Staying Involved State Side

Yesterday, nearly 4 years since I carried out my Health Education Project in Uganda, I received an email from a medical professional based out of Kampala, Uganda. He will be carrying out a program of his own in the community and was looking for advice.

I am finally a nurse, and while at this time I am unable to travel internationally due to my current job, I love being able to stay involved.

Best of luck Denis on your project! I look forward to the day I am able to return to Uganda!

Update

Although I have not been back to Uganda since 2009, the Kasiisi Project is always on my mind.  I will graduating in May 2012 with a bachelor of science in nursing from Boston College, and hopefully I will be able to return to Uganda once again to use my nursing skills to help the children and families of the Kasiisi Project!

My Final Project Report

On August 9^th, I traveled across the Atlantic Ocean to another continent, to another world. Nearly 20 hours after leaving the United States, I landed on African soil in Uganda. My plan was to carry out a disease prevention educational program for the group of schools in western Uganda that the Kasiisi Project supports and that I had visited the previous summer. The basis of the program was intended to be disease prevention through basic health and hygiene education, which was to include hand washing and basic first aid. In order to maximize the success of this project, I planned to work with a local clinic, which is involved in health education outreach as well as first stage medical care. The second part of my project was going to involve spending time working in the clinic, observing health care in a developing country, developing my nursing skills, and expanding my medical knowledge.

In the weeks leading up to the trip, I spent many hours searching the internet for material to use for the disease prevention educational program. I found an endless amount of websites on germs, hand washing, and first aid. I compiled the most important information into a report and found activities that correlated to each subject. This included coloring sheets for the younger children and word searches and word scrambles for the older kids. I found songs addressing hand washing, which I used to write my own. Sung to the tune of Row, Row, Row Your Boat, the words to the song I wrote are: Wash, wash, wash your hands; Wash them everyday; Scrub, scrub, scrub them well; Wash those germs away. Once everything was together, I started creating posters and making copies of the activity and information sheets.

During this time, I was also collecting basic first aid and medical supplies. With the help of family and friends, I put together 75 small first aid kits that consisted of adhesive bandages, gauze for cleaning wounds, alcohol wipes, and non-latex gloves. In addition to these, I also created five large first aid kits, one for each headmaster or headmistress at the five primary schools supported by the Kasiisi Project. These first aid kits included all of the same supplies as the small ones, but in much larger quantities. They also had gauze rolls and pads for covering wounds, medical tape, scissors, ace bandages, and antibacterial cream. People also donated hand sanitizer and bars of soap, which were to be donated to each school. Many of the donations I received were from the community, who became aware of my project after an article was printed in the local newspaper. All together, the supplies filled three large duffle bags and weighed close to 175 pounds.

After weeks of preparation, I had finally arrived in Uganda. I had gone to Uganda for a reason. I had gone to make a difference in the lives of the Ugandans and in my own life. I had gone with expectations. I had gone expecting to find a clinic bustling with patients. I had gone expecting my help would be needed. Instead, I found a small three-roomed clinic. I found a clinic with only around ten patients per day. I found a level 2 clinic, the lowest level healthcare center. I found a clinic that does not admit patients, a clinic with no lab services, a clinic where babies are not delivered. I found a clinic underused and underfunded, lacking in resources.

Things change. Expectations change. I learned that in my first week there. I had gone to develop nursing skills. Instead, I developed a clear understanding of what a health care system looks like in a developing country. I saw what it means to have to walk to get medical treatment. I witnessed diagnoses being made strictly based on symptoms. I watched and I learned more than I could have ever learned by staying within the United States.

I had gone to provide heath education to five primary schools, to over 5000 schoolchildren. Instead, I found that with the language barrier and with the supplies I had, I could only educate one school, one school where over 100 students are packed into each classroom. I taught 1199 children about germs and the importance of washing one’s hands for disease prevention.

I had gone to donate supplies to be used for first aid and hand washing. I had gone with the intent to provide each teacher with a mini first aid kit and each headmaster or headmistress with a large first aid kit and many bars of soap. Instead, I found that schools have no water sources and teachers do not know how to treat even a basic cut. I handed the soap over to the headmistresses and headmasters of all five schools with information on how to create a hand washing facility. I learned that it would be best for the headmasters/mistresses to keep all the first aid supplies in their offices so that teachers do not use them for their own personal need. I realized that hand washing and first aid supplies can only be used if people know how to use them.

