A Day with The Water Trust by Nikko and Jeff

Posted on October 8, 2013 by kbohan

ImageToday we worked with The Water Trust in the villages outside of Masindi. We drove with The Water Trust workers Lynet and Tadeo to Nyakatoogo to see the progress on a well they are building there. They were currently about 13 feet deep but need to go an estimated 10 feet more before the well can be finished. We were surprised to learn that they dig these wells by hand with pick-axes!Image The village submits an application to The Water Trust that they want a well and then they supply the labor to dig it. They take turns going into the well to dig; one man was down there when we were visiting. The villagers then showed us the current water source that they use which turned out to be a spring about 5 feet deep that looks very unsafe to drink. They told us that they don’t boil the water because it would ruin the flavor and it also helps them grow big and strong. ImageThe Water Trust works with these beliefs and educates the village about clean drinking water and proper hygiene before the well opens. We toured a few nearby homes to see if they were ideal homesteads. An ideal homestead has a proper latrine, separate houses for people and animals, and a drying rack for dishes. All homes that are to be served by the well must be ideal homesteads before the well is allowed to open. The houses we saw were all missing something but they were working on complying with The Water Trust’s standards. ImageAll of the people we met were very kind to us. They shook our hands, brought us chairs, and one woman even bowed to us. Then we drove to the second village called Kyakacunda, which already had a completed well that has yet to open. We saw a few more homesteads that aren’t yet up to The Water Trust’s standards but are almost there. The well has been finished for about 2 months and will be opened as soon as all of the villagers comply with the health and sanitation standards they agreed to before construction began. It was an interesting cultural experience and we learned so much about hygiene, health, and sanitation in outlying areas in Africa.Image

Bonus:  More Pictures of the Blood Pressure Screening at Miracle Center Church on Oct 6, 2013:

ImageNikko and Jeff with the Pastor of Miracle Center

ImageJeff and Nikko with the Praise and Worship Music Leader

 

 

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The Weaver Bird and Some Interesting Colloquialisms

Posted on October 7, 2013 by kbohan

20131007-225121.jpgWhen we were at the Ziwa Rhino Sanctuary on Saturday we a really interesting bird. It is bright yellow and called a “Weaver Bird”. It weaves these really neat round nests that hang down from the tree branches. The birds enter them from the bottom. In the past, I’ve never been able to get a decent picture. You have to have a good zoom lens to capture birds, but this time, despite my inadequate zoom, I was able to get a picture that is good enough to demonstrate these interesting creatures. 2nd picture show the yellow bird’s bottom as it burrows up into the nest from the bottom. I hope you can get the gist of the 3rd picture which is showing you how there are numerous nests in one tree.

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INTERESTING COLLOQUIALISMS:
1. In Uganda, when one wants to cut the grass the activity is called “slashing”. The one who does it is the “slasher” as is the implement with which it is done- basically a long knife that is swung in an arch-like motion back and forth. Sentence: my son is out slashing the lawn. If you thought mowing the lawn with a push lawn mower was a lot of work, you haven’t tried slashing a several acre piece of land.:)
2. The people in Uganda are extremely welcoming, kind, and generous. They are also excellent hosts. Whenever you come into a store or go Up to someone’s house, they always remark “you are most welcome”. When we return to the hotel from a day of work, we are greeted by everyone we meet “welcome back, how was the day or how was the work?” They greet us like long lost cousins they haven’t seen in awhile. When we go to meet with people whether planned or on the spur of the moment, we are ushered in and everything stops until enough chairs are brought for us to sit. If there aren’t enough chairs, they will get up and insist we take the seats. It is also quite normal for tea and water and sometimes snacks to be brought even if we said we didn’t need anything. Of course then the appropriate thing to do is to graciously accept the offerings.
3. Two other interesting phrases are “ok please” and “It’s ok, it’s ok”. The former is used why we might just say “ok”. The latter is used when you ask if it is ok to do something, like take a picture. We might say “sure” or “ok” or “yes” but they would say “it’s ok. It’s ok” in rapid succession- kinda of like how we might say “no problems” or “no worries”.

