A Mate of a Different Color

The news of the weekend is that I bought a moped.

Mopeds are hard to find - everyone has motorcycles here, and they like them fancy, new and fast. I didn't want any of those things - I wanted quaint, slow and safe. I was picturing something Vespa-like.
By asking around, and stopping people on the street who had what I wanted, I discovered that my 2 options were the Yamaha Mate or the Honda Super Cub. They are not available here new - only reconditioned (read old). I couldn't buy them in Tororo, so I decided to try Kampala.
My first trip to Kampala was unsuccessful - we got pointed in every direction but never found anyone selling any moving vehicles whatsoever. I was told that I might be able to get them in Jinja or Mbale, which are both closer to Tororo than Kampala.
On my second trip to Kampala, I found the neighborhoods Katwe and Ndeeba, where all of the mechanics seem to reside. A few places had lots of Yamaha Mates, but all seemed to want 2.2 million shillings ($1100) which was more than I had expected. I could probably negotiate down to USh 1.8 or 1.9, but I'd also have the problem of how to get the scooter back to Tororo. I later found out that Katwe and Ndeeba are very, very dangerous neighborhoods, diminishing my motivation to go back.

Mbale is a bigger town than Tororo, only 45 minutes away. Scott and I decided to do a fact-finding mission this weekend. We took a Matatu from the Shell gas station in town, on which we met a woman named Rebecca who wanted to be our friend. I liked her, and she read over my shoulder the grant proposal I am writing, asking me about "placental malaria." She had had to drop out of studying to be a nursing aide for lack of money.
The woman who sat next to Scott was dressed to the nines, in a lavender satin strapless gown with rhinestone embroidery, and her hair was fantastic. Her son (he looked about 7 or 8) was in a tan three-piece suit with a pink shirt. When she got off, we looked across the road and realize that there was a big fancy wedding that she was going to.

In Mbale, the first thing we did was have lunch at an Indian restaurant. I had Paneer Chicken, and Scott had Goat Muchomo.



Next, we walked around Mbale. It was extremely hot. I bought a sweat rag in a "supermarket" because I had regrettably neglected to bring one. We finally found a store selling a few motorcycles, but they didn't have any mopeds. They said we had to go to Kampala, and sort of offered to let us pay money down and they would get one for us. Sketchy, yes.
On the street, we found a guy driving a Mate, and we asked him where to get it. He pointed behind him, to a side street. There was another, even smaller, motorcycle shop, but no mopeds. We walked further down the side street, and realized that it was full of mechanic shops. There were men welding and drilling and sawing and sparks flying and whatnot - and of course no safety equipment whatsoever.

We turned into one cramped area packed with mechanics, motorcycles and motorcycles parts. Some of the men were wearing royal blue uni-suits open in front with chests exposed proudly. All heads turned to stare at us as we walked in (or so I felt). It was like West Side Story meets Grease Lightning meets Bad minus the singing and dancing. As we walked in, I turned to Scott, very intimidated, and said "This is going to be interesting."

I approached the burliest of the mechanics, and told him I was looking for a Yamaha Mate to buy. There was a flurry of activity - he dashed over to one storefront, then people started making phone calls, and they said "He is coming! He is coming!" Apparently meaning the man selling the Yamaha Mate. Until he arrived, we were the center of attention.

He did finally show up - this was the aforementioned Pory. He showed us a beat-up old Mate (they are all beat-up and old), and he did a short test-drive with both of us on the back. (There was lots of laughing and jeering as we pulled out of the mechanic area). He wouldn't let us drive it, though, because we admitted we had no idea how.

The asking price was less than in Kampala - USh 1.5 million ($750), and I tried to negotiate for 1 million given that the front brake was broken. Instead, he offered to fix the brake and some other things.
We debated it. I figured it was no less reliable than the reconditioned ones in Kampala, and a lot cheaper and more convenient. If I get screwed, then I guess it was part of the adventure.

