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Holly Doyne
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Herd Immunity

Holly Doyne Posted on 2020-10-15 by Holly2020-10-15 3

This is a rant – delete at will.

Before I even go down the trail of why this new plan of the US White House is immoral, obscene, and not even remotely ethical – let us talk about herds.

Herds are groups of bovine or related species.  There is absolutely no question in the herd that all are not equal, not all members have equal chance at survival, that there is limited ability to protect the most vulnerable members of the herd. It is Darwin at the finest. The weakest members can and are left behind. They are brought down by predators while the rest of the herd escapes. A balance of nature – so to speak. If a member of a wild herd gets a serious infection – it dies. A newly born member of the herd, if physically “defective” dies. The elderly members, especially those past reproductive age, who can’t keep up with the herd – die.

As humans – we like to pretend that we are not herd animals. We care for our young, long past the point in most societies where children born with defects are left outside for the elements. We have antibiotics and treat all those infections that we can. We don’t routinely discard members of society who are past childbearing age so that there is enough food for those who are perpetuating the species (not going down this rabbit hole at the present – as there are way too may locations in the world where grandparents are raising their grandchildren). We pride ourselves on care and respect for our elderly, elders, and aged.

Or, I thought we did. That we were not a herd.

So why would we pretend that it is perfectly all right for us to say that “let the disease spread while those who are vulnerable are protected”?

Is this idea finding root now because one person has survived his episode of COVID-19 with a level of medical support that is not available to the vast majority of the US -especially those of us who live in areas where the hospital infrastructure is old, crumbling, inadequate, and lacks even remotely current ventilation standards?

Is it because the vast majority of deaths thus far have been in aged care facilities, nursing homes, residential homes, poor neighborhoods, essential workers of color? Do those in certain places assume that their whiteness, their economic status, their privilege will protect them? Their families.

Is it because it is easy to assume that SARS-COV2 is a one and done? How easy is it to ignore the reality of long-haul COVID and the thousands upon thousands who will be living with the consequences for years.

Does someone, somewhere think that we can identify who is vulnerable? That we have enough trained personnel to staff our hospitals and care facilities to take care of that 60% of the population getting infected that it will take?

Are we willing to accept that – with our current best medical care available to all – that the death rate is about 4%? That, my friends, translates to 12 MILLION people dying in the US. Our current US death count is just past 220,000.  Look around you – that means that 1/25 of those you know would be sacrificed to herd immunity. Does your family – including partners, parents, off-spring, siblings – number 25?  Who are you willing to let die for the cause? How about your friends, colleagues? How about you? Are you willing to die to promote herd immunity?

This disease is real. It is deadly.   All those scientist who signed the Barrington? All I can think of is that they don’t view themselves at risk. That they are sure they can protect themselves. I can play with numbers. But as a physician – those numbers have human faces; dreams, families, futures. Do I, sitting behind a computer and playing with numbers have a right to say – you get to die so that others can have a “normal” life?

The long term consequences of this disease are ugly in human life, in disability, in economic cost. No one who survives an intensive care unit stay ever returns to full normalcy. The idea that political leaders could advocate sacrificing a portion of the US population to death so that they don’t have to wear a mask is ludicrous.

Excuse me – but I think we have been here before in history. When a particular movement decided that cleaning house would be advantageous to themselves, their beliefs, and their economy. The result?

We call it the Holocaust.

And now? Will we go down the same path using a disease rather than ovens?

Think about it.

 

 

 

 

Posted in Medicine, Prose | 3 Replies

New light

Holly Doyne Posted on 2020-10-07 by Holly2020-10-07

is being shed on me.

Ok, I decided to not get too far into the puns. Just to relate that I purchased (thank you Amazon) a new small lamp to sit next to my chair in the living room.

simple, useful…



Oh, of course it was on sale. But it has several important features – like a long cord, two outlets and 4 USB plugs besides having a lovely and bright light which I can direct toward my computer, reading, or stitching.

Otherwise, it has been a Webinar day – starting at 0600 which is too early for any reasonable human being (but corresponds to a reasonable time for the speakers in the Philippines and South Africa). I guess I should just be glad that I am not living in Hawaii… 

Tomorrow will be more of the same. The great thing about virtual meetings? Among others of course, is that I can listen, learn, and stitch or knit at the same time. Multi-tasking!

Speaking of which – 

Baba Yaga
Oct 7 – Trick or Treat
Day 7 – magic potions

 

Posted in Cross-Stitch, Home, Medicine | 2 Replies

UCSF Medical Grand Rounds

Holly Doyne Posted on 2020-10-06 by Holly2020-10-06 2

Since the start of the SARS-COV2 Pandemic, the regular Medicine Grand Rounds have been co-opted by COVID-19 epidemiology, research, medications, treatments, and the like. Thursdays at noon saw hundreds of us linked in by Zoom to hear the latest which was not always the greatest or good news. 

