Tuesday, March 31, 2009

Clinic #4: Mityana

This was going to be our final clinic, and we knew it. It was a little bitter sweet loading up the luggage of medications for these final two days. Ok, it was mostly sweet, since I know I was darn tired of lifting and pulling 7 bags through the back windows of the bus and lugging them over uneven dirt sidewalks.

The night before our first day, we brainstormed on how to make this one run most efficiently. We had definitely run into some speed bumps along the way. So, we formulated a plan to try and get through all of the orphans and school kids as well as the adults in the community. So, with a plan in hand, we started the clinic early.

Things ran really well. Partly because we finally knew what we were doing. Partly because Joshua and Paul, who run the orphanage, were very capable leaders [in the photo below, Joshua is on the far right, with Paul in the yellow shirt]. We arranged a line of children and the NPs saw them. We arranged a line of adults who saw the nurses for vital signs. Then they arranged in a line outside the door and waited for the PA or me to be free. By this time, we all had our own translator. I worked with Nicholas, a very bright and caring young man who one day will be a world-class economist. However, I was lucky enough to have him as my translator and friend. By the end of our week together, he could diagnose arthritis, give medication precautions for Benadryl and educate people on conservative treatment of low back pain. He was a lifesaver.

We were seeing a young mother who was holding a baby who was about 5-6 months old. All of the sudden, the baby's arms started shaking. Nicholas jumped up and translated for me: "She says this has never happened before - what's wrong with the baby?" I looked at the baby. His pupils were fixed and pinpoint. He was unresponsive to painful stimuli. He was shaking. He had a pulse. I grabbed my sister-in-law, the NP: this baby was having a seizure. {He only seized for a few minutes. Needless to say, we recommended that the mother take the baby to the hospital to get evaluated for a seizure disorder.

We saw about 250 people in 2 days. We were running out of medications at the end of the second day. Mostly over-the-counter things like Tylenol and Omeprazole. But, we did what we could, and the people were very thankful.

It was sad to pack up at the end of the day on Thursday. We said goodbye to the people in the town. We said goodbye to the kids. We eventually had to say goodbye to the translators...our new friends [here's a picture of some of them with some of us]. But, we have great memories and thanks to Facebook we are still keeping in touch, all these miles away. I have no doubt that some of us will go back to Africa, perhaps even Uganda. Some of us will work on helping the poor and under-served right here at home. All of us have been touched by the warm hearts of the people of Uganda, and that will leave a mark on us forever.

Monday, March 30, 2009

Clinic #3: Canaan

For the next two days, the group split up. The 4 providers (me the MD, a PA and 2 pediatric NPs), along with another NP who was running the pharmacy, would go to the orphanage in Canaan. There, we would see the 100 orphan kids along with the 200 kids who come in for school there. Now, that's a lot of kids, but we had a plan. The PA and I would screen the kids with a quick eye-ear-mouth-heart-lung-skin check. Anyone with any issues would go to see the NPs (since they do peds for a living) and get meds from the pharmacy. We'd give worm meds to the appropriate kids (ie, kids with big bellies).

This started out great. We had Paul, our Ugandan friend and translator, helping give out worm meds after we checked the kids. The meds taste awful, so he'd tell them in Luganda, "Be strong!" and make a chomping noise. Then, he'd give them a yummy vitamin to follow it up with. We laughed every time we heard him say, "Be strong!"

Then, at about 10:30a, I noticed that more and more adults were congregating in the big main room. The main woman at the orphanage came over and asked me when we were going to see the adults. I nearly bit her head off. We had 300 kids to see, when exactly did she think we were going to see the adults?? And we had never planned to see any adults, so what would make her think this was part of our day? I asked how many there were, and she said about 27. I said I would start seeing them after lunch. I figured I could see them all in the 3-4 hours after lunch, and let one NP and the PA do the congo line of kids. We weren't sending too many back for treatment.

At 11a, I see a ton of adults now, hanging around. I marched over the lady and saw that her sheet of paper, previously 2/3 full on one side is now full of names, front and back. I'm livid. I just told her that we weren't supposed to see any, and now she's adding on names?!?

