SATURDAY, NOVEMBER 11, 2006
So I got an e-mail a couple days ago offering me a spot in Uganda for a one month elective. The day before my other best chance for an african elective was shot down as I heard that the doctor in the town to which I would be going died of tuberculosis as a complication of HIV/AIDS. Quite the e-mail to bring home the day-to-day effects of AIDS on the locals.
So now we see.
Virika Uganda
Approval... the continuing story
FRIDAY, JANUARY 26, 2007
I have faculty approval, and am jumping through the many hoops of the approval from risk management on main campus. How much fun is that. But I have bought my plane ticket in spite of the uncertainty over final approval... I can only hope. An elective in Fort Portal, Uganda it seems to be, the nicest town in Uganda (according to the Bradt travel guide) and sitting on the edge of the Rwenzori mountains, just in the middle of the rainy season.
But before that my cross country CaRMS tour starts, a three week marathon of interviews. 15 interviews, 8 provinces, 20 days, middle of winter. Yay! Then three weeks in Pincher Creek for family medicine and off to Uganda!
I have faculty approval, and am jumping through the many hoops of the approval from risk management on main campus. How much fun is that. But I have bought my plane ticket in spite of the uncertainty over final approval... I can only hope. An elective in Fort Portal, Uganda it seems to be, the nicest town in Uganda (according to the Bradt travel guide) and sitting on the edge of the Rwenzori mountains, just in the middle of the rainy season.
But before that my cross country CaRMS tour starts, a three week marathon of interviews. 15 interviews, 8 provinces, 20 days, middle of winter. Yay! Then three weeks in Pincher Creek for family medicine and off to Uganda!
Posted by
Mark Masterson
Approval
WEDNESDAY, FEBRUARY 28, 2007
I have approval, it came through while travelling around the country
on the CaRMS interviews. Quite exciting to know that they can't
prevent my elective now (or at least are less likely to do anything).
So now its packing and then off on Mar 10th.
I have approval, it came through while travelling around the country
on the CaRMS interviews. Quite exciting to know that they can't
prevent my elective now (or at least are less likely to do anything).
So now its packing and then off on Mar 10th.
Posted by
Mark Masterson
MATCH
So with the call of the muezzin in the background on the yellowest, stickiest keyboard in a while, I am awaiting the slowest internet connection to open my match results and tell me:
University of British Columbia / Anesthesia (857513)
Yay. No unmatch! How do I feel. I don't know. So... No anxiety during the wait there!Actually not much stress until the last hour or so, I've been too distracted until then. More in my next post... momentarily.
University of British Columbia / Anesthesia (857513)
Yay. No unmatch! How do I feel. I don't know. So... No anxiety during the wait there!Actually not much stress until the last hour or so, I've been too distracted until then. More in my next post... momentarily.
Posted by
Mark Masterson
WEDNESDAY, MARCH 14, 2007
This is try number 3 to post this bad boy. Makes the apology in the next line all the more important.
Sooo. Its been a while. Sorry to all the anxious types waiting to see if I am alive. I am, just have been travelling.
I'm in Kampala, not Fort Portal as I was supposed to be two days ago, but I'll get there tomorrow... I hope.
After London I caught my nice long flight to Dubai. Not crowded at all, I had a row to myself, until some damned brit came and sat at the other end. The row of 4 seats he was sharing with someone was too close to the pantry, so instead of spreading out completely to sleep on the plane I dozed uncomfortably with only two seats instead of 4! I know life is rough. ;) But for some reason I can no longer sleep through flights. I am in this wierd jet lagged zone of insomniac uncomfortable bleary eyed dozing with no sleep watching bad movies. We've all been there, I just can't get out of it.
Plane crash in Dubai. Not mine but apparently and air Bangladesh plane skidded to a stop during take off, an hour before I was supposed to land. They circled us over the gulf for an hour and then diverted us to Abu Dhabi (yes back to Abu Dhabi for Mark). Off the plane into the chaos of an airline basically shut down (shutting down Dubai for Emirates is roughly equivalent to shutting down Heathrow for British Airways. I think they'd just give up and go home). Eventually I was herded through customs, onto a bus to get me over to Dubai by land, only an hour away. Then came the madness of the ticket line, designed as a last-minute businessman changing his ticket line, not a 1000+ tired and confused passengers rescheduling line. Got through that and then had to go through two more lines to get myself into a hotel, there were different people doing the bookings and doing the vouchers. Finally though I got a hotel for two nights and meal vouchers.
Enough of that, I had a day in Dubai as was confirmed on the Wed flight to Entebbe, but me being keen to get to work I went standby at 0530 for the Tues flight to Entebbe. I got the last seat on. Wandered back to my seat (BTW Dubai airport is huge and when you are only given your ticket at the check-in counter 45min before your flight it requires a solid jog to get to your gate before they close the holding lounge 15min before take-off!). So IO wandered back to my seat and lo and behold someone was sitting in it, with a ticket printed with the same seat number. I told the stewardess I would wait in the back while she sorted that and got the other guests settled (I wasn't going to get things done any faster hanging out in the middle of the aisle). She was uber glad for that offer and then it turned out the guys seat had been changed, I was in the right spot but he wasn't. It wasn't just that his seat was changed but they wrote the new seat number on his boarding card, so it is is fault. I volunteered, to expedite things, to take his seat. Seemed like a good idea, he was settled and the guy with his boarding card was two rows behind him so I assumed he was travelling with people. Also he had a B seat and I had an D, B being an aisle and D being in the middle. As I walked towards 10B I reached 15, the last economy row (or the first depending upon your perspective) and was suddenly in the land of champagne before take off, flowers on your dinner tray and a complimentary socks. Yes I had traded for business class. The stewardess came forward and saw me and promised not to say anything. I can just imagine the headache she was looking forward to of getting the guy and moving him, and all his bags, with the plane already late. In the end I stayed in Business Class (yes I am capitalising it, they have seats that actually recline, that deserves caps) for the not uneventful trip to Entebbe.
I arrived Entebbe, a day late, smelling horrible and with that same hazy sleep. Thankfully I had a bed in Dubai, but with jet lag I still woke before the 0500 wake up call, and couldn't get to sleep (thankfully Hope Floats was on, the only thing on in English, and that helped). I arrived, paid my fees, I mean got a visa, and wandered over to see the beautifully hand written names of the people whose baggage would not be arriving with them, mine included obviously.
