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.

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

 
and pharmacy, even if they were carefully and safely ensconced behind glass.

but the most fun exhibit of all was the following:

If you are under 55, I don’t expect you to recognize it. But for the rest of us? Think shoe store….

So that you can see what I see.

toward the river

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…

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)

Hospital Laundry – as managed by patients families

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

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

(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

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.

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

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.

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.

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

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 –

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.

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

As you might guess, HIV is a major issue in Uganda as it is in other sub-Saharan countries. The plan for the morning is a review lecture followed by ward rounds at the Joint Clinical Research Center in Kampala.

Established by the Ugandan Government, the Center works in collaboration with UCSF, Johns Hopkins, NIH, ITM (Antwerp & Hamburg). Much of the funding comes from PEPFAR & EDCTP.

forget your standard thoughts of US or Ger man hospitals.  There are two wards where we made rounds: one for the men, one for women. The windows are open with light and fresh air coming in. The nurses here know how to manage IV medications as there are no fancy electronic pumps.  The ward is squeaky clean.  Some family are present helping.  Opportunistic infections are the reason every is here. Malnutrition is a fact of life.

Currently (WHO statistics) – HIV disease accounts for 17% of the annual mortality over all and about 7% in those under the age of 5. Life expectancy at birth is 57 years. If you make it to age 60, you have on the average another 16 years ahead of you. The death rate/100,000 population from HIV/AIDS has dropped from 440 in 1990 to 169 in 2013. The accuracy of either statistic is in serious question. 85% of the population is rural. Death registration is no more accurate I suspect than birth registration and cause of death is going to be as much political as medical.

Our early afternoon has a lab and discussion of opportunistic infections. We drive to Mobria for a field trip on medical botany. Pictures will be forth coming, but the 2 hour hike through the forest was a blast. The plants are blurring in my mind, the red tail monkeys were a hoot and there was something called a blue ttracto ??? flying from tree to tree and expressing extreme displeasure at our presence

road construction delayed out arrival to Jinja till about 2000.  The rain kept most vehicles and people off our interesting back route alternative

Reflections happen every once in a while. Sometimes deliberately and other times triggered off by a simple event, object or gesture. So it was for me this morning while sitting in the Star Alliance Lounge at Heathrow T1. I have been here before.  In fact, I distinctly remember being here for hours while waiting for a flight. Plugged into power and catching up for hours. I can’t find a post about it (searched Heathrow, Lufthansa and Riesling for the lovely wine that captured my attention six hours into the wait – after 1700 as well) but I can even remember where I was sitting.

However, it wasn’t any of that which caught my attention. Rather it was hunting down the women’s restroom.  There are two restrooms clearly marked in the Lounge; one men’s and one women’s. But I can remember when this simply wasn’t the case. This is allegedly a business class lounge which used to mean business travelers since no one who didn’t have a company paying the high tariff for the seat would travel in business. Especially not if you are from Minnesota – it wouldn’t seem like a sensible use of funds. Except for one time during my college/professional school/residency years on the rare times I flew – it was cattle car. Once, for whatever reason having to do with exhaustion, a kind check-in agent and a strike of fate, I wound up with a free upgrade. It also might have had to do with being well dressed and traveling alone. In any case, I was directed toward the lounge. There were no women’s restrooms; business travelers are men, right?

Seemed to be just the way of the world in the early 1970s. I can remember being on a surgical rotation at one of the U of MN affiliated hospitals. The surgeon I was with sent me off to change so I could scrub in on his cases that day. There were three changing rooms: Doctors, Nurses, Orderlies. Female med students, who it turned out were a rarity at this hospital for excellent reasons, don’t fall into any of those categories. When I failed to show up in the expected five minutes, one of the orderlies came to find me. Why wasn’t I changed? Where? The nurses had already told me that their changing room was for nurses (note the lack of male nurses in that time frame. And the fact that nurses are assumed to be female. It is 2014, and most of the time we still caveat nurse with “male” for the 20-35% of the professional who aren’t female. The assumption is not quite so obvious that doctors are male only due to the overwhelming numbers of young women entering med school in the last 10 years).  Said orderly thought the whole thing was funny, explained that the place had a reputation which is why they almost never had women rotating through there on surgical clerkships and found me “the closet.”

That is right – a closet. Not the nurses changing room with lockers, not the orderlies with one of the guys standing guard at the door. And certainly not the doctor’s changing room where the male med students were more than welcome to change. Today? I would have just let the chips fall where they may and used the doctor’s lounge but I was not at all willing to rock the boat back then.

When asked why I was late I explained about the changing rooms. The surgeon was astonished. Obviously this was not something that had occurred to him as an issue. I suggested that if he could not get this resolved that I could change preceptorships so as to go to other hospitals. How would I do that? Talk to Mamma Pearl (Assistant Dean of Students) about this hospital not being “ready” to have female med students……

Fast forward to 2014. There are men’s and women’s changing rooms, restrooms, locker rooms (unless of course you are a Dutch military deployed camp. Then it is uni-sex with locks on all doors, stalls and showers. Everyone is an adult, everyone gets privacy).

In most shopping centers there are family restrooms. There are set-ups to change diapers which didn’t exist when mine were young. Some of the airport lounges even have a “child room” which I think is de facto recognition that whether or not you want small children in the executive lounges adults are going to keep brining them. The goal then is to keep them separate enough from the rest of the travelers that no one gets hurt…

Drifting around from topic to topic I guess. But I have managed to get caught up on all of my audiobook downloads, two novels I hadn’t gotten around to finishing and some nice munchies courtesy of Star Alliance.  Their timetable download turns out to be a PC app but booking a round the world flight is easy and relatively cheap compared to a couple of round trip FRA-SFO round trips.

Who knew?

Wonder if finding clean bathrooms and changing rooms is going to continue to improve?