I had gone to teach teachers and administrators about first aid. Instead, I realized not everything could be done in a month and that sometimes it is best to pass along responsibilities to someone else. I gave the first aid supplies to each school with the agreement that Lucy, a Ugandan nurse, would come show them how to use them. I handed this part of the project over to Lucy, who will carry it out as part of her outreach. I also left her with the task of carrying out my health education program in the four schools I was unable to educate.

My time at the clinic was spent mainly talking with the nurses and observing health care. Because the clinic was the lowest level medical center, all diagnoses were made mainly based on symptom evaluation. There were times I would spend hours at the clinic and not a single patient would come by. When a patient did, I would go into the examination room with the nurse and patient. The nurse would translate the discussion for me, as most of the locals do not speak English. Once I got to take a woman's blood pressure. It was extremely high and she was diagnosed with hypertension. Another time I got to listen to the lungs of a child diagnosed with pneumonia. This for me was an eye-opening experience. Being a person who has had pneumonia on numerous occasions, I was shocked at how the diagnosis was made. Each time I have been diagnosed with pneumonia, I have received a chest x-ray, but without this resource, the nurse made the diagnosis strictly by listening to breathing sounds. I wondered how accurate this diagnosis was and whether the nurse could really distinguish between breathing sounds to know which ones were associated with pneumonia or whether the diagnosis was completely unsubstantiated.

Here in the United States, and especially on the East coast, we are so fast paced. Ugandans are the complete opposite. Everything is done on their own time and at a very slow pace. I wasn't able to get into the schools until my third week there, and because each school has over 1000 students, I realized that I was only going to be able to educate students in one school. Lucy, one of two nurses who work at the clinic, helped me with this portion of my project. She came with me as a translator and collaborator to educate the younger children, who had not learned English yet. I was on my own the second day because Lucy was on duty at the clinic, and while the older schoolchildren have learned English, it was difficult because English is not their first language. I walked away that second day uncertain about whether or not I had really gotten through to the children.

On one of my last days in Uganda, I returned to the school and visited the P1 (our equivalent to kindergarten) classroom. Upon entering, the teacher spoke one word in the native language, Ruturo, and in unison the entire class brought their arms up to their mouths and coughed into the crook of their elbows. It almost brought me to tears. Before my arrival, the children had been coughing into their hands, which is an easy way to spread germs. Realizing that the children had in fact been listening and taken in the information really made me feel as though my entire project had been worth it.

When not at the clinic or doing health education, I spent time working with two McGill University students, Lulu and Cristina, who were doing an internship under the Kibale Health & Conservation Project. They were working to create a health outreach program for the surrounding communities. Because the clinic did not see many patients each day, I had a lot of time to fill. I filled these gaps by helping create the outreach program. During the time I spent with them, the material I helped create addressed water sanitation and family planning. I was able to attend one presentation on water sanitation. This was a wonderful experience for me. Lulu, Cristina, the two nurses, and I walked to a village 45 minutes away. About 15 people showed up for the presentation. While I could not understand what was being said as the presentation was done in Ruturo, I could tell that the villagers were fully engaged and interested. A lively discussion followed in which the villagers mapped out the different sanitary water sources in the area.

The McGill students returned to Canada at the end of the first two weeks, leaving me to focus more on my health education project. In my third week, I created folders for each school and a folder for Lucy. In the school folders were the packets on how to create a proper hand washing facility, sets of posters to be hung around the school promoting hand washing and stopping the spread of germs, and first aid information on how to treat wounds and how to use the first aid supplies properly. Lucy’s folder contained everything the schools’ folders did, but it also had everything I used for my presentations and some extra information. That same week, I went and delivered the supplies and folders to the schools. I also met with Lucy at the clinic to discuss her outreach. I brought over a suitcase filled with supplies and the folder, which were intended to aid Lucy in carrying out her outreach and the rest of the health education project.

Because of how slow paced everything was and because there wasn't always much going on at the clinic, I added a third part to my project. This part consisted of visiting different levels of medical centers. The clinic I was in was a level 2 medical clinic, the lowest possible care center. I traveled to a nearby village, where I was shown around a level 3 medical clinic. The main difference between the two was the presence of a laboratory and maternity ward in the level 3 center. I also visited a hospital and nursing school in the town of Fort Portal. Having the opportunity to visit these different medical centers allowed for me to see what the full range of medical care looks like in a developing country.