We went to the bank to withdraw the cash, came back, and had to wait for Pory to arrive again. At this point it was almost 4pm, and we wanted to leave by 5pm to beat the sunset - it would take more than an hour to drive back to Kampala.
Pory had his men fix the front brake, except they didn't start for a long while - they were working on another motorcycle. Finally he cajoled them into working on it. It turned out to be more involved than he thought - really the entire brake was missing, not just the cable to work it. But he replaced the whole thing. It took a lot of adjusting and removing and replacing the wheel.
Scott watched closely and learned how to do it, and by the end, he was buddies with Pory and the mechanics (it took over an hour). The rest of the mechanics in the area were no longer interested in staring at us (we were old news by then), and I started talking to these 5 muslim women in headscarves running one of the auto-parts shops. The women called me "mzungu" as if it was my name. As in "Mzungu, do you prefer a red helmet or a blue one?" They were serious business women and not interested in chatting with me or answering my questions about what it's like to run a shop as women surrounded by mechanics. I bought 2 helmets from them.

Once the bike was ready, we paid Poly, and then we had to wait for his son to arrive with the registration. While we waited, I asked a group of mechanics if I could take a picture of the whole area, including them. There was much laughter and debate, and the answer was Yes, No, Yes, No, OK Yes take it!



I showed them the picture, and there was even more laughter and excitement, at which point everyone wanted their individual portrait. I took a closer group shot instead.



Then one of the guys announced, "I want a picture with THIS GUY!" pointing to Scott. He ran up and I took a picture with him (left), Scott and Pory (right).



As we drove off on our Mate, we got lots of exuberant waves goodbye - it was a little like leaving Oz.
We drove home to Tororo, Scott learning how to drive the thing remarkably quickly. Thankfully, there was very little traffic. The only scary moment was when we were trapped between a Matatu and a goat. I voted for hitting the goat (dinner!) but Scott skillfully maneuvered us out of the jam, avoiding any mammalian injury.
The drive home took over an hour, and was a bit uncomfortable for the vibration of the Mate, the bumping over potholes, and the fact that I had nowhere to put my left foot. Nonetheless it was fun and exhilarating, and I was glad to be going no more than 30 miles an hour.



Soon to follow: video of me driving my new Mate.

Misunderstood

Here in Uganda, I am the one with the accent, and I know that people have trouble understanding me. I am trying to modify my speech without sounding super-phony or ridiculous. The more I imitate the Ugandan accent, the more people seem to understand me, but the more obnoxious I feel.
One of the reasons Americans are so hard to understand is that we jumble our syllables together, whereas Ugandans pronounce each syllable individually – which is sort of how Swahili (and I think Luganda) are. For example, when I say, “You are here,” it comes out as “Yerheer,” and when a Ugandan says it, it is “Yooo ahhh hee-ahhh.” I am starting to think that my speech is kind of ugly in comparison.

I really like the Ugandan pattern of speech. It is very musical – which is what people say about the Colombian accent in Spanish. People vary their tone expressively as they speak, and it’s very endearing. One of the ways is by speaking in a higher tone when expressing “very” or “high up.”
When walking around Kampala, we were looking for the National Theatre, and to find it we had to make a left and walk up a block. We asked a security guard, and she was very helpful, telling us to make the left at the corner, “and then you walk UUUUUUUP THERE! and you will find it.” – using the higher tone for the ”up there” and pronouncing “there” like the British “theh – ah.”

I also like how people use express surprise or amused emphasis, by uttering “eh!” in a ghih-pitched tone. It seems to always go with laughter.

Apparently, “r” and “l” are often confused here, because one or the other (I can’t figure out which) doesn’t exist in Luganda. (Someone told me a story of going to karaoke in Malawi. Her favorite songs that she heard there where 'Cly Me a Liver' and "I Bereave I can Fry'.)
To add to that, the pronunciation of Ugandan English is based on British pronunciation. Most British people (and Australians, etc) can figure out what we are saying because they know how we speak. But here, people aren’t used to it, and are bewildered by our speech.
This weekend, we were speaking to a mechanic who was called what sounded like “Puli” by everyone around. I even called him that to make sure, and it was right. But when I asked him to spell it, he spelled out “P-O-R-Y.”
Scott asked Pory a question about a filter. Pory didn’t understand. “Filter,” we repeated “Filter!” Trying to enunciate more and more. The thing is, when you are American, enunciating only makes it worse, because we overpronounce the “r.” Finally I cringed at my own obnoxiousness and said “Filta.” And Pory said “Oh, the ‘filta’! Yes, it is hee-ah.” He didn’t notice anything out of the ordinary (or even that I had changed my accent), he just seemed glad to know what we were trying to say.

