Murchison Falls National Park Safari Day 2

April 25, 2015

DSCN8880We thought our Safari experience couldn’t get any better than seeing 2 lions plus a cub on our first outing, but we were wrong. DSCN9027The day started out with a lovely boat cruise up the Victoria Nile where we saw lots of croccodiles, hippos, birds, and other animals watering down by the river.

Many animals came to the riverside for water- I just love to capture photos showing multiple animals species- here we have elephants, cape buffalo, jackson hardebeest

Many animals came to the riverside for water- I just love to capture photos showing multiple animals species- here we have elephants, cape buffalo, jackson hardebeest

Then after a nice refreshing dip in the pool and another yummy lunch, we embarked on our final game drive. This time, not only did we see 2 lionesses with their cubs, but we also saw 2, yes, you read that correctly, 2 leopards!!

I couldn't have posed this picture better if I tried.

I couldn’t have posed this picture better if I tried.

A warthog family- notice the nursing baby in the background- although we think of "Pumba" as the name of the warthog in Disney's Lion King movie, the locals call the warthog- Pumba. I think it is the Swahili name for the animal.

A warthog family- notice the nursing baby in the background- although we think of “Pumba” as the name of the warthog in Disney’s Lion King movie, the locals call the warthog- Pumba. I think it is the Swahili name for the animal.

Leopards are shy creatures and stay up on high branches in Acacia Trees all day and they are usually not near the vehicle paths. Our wonderful tour guide, though, seemed to have the eye for the leopards because he spotted 2 of them for us. The first was quite far and only 2 of us had cameras that could pick them up. But,we all had a great view through the guides binoculars.

This Mama had 2 cubs and boy were they playful.

This Mama had 2 cubs and boy were they playful.

As we watched the 2 cubs ran under a bush for awhile and then all of a sudden, they sprung out and just hopped on top of the Mama- it was so cute!

As we watched the 2 cubs ran under a bush for awhile and then all of a sudden, they sprung out and just hopped on top of the Mama- it was so cute!

The 2nd leopard, though, was much closer and even my point and shoot automatic camera with only a modest zoom lens picked it up. Check out the photo!  All in all, the weekend was fabulous and although we saw lots of animals, we left Murchison eager to go back another time.

This leopard shot is from my camera-and you can definitely make out the leopard in the distance on the tree branch

This leopard shot is from my camera-and you can definitely make out the leopard in the distance on the tree branch

Now we’ve safely reached Kampala and had to say goodbye to one of our party- Hanna’s flight leaves shortly to head back to the USA.  Tomorrow night we will say goodbye to Lizzie and Amanda, then Kristen and I will be left to carry out some work for the Makerere Pharmacy School.  More on that later this week. For now, enjoy some more animal photos.

This amazing picture is from Hanna's camera- there is no doubt we saw this leopard.  He just watched us intently as we gazed at him for about 20 min.

This amazing picture is from Hanna’s camera- there is no doubt we saw this leopard. He just watched us intently as we gazed at him for about 20 min.

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Murchison Falls National Park Safari Day 1

April 24, 2015

The Wilkes crew at the top of Murchison Falls

The Wilkes crew at the top of Murchison Falls

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“What a nice meal of warthog, now I’m so tired…”

Murchison Falls National Park, Uganda truly is a gem. It is smaller than the large game parks in Kenya, Tanzania, and South Africa, but it has most of the same animals and is very non-commercialized.  I haven’t been to the large parks, but this is my 5th time to Murchison and I never ceased to be amazed.  The 4 woman seem to have brought good luck for animal sightings this year.

Nap-time after the exercise of the kill (warthog in the background) and a delicious meal.

Nap-time after the exercise of the kill (warthog in the background) and a delicious meal.

On the first day we saw the best lions I’ve ever seen- a large male resting next to his kill and a Mama lioness with her single cub playing around while we watched from about 10ft in the vehicle.  We also saw many of the other animals- I’ll let the pictures do the talking- enjoy!

Elephants just crossed the road right in front of us!

Elephants just crossed the road right in front of us!