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More Blood Pressure Screenings, and “What we saw on our way to the Rhinos”

Posted on October 6, 2013 by kbohan

20131006-193906.jpgToday, Sunday, we conducted another Blood Pressure screening for the Masindi Red Cross at 2 more churches. Our total today was 302 people and so altogether between last Sunday and today we took the BP for 652 people. Of these 70% had normal BP’s, 19% were slightly elevated (140-159mmHg systolic or 90-99mmHg diastolic), and 11% had stage 2 high blood pressures of >160 systolic or > 100 diastolic. We gave all the participants a sheet of paper that explained the reading and what to do about it according to the Uganda Clinical Guidelines (which is basically what the USA guidelines would recommend as well). And this was also verbally explained with the help of a translator if necessary. For the first day we only had the cards in English but a health missionary to the Church of Uganda volunteered her personal translator to create a version in Runyoro, the primary local dialect so today we could ask their choice of language. The whole experience of participating in these BP screenings as a way to improve public health has been very rewarding for the students and me! We are truly thankful to the Masindi Red Cross for allowing us to participate. Many of the people had never had their BP taken and a lot of children were interested in finding out their own readings. Even though most of the kids and teens were normal, I think it is great that they are now aware of the ability to monitor BP and when elevated that it can be treated to help prevent heart problems, heart attacks, and stroke. The pictures below are of the “BP Screening Team”. Included are me and my students along with 2 Red Cross staff workers and a local teen (the one with the yellow shirt around his shoulders) who became interested last Sunday and stayed around to help out. Nikko and Jeff taught him all about high blood pressure so he was a real asset when it came to translating and helping with the explanations. Our driver, Sam, also was indispensable. He hung around all day and also assisted in translating at times and today he acted as transport when we had to send a 14 year old to the clinic to be seen for a persistently elevated heart rate of 160.

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NOW CHECK OUT WHAT WE SAW ON OUR WAY TO THE ZIWA RHINO SANTUARY:
Yesterday I wanted to focus on the rhinos since I knew many of your were looking forward to that but we also saw some pretty cool stuff on the way there. First, see how beautiful the day was with blue skies and puffy white clouds.

20131006-214223.jpgNext we saw some monkeys. They are really hard to capture on film because they are so quick.

20131006-214348.jpgWe also saw a mother Ankole cow nursing her calf.

20131006-214543.jpgFinally, check out this video of an Ankole Cattle drive. Note, I didn’t put this to music. I didn’t realize there was music until I played it back for the first time and found out the radio recorded on the video. I burst out laughing because if you look carefully it looks like the cattle are bopping to the music as they walk along.

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We Saw Obama! (the Rhino, that is)

Posted on October 5, 2013 by kbohan

20131005-194913.jpgToday we went on an adventure to trek into the wilds to see White Rhinos, at Ziwa Rhino Sanctuary. Actually, today the trekking was quite easy since the rhinos had decided to rest in the shade pretty close to the safari trail. And we really did see Obama- he is the first rhino born in captivity at the center and so named because his mother is from the USA (a gift from Disney in Florida) and his father is from Kenya. The picture below is Obama.

20131005-192159.jpgThe rhinos are gray, as you can see, but they are called “white” because their mouths are “wide” and a long time ago the translation was messed up and they became called the “white rhino”. In the picture above, the guy in the blue shirt is our wonderful driver, Sam.

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Check out the rhino video below.

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Ugandan Potpourri

Posted on October 4, 2013 by kbohan

20131004-205420.jpgThe morning started out with a light rain and while the students spent the morning in the clinic at Masidi-Kitara Clinic, I again headed out to the rural villages outside of Masindi Town to visit 2 health clinics with the District Biostatistician and my driver, Sam. The picture above shows the road when there is just a little bit of rain. Imagine the conditions in a downpour. Even with light rain it feels like the car is sliding around on an ice rink. I do have to say that out driver is wonderful and navigates the poor conditions really well! At one point along the road we traveled behind this motorcycle (boda-boda). Note the load he carried. This is not an unusual site!

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The picture below is me and Moses, the Biostatistician in front of the Kyatiri Health Center.
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So with this post, I also thought I would just add in some miscellaneous stuff. Look at this cool snail- it was just outside the door to my banta. I know it is hard to see the size, but the shell was about 2.5 inches long.

20131004-212707.jpgBelow is Jeff with one of our favorite meals at the New Court View restaurant- the sizzling beef (or you can also get it in chicken). The plate comes out steaming and literally sizzling we always feel a little bad for the waiters since it is so hot. Note the large rice portion. It is huge! I think they have cooked a full cup of rice for each portion which is 2 cups of cooked rice! Here in Uganda, they call the starch “the food”. For example, when you order a sauce, be it stroganoff or beef stew or sizzling chicken, they ask you what “food” you want with it. The choices are matoke (mashed cooked banana) or chips (french fries) or rice or cassava or chapatti (a delicious flat bread).

