Day 15-17 Equator and Warthogs

Queen Elizabeth National Park is the largest national park in Uganda and is home to several hundred species of birds and animals. Although several companies offer complete packages, none fit our budget or our dates – we decided to be adventurous and planned the whole trip ourselves, thanks to the wonderful advice from the folks at Lonely Planet.

It was pouring rain when we woke up on Saturday morning – we got to the bus station almost 30 minutes early and found decent seats. The blogs, we had read back home, had mentioned that African buses tend to run late, sometimes upto an hour late in order to fill all the seats in the bus. Nothing could have prepared for what came next – maybe it was the rain or the start of the long weekend - the bus took almost 2 ½ hours to fill and we left the bus station exactly 3 hours after we boarded the bus! We had plenty of leg room but were cramped at the shoulders as there were no armrests. The bus stopped at every village and town on the route boarding passengers, chicken and some street vendors. We passed rolling hills with lush green tea plantations and miles of banana and sugarcane crops before reaching the famous Rwenzori mountains that form the Ugandan-Congo border. From there we headed south to Kasese, the closest town to the park, 7 hours after we left from Kampala.

Fortunately, our driver/ guide, Vincent was waiting for us at Kasese and drove us straight to the park to the Mweya peninsula where we were staying. We were lucky enough to come across a herd of African elephants as they were finishing their dinner before we checked into our hostel. After a lovely three course dinner at the Mweya Safari Lodge, we went to bed that night, exhausted but content.

QENP 1

The next morning we were up early for the game drive – it was a cool, calm morning and we got to hang out with a family of lions lounging after a big meal (supposedly wild buffalo). We saw plenty of Ugandan Kob (part of the antelope family), waterbucks, elephants and a small family of hippos before we returned back to the hostel for breakfast. Ugandan kob are graceful animals with exquisite eyes - its is featured on the coat of arms with the gray crested crane.

After lunch, we headed to the Kazinga channel for the boat ride. The Kazinga channel is a 41 Km natural waterway that connects Lakes George and Albert in South-Western Uganda and is home to hundreds of native bird species. While it was one of the hottest days of the month, we did get to see some amazing birds- kingfishers, sandpipers, egrets, herons, eagles and even a few flamingoes. The ‘biggest’ surprise was the hippopotami – apparently they spend the entire day in water and graze at nights. They seemed pretty shy and would duck completely into the water as the boat crossed past them but our guide warned us that they could easily topple a big boat when aggravated. When we got off the boat, we visited the Mweya Visitors Center which has an interesting museum – several displays on the geology of the area, bird species, skeletal remains and stuffed animals. One box I found quite curious was neatly organized and labeled – animal dung from the various animals in the park!

We had an excellent time at QENP and were happy to have seen 3 of the ‘big 5’ (in safari terms, lion, leopard, rhino, elephant and wild buffalo). The return trip was only slightly better since our seats were in the last row !

QENP 2

Day 14 - M & M and Eminem

Fridays are usually clinic days in ID and I spent the morning in HIV clinic. The HIV clinic was better organized and I got to use the new standardized forms for monitoring HIV patients. It has information for adherence, lab values, prophylactic meds, family planning and routine preventive medicine – I believe this will make outpatient visits in the future much easier. I also learnt about the various drug regimens they use here – CBV, EFZ, TAF, 3TC – quite an alphabet soup!

Post mortem conferences are usually held on Friday afternoons. While we were waiting for the conference to start, I was chatting with one of the residents and mentioned that we had a similar session back in the US called the ‘morbidity and mortality’ conference, in short ‘M&M’. The resident asked incredulously ‘so you have named it after the singer, Eminem?’ Unfortunately, the conference started and I did not have the time to correct her!

We are off to the countryside tomorrow - Happy weekend !

Streets of Kampala

Day 12 - Fang-Fang and Rolex

Being a vegetarian, food is always an issue when I travel. I am happy to report, not even the slightest concern here. They eat simple here - rice, beans, posho (porridge-cake made from cornmeal), cassava, 'irish' potatoes,collard greens, matoke (mashed plantains) and g-nut sauce ( peanut sauce) with fish or goat curry. Lunch or supper is a combination or all of the above and I must say with the exception of the matoke (and the fish/goat curry), I find rest of the meal tasty. It is quite filling and leaves you hunger-less for atleast6 hours afterward.

