November 2-November 5th, 2010

Sorry for the lengthy entry, but need to cover 4 days!

Tuesday, I was helping Nurses Phrelym and Marcy prepare the medications for the children.  Shortly thereafter, Janice, Matt and Kourtney arrived, as did our driver.  Unfortunately, Kourtney was feeling pretty sick, so I don’t think it was a very good day for her.  I had some medication for her and both Janice and Matt are doctors, so between us, we did the best we could to keep her comfortable. 

We picked up Sumant Desai, his wife Jyoti, and a couple of other Rotarians.  We then  headed for Makuru.  At the school we met with the principal for a few minutes for Janice and Kourtney to present their proposed curriculum.  The principal seemed to have a positive response.  We visited a couple of classrooms.  We then walked around the very muddy property.  I was most interested in seeing the completed project I began almost two years ago.  When I last visited we saw  the dorms.  About 100 children live there, either because they are orphaned  or because it is better than living at home in the slums.  There were two water tanks on the premises, but no toilets, sinks or showers.  What they had  was a rock floor behind some sheet metal with a broken bucket.  I had been  given the authority by our district to use some District Simplified Grant money for any worthy  projects I found while traveling with the GSE team.  This was one of the projects I chose.  I worked with the Rotary club in Nairobi that had taken us to see the school.  It took over a year with some help from a past district governor in Uganda.  We finally got the paper work telling us the project was complete.  Well, I was in for a big disappointment.  The toilet block building and shower structure were there and complete.  However, the doors to the toilet areas were padlocked.  Matt stood  up on a rock and  put his camera through the window.  No toilets or latrines.  There was no sink and no shower heads.  I asked the principal and he told me that they were waiting for the sewer line to be connected and  it might be another month.  Obviously, the follow up on this is something I am going to have to handle while I am here.  I will be seeing the past district governor who previously helped me this coming Sunday.  I will certainly ask for his assistance in getting this handled. 

We were taken by the Rotarians to a part of the Mukuru slums where we walked around and saw a couple of Rotary projects and a microcredit project.  Kourtney did not get out of the van and decided to go back to where she was staying instead of joining us for lunch.  I felt so badly for her.

We met Sudesh Walia and Geeta Manek for lunch next to the market Geeta owns. Geeta has been wonderful in helping with so many details of my trip.   It was wonderful to see her again.  Sudesh had made all of my inter and intra country travel arrangements and gave me all the paper work.  I was then taken back to Nyumbani.

There was a woman at the House Tuesday night who has been staying at the village.  She sold her house, took her 3 kids (12,13,18) and a friend’s son who is also 18.  They are traveling around the world for a year and targeting projects they can work on.  From Africa they will head to China, Viet Nam and Cambodia.  What an incredible experience for her and the 4 kids.  They have learned to farm, assist with clean water projects and do with very basic needs.

Wednesday morning I again assisted Phrelym and Marcy prepare the medication trays.  Interesting how quickly I have learned where each med goes and how many times a day each child gets what med.  you note for helping them.  Phrelym  then took me over to the lab where I got a tour.  They have a CD4 machine  and a centrifuge and many other wonderful pieces of equipment.  Then Phrelym took me to see the new lab facility they are building.  It’s huge and still in early stages.  The equipment they will have at that facility will allow them to more closely monitor the children who are becoming  resistant to their ARV drugs.  Sister Mary has been fundraising for this all over the world.  I was very touched when Marcy and Phrelym presented me with a thank you note for all the wonderful things I am doing, especially for the children of Africa.  It is truly these two dedicated nurses who have given their careers to work at a place where they will make less money, all because they love the children and love what they are doing.  I went to the gift shop in the afternoon.  There were things made locally and things made by the children.  I would much rather buy things where I know the money is going to a wonderful cause.

In the evening, I went to the Rotary Club of Karen with Protus.  I had been to that club two years ago, and know some of the members, including Protus.  The country club where the meeting is held is beautiful.  Alex Nyaga is a member at the club and took me GSE team  there to swim and relax two years ago.  Karen is a very nice part of town, and certainly the most expensive.  It was really nice to see Kate Fletcher and some others. 

I told Protus on the way back to Nyumbani that I was very sad about leaving.  4 days was not enough.  I would love to go back for a month.  I could spend more time at the home, spend some time in the village and visit the Leatoto outreach  program.  The social worker told me that she also could have used my help.  The social workers interact with the schools and do home visits if needed.  They work as an integrated part of the team.  The social worker was aware of my background and said that next time I should spend some time with the nurses, some time with the social worker and certainly time visiting the other two programs.

I am now on my way to Mbarara by car on some paved roads and some very wet, unpaved and muddy roads.  It’s not a quick journey and certainly bumpy.

Arrived in Mbarara a bit late, but met Kenneth Kagame at his Rotary meeting.  Kenneth was the GSE team leader who came to San Diego last spring.  I was asked to speak at the Rotary meeting for a few minutes about my club, our district and projects we are involved in.  There were many questions; some about the size and management of our club, but even more about Obama, the tea parties and our recent elections.  Luckily, I had read all the news online!

