Flying Thoughts

Is it really July 20th already? I am hard pressed to believe that I have truly been in Uganda for 8 weeks.

Today's goodbye at the office was bittersweet. There was another bridal shower to attend, then I ordered in pizza and soda for our office as a "thank you."

A Ugandan custom that I don't think I've explained yet is the way everyone speaks at an event. For instance, even though I've never met the brides of the shower previously mentioned, I, along with every other woman in the room, offered congratulations, well wishes or advice. In my thank you party to the office, the advice was turned to thanks and well wishes to me from my office. As someone who does not like to be the center of attention, it was a little bit uncomfortable, but that didn't last long because of the things they had to say.

Nearly everyone in the office mentioned my "out-going" character and evidence of faith in my life. Now, I have the Meyers Briggs results proving I'm an introvert, so that surprised me. But one of the interns took it a step further to explain that to me. He said he had a perception when I arrived that I would isolate myself and avoid intermingling with the rest of the team. He admitted I proved him wrong and have encouraged his opinion of Americans who spend time in Uganda. Regarding my faith, I was not expecting a mention of that since everyone else in the office is a Christian, like myself. They said they were encouraged by the way my life reflected my faith, in the way I dressed, spoke and treated the people around me. Hearing that, somehow during my short 6 weeks with them, I was able to encourage the faith lives of my coworkers and friends was a very humbling moment to me. A moment where I realized the powerful impact that actions and words can have when they are communicating the same thing.

Of course we needed to have a quick photo shoot before I left!

I found it is hard to get everyone together for a group picture...

But we got it eventually!

The guys.

The gals.

Selfies are big, especially with the mazungu. They are definitely a fun and goofy group.

I am excited to come home. I have missed my family. Yet, I do not want to leave. I think there is something in the air here (and I'm not talking about the dust and exhaust fumes). Something about the way the sun sets, the monkeys swing, the children sing. I haven't been able to figure it out exactly, but whatever the combination, it's captivating and it made packing my bags one of the most unpleasant experiences.

Mangos, Bananas, Matoke, Mmm!

Ugandan chicken on a stick!

I can honestly say I have thoroughly enjoyed almost every meal I’ve had in Uganda. The one that did not sit too well with me was a dish of goat intestines for breakfast... But aside from that, its been quite delicious! Breakfast is usually eggs, toast, fresh fruit, coffee or tea, freshly squeezed fruit juice and sometimes avocado. Though I usually just have instant coffee in the morning, I have had the locally grown beans and, mm, this coffee lover is in heaven those days.

I actually prefer the little bananas to the big ones, they have a sweeter taste.

I usually eat lunch from MU-JHU (Makerere University-John Hopkins Research Collaboration Building) or a close by canteen. They serve local food every day for a very reasonable price. We usually get rice, matoke, g-nuts, beans, and sometimes a meat "soup" take away. All that filling a Tupperware costs 3,500 shillings. Lunch is often the largest meal of the day.

What lunch usually looks like (and it's actually really good!)

I actually crashed a party on my front lawn for this dinner. Goat meat on a stick, chichen, pillou (rice cooked with meat), two kinds of salad and roasted matoke (still in the peel)

Meat soup is more like a gravy with meat chunks that goes over the rice and matoke. Matoke is technically in the same family as bananas, but since I prefer them steamed in banana leaves, they remind me more of a mashed potato. Potatoes here taste very similar but are called by different names. A roasted baked potato is called an "Irish Potato," the french fries are called "Chips," and the chips are called "Crisps." Very British, I'm learning. Maize is also a big food source here. You can find it growing almost anywhere. Many people enjoy buying the roasted corn from the street vendors.

They really do grow it anywhere.

Honestly, I don't know if it's banana or matoke. My coworkers laugh at me all the time becasue I can't tell the difference between the trees...

Because lunch is so big, dinners usually consist of toast with peanut butter and a mango. Sometimes I’ll run to a market and get veggies for guacamole and days where I am very hungry I’ll make up pasta or run to the Good Samaritan Canteen. Some nights the other guests in my house and I will order dinner off Hello Food. This website has tons of restaurants that you can order from and a boda-boda will bring it to your door within the hour! It is a great thing we’ve discovered. We even had pizza the other night!

I think that will be one of the hardest things about returning to the states. I will really miss being able to buy bananas, mangos, avocados, onions, tomatoes, chipati, and any of the other foods I have become so used to buying on the street. Sure, I have to soak it in a cleaner to make sure I won’t get sick, but when a full load of groceries usually costs me a dollar at most, I’m happy to let it soak for 20 minutes.

Enough to make guacamole for days (and a banana) for ~$.65!

As yummy as the food has been, I will say I'm pretty excited to come home and have blueberries and a hamburger. It has been very fun to jump into the culture and try new things, but as home gets closer and closer, I find myself looking forward to things I haven't had access to over the past few weeks. 