Perinatal Meeting

This week I was in Kampala for some meetings. The obstetrician I am working with here had invited me to his hospital in Kampala any Tuesday morning for perinatal conference, where they review the weekly morbidity and mortality (fetal and maternal). I love things like that – I always found it fascinating in residency – so I made a point of going while I was in Kampala.
The hospital is about 30 minutes away from where I was staying, and we left late, so I arrived about 20 minutes late. I missed the morning report, but got there just as the perinatal meeting was starting.

One intern presented each case briefly, and then another resident led the discussion about it, examining the cases critically. I liked the resident because she seemed to be demanding and strict, pointing out deficiencies honestly. Everyone was invited to participate, but they seemed to require prodding to speak up. The obstetrician who invited me spoke up often, asking details or pointing out missing information or problems. The resident then prompted the group to judge the management of each case as Optimal, Probably Acceptable, Probably Suboptimal, or Suboptimal. I wasn’t clear if these were considered ordinal (as in, Probably Suboptimal being less bad than Suboptimal) or if the “probably” referred to lack of clarity. All presentations were anonymous, and the group seemed to judge each case fairly.

After all of the prepared cases had been presented, the obstetrician pointed out several that had occurred during the week and chastised the residents for not having tracked down those charts. Last, the cases were listed again, and the group discussed whether there was a broader conclusion that could be drawn from these cases in order to make systemic improvements. This particular week, there was no consistency to the cases – most of them were macerated stillbirths (indicating that death of the fetus had occurred several days or more before presentation), but in previous weeks they had suggested improvements such as retraining of staff on neonatal rescusitation, and stricter regulations about obtaining syphilis tests prior to discharge home.
It was very enjoyable for me, both because it was nice to be hearing about obstetrics again, and also because it was a good example of honest internal review and non-punitive systems improvement. I hope I can attend more of these while I am here.

Rediscovering My Inner Mermaid

The Rock Hotel is one of the nicest hotels in Tororo (and, as everyone who has stayed there mentions - it has round beds! For what, I don't know). It also has a "health club" that has a nice pool, a sauna, a steam room, and a "gym" (some weight machines, a rowing machine that seems straight out of Woody Allen's "The Sleeper" and a nonfunctional treadmill). You can pay USh 5000 ($2.50) each time you go, or get a membership for 3 months for USh 180,000, which includes unlimited use.
We decided to get a membership, and have not regretted it. I have gone pretty much every day since to swim. We have gotten to know Hamida and Janette, the pool attendants, who hold our bags while we swim, and look bemused but unsurprised when we show up to swim every day, even when it's as "cold" as 70 degrees and the Ugandan children are running around in down jackets (not kidding).

I think swimming is my sport. Unlike running, in which after the first step I am thinking "WHEN IS THIS OVER, FOR THE LOVE OF HUMANITY, MAKE IT STOP," I feel like I can swim forever and not want to stop. I think I am growing gills.
It is especially nice get so much exercise because I spend all day sitting in front of my computer, which is so different from residency where I spent all day sprinting up and down L&D. After I swim, my back doesn't hurt anymore and I feel strong and refreshed.
The only problem is that the rain is unpredictable here, and a beautiful hot day can end in a chilly, rainy evening, which makes getting into the pool a little less motivating. Now I see the benefits of a heated pool.

On Friday, I was excited to go swimming, but had to wait for a short rainstorm to pass. Finally, I walked over to The Rock, but 5 laps into my swim, the drizzling restarted, and I saw lightning. I tried to keep swimming, but visions of my electrocuted self stopped me mid-lap, and I got out of the pool to shower. While I was in the shower, the rain started coming down in buckets, and I had to be picked up in the car because the rain was much to heavy to walk home in.