20131004-213543.jpgIn Uganda the chickens are truly “free range”. You can see not only chickens just out and about but also goats and cows. I often wonder if they ever run off. It makes me think about now much more Americans will pay for “free range” and “organic” meat and here in Uganda, this is the norm. 20131004-212727.jpg a>
And finally, even though we are half a world away, something’s are the same. The hotel has a bunch of cats running around- I’m sure they keep down the pests, and here is a picture Nikko took of a mama cat nursing her kittens.
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A Rainy Day and No Power

Posted on October 3, 2013 by kbohan

20131003-224031.jpgIf someone said to you that it is the rainy season in Africa, what would you imagine? Well before coming to Uganda for the first time in the summer of 2011, I would have envisioned torrential rains that didn’t stop for a whole season and you would just have to learn to be wet all the time and live in the midst of mud. But, so far that is not what I’ve seen in Uganda, until today. In Summer 2011 it was the dry season so obviously I didn’t experience this type of rains. Last fall and this fall, although it is called the rainy season, it is more like our Florida rains where it will rain hard for a short time and then the sun comes out and dries everything up.

20131003-224123.jpgAs you drive through town, though, both in Masindi and Kampala, it is clear that there are large rain gutters and ditches meant to collect and direct water away from the roads so I’ve been wondering if it really does rain like crazy sometimes. So, as you have guessed it, today we found out that, yes, the rain can be so bad that it really disrupts everyday business. When we woke up, it was overcast with dark clouds rolling in but by about 8:30 when we were heading out, the rain clouds broke loose and boy did it rain. The plan for today was to go to to 3 rural village health clinics to get a better idea what kind of data they collect on patients so that I can better plan a research project to help The Water Trust assess the impact of their programs of the health of their partner communities. But, we were to meet the district biostatician at 9am to head out but he got stuck in the rain and had to pull over to wait out the rain. Like many people around here, his primary mode of transport is a boda-boda (motorcycle) rather than a car. So, obviously this becomes more difficult when it rains. Actually people around here function quite well in the rain but today’s rain was definitely worst than usual. Anyway, we had to wait for the rain to slow down so he could get to town. We did finally get on the road and the rain did stop but when we got out of the car at our first clinic, I learned to to not trust the ground. It didn’t look that bad but it was thick with mud that was extremely slippery. Even though the rain had stopped, by the end of the day I had mud all the way up my legs under my skirt, and I didn’t even fall down. It was just sloshy at times. But, our driver did amazingly well on the red dirt/mud roads. As we were out and about in the villages, we saw several vehicles stuck in the mud, but not our little car. At one point, though, Sam did have to ask us to get out so he could get a running start and gun the engine to get up a steep hill filled with muddy ruts, but he did make it!

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To make the day even more interesting, the students were finally able to experience what it is like to be without electricity for more than 24 hours. We are lucky to be staying at a hotel that does run a generator from 7-11pm, but without this, the electricity has been out since about 8pm last night. We all had to get up and dress in the dark this morning and I think we were all glad for my advice to bring not only a flashlight, but a latern-style flashlight that can be propped up and illuminate the room.

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Hopefully tomorrow the electrical grid will resume work and maybe the ground will try out a little…

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The Boys Do Laundry

Posted on October 2, 2013 by kbohan

When we are in Uganda the normal way to have your laundry done is to leave your clothes out on the bed and the housekeeping staff pick it up, wash it, and then leave it for you at the end of the day, when possible. The way they do laundry is all by hand with a pail of water and soap, and then they hang it out to dry. If we have a dry day with sun, the clothing dries really fast. But now it is rainy season in Uganda so most days it rains at least some of the day. If your laundry is hanging out when the rain starts, you probably won’t get it back that night. So…on Monday I left some clothes out to be washed but at the end of the day, I still had dirty clothes. It turns out that on Mondays they wash the sheets so they don’t do personal laundry. So on Tuesday I left my clothes out again and sure enough they were clean and nicely folded when I got back from the clinic. But, the boys clothes were forgotten and didn’t get cleaned. Since they were running really low on clean clothing this was somewhat disturbing to them. I decided to share my bill with them because it was more than I anticipated. Upon seeing that, the guys decided that maybe they could try washing their clothes by hand. I had brought laundry detergent and had a bucket in my room so I shared these and off they went.