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Uganda Kob, a type of Antelope

Uganda Kob, a type of Antelope

We sat in the vehicle only 10 ft  away from this Mama and her cub for probably 30-45min.  She was loving and playful with the cub and didn't seem to mind that we were watching

We sat in the vehicle only 10 ft away from this Mama and her cub for probably 30-45min. She was loving and playful with the cub and didn’t seem to mind that we were watching

A Patus Monkey

A beautiful sunset over the Savannah to end a beautiful day!

A beautiful sunset over the Savannah to end a beautiful day!

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An Afternoon with the TASO Drama Team

Friday, April 24, 2015: We are currently on safari at Murchison Falls NationalPatk in Uganda but you will have to wait until tomorrow to hear about our first days escapades. 😊

Wednesday afternoon we had the unique opportunity to go to a rural village and observe the TASO Drama Team provide both an afternoon of entertainment as well as HIV testing and counseling (HCT). The entertainment started with drumming, singing and dancing. It was extremely energetic and joyful. The crowd grew as the music went on. There were many, many children along with adults numbering greater

TASO drama team in their opening dance

TASO drama team in their opening dance

than 100! Although the HCT started right away at some tables set apart from the show, it didn’t become swarmed with people until the Drama Team took an intermission. The Team also acted out a short skit to encourage use of condoms for safe sex. This was all conducted in the local language so we couldn’t understand all of it but the acting conveyed the gist of the points made. The villagers obviously found it hilarious by their robust laughter. Later, the Team Leader elaborated a little more so we could fully understand. Culturally, infidelity is common and accepted as a part of adult life with both men and women, but is much more common with men. The aim of the skit was to use condoms to protect against HIV transmission with all sexual partners to stay healthy. The TASO team seemed really happy that we took the time to see this side of their work, but truly, the pleasure and honor was all ours. Check out the pictures to get an idea of what went on. (Having internet issues- will add more photos and 2 videos later)

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A Fond Farewell to Masindi-Kitara Medical Center

Friday, April 23, 2015

The students worked hard but there was definitely time for some play with the kids at the clinic.

The students worked hard but there was definitely time for some play with the kids at the clinic.

Today was our last day at Masindi-Kitara Medical Center (MKMC) and tomorrow we are embarking on our Safari to Murchison Falls National Park.  It has been a wonderful two weeks at the clinic working with the competent clinicians and other medical staff. They have warmly welcomed us into their lives and shared their experiences with us. We have all gained a better understanding of the healthcare challenges facing Ugandans.  We have learned not only about the diseases but also about the barriers to treatment.

This is Dr. Godson, an amazing physician. His insight about the illnesses his patients have is amazing.

This is Dr. Godson, an amazing physician. His insight about the illnesses his patients have is amazing.

For example, today I learned that many Ugandans don’t really understand the disease, Cancer, and we were asked to consider doing some educational programs about this next year. It is really hard for them to understand that cancer of the breast is different from cancer of the lung and why some cancers can be treated and others don’t respond well to therapy.  Also, cancer doesn’t always cause pain so women who have breast lumps often don’t seek care until the cancer has spread greatly because initially it doesn’t affect their ability to continue on with their normal life.  As I mentioned in a previous post, we have learned that many patients don’t understand the concept of chronic diseases that need medications every day for the rest of their lives to prevent complications and illnesses.  In this resource-poor environment, many people just live day to day and crisis to crisis and have no  capacity to plan for the future.

This is Patrick, the onsite Project Manager of the Masindi-Kitara Medical Center

This is Patrick, the onsite Project Manager of the Masindi-Kitara Medical Center

But, we also have learned how much families care for each other. When someone is sick, the entire family may come to stay at the hospital. And when bills need to be paid, the family at large will chip in to cover the bill.  As I have kept all I’ve learned with me over the years as I practice in the USA, I hope the students and resident with me will also ponder their experiences and let them shape the way they care for patients as well as the way they think about the U.S. Healthcare System. We are so fortunate to have the opportunities afforded us in terms of healthcare services. Even patients without any insurance or those with poor insurance are able to access care. No one will be turned away and the variety of testing available to determine the problem is amazing.  But as we have seen here, tests are not always necessary to provide good patient care.