The Rock Hotel has other benefits, too. We can spend weekends sitting by the pool, drinking beer (USh 2000, or $1). We can even order food from the Hotel, although make a note to order well in advance of hunger. Last time, we swam and then ordered cheese nan and large passion juices. The passion juice took about 45 minutes, and the cheese nan was about an hour and a half.
We have also had dinner at The Rock Hotel. They have fried fish, chips, some meat dishes and indian food. At least it's some variety other than rice, matooke and beans.
The Rock Hotel seems like a good place to stay, with one problem. On weekends, they sometimes have huge parties and concerts by the pool until about 4am, and it is so loud that it sounds like it was outside our window at the house, which is at least a half-mile away.
Regardless, it's a welcome comfort.

Power Less

I haven't posted in a while. We had some internet problems this week at work. The power was often out all day at work, which meant we had to work off the generator. Currently, the generator is small, loud and not very good, which means that only the minimum of things could be plugged in - printers off, refrigerators off, etc.
My plug adapter is also a surge protector, which sounded like a good idea at the time, but when plugged into the wall when the generator is on, it senses either too strong power or fluctuating or something, and it refuses to give power to my laptop plug. So I had trouble charging my computer, and had to sit in a tiny, cramped corner near a usable adapter.
The wireless modem was sensitive to the weird power situation, and couldn't maintain a constant signal (for some reason, the wireless sometimes works fine on the generator, sometimes not), so internet was pretty much nonexistent. I had so much to do online that blogging went out the window.
To add to our power woes, for the first time, the power was out in the house when we woke up in the morning earlier this week. It had been out in the evening before, which is fine because you just eat by candlelight and play many rounds of Bananagrams. But having power out in the morning meant that the electric showerhead that heats the water as it comes through was not working - which meant cold shower or no shower. (I opted for half shower - attempting but unable to drench myself in cold water, I had a quick cold sponging and wet my hair a little. I might as well not have bothered.)
Then we noticed that the water quickly disappeared at work, and when we returned home, we found the power back, but no water. This meant no hand-washing, no nothing. Even Mohammed, our cook, couldn't make dinner, so at 8pm we found ourselves both dirty and hungry. We managed to scrounge up some eggs and rice and potatoes (using store-bought bottled water that we use for drinking), and went to bed wondering if we would be able to shower the next day.
Happily, the next morning we discovered both power and water, as well as fully functional internet at the clinic. I will never take any of those for granted again.

Power Less

I haven't posted in a while. We had some internet problems this week at work. The power was often out all day at work, which meant we had to work off the generator. Currently, the generator is small, loud and not very good, which means that only the minimum of things could be plugged in - printers off, refrigerators off, etc.
My plug adapter is also a surge protector, which sounded like a good idea at the time, but when plugged into the wall when the generator is on, it senses either too strong power or fluctuating or something, and it refuses to give power to my laptop plug. So I had trouble charging my computer, and had to sit in a tiny, cramped corner near a usable adapter.
The wireless modem was sensitive to the weird power situation, and couldn't maintain a constant signal (for some reason, the wireless sometimes works fine on the generator, sometimes not), so internet was pretty much nonexistent. I had so much to do online that blogging went out the window.
To add to our power woes, for the first time, the power was out in the house when we woke up in the morning earlier this week. It had been out in the evening before, which is fine because you just eat by candlelight and play many rounds of Bananagrams. But having power out in the morning meant that the electric showerhead that heats the water as it comes through was not working - which meant cold shower or no shower. (I opted for half shower - attempting but unable to drench myself in cold water, I had a quick cold sponging and wet my hair a little. I might as well not have bothered.)
Then we noticed that the water quickly disappeared at work, and when we returned home, we found the power back, but no water. This meant no hand-washing, no nothing. Even Mohammed, our cook, couldn't make dinner, so at 8pm we found ourselves both dirty and hungry. We managed to scrounge up some eggs and rice and potatoes (using store-bought bottled water that we use for drinking), and went to bed wondering if we would be able to shower the next day.
Happily, the next morning we discovered both power and water, as well as fully functional internet at the clinic. I will never take any of those for granted again.

Greetings

Yesterday Scott and I were sitting in the grass on the hospital grounds, when a small child (she looked about 6 years old) slowly approached, grinning from ear to ear. She extended her hand to Scott (the warm handshake is an important greeting between adults here, and children are taught to do it from very young), and when Scott took her hand, she beamed so much she looked like she was going to fall over from excitement.