The problem with this is that Emirates doesn't deliver in Uganda, and Kampala is a 40 000Shilling trip each way from the airport. So I was stuck in Entebbe for the night, no change of clothes, and I had, foolishly, packed my toothbrush in Dubai. I got a ride with a fellow Canadian who was visiting family in to a hotel to save the stupid cab charges. Made it, slept bad, woke late, called and was told my baggage should arrive, went to the botanical gardens for the afternoon to wait for my bags to get to the airport at 1600.
So the botanical gardens are quite cool. Made by some random brit it is quite stunning and has been re-worked. Medicinal plants from across Africa, and then other important species from as far away as Madagascar (not so far from here, but still a bit isolated). More importantly, to make mother jealous, were the ridiculous numbers of monkeys and birds. There were two species of monkeys (one was, I believe Vervet, black with white tails, the other an uninteresting, to my local guide, brown one running around in troops with babies), then I was watching a plethora of herons, egyptian geese, fish eagles, kingfishers, some yellow bird called sunshine at some point in its name, hornbills, some bird that looks like that crazy dinosaur with the giant horn on its head, some random white birds, something blue and black... and yes at that point that's all I can remember of their names. Yes, they were all running around wild, no cages, just hanging out on the beach with the guys up to their waist in the water fishing with line or nets, the kids swimming and playing, the farmers feeding their goats etc.
My bags arrived today, I got a nice guy to take me on the back of his scooter to the airport (a common form of taxi-like transport). Passed through security three times, once to get a badge to get into the terminal (for which I had to leave my passport) and twice with the perfunctory bag search, yep its a bag, yep, its got a camera in it, and the wand search, which in spite of it beeping they didn't seem to concerned and they only gave me the most cursory of scans, missed the feet etc.
Got the bag, then grabbed a cab and headed up to Kampala, a busy bustling town, reminds me much of Kathmandu, a tropical and busy city. Dirty and cramped shanty atmosphere, but lively. I wandered a bit and saw the mix of guys playing dice, and random meet shops, people just hanging out, the usual big city stuff.
Anyways, I think they are closing here so more later... But I'm matched!
This is try number 3 to post this bad boy. Makes the apology in the next line all the more important.
Sooo. Its been a while. Sorry to all the anxious types waiting to see if I am alive. I am, just have been travelling.
I'm in Kampala, not Fort Portal as I was supposed to be two days ago, but I'll get there tomorrow... I hope.
After London I caught my nice long flight to Dubai. Not crowded at all, I had a row to myself, until some damned brit came and sat at the other end. The row of 4 seats he was sharing with someone was too close to the pantry, so instead of spreading out completely to sleep on the plane I dozed uncomfortably with only two seats instead of 4! I know life is rough. ;) But for some reason I can no longer sleep through flights. I am in this wierd jet lagged zone of insomniac uncomfortable bleary eyed dozing with no sleep watching bad movies. We've all been there, I just can't get out of it.
Plane crash in Dubai. Not mine but apparently and air Bangladesh plane skidded to a stop during take off, an hour before I was supposed to land. They circled us over the gulf for an hour and then diverted us to Abu Dhabi (yes back to Abu Dhabi for Mark). Off the plane into the chaos of an airline basically shut down (shutting down Dubai for Emirates is roughly equivalent to shutting down Heathrow for British Airways. I think they'd just give up and go home). Eventually I was herded through customs, onto a bus to get me over to Dubai by land, only an hour away. Then came the madness of the ticket line, designed as a last-minute businessman changing his ticket line, not a 1000+ tired and confused passengers rescheduling line. Got through that and then had to go through two more lines to get myself into a hotel, there were different people doing the bookings and doing the vouchers. Finally though I got a hotel for two nights and meal vouchers.
Enough of that, I had a day in Dubai as was confirmed on the Wed flight to Entebbe, but me being keen to get to work I went standby at 0530 for the Tues flight to Entebbe. I got the last seat on. Wandered back to my seat (BTW Dubai airport is huge and when you are only given your ticket at the check-in counter 45min before your flight it requires a solid jog to get to your gate before they close the holding lounge 15min before take-off!). So IO wandered back to my seat and lo and behold someone was sitting in it, with a ticket printed with the same seat number. I told the stewardess I would wait in the back while she sorted that and got the other guests settled (I wasn't going to get things done any faster hanging out in the middle of the aisle). She was uber glad for that offer and then it turned out the guys seat had been changed, I was in the right spot but he wasn't. It wasn't just that his seat was changed but they wrote the new seat number on his boarding card, so it is is fault. I volunteered, to expedite things, to take his seat. Seemed like a good idea, he was settled and the guy with his boarding card was two rows behind him so I assumed he was travelling with people. Also he had a B seat and I had an D, B being an aisle and D being in the middle. As I walked towards 10B I reached 15, the last economy row (or the first depending upon your perspective) and was suddenly in the land of champagne before take off, flowers on your dinner tray and a complimentary socks. Yes I had traded for business class. The stewardess came forward and saw me and promised not to say anything. I can just imagine the headache she was looking forward to of getting the guy and moving him, and all his bags, with the plane already late. In the end I stayed in Business Class (yes I am capitalising it, they have seats that actually recline, that deserves caps) for the not uneventful trip to Entebbe.
I arrived Entebbe, a day late, smelling horrible and with that same hazy sleep. Thankfully I had a bed in Dubai, but with jet lag I still woke before the 0500 wake up call, and couldn't get to sleep (thankfully Hope Floats was on, the only thing on in English, and that helped). I arrived, paid my fees, I mean got a visa, and wandered over to see the beautifully hand written names of the people whose baggage would not be arriving with them, mine included obviously.
The problem with this is that Emirates doesn't deliver in Uganda, and Kampala is a 40 000Shilling trip each way from the airport. So I was stuck in Entebbe for the night, no change of clothes, and I had, foolishly, packed my toothbrush in Dubai. I got a ride with a fellow Canadian who was visiting family in to a hotel to save the stupid cab charges. Made it, slept bad, woke late, called and was told my baggage should arrive, went to the botanical gardens for the afternoon to wait for my bags to get to the airport at 1600.