I walked away from the clinic, from the schools, from Africa, knowing I had accomplished everything I could accomplish in the time I had. One of the things I learned while in Uganda was the importance of reducing dependency. A Vanderbilt student helped me see this. She is a huge believer in this. It had always been easy for me to provide support and resources to those who need it, but I never thought about what would happen if I weren’t there. While my work in Uganda and the supplies I brought over are going to help the people in the Kibale National Forest in the short term, the question is what is going to happen when the schoolchildren forget, when the supplies runs out. What I had failed to realize before is that the project I created was not a sustainable one. By leaving the health education portion of the project for Lucy to continue, I have made it so that the schoolchildren do not have to depend on an outsider to learn about germs and hand washing. Now, instead, a native Ugandan will continue to have a job and the schoolchildren can continue to learn about the importance of preventing the spread of disease and the proper methods of doing so. I also left Uganda with another project idea, one that will provide a source of income for the girls and one that will provide soap for the locals. Alice, the Vanderbilt student, and I thought up the idea of starting a soap making club for the girls. Once again, while outside help is important, it is even more important for the locals to learn to take care of themselves. The idea would be for the students to at first make soap to be used at their schools and at their homes, and then eventually they would learn to sell their soap as a way of supporting themselves and their families. As Alice says, it is important to create independence and equip a community with skills that are transferable and sustainable.

Four weeks in Uganda taught me more than I could have ever learned here. The whole experience was a growth experience. While my time in Uganda was meant to be a nursing experience, it became much more than that, and while I did get some health care experience, the life experience was much greater and will have more of an impact on my life in the long run. There were times I wasn't thrilled about being on my own in Africa, especially when I got sick, but I learned so much about the health care system, about the people, and about myself. This summer I stepped outside of my comfort zone, and in doing so, learned things about myself that I never knew. This experience has helped me to grow as a person.

In terms of health care, I learned many little things this summer that I can take with me into the nursing world. For one, being able to witness and observe a health care system in a developing country has given me a better understanding of the importance of the medical and scientific advancements we have here in the United States. My own bout of illness taught me that ginger tea settles an upset stomach and giardia is a parasitic disease that one acquires from accidentally swallowing Giardia picked up from surfaces or by ingesting contaminated food or water. I learned the importance of taking one’s medication first hand. Ten days on metronidazole, or Flagyl, an antibiotic effective against anaerobic bacteria and certain parasites, and I was feeling good as new. I learned the importance of natural medicine in the Ugandan culture. I was told that one of the reasons that so few patients came to the clinic was that many families still believe in using natural medicine. I learned what happens when the proper tests aren’t given and the wrong diagnosis is made. In a country where malaria rates are high, it is often assumed that any person complaining of chills and a fever has malaria. Tests are rarely done, even if they are available. In recent months, typhoid rates have risen and worse cases of the disease have been recorded. This is because people are often given an anti-malarial medication to take, when they in fact have typhoid. With the knowledge I have now, I am sure that I will be a better, more informed nurse. I have a broader understanding of medicine than I had before. I have a much better understanding of the importance of health education than I had before and certainly a better understanding of medical care in a developing country.

More Pictures

Reflection

I was going to write a blog reflecting on my project and my experiences, but because I have to do a write-up for my project as part of my Advanced Study Grant, I think I will wait and post that.

For now, here are some pictures (not the ones I originally said I was going to post).

Home Sweet Home

I am going to keep this brief as it is 4:45 in the morning my body time and my bed is calling to me. I have made it home safely. A reflection blog post with pictures will be coming soon.

Final Post Before My Return

Today was my last day at the clinic. Now, I am officially done with my project for the summer. I met with Lucy today, something I needed to do before I leave. The Weston teachers and students donated their extra first aid supplies, sanitary napkins, hand sanitizer, soap, and medicine, which I brought over to the clinic. Some of the supplies will stay at the clinic and some will be distributed amongst the schools. I also brought Lucy all my project supplies that I have left: documents, posters with information, folders, coloring sheets, word searches, word scrambles, scissors, tape, crayons, and blank poster board. I hope that Lucy can use all the supplies to carry out a successful health education program in the schools on her outreach days. I also left her with first aid sheets and activities for the teachers and administrators. We both thought it would be good for her to do basic first aid training with them, so that they know how to use the supplies that I supplied each school with. After we went through all the supplies, Lucy and I went through the folder I put together for her that contains a bunch of important documents. We also discussed what Lucy needs to do next. I had talked to Alice, who is working with the peer education project here, about whether or not she thought it would be good for Denis, the male nurse, to discuss sex and respecting woman with the boys, since Lucy and the peer educators will be working with the girls. I also ran this by Lucy, who thought it was a great idea.