Hagai is the MKMC Manager.  Although his expertise is business management, he has great ideas about how to improve healthcare services at MKMC

Hagai is the MKMC Manager. Although his expertise is business management, he has great ideas about how to improve healthcare services at MKMC

A good clinician can listen to their patient’s story and use their astute clinical assessment skills to determine the problem and devise a solution.  It is great that in the USA we have more lab tests and radiology test to diagnose diseases, but I think these are often overused. We could all learn a lot from the clinicians at MKMC and in Uganda, in general.

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Learning More About TASO and Safe Male Circumcision To Prevent HIV Transmission

Wednesday, April 22, 2015:  A Blog Post by Hanna Raber and Lizzie Cook

These are the Boda-Boda's (motorcycles) that the TASO healthcare workers use to go to the field to set up clinics. The supplies and equipment to do HIV testing and CD4 counts along with the drugs follows behind in a 4-wheel drive vehicle with more healthcare workers.

These are the Boda-Boda’s (motorcycles) that the TASO healthcare workers use to go to the field to set up clinics. The supplies and equipment to do HIV testing and CD4 counts along with the drugs follows behind in a 4-wheel drive vehicle with more healthcare workers.

We spent Monday morning at TASO, The Aids Support Organization, once again today. The original plan was for us to spend time in the clinic, checking weights and administering surveys on their general health status. However once we arrived we were told that because of the Easter Holiday the schedule was really light today- only 16 patients were scheduled as opposed to some clinic days when over 150 patients would be scheduled. So instead we were given a really in depth tour of the facilities. We were really impressed by the holistic approach that TASO takes to HIV management. There were patient counseling rooms, education rooms, family planning space, an area dedicated to youth, and a well-organized pharmacy (a rare site to see). We were also shown an area of the property where a little garden was growing. They called this the “demonstration garden” and taught clients how to plant seeds and care for crops at their own homes. TASO also provides certain patients with “starter-kits” for certain careers including farming, hair dressing, and auto-mechanic.

This is an example of the cute huts that are used as patient consultation rooms at the TASO facility in Masindi, Uganda.

This is an example of the cute huts that are used as patient consultation rooms at the TASO facility in Masindi, Uganda.

After we finished touring the TASO facility we were able to walk down the road to the government sponsored HIV clinic. It was significantly smaller than TASO but did include a counseling room, pharmacy, lab, and physician rooms. The TASO facility does see more patients per day than the government clinic- on their two clinic days they see about 50-70 patients.

One of the most interesting parts of the day was our next stop- we were taken to the SMC (Safe Male Circumcision) tents out in a field across the street. We were told that males from age 10 and up were taken to these tents to undergo circumcision. This has been a huge initiative to help reduce the spread of HIV. One significant caveat of providing such a service is that many men believe they are immune from contracting HIV if SMC is performed. This prompts many men not to use condoms and many women to believe that men who are circumcised are “clean.” Therefore, it is very important that a comprehensive approach is taken to educate both men and women on safe sex practices.

This is one of the Safe Male Circumcision (SMC) tents

This is one of the Safe Male Circumcision (SMC) tents

When we arrived to the circumcision tents, there were roughly 30 boys waiting (they were brought in from a school with permission slips signed by their parents or older siblings) to be circumcised. Prior to the procedure, each boy would be taken under an awning for a counseling session about the scope of the procedure and how to use barrier contraceptives, such as male and female condoms.

None of the boys who were waiting seemed nervous and there were no sounds of screaming coming from the tent. We were later told that this was a right of passage and that the boys were expected to be calm, cool and collected during the process in order to be deemed “men.” We were told that the boys were not given any topical numbing agents before the procedure and they were only given Tylenol after for pain management.

Another SMC tents

Another SMC tents

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Reading Glasses for Masindi-Kitara Diocese

Tuesday, April 21, 2015

Lots of reading glasses donated by St. Luke Lutheran Church in Bloomsburg, PA USA to bring to Masindi, Uganda

Lots of reading glasses donated by St. Luke Lutheran Church in Bloomsburg, PA USA to bring to Masindi, Uganda- there are 192 pairs!!!!