So the botanical gardens are quite cool. Made by some random brit it is quite stunning and has been re-worked. Medicinal plants from across Africa, and then other important species from as far away as Madagascar (not so far from here, but still a bit isolated). More importantly, to make mother jealous, were the ridiculous numbers of monkeys and birds. There were two species of monkeys (one was, I believe Vervet, black with white tails, the other an uninteresting, to my local guide, brown one running around in troops with babies), then I was watching a plethora of herons, egyptian geese, fish eagles, kingfishers, some yellow bird called sunshine at some point in its name, hornbills, some bird that looks like that crazy dinosaur with the giant horn on its head, some random white birds, something blue and black... and yes at that point that's all I can remember of their names. Yes, they were all running around wild, no cages, just hanging out on the beach with the guys up to their waist in the water fishing with line or nets, the kids swimming and playing, the farmers feeding their goats etc.
My bags arrived today, I got a nice guy to take me on the back of his scooter to the airport (a common form of taxi-like transport). Passed through security three times, once to get a badge to get into the terminal (for which I had to leave my passport) and twice with the perfunctory bag search, yep its a bag, yep, its got a camera in it, and the wand search, which in spite of it beeping they didn't seem to concerned and they only gave me the most cursory of scans, missed the feet etc.
Got the bag, then grabbed a cab and headed up to Kampala, a busy bustling town, reminds me much of Kathmandu, a tropical and busy city. Dirty and cramped shanty atmosphere, but lively. I wandered a bit and saw the mix of guys playing dice, and random meet shops, people just hanging out, the usual big city stuff.
Anyways, I think they are closing here so more later... But I'm matched!
Posted by
Mark Masterson
I'm in Fort Portal.
Yes, I made it, and found a computer that will actually allow me to post! How exciting. Hopped the bus from Kampala to Fort Portal early in the morning after changing money (i.e. got on the bus at 9:15). I had been told that the buses were scheduled and left every hour on the half hour. Unfortunately they don't, they leave when they are full. I sat on the bus for two hours waiting for them to leave, then we zipped along the road to Fort Portal through sometimes boring and sometimes stunning scenery. As we approached Fort Portal we hit the tea plantations, rolling hills with stubby little tea trees and small armies of workers picking their way across them.
Then Fort Portal and the hospital yesterday, I met Dr. D, started work today, mostly introduction now, rounding and getting a feel for the place. There are lots of other Muzungus here (the somewhat loving name given us whites). A group of MBA students from Michigan rebuilding their business model, a Dr. from the US, Dr. F, and a nurse, J, from the states who has been showing me around more than anyone.
We all headed out last night for alley meat at the local pub which has an alley with a grill in it last night, met up with a few other expats, young-uns, including M who is 17 and alone in Uganda volunteering. Bloody hell she isn't even legal to drink in Uganda! We had a time, to bed and the work today.
Tonight the nun who is in charge at the clinic is organising a dinner for us muzungus for which I must soon be off.
Cheerio.
Then Fort Portal and the hospital yesterday, I met Dr. D, started work today, mostly introduction now, rounding and getting a feel for the place. There are lots of other Muzungus here (the somewhat loving name given us whites). A group of MBA students from Michigan rebuilding their business model, a Dr. from the US, Dr. F, and a nurse, J, from the states who has been showing me around more than anyone.
We all headed out last night for alley meat at the local pub which has an alley with a grill in it last night, met up with a few other expats, young-uns, including M who is 17 and alone in Uganda volunteering. Bloody hell she isn't even legal to drink in Uganda! We had a time, to bed and the work today.
Tonight the nun who is in charge at the clinic is organising a dinner for us muzungus for which I must soon be off.
Cheerio.
Posted by
Mark Masterson
Fort Portal... parte the first
SATURDAY, MARCH 24, 2007
So, I'm getting my hospital on in Fort Portal now. Its an experience, for sure. I don't know what to say. Many of the details are gross and I doubt you really care that much, lots of malaria and a new perspective on HIV.
The hospital. Its a nice place to be honest. Run like... well I'm stuck for a simile. There are a lot of infuriating things. For one, lab tests have to be in by noon, and you might get them back in two
days, they definitely don't know the meaning of STAT, even for something like a urine Beta-HCG, or a hemoglobin. But what did I expect really? They do seem to do a good job, for the most part, with
what they have, and they are asking for help.
The staff are very friendly. They are all happy to have me around and its impossible to get them to refer to me as anything but Doctor. So I guess I'll be used to it by the time I am actually one. I've been
hanging out in the pharmacy doing some research for Dr. D, the head guy here, the last few days (since I got kicked off service) and the staff there are just fun to hang out with.
I've insinuated myself into the anaesthetic world as well. I have been doing most of the anaesthesia with T, one of the nurse anaesthetists. Its interesting, they have three nurses who do anaesthesia, each with different levels of training. T did a 1.5year course in Mulago Hospital, the big hospital in the capital,
G did a few weeks course at the local government hospital and the other one just picked it up here. It shows quite clearly in their confidence (and that T walks into the OR every day with her Oxford manual of anaesthesia and is constantly bugging Dr. D for a full on modern anaesthetic machine, one with cardiac monitoring, they don't have an ECG here BTW).
I was working with Dr. F for the last week. She is an American Dr. She is keen to let you know she is doubly board certified in surg and emergency medicine, and that she was in charge of a level 1 trauma
centre, whatever that means.
It was a hellish week. She complained constantly. At first I thought it was good to hear, that I could learn about the differences, but she seems to have expected a bunch of stoic North American patients, who
just happen to be black and infected with tropical diseases, in an equivalent to a level 1 trauma centre in the US. I kinda realised how amazingly out of whack her perspective was when she was distraught
that they didn't do laparoscopic surgery here. Considering how she complains about their open surgery I can't imagine what she was thinking. The maintenance and service of laparoscopic equipment alone
would kill the hospital, (for those poor sots who don't know what laparscopic is, its when they do the surgery without cutting you wide open but just make a few small incisions, put in a camera and some
manipulators and work that way, the two stitch surgery concept). I was just surprised that they actually intubated and didn't do the surgeries with bag and mask.