We have been eating traditional Ugandan food for lunch at the Hospital cafeteria and usually venture out for dinner. Most of our culinary adventures have had happy endings - we have tried two Indian restaurants - Haandi and Pavement Tandoori, a Pizzeria - Mamba Point, Continental - Crocodile and American Deli - Ranchers. Last night, we discovered a scrumptious Ugandan secret (imagine drum roll) the Rolex. Its a freshly made roll of chapati and omelette, made to order by your friendly neigbourhood street vendor, that is absolutely delish ! I wish we had taken our camera to record our rolex guy making the rolex - he has about 1 square feet of space to share with a coal stove, all the veggies (onion, tomatoes, cabbage) and atleast 3 dozen eggs :)

Tonight's dinner was a different story - we walked almost 30 minutes to try chinese food at Fang Fang. The restaurant is quite big with artificial plants and calligraphy signs hanging from the ceiling, a three level water fountain and silk upholstery. The menu was long but we narrowed our choices to sweet corn soup, vegetable dumplings in garlic sauce, chilli beef and egg fried rice. We were sad to find the dumplings were doughy and the fried rice somewhat sticky. The soup was bland and had no flavor. The only positive factor was the attentive staff. So there it was - our good and the not-so-good culinary experiences on consecutive days.

Rolex

Day -10 Bitter lemon

I started my new rotation today in the infectious disease ward – female side. Apparently there are one too many patients in the ID ward for just one team to manage everybody and so there are separate teams for men and women. I feel less like a visitor this week although I still don't know anything besides the medicine department, the outpatient clinic, the wards and the library. Rounds today was really interesting - I have never seen so much collective pathology in one area. There were several patients with Cryptococcal meningitis, Tuberculosis, Kaposi's sarcoma and few patients with suspected toxoplasma. I even saw this one young girl slowly recovering from tetanus.

Later in the afternoon, we went to Garden City, Kampala's most happening mall. It houses a casino, supermarket, food court, a movie theater and few restaurants including a rooftop bar that is a bit too pretentious. We had dinner at Ranchers - an American style deli/steakhouse. There is not much to say about the ambiance as the gingham-tablecloth covered tables are placed in the corridor surrounding the store but the food was fresh and delicious. I even got to try bitter lemon !

Bitter lemon

Day 8-9 Weekend surprise

It was a beautiful morning today – fluffy white clouds and blue skies all around. We had a lazy brunch at Crocodile ( a continental restaurant in Kisementi) – Spaghetti Carbonara for me and Tilapia for Sandeep. The food was actually quite good and a welcome break from the rice and beans we had been eating all week. We then spent the rest of the afternoon browsing the local grocery stores and craft stores. On our way back, we dropped in at Adrift, a company that specializes in rafting expeditions on the Nile- they assured us that no swimming experience was necessary to go rafting. After some consideration, we decided to go ahead and made reservations for the following day.

The Source of the Nile was much debated until the mid 19^th century when European explorers such as John Speke and Henry Stanley finally proved that the Nile flowed from Lake Victoria. Jinja is a local town on the banks of Lake Victoria, from where the river begins its 4000 mile journey across the Sahara desert. Adrift picked us from the guesthouse around 7:30 in the morning and we were in Jinja by 9:30. The skies were overcast and there was a light drizzle but that did not stop us. Still, the water felt warm. After a couple of practice runs, we headed straight for the rapids. I fell out of the raft twice but was rescued within seconds by the rescue kayakers. We flipped twice – the first a practice session and the second on a Grade V rapid! (BTW, rapids are graded from I to VI with V and VI being expert levels). Sandeep managed to stay on the raft except when we flipped – he really seemed quite good at it. Overall, we rafted 31 Kms and scaled 11 rapids in 6 hours under the expert guidance of our guide, Cam. It was an amazing experience even though we were both exhausted and sore the next day.

Next rafting trip - Colorado river and someday, the Zambesi !

Weekend surprise

Day 7- Passion fruit and Pulmonology

It has been raining intermittently the last 3 days here and the roads and sidewalks are covered with red soil. All this water has made the trees, plants and shrubbery appear greener than normal. Every morning, a flock of squawking birds (Hadada ibis) and monkeys come out to feed in the trees surrounding the guesthouse. We have freshly squeezed passion-fruit juice for breakfast along with plates of pineapple/papaya and toast with plum jam. I really could get used to this pampering.