The Jam

One of the first things you hear about in Kampala is the jam. Traffic jam. And let me tell you, I will never again complain about traffic in Ann Arbor or going through Chicago. Kampala takes the cake.

A trip of 20 km can take anywhere from 15 min to 2 hrs if you leave at the wrong time of day.  Notice in the intersection above, no stop signs, traffic lights, traffic police, anything. There's also no dream of people treating it like a four-way stop. The other picture is a road, meant to be a 4 lane highway, but the money was poorly managed and two were all that were completed.

This is one of the nicely paved roads in Uganda! The mountain in the distance is Mount Elgon, near Mbale, which we passed through on our way to Tororo. The vehicle heading toward us is a Uganda taxi, or a Matatu. Matatu drivers are some of the most aggressive I've ever seen. They seem to think they are able to squeeze those 14 passenger vans in to spaces many people wouldn't even walk... This two-lane, paved road is considered a main way. There are some roads with four lanes, but many don't even need to have lines, because drivers like to create their own lane anyways.

What the roads more often look like in Uganda - dirt with the biggest potholes I've ever bounced through.

Other ways you see people moving around include privately owned cars, private hires (private taxi drivers), Boda-bodas (motorcycles that can be a quick way to your destination, but also dangerous, depending on the caution of the driver), bicycles and trucks. With all these moving many, many people around, you can imagine how congested the small roads become.

All of the above mentioned vehicles will carry anything from produce, to furniture, to coal (as pictured below). It's amazing the things you see on a boda-boda in Uganda.

We got stuck behind this truck one day when we were in the field training children in out study. It is hard to see, the with the potholes of this road, you wonder how more don't get stuck. But hey, why not just use another truck to push it through?

Construction, bad parking, small roads, anything and everything contributes to the jam.

There are an estimated 1.2 million people in Kampala with thousands of people commuting in and out of the city every day. With only a few roads leading in and out of the city, you can only imagine the morning, evening and weekend commuter times... Work, vacation, meals, everything is planned around the Kampala jam.

It is not uncommon to pass big guys like this in the road. Long horn cattle are everywhere, even in a big city like Kampala. They often just wander on their own and I am constantly wondering who they belong to. These horns are not even the biggest I've seen around.

I have always felt very safe moving around the city. I stick mostly to walking, but will hop in a matatu if there's someone with me. A few days back, however, the hovering danger of the Kampala jam was made very real to me when I spent a morning shadowing in the adult casualty ward of Mulago. A little while before I arrived, there had been a large accident on one of the main roads involving at least 9 cars and over 50 people injured. Almost all of them seemed to come through out unit that morning. The head nurse mused that there would continue to be many more trickling in throughout the day. Some chose to go to local clinics first, then were referred to Mulago due to the severity of their illness.

That morning made me grateful for my own safety traveling about Kampala the past few weeks and also for the experience of seeing trauma triage following a disaster first hand. The doctors and nurses knew exactly what to be prepared for and worked seamlessly as the Ugandan Red Cross started bringing in patients on stretchers.

Kampala Fun!

Now, it hasn’t been all work since arriving in Kampala. I have been able to explore, shop, rest, but maybe most importantly, experience two very important aspects of Ugandan culture: futbol and weddings!

How convenient is it that during my short stay here, the Uganda Cranes had a match against Botswana in the Mandela National Stadium? I’d say we were pretty lucky! Tory and Ronak came into Kampala for the weekend so we decided to get into the Cranes spirit as much as possible, face paint and jerseys to boot. The stadium was HUGE. Pretty sure it’s bigger than the Big House. I’d even argue the hype parallels that of us Wolverine fans. There was a pep band and a group leading cheers and motions. The Uganda spirit only continued as we scored two awesome goals in the 2^nd half to win 2-0! The win made for hectic traffic, but I wouldn’t change it for the world, it was such a great day!

 

In the true fashion of Ugandan hospitality I was actually invited to attend a surprise bridal shower for one of the gals who works for GHU (whom I’ve never met). It was so fun to join in the fun to celebrate her and her upcoming marriage! Following that, I was also invited to attend the wedding that weekend! Didn’t give me much time to make sure I had an outfit appropriate for the event, but the ladies I work with were more than happy to take me into town, haha. So, we found a maize and blue African-style dress and spent all Saturday celebrating marriages! Yes, marriages is plural. We ended up seeing three couples leave the church as husband and wife! As weddings are very popular, churches will actually book them back to back. Same flowers, decorations, and even same sermon at some locations, haha. The ceremony lasts about an hour. It was actually quite fun to listen to a service that only had bits and pieces in English. The reception starts a few hours later. We were there from 4-930 and didn’t even stay the whole time!