"What's going on? How many people do you have?" Before she can answer, I continue. "No more. I will see as many as I can see, but I cannot see everyone. No more." "No more?" she asks. "NO. MORE." I state firmly.

I grab Paul to help me translate; he gives his "Be strong" strategy to Seggy, our main point-person in Uganda.

To make a very long and painful story short(er), I saw 55 adults in 5 hours. We got a 20 minute lunch consisting of Coke and Poptarts. We saw 160 kids. We saw one baby with meningitis that the parents didn't want to take to the hospital. We were exhausted, emotionally and physically.

When we finally got home, dirty and tired, we found out that the other group had a fairly relaxing day in Waka Waka - eating lemongrass fish cooked by Carl the South African, playing with kids at the orphanage, and talking with the orphanage staff about their needs. Granted, they did arrive at the Waka Waka clinic to an angry mob of 100 people who thought they would get medical care (miscommunication). They triaged those people and had about 20 for us to see the next day, as we switched sites. The providers went to Waka Waka and the rest when to Canaan the next day. We didn't get lemongrass tilapia, but we did get to see some monkeys running around Carl's yard. [this is a picture on the way to Waka Waka...Lake Victoria is in the background]

Next up: Mityana.

Monday, March 23, 2009

Clinic #2: Seeta

Our second clinic was in a place called Seeta. Pronouced See-et-uh. There we met Betty, who runs a school for the surrounding children. It's not an orphanage, but many of these children come from vulnerable families and wouldn't have the chance to go to school if not for Betty. Most of the children have classes with her and the teachers in the morning and afternoon. Some of the older kids return to her HOUSE in the evenings for additional classes. (Here's a pic of some kids outside the school.)

There is one building for the school, divided into 4 sections. Each section holds two classes. The classes are divided by a chalkboard -- one teacher writes on one side, the other writes on the other side. The kids face each other, but can't see one another because of the chalkboard. The whole room is about 8x16 feet. Pretty small once you put a chalkboard and 2-3 benches on each side.

We went to the "clinic" after meeting Betty and the students at the school. One of the community leaders lent his house for us to hold the clinic in. We had 2 rooms -- one for seeing patients and one for the pharmacy. Each of us 4 providers took a corner of the room. We put 2 chairs in each corner and a coffee table dividing the room in half.

At this clinic, we learned that each provider needed her own translator. Waiting for one to free up was not working. We became more efficient in seeing patients this way. We also set up our pharmacy with several chairs so people could wait for their medications. We learned that it's essential to have a dedicated translator in the pharmacy.

We saw about 180 patients over those two days. There was some chaos, but overall it wasn't bad for our first real clinic. We had a very dehydrated baby that we mixed up some oral rehydration solution for. We also had a baby with suspected pyloric stenosis versus severe reflux. He would vomit after almost every feeding. He had gained only 1lb in the 2 months since birth. He should've gained over 10. His mother was also have severe pelvic pain after having a C-section.

We arranged for them to go to the hospital. We actually took them ourselves on one of our final days in Uganda. Mom ended up having a severe bladder infection (thankfully nothing worse!), and the baby was going to be checked by a radiologist a few days later to look for pyloric stenosis. I'll have to check to see if we have an update on the little guy.

Seeta was a good way to start things off. We learned how to pack and unpack all of the meds into our 7 suitcases. We learned how to maneuver all of the suitcases on and off the bus. We'd have to do this every morning and every night, so that we could keep the meds safely with us.

The next clinic was supposed to be more low key. Half the group would go to Waka Waka and the providers would go to Canaan. Then we'd switch. Let's just say it didn't turn to be as "low key" as we anticipated.

Saturday, March 21, 2009

Uganda - Clinic #1

Our first clinic in Uganda was in a Kampala Slum. Kampala is the capital of Uganda (see map). There are about 30 million people in Uganda; about 1.5 million live in Kampala. I'm not sure exactly where we were in relation to the rest of the city, but we turned off the main (paved) road down into a dirt road. All around the mini-bus we saw little stands set up. People were selling tomatoes, potatoes, bananas, shoes, etc. Children were running around and people walked, shopping for goods.