At the hospital, I went to the post mortem conference today. The case presented was a 24 yr old male with recently diagnosed HIV and Hepatitis C who presented with altered mental status. He was admitted and started on treatment for hepatic encephalopathy only to be found dead 2 hours later. The autopsy showed aspiration as the immediate cause of death but also found disseminated tuberculosis that was not diagnosed ante-mortem. At the end of the discussion, the consultant concluded that every HIV patient in Uganda had tuberculosis unless proven otherwise.

I was planning on doing pulmonary next week - the thought of active tuberculosis lurking behind has me thinking twice :)

Passionfruit and pulmonology

Day 5 - Milligrams and Micromoles

My one regret is not having brought my PDA along to convert all the lab results from micro and milli moles to mg/dl. Imagine my surprise when I calculated the urea in a patient at 432 mg/dl and creatinine 24 mg/dl – needless to say, the patient was encephalopathic from obstructive nephropathy with severe bilateral hydronephrosis. We talked to the family about emergent dialysis but they could not afford it. The poor man passed away that same night.

I guess this is one reason why not many physicians are interested in Nephrology here. Dialysis treatments are exorbitantly priced for an average Ugandan family and transplantation requires travel to either India or South Africa. I have been told there are only 25 patients on hemodialysis at Mulago and only 4 dialysis centers in the whole country. I suppose, our patients are really fortunate in the US in that they are treated regardless if they can afford it.

Day 3 - Mulago

Kampala is a city of hills and the Makarere University -Mulago Hospital sits on Makerere Hill. I believe the Mulago Hospital has about 1500 beds and serves as the National Referral Center for the entire country. I was planning on starting with Medicine wards but soon found out that the wards in Mulago are organized based on specialty – ID, Nephrology, Cardiology, Pulmonology and such. Each unit is staffed by a registrar and consultant, couple of residents, 1-2 interns and 3-5 medical students. The interns pretty much do the scut work here and take call every 6-7 days. I still have not figured out the whole system yet but it seems that patients present to the ER (called Casualty), get admitted to a holding ward for 24 hours, where the medical resident finally determines which specialty the patient would be finally admitted. It sounds difficult but somehow they make it work.

Rounds here are a bit different from what we are used to – there are no flow sheets and labs are done only at admission. Most management decisions are based on clinical assessment and I find myself having to retrieve my medical school memories for physical exam signs and findings. One medical student asked me why the patient had a loud P2 if he only had systemic hypertension! They measure blood pressure, pulse and weights on all patients during rounds and the family members (gu) estimate the intake-output. Patients are responsible for their meds and have all oral and intravenous medications at bedside -I suppose that’s one way to make sure your patients are taking their prescriptions.

Makarere and Mulago

Day 2 - Kasubi

We spent our first day in Kampala visiting the Palace-turned- tomb of Kabaka (King) Muteesa I in Kasubi. He was apparently the first to invite the British and helped many pioneers in their expeditions. The palace is a circular hut with a thatched roof,made of grass and reeds that was initially constructed in the 1880s, inside which lie the tombs of Muteesa I and 3 of his successors. Our guide, Joseph, told us that each King had 50+ wives just to disprove any favoritism among the numerous tribes! The hut is covered in bark-cloth (made from the trunk of fig trees) which apparently was used as clothing and upholstery until the 19^th century. The royalty is still respected and liked by the Baganda (people of Uganda) even though the present King (Ronald Muwenda Mutebi II) has no political powers.

We then ventured into the city center equipped with the Lonely Planet guide to East Africa and several downloaded maps of Kampala – sadly, that didn’t prevent us from getting lost! We somehow ended up in the taxi stand, and were shuttled back and forth for about an hour - I’m sure pointing to the map and asking for a restaurant in miniscule print did not help! We eventually made our way to Kampala Road, which runs right down the city center and is home to many Government offices. Kampala road is broad and lined with shady trees and unlike most other roads in Kampala, without any potholes! One big surprise were these gigantic Maribou storks that had nests all along Kampala road – they seemed least bothered by the traffic or the gawking tourists ;)

Kasubi

Day 1 - Olyotya

Olyotya from Uganda ! I know, I know – I said I would send regular (daily) updates on life in Kampala but trying to get a decent internet connection has been difficult. The guesthouse we are staying, is supposed to have 24 hours wireless internet, but apparently it stopped working last week. So bear with me, as I update you periodically (as and when the internet is available).

Our Emirates flight to Dubai was extremely long – the only ‘bright spot’ being the Aurora Borealis as we passed the North Pole – shimmering green and pink clouds of light that was outside our window for hours. Crossing the Gulf of Eden and Red Sea, we finally landed in Entebbe on Saturday afternoon time.

Olyotya