There are a few other things too, like she gets mad at them when they say she, or J, the nurse volunteering here are fat. I understand the N American view, but they were very clear that here that means that you are obviously successful, well fed and happy. Its quite a compliment, and most of the people at the hospital are fat..ish.
So I worked with Dr. F for the week rounding on medicine and surgery. Turns out she's not the best teacher (I have to be somewhat careful depending on who ends up reading this). She was very happy
with me when she could send me to pass messages to the nurses, and send me to get samosas for her when she was stuck infusing a unit of blood via an art line (they don't have central lines and a pt who was bleeding profusely needed good access and they couldn't get peripheral access. BTW Dr. F kept talking about how they didn't waste time with peripheral IVs they went straight to central lines which
seems... bad to me. Anyways, they tried a saphenous vein cut down, but she hadn't seen one since her internship, I hadn't even read about them and only heard about them on MASH, and the other surgeon
obviously hadn't done one in a while, they ended up missing the saphenous vein, but dissected down the the posterior tibialis quite nicely and cannulated it well). When I was called in early one morning to do some anaesthetics and then rounded on surgery before she arrived she wasn't happy. I went in at 0700, after a shower and breakfast, and rather than sit around I thought I would just get things going. I rounded, wrote my impression and plan and kept detailed notes to discuss with her when she arrived. We had thrice discussed my level of responsibility and what was appropriate. So I did this and she came in as I was finished examining the last patient, and went off. She said I couldn't do this, that I couldn't write
orders, and I said I was ready, and happy, to review every patient with her, she in a hmph said review, if you're going to be like this you are going to have to be on someone else's service. At this point I was so fed up and she was being so amazingly unprofessional and inappropriate that all I did was said fine and walked off the unit. What a saga eh? So I am now banished from medicine, and surgery until the local surgeon gets back for doing no more than I would have done as a Canadian medical student (which is much, much less than a Ugandan medical student would have done). I don't think she was ever
interested in me being anything more than a trained show dog, like she breeds at home. Following, watching, listening to her complaints and never having my own opinion, never seeing a patient independently (except with explicit prior direction from her and as nothing more than relaying orders) and just running errands and watching. Not for me.
So I'm killing time now, next week I start on Peds with Dr. C and we'll see what happens there.
But the anaesthesia is fun, except Dr. F expects to be involved in all the surg so I'll have to deal with that from now on, anyways, the surgery is done in old style. Manual BP, of course, but under Ketamine or Thiopental induction (decision based on BP) with Halothane or Ether maintenance. There is no oxygen tank but they have a concentrator, which I had never seen before. Many of the surgeries
are done under local with sedation, to minimise the risk of GA, something I totally agree with, but Dr. F seems un-impressed with. Without an ICU backing her up T (the nurse anaesthetist) didn't want to use a GA on an 80year old, so she sedated him, Dr. F bitched the whole way. I thought T was pretty reasonable about it.
Anyways, what else. I've been hanging out with a guy named B the last few days. Its a bit scary, he's from Alabama, nice guy but right wing, the scary thing is on how much I agree with him. I didn't
think I could agree with a southern USer, but we have a lot of common ground. We just don't agree with the liberal PC dogma without some basis to it. Its just been fun shooting the shit for the last few days with him drinking ungodly amounts of tea. Since Dr. F kicked me off her service I haven't had a lot of work to do.
So that's my story these days. More to come I'm sure.
So, I'm getting my hospital on in Fort Portal now. Its an experience, for sure. I don't know what to say. Many of the details are gross and I doubt you really care that much, lots of malaria and a new perspective on HIV.
The hospital. Its a nice place to be honest. Run like... well I'm stuck for a simile. There are a lot of infuriating things. For one, lab tests have to be in by noon, and you might get them back in two
days, they definitely don't know the meaning of STAT, even for something like a urine Beta-HCG, or a hemoglobin. But what did I expect really? They do seem to do a good job, for the most part, with
what they have, and they are asking for help.
The staff are very friendly. They are all happy to have me around and its impossible to get them to refer to me as anything but Doctor. So I guess I'll be used to it by the time I am actually one. I've been
hanging out in the pharmacy doing some research for Dr. D, the head guy here, the last few days (since I got kicked off service) and the staff there are just fun to hang out with.
I've insinuated myself into the anaesthetic world as well. I have been doing most of the anaesthesia with T, one of the nurse anaesthetists. Its interesting, they have three nurses who do anaesthesia, each with different levels of training. T did a 1.5year course in Mulago Hospital, the big hospital in the capital,
G did a few weeks course at the local government hospital and the other one just picked it up here. It shows quite clearly in their confidence (and that T walks into the OR every day with her Oxford manual of anaesthesia and is constantly bugging Dr. D for a full on modern anaesthetic machine, one with cardiac monitoring, they don't have an ECG here BTW).
I was working with Dr. F for the last week. She is an American Dr. She is keen to let you know she is doubly board certified in surg and emergency medicine, and that she was in charge of a level 1 trauma
centre, whatever that means.
It was a hellish week. She complained constantly. At first I thought it was good to hear, that I could learn about the differences, but she seems to have expected a bunch of stoic North American patients, who
just happen to be black and infected with tropical diseases, in an equivalent to a level 1 trauma centre in the US. I kinda realised how amazingly out of whack her perspective was when she was distraught
that they didn't do laparoscopic surgery here. Considering how she complains about their open surgery I can't imagine what she was thinking. The maintenance and service of laparoscopic equipment alone
would kill the hospital, (for those poor sots who don't know what laparscopic is, its when they do the surgery without cutting you wide open but just make a few small incisions, put in a camera and some
manipulators and work that way, the two stitch surgery concept). I was just surprised that they actually intubated and didn't do the surgeries with bag and mask.
There are a few other things too, like she gets mad at them when they say she, or J, the nurse volunteering here are fat. I understand the N American view, but they were very clear that here that means that you are obviously successful, well fed and happy. Its quite a compliment, and most of the people at the hospital are fat..ish.