Just as we were ending our meeting, a little girl arrived. She had little skin bumps (almost like warts) all over her feet and ankles. I asked Lucy if she thought they were gejjers, which are a type of insect that lay their eggs under a person’s skin. Apparently two of them were. They had already been removed, but improperly, so they had gotten infected. Lucy sent me to get a safety pin from the supplies the teachers donated and I disinfected it with an alcohol wipe. The poor girl, who was only three years old, was so terrified she was shaking and then when she saw the safety pin she started screaming bloody murder. I tried comforting her, but it was hard because of the language barrier. Lucy stuck the tip of the safety pin into the two bumps and pus was released. The girl’s father had to hold her down. I was so sad for her because she was so upset, but then she saw the needle for the other bumps, which was a bacterial skin infection, and her reaction was even worse. Her dad really had to hold her down. All I could think was that if that had been me I would have been screaming just as loud. The needles here are remarkably long and appear to be quite thick. She was given the injection on her back side, right above her right butt cheek. I wouldn’t be surprised if the needle went through to the bone. Lucy said that she has to come for five days for injections and take an oral antibiotic for five days as well and the skin injection will clear up. As sad as it was, I thought it was a good experience to end with.

Tomorrow, we are going on a small hike around a bunch of crater lakes and on a tour of a vanilla plantation. We end the day with dinner at Ndali Lodge, a wonderful lodge that overlooks the lakes. Sunday, we leave for Entebbe at about 9. The plan is to spend the afternoon at the Lake Victoria Hotel, where we will also eat an early dinner. We head to the airport at around 6:30 and our flight leaves at 10:20. I will be home Monday morning. We are set to land at Logan at 10:20 AM. As sad as I am to be leaving, I am really looking forward to finally being home.

I have plans to make my health education project a more sustainable project. Lucy will be carrying out the health education in the schools, and although I plan on collecting supplies over the next year to ship here, my ultimate goal is to hand the project over to the locals. Alice helped me come up with the idea of a soap making club. The idea would be that the school children make soap with local products. They could try to sell the soap to locals or they could use it. Either way, it would be something the children could really benefit from. When I get back to the States, I need to look into different soap making methods. I hope that the materials are accessible and relatively cheap (if not free).

Please feel free to contact me via email with any questions about my project or future plans in regards to Uganda. I would be happy to discuss it.

Final Week

I cannot believe that in less than a week I will be back in the States. I would be lying if I said I wasn't excited. I actually can't wait. This does not mean my time here has not been good, but with being sick (I am still suffering some problems), I am looking forward to being home. I have officially gotten everything I wanted to get done done. I have visited three different levels of medical centers. Yesterday was the trip to the hospital. It was incredible to see what a hospital looks like in a third world country, since I had expected more at the clinics. The hospital, however, was what I expected. I will post pictures of two different medical clinics and the hospital when I am back in the states. I will also post the information I typed up on each.

Right now, looking at everything I accomplished, I feel as though I got the most out of the health education and donating of supplies to the schools. This is mainly because I felt the children benefited extremely from it. Beatrice, a P1 (kindergarten) teacher, said her students have been practicing the coughing into the sleeve rather than the mouth. Another teacher told me that she and her students learned something new. They didn't know before that you should rub your hands together with soap for 20 seconds. She said that before my lesson she would just wipe her hands on the bar of soap and then rinse it off. I had a wonderful moment the other day when I went to the schools with the first aid supplies and soap. The headmaster at Kikko ran and came back with a locked box that read first aid. He said, "This has been empty for years and now it will be filled." It really touched me.

Before I leave, I have a meeting with Lucy the nurse. I am leaving her with my materials and health education project so that she can carry it out in the other schools. We have also arranged for her to go to all five schools and show the teachers and administrators how to use the first aid supplies I provided.

Once again, thank you to everyone who helped make this happen.

Update on Project

Hi All. So this week was quite busy, but also started off slowly. I got sick on Monday and was still not feeling well Tuesday. We decided I have jardia and I have started on medication, which seems to be working other than some minor symptoms from time to time and the side effects of the medication. Wednesday was a welcoming ceremony that lasted a full day. It was quite exciting. My plan for Thursday was to begin dividing up the medical supplies and soap for each school and create a folder with important paper work for each school. I was then going to deliver one set in the afternoon to one of the schools which is in walking distance. However, I ended up being even more productive and was able to put together all packages for each school and get to four out of the five schools, where I met with the headmaster/mistress and handed over the supplies. It was such a great feeling to have gotten so much done. Yesterday, I visited another clinic. The Kiko clinic is one level up from from the clinic I work at. They do bloodwork, admit people, and have a maternity ward. I then went into Fort Portal. Because I have been sick, half a day wipes me out and I had to take the afternoon to just relax. Monday I go to the Fort Portal hospital and nursing school.

