Thank you so much for taking time to look at our blog! We are a group of edical students who are passionate about training and in underserved areas. This January and February, we are in Peru, the Dominican Republic and Costa Rica internationally as well as locally in Flint and Lansing completing volunteer service, rotating in hospitals and clinics, and learning about international medicine and local underserved health care. We appreciate any time you take to read our reflections and any donations you might offer.

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Tuesday, February 11

Uganda Updates - three weeks worth...

We have had very little internet access in the past couple weeks, but a couple of us are in Mbale now, the closest city to our little village, and we finally have access! So much has happened in the last few weeks, so I thought I'd just write a few highlights.

A number of us spent the beginning of this week in the district hospital. We rounded with the one physician responsible for the whole hospital, including 3 30-bed wards (male, female, and pediatric), the operating theatre, labour and delivery, the 'casualty' ward AKA ER, and the outpatient HIV clinic. Obviously he doesn't see every case, but only the most critical. Everyone else is tended to by nurses or clinical officers, which there don't seem to be enough numbers of either. 

One patient we rounded on was a woman in a cot in the very corner of the large ward. As we approached her, the massive tumor on her neck became quickly obvious. It was the size of a pineapple, oddly shaped like one as well, sitting on the side of her neck and growing out of it. The doctor asked us what it was, and in true med student fashion we began to list off possible diagnoses and form a list, but when he didn't get his answer, he gave in and told us "TB adenitis." 

He had shown her to us as an example of a patient for whom surgery would be inappropriate, explaining that palliative care with pain meds and anti-TB meds was the right course of action. Androuw continued in this ward, and followed this woman as a patient. On his second day he realized that she was not taking meds, and quickly found out that she had only been taking her TB meds sporadically. We learned it is not the job of the nurses, but of the family members, to administer meds. The hospital was so disengaged with her, probably because they just didn't have the time. The family was so invested though, and yet the most critically ill patient in the ward was not being treated adequately because the most important pieces of information were lacking. Androuw was able toclear up the regimen with the family, but I'm sure there ad many similar cases. 

We spent our weekend at Lake Bunyonyi in far Southwestern Uganda, by the Rwandan border. After a 14 hour van ride across the country, we arrived to a late-night canoe transfer to the island our hostel was on. The starry ride was a perfect start to the weekend, which we spent canoeing in dugout canoes and exploring the 29 islands in the lake. Gorgeous! We had a stop at the equator on the way. 

Sunrise in Southwestern Uganda

Karthik on a rope swing over Bunyonyi

FIMRC volunteer Michael and John working hard in the canoe

Photo op at the Equator

We arrived back to our little guest house of a home to the news that our water had run out. It's currently dry season in Uganda, and the water system is based on tanks that collect rain water, so we knew this was bound to happen some time! Our spoiled days of tap water are over... So we began collecting water just down the hill and carrying it up. It's interesting how acutely aware of your water use you become when you have to drag it up yourself! 

Otherwise this week was packed. Our friend and PA volunteer, Kristen, left Uganda the past weekend, so a few of us helped see the kids in the clinic during the transition to the local clinical officer. The more patients I'm seeing in the clinic, where the diagnostic tests we can order are basically limited to malaria, HIV, and urine dips, the more confident I'm becoming in my history and physical exam skills, I think this goes for our whole group. You begin to understand you can't use all those extra tests as a crutch... That a lot of the time you can get most of what you need from a good H&P. 

We also spent this week doing check-ups on kids in local orphan programs, mostly looking for tinea infections, or referring for other problems. We had a few pretty interesting cases, including one unfortunate little boy who was brought to us in tears, covered from head to toe in a rash. With the help of another FIMRC volunteer, Dr. David from the UK, we diagnosed him with chicken pox... Which might be one of the only times I'll see this in my career! All we could really do for him was reassure and educate, but it was interesting to see all the same.

Young boy with rash at the Bududa orphan program

A few of our group spent part of the week at the regional hospital and Cure hospital in Mbale, and then went rafting on the Nile. They had a great time! 

Busy week so far! A couple of us are in Mbale at Cure and the regional hospital (see post below). 

Back in the village we are pushing women's health changes at our clinic in Bududa, spearheaded by Karthik. He gave a lecture last week on basic work-up for various gynecological conditions and cervical cancer screening in low-resource settings. A few of our group got the necessary supplies this past weekend, and along with the slides and speculums Dr. Maurer donated during his time here, this week the clinic has already done their first cervical cancer screenings! We plan to do the first wet preps this week as well.

We have so little time left, we hope to make the most of it! Not sure when my next internet access will be, but I will post another update when we get it!

~ Monika and the LMU Uganda Team

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