So I worked with Dr. F for the week rounding on medicine and surgery. Turns out she's not the best teacher (I have to be somewhat careful depending on who ends up reading this). She was very happy
with me when she could send me to pass messages to the nurses, and send me to get samosas for her when she was stuck infusing a unit of blood via an art line (they don't have central lines and a pt who was bleeding profusely needed good access and they couldn't get peripheral access. BTW Dr. F kept talking about how they didn't waste time with peripheral IVs they went straight to central lines which
seems... bad to me. Anyways, they tried a saphenous vein cut down, but she hadn't seen one since her internship, I hadn't even read about them and only heard about them on MASH, and the other surgeon
obviously hadn't done one in a while, they ended up missing the saphenous vein, but dissected down the the posterior tibialis quite nicely and cannulated it well). When I was called in early one morning to do some anaesthetics and then rounded on surgery before she arrived she wasn't happy. I went in at 0700, after a shower and breakfast, and rather than sit around I thought I would just get things going. I rounded, wrote my impression and plan and kept detailed notes to discuss with her when she arrived. We had thrice discussed my level of responsibility and what was appropriate. So I did this and she came in as I was finished examining the last patient, and went off. She said I couldn't do this, that I couldn't write
orders, and I said I was ready, and happy, to review every patient with her, she in a hmph said review, if you're going to be like this you are going to have to be on someone else's service. At this point I was so fed up and she was being so amazingly unprofessional and inappropriate that all I did was said fine and walked off the unit. What a saga eh? So I am now banished from medicine, and surgery until the local surgeon gets back for doing no more than I would have done as a Canadian medical student (which is much, much less than a Ugandan medical student would have done). I don't think she was ever
interested in me being anything more than a trained show dog, like she breeds at home. Following, watching, listening to her complaints and never having my own opinion, never seeing a patient independently (except with explicit prior direction from her and as nothing more than relaying orders) and just running errands and watching. Not for me.
So I'm killing time now, next week I start on Peds with Dr. C and we'll see what happens there.
But the anaesthesia is fun, except Dr. F expects to be involved in all the surg so I'll have to deal with that from now on, anyways, the surgery is done in old style. Manual BP, of course, but under Ketamine or Thiopental induction (decision based on BP) with Halothane or Ether maintenance. There is no oxygen tank but they have a concentrator, which I had never seen before. Many of the surgeries
are done under local with sedation, to minimise the risk of GA, something I totally agree with, but Dr. F seems un-impressed with. Without an ICU backing her up T (the nurse anaesthetist) didn't want to use a GA on an 80year old, so she sedated him, Dr. F bitched the whole way. I thought T was pretty reasonable about it.
Anyways, what else. I've been hanging out with a guy named B the last few days. Its a bit scary, he's from Alabama, nice guy but right wing, the scary thing is on how much I agree with him. I didn't
think I could agree with a southern USer, but we have a lot of common ground. We just don't agree with the liberal PC dogma without some basis to it. Its just been fun shooting the shit for the last few days with him drinking ungodly amounts of tea. Since Dr. F kicked me off her service I haven't had a lot of work to do.
So that's my story these days. More to come I'm sure.
Posted by
Mark Masterson
MONDAY, MARCH 26, 2007
So its a bit rough here on the technology side of things. I just gave an anesthetic for an urgent c-section, prolonged labour and cephalo-pelvic disproportion. Just as we were about to start the
anaesthestic... rain, and the power goes out. There is no O2 cylinder, just an oxygen concentrator, and there's some hesitation about inhalational anaesthetic in the absence of supplemental oxygen.
Oh and the generator wasn't kicking in, they were trying to fix it.
So by the light filtering through the window we induced and used ketamine for the anaesthetic, supplemented with valium after the baby was out, the surgeon worked with just one high efficiency bulb (i.e not terribly bright) hanging from a wire in the ceiling, and flashlights to check for bleeding before closing. But it all worked out, the baby is well, mother is well.
I also saw a bit of a funny moment, the student nurse had taken the baby out for to run to the ward and was changing into his regular uniform from his scrubs before heading off, and he had placed the baby, wrapped in fuzzy blankets and all, in the cubby hole for large scrubs while he changed. I thought that was hilarious. We'd have had a complex and expensive system for bypassing that happening.
It all fit, the OR is kinda like what you'd see in MASH, its a permanent building, but with pretty open circulation, widows for sure, but not air tight. A bare concrete floor in the OR, plain wooden
benches in the change room with the door leading right out side looking over the valley. There's a serious shortage of clutter (which is awesome!) no extra tables for instruments (no extra instruments) and no piles of random machines, just wooden walls, the OR table, the instruments in use, an anaesthetic table and a portable surgery light... and the single high efficiency solar powered bulb hanging by a wire from the ceiling.
Enough babbling already.
So its a bit rough here on the technology side of things. I just gave an anesthetic for an urgent c-section, prolonged labour and cephalo-pelvic disproportion. Just as we were about to start the
anaesthestic... rain, and the power goes out. There is no O2 cylinder, just an oxygen concentrator, and there's some hesitation about inhalational anaesthetic in the absence of supplemental oxygen.
Oh and the generator wasn't kicking in, they were trying to fix it.
So by the light filtering through the window we induced and used ketamine for the anaesthetic, supplemented with valium after the baby was out, the surgeon worked with just one high efficiency bulb (i.e not terribly bright) hanging from a wire in the ceiling, and flashlights to check for bleeding before closing. But it all worked out, the baby is well, mother is well.
I also saw a bit of a funny moment, the student nurse had taken the baby out for to run to the ward and was changing into his regular uniform from his scrubs before heading off, and he had placed the baby, wrapped in fuzzy blankets and all, in the cubby hole for large scrubs while he changed. I thought that was hilarious. We'd have had a complex and expensive system for bypassing that happening.
It all fit, the OR is kinda like what you'd see in MASH, its a permanent building, but with pretty open circulation, widows for sure, but not air tight. A bare concrete floor in the OR, plain wooden
benches in the change room with the door leading right out side looking over the valley. There's a serious shortage of clutter (which is awesome!) no extra tables for instruments (no extra instruments) and no piles of random machines, just wooden walls, the OR table, the instruments in use, an anaesthetic table and a portable surgery light... and the single high efficiency solar powered bulb hanging by a wire from the ceiling.