She backed away, still grinning, returning to the group of children she had been standing with, who were all watching.

One by one, each of the other four girls in the group approached us for a handshake. The youngest who looked about 4, came first and was smiling nervously. The oldest two, who looked 12 and 14, came last, both solemn and graceful, kneeling to reach us, making stoic eye contact and shaking hands very professionally.

As each one approached, the rest of the group grinned and giggled in the background. It seemed like the most exciting event of their day. TWO mzungus!

I Like Kampala in August, How About You?

I was in Kampala from Saturday, August 1 until yesterday (Tuesday, August 11).
We went to have some meetings with doctors there, and so Tamara could do some work.

I like Kampala a lot.
Good things: Very cosmopolitan, fun and active nightlife and lots of good food. Also remarkably safe.
Bad thing: Traffic. New York is nothing compared to Kampala. It is a city seriously in need of urban planning. Going anywhere between 4pm and 7pm means not going anywhere from 4pm to 7pm. You just sit there.


We stayed at a house (a friend of Tamara's) in a neighborhood called Mbuya. It was very pleasant - a big yard with trees, a nice house with a little tiny house out back for us to stay in (bathroom + bedroom). They had guard dogs on the property who really enjoyed barking, especially at cars. Two of them came to really like me, and would always come to me to be petted, but whenever we arrived in a car, they would go nuts barking. This dog is peering through the little hole in the metal gate as we arrive.


We had lots of good food in Kampala, including Thai, Indian (fancy, regular and Thalis), German, brunch, good coffee, Persian, Chinese, Turkish and Italian. There's even a place called New York Kitchen, where you can have burgers, pizza, bagels, and even lox! I had egg salad on an everything bagel, and it was delicious. It had nice herbs, almost like deviled egg salad.















We also did some fun stuff. We went bowling with some people who worked for Tamara when she lived in Kampala.


Before bowling, we had dinner in the food court in the Garden City mall, where there are a lot of international fast food places. It's a weird setup - there are waiters for the fast food places, and as soon as you sit down, they all surround you (maybe 12-15 people) and shove menus in your faces and try to get you to order from their place. It's overwhelming, and especially bizarre since I have noticed that Ugandan merchants seem to be much less aggressive than in other countries like Kenya and India. They usually don't pressure you to buy things or bug you by talking constantly and offering random things. They just tell you the price, and negotiate a little. And even more interestingly, the mzungu tax doesn't seem to be very high at all. Many of the prices you get are close to or the same as what the Ugandans get (it's just a little harder to bargain down, but I hate bargaining anyway - I just do it a tad to save face and then give up and buy or don't buy).
Anyway, the fast food waiters (oxymoron?) are pretty active, but they calm down as soon as you pick one menu and order.

The next night we went to a bar called Bubbles O'Leary for Trivia Night. As you can imagine, it was chock full of mzungus. But it was very fun, until it fell apart. Apparently the people who usually design the questions got stuck in Sudan. They had to improvise some questions, and when they ran out, they started doing a capella karaoke, and it turned tragic and painful.

I had a great time in Kampala, but I was glad to get back to quiet, peaceful Tororo, where the worst traffic jam you can have means you see more than one car on the road at the same time. Still, I'm glad that Kampala is only 3 hours away on a newly paved, remarkably smooth road.

AOGU Annual Conference

This past Friday and Saturday, I went to the Annual Conference of the Association of Obstetricians and Gynecologists of Uganda. The title of the conference was "Advances and Technologies in Maternal Health."

I really enjoyed it. It cost 50,000 shillings ($25) to go, although 30,000 shillings ($15) for midwives, which I was glad to see. The level of discourse was very high, and the topics were very relevant and important.
Sometimes I feel like a lot of research is done (and presented) just to do (and present) research, not because it's a burning question that needs to be answered. And often I think the things that are researched are chosen because they are popular, rather than interesting or valuable. (This is not just in Ob/Gyn, but in a variety of academic fields). But I didn't feel that way at this conference.
The first session was on cervical cancer screening and vaccination. I learned that paps and VIA (see-and-treat methods) are both considered reasonable options, depending on the resources of the region/institution, and there were comparisons of those methods and discussions of their value. I learned that they are using the cervical cancer vaccine in Nairobi, and how much it costs here (about $170 for all 3 shots, which is less than in the US), and there was discussion of whether it is reasonable to use here.