UCSF stands for University of California – San Francisco and is comprised of a hospital system, dental, research, and the affiliated professional schools. Where I did my undergraduate and medical education – University of Minnesota – everything was more or less located on the same campus. As a result, there was a lot of cross-course work between basic sciences, public health, and the medical/dental/nursing schools. Not so here in the Bay Area where much of the basic science graduated programs and the School of Public Health are at UCBerkeley (aka CAL) across the bay and about an hour + by public transportation. 

Prior to the pandemic, there was little participation from my side of the Bay in UCSF weekly educational activities – the travel time just made it prohibitive. Now? Zoom, my friends, ZOOM.

Anyway – the usual Tues Grand Rounds were preempted today by a discussion of current status of COVID-19 as it relates to certain events of this past week and weekend. It was a moderated, good, free wheeling discussion of actions, testing, current treatments, and how you manage all of those. 

The link is here

If, for any reason you happen to think that wandering around (at least anywhere there is ongoing transmission) without a mask – you might want to watch and see a discussion of what happens when people blatantly disregard common sense and medical recommendations.  

(FYI – the rounds are posted on YouTube that evening if you are interested in a bit of pandemic history as it developed in the US).

In more fun stuff – stitching progress –

Day 6 – proper caldron
Day 6 – will probably do over

More on the house
Spooky Sampler 3/9 finished

Posted in Cross-Stitch, Medicine | 2 Replies

CISTM16-P

Holly Doyne Posted on 2019-06-05 by Holly2019-06-06  

Ok, title coding first. This is the Conference, International Society of Travel Medicine, #16. This afternoon was dedicated to the pre-conference workshops. Those included to take examinations could have spent the morning on the Certification Exam. I decided that I didn’t want to do years ago. I enjoy the meetings and I have a network now of fabulous people. But another exam? Done with those, thank you very much. And if I had, had even the smallest temptation, UCHastings and legal exams have thoroughly cured me.

I successfully made it from the airport to the Metro to the meeting hotel. I am still contemplating whether it is better to walk 4 blocks up hill from Dupont Circle, or 8 blocks downhill from Woodley Park. Such hard decisions are the bedrock of life.

The pre-course, mostly organized by my French colleague ran smoothly, so that is one critical item checked off my list. After thinking carefully, I bagged the opening ceremonies and reception in favor of heading to my hotel (the cheaper one a few stops up the Red Line Train to ….

 

Posted in Medicine, Military, Travel | Leave a reply

back in the lounge chair

Holly Doyne Posted on 2018-03-07 by Holly2018-03-16  

in this case it was both dental and the infusion center chairs. Not the most thrilling way to spend the day mind you but my port was functional.

Then I went home and got some sleep….

Posted in Medicine | Leave a reply

CISTM15 – Day 3

Holly Doyne Posted on 2017-05-17 by Holly2017-05-17  

Both the education and the entertainment continued today. Takeda (Pharma) was kind enough to provide both wifi and an app for the program. As a result figuring out where to go and what to do has been extremely simple. It has also made the evaluation of each presentation and panel easy as the usual questions can all be answered on line.

The highlight of the day was a presentation by Jay Keystone (Canada) who has an extremely dry sense of humor as well as a breadth of knowledge in infectious disease. For this conference he was tagged to discuss STIs (sexually transmitted infections in CA/UK parlance often referred to as STD – diseases in American English) as they relate to the travel population. The issues of human trafficking, sex tourism (which includes both men and women on the travel side – men, women and children on the host country side) and disease spread aren’t particularly funny. But confirmation of sexual activity in the younger set (hey – alcohol, drugs, opportunity with fellow travelers and rarely planned) is not the same as the business traveler (older, money, often planned) still leads to consequences in both groups. As a side note – the CDC’s condom information includes the reminder to “open the package.”  Most of us assume a slightly higher level of intelligence in our patients. Our issue is reminding them to take condoms along on the trip.

The business meeting at the end of the day was just about as boring as one would expect. The money is being handled responsibly, awards were given out, the outgoing and incoming executives shook hands and gave speeches (yada, yada, yada).  I stayed through about 15 minutes of the reception then headed to the Tram. My flight is early in the morning (looking at an 0430 cab ride) and grabbing coffee at the airport. It is going to be a really, really long day…..

Posted in Medicine, Travel | Leave a reply

CISTM15 – Day 2

Holly Doyne Posted on 2017-05-16 by Holly2017-05-17  

There wasn’t anything in the 0800 offerings that thrilled my heart which gave me more time to wander from the hotel to the conference center. It also meant being on a slightly more crowded Tram which wasn’t all that exciting.

Today’s sessions covered the range from effects from climate change through public health emergencies in the morning to special groups of travelers, new vaccines and the usual discussions on malaria.  What I didn’t do was attend the Gala Dinner thinking an early bedtime was much more interesting

The cross stitch is now going more slowly. Not surprising as the sections are smaller, starting to curve. This results in ending the fun of long runs of a single color mostly in straight lines which translates to mindless stitching while listening to an audio book. I’m on the last Daisy Dalyrumple (Carola Dunn, author) that is available on Hoopla. But this way I don’t wind up with another half dozen audio books in my “collection.”

