Liz's Medical School Journey

Hujambo! This is the story of my trip to Uganda, which actually begins long before Uganda. About four years-ago, I returned from Peace Corps and my dad began traveling to accredit international laboratories as part of his work as a pathologist.  He invited me to join him again and again, and as the lives of two busy adults often interplay, we found no synchronicity.  That was… until my recent 3-week vacation between my 3^rd and 4^th year of medical school.

My dad will tell it another way.  He’ll say that he took my brother to Kenya last year, so he had to take me to Uganda this year.  But truth be told, it had nothing to do with the destination or sibling equality.  It was pure chance of timing, but after four years of failed timing, I’m glad it finally came to be.  After all, didn’t I (his future physician child and returned Peace Corps Volunteer) deserve to share the family experience of international medical work?

The saddest part of our trip to Africa was the beginning.  My dad and I found out days before leaving the country that he had $3,000 stolen by an African internet scammer.  I won’t go into details, but this is the type of problem that Africa is well known for, unfortunately. And to make matters worse, the day before we left the country there were violent riots in our destination city. Five Ugandans were killed and flights were cancelled.

As we left the USA, I wasn’t sure what was awaiting me in Uganda. After a long 13-hour sleepless flight, I saw my first glimpse of Africa, the yellow, dusty landscape of Addis Ababba Ethiopia. Our second flight took us to Uganda, with contrasting lush green hills.  We flew down over Lake Victoria, and I had a wonderful view.  I was expecting clouds because it was “rainy season,” but all I saw was gorgeous sunshine with cool breeze.

There was no difficulty getting visas, or getting to the hotel.  And on our way into town I saw one of the most impressive things of my whole trip to Africa – a guy with about 50 live chickens driving a motorcycle!  The chickens were flapping, giving the impression that the “chicken-cycle” was a live creature, half human and half wings.

We hired a driver named Mousa (pronounced “Moose- ah”) to take us around Kampala.  We stopped at a craft market, supermarket, the parliament, Makarere University and “Old Kampala” with its impressive Gadaffi Mosque.  We didn’t go inside since Bin Laden had just been killed.  However, the atmosphere in Kampala seemed too caught up in its own political unrest to care much about Bin Laden.

The next day I accompanied my dad to the research laboratory. The political situation did not deter us from the trip’s purpose.  The lab was a research laboratory dedicated to HIV, and their biggest project was developing an HIV vaccine currently in stage 1 trial.  The director told me he feels in about 15 years we’ll probably have an effective HIV vaccine, at least for the African strain of HIV.

Amazing, isn’t it?  All the work that goes into developing a successful vaccine is astounding – freezers, energy to store specimens, all the specimens extracted by hands, volunteer patients, years of dedication, etc.  To respect all these efforts we ought to feel honored as patients able to get annual flu shots (and other vaccines).

Yet I know so many people who don’t even make the effort to get vaccinated.  Do it!  Vaccines are miraculous, in fact so miraculous that I might even overlook the cost of my recent vaccines for Uganda (which I recently discovered is not covered by my insurance).

I observed my dad while he did his work, and asked lots of questions about the research.  Then, I got my own personal tour of Makarere University medical school and public hospital. It felt similar to my experiences touring the public hospital in the Dominican Republic.  Room after room of patients overflowing onto the floors, warm spaces with scarce plumbing, doctors and medical supplies.  The main difference were individual specialty departments for diseases common in Africa like “Sickle-Cell Disease” and “Burkitt’s Lymphoma.”

Uganda met my expectations as a developing country in political turmoil, with very little tourism.  However, I didn’t expect to love the culture as much as I did, especially after having $3,000 stolen.  Yet my experience with Ugandans was friendly and polite, and I loved our conversations.  I felt it was easy to ask people about everything, and they seemed excited to tell me about their birds, politics, weddings, lack of cemeteries, etc.

Ugandan cuisine was delicious – soups, goat stew, mashed plantains, peanut butter sauce and tropical fruits.  I tried grasshoppers and even those were delicious.  Seriously- imagine buttery-cheesy pop corn.

And after the inspection was over, dad and I went on a safari to the national parks, overflowing with animals which are crowded into small confines by the growing population.  Villages shared fence-less borders with the land that was once all home to elephants and lions.  And chimpanzees watched me as intently as I watched them.

I found myself excited by the natural beauty, and the birth-land to humanity. I want to go back, and maybe somebody as a physician I will.  After all, it seemed like every American we met had some connection to health care or public health projects.

