Ayilo

Week 2

The pictures are the hospital in Ayilo 1 refugee camp where I spend most of my time.  First is the female ward and second the pediatric.  It gets pretty crowded as although every patient is supposed to only have one caretaker often more family wants to stay or other young children have to stay with the mother.  We also have kids bringing kids for treatment and will admit them without any adult in sight. Yesterday I admitted a baby with severe malaria and the mother had 4 other children with her all of whom had malaria.  The older ones were not sick enough to be admitted but all stayed.  We managed to find 2 beds for the 6 of them and the nurses helped the Mom give medicine to everyone.  Patients and one caretaker get lunch and dinner from us.  The caretaker has to provide any juice or other food. They also have to provide any sheets and the bathroom is a pit toilet outside.  One thing I find hard is seeing feverish kids on plastic mattresses with no sheets. We did get a shipment of blankets this week and were able to hand them out so at least there was something over the mattress. There are no diapers so Mom’s are often outside washing sheets or clothes and I have picked up more than one soaking baby. Had a patient tell me today she couldn’t be discharged as her laundry was still drying. 

One of the advantages of this type of construction is ease of modifications. Yesterday I asked for a window near where we sit and write and today a couple of men came over and made it. No glass or screens on any of the windows but they do have a closing door.

All of October is “child health day”  (yes I know that doesn’t make sense) meaning that any child seen by any health care provider is supposed to get a dose of Vitamin A (to prevent blindness) and worming medicine. Since at least half are being seen for a fever many get malaria screening as well.  While of course I have read about the toll that malaria takes on children it is quite eye opening to actually see the hundreds of sick children. The outpatient department treats 100-150 kids a day for malaria and we usually have a few admitted with severe malaria.  The ones that are not sick enough to get admitted are cured by 3 days of medicine but of course often get infected again. Most do not have mosquito nets.

I have a lot of trouble understanding the Ugandan accent (British influence but definitely different), which causes my clinical officers (CO’s) a lot of amusement. The problem is even when I understand the words I’m not always sure what they are talking about. During morning rounds we got to an empty bed and I asked where the patient was. The exchange went something like this:

CO: “lonca” 

Me: “what?” 

CO: “lonca”

Me: “what”

CO: (very slowly) “long call”

Me: “what’s that”

CO: (laughing) “toilet, long call or short call”

Another one I liked

CO: “Mamma you must wash and smear this baby”   (smear=lotion)

A hospital worker in Kampala died from Marburg fever a couple of weeks ago.  Marburg is a hemorrhagic fever similar to Ebola. MSF is in charge if there is an outbreak around here and is helping with preparations/isolation in Kampala. We have kits with full protective gear and instructions on what to do if a case turns up.  There hasn’t been a second case yet but everyone is holding their breath for another few days. A couple of MSF staff on this mission will be going on a 6 week Ebola mission in West Africa after a rest at home.

If the refugee population stabilizes MSF will eventually hand over the health center where I am working to the Ministry of Health and they will run it.  Right now there is concern that the refugee population may swell in the coming months due to the possibility of famine in South Sudan.  Although the fighting seems to have calmed down it disrupted the normal farming that would have been done. The other concern is the possible outbreak of epidemics. MSF has just finished a huge door-to-door effort to get all children under two in this district vaccinated.  Usually the limit in Uganda, set by the Ministry of Health, is age 1 for vaccines (i.e. if you don’t finish your vaccines by age one you don’t get them) but they extended it to two for this effort among the refugees. The exception is all women of childbearing age get tetanus to try and prevent neonatal tetanus and all refugees get measles as outbreaks in refugee camps are common and severe.

This project now has a staff of15 expats and 145 nationals. The expats are from Somalia, South Korea, Nigeria, France, Kenya, Czechoslovakia, Italy, New Caledonia and Liberia and the US(only me).  It is a very nice group of folks and it is fun getting to know them.  My favorite though has to be a Kenyan woman who is the nurse manager and reminds me of Mma Ramotswe from the The No. 1 Ladies Detective Agency.  She has an infectious laugh and helps me out all the time at work with understanding how to get things done. Being on our own for entertainment we have designated Tuesday as movie night and Friday night as team meeting, games and dancing.  Trying to play charades with an international crowd is interesting.

I miss swimming and water polo but have started playing a little badminton in the evenings right before dark when it gets cool. Have also started going for walks outside the compound with a couple of new friends.  We walk on the main dirt road but traffic is infrequent and it is pretty.  As we were walking yesterday someone yelled out “hello Dr. Megan” which is what everyone here calls me. Turned out to be one of my CO’s that lives close to the compound.

Working 6 days a week and being on call 24/7 is tiring but so far I'm doing well.  The call part has been fairly minimal.  I’m doing a lot of pediatrics, which I love because most of the patients get dramatically better with treatment.  I also get to do things I would not in the US.  Yesterday the midwives asked me to consult on a young woman 32 weeks pregnant with malaria, a kidney infection and very anemic (hemoglobin of 6.1).  Besides figuring out what drugs to use I got to type and cross match the blood myself for a transfusion and retest it for HIV, syphilis, Hepatitis B and C and malaria.

Thats some of the news from Uganda and probably more than enough for most of you!

Adjumani

Oct.  6. 2014

My address for those that have asked: (letters or padded envelopes only as it will be hand carried to Uganda from Paris).  