16 May 2017

Posted in Cross-Stitch, Medicine, Travel | Leave a reply

CISTM15 – Day 1

Holly Doyne Posted on 2017-05-15 by Holly2017-05-15  

Picking up where I left off yesterday, this is the official first full day of the conference. As professional organizations go, it isn’t all that large. Even with membership from 120 countries, the vast majority still belong to the major four English Speaking (UK, US, Canada, Australia) which makes sense in terms of the founder group and the original focus on medical care for tourists.

The first plenary session addressed the issues of migration from the EU perspective. From the US side of the Atlantic, we read about immigration from Afghanistan, Iraq, Syria but don’t always have a good idea of the actual impact on the towns, cities, villages and countries that are the receiving side. It is startling to realize that there are now countries where 1:4 or 1:7 total population is refugees. Few, if any countries are stable enough or wealthy enough to absorb that kind of population increase. From the medical side, infectious diseases aren’t really the issue; it is trauma along the way and chronic disease that put a significant burden on the receiving country.

I spent a fair amount of the rest of the day listening to vaccine updates or conversing with various other members of the Responsible Travel group.  I also ran into an old French Military Colleague and may just have gotten suckered into working on the establishment of a new interest group.

Taking the tram back was easy but used up the last of the change in my pocket….

 

Fractal

15 Mary 2017

Posted in Cross-Stitch, Medicine | Leave a reply

Travelers, Immigrants & Refugees

Holly Doyne Posted on 2017-05-14 by Holly2017-05-14  

From it’s inception in 1991 the emphasis of ISTM has been the traveler. Usually in fact the tourist. Over the years the membership has expanded both beyond Western travelers and health care providers into areas of travel and those who worked there.  Over the last ten years both regional meetings and involvement in issues of population movements has spread. No longer just oriented on the tourist experience, the organization has been active in environmental impact, expedition, altitude, wilderness medicine in addition to increasing involvement in travel by and problems of refugees.  It has taken a lot of work over the years to reorient even a little from a primary concern with infectious diseases. Face it, we all like malaria. It has a clear path from infection to treatment, lending itself well to Western concepts of curative medicine.

And so, the emphasis of this year’s ISTM conference is on travelers of all kinds, not just tourists.  The young Japanese doctor who is the chair of the Refugee & Migrant Interest group had put together an extremely interesting and educational recourse for those of us who want to maximize our learning for the number of hours spent in Barcelona.

 

Completely aside, this is probably about the 9th or 10th time I have been in Barcelona.  There is always something to explore; a museum, a gallery, an old neighborhood .  I am finally conversant with the Metro and tram system; leaving me to wonder why I had not made much use of it in the past. Getting from the airport to the Congress turned out to be easy and 4.50€ (compared to taxi or private transfer fees).  As an aside another participant asked me in all honesty if a day would be enough to see the city after the conference.  Hum, would you expect to be able to do that in Berlin, St Petersburg, London, Paris, NYC? Perhaps five days might be a good start….

So I attended the afternoon course following my early flight from Munich before going to my hotel.  I had stayed for the opening remarks but bagged the reception on the grounds of being tired.  I’ve free wifi at both conference and hotel resulting in my sparing of our phone budget

 

 

 

Posted in Medicine, Travel | Leave a reply

Last flight out

Holly Doyne Posted on 2017-05-06 by Holly2017-05-06

All of us who fly to Europe are used to the “leave in the evening and arrive the next morning” method of travel. For years when traveling from the East Coast, this meant a flight leaving somewhere after 2000 and sometimes as late as 2230. After moving to the West Coast things changed a lot. If you are stuck (schedule or expense) changing planes in the US it normally means a morning departure. You have to account for 4-5 hours of flight plus three hours of time change. And, if you are smart, at least 2 hours at the change airport just to have 1/2 a chance of making your flight.

Even the direct flights from SFO seem to leave early afternoon. But then, my most recent flights have involved Frankfurt, a plane change in Frankfurt or Copenhagen. Imagine my surprise when informed that the flight to Munich (why wouldn’t I fly direct?) didn’t leave till 2055! Of course, it doesn’t exactly arrive in the morning, now does it? This is not a flight for someone who needs to be able to work the same day they arrive. But it is totally and completely perfect for someone who needs to get there, have a light supper and crash for the night.

Oh, I didn’t say? It doesn’t arrive till 1715 in the late afternoon. For me, this is perfect. I need to be at the SanAK the next day for registration and my conference is Tue-Thurs. Makes complete sense; within the week travel for everyone in Europe and in country.

