Medical updates 1/2 - 1/4/09
Trip Start
Dec 26, 2008
1
6
15
Trip End
Jan 17, 2009
Mbale, Uganda
Tuesday, January 6, 2009
On Sunday we did a day of medical outreach in Namatumba, while the HIVcousenling and testing went on. What is a joy to see is the incredibly organized and state of the art HIV work is done. Several community mobilizers, young men and women who are just phenomenal human beings, had the whole thing set up in the "trading center" - imagine 10 or 11 tiny huts or rooms (can't really call them storefronts but that's the idea) on both sides of a widened very dusty road with a tree or two nearby. My friend Hedy has been extremely helpful to them and they have all done this fire drill several times in various villages. We pull up, a van with me, another doctor (Samson had meetings), a nurse Miriam, 4 counselors, the 2 lab techs - the mobilizers take the lab folks to set up their testing station in one room/store, several volunteers begin registering people in another, the counselors stake out shady spots and sit on tiny stools to counsel individuals. Every thing proceeds methodically - people register, get sent for pretest counseling by number, line up to get their finger stuck - there are 3 levels of tests - the first is a rapid immunoassay, if positive then the second is a different immunochromatographic assay, and there is a third confirmatory (you HIV folks will know all this, but it was new to me) - results were ready in about 30min, people wiated and then got their results and posttest counseling, and condoms. Here we were in the dusty tiny village with no running water or electricity, and this ran totally high-tech, also high touch, with really well trained caring compassionate counselors! I can't say enough about it!| Meanwhile, Walter the doc, Miriam and I were led to another store front to set up shop, with my amazing wonderful 17-yr old translator Sara, the daughter of one of the most experienced health educators among the Abayudaya, Mama Rebekah. SO I sat on a chair, the patient came and sat on a tiny bench next to me (usually with a child or two - this was family medicine!) and then Sara squished next to the, and translated. About 2 feet away was Walter seeing patients on another tiny bench. Miriam was out in front with a volunteer doing education on oral rehydration, filling our scrips and dispensing meds with advice, and also seeing her onw patients independently when it got too crazy, which was always! So in 5 hours I thnk we each saw about 30 patients - fewer for me since we had to translate. Lots of malaria and pneumonia and asthma and skin rashes and abdominal pain and joint pains (there was a back room with a mat on the floor where I brought a few people so I could examine them lying on the floor as I kneeled next to them) - one fellow with epididymitis. The older woman I'd seen on the previous week with a huge neck mass came back, and gave her the thyroxine I got in town - empiric treatment for possible goiter - try doing education about that when you can't get even one TSH, much less monitor treatment! SHe is supposed to come see Samson in 6-8 weeks in his clinic - unlikely as this was an hour away and she would have no transportation. So I gave her my progress note (on half apiece of notebook paper - wehad to use halves or we would have run out) possible diagnosis, and wrote down the 50mcg of L-thyroxine and told her to take it to the "closest" pharmacy in Iganga, a closer town, for refills, if it seemed to be helping. (I have permission to use her photo, by the way. ANd if any ENT surgeon or endocrinologist wants to comment on this, that would be awesome. THanks) Also the woman with possible angina returned, and I gave her the "glyceryl trinitrate" (Had to go to 4 pharmacies before I found one who carried it!) - no way to do any testing at all, of course. Believe it or not, Sara and I had a really great time working together all that day, and although waht we did was limited, it was kind of what is available here, and we did do quite a bit of education about using steaming with eucalyptus leaves for cough, and how to prepare foods for diarrhea, and other educational issues. I saw a few pregnant women and tried to get them to agree to go for antenatal care. Walter taught me some finer points of empiric diagnosis of malaria. It was actually extremely rewarding to do that! I was swarmed when we stopped, so one of the young health eductors, Robert, became my secret service agent and led me around the back so I could take a break!
(More about him later. Amazing person) Of course seeing all the many smiling children with their many runny noses and coughs and rashes was sad. Oh |I forget, I diagnosed several cases of pertussis from among he horde that crowded by our "clinic" - just by the sound - we'd figure out which child was cough/whooping, pull them out, give them erthromycin (we were unable to locate our prednisolone, and had no other relevant meds) and try to talk about contagion and handwashing. BUt where you have to walk far and carry heavy jericans to get water, hygiene is a "bit" challenging! Still I mimicked covering your mouth when you cought wuite a bit. Sure glad I got my dTap booster! Oh, and of course this medical clinic was free to everyone of all religions, sponsored by those of you who gave me money for my trip. Thank you so much.
Fast forward to yesterday - I was invited to do health education at the Abayudaya WOmena's Association meeting. 45 or so women from the 4 different villages greeted one another warmly, sat on the floor on mats and on low benches (a few chairs were there for mizungos like me and Hedy) - after opening prayer, Torah teaching and some other administrative issues, I spoke for about 40min on diabetes and hypertension, at their request. A different wonderful young woman, Susan, was my excellent translator and helped me hold up the posters I'd made to accompany my talk. Try explaining a conplex disease like diabetes mellitus when people have little context - but actually they were fabulous, asked REALLY great, astute questions, and the model of screening for a disease before it becomes so bad was well known due to HIV. (I just saw today in a pharmacy that there IS Metformin in Uganda - Samson only uses chlorpropamide and insulin) - we tlaked alot about which foods are better and worse - it was just so great. After we broke for lunch I assumed my part was done - but no, they really wanted to hear the third topic I'd brought, cervical cancer screening. They sang one gorgeous song and then we began. First time for 95% of them to hear about this concept. Tzipporah, Rabbi Gershom's wife, agreed to tell about getting a PAP smear in LA (she spoke in Luganda so I don't knwo what sh said exactly) - one other woman in the room had had some sort of screening in Kampala 3 yrs ago - we talked about what cervical cancer is, why to get tested, what a speculum is and its size in relation to the male organ (!) - from A to Z - again, they got it so fast, and asked raelly thoughtful questions. They really seemed to like it and want to organize as a pilot site for the screening that some Kampala folks are trying to do - as soon aspossible, they say! It was a wonderful day.
Last medical note, when I got back to Nabugoye there were 3 patients on IV quinine drips - one with apparent cerebral malaria as she was hallucinating, shouting and screaming. Miriam gave her lactated Ringer's for dehydration, then IV quinine, and IM diazepam 5mg so she would calm down. I saw her 3-plus positive malaria smear. The lab tech and clinic staff are just so supremely calm and blase about all this. THis woman looked 1000% better this morning, thank God! There are two beds in the room which she shared with 3 other patients on quinie drips this morning. I've got lots and lots of pics of all of this, but not yet able to show them to you. YOu can be sure I will do some kind of evening when I get home, and post them all for you to see (once I have a high speed computer and Jay's help!!! :)
Tomorrow is the youth conference. I am doing family planning, STD infections and some more HIV education - they say you can never have too much of this.
Oh - Robert (my protector in Namatumba) is one of 7 children, he is around 32, h is mom died when his youngest sib was 4months old - the dad raised all of them - Robert does 6 or 7 different "jobs" to help support the family - he built a great shelving unit for the clinic, he majored in sustainable agriculture and wants to work in that area, but also loves health education - last evening I saw him playing solitaire on the computer so he came back to the guest house where I taught him double solitaire. He had never played even singel with a deck of cards, but (like most of the folks around here), he is a SUPER quick study!!!! He will beat me before long.
That's all for now. As you can tell, this is more amazing than I thought it would be.
Jewish-related entry follows, Liz
