Back from the bush
So I'm finally back after 2 days and a night in central Uganda, and I have to say, that it is really very pretty. I actually much prefer driving in the countryside to being in Kampala, surrounded by the hectic city life, and the multitude of staring eyes... I think I'm still not used to it, and it adds to the uncomfortable feeling I get with being a foreigner.
The roads were both surprisingly good and surprisingly bad. Surprisingly good in that they were well paved (better than many of the streets in Kampala proper) from Kampala most of the way up north, but once we got onto the dirt roads, the going was pretty rough. It made me laugh thinking about people in the US with their SUV's, or "off-roading" vehicles that will probably never see the roughness of the roads that we drove on. They weren't really that bad- there were parts where the drivers were going at least 40-50 miles an hour, and just dodging pot holes, but there were definitely times, especially on the way back, when we actually used the 4 wheel drive function on the land rover, and were bouncing up and down pretty violently, even at 10-20 mph.
One very neat thing that we did with one of the 5 hours we spent traveling was fording the Nile. I didn't expect it- I heard something about a ferry/barge crossing, but I didn't realize it was the Nile that we were fording. I was also surprised by the craft we were crossing on. Advertised at being able to carry like 2 fully loaded cargo trucks and 3 cars and 100 people, I expected something much bigger and more... stable looking than what I found. The barge was basically two ramps on either end of a platform, which was two car parking spaces wide, and 3 car parking spaces long. On either side of the platform was a large turbine engine, one side with a broken motor, and the other side with an identical, but working propeller motor. The platform itself was made of two pieces of metal, with a crack between them, where joints held the halves together. On top of the metal, planks of wood (some of them broken, and some areas not having any at all) covered the metal. It was quite a sight. The crossing was fantastic though- the Nile, where we crossed it, was really wide and beautiful. Apparently the Egyptians sent people down to Uganda to keep the Nile clean and clear of debris (otherwise Egypt's delta would dry up and go kaput). The Nile is said to have its mouth in Uganda, near a city named Jinja. I might go on a rafting trip there sometime- they have class 5 rapids and lots of whitewater trips there, but that all depends on the clearance of my resident vet, Paula (and whether or not I decide to do it myself).
Uganda is surprisingly flat, and for most of the drive, it was hard to get a good overview of the country, since foliage blocked the view on either side pretty frequently. It's very green this time of year, with lots of trees and grasses. There wasn't any big fauna to be seen, presumably they've been hunted and eaten, except in national parks. I did see a few monkeys that looked like howler monkeys on the side of the road on the way up, and there were huge ant hills that I only noticed and identified as ant hills on the way back. Pictures will get posted eventually, but I have to get to a faster internet connection.
The staple crops that were being farmed on the roadsides were corn and sunflowers, surprisingly enough. I saw my first field of sunflowers on the drive up, and it was rather impressive how tall the stalks were and how large the flowers were. There were quite a few herds of cows, and I could see only a few goats and chickens. Apparently meat is pretty rare up there, to the point where even the dogs are supposedly vegetarian! I'll have to confirm with paula whether or not canines are omnivores, but I was under the impression that they were hunters, and hence carnivores. But one of the doctors I was driving with said that in one of the villages he was working at, the people there had virtually no meat, but they had dogs. He asked what the dogs ate, and they said corn and beans! And I did see one bony dog chewing on a corn husk in the middle of the road, so it seems that they are at least part vegetarian, if not completely. Surprising!
After the 5 hour drive, I finally got to the clincs, which were actually surprisingly good. A good bit of this is due to the fact that UCSF was recruiting for a study there, and there were UCSF hired people in addition to the normal staff that work at the hospital, but the facilites were much better than what I had envisioned. The clinic had separate buildings for each department- the first building was the building with the head clerk and the doctor who diagnosed and prescribed treatments, there was a building for inpatients, a maternity building, and a lab building. The power there is intermittent, and similar in that sense to Kampala.
Apac, the name of that region, is striking for a number of reasons. One, apparently 90% of people in the region are positive for malaria, in that they have active parasitemia (but due to their high resistance and immune status, not all of them show symptoms). That in itself is crazy, but then I realized that all the grassy fields that surrounded the clinic and that region in general, was swamp, not grassy field. And apparently at night, there are swarms of mosquitoes that will follow every human being, and suck blood like crazy. It's like a nightmare, something from a horror movie.