My studio is almost clean. There are several hundred books and a dozen or so audio books ready to go to the used bookstore. I passed along a couple dozen weaving books to a new weaver and 500 gm of beads to a friend of the Eldest. Between College Guy and myself, there are three bags of clothing to go to the Charity Shop and three baskets of craft supplies are going to be rehoused on my just emptied shelves in the garage.

I’ll have phone and wifi while gone. I will miss the family (no, not you dogs) but not the construction noise. The Eldest is documenting the whole process for me.  Meanwhile, there has to be something interesting to snack on here in the United Lounge (no, I’m on Lufthansa).

Ah!, cookies….

Posted in Home, Medicine, Military, Travel | Leave a reply

International Society of Surgeons

Holly Doyne Posted on 2015-06-05 by Proseknitic2015-06-05

Every once in a while I will still wander to a museum. At least if it is one in which I might have half an interest. In this case, it was the above named societies’ Museum of  Surgical Science. Located at 1524 N Lake Shore Drive, I really didn’t have a clear idea of the length of my hike when I started out.

IMG_0793

It was a bit further than I expected.

The Museum itself is well organized with sections on modern surgical and forensic science, and historical exhibits on dentistry

IMG_0797

 
and pharmacy, even if they were carefully and safely ensconced behind glass.
IMG_0796
but the most fun exhibit of all was the following:
IMG_0798
If you are under 55, I don’t expect you to recognize it. But for the rest of us? Think shoe store….

Posted in Medicine, Travel, Uncategorized | Leave a reply

Being High

Holly Doyne Posted on 2015-05-27 by Proseknitic2015-05-27

Trekking isn’t just about altitude it is also about Attitude.

Of all the seminars today – the one on altitude medicine was the most interesting. When you think about it – a lot of the real fascinating places in the world are not exactly at sea level.

There are the low mountains – NE US, the Alps, Northern Scandinavia, Southern Argentina and Chile. Then there are those higher places which are jumping off points – Nepal for the Himalayas , Cuzco (Peru), Quito (Ecuador), La Paz (Bolivia). Places that large numbers of people live and work which leaves tourists (not just Western but Korean, Chinese and Japanese) with the idea that altitude really isn’t a big deal.

Wrong.

For example – in a mountain climbing population in Nepal the incidence of AMS (acute mountain sickness) was 42%. And these were those who hiked up the mountain, not those who were delivered there by air. On the Lukla to Pheriche the incidence increased to 60%. If there are no rest days and as the rate of ascent increases – the incidence goes up…. Including extra time at 3450 meters, and 14000 feet – decrease to 35-43%. Mt Everest is the highest point, 8380 meters that people walk to. It can be done without oxygen.

Definitions:

AMS – acute mountain sickness – just your basic headache nausea, tired and weakness
HACE – High Altitude Cerebral Edema (think the worst hangover – ever)
HAPE – High Altitude Pulmonary Edema

Dealing with these extremely likely and potentially fatal diseases is like pre-medicating for seasickness. It is not the same as malaria. Taking medication is mostly for comfort, to stave off symptoms and not have one’s trip wrecked. The critical information includes – an honest evaluation (been at altitude before, and what happened, what is the itinerary & what are the options for descending rapidly). The second two above are fatal diseases and death without descent.

Factiods: 15/100000 died trekking in the 1980s. 1/40 who have attempted the Everest Climg died (2900/100,000). In contrast – the Sherpas die not from climbing but from accidents. Westerners die from altitude and injury. 40% of trekkers are organized groups but 80% of deaths occur are in organized groups.

Itinerary Truths – published schedules are averages, and will not prevent all AMS. its ok to get altitude illness – its just not ok to die from it!

    #1 – learn to recognize the early sx and be willing to admit that you have them
    #2 – never ascend to sleep with any sx of altitude
    #3 – descend if symptons are worse while resting at the same altitude.

and now you know as much as the rest of us…

Posted in Medicine, Travel, Uncategorized | 2 Replies

Out the Window –

Holly Doyne Posted on 2015-05-26 by Proseknitic2015-05-26

So that you can see what I see.

toward the river

toward the river

and toward the city

and toward the city

My ten minute stroll over this morning was lovely and the sessions today covered a wide range of subjects. I most appreciated the discussion of the viral mosquito born illness that have spread from Africa, especially in the last decade and the symposium on the long term traveler (think ex-pat, NGO, IVO, multi-year employment).

Then there is the following thought….

and the fourth sculpture is on the wall ready to launch again...

and the fourth sculpture is on the wall ready to launch again…

Posted in Medicine, Travel, Uncategorized | Leave a reply

Quebec City

Holly Doyne Posted on 2015-05-24 by Proseknitic2015-05-24

It is only 1300 and I feel like I have been traveling all day.