We travelled a bit down the main dirt road (which was only wide enough for the mini-bus), when all of the sudden the driver stopped. Apparently we had arrived. The building was made of concrete and, like most things in Uganda, adopted the red hue of the dirt. We piled out and went in. Inside the main room (which stood about 50x30ft), approximately 25 people sat on plastic patio chairs. There were 2 tables in front and some chairs up there. We had carried in the 7 suitcases that contained our "pharmacy" -- medications purchased both in the States and in Uganda that morning.

We were ushered to sit in front of everyone, behind the tables. We introduced ourselves, and Seggy (our Ugandan partner) told everyone in their native Luganda language that we were from the US and here to provide medical care.

We went back to the "treatment rooms." We discovered that this building was probably a type of hostel or dorm. The rooms were small -- about 10x6ft -- with barely enough room for a twin bed. Myself and the PA (who also saw adults) took one room. The two pediatric NPs took the other room. Across the hall from our rooms was a slightly bigger room -- about 15x15ft, with a queen bed. We unloaded the drugs on to the bed and left a 3rd NP and a lawyer to figure out the pharmacy.

The 4 providers looked at each other and got to work. We had enough Purell for a small country, and we used a ton that day. After a few patients, the PA felt comfortable enough to look for another room. Having 4 adults in that tiny space was too much. Thankfully, she found another room down the hall.

We had some translators bouncing between rooms to help with the people who didn't speak English. School is taught in English, so anyone who spent any significant amount of time in a classroom spoke fairly good English. However, most of the people who we saw didn't have much of an education.

The saddest case I saw was Ronald. He is 26, and his English was amazing. He had served in the Ugandan Army and was stationed in Iraq. He sustained an injury to his left eye in 2003 and was sent back to Uganda. He was discharged from the military, but his vision continued to decline. He came to me with a letter from a Ugandan ophthalmologist. She described his eye and the growing pressure that was occurring. She had performed a few drainage procedures, but the fluid kept returning; he needed a definitive procedure if he had any hope of saving his vision. As it stood, he could see light and dark and basic shapes on my exam. He couldn't count fingers in that eye.

The letter went on to explain that there were no doctors in Uganda who could perform the procedure. They hadn't been trained to do it. She asked for help so that this young man could get a place that might be able to help him. My guess is that the closest facility would be in Nairobi.

I introduced him to Julie Clark, the leader for doma. We had travelled to Uganda with doma so Julie could try and figure out how doma could best partner with orphanages and community groups to provide medical care to orphans and vulnerable families. Julie took down his name and contact information, and her hope is that we can raise money to get him to Nairobi for further care. He was very thankful, and he came back to my room twice to express his gratitude. He was hopefully that we might be able to provide some way for him to save his sight.

We saw just over 200 people in 5 hours. We had to turn about 30 people away because it was getting dark, and we needed to be on the road before it got too late. There was such a need for basic primary care -- blood pressure monitoring, nutrition counselling for new mothers, STD testing and treatment -- we probably could've spent all week there and barely made a dent in the population that lives in the slum.

However, we had 3 more locations to visit before our trip was done. Next up: Seeta.

Monday, March 16, 2009

HWC Recap

So, we had a successful event on March 1.

Caitlin rocked the house with an amazing performance. Jesse Spencer on violin and James Denton on guitar provided excellent support. It was magical. I hope to have a video up soon.

Kevin Pereira and Alison Haislip were awesome co-hosts. They put together a video of their experience, which you can find here. I hope you like it! The best part: you can make a donation from the page to support the great work at the Los Angeles Christian Health Centers.

Kevin Parry, of wireimage, did an amazing job photographing the event. You can check it out at the wireimage site here.

So far, we've raised almost $28,000 for the clinic! This is amazing, especially given the current economy. It reminds me once again how generous people are. We had so many people donate auction items, donate their time to help organize the event, and then donate their money via ticket sales and auction bidding.

A big thank you to everyone who came out to support us! Remember: whether you donate to our charity at the link above, to another charity, or whether you give of your time to help those in need, we can all make a big difference if we just take the first step to care.