Ever since I started coming to Uganda, I have tried to bring gifts with me to serve the people I’m working with. They so graciously welcome us into their lives and allow the students and I to learn from and with them and I want to give them some sort of small token of thanks. Early on the Professor at Makerere University School of Pharmacy requested we bring pharmacy textbooks because their supply was low and very old. Over the past few years I’ve brought several hundred pounds of textbooks. This year was no different, although in the future this may have to be curtailed because British Airways may cease letting volunteers bring extra luggage at no charge.  This year although I had confirmed ahead of time that we were allowed to bring 3 bags each, at the airport gate check-in I had to bargain with them to let us take the bags we had packed with the books and Blood Pressure cuff supplies needed for the screenings.

Janine, Rev. Josebard, and Dr. KarenBeth Bohan

Janine, Rev. Josebard, and Dr. KarenBeth Bohan

In addition to textbooks, I was also able to identify a need for reading glasses from talking with the Rev Evas of the Masindi-Kitara Diocese and Janine, the Diocesan Health Coordinator a couple of years ago.  Almost everyone’s eyes change as we grow older and in fact long distance vision can improve but close up reading distance vision can grow worse. This is a condition close to my heart since I heavily rely upon my own reading glasses to perform any kind of computer or reading work.  Even selecting money from my wallet requires the use of my reading glasses.  If you look back at pictures of me on this blog, invariably you will see me wearing glasses on top of my head and this is so the glasses are never far from me.   Thus we have also brought reading glasses to Uganda and below is a note of thanks from Janine.

Janine hands out the glasses- The Rev Bishop Julius Caesar was one of the grateful recipients

Janine hands out the glasses- The Rev Bishop Julius Caesar was one of the grateful recipients

She introduced me to two clergy who have personally benefited from the glasses and who are pictured in this blog.  They expressed sincere gratitude to me and the members of my church, St. Luke Lutheran Church in Bloomsburg, PA, who collected and donated the glasses. Reading glasses are available in the USA at all pharmacies and even at some convenience stores; they also tend to be reasonable priced.  Unfortunately that is not the case in Uganda.  Although they may be available at some stores, the price is not affordable for most people.  The provision of reading glasses seems simple but can really make a big difference in the lives of a person who can no longer read without great difficulty.  Reading their Bibles and conducting basic business transactions like signing their name or selecting money for a purchase can now be accomplished without eye strain or assistance.

Note from the Diocesan Health Coordinator:  We here at Masindi-Kitara Diocese are most grateful for your donation. Here we have many people such as pastors and lay readers who dearly desire to read the Bible, and who are needing to preach and share from the bible. Unfortunately, as they pass the age of forty or so, many of these key people start losing the ability to read the bible as they don’t have reading glasses. Your donation will help the Health Office of Masindi-Kitara provide those who need them these reading glasses. Thank you so very much and may God richly reward you.

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Blood Pressure Screenings in Masindi, Uganda- What Fun!

Sunday April 19, 2015

Hanna, the pied piper, had children lining up to see what was going on and to have their BP taken.

Hanna, the pied piper, had children lining up to see what was going on and to have their BP taken.

Wrap the cuff around the arm, apply the bell of the stethoscope to the antecubital space (inside of the elbow), pump, pump, and pump some more as the dial goes up and up and up, then slowly release the knob to let the air out and then finally, carefully read dial as it descends through the numbers listening for the first drum beat through the stethoscope and then the cessation of all sounds to determine the blood pressure (BP) reading. This procedure can be life saving as it can discover people who are at risk for developing heart and kidney disease that can lead to stroke, heart attacks, and death.

Amanda, Lizzie, and Dr. Bohan at All Saints Church

Amanda, Lizzie, and Dr. Bohan at All Saints Church

Today the Wilkes students and St. Joe’s Pharmacy Resident completed this procedure about 252 times while they screened parishioners at St. Matthew and All Saints Church in Masindi, Uganda. In fact, most people who had a high reading were tested at least one more time, to double check. We were able to identify 84 people (33%) who had high readings and 33 (13%) had extremely high readings and were referred to seek medical care as soon as possible this week. Although there are plenty of medical clinics around, some of the patients with high BP that I counseled admitted they had never had it taken before and also had not ever seen a doctor.