There was a session on misoprostol, which to me was the most exciting. Up until 2 months ago, miso had not been approved for use in Uganda. It's an incredibly inexpensive and safe medication that can prevent or treat hemorrhage after delivery, but it is often not distributed because people are afraid it will be used for abortion (which it can be). Obviously, it's ridiculous to let hundreds of thousands of women die in labor every year because other women might have safer abortions. (A study in the Lancet from October 2007 showed that abortion is no less common where it's illegal than where it's legal. Where there's a will there's a way.)
A nonprofit organization called Venture Strategies has been approved by the Ministry of Health to roll out a pilot program of misoprostol distribution in 11 districts in Uganda. It started in June 2009. I was really excited to hear this, and even more excited to discover that the AOGU was submitting a resolution to call for more widespread distribution of misoprostol throughout Uganda. It was signed with big fanfare by the important members of the AOGU, and later by everyone else.
When I had asked in Tororo District Hospital if they had misoprostol, the head of nursing for maternity had never heard about it. When I described it, she said they would be very excited to get some and try it out, because postpartum hemorrhage is a big problem and they need more medications.

Another talk in the conference was about postabortion care, and I was surprised to hear the speaker say, "Many of us don't want to talk about the difficult subject of abortion because it is uncomfortable, but we must talk about it. Unsafe abortion is the number one killer of pregnant women in Uganda. It will not go away, and so we must talk about it. We must improve our postabortion care services for women because they should not die."
Of course it's not exactly a call to legalize it, but it was a forthcoming and nonjudgmental statement, and there wasn't one objected verbalized in the room.

There was a session on maternal mortality, in which presentations looked a mortality rates in Uganda and in specific hospitals. One presentation looked at decision-to-incision time in cesarean sections, which in developed countries is generally supposed to be 30 minutes or less, with exceptions for emergencies or extenuating circumstances. This presentation looked at the times in a large hospital in Kampala, and found that the average wait time is 7.5 hours. While 30 minutes is not really a viable possibility here, the speaker was arguing that times need to be shorter. He found that to reduce infant morbidity and mortality, a wait time of 2.5 hours or less is ideal, and to reduce maternal injury or death, a wait time of 4 hours or less is ideal. When he looked at the reasons for delay, 91% of the time it was unavailability of surgical space. It was a very dramatic argument and created a good discussion during the Q&A - clearly, more space needs to be a priority.

Another presentation I really liked was an Ob/Gyn who is also a nun, and she works upcountry in Lira. Her talk was about a day in the life of an upcountry Ob/Gyn. It went something like this:
-- 8am start rounds. 48 patients on the wards to be seen.
-- Finish seeing 3 mothers, and receive 4 transfers from health centers
-- 2 of the transfers need urgent c-sections - one for ruptured uterus, one for obstructed labor with fetal distress
-- Do both cesareans, then go back to ward round
--Continue rounding. Mothers to be discharged are getting anxious because they have not been seen, and if they leave the hospital late, they will not be able to get transport home.
-- A postpartum hemorrhage on the labor ward - doctor is called
-- Finish with postpartum hemorrhage, mother is stable
-- Return to ward rounds - it is now 3pm and the nurses want to give report and go home soon
-- Another transfer comes in, needing emergency cesarean
-- Return to ward round, continue rounding alone (nurses have left)
-- Doctor is on-call all night, and must cover entire hospital

It was a very moving presentation, and really made me appreciate the dedication of these upcountry physicians. Every Ob/Gyn in Uganda seems to work very, very hard, but these people are the toughest. According to Eve (my Ob/Gyn friend from Mbarara who I reconnected with at the conference), 90% of Ob/Gyns in Uganda live in Kampala. There are only 20-30 Ob/Gyns outside Kampala.

Another set of presentations surrounded improvement in maternal services delivery, and community involvement. Apparently, two districts, Kibogo and Kibale (I think) were singled out at a previous conference for having the worst maternal mortality in Uganda - around 2000 deaths in 100,000 livebirths. The AOGU at that time took up a resolution to create pilot projects in those districts. They involved the community, conducted education campaigns about the importance of maternal health and delivery, and created Village Emergency Funds for transport to the hospital in emergency cases (many of the women are delayed in making it to the hospital because they can't afford transport). Apparently there was good success with the pilot projects and a reduction in maternal mortality in the districts.