Enough babbling already.
Posted by
Mark Masterson
Questions answered
A few generic questions I was asked I thought I'd throw out for everyone, as there's probably some general interest. Food here is horrible. We all do our best to escape it. Breakfast is cold, stale bread and an egg or two, fried or boiled. I am now able to get toast easily where I stay, and peanut butter and tea. They have tea plantations everywhere but getting a cup of tea is no mean feat!
Lunch is some combination of matooke or rice with beans or g-nut sauce. Matooke tastes kinda like potatoes, a bit sour but not too bad. G-nuts are like peanuts, for the most part, so g-nut sauce is kinda like a thin peanut sauce, without the varied taste. I described the meals as bland and they just don't stop, which everyone agreed with, there's no spice and no variety, which is hard to understand. Its a tropical heaven in many ways, warm and wet, things must grow like weeds, you could probably plant basil and never run out here, but they don't. So we go to the muzungu restaurants and get chips and sandwiches. They do have one redeaming thing, alleymeat, basically kebabs of chicken or goat (not tender cuts, stringy and boney) which are quite tasty, and sold with alley deep fried chips. Not too shabby.
The locals are great here. Most everyone I have met has been very friendly, people on the road will wave a hello (here its how are you, which is the translation of their greeting, they don't have a "hello") kids are always calling out hello. The hospital is a catholic run hospital and the nuns run around in their full habit, and some are nurses, some in administration, others floating etc. The docs have been very friendly to me, and the nurses when they come on the ward always greet with a smile and "Hello Dr". Of course its pretty laid back too. No one runs. Ever. Which can be frustrating, but its how they do it. I've really been amazed at how friendly everyone is. I even got to go over to the convent to watch a movie with the nuns last week! It was "Our Lady of Fatima" which was followed by "Miss Congeniality" but I couldn't make it through a poorly copied, black and white version of a Sandra Bullock movie. We had juice and tea
and little pastry things (quite tasteless actually) with the movies and a great time. They had the most hilarious reactions, and would start cheering when everyone said the Hail Mary together, or hissing
at someone blaspheming etc.
I'm staying in a nice little hostel. Its St Joeseph's Hotel, right across from the hospital. I have a room with a bed, mosquito netting and enough room for a tiny desk beside it. But the batthrooms are clean, I think they clean them 3 times/day, and the people are very friendly. The Drs all live on the compound of the hospital, pretty basic accomodations but again, clean and solid. Concrete floors, simple kitchen, but its kinda the right style for the weather here, its hot and the houses stay coolish, and they protect from rain. What more do you want? The locals live in everything from apartments to shantys with thatched rooves, or maybe a bit of corrugated iron. But they live in the tropics and that really does work as housing,
although I think they'd prefer a bit more.
So that's the generic stuff. Cheers.
Lunch is some combination of matooke or rice with beans or g-nut sauce. Matooke tastes kinda like potatoes, a bit sour but not too bad. G-nuts are like peanuts, for the most part, so g-nut sauce is kinda like a thin peanut sauce, without the varied taste. I described the meals as bland and they just don't stop, which everyone agreed with, there's no spice and no variety, which is hard to understand. Its a tropical heaven in many ways, warm and wet, things must grow like weeds, you could probably plant basil and never run out here, but they don't. So we go to the muzungu restaurants and get chips and sandwiches. They do have one redeaming thing, alleymeat, basically kebabs of chicken or goat (not tender cuts, stringy and boney) which are quite tasty, and sold with alley deep fried chips. Not too shabby.
The locals are great here. Most everyone I have met has been very friendly, people on the road will wave a hello (here its how are you, which is the translation of their greeting, they don't have a "hello") kids are always calling out hello. The hospital is a catholic run hospital and the nuns run around in their full habit, and some are nurses, some in administration, others floating etc. The docs have been very friendly to me, and the nurses when they come on the ward always greet with a smile and "Hello Dr". Of course its pretty laid back too. No one runs. Ever. Which can be frustrating, but its how they do it. I've really been amazed at how friendly everyone is. I even got to go over to the convent to watch a movie with the nuns last week! It was "Our Lady of Fatima" which was followed by "Miss Congeniality" but I couldn't make it through a poorly copied, black and white version of a Sandra Bullock movie. We had juice and tea
and little pastry things (quite tasteless actually) with the movies and a great time. They had the most hilarious reactions, and would start cheering when everyone said the Hail Mary together, or hissing
at someone blaspheming etc.
I'm staying in a nice little hostel. Its St Joeseph's Hotel, right across from the hospital. I have a room with a bed, mosquito netting and enough room for a tiny desk beside it. But the batthrooms are clean, I think they clean them 3 times/day, and the people are very friendly. The Drs all live on the compound of the hospital, pretty basic accomodations but again, clean and solid. Concrete floors, simple kitchen, but its kinda the right style for the weather here, its hot and the houses stay coolish, and they protect from rain. What more do you want? The locals live in everything from apartments to shantys with thatched rooves, or maybe a bit of corrugated iron. But they live in the tropics and that really does work as housing,
although I think they'd prefer a bit more.
So that's the generic stuff. Cheers.
Posted by
Mark Masterson
Running Joke
WEDNESDAY, MARCH 28, 2007
The running joke here is me getting fired. Dr. D asked me in surgery the other day, anything exciting happen? I asked what he meant as exciting for me is pretty simple, I hadn't seen malaria before. He said, have you been kicked off any wards today, with a twinkle in his eye.
Every time the Michigan Business team see me they ask me if any more volunteers have fired me, they like the irony that I, a volunteer, was fired by a volunteer.
The running joke here is me getting fired. Dr. D asked me in surgery the other day, anything exciting happen? I asked what he meant as exciting for me is pretty simple, I hadn't seen malaria before. He said, have you been kicked off any wards today, with a twinkle in his eye.
Every time the Michigan Business team see me they ask me if any more volunteers have fired me, they like the irony that I, a volunteer, was fired by a volunteer.