Well, I probably have since my flight from DCA was 0600 in the morning which meant a wake-up before 0400 coupled with a no coffee ride to the airport. To add insult to injury – there is no lounge in Terminal A. Makes sense considering it is primarily SW Air, Frontier Air and Air Canada. The lovely woman at the check-in counter informed me that there was a Star Alliance Lounge over in Terminal B, but that I might not have enough time to safely wander over and get back. So there I was, early to the gate area at 0450 (did I mention that the counter was not exactly manned early but security was an absolute breeze) without coffee but in possession of free Wifi.

My connection was through Toronto where I may have encountered the one pleasant immigration agent in the whole Canadian system. She smiled, agreed that I could have put either “personal” or “business” down as the reason for the visit; either was fine. Especially since I had a return airline ticket to the US.

Toronto to Quebec City was Air Canada Express. And yes, a slightly bigger than the average puddle jumper. I had the mis/good fortune to be in the first row of this classless aircraft. My seat mate turned out to be headed to the same meeting. A pharmacist from South Africa, we had a nice conversation about traveling in sub-Saharan Africa. This is her first time attending an ISTM meeting and we have agreed to meet later for lunch/supper/whatever.

It was a taxi to the city: the public bus doesn’t run on weekends. At least it is a fixed rate to the CBD (Central Business District). From the hotel it was just a short walk to the Convention Center where I received a nice bag, various assorted seminar invitations and the Wifi access code. I am contemplating walking back to the hotel about 1600 in order to charge up the electronics and divest myself of the heavy backpack before returning for the 1700 opening…..

Or I could wander the streets with my camera…..

Posted in Medicine, Travel, Uncategorized | Leave a reply

more than 100

Holly Doyne Posted on 2015-04-07 by Proseknitic2015-04-07

miles or km for prescription refills. It really doesn’t make any difference which it is really since it means time, distance and diesel burned round trip.  If mail order pharmacy was a reality I might just indulge, but Germany is not exactly friendly on drug imports and I would have to get an APO box again. Instead, I get to drive to LRMC. I could take the train – minimum of 90 minutes each way followed by 20-30 minutes up hill from the train station.

That is right – put the hospital on top of the highest mountain in the area just to make sure that it is totally and completely off the beaten track. Add in paranoia on the part of the military which resulted in what used to be the front gate being redesigned into heavy metal most closely resembling a river lock followed by closing it to vehicular traffic. Why? I can speculate but it does keep incoming traffic away from the ER. Never mind patient transfer time from the Ramstein Flight Line has significantly increased…..  There is a pedestrian gate which I know to be open at shift change and is usually but not always open at other random times.

I thought about the train for about five minutes. That is about how long it took me to decide that half a day spent collecting refills was enough. If the pedestrian gate is not open then it is back down the hill, 5 km around the mountain and back up to the nearest gate which is as far away from the pharmacy as you can get and still be on post.  I drove the 115 km according to Google maps from my house to find that Gate 3 was closed. Gate 4 was now the entrance and Gate 2 the exit. None of this makes any difference to you unless you know the place.

The nice tech at the pharmacy pulled my refills and filled my new script on one counter trip which I really appreciated. Yes, I understand my refills – coming up on 20 years now. Yes, I am fine with Doxycycline – no I don’t need Primaquin, this will do me just fine.  Since I hadn’t had quite enough pain for the day I stopped at the immunization clinic. One needle (Zostavax) in the left arm, updated shot record and I was on the road to home.

 

 

Posted in Medicine, Military, Travel, Uncategorized | Leave a reply

Botany, no fooling

Holly Doyne Posted on 2015-04-01 by Proseknitic2015-04-01

Never mind it is April Fool’s Day. What happens if you are a German traveling and fall in love with Uganda? You work hard, buy 72 acres of land near Fort Port and set up a guest farm. You employ people, you accommodate visitors. You can even provide German style salads with the meals (although better because everything is locally grown). Kluge’s Guest Farm is more fun to think about that River Blindness so I am not going there for the moment. Rather, if I could get any of the black and white col0bus to hold still for a photo I would be really happy. Otherwise it is like seeing a plumy tail striped like a skunk go flashing by in the canopy. I have hope…

a black and white blur, the best I ever got....

a black and white blur, the best I ever got….

Our program today ran well in spite of the two people with onchocerciasis thinking that there could not be a group of white doctors coming especially to see them. After all, it is the first of April.  Once we had that sorted out, the day went well.

the guilty fly

the guilty fly

But let me just leave it with: you do not want River Blindness. You do not want worm filaria traveling around your body, accumulating under the skin and seeking a home which they may well decide to find in your eyeballs. More cases every year than Ebola (but same with measles, malaria and a number of other miserable diseases).  But then there are those who have taken the mosquito netting and turned it into fish-netting to feed their families. The Health District is trying to get them to stop. My thought is it might be better to find an organization to get them fish netting so they have an ability to use bed nets for their intended purpose.

The rest of the day we spent on medical and herbal botany. I have been entertaining you with animals and birds. Now on to plants, flowers and strange looking seeds…

on to the plants!