I feel as though I have accomplished everything I planned to accomplish and even some extra. My plan for next week, besides the trip into Fort Portal, will be to spend some time in clinic and just reflect on my trip. I have begun to reflect on what I have seen and what I have done. I might begin my write-up.

Thank you to Boston College and to everyone at home for helping to make my trip a success.

Sorry No Pictures

Sorry, but the internet is too slow to upload pictures. I will have to do so upon my return. Hello to all.

Pictures

Sorry. It is not working. I will post them next time I am in Fort Portal, probably next weekend.

Sunday - Lots to do

Sorry if anything I just posted has already been said. I decided I would post my old entries even though I had summarized them.

So my mom left yesterday and arrives in Entebbe tonight. She will be at the field station on Tuesday. The weather last night and this morning has been yucky. Rainy, and cloudy. Which here also means no electricity. Fortunately, there is an internet cafe in Fort Portal with a generator. The internet is quite fast since no one else is on.

I am going to have lunch at Mountains of the Moon with Barbara. I am very excited.

As you know, Monday and Tuesday I am doing health education at the Kasiisi School. Wednesday, there is a full day welcoming ceremony for the American visitors. This is meant for the Weston teachers and students, but I must also attend. I will most likely be in the clinic on Thursday, Friday, and Saturday. I was there yesterday for two hours and no one came. Lucy said that she only had one patient yesterday, a young girl who had fallen out of a tree and couldn't move her neck. Lucy referred her to the hospital for x-rays. She said she suspected a spinal cord injury.

My final two weeks I will spend creating folders with important paper work for all the schools, distributing medical supplies, working at the clinic, and taking a tour of the nursing school and hospital in Fort Portal. Lucy said she would take me to see the school and hospital. I am very excited for this.

Thats all in terms of what I have been up to and what I have planned.

I am going to attempt and post a few pictures.

The first is of the hotel I stayed in the first night. My living conditions now aren't as fancy.
The second is a landscape picture - a tea plantation.
The third is a baboon.
The fourth is a picture of colobus monkeys, playing in the sand, right outside the kitchen.
The fifth is of the clinic.

I am going to post them in a separate post. It doesn't seem to be working for this one.

July 24

Wow. I cannot believe it is already July 24. I have been here for a while now. Today was my first health education day at the Kasiisi School. I worked with P1, P2, and P3, which in the United States is kindergarten, first grade, and second grade. Lucy came with me. I did the introduction in ruturo, the language spoken in this region. Muli Muta (how are you/hello – greeting) and then I introduced myself in ruturo, but I don’t remember how. While I read the book on germs in English, Lucy translated. Then, Lucy did the rest of the presentation I designed because that was easier than me saying it in English and her translating. She was so great with the kids, very engaging. I did three demonstrations, washing hands with soap, ash, and handsanitizer. Then, the kids got to color, either a coloring sheet of germs or of a handwasher, which they loved.

During the coloring activity, I went around and gave each kid a drop of handsanitizer. It was great when the P3 students started singing their version of the ABCs while rubbing the handsanitizer all over their hands. Lucy and I taught them that while washing your hands with soap or ash you should rub your hands together for at least 20 seconds. We suggested they sing the ABCs while rubbing because the song lasts about 20 seconds. While this does not apply to handsanitizer, since it dries so quickly, the kids were obviously listening. It really made me feel like they got something out of it.

Hopefully Monday and Tuesday go just as well. Lucy will be working at the clinic so I am on my own.

Tomorrow, I am going to the clinic in the afternoon. On Saturdays it is only open from 1 to 4. Sunday I plan on heading into Fort Portal. I am hoping that the internet café will be open. If this isn’t posted on Sunday, then you know it wasn’t open. I am also going to grab lunch at Mountains of the Moon, a restaurant that I ate at last summer. Barbara Stevens, a colleague of my mother’s who has been setting up a library at the Kasiisi School, may or may not join me. I am excited to eat out. Don’t get me wrong. The food here on the field station is great. I have been eating around three times as much as I eat at home, but its always nice to eat out from time to time.

Night.

July 21

So after writing yesterday’s blog entry, I got sick again. Fortunately, I was able to sleep through the night. Although I am feeling much better in terms of stomach stuff, I do not have my full energy back. One short walk leaves me exhausted. I needed to take it easy today. This afternoon I went to the clinic for two hours to work on posters for the health education project. Tomorrow, I will go in the morning and hopefully spend most of the day. Wednesday is Lucy’s day at the clinic, so I should learn a lot, as long as patients actually show up.