Sweat drips down the side of my face.  I do not move, even though it tickles.  I am wearing plastic gloves covered with starchy-feeling powder.  I am in a cement box with a tin roof, and surrounded on all sides by mint green walls.  This is not a clinic, but momentarily I am trying to transform it into one.  I have my stethoscope draped across my shoulders, a sign of my medical training (they told us that white coats would be much too intimidating).

So instead of the usual outfit and setting, I am focusing on acting kind and treating my patient with a lot of respect, something I know is lacking at the other state and rural clinics.  I leave the room to let her undress and I knock before I come in.  I can tell she is not used to this.  In my best Spanish I try to gently explain everything, like my OBGYN at home.  “Have you had a pap smear before?” “I’m going to tell you what I’m doing, and it won’t hurt.  Just pressure.”  After all this comes the moment when I can’t wipe my own sweat.

I lean over her with the plastic gloves and jelly covered fingers holding a disposable speculum.  She’s on a camping cot, a poor stand-in for a hospital bed.  The cot hovers about a foot off the floor, so I am leaning and squatting.  I have a small flashlight to guide me, and the presence of a 4th year medical student, Phil, who is a wonderful teacher.  She’s very matter-of-fact without any complaints while I’m doing her pap smear.  Three brushes from different areas that I smear in order on a glass slide.  The final brush must go into the cervical opening.  Then, I’m done.  I carefully move the brushes and glass slide.

I leave the room quickly- to spray the slide with hairspray.  This final step is oddly different from the USA where pap smears usually go in liquid preservative.  But my first pap smears are in this hot, mint green world, where I’m not only struggling to focus on my new skills. I am also trying to ignore my sweat, my mosquito bites and stomach cramps.

In these conditions, I’ve had many firsts in medicine.  My first time removing stitches from a motorcycle accident victim.  My first time unwrapping a finger that’s been half-way severed across the knuckle with a machete knife.  We examine it and confirm that the extensor digitorum tendon has been severed. My first time pulling tobacco out of wounds.  My first time hearing murmurs and Mobitz Type I.  My first positive shifting-dullness test.  My first time watching teeth being pulled.  My first time interviewing patients in Spanish.  It’s exciting and sometimes scary.

Most of the children have never been to doctors like us.  Our digital thermometers, metal odoscopes and stethoscopes seem like needles to them, and I flinch as mom has to hold down her screaming child so I can confirm an ear infection or skin rash.  I am trying to comfort- I show them the light, I do it to myself and to mom.  I tell them it won’t hurt, but to no avail.  To them it’s still a scary needle-like metallic glean.

The best part of living with my patients in a small community is seeing them often.  There is a sweet guy who was concerned about his prostate- now he’s smiling and hugging me on the street.  There is a little boy who I made cry, so hard that he vomited.  Now he’s started antibiotics and he’s playing, and waving at me as if to say, “Thanks, I forgive you for that torture.”  My host sister’s friend had her tooth pulled and she says she feels so much better now.  Overall so many people look familiar- they smile at me, and I know I have seen them in clinic.  I can’t remember all the details, but I do know the faces, and in this small town, it’s easy to feel that the patient-doctor relationship is more than a 30-minute visit.

As I get ready for my last days in Sabana Rey, what I have come to love most about this community is what I originally feared the most.  It is the conditions of poverty that force everyone to be so much closer than is comfortable in the USA.  I have experienced closeness here like I only share with my husband at home.  For example, my bed in the Dominican Republic is a full-size bed, and it fits three volunteers sideways.  What I feared would be uncomfortable has now become a source of great enjoyment.  I love sharing this bedtime where we talk about everything- whatever is on our hearts after a challenging day.  We don’t hide anything, and I feel so comforted and protected.

My host family and many of my patients in clinic have told me that they love me, which are words rarely used in the USA.  Little children hold my hands, and sit on my lap.  It makes me want to share more closeness with my patients, my family, and my friends.  Why is it less awkward to share so many close moments with people in the Dominican Republic who I barely know- than back at home with people to whom I consider myself close?

I wonder how I can bring some of this back in a culture, a city and a profession that doesn’t encourage or allow a lot of time for real human relationships.  Volunteering in Sabana Rey has given me a lot of new things to ponder mixed with new knowledge.  As I prepare to start my second year in a few weeks, I look forward to the fond medical and community experiences that I will bring with me.