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