De Nile Ain't Just a River in Egypt...

Sorry it's been such a long time since I've blogged; the internet was frustratingly slow last week. Today it seems to be back to normal, so here goes.

I've been busy the last couple of weeks and have fallen into a routine. I've become more used to the noise at night, the pollution, those god awful storks, and the horrors at the hospital. I have actually become sort of-- can I say it?-- comfortable here. I have been out and about the last two weekends, which I will describe below. During the week, I have been spending the mornings at dermatology clinic, which has been amazing, and doing "consults" at the hospital and various clinics around Mulago Hospital in the afternoons. Dr. Bohjanen, the Principle Investigator on the research project I'm working on, has just arrived, and Dr. Maurer, my mentor from UCSF, will be at the hospital tomorrow which should be a fantastic learning experience.

Now for my weekend warrior tales...

First of all, I was able to drum up some photos of our Nile rafting trip a few weeks ago, I will post some below.

That's me with the brown shorts and the whitest legs EVER which were unfortunately about to become the reddest legs ever... wish i had a picture of that to post, i'm still peeling.

I just returned today from a weekend trip to Murchison Falls. Murchison is a National Park about 6 hours northwest from Kampala, on the Victoria Nile and Lake Albert. It is supposedly in a not-so-safe part of the country, although nothing bad has happened there in over 5 years, i was still a little nervous. Turns out it was worth the risk.

I went with two girls who are 3rd year medicine residents at UCSF. We left Friday morning and drove all day to get to our camp. The camp was on this gorgeous vista overlooking the river. We arrived and Puumba and friends had taken over the campsite-- see below...

Don't worry, they were actually pretty friendly little warthogs, and the babies are awfully cute.

The three of us paid 5 dollars extra to have a cabin with walls, instead of a tent (which still did not prevent the giant insects from disturbing my sleep-- reminiscent of the June Bugs at Girl Scout Camp, mom and dad), but we felt a little safer since hippos, who graze and night and are very dangerous, have been known to wander through our campsite at night. Not to mention that the warthogs will sometimes try to pull down the zipper of your tent if you have food inside.

We got up early Saturday morning and went for a game drive, which was unbelievable. Some highlights include: coming around a corner and almost running in to this

I took that photo from about 20 feet away; we are lucky we didn't die, as elephants are not known for their easygoing nature.

Another highlight was driving off the road at a point where lions are often spotted and catching the tail end of a hunt-- a female lion had just nabbed a baby warthog (didn't turn out too well for the warthog), and she and a male lion were trotting around with the struggling piglet while the rest of the warthog family was running around in chaos. Unfortunately it was about 50 yards away so my photos didn't turn out (darn camera doesn't have the greatest zoom capacity), but one of the other girls i was with got some pretty good shots so i will post them when i get them from her.

In the afternoon we took a boat trip down the Nile. There were hippos and crocs everywhere-- to the point where we would pass a herd of hippos and say, ho hum, show us something exciting. Who eats hippos? I don't think they have any natural predators and they seem to be multiplying like rabbits there-- i am not exaggerating when I say we saw about 500 hippos.

The highlight of the boat trip was an elephant who had come down to the water's edge to drink and take a little shower. His trunk was short (apparently he probably had it caught in a poacher's trap at one point). Did you know the average lifespan of an elephant is 80 years? Long time to live with half a trunk if you're an elephant.

The next morning we got up and hiked the falls, which was gorgeous. It's tough to appreciate from the picture, but this is the largest waterfall on the Nile. It's a very violent falls because the river narrows abruptly right as the water is dropping over the edge. It's really a sight to see.

Sorry, turn your head to the side.... this is the view from the top of the falls

The weekend before last I took a ferry to Ssese island, a small island in the middle of Lake Victoria. It was a little like being at a Lake Cabin for the weekend in the midwest. Except we couldn't swim for fear of contracting Bilharazia (snail schistosomiasis, not just your garden variety swimmer's itch, Jennifer, but the kind that then burrows into your internal organs and you die a horrible death-- this disease is rampant on Lake Victoria and thankfully doesn't exist on Lake Camelot or anywhere else in the U.S.). So we just sat in a hammock and read and relaxed, and it was nice to get out of the city for a weekend.

I hope you have enjoyed reading this novel of a post; as you can see I've been very busy. My trip is already half over, which is hard to believe. I hope all is well at home, keep writing, I live for emails here :)

Life at Mulago

I thought you all might like to see pictures of the places I'm living and working. I took a few today, and I'm sure there will be more to come, but at least you can get an idea.

I am living at a guest house paid for by the Infectious Diseases Institute, one of the many clinics at Mulago Hospital, where I am working. The guest house is pretty nice, we have hot water, and a maid during the week, she even cooks for us sometimes and does the laundry, makes the beds, etc. Above is a picture of my room. Not bad, eh? I am getting used to the mosquito nets.

The house has 4 bedrooms and is about a 15 minute walk from the hospital. Here are some views from our 2nd floor porch (difficult to capture, I did my best).