I was there to try to help out with the surveillance data, and try to fill in the gaps, or at least figure out why there was missing data, and try to fix the problems. It turns out that one of the biggest problems was the fact that the UCSF research group was recruiting for a randomized clinical trial, where a new frontline malaria drug was being evaluated. Apparently, everyone in the area wanted to get into the study, and showed up- however, if they weren't accepted into the study, they just left, leaving their records only half filled out.
The way records are filled out at this clinc is:
1) the sick talk to the main clerk, who takes down their basic data (name, age, etc.)
2) they go to the doctor, who diagnoses them, and sends them to the lab if they want tests done (they do a few tests, but the main one of interest is the blood smear test, where they can identify if you have malaria infection- and 90% of them do)
3) they go from the lab back to the doctor, who after seeing your results, prescribes you some meds
4) they go back to the main clerk, who writes down next to the basic info the diagnosis and treatment given
5) they then go to the pharmacy to get their drugs.
Apparently, a lot of people did steps 1 and 2, but after the lab results didn't indicate that they were eligible for the study, they skipped the following steps, thus leaving a lot of blank data in the clerk's data book.
While I was entering data over in Kampala, I was pretty frustrated when I couldn't read the handwriting of the head clerk, especially when it was just scrawled to the point of illegibility. But after sitting next to him, I realized how busy the guy is- there's a constant flow of people coming in, and the clerk has to see everyone twice in order for his job to be done well- once when they first arrive, and once after doctor's diagnosis and treatment prescription. It's a very busy chokepoint, and keeping his handwriting neat I could see was a losing proposition. It would be ideal if he could have a computer in front of him, where we'd never have to worry about his handwriting or even entering the data ourselves, but the intermittent power and the lack of resources really makes this surveillance project hard to improve on.
I'm also thinking about getting involved with some of the lab work and looking at the collected blood samples and slides, even though I told myself that I was going into epi to get out of the lab. It just seems that most of the interesting questions that I can address are in the lab.
Today is the start of the World Cup, and Ugandans in general are pretty crazy about soccer. No TV in the house, so I might stay ignorant, or brave the muggers and go across the street in search of a TV at the Blue Mango.
The roads were both surprisingly good and surprisingly bad. Surprisingly good in that they were well paved (better than many of the streets in Kampala proper) from Kampala most of the way up north, but once we got onto the dirt roads, the going was pretty rough. It made me laugh thinking about people in the US with their SUV's, or "off-roading" vehicles that will probably never see the roughness of the roads that we drove on. They weren't really that bad- there were parts where the drivers were going at least 40-50 miles an hour, and just dodging pot holes, but there were definitely times, especially on the way back, when we actually used the 4 wheel drive function on the land rover, and were bouncing up and down pretty violently, even at 10-20 mph.
One very neat thing that we did with one of the 5 hours we spent traveling was fording the Nile. I didn't expect it- I heard something about a ferry/barge crossing, but I didn't realize it was the Nile that we were fording. I was also surprised by the craft we were crossing on. Advertised at being able to carry like 2 fully loaded cargo trucks and 3 cars and 100 people, I expected something much bigger and more... stable looking than what I found. The barge was basically two ramps on either end of a platform, which was two car parking spaces wide, and 3 car parking spaces long. On either side of the platform was a large turbine engine, one side with a broken motor, and the other side with an identical, but working propeller motor. The platform itself was made of two pieces of metal, with a crack between them, where joints held the halves together. On top of the metal, planks of wood (some of them broken, and some areas not having any at all) covered the metal. It was quite a sight. The crossing was fantastic though- the Nile, where we crossed it, was really wide and beautiful. Apparently the Egyptians sent people down to Uganda to keep the Nile clean and clear of debris (otherwise Egypt's delta would dry up and go kaput). The Nile is said to have its mouth in Uganda, near a city named Jinja. I might go on a rafting trip there sometime- they have class 5 rapids and lots of whitewater trips there, but that all depends on the clearance of my resident vet, Paula (and whether or not I decide to do it myself).