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20131002-232403.jpgI was careful to make sure they knew to use the soap sparingly and it was a good thing I did because they both thought they would have used a cup or more and I had let them know that only a tablespoon or 2 would be more than plenty for the amount of clothes. At dinner tonight we laughed a lot about their escapades. I really wish we could have videotaped it; I’m sure it would have been quite funny. They both agreed it was not so easy and Nikko said his arms hurt from wringing out all of the clothes. So now they have clothes hanging up all over their room but at least they saved about $20 each. It doesn’t sound like much but here in Uganda, that would buy 2 really nice dinners each. Now at least they can say they learned something on this trip- how to do laundry by hand. 🙂

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Life in Masindi, Uganda

Posted on October 1, 2013 by kbohan

20131001-204247.jpgOur time in Masindi, Uganda is going really well so far. Today we spent all day at the Masindi-Kitara Medical Center (MKMC). MKMC was started by the Palmetto Medical Initiative from South Carolina to meet the healthcare needs of this small community and they continue to support the infrastucture (buildings) but the all of the staff are Ugandan and they operate using a fee for service model so the daily operating costs are self-sustainable. MKMC is a small clinic that has a 16 bed inpatient unit along with a 12 bed maternity ward, and a labor and delivery suite with a theater where they can do Caesarian sections and other surgeries (note: “theater” is the British name for an operating room that has been adopted widely throughout the world).

20131001-204351.jpgMKMC also has a busy outpatient clinic and with its own pharmacy. Today we arrived at the clinic by 8am so we could participate in the hospital inpatient rounds. It was extremely interesting and we loved that the clinical officer took the time to explain everything that he was doing. Most of the patients had malaria, but we get to see a healthy newborn baby and mom. Later on we split up and I spent the day in the pharmacy helping to dispense medications and learning about the drugs that are available here. MKMC will be the primary work site while in Masindi for the students. It is a really great place for them to learn and the staff is very open to collaborating as a team.

Life in Masindi is quite a contrast to Kampala. First of all it is a small town with one main road that runs through it. Off of this there are a few side roads where you can find numerous small shops. Today we visited the Quilt Shop that the Peace Corp volunteers helped some local tailors to start. Their work is very nice and I have been so happy with the beautiful quilt I bought last year that I just had to go back and get another one.

20131001-202304.jpgAnother difference is that we stay in a hotel (The New Court View Hotel) where each individual room is its own banya (hut). They are self-contained, which means they have a bathroom with shower. We end up spending a lot of time outside as most of the prime eating areas areas are basically outside.

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20131001-202450.jpgThe porch you see is where we have breakfast and the hut is where we eat most of our lunches and dinners. We only go inside if it is raining really hard. Another great thing about the New Court View is that it is a local hangout and we run into many people we have met. I think one of the biggest difference is the lack of any traffic – no “jams” at all! We are also surrounded by beautiful green scenery.

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My Time In Infectious Disease by Jeff

Posted on September 30, 2013 by kbohan
Vivian, Pharmacy Intern, and Jeff

Vivian, Pharmacy Intern, and Jeff

During our stay at Mulago I have spent most of my time in Ward 4A, infectious disease. The infectious disease ward is a little more chaotic than the other floors at the hospital. The ward is very crowded, patient beds are very close together and there are even more patients on the floor. The male and female patients are housed on opposite sides of the ward with the all the critical patients are in the middle. At least once a day there is some sort of screaming outburst, mostly because a patient has passed away. Unfortunately, death is very much a part of 4A. The doctors care for their patients and do everything they can to save them but many of the cases are very complicated.

I’ll explain a little as to why the cases are so complicated. Around Uganda, Mulago has a reputation that “you come here to die.” Due to this reputation, many patients wait as long as possible to come to the hospital because they are afraid if they go there they will die. When they finally do come to the hospital, many of their diseases have progressed far past treatable stages. They remain in the hospital with the doctors doing their best until they pass away because they waited too long to come in. This adds another death at Mulago and perpetuates the reputation Mulago has. I have seen the doctor’s work and I know they are dedicated medical professionals but they are limited by the culture and perception of the hospital. This is what makes the infectious disease ward so prone to deaths.

I saw many interesting patients while doing rounds. They have many infectious diseases that you don’t commonly see in the United States. I was able to see patients with conditions like meningitis, tetanus, hemorrhagic fever, and tuberculosis. One day a woman came in, jumped out of bed, and immediately fell to the floor dead. Patients like that made daily rounds completely unpredictable.