Posted by
Mark Masterson
Dirty
FRIDAY, MARCH 30, 2007
I feel dirty every time I chat with the business students about this stuff. Their focus is so intent on the business of medicine, obviously, but just the way they look at it, not what services do we need, but what services could we offer and make some cash off of. There's something deep down in my Canadian socialist self mixed with the medical ethic that just feels dirty talking about health care services as a business like that. But in the system they have here its what they have to do to keep afloat. Thankfully I can keep arms length and maintain my "moral superiority" and continue my high calling of seeing patients.
Having said that its really put things in perspective, they ask intelligent questions about changing the system and how we do things back home. I really have to think about whether what we do is possible
here, whether we do it that way because our system is so different and the patients we deal with are so different, or if it is something they could really benefit from here. It really does get me thinking about
why they do what they do.
One example, they don't have the concept of resuscitation here. But then they don't have an ECG, they don't have an ICU, so if you do resuscitate someone what do you do with them? Not to mention the only
intervention shown to save lives in a resuscitation is early defibrilation, and they don't have a defibrilator, the rest of it would just be going through the expensive motions. And if they had a defibrilator? They still don't have an ICU, and ECG, access to the drugs or pacemakers likely necessary to keep the patient from doing it again. So maybe its good they don't run around fighting to resuscitate arrests.
I feel dirty every time I chat with the business students about this stuff. Their focus is so intent on the business of medicine, obviously, but just the way they look at it, not what services do we need, but what services could we offer and make some cash off of. There's something deep down in my Canadian socialist self mixed with the medical ethic that just feels dirty talking about health care services as a business like that. But in the system they have here its what they have to do to keep afloat. Thankfully I can keep arms length and maintain my "moral superiority" and continue my high calling of seeing patients.
Having said that its really put things in perspective, they ask intelligent questions about changing the system and how we do things back home. I really have to think about whether what we do is possible
here, whether we do it that way because our system is so different and the patients we deal with are so different, or if it is something they could really benefit from here. It really does get me thinking about
why they do what they do.
One example, they don't have the concept of resuscitation here. But then they don't have an ECG, they don't have an ICU, so if you do resuscitate someone what do you do with them? Not to mention the only
intervention shown to save lives in a resuscitation is early defibrilation, and they don't have a defibrilator, the rest of it would just be going through the expensive motions. And if they had a defibrilator? They still don't have an ICU, and ECG, access to the drugs or pacemakers likely necessary to keep the patient from doing it again. So maybe its good they don't run around fighting to resuscitate arrests.
Posted by
Mark Masterson
Frustration
TUESDAY, APRIL 03, 2007
Some things can start to be frustrating, I'm not patient enough to work here a lot of the time. You see nothing happens fast around here, no one runs, in fact no one walks quickly, its purely unconcerned sauntering. Often people don't answer questions, they will respond with a monotonic nnnnnnn. Not a
problem in most settings, but when I am assuming that that means yes when asking about sympyomology.... I was under the impression that means yes, Dr. D today gave the nurse a hard time for answering that way as he too needs confirmation of yes or no.
The nurse today wouldn't translate for me on rounds. I would ask how the patient was, she would say they are changing her dressing. I would eventually get exasperated and curtly ask, but how is the patient!, then I might get a vague answer. Forget doing a proper post-op bleeding, blues, baby, breastfeeding, bowels, bladder, pain history on every patient. Another frustration is purely mine, I'm not
sure how they go about changing dressings, when sutures come out etc. We do things rather differently, discharge sooner and have nurses follow up at home. They don't have home care, and they have a
horribly high incidence of wound dehissence (superficial usually) and infection. I think I've only seen one infected c-section wound before, today I saw about 10. So evn though I don't know their protocols I fear they might not be doing it right at some point, but I don't know enough of the litterature to really correct them. I don't even know if its a problem with technique in OR, with the sutures they use, or with the post-op wound care.
Then nothing is stocked enough. There's always a wait to get a pair of gloves, or a BP cuff as they search the ward for the one. There's never enough of the drugs we need on the anaesthetic cart for the day, sometimes cases are held up because we have to get drugs out of the storage locker, and they won't just bring 20 and then restock, they only bring a few. I don't know where things are so I rely on a nurse,
or student, to get things for me, which slows things up even more, and really cramps my independance on simple things like starting an IV. I still can't get a swab to clean the area on my own, and its expected
that I don't. That's the nurses job here and the Drs just don't do it, but I just want to do it to get the bloody job done. Especially in an urgent situation (there are no emergencies here) I get frustrated when slowed.
The OR today was a gong show for all that, and my usually ordered, smooth running anaesthetic routine was constantly interupted by supply shortages, and we need to start an IV but the nurses are all busy helping drape the patient etc etc. Frustrating...
Some things can start to be frustrating, I'm not patient enough to work here a lot of the time. You see nothing happens fast around here, no one runs, in fact no one walks quickly, its purely unconcerned sauntering. Often people don't answer questions, they will respond with a monotonic nnnnnnn. Not a
problem in most settings, but when I am assuming that that means yes when asking about sympyomology.... I was under the impression that means yes, Dr. D today gave the nurse a hard time for answering that way as he too needs confirmation of yes or no.
The nurse today wouldn't translate for me on rounds. I would ask how the patient was, she would say they are changing her dressing. I would eventually get exasperated and curtly ask, but how is the patient!, then I might get a vague answer. Forget doing a proper post-op bleeding, blues, baby, breastfeeding, bowels, bladder, pain history on every patient. Another frustration is purely mine, I'm not
sure how they go about changing dressings, when sutures come out etc. We do things rather differently, discharge sooner and have nurses follow up at home. They don't have home care, and they have a
horribly high incidence of wound dehissence (superficial usually) and infection. I think I've only seen one infected c-section wound before, today I saw about 10. So evn though I don't know their protocols I fear they might not be doing it right at some point, but I don't know enough of the litterature to really correct them. I don't even know if its a problem with technique in OR, with the sutures they use, or with the post-op wound care.
Then nothing is stocked enough. There's always a wait to get a pair of gloves, or a BP cuff as they search the ward for the one. There's never enough of the drugs we need on the anaesthetic cart for the day, sometimes cases are held up because we have to get drugs out of the storage locker, and they won't just bring 20 and then restock, they only bring a few. I don't know where things are so I rely on a nurse,
or student, to get things for me, which slows things up even more, and really cramps my independance on simple things like starting an IV. I still can't get a swab to clean the area on my own, and its expected
that I don't. That's the nurses job here and the Drs just don't do it, but I just want to do it to get the bloody job done. Especially in an urgent situation (there are no emergencies here) I get frustrated when slowed.
