Unexpected trip to Kampala

 Last Monday I woke up with a high fever, headache and vomiting. Called the other doctor here, who came right away, and started me on Cipro after determining it wasn't malaria (I do take prophylaxis).  I was pretty miserable all day--a fever in a hot place is a bad combination. When she and a Nigerian doctor, here on an epidemiology project, came to check on me that evening they decided I needed an IV and to go to Kampala.  MSF doesn't like leaving sick expats out here because if they get worse there are not any options but air evacuation. The next morning they put a mattress in the back of the land cruiser and the doctor and I traveled to Kampala--8 bumpy, sweaty uncomfortable hours.  Got to the MSF compound there, rested a bit, and then one of the staff took me to the International Hospital.  It was quite nice and equipped with it's own airport to med-evac people to Nairobi.  Saw the doctor there, got tested again for malaria and some other things and with still no diagnosis he advised finishing 5 days of Cipro.  I was much better the next day and after resting for a couple of days was able to come back here. Everyone was happy to see me and some of my dorm mates decorated my room with balloons.

Nile River on the way back from Kampala

Close to where I work there is a little shack by the side of the road with a sign saying "drug shop" and these shops are quite common.  People come in and ask for what they want or untrained people help them decide.  This often includes injectable and IV medications although they officially are only supposed to give oral medications.  If the patient doesn't do well they scribble what they've given (if we're lucky) on a scrap of paper and "go to MSF".  We get 3-4 severely ill children a week from them--sometimes comatose.  A mother brought a child in that had had both IM and IV injections and was given 3 different pills to take as well.  My favorite was "Spamicillin"  a combination of amoxicillin and cloxacillin.  While the Ugandan Ministry of Health will shut them down if they catch them they usually just relocate if they hear enforcement is on the way.
One of their referrals was an 8 year old that was brought in unconscious with cerebral malaria. I was pretty worried he was going to die as 2 children with similar stories did last month. His mother kept saying she had no hope but then asking why she couldn't feed him if he was alive. The only lab tests we can do are a rapid malaria test, hemoglobin and blood sugar.  We started him on IV antimalarials, and antibiotics, IV's fluids, did a blood transfusion for severe anemia and after 24 hours he woke up. Quite a miracle!  

Riding home after work one day I was sitting next to a translator who told me his "war story".  He was in Kampala studying computer science at the University, with one year to go, when war broke out in South Sudan. He left school to go home to help his family. He said that at that time he had 30 cattle he was selling off as needed to fund his education.  Due to the war his family fled to Uganda and he lost his cattle.  The family now lives in the refugee camp and he is working as a translator for MSF.  He hopes to save enough money to go back to school and finish his degree.  It’s unclear when or if his family will be able to go back to South Sudan.

Late Saturday afternoon after work a group of us went to Adjumani market to look for material and then to the tailor. Although six white women in the market are quite noticeable not one person tried to beg, push us to buy something or hassled us in any way. While there's not much one would want to buy here the fabrics are fun. We ordered pants and skirts for $11 dollars each and I got my scrubs hemmed for 40 cents. 

I have been going to Catholic church as even though the country is about 40% Catholic and 40% Anglican what's close by is two Catholic churches.  Last week we went to the larger one and got there when the English language service was supposed to start.  The previous service ran late and everyone patiently sat around waiting for it to end.  While we were standing there a group of little children came up to look at us.   Other children started to join them and eventually there were around a hundred of them--just quietly looking at us.  The service is mostly sung and the music is beautiful.

It is the tail end of the rainy season here but it still rains for a little bit most days. One evening we had an amazing storm and we sat out on the porch and watched  lightening in all directions amidst a terrific downpour.  Rainy (malaria) season should give way to dry (meningitis) season by December when it is supposed to get unbearably hot. Lately there has been an increase in the number of bugs around and we are talking big ones!  There was a huge flying one in my room one night and it wasn't clear who was going to die first from the insecticide spray I was spraying while chasing after him.