Barbara and Ethel

Michael and Richard wanted in too!

Ethel met us at the reception.

Monica!

Ugandans love a party and they love welcoming anyone to join them. It has been too cool to hop right in and experience their lives and culture right alongside them.

Hospital Experiences

Mulago PICU

Along with conducting my research, I have also been able to shadow doctors and nurses in the Mulago Hospital. Most of my time there has been spent in the Pediatric Acute Ward or the Pediatric Intensive Care Unit. In the states, patient care areas are usually called “Units,” but in Uganda they are called “Wards.” This was tricky for me are first because “Ward” spoken by a Ugandan can often sound like “World.” Being told to go to the “Acute World” made me a bit confused the first day. The Female Ward, the Male Ward, Operating Theaters, the terms and organization are a bit different, but not difficult to get used to after being here a few days.

Direction signs at Tororo.

This acute ward has a triage waiting area, a resuscitation room, the floor (where less acute children go), a small neonatal intensive care unit and a small pediatric intensive care unit. Every morning the children on the floor are determined to be stable enough to move to a specialized ward, such as cardiac or GI, or they stay with us a bit longer.

Mulago Pediatric Triage

I spend most of my time in the resuscitation room, which functions most like an American emergency room. We see many children come in with respiratory distress from bronchial pneumonia, malnutrition, and suspected malaria. The room has 5 beds, between 2-5 residents, usually one nurse, and anywhere from 2-10 patients (the little ones share beds). It is interesting to see that the residents conduct many of the assessments and interventions done by nurses in the states and the nurses either focus on stocking the room or telling the doctors what to do.

Mulago Peds Resuscitation Room

Family and friends of the patients perform all the personal patient care, such as feeding, bathing, washing the linens (if they have them), and even purchasing medications when the hospital does not have them available. Though it’s hard to know there is limited available to offer our patients in need, there is some comfort in the fact that there are many well stocked and accessible pharmacies nearby. Slightly less comforting is that there are no prescriptions required, but at least meds can be accessed when they’re needed. 

Laundry being done by family of patients at the Tororo Hospital.

I’ve been able to experience quite a few hospital environments: Tororo District Hospital, Cure Hospial, Kanginima Hospital, Benedictine Eye Hospital and Mulago. My first real exposure to health care systems in a developing country has been truly eye-opening. At first it is heartbreaking to see how little doctors and nurses have to work with, the environment they have to work in, and how hardened they’ve become to losing their patients. But those feelings are quickly replaced with awe and encouragement when you see what all they CAN do with how little they have, what all they CAN do in less than ideal environments, and how hard they DO work to provide life saving measures to their patients. I think westerners sometimes come with the thought that we will bring our skills and technology to make it better here, but in the end, we are usually the ones who come away learning skills we carry throughout our life.

Tororo consultation room.

Research Time

It’s about time to tell you about what I’m actually doing and why I’m in Uganda! After Dr. Giordani got me moved into Mulago, I quickly settled in with the Global Health Uganda (GHU) Computerized Cognitive Rehabilitation Therapy (CCRT) team. Michigan State University has a partnership with GHU and Makerere University to conduct this study. The main goals of this study are to determine the effectiveness of CCRT on improving neuropsychological and psychiatric outcomes in Ugandan child survivors of severe malaria and if severity of malaria is predictive of the effectiveness of CCRT.

One of the programs on a training computer.

The computer "mouse" used to control the game.

CCRT is a type of computer intervention that is often used in the states for elderly individuals or children with ADHD to improve their memory and attention skills. In a similar way that this program is used stateside, the hope is that CCRT will improve the cognitive abilities of children following severe episodes of malaria. Testing is done by Mariah, Titus, and Ethel pre-intervention, post-intervention, and one year post-intervention. Our trainers, Michael, Irene, and Richard take laptops with the program to the participants’ schools 3 times a week for 8 weeks.

Two of our trainers, Michael and Irene, administering CCRT. To have a slightly less distracting environment, it is done in our car.

When I say severe malaria, it entails cerebral malaria (CM) and severe malaria anemia (SMA). In CM, the parasitic load of malaria becomes so great, they actually settle into the ventricles of the brain and begin affecting brain tissue. SMA occurs because the parasite attacks the red blood cells. When this happens the cells ability to carry oxygen to the brain and other areas is impaired. As you can see, children who are fortunate to survive can, unfortunately, suffer cognitive deficits, either from lack of oxygen or direct tissue destruction, impacting many areas of their lives.

There is clearly a lot going on here and it is a well-established study. But one aspect that is not being directly explored is the relationship between CCRT, neuropsychological testing and academic performance. That’s where I come in! I am currently working to standardize school reports from study participants and record that information in a reliable database. My hope is to identify any differences in academic performance between children in the CM, SMA, and CC (community control) groups at baseline and their one year follow up. We will also be looking at whether the neuropsychological testing is predictive of those differences.