Uganda is surprisingly flat, and for most of the drive, it was hard to get a good overview of the country, since foliage blocked the view on either side pretty frequently. It's very green this time of year, with lots of trees and grasses. There wasn't any big fauna to be seen, presumably they've been hunted and eaten, except in national parks. I did see a few monkeys that looked like howler monkeys on the side of the road on the way up, and there were huge ant hills that I only noticed and identified as ant hills on the way back. Pictures will get posted eventually, but I have to get to a faster internet connection.
The staple crops that were being farmed on the roadsides were corn and sunflowers, surprisingly enough. I saw my first field of sunflowers on the drive up, and it was rather impressive how tall the stalks were and how large the flowers were. There were quite a few herds of cows, and I could see only a few goats and chickens. Apparently meat is pretty rare up there, to the point where even the dogs are supposedly vegetarian! I'll have to confirm with paula whether or not canines are omnivores, but I was under the impression that they were hunters, and hence carnivores. But one of the doctors I was driving with said that in one of the villages he was working at, the people there had virtually no meat, but they had dogs. He asked what the dogs ate, and they said corn and beans! And I did see one bony dog chewing on a corn husk in the middle of the road, so it seems that they are at least part vegetarian, if not completely. Surprising!
After the 5 hour drive, I finally got to the clincs, which were actually surprisingly good. A good bit of this is due to the fact that UCSF was recruiting for a study there, and there were UCSF hired people in addition to the normal staff that work at the hospital, but the facilites were much better than what I had envisioned. The clinic had separate buildings for each department- the first building was the building with the head clerk and the doctor who diagnosed and prescribed treatments, there was a building for inpatients, a maternity building, and a lab building. The power there is intermittent, and similar in that sense to Kampala.
Apac, the name of that region, is striking for a number of reasons. One, apparently 90% of people in the region are positive for malaria, in that they have active parasitemia (but due to their high resistance and immune status, not all of them show symptoms). That in itself is crazy, but then I realized that all the grassy fields that surrounded the clinic and that region in general, was swamp, not grassy field. And apparently at night, there are swarms of mosquitoes that will follow every human being, and suck blood like crazy. It's like a nightmare, something from a horror movie.
I was there to try to help out with the surveillance data, and try to fill in the gaps, or at least figure out why there was missing data, and try to fix the problems. It turns out that one of the biggest problems was the fact that the UCSF research group was recruiting for a randomized clinical trial, where a new frontline malaria drug was being evaluated. Apparently, everyone in the area wanted to get into the study, and showed up- however, if they weren't accepted into the study, they just left, leaving their records only half filled out.
The way records are filled out at this clinc is:
1) the sick talk to the main clerk, who takes down their basic data (name, age, etc.)
2) they go to the doctor, who diagnoses them, and sends them to the lab if they want tests done (they do a few tests, but the main one of interest is the blood smear test, where they can identify if you have malaria infection- and 90% of them do)
3) they go from the lab back to the doctor, who after seeing your results, prescribes you some meds
4) they go back to the main clerk, who writes down next to the basic info the diagnosis and treatment given
5) they then go to the pharmacy to get their drugs.
Apparently, a lot of people did steps 1 and 2, but after the lab results didn't indicate that they were eligible for the study, they skipped the following steps, thus leaving a lot of blank data in the clerk's data book.
While I was entering data over in Kampala, I was pretty frustrated when I couldn't read the handwriting of the head clerk, especially when it was just scrawled to the point of illegibility. But after sitting next to him, I realized how busy the guy is- there's a constant flow of people coming in, and the clerk has to see everyone twice in order for his job to be done well- once when they first arrive, and once after doctor's diagnosis and treatment prescription. It's a very busy chokepoint, and keeping his handwriting neat I could see was a losing proposition. It would be ideal if he could have a computer in front of him, where we'd never have to worry about his handwriting or even entering the data ourselves, but the intermittent power and the lack of resources really makes this surveillance project hard to improve on.
I'm also thinking about getting involved with some of the lab work and looking at the collected blood samples and slides, even though I told myself that I was going into epi to get out of the lab. It just seems that most of the interesting questions that I can address are in the lab.
Today is the start of the World Cup, and Ugandans in general are pretty crazy about soccer. No TV in the house, so I might stay ignorant, or brave the muggers and go across the street in search of a TV at the Blue Mango.
posted by Vince at 8:43 AM
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