After leaving the clinic, I went back to my room, where I finally sorted through all the things I brought for the clinic and for the schools. I put together a pack of one of everything to show Elizabeth so that she can see what I brought and so she can help me figure out the best way to distribute everything to the schools. The pack includes the laminated handwashing posters, the first aid kits (for teachers and for headmasters/mistresses), books on germs (there are only two, so we have to pick which schools to leave them at – probably Kasiisi and Kanuyara, the two schools I will be doing my health education at), soap, and handsanitizer. Elizabeth and I also need to sit down and figure out when I am going to get into the schools. This morning we discussed doing a trial run with the girl guides (our equivalent of girl scouts) at the Kasiisi School. We will figure out the details later.

On my way to the chimp house, where Elizabeth lives and where my food is served, I had a bit of a delay. Just as I was heading down the road, over twenty baboons sat down in the middle of the road. I waited for over 10 minutes and they still didn’t budge. Then, a local man came along and said that it was safe for me to walk, that the baboons wouldn’t bother me. I wasn’t so sure about that after having heard multiple stories about the males charging at people. So instead of walking on, I inched my way forward. Some of the baboons began to move in the direction I was headed, which was better than the direction I was coming from. Had that been the case, we would have had a problem. Other baboons walked off into the woods, so I continued on forward. At one point, I looked to my right and there were a bunch, including a massive male, sitting right on the side of the road. I clapped my hands loudly (as I have been instructed) and picked up my pace. Unfortunately, by picking up my pace, I gained on the other baboons. I scooted around them and started to run. I finally made it and the local man had been right. The baboons did not bother me.

It is almost four now and I am going to take the rest of the afternoon to lay low. If I don’t, I will probably get sick again. Hopefully, by tomorrow, I will be back to my old self.

My mom arrives at the field station a week from today! I can’t wait to see her!

July 20

I think I jinxed myself. Just yesterday I was thinking about how I had made it through the week without getting sick. I thought it was a good sign. Apparently not. I woke at 4 this morning with some of the worst stomach pains I’ve ever had. For about 5 hours, I was pretty sick. It wasn’t pleasant. Unfortunately, this morning was the visit to all five schools with Lucy the nurse. I was suppose to go along, but was unable to. Which, coincidently, I missed last summer because I was stuck in bed sick. I am feeling better already and should be ready tomorrow to get back to work.

Update from Uganda

Hi all. So I typed out blog posts for the last few days, but I didnt put them on my flash drive. So I will summarize briefly. My taxi is coming soon, assuming he did understand me. He didnt seem to speak much English. I got sick :( so I missed the school visits Monday (Lucy, the nurse, visited all five schools to introduce herself). I was sick Monday and layed low yesterday, doing some organizational things I needed to get done.

Today, I scheduled my health education teaching for the Kasiisi students. I am doing it Friday, Monday, and Tuesday morning (I will be back at the field station to welcome my mom and the other teachers). It seems I will only be able to do the health education at the Kasiisi School, but that is close to 1000 students so it will still be making a difference.

Till next time. Katya

Fort Portal - Going into town

Hi everyone. So I just posted a lot. My apologies. You have a lot to read. Feel free to skim through it or not read it at all. I have finally made it into Fort Portal and into an internet cafe. I have not really had access to email or the internet at all till now, but still feel free to contact me because I will do my best to come into town once a week.

Last night I went to the Kasiisi School, after a long day of health education planning. They put on a little ceremony for a fourth grader from Weston who is visiting and is a big contributor to the Kasiisi Project. There was song, dance, and poetry reciting. There was also a wonderful meal.

As I am taking weekends off for the most part (I may go to the clinic tomorrow and I will be sorting through first aid kits and paper work later), I went to Kasiisi this morning and helped work on the library they are creating. Tomorrow, I will take the day to catch up on much needed sleep. I hope all is well in the States. Thanks for following my blog.

Update - July 17

It has been a few days. The last few days were similar to those I have already described. Instead of describing what I have been doing, I am going to describe what I have seen, observed.

My work in the clinic has not been what I had expected. I was expecting a place with people constantly coming and going. I had expected to see all kinds of different people with all kinds of different ailments. This has definitely not been the case. The clinic gets about 10 patients each day. I think its location may be part of the reason for this. The clinic serves about five villages. People have to walk quite a distance to get there, which when a person is sick can be very difficult. Two or three of the patients who come each day come every day either for medication, an injection, or to get their dressings changed. It has also surprised me how diagnoses are made. The nurse typically listens to the person or the parent describe the symptoms, makes a diagnosis strictly based on that, and prescribes medication. In some cases, the nurse will listen to the patient’s lungs or take their blood pressure, but not often. Lucy diagnosed a little baby with pneumonia the other day after hearing a wheeze that is associated with pneumonia. She let me listen, and while I heard the wheeze, I wondered how one can distinguish between a wheeze caused by a cold, an asthmatic wheeze, and a pneumonia wheeze. I guess if you do this often and if you don’t have access to an x-ray machine, you learn quickly how to diagnose strictly based on the sounds from the lungs.