Kristen at St. Matthews Church

Kristen at St. Matthews Church

Identifying people with high BP is the first step in improving their long-term health, but unless they follow through with treatment, which will probably be daily medication(s) for the rest of their life, patient health outcomes won’t be actually altered for the better. There are many barriers to sustained medical care that will have to be overcome and when you consider them, it is easy to get discouraged and wonder if we are really making a difference. The majority of people in Masindi live on extremely modest incomes and affording regular medication is nearly impossible for most. Think about having to make the decision “Do I pay my kid’s school fees* or purchase my BP medicine this month?” If they seek care through the government health system, medications will be free but unfortunately, you can’t always rely on the medications to be available every month. Using a private doctor or clinic is much more reliable in terms of available medications and healthcare providers, but this will cost the patient some amount of money.

Lizzie had fun playing with the children too! She not only had her BP taken but also had her hair braided.

Lizzie had fun playing with the children too! She not only had her BP taken but also had her hair braided.

Another factor is lack of education about illnesses that we in the developed world are well aware of. Just about anyone you ask in the USA probably knows what a heart attack or a stroke is and that medical care and drugs can be helpful. In the developing world, this may not be common knowledge and trying to explain it is difficult. There is also poor comprehension about the concept of “preventative care”. In fact, this applies to not only to personal healthcare but also items like cars and generators. During one of my trips to Masindi, the hotel’s generator stopped working. A generator is a really critical piece of equipment here because the electricity commonly goes out for some amount just about every day and often is out for days at a time. That time, though, the electricity went out and the generator broke down. It turns out that the reason for the malfunction is that no one had done the preventative maintenance necessary and let it run without oil.

We spoke to all of the patients who had high BP to give advice. Much of the time the patients understood and spoke English but when Runyoro was their best language, we had the help of 2 wonderful translators.

We spoke to all of the patients who had high BP to give advice. Much of the time the patients understood and spoke English but when Runyoro was their best language, we had the help of 2 wonderful translators.

I don’t really know the route of the problem but suspect it has something to do with not having a lot of money to do the upkeep necessary but I think they also don’t understand the concept of paying a small amount to keep equipment or your health in good shape so that you don’t have to pay catastrophic fees later. But, we have to start somewhere and identification of the health problem (elevated BP) and discussing the potential benefits of treatment is what we are able to do when we just come here once a year. People are starting to remember us, though, since this is our 3rd time doing BP screenings at these 2 sites. In fact, one patient actually came with his 3 prior BP readings on the cards we provide!

Lizzie at All Saints Church

Lizzie at All Saints Church

All of the crew agreed their work today was really fun and they had a great time- it was a 10/10 experience and they would “do it again!” There were lots of children hanging around watching us and at one time, Hanna had 2 lines going where she was measuring the little kids BP with the automatic cuff while she took the adult’s BP with the regular BP cuff. One story Amanda recounted to me was pretty amazing. She got herself a mint and saw a little girl watching her and so she offered her a mint. She promptly put it in her mouth to soften it up and then bit it into pieces and gave it out to the other children there. The extent to which they share and care for each other is really touching!

*Most children go to one of the many private schools available and those prices range from really low but likely low quality to really high providing a high quality education. There are free government schools, but these are considered poor quality and even when utilizing them, parents still need to pay for uniforms, shoes, writing tablets, and pencils. Education is something that is highly valued in Uganda, as most parents know that sending their kids to the best schools they can afford is the most likely way to advance their financial status and position in life.

Amanda and Lizzie with Jackson, the excellent translator at All Saints Church

Amanda and Lizzie with Jackson, the excellent translator at All Saints Church

Kristen and Hanna with Godwin, another excellent translator for St. Matthews Church

Kristen and Hanna with Godwin, another excellent translator for St. Matthews Church

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