019A7060

 

The Tooro Botanical Gardens grow plants and herbs  representative of that which is found in the Albertine Rift. They dry, process and sell herbs to supplement their income and run a nursery of plants for sale.  Our guide today specialized in these plants and explained the use of all. Some of it makes sense, some it pretty far fetched.  It just makes me wish that pharmaceutical companies spent a bit more time looking at the army of botanical compounds and a bit less time running panels of chemicals “almost but not quite identical” to known drugs. That is not how you discover something new…

Artemesia

Artemesia

two monkeys - would have been nice to have my zoom lens

two monkeys – would have been nice to have my zoom lens

organic lawn mower

organic lawn mower

019A7088

seeds on the bottle brush

seeds on the bottle brush

bottle brush - actually pretty soft

bottle brush – actually pretty soft

019A7095

passion fruit

passion fruit

019A7106 019A7110

tree house

tree house

019A7120

Artesema dried and chopped. ready to be made into tea

Artesema dried and chopped. ready to be made into tea

Posted in Medicine, Travel, Uncategorized | Leave a reply

Mixed Challenges

Holly Doyne Posted on 2015-03-27 by Proseknitic2015-03-27

aka – poop, rashes and break bone fever.

Diarrheal disease is a fact of life. Not restricted to the third world, it is a major component of most potluck food poisoning, cruise ship Norovirus outbreaks, and numerous other infectious diseases. For the moment in the Kampala area, there could be typhoid involved (outbreak is well into its third month).

Two things can make a serious difference to whether you shrub off the illness, lose a day of your holiday to hang out near a toilet but other wise recover or potentially are headed to life threatening illness. The particular disease you have been unfortunate enough to acquire is the first and the individual is the second. Extremes of age, marginal to poor nutrition, intercurrent disease, immune compromise can turn what should be mild discomfort and a need for an extra roll of toilet paper into potential death.

Not to be too morbid, from that discussion we are going to be moving on to rashes. Now, rashes are not my favorite thing. I can identify the simple infectious diseases (measles, chickenpox) because I grew up while they were still prevalent. Poison Ivy is obvious as is acne and warts. But for the rest of it? Hey, it is dermatitis (skin irritation, eruption…) and there are the standards (if it is wet -> dry it; if it is dry -> wet it, etc). Since I know so little (and remember even less – it is a great opportunity to learn.

The last disease of the day is Dengue which comes in four major flavors (I mean serotypes). It is viral. There is no immunization. There is only supportive treatment. Many call it “the worst case of flu” they have ever had. Just in case you are feeling comfortable about being “there” while I am “here” may I simply remind you that the mosquitos are well established in the New World as well as the Mediterranean Basin.  It has been around for a while.

In the last several years (not seen here that I am aware)  Chikungunya (viral) is now an issue.  Given that people travel, even sick people travel it shouldn’t be surprising to note that the disease is rapidly spreading across the Caribbean and Central America. Whether hitch hiking mosquito or human vector – this is another disease which has escaped its original habitat. Packed its suitcase and is off to see new countries and infect new populations.

Anyway – morning was dermatology, afternoon was adult ward rounds divided in the middle by lunch.  The less said about luncheon challenges the better. Mine was excellent, but it took a bit of an effort to get the staff to understand that we didn’t have the whole day for lunch.

Hanging out with the Marabou Storks (but not one)

Hanging out with the Marabou Storks (but not one)

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Hospital Laundry - as managed by patients families

Hospital Laundry – as managed by patients families

and no clue why a batch of pelicans. Mbarara is not exactly on water

and no clue why a batch of pelicans. Mbarara is not exactly on water

Posted in Medicine, Travel, Uncategorized | Leave a reply

Crossing the Equator

Holly Doyne Posted on 2015-03-26 by Proseknitic2015-03-26

Which reminds me – I picked up The Sugar Barons on the most recent Tantor Audio Book sale. For $4.99 I can listen to non-fiction and learn something about the sugar trade and the Caribbean from the 1650s on ward.

Leaving infectious disease behind for the day, a discussion about occupational health and safety is in order. As it turned out – no tour was on offer at  Kakira Sugar (the largest manufacture here in Uganda).  The photos are from outside the compound as picture taking is not allowed on the compound much less in the clinic or on the wards. The fields are easy – the alternative hauling (dude on the bike is blurry – sorry about that).

Sugar Cane in the fields, areas of cut and ares just planted a few months ago

Sugar Cane in the fields, areas of cut and ares just planted a few months ago

man on a boda loaded with sugar cane

man on a boda loaded with sugar cane

We left Jinja at a relatively early time in order to avoid traffic, if that might ever be even remotely possible. The field trip this morning (starting to feel like a happy elementary school child without the burden of parent chaperone.  Kakira is one of the major sugar producers in the country. Not only do they have plantations and factories – they have an incredibly huge compound with all the amenities of your average overseas military post.