I have, however, had the opportunity to see a skin infection that is only really seen in Africa. This one girl comes daily to get her dressings changed and to get an injection (in her butt). At first glance, it looks like nothing is wrong with her finger, but spreading her fingers apart, exposes a cavern on the inside of her index finger where skin should be. Yesterday, it was bleeding a bit, which means new blood vessels forming and is a sign that the healing process has begun.

Last night, I went to a presentation on water sanitation in a nearby village (40 minute walk) put on by the clinic nurses and McGill students. While I could not understand what was being said (they were speaking Ruturo), it was interesting to the see the interactions that were taking place. One very old man with a cane was riding by on his bicycle and decided to stop in. He was very opinionated and got the whole crowd (about 10 adults, 6 children) going. He kept going to leave, then would think of something else to say, and would turn around and come back. The presentation went on longer than expected partly because everyone showed up an hour late, so by the time it was over the sun was beginning to set. I didn’t really like having to walk back to the field station without a flash light, but at least I had company. The last stretch I did on my own in the pitch black. That wasn’t very much fun. Every sound seemed to be amplified. I did make it, however, and had a wonderful dinner, including banana bread. Everyone else was done eating, but the food was still out.

My mom arrives in Uganda in 11 days!!! This afternoon I am going over to the Kasiisi School. It will be a nice break after spending most of the day creating visuals and working on simplifying the information for my presentation. I better get back to work.

Clinic Day 2 - July 14

I just realized I think I have been writing June in my journal. Seems I am a month behind. Today I had a nice long phone call with my mother, which despite it going in and out of service on my end (I could hear my mother clearly the whole time, but she could not hear me at some points) went well. She informed me of my spelling error in a previous post where I have accidently wrote about the taxi drivers driving erotically, rather than erratically. I would apologize, but from what I hear, I have kept all my readers entertained. I will warn you right now though that there will be future spelling errors. I may overall by a good student, but spelling is not what got me to this point. Actually, I am surprised I have made it this far with the spelling capabilities I have. Thank goodness for spell check. I told my mom how to log into my account, so that she can fix that major spelling mistake. It wasn’t until after that I realized that probably was not the best idea because knowing my mom, she may go through each point, correcting other spelling and grammatical errors. That’s what English teachers do, right?

Today was day 2 in the clinic. After only two hours of sleep (the neighbors had music going all night and I was quite cold), I was not thrilled to be waking up, but I did. I snuck up to shower in the heated showers. I didn’t think I could handle another ice cold shower, especially after freezing the entire night. I then met with the McGill girls and Elizabeth Ross, before heading over to the clinic. I had planned on shadowing Denis, the male nurse, today, as today was his day there, but he actually had to leave to do some budget work, so I ended up working with Lucy instead. Although my first impression yesterday was that she is quiet and quite reserved, I was happily surprised to find that she is a wonderful teacher.

Our first patient of the day (while I was there) was a four-year-old girl. She was absolutely precious, wearing a pink and blue “plad” osh-kosh dress. She arrived a few minutes before her mother, so I colored with her outside on the front steps. Then when her mother arrived, we went into the consultation room. I asked Lucy to ask the mother if it was ok if I was there, but I guess she had already told the mother all about me. In the consultation room, the mother described her daughter’s symptoms in Ruturo, so unfortunately I was unable to understand. I started to worry that I wouldn’t get much out of the shadowing because I had no idea what was going on, but this is when Lucy surprised me. She repeated in English everything the mother had said and then she told me the treatment. She also showed me how they fill out the patient booklet. I continued to draw with the girl, while she waited for her medicine.

Once mother and daughter left, Lucy and I stepped back outside to join the McGill girls. We were soon joined by five children who spoke neither English nor Ruturo. They were speaking Swahili and were from Congo. We gave them crayons to color with, but when the little baby girl, who was probably about a year and half, started eating the crayons we politely collected the crayons and put them back in their box. Later one of the children (maybe about 5) returned and after a moment where he appeared deep in thought, he said in English, “Give us colors.” When we said they were gone, he walked away only to return a short minute later holding his little baby sister. He reached up to hand her to us. We could only guess that he was trying to trade his sister for the crayons.