This is our little office with Mariah, JP, Irene and Barbara!

The study has been going on for a few years with a total of 300 participants, so there are lots of school reports, and more continuing to come in. My goal is to have as many children as possible with both baseline and one year school reports to analyze and develop a conclusion.

One of the schools we visited to train.

The time has been flying by so quickly. To think, I am already half way through my time in Uganda! At times that is a comforting thought because it means home is not so far away, but when I’m at work, I often feel I could stay here a few more months to accomplish everything the way I want. It is a lot of work, learning a new research and health care system. I am enjoying every moment though. Not everything is easy, but that’s what makes it fun. I love the challenge and Kampala definitely keeps it coming!

Mulago, Sweet Mulago

My front porch for the next few weeks!

What a good feeling it is to settle in a place knowing you won’t have to repack and move again for some time! After spending 2 weeks bouncing from guest house to guest house, I have finally unpacked my bags in the Mulago Guest House. “Home” for the duration of my time here, I’m quite content. It is a big guest house with 6 rooms, two beds in most, and there are two other buildings for visitors. Door to door, it is about a 10 minute walk to the hospital office where I work. There’s a little café and a restaurant on the guest house grounds for when I don't feel like making dinner. If I take a left out my drive, instead of a right towards the hospital, there are many people selling bananas, mangos, g-nuts and other things, so that is a quick and affordable place to grab a snack. For comfort and exercise, it’s about a 20 minute walk to the nearest coffee shop with wifi.

The common area, the kitchen where I make dinner is just through door on the left.

My room!

The majority of my time so far, I’ve been the only guest. There were 3 anesthesiologists my first night, 5 students for one night a few days later, and a young family just moved in for the week. People have been coming and going, not staying for very long, but I have been able to make friends with many of the people who work here, making it a little less quiet when I’m the only one around. Sarah is the woman who makes me breakfast every morning and who I spend the most time with. I gotta say, fresh fruit, juice squeezed that morning, Ugandan tea, eggs to order, avocado, she is a great cook and successfully sends me to work with a satisfied tummy every morning. I went with Sarah to the Wandegaya Market the other night to get food for the next morning and that was definitely an adventure! We walked there as the sun was setting, which means it was completely dark on return, my first night out in Kampala! That’s one thing about Uganda nights, there is very little dusk. Sunshine to pitch dark. Because it was dark and our arms were full of groceries we took a taxi back to the guest house.

My first time in a Ugandan taxi deserves a special explanation. I don’t know about you, but when I think of a taxi, I think of New York streets full of yellow cars taxing 1 or 2 people around. In Uganda, taxis are large vans that have a licensed maximum of “14” passengers. Yes, 14 is in quotes, because many drivers don’t remember that number if it means they can get a few extra shillings. Oh and it only costs 500 shillings, no matter the length of the trip (from my understanding). $1 US is equivalent to approximately 2,900 UGX. If my math is correct, that made my taxi trip under 25 US cents. No complaints from me.

Some other friends I’ve made are the animals that often make me feel I’m at the zoo. The turkeys usually wake me up in the morning, they’re louder than the roosters. The hawks and black and white crows stay mostly to the trees out front and are usually pretty active in the evening when I come home from work. Little lizards are common. One that I’ve named Fred, is particularly fond of my bathroom walls and curtains. We have an agreement that he can stick around and eat all the mosquitoes he wants, so long as he stays out of my bedding and clothes. My rarer animal visitors are the monkeys, I’ve only seen them one morning so far. They were so fun and cute! At first. I stepped onto the porch and saw them in the bushes and trees, so naturally I took some pictures. Then the babies ran onto the porch posing for pictures, cute. Then the moms came. Not so cute. The sneaky babies were distracting me while the moms tried to get in my backpack and then in the house! Sarah was still here, thankfully, and she came and shooed them and made sure I could leave the house without getting attacked by the monkeys. She warned me to be careful, for as cute as the little ones can be, the bigger ones can be dangerous. As we were walking around the house we saw about 7 more, so I think there were at least 15 around our house that morning!

Fred chilling in the bathroom.

I call them Tom and Jerry because they always seem to be chasing each other around.

Monkeys in the distance.

Babies up close.

They were pretty curious of me.

Overall, it really is a nice place to settle and call home for the next few weeks. I feel truly blessed to be surrounded by such beauty and friendly people. It can be hard to be alone sometimes, especially in a foreign country, but I’m learning to value the quiet time as well as putting myself out there to make friends. It's not always easy for the introvert in me, but the friendships I've already started to make are already showing me it's worth it. Taking a small step of kindness can go a long way to make a friend.