Because of some delays in the schedule, I had to miss out on the talks on malaria and HIV (aargh!) and assisted reproduction (I wasn't too upset about missing that one. Yawn.).

There were some pharmaceutical companies (mostly Indian) there to advertise medications (not nearly as prevalent as in American conferences though), and I picked up some free meds, mostly pain meds and antibiotic creams. But I also got to learn the names and doses of common medications here, because they are all different.

I am really glad I went. The talks were very interesting, the Q&As had great questions and discussions, and it was very informative learning where the AOGU stands on many things, and what it feels is important. It sounds like they are on the right path toward improving maternal health, but there is a long way to go still. I felt really inspired to try to be part of the solution.

This Post is For Dad

There is a golf course in the middle of Kampala. I hear it's quite nice. I took a picture as we were driving by.

Kampala

A soccer game in the middle of Kampala:

Kampala morning traffic:


This is a view from Mulago Hospital at sunset:

Some big ugly birds in a tree near the shopping center:

AIG

AIG paraphernalia seems to be ubiquitous in Kampala. I thought it was one of those companies that was everywhere and did everything but you rarely heard about it, but apparently you hear about it a lot in Kampala.

There are bumper stickers

Spare tire covers
























Motorbike seats


Even T-shirts



Bizarre.

New Assistant

I had some help at work last week.

Frisbee Afternoon

After work last week, several house members decided to play a game of frisbee.
First we threw the disc around, and then played a game of 3-on-3 Ultimate.

With the high elevation (read being out of shape) we only lasted a few points, but it was fun.


After we all got tired, we sat in the grass and chatted. Tamara tried to teach everyone to whistle through your hands, but no one could.


Here's everyone: Bryan, Humphrey, Tamara, Me, Beth and Victor.

Maternity Ward

I was impressed by the labor ward at Tororo District Hospital.
At Mbarara, I rememeber chaos. Patients packed in, many cringing and rolling in pain on the floor, waiting to become fully dilated. Once ready to deliver, they are given 1 of 3 delivery beds, quickly delivered, cleaned up and sent over to postpartum for 2 hours, at which point they were sent home.

L&D at TDH was clean, calm and organized. (It helped that there was no one in labor the first day I went. But even the second time, there was yelling from pain, but everyone had a bed and a modicum of privacy (effective curtains).
The walls are painted white, and there are specific instruction on what to do in case of pre-eclampsia.

I was very impressed with those instructions, and I told the nurses. Later, they told me that they are writing up similar ones for postpartum hemorrhage. I got the impression that the leadership of the maternity ward was forward-thinking and interested in improvement.

Patients stay 24 hours after a vaginal delivery (longer than the 2 hours in Mbarara) and 7 days after a cesarean (so that the sutures can be removed before they go). I saw the antepartum and postpartum wards, and while there were many women there, it was not full, and definitely not overflowing like in Mbarara (where vaginal delivery patients all lay on the floor because the beds were filled with cesarean patients).

One problem that TDH does have is that there are only 2 doctors for the entire hospital (general practitioners), so if neither is available to do the cesarean, the patient is referred to another hospital, and presumably she or the baby (or both) could die on the way. (I am applying for a Ugandan medical license and hopefully will be able to do some clinical work and operating there. The nurses and administrators seemed very receptive.)

The delivery beds were spartan like the ones in Mbarara (all the birth-plan, doula, water-pool-delivery types would be shocked), but newer, nicer and cleaner-looking.


There was even a very fancy one with leg rests and foot rests, but apparently it's rarely used because many of the nurses are not comfortable using all the movable parts.


When women come to deliver, they bring large printed cloths and a plastic garbage bag - these are used to deliver her on and clean up the blood. Sometimes they even bring supplies like latex gloves, plastic wash basins, and cotton wool (although TDH seems better-stocked than Mbarara). Here, a birth plan is not deciding what you want your "experience" to be - it's determining what you need to do to survive it.