Megan Ancker

Mission Uganda

MSF

8 Rue Saint-Sabin

75011 Paris

France

Kampala to Adjumani

After a week+ of traveling, stops in NY, Paris and Kampala, I have finally made it to Adjumai in Northern Uganda. The ride here was long, 8 hours, and the last 2 were on a very bumpy red dirt road.  We left at 6 in the morning but still the traffic in Kampala was bad. Two-way streets with lots of traffic, including motorcycles weaving in and out, many with woman on back sitting sidesaddle. Not to mention all the people walking on the side of the rode and the people sweeping the street in the middle and on the sides.  Saw a truck with dead chickens strung on the side, live cows on the bed and men in hammocks above them.  Once we got out of Kampala it was better but we went through lots of little towns with lots of little children walking to school (all in uniforms) on the side of the road.  We crossed over the Nile, which had pretty impressive rapids at that point.  Saw some monkeys and baboons near there.

Finally arrived at the MSF compound, which is in the middle of nowhere about ½ hour from the town of Adjumani, and 2 hours from the South Sudan border. It used to be a school and is quite spacious. Besides two dorms it has an administrative building, a pharmacy building and a building where meals are served and people can hang out. I have a room in the scorpion house (the other house is called the snake house so I guess this is better). The houses are dorms with about ten rooms each that were built as doubles. We have our own room so it is quite spacious. I have a double bed with a mosquito net, a table and chair and a nice fan!  There are male and female bathrooms down the hall with cold showers and flush toilets except the toilet part is missing and it’s just a ceramic basin set in the floor.  At least I will come home in shape for deep knee bends. They do your laundry for you but have to iron everything due to a parasite (the tumbu fly) that gets in drying clothes and causes nasty boils when the larva burrow in your skin. There are ~20 people from all over the world living in the dorms.  I am the only one from the US.  The overall number should be going down though as they have just finished a big immunization project. The weather is surprisingly pleasant with some rain every day.

Northern Uganda is very peaceful at this time and while we live in a guarded and fenced compound there are only pretty basic security concerns—don’t walk alone, don’t go out after dark.  Due to the fighting going on in South Sudan since last January about 70,000 South Sudanese have come to Uganda.  Mostly it is women and children as the men stay north to fight and tend cattle.  The men do come across the border freely to visit their families. All refugees are bused to the Nyumanzi transit center where they are registered, given vaccinations, food and assigned to a tent.  They stay there and within 2 months are relocated to one of the permanent camps which is determined by which tribe they are from.  Luckily for them Uganda is very welcoming to refugees and has donated large tracks of land.  In the permanent camps they all have a plot big enough to grow some food.  MSF is in charge of health in the transit camp and at two of the permanent camps, Ayilo 1 and Ayilo 2. There are ~30,000  Dinka (one of the tribes) refugees in those 2 camps, most at Ayilo 1 where I am working.  MSF has set up an outpatient center and an inpatient center.  The inpatient center, where I mostly work, is just finishing construction. It has a wood frame and some internal brick and cement ½ walls to divide up the different areas.  It is pretty dark as there are not many windows.  My job consists of supervising the 4 Ugandan clinical officers (3 years of training) that do most of the work taking care of the inpatients.  There are 4 male beds, 6 female beds, 9 pediatric beds, 2 ER beds and 2 ICU beds and a separate structure with 4 isolation beds.  “Isolation” is a relative term in that despite instructions the inside dividing walls do not reach the ceiling. I also see problem patients at the outpatient center that is run by another 4 clinical officers and sees 250-300 patients a day.  I am busy learning a lot of new stuff!  The woman I am taking over from leaves Monday so I will be on my own after that.  Well not exactly. There is a MSF Medical Team Leader, who is a doctor from Somalia, running the whole show whom I can consult.  She spends her time doing administrative stuff including meeting with the local minister of health and coordinating with UN efforts. There is tons of malaria here and I have already admitted 3 kids with cerebral malaria, 2 of whom were suffering from severe malnutrition as well. There are also a fair number of kids that get burned from all the cooking fires.  The clinical officers, nurses and translators are all Uganda.  They are incredibly friendly.  I must have been introduced to 100 people in the last few days and they always shake your hand, give a big smile and say “you are welcome”.

The camp where I work is about ½ hour drive from the MSF compound.  2 land cruisers leave the compound at 7:30 every morning to take staff over to the camp for work.  It is a beautiful drive, quite bumpy, with lots of honking at people, goats, cows and chickens to get out of the way. Due to all the rain the countryside is lush with lots of bushes and trees.

October 9, 2014

Today is Ugandan Independence Day so we just worked in the morning. On the way home we drove by the local parade of school children from different schools all marching and singing. Late this afternoon a group of 8 from the UN relief team joined us for a barbecue. We roasted a goat, and when I saw we I mean those experienced in such things, and it was excellent.  They brought lots of side dishes and it was a very fun evening complete with a beautiful sunset. Have met so many interesting people in just a few days.  We are hopeful they will invite us over soon as their compound is reputed to be quite nice.

October 10, 2014

First day on my own running the “hospital”. Fortunately it’s the day the world food bank hands out food, a gathering of thousands, so outpatient visits were pretty light and we only had a couple of new admissions.  I made it and so did all the patients!  The Ugandan clinical officers were wonderful in helping me with a million questions.  Have two new HIV patients who are pretty sick so trying to figure out how to help them.  Can treat their infections but don’t have any medicine for the HIV right now. There is an HIV counselor here who is supposed to get a supply of the right medicine next week.

Would love to send pictures but the internet is pretty slow and I will be lucky if this gets out!