was honored to be the guest into their homes and sit in the one chair or bench of their home. The houses are usually made of clay, using old palm tree leaves as the structure backbone of the clay walls. The roof is usually made tin or dry palm leaves weaved together.

View of Mbarara Regional Referral Hospital
Today, I accompanied one of the internal medicine residents who is also here to a rural clinic that was 4 hours away from Mbarara. In order to get there, you have to drive through Queen Elizabeth National park, which is the main game reserve here in Uganda. There we were, making a very ordinary drive out to the clinic while seeing elephants, water buffalo, water bucks, and exotic birds on the way. No big deal. Just another part of our day! I couldn’t help but laugh and smile about the life I am lucky enough to live. 

The clinic experience was eye-opening. These patients are so far away from any major city, that this clinic is all they have for medical assistance.  There is no doctor. There is a chief medical officer, who was trained for 3 years after high school and is responsible for every patient, and a team of nurses. The clinic has a catchment area of about 40, 000 people, so it is no small task. He is able to work with limited medications to treat diseases that would require entire medical teams in the west. It was very humbling.

May 11, 2014
This first week was all about getting to know my environment, the people, the culture. I spent months trying to plan out my project, but it is so different to actually arrive and to start doing it. The beginning stages of organizing the first aid course have started. I have a specific plan of action. The program coordinator, Sarah, has been here for about 2 years so she knows the system very well. I had the curriculum and overall concept of the course planned out in my mind, but she is helping me adjust it to the setting in which I am working. Next week will be very busy. We are implementing the course in 8 days. It is not a lot of time to implement a course that I have never executed before in a setting that I am just getting familiar with. Yet, I know that we will get it done. We are going to start off small. We are planning to have only 40 participants this time around. My hope is that this course will grow and develop to become a city-wide event. 

Central Market

Chickens for sale at market.

Roadside Rest Stop

Elephant on my way to rural clinic.

Lake Bunyonyi
Ugandan kids

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