Nolan - 7/17-18/08

7/17/08 5:39 PM

It is hard to believe my time in Uganda in nearly ½ way done. My time here so far has been consumed with data crunching, training days, and analyzing pieces of information. It is not glamorous all the time, but will lend itself to big outcomes in the end., I hope. The moments of interacting and seeing real patients, (instead of a public health equivalent such as DALY’s ) is both depressing and motivating. Depressining because these people have illnesses that would be easily fixed and attended to in a country overflowing with money, such as the US. Motivating because maybe someday I can change their outcome…

In my time free from the “lab with the pen and the pad” (Thank you Dr. Dre)… I have been trying to make the most of genuine moments. To capitalize on those irreplaceable moments, conversations, and smiles that will forever be remembered. What I expected as those genuine moments are not what I thought of when I thought of Africa. When one thinks of the red soil of this great continent one is reminded of tribes, dances, hunters, cultural rituals and the obligatory safari. However from my time here that is not apart of life. The dances, safaris, and “tribal walks” are filled with tourists with 10” zoom lenses. I imagine this is like the toursists that visit the USA and look for cowboys, or who go to New York and visit the Statue of Liberty. If one goes to the US looking for such things then to leave without being apart of the them, they are left with a “dis-genuine” experince of the USA. Yet, a real experince of the US varies by City and by neighborhood. For instance each area of San Franciso has its own culture, people and atmosphere. Yet all of that has nothing to do with the GG Bridge nor Alcatraz. Those big touraist attractions are there for the tourists not the people that reside in the area. The same is true to the typical “African things here”. The most genuine moments we have had have been the unexpected African Club or Bar, getting lost on a stray matatu, or getting consistently cheated on receiving change on our purchases. Outside of the designated safari, I do not feel like a tourist here nor do I believe I am treated as such.

7/18/ 2008 12:16 PM


This morning Justin and I began our rotations with the Trauma Causality Surgery Department. We both want to work with the Casualty to get a feeling for how the presentation for traumas arrives at the hospital and how they are dealt with. This will give us a comprehensive understanding of the problem on the ground.

Upon arriving into 2A the smell of urine, puss and death was continually evident. Our first patient an elderly gentleman had an axillary lymphoma comparable in size to a large cantaloupe arising from his shoulder. This cancer is slow growing, but malignat… This hyper growing lipid filled carcinoma felt like a waterballon I used to fill as a child. He seemed to be in no pain, but sat there with his shirt off just looking at me. The head doctor asked if I would like to take a picture of it. I had an immediate juxtaposition of thoughts. On one end this is an amazing specimen. To feel the flowing fluid just below his skin made me want to catalog it in my medical records. However, on the other end the mans eyes reminded me of something so much different. Why had he waited so long to reach care? He had been hospitalized now because his condition had deteriorated. Why not come for care when the disease had not spread so far. Was it because he lacked any money to be helped? Did he not have transportation or the family to help him? Was taking pictures of patients from foreign doctors routine? Are the poor and disenfranchised even in the 3rd world put on display for the amusement of others, all to similar to the safari ride I had taken the week before… These questions flooded my mind as I asked the gentlemen to place his shirt back on.

The next patient was an advanced AIDS patient who with his sunken flesh, bleached palor, and frail body reminded me more of something from TV then reality. He lacked any palpable pulse, and could not have weighed more then 95 lbs. A Hb count was ordered and we just moved on. Seeing death gripping a man was normal there, was an everyday occurrence, we just moved on….

We saw gang green, empyema that made me sick to my stomach. We witnessed profuse bleeding from lacerations and burns that gauze was suppose to cure. So much death, so much mutilation, yet the world seemed to carry on as if life were no different. And yet to Justin and I the world seemed to move a little slower. The cries of the babies in the halls searching for their mothers, the boy who had necrotic burns on his back,… life just seemed somehow changed for us.

In the hospital it amazed me how close a family must be. If the family is not there to feed, wash, help the patient then the patient receives no food, cleansing, or bed changing. There is a lack of medical care and the family is integral in the care of the patient. Colorful outfits of women at the bedside filled the wards as men in white coats talked about them as if they could not hear. Discussed there life as if they could not understand. Yet, they understood. Their silent voices upon us arriving did not constitute incomprehension but rather a deep reverence for the medical treatment, something unlike anything I have experience in the States. At the bedside of one patient was a mother, brother, sons, wife, and daughters. He had been badly damaged in a recent RTA. The mother of possible 70+ in age, immideitly rose from her chair and sat on the cold, hard, unsanitary floor. In her words, that I could not put meaning to them, I saw respect for the white coat I was wearing. I did not know precisely how to feel, but I knew this woman was older, wiser, and more deserving of any chair before I.

In the Causality ward in the late afternoon Justin and I had been waiting for nearly 2 hours for a surgical team to scrub in with. During that time I felt the most useless as an individual as I think I might ever have. Imagine a filled waiting room with injuries that would in the USA be rushed off to immediate care. Here patients wait until a doctor can arrive in the ER (Casualty Ward) to take care of them. Head Trauma, Snake Bites, RTA’s… Patients were desprate for care, and there we were in our white coats waiting…. People continually gazed in our direction believing us to be doctors wondering why weren’t doing anything for them or their family. Continually looks of sadness which rose to disdain were shot at us. I tried to justify it in my mind: I have only been in medical school for one year, I don’t know how to remove the skull cap on my own… I don’t know how to fix a lacerated liver. At this moment most of my knowledge is theroretical, un practiced, un refined. Also I am at a hospital with permission to learn and heal under the supervision of a local doctor. I can not just jump the the front of the lines and start sowing flesh together and cutting disease apart….. Yet, none of these self-justifications vindicated me from the needs of the onlookers nor the confliction in my heart. Eventually I removed my white coat, and sat in an area away from the patients with care… Again I just walked away. I felt ashamed, worthless… If only I had known what to do… I know that is why I am in school, to learn…. But my learning didn’t help anyone that day. They were still waiting for a doctor…