We also have a night watchman, see him above? Never thought I would be living in a gated community in Uganda, pretty much all the musungus (Ugandan for "those idiot white people") do. You can see the hills of Kampala in the background. Kind of reminds me of Honolulu. But not really.

We are right in the middle of town, which means no peace at night. There is a nightclub down the street that thumps all night long (Kampala is known for its bumpin' night life, no joke. Some of my friends have been to the clubs, they cater to the Musungus and are apparently nice even by US standards and play nothing but American HipHop and Rap). Contrast that with the Islamic guy across the street with the megaphone who chants to Mecca every hour on the hour from 4am to 11pm. And sometimes he indulges us with a little bonus track in between, which is always a treat. Not to mention the barking dogs and the feral cat that has staked out its territory underneath my window, and happens to run into a challenger of that territory every night at precisely 3am. I finally got a loud fan for my room, so now I sleep a little better...

Here is a photo of the IDI clinic where I work. It's a brand new building with an atrium, and it's actually not bad. It is always horribly crowded-- average of 400 patients a day, and they all sit there all day long waiting to be seen. Luckily there are lots of volunteers (most of whom are HIV+) that do art projects and sing in the lobby, this keeps the place from feeling like a morgue. A lot of the patients are surprisingly healthy, and some are definitely NOT.

Sorry, can't figure out how to flip that rightside up. You get the idea.

While our clinic is relatively nice, the actual hospital is the saddest part, by far. Keep in mind, this is a state-of-the-art African hospital, probably top 5 on the continent. The wards consist of big rooms with rusty beds packed side by side. You have TB patients with AIDS coughing all over the AIDS patients without TB (but not for long). No private negative pressure isolation rooms and yellow paper gowns and particulate filter masks here, my medically savvy friends. You just cross your fingers and pray to the Mantoux gods. The other crazy part is that there is very little nursing care at the hospital. The patients' family members or friends basically move in for the duration of the inpatient stay. This lucky caregiver gets to deliver the patients' lab tests and results to and from the lab, admister their meds, record their ins and outs (for those not fluent in medical-ese, that means measure their food/fluid intake and its resulting excretion from the body), do their laundry, clean their messes, you get the idea. And strangely they don't seem to mind. Never mind that this healthy caregiver is putting themselves at risk by being exposed to all this communicable disease as well as missing weeks to months of work (read as: their kids don't get to go to school the next year, IF you are one of the middle class folks who can afford to send your kids to school in the first place). Here is a picture of the front lawn at Mulago Hospital-- these are family members washing and drying sheets and blankets brought from home for patients, as well as a shot of one of the wards

Patients who stay here are also responsible for paying for all their own care-- medications, lab tests, xrays, everything. No Blue Cross Blue Shield PPOs here. Think of that the next time you gripe about your $20 copay.

I know it's depressing, but it's reality. I have counted my blessings so many times since being here that I've lost track... Sorry, this will be my first and hopefully last preachy post.

Miss you all

Erin

P.S. -- Corrections from my first post

A few things to add to my first post:

Apparently the abundance of storks in Kampala is a relatively new phenomenon-- they moved in after Idi Amin had his killing spree in the 70s and 80s-- lunchtime for the storks. Which makes them even more disgusting IMO. And they have never left.

My humble apologies to Sofia Coppola-- Drew reminded me that Lost in Translation, one of my favorite movies in the last couple of years, was written and directed by her.

Additionally, there is a reason every car here spews pollution-- most run on diesel and don't have catalytic converters, which apparently means they don't need to change their oil. Sadly, they get a lot of cars from Japan, which requires high environmental standards, so a lot of older Japanese cars that don't meet the standards are sold very cheap here. And then the Ugandans remove the catalytic converters because it makes their gas last longer. So environmentally sad. The Sahara desert is apparently expanding by 30 miles each year here, and already the Nile is about a foot lower on average than it used to be-- so low that Kampala has electricity only every other day, because the water does not have enough energy to turn the turbines (most of the wealthier establishments have generators that run on the off days, so i have not been without power yet.)

That's all for now...

Adventures on the Nile River

Greetings again!

I survived my whitewater excursion on the Nile-- it was an absolute blast. However, I have committed the ultimate dermatologic faux-pas-- I am ridiculously sunburned! I probably shouldn't admit that in a public forum, it could be blackmail material someday.... FYI to all my derm colleagues, mexoryl is NOT waterproof! And yes, I reapplied about every hour, but to no avail. Even the folks wearing waterproof sunscreen got really burnt. I guess our latest technology is no match for a sunny day on the equator. And I am paying the price, let me tell you.