Finally, another patient arrived, a fifty-six year old woman, suffering from severe headaches and dizziness. She was also fine with having me in the room. Once again, Lucy translated to me what the woman’s symptoms were and what she believed the diagnosis to be. She believed it was probably hypertension. Sure enough, the woman’s blood pressure was 160 over 90. Lucy even let me take the woman’s blood pressure after she was done. Later Lucy told me that high blood pressure is common in older people and had the woman been in her 70s, a blood pressure of 160 over 90 would have been normal.

At around 1, I left the clinic and headed to lunch. I spent the afternoon going through materials and working on my project. Tomorrow, my plan is to sleep in a bit since running on two hours of sleep doesn’t seem to be working very well and then work on stuff here in the morning. In the afternoon, I will head over to the clinic and observe Lucy with her patients. I presume that Thursday and Friday will also consist of half day clinic, half day preparations. Hopefully on Saturday, I will be able to go to the Kasiisi School in the morning to help work on the library they are building shelves for and then head into Fort Portal in the afternoon. Fort Portal is where I will have access to the internet. I am not sure when I will begin my health education in the schools because Elizabeth has yet to meet with Lydia, the headmistress of the Kasiisi School, and with Lucy. I guess once they meet and figure out what works I can figure out where to go from there.

I am exhausted after a long day, sans a nap. (I had originally planned to nap, but got caught up at the house where I eat lunch when the sky opened up and it began to absolutely pour.) Goodnight.

Clinic Day 1 - July 13

This morning I woke up bright and early and had a freezing cold shower. I did the hokey pokey – “Put your right arm in. Put right arm out. Put your right arm in and shake it all about…” I did that until it came time to wash my hair and I was forced to “put my whole body, put my whole out, put my whole body in and shake it all about.” I then walked down the road to the chimp house, a house where the chimp researchers are based, where I had breakfast.

Today was my first day (or part of a day) in the clinic. I met up with Lulu and Cristina, the McGill students, this morning after breakfast. Despite not being health majors, they both seem fully prepared to create a successful health outreach program. I was happy to be working with them. Upon arriving at the clinic, I met both nurses: Denis, the male, and Lucy, the female. I was also given a tour of the clinic, which did not take long at all, as the clinic only consists of three small rooms. One is for consultation. The second contains two beds. The third has a desk in the middle, a closet filled with medication, and a little room with a window where the medicine is distributed from. The clinic is a level two clinic, which from what I understand means that it does not do lab work, and therefore cannot make proper diagnoses, and does not deliver babies, although both nurses are trained to do so. Diagnoses are based on symptoms and are more of a guess and treat. For example, patients suffering from a fever and the sweats are typically diagnosed with malaria and given anti-malarials. Recently, as there has been a breakout of typhoid, patients have been misdiagnosed and treated for malaria, rather than for typhoid.

All five of us sat around discussing the outreach program, logistical details, as well as the material to be taught. I mostly listened, and gave input when it felt appropriate. Tomorrow, I am going to return with the girls, but Denis is letting me shadow him. Not many patients come by, maybe ten per day, but I will be able to observe Denis as he treats those villagers that come for services. Today, while I was there, a man came with a swollen foot. Cristina and Lulu said that he has been coming for a month to get shots and treatment for what is believed to be a spider bite. Two mothers also came by with their babies, although I am not sure who was the patient, mother or child.

Still jet lagged and exhausted from lack of sleep, I came back to my room in the afternoon, where I napped and did some reading in preparation for tomorrow. I also enjoyed a nice cup of Ugandan tea.

It looks as though I might be spending the next week or so in the clinic, either shadowing one of the nurses or discussing the health outreach program with Lulu and Cristina. I may also tag along with them when they go into the villages to give presentations. They have been doing presentations on subjects such as water contamination and family planning.

I will be meeting with Elizabeth Ross and some of the headmasters/headmistresses of the schools at some point to work out when I can go and do my handwashing and basic first aid education. I also need to distribute the first aid kits. As I will probably only be in each school for a day or two, I will be spending most of my time in the clinic or with the girls developing the outreach program. I also have some projects I am working on, which when completed will be handed out at each school, either to be used or as an example for something they could create on their own. What I am making are mesh bags that hang from the ceiling, with soap in them. This prevents the soap from being placed directly on the contaminated ground of the latrine or on the soil and from students accidently walking off with them.

On a different note, it was quite hot here today, especially this afternoon, although there was a nice breeze from time to time. This evening a thunderstorm blew through. There was some thunder and lighting and a slight bit of rain, but it didn’t last that long at all.

Sorry for such a long post. I will do my best to keep them short from now on. Goodnight.