I was welcomed to Kenneth’s home by his lovely wife, Hope.  We had a wonderful dinner, another typical African meal of rice, peanut sauce, beans and salad with avocados and tomatoes.  This morning, Kenneth and I took off early.  Hope is up at the crack of dawn, because she recently bought a fast food restaurant in town.  She does all of the cooking for the buffet at home, and takes it in with her.  She has also hired a chef.  The a la carte food she orders from local vendors.  Kenneth and I went to his clinic where he volunteers his time as an ophthalmologist.  I got a tour and then got to go into the operating “theater” to watch a few cataract surgeries.  I was given scrubs, a mask, and sandals…yes sandals that are meant only for the “theater”.  The cataracts in Africa are far different than in the USA.  They are much more extensive and most of the patients are totally blind in the effected eye.  Also, children get hat cataracts here, it’s not uncommon.  The cautery machine is not electric.  There is a small oil lamp with a flame, and a glass rod is heated and used to cauterize!  Sometime during the surgeries, the lights went out and someone had to go start the generator.  I am so glad that the surgeon’s knife was not in someone’s eye at the time!  The operating theater is one big room with two patients being operated on at the same time, but with two different teams.  One team consisted of a German doctor who was not wearing a mask!

From there, we went to pick up tow Rotarians and went to visit a school for handicapped children.  The handicaps ranged from  physical deformities to deafness.  The school was in a very poor area and in some ways, a similar environment to Mukuru in Nairobi.  They need a lot, but they do have water and sanitary facilities.

After dropping off the other Rotarians, Kenneth and I went to have lunch at his wife, Hope’s restaurant.  The buffet had matokeh (steamed bananas) taro, a white sweet potato, cabbage, peanut sauce, and a choice of fish, chicken, beef or goat.  I had the goat because I cannot get that at home.  It really tastes like lamb and is very tasty.

From there, I was off  to give a lecture at the University where Kenneth volunteers his time as a professor of ophthalmology.  I spoke to the nursing students, and a few doctors were in and out.  I talked for about 45 minutes about legal nurse consulting which is a totally alien concept here.  However, I was able to impart to them the importance of accurate and complete documentation and general information about the services I provide.  They were genuinely fascinated and had terrific questions.  Many of their questions were about ethical issues.  They were amazed that patients in the US actually have the right to refuse treatment and make advance directives.  They asked what we do if a patient refuses surgery that would save their life.  I told them as long as a health care provider has explained the consequences, then they are entitled to make a choice for no treatment.  The next question was about attempted suicide.  They wanted to know if that was also ok because it was a patient’s choice.  I explained the difference to them  between attempted suicide and choosing to stop treatment  or refuse treatment.  I put that also in the context of hospice patients not getting further treatment.  That they understood.  They wanted to know if they could be sued if a patient died on their shift because they were the only nurse present with a case load of 60 patients.  I told them that in the US, the hospital might be sued for not providing adequate staffing, but nurses can be named in any suit.  The next question was could the nurse turn around and sue the hospital if they failed to provide adequate staffing and there was an occurrence during that shift!  And so it went….I was with them for a total of about 90 minutes.  I left my brochures for information and business cards so they could contact me by email.

Kenneth said next time I am here, he will arrange for me to be the presenter at grand rounds with the physicians.  After the university, he dropped me off at the local hospice.  I met with them there for about 45 minutes.  They provide hospice and  palliative care to about 450 patients at any one given time.  The nurses can write prescriptions that do not need to be counter signed my a physician.  Patients who are still reasonably well, come into their facility to be checked.  When they are too sick, nurses are sent out to the homes that are within a reasonable distance.  Some are just too far and the roads are terrible.  They try to teach family members how to keep the patients comfortable, not much different from what we do.  This hospice is the Hospice of Uganda and has several locations within the country.  It was started by a woman from England in the 90’s.  I was told that their primary focus is cancer patients, not AIDS patients, unless there is associated pain.  However, in looking at the list of cancers, Kaposis Sarcoma and Burkitt’s Lymphoma are a large percentage.  So.;.;..of course they are treating AIDS patients, but they are not treating them because they have AIDS, it is for their cancer diagnosis. They have the same problem we do with patients being referred to hospice far too late.  They are getting patients that die a couple of days later, though many patients are on service months before dying.  As in the US, early referral, when patients are still well enough to get around, is a far better choice for the patient as well as the families.  It gives hospice a chance to really do what they are there to do.

Tonight we went out to dinner at the Acacia Hotel.  Turns out that Kenneth and Hope own this hotel!  They also own some other commercial property in town.  Benon Mwegera met us for dinner there.  I stayed with him and his wife when I was here last time with my GSE team.  It was wonderful to see him again as well.  He also talked to me about some possible projects!  He is a physician and built and owns the hospital where he works.  Two days was not enough in Mbarara, but I packed a lot into these two days….actually, only a day and a half!

Off to Kampala tomorrow.