I wish I had pictures of the trip, my camera is not waterproof so I didn't bring it. We left from Kampala at 7 am for the town of Jinja, about 90 minutes away. The river (which originates here in Uganda) is so beautiful. I would guess the river is about three times as wide as the Mississippi in Minneapolis, and very deep, so it appears midnight blue, and surrounded by tropical rainforest. There were monkeys in the trees, and their dragonflies here are cherry red, hot pink, and lime green (no, I was not on drugs, they really are). Little Ugandan kids were on the banks everywhere, playing in the water. There were 4 sets of class 5 rapids, plus many slower ones, pretty scary, but somehow we managed not to flip over and I was one of the few who never got ejected from the boat. At one point, we went over a 15 foot waterfall! Our boat sanwiched in half when we landed, but everyone was OK. The whole operation was American run and the guides were really well trained. Our guide was a Ugandan named TuTu, who is a world class river kayaking champion, and his favorite expression was "SWEEEET"-- I think South Park has finally made its way across the Atlantic, it was like Eric Kartman was in the boat with us. We got to swim for about half the trip as well, where the water was calm, floating down the river in our lifejackets (and hoping their assurances about the lack of crocodiles in this part of the Nile was true-- don't worry, no one got eaten). I went with some other residents who are here from Yale, Harvard and UCSF, they were a lot of fun, and it is nice to get to know some other people my age who are living here.

No real birthday plans today, I need to get some studying and grocery shopping done, but again would love to hear from any of you!

TTFN
Erin

Beware the Storks

Contrary to popular belief, storks are NOT cute fluffy white animals that are fit to deliver our little newborns. They are, in some respects, the scariest aspect of living in Kampala. These gigantic vulture-beastmonsters hover like angels of death in the trees around the city, feasting on garbage and all things rotten. And there are seriously as many of them as there are pigeons in New York City.

My flight over here was pretty uneventful. I stopped in Amsterdam for about 5 hours-- has anyone ever been to that airport? I swear, it's just like an Ikea, everything is compartmentalized and painted in bright colors, it's weird. My plane had individual tv screens on the back of each seat with a remote control and a choice of like 100 movies (including a bunch that are still in the theatre), tv shows, etc. i planned on getting all this work done on the plane and instead got caught up in the entertainment vortex. However, I picked some BAD movies-- Marie Antoinette (written and directed by Sofia Coppola), which I had been looking forward to seeing-- big disappointment. Sofia should stick to doing what she does best-- acting. Honestly, it was that bad. And, Night at the Museum (scraping the bottom of the barrel there), which I turned off after about 30 minutes.

My first Ugandan adventure occurred right after I arrived at 9pm Uganda time Tuesday night. Drew has some friends from college, Paige and Phil, who are living in Kampala, and they had offered to pick me up from the airport. Like an idiot, I didn't write down their phone number, and (I found out later) they had accidentally thought my arrival time was 11 instead of 9. So I sat outside the airport for an hour, trying not to have a nervous breakdown, not knowing if they had gotten the wrong date or if they had blown a tire on the way to the airport (which is in Entebbe, the site of the famous hijacked Israeli plane, about 45 minutes out of the city), having no place to stay that night if I didn't reach them. A cab driver took pity on me and waited with me. Then he took me to an internet cafe in Entebbe at about 10:30 at night, which consisted of about 8 ancient computers sitting on cardboard boxes, so I could get Phil's number off my email. I didn't have any Ugandan money changed yet, so the driver even paid for the internet fee. I got a hold of Phil, who had just realized the mistake and was on his way, but still 40 min away. So, my driver and I drove 20 minutes toward the city and stopped at a roadside clapboard bar and had a beer (which I really needed at this point), and Phil and his driver showed up 10 minutes later. I was pretty scared, but it was a testament to how nice and trustworthy the Ugandans really are.

So besides the freaky storks, Kampala is actually a pretty great place. The weather is perfect (about 80 degrees most days) and there are tons of birds and plants that look like they're from another world. Almost everyone carries a cell phone and internet is available most anywhere (although during the day it kicks you offline about every 5 minutes, which is frustrating). The people are about as friendly as can be-- walking home from the clinic today, carrying my white coat, a ton of random people I passed on the street said "Hello Doctor, how are you today?" And every patient we see in clinic says thank you about 12 times. So nice. However, the signs of poverty are everywhere, and the pollution is god awful (the quote from my Lonely Planet guide said you can "chew the air" in the city, and that's pretty accurate. I don't think anyone here gets the concept of an oil change. Or more likely they can't afford it.) Below is a shot of some little guys I met walking to work the other day, they were walking home from school and kept running past me, then slowing down so I'd pass them, and giggling. If you look carefully, they are wearing press-on nails (god only knows why... they seemed pretty amused with themselves, though). Aren't they cute?

The clinic I'm working for sees all HIV+ patients, about 400 a day. It is part of the Mulago Hospital complex (the hospital in the movie "The Last King of Scotland", if anyone has seen it). It's been a pretty amazing experience so far, in the future I will dedicate an entire post to the subject.

Tomorrw I'm going to a town called Jinja, at the mouth of the Nile, to go white water rafting with some residents I met from Yale who are here (don't worry, the water is deep and turbulent there, which keeps the crocs and hippos away and actually makes rafting safer).

I would love to hear from everyone, feel free to reply to this post!