I worked closely with the pharmacy intern in Ward 4A, Vivian. She was very helpful and we were both able to teach each other so much about medications and pharmacy practice in our countries. Everyday we would dispense medications to all of the patients in the infectious disease ward. We would also make interventions when patients were prescribed inappropriate drugs, doses, or regimens by talking to doctors and getting things switched.

I included a picture of Vivian and I. My time in the infectious disease ward was both startling and informative and I know I won’t be forgetting this experience anytime soon.

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Blood Pressure Screenings in Masindi by Nikko

Posted on September 29, 2013 by kbohan
Nikko and Jeff at St. Jude Roman Catholic Church, Masindi, Uganda

Nikko and Jeff at St. Jude Roman Catholic Church, Masindi, Uganda

After two extremely fast weeks in Kampala, we have moved on to Masindi.  It is amazing how fast time is moving.  We made so many new friends that we were very sad to say goodbye to.  But, we have more things to do while we are here in Uganda.

Friday, we met with Ivan from the Red Cross while we were still in Kampala to discuss the Blood Pressure screening that we were going to do at two local churches in Masindi called, St. Judes Church and All Saints Cathedral.  Since there were four churches that Ivan had planned for us to do BP screenings at, we had to split up and decided to do two churches this weekend and two churches next weekend.  Jeff and I took St. Jude’s Church and Dr. Bohan and Stacy went to the All Saints Cathedral.  From talking to Ivan about these churches, we knew that we would be busy because he explained to us that these people don’t often get to talk to healthcare professionals and that everyone will likely want their blood pressures taken.  Well, he was right.

1383755_10200780083649564_641954405_nThe night before the screening we met with Cleophas, a member of the Red Cross who would accompany us to the church and help us with the screening.  Jeff, Cleophas, and I arrived at St. Jude’s Church around 7:50AM as mass was just starting.  As we approached the church we could hear the choir singing very beautiful music.  We felt like dancing, so naturally we did a little bit.  We met with one of the church’s workers and set up our spot just under a large tree in front of the church.  The church was now jam packed with people standing outside the doorways so that they could attend mass.  The people sang louder and chanted as the mass went on.1379365_10200780094049824_1940581329_n

While waiting for mass to let out, we made friends with a young man named Vincent who extremely helpful throughout the whole day since he was able to translate for Jeff and I as we counseled patients on their blood pressures.  We also made friends with a small group of children.  They were so happy just to have their pictures taken with us.  They were amazed at the camera on my iPhone.

537258_10151705085921309_1940324886_nIt was a slow start but as soon as one person had their blood pressure taken, we soon became the main attraction and every single person that stepped out of the church wanted their blood pressures taken.  Soon enough, we were flooded with people would wanted to be screened and so we had Vincent and Cleophas organize people and we started going.  There were two services but the line didn’t die down at all so it seemed like it was just one unending line of people.

Jeff, Nikko, and the Children

Jeff, Nikko, and the Children

Within 3 hours, we had almost run out of our blood pressure handouts that Stacy made for us prior to departure.  While taking blood pressures I had little children leaning over my arm to see what I was doing.  People were so thankful to have us there because they rarely get to go to a healthcare professional at all.  For many older adults, it was their first time ever getting their blood pressure checked.  Many people had other problems that they wanted us to address but unfortunately we were only there to assess their blood pressures and since there were so many people to help we had to simply refer them to see a physician. Some people were extremely scared to be screened, in fear of having high blood pressure.  I asked Vincent how to say “great” in their language so that I could tell some people that their blood pressure was great.  When I told these people that their blood pressure was “kirungu” or “great”, they were so relieved that they couldn’t help but smile and throw a small celebration which made me happy as well.

Stacy and Dr. Bohan take Blood Pressures at All Saints Cathedral, Church of Uganda

Stacy and Dr. Bohan take Blood Pressures at All Saints Cathedral, Church of Uganda

Stacy was surrounded by children all day watching and wanting to have their BP checked

Stacy was surrounded by children all day watching and wanting to have their BP checked

By the end of the screening we estimated that together, we had done somewhere between 300-400 screenings that day.  We were able to refer some people to their doctor and counsel many on the importance of controlling their blood pressure.  Afterwards, we met back the hotel for lunch with Stacy and Dr. Bohan who also had a great day at their church.  I’d say that our day was “kirungu”

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