Besides the headquarters and administrative areas there are shops, post office, barber shop, schools, clinic and hospital. Extensive housing is on the ground for workers of a certain level. Housing is also supplied for the contract workers: cane cutters, truck drivers. Given the geographical location in the world (see today’s subject line) growing and harvesting sugar is a year around proposition. Unlike a long time ago when I lived in the neighborhood of Crystal Sugar which ran shifts around the clock for the few weeks after harvest of the sugar beets. 

Since I  mentioned cane cutters – you have probably already figured  that the cane is cut by hand, loaded into the trucks by hand and, for that matter, sorted off the trucks by application of significant amounts of human labor. It is a good job in a country where employment is difficult to find, especially that which includes the provision of free medical care. The downside for the cane cutters – besides the risk of injury is living in extremely crowded barrack type situations away from their families for extended periods of time. 

And then we got on the bus to start our 320 km trip to Mbarara. Not that the traffic was horrible or the roads a challenge. Our driver said we did well to make it back to the North Kampala by-pass in about three hours (100km).  

Once past Kampala our pace picked up and the traffic decreased.

2 Bodas, five passengers, multiple packages but no chickens

2 Bodas, five passengers, multiple packages but no chickens

Our rest stop was at the equator (see photo) and consider this probably the only pix of me that you will see for this trip. My partner in crime is Canadian. In fact, I am not sure that I mentioned it – but we have four Germans (usually living in Germany), one Canadian and me living in Germany, one Ugandan living in the Caribbean for greater than 30 years and a Canadian living and working in Hong Kong.

standing at the monument

standing at the monument

Apparently end of the month is low economy for the Police; I counted over 25 radar stops along the way. Usually located about .5 km out from town or a few hundred meters after where everyone is hitting the accelerator it seemed at least that they were not interfering with commerce. I missed catching the fish and fish standards but there were plenty of opportunities for anyone to buy vegetables, chick-on-a-stick, catch a Boda or buy any number of things in town.

Stands in town

Stands in town

Bodas for hire

Bodas for hire

typical main street in the many, many towns we drove through

typical main street in the many, many towns we drove through

fruits and vegetables

fruits and vegetables

houses, animals and kids line all the roads

houses, animals and kids line all the roads

sun headed down before we arrived

sun headed down before we arrived

Posted in Medicine, Travel, Uncategorized | 2 Replies

Fever is/

Holly Doyne Posted on 2015-03-25 by Proseknitic2015-03-25

aka – it isn’t alway Malaria. Although when you are in Africa for more than 8 days it could be a good guess.

This morning we went to the Buikwe Subdivision Hospital where fever was the symotom under consideration. There was an excellent lecture about Ebola (last outbreak in Uganda was 2012 and not the same variant as in West Africa). This is also an areas where Trypanosomiasis (sleeping sickness) is endemic. Ward rounds: in a room about this size

yes, exactly this crowded and no better furnished

yes, exactly this crowded and no better furnished

(except with bright animals painted on the wall) where we saw several older mothers caring for their babies on the pediatric ward. Older means 18 with your first child or 26 with your fourth/fifth and most with a child over the age of 12 months were visibly pregnant. We saw sickle cell and cerebral malaria. Unhappy babies and ones that could peak out a smile.

To Build a House

To start – the room I currently have. Please note the frame on the bed. It makes it easier to drape the mosquito netting and have it work while leaving enough space to turn over.

#21 Upstairs

#21 Upstairs

 

The population density in the rural areas is amazing. If you live in North America, Western Europe or Australia, you know that few people leave outside of the major areas. In North American, rural areas are characterized by long stretches of empty, a few scattered towns and houses surrounded by out buildings and land. In Europe it is most often small tows surrounded by extensive fields under cultivation. In Australia, you are either along the coast or literally “outback” somewhere that no one usually goes.

Uganda has 85% of its population in rural areas. It isn’t just the houses and shops lining both sides of the road at what are probably towns even tho there are no town names, road signs or route numbers. I can understand the concept of “Plot Number” but do not appreciate at all what it might tell me about location. People are continually in motion. There are children all over the place: in school yards, walking along the roads, playing in front of the house, working in the fields, sitting with their mother as she sells vegetables from a road side stand. There is absolutely no question that children form half of the population.

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From the Buikwe Subdivision Hospital where we saw babies, discussed African Trypanosomiasis and Ebola we took a drive to both have lunch near Lake Victoria and see one of the local fishing villages (small smelly fish which require drying….). While we were at it, we set a TseTse fly trap to see what we could capture. These critters are first cousins to horse flies and we all know how great it feels to be bitten…

simple and effective trap. the flies come to the dark colors, then always fly "up" when they take off, becoming trapped in the netting

simple and effective trap. the flies come to the dark colors, then always fly “up” when they take off, becoming trapped in the netting

For those of you who haven’t met them – tsetse flies are nasty biting flies capable of happily transmitting parasites from infected mammal to uninfected in pursuit of blood – a favorite food. Since they are so effective in disease transmission, they have been well studies in the lab, as well as extensive vector control programs. (Trapping, release of irradiated males…..)

One wonders about their place in the food chain. Effective disease vectors, still something else had to have been eating them. I couldn’t find any information at all about what species, a bird perhaps, used to find this fly a nice juicy treat. Not that I want disease back. The effect on humans, livestock and wild animal populations was devastating but some critter somewhere has lost their lunch.

I started thinking about where all these children and their relatives live. You may have a landlord who owns the land, most of the time you are responsible for your own shelter. Round houses with mud dabbed walls and thatched roofs are out. Not only are they impossible to live it, but they provide an absolutely wonderful vector habitat.

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So you want to build a house. First you either make your own bricks or buy them from someone who is in the business. Made from the local iron rich red clay they are stacked in a standard form and the outside is coated. A fire is then started inside and is maintained until the bricks are hard enough to build with. Age them a bit along the side of the road.

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When you have time/money, draw out the walls, then start the layers after leveling your dirt floor.

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Maybe sometime in the future you will be able to afford to pour cement inside to have a solid floor.  If you have money, you can buy supplies – including your bricks and mortar from a commercial store –

 

019A5851 019A5863

 

Continue building your walls, leaving space on one side for doors and windows. Make one side of the roof higher than the other so it slants and the water will run off and away.  (Gutter could collect rain water, but then still water could also provide a breeding place for insects).  If you don’t have money for the roof right now, you can always start raising crops inside the buiing. (which means that like Death Valley in the Balkans – trees inside a currently unoccupied house doesn’t mean war, someone died or the house was bombed.)

When you have a bit more money add the tin roof. Even better, you can have windows and a door rather than cloth curtains.

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The white X you see on some of the buildings is from the Transportation/Highway Department. Sometime in the future this is going to become a paved road and probably two lanes. The houses in question are going to have to be taken out to build the road….

and ending with birds

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Posted in Medicine, Travel, Uncategorized | Leave a reply

Leprosy

Holly Doyne Posted on 2015-03-24 by Proseknitic2015-03-24

Doesn’t that stir up thoughts of Gothic castles, strange asylums and nuns nursing the damned in the slums of Calcutta?

Otherwise known as Hansen’s Disease, it is caused by one of the mycobacterium family (TB ring a bell for anyone?)  Similar to TB, causes granulomas and can be treated with a long course of a couple of particular antibiotics. It doesn’t cause parts of the body to fall off, but does severely damage nerves which results in the patient having decreased ability to feel pain. Recent research in genetics has lead to the assumption that about 95% of the population is naturally immune.
The other five percent? They can become infected.

We drove along between klick after klick of sugar cane fields between Jinja where we are staying and Buluba where the St Frances  Hospital is located. Founded in the 1930s and mostly funded out of Europe (esp Germany and UK) it was initially solely dedicated to the care and treatment of Leprosy. It’s role has evolved over the years as antibiotic regimes have proven to stop the progress of the disease. Unfortunately, neurological loss is normally permanent. In a culture that values village and family times, most patients are not welcome back home. Even though the treatment is outpatient now, occasional medication reactions but mostly lack of support have a significant number of patients remaining for an extended period of time. No matter how much education you provide, some superstition remains. Medication is provided by the government free of charge and it also pays for care.  There are a handful of patients who consider St Francis home and the nuns who run the hospital their home (all over 75 years old).  M. leprosae is not an opportunistic infection, so there has not been any increase with the spread of HIV. 

The infra structure needs help, the generator only supplies those area which require power. We saw a number of patients with leprosy as well as babies with malaria, a toddler with tetanus and several other diseases not routinely found in North American or Western Europe practices.

When you think about it – the characteristics of leprosy with all the associated myths might well have played into nightmare, fantasy, fear and the belief that the living dead really exist.
Zombies anyone?

Water Birds and Sacred Ibis

On a much lighter note, the weather held without rain so we went ahead the planned short boat exploration of Lake Victoria. What follows are pictures of water birds, shore birds and, of course – the source of the Nile (which is the longest river in the world. Yangtze is the third and the Mississippi is the 4th. Blanking on the thirds – but thinking it is the Amazon…) a couple of lizards and one monkey determined to ignore us.  With the skyrocketing population, this area has been extensively fished. Fish farms are now in operation along the shore. Each “container” is stocked with small fish which are fed and will yield about 1000 fish at full growth. What is obvious is that several of the bird species think this is just a special version of “fish in a barrel” created especially for them.

We ate dinner before returning to Jinja.  Since it was too early in the day for the fruit bats I am afraid that I can’t provide you photos of them. 

The origin of the Nile

The origin of the Nile

headed OUT

Source of the Nile

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I'm ignoring you

I’m ignoring you

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Vegetarian Kebab Platter

Vegetarian Kebab Platter

Posted in Medicine, Travel, Uncategorized | 1 Reply

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