The OR today was a gong show for all that, and my usually ordered, smooth running anaesthetic routine was constantly interupted by supply shortages, and we need to start an IV but the nurses are all busy helping drape the patient etc etc. Frustrating...
Posted by
Mark Masterson
Breasts
I don't know how to title this. There's a bit of a different perception of the woman's body here. Breasts aren't something to be ashamed of. For a pelvic or rectal exam we pull a screen, or offer some privacy, but for any exam where the breasts are bared we don't. Dr. F complained about this at the start. But its not out of insensitivity its that the breasts aren't seen that way here. There is no stigma to a pregnant or just delivered woman lying in bed uncovered. And there's no stigma to breast feeding. In fact one of the problems with getting HIV +ve mothers to not breast feed (aside from the cost) is that she is so expected to breast feed her child that if she doesn't the community would question if the child is hers, and rumours abound, so many HIV positive mothers choose to breastfeed in spite of the risks.
I'd think, being somewhat of a crazy feminist, Dr. F would be rather glad at this, the stigma isn't there, its not immodesty just a bit more liberation. But to our western minds I geuss it can be wrong because its different?
I guess I mostly found the stigma about not breast feeding interesting, and it fits in the context of the rest.
I'd think, being somewhat of a crazy feminist, Dr. F would be rather glad at this, the stigma isn't there, its not immodesty just a bit more liberation. But to our western minds I geuss it can be wrong because its different?
I guess I mostly found the stigma about not breast feeding interesting, and it fits in the context of the rest.
Posted by
Mark Masterson
Dirtier
THURSDAY, APRIL 05, 2007
Now they are doing a survey of the richer people of town, looking at what services can be provided them. The ends are to generate revenue to serve the less priviliged, but the means? Offering two tiered health care? Sound familiar? But here its the difference between getting service or not at all, not our problem of getting it now or waiting. Difference in kind or degree though? There's something deep down in the cockles of my heart (maybe even the sub-cockels) that makes my skin crawl with this project.
Now they are doing a survey of the richer people of town, looking at what services can be provided them. The ends are to generate revenue to serve the less priviliged, but the means? Offering two tiered health care? Sound familiar? But here its the difference between getting service or not at all, not our problem of getting it now or waiting. Difference in kind or degree though? There's something deep down in the cockles of my heart (maybe even the sub-cockels) that makes my skin crawl with this project.
Posted by
Mark Masterson
Went to Rwanda, Climbed a mountain, Hate the parks
Easter came and went, I was taken away for a weekend to the border regions, a town called Kisoro within 20k of the Dr. Congo and Rwandan borders (yes I call him Doctor Congo). One of the nuns from here wanted to go and I offered to pay gas if she got a car, and then she put me up and got me food and drink at her brother's place for the weekend as well.
We left fri, drove down along the edge of the ridge of the Rwenzori mountains (I don't know I'm not impressed, it just looks like a jungle ridge to me, but I keep being told there are mountains with glaciers beyond). We descended into the dry plains area which was rathersavana-esque. Funky umbrella trees and all, water buffalo, gazelles and various birds. Oh and hot and sunny.
From there you climb up a ridge which borders the rift valley and descend into the valley proper, much greener and lusher than before,drive through constant forests, past a crater lake or two and then,from Kabale on, down a dusty dirt track to Kisoro. Turns out we overloaded the car on the way down, the nuns filled it with food, and so the muffler fell off about 10k from our destination, which means that we pulled into town with the muffler nestled comfortably between my legs... They got it fixed the next day though.
The next day, Sat, we feasted and wandered the town shoe shopping (yes nuns, being women, shoe shop) and then eventually went to meet my travelling Nun's brother who lives on the Rwandan border and is a business man of some sort (I didn't ask what sort). He wasn't there so we wandered across the border for a peek, went into a restaurant and Sister ordered every beer on the menu so I could try them all... Then her brother came and ordered spicy chicken wings! So good, roast chicken served with spicy peppers and fresh lime, you just rub the peppers and lime on to taste and go nuts, first spicy food in ages! So drunk(her brother and I, not the nuns) we wandered back across the border after it seemed to be closed, but it was ok, he knew the guards (hence not asking his business). The stopped us at first but he said hi, and they recognised him and just wondered if he had anything for them to drink, they were thirsty and wanted some water!
Oh and we did the whole Rwanda thing with no passports for the locals, and Jesse, the nun with whom I travelled's 8 year old nephew in tow and no parents.... a bit different from US border controls.
So yeah, the next day I climbed Sabinyo, an extinct volcanic cone (i.e. mountain) in Magahinga National Park. I was thinking of gorilla tracking but, alack, the gorilla's had gone back to Rwanda so I was SOL. Anyways, climbed the mountain which was cool, not hard, just a 1400 vertical metre slog, through new forest, then into virgin bamboo forest, into the acacia forest with great gobs of hanging old man's beard, then up into the montane (I guess that's what they call it)with the giant lobelias that are so talked about and yet I'm not entirely sure why.
It was misty on the ridge, a constant stream of misty cloud blowing onto us from the Rwandan side of the mountain. Fitting, you'd feel cheated if you didn't get the mist eh? Then I stood on the summit which straddles the Dr. Congo, Rwanda and Uganda, so I've now been to Dr. Congo as well, if only about 5 m. into Dr. Congo but that's really not the point is it?
Yeah, but the parks piss me off. I don't know what there point is really. If its to preserve natural wonders than who for, cause the way it is now I have serious ethical concerns. Ya see, its damned expensive, you have to go with a guide and an armed guard (we are assured he is for the animals more than anything, I suspect its for the guerrillas more than the gorillas). No wandering on your own. Its USD40 for a day, USD375 for a day of gorilla tracking.The locals have a reduced price, but by reduced price you are still talking a huge chunk of someones income, to the point that all these great parks are pretty much exclusively for the use of rich tourists. Which bothers me. We applied pressure through the WWF etc for them to define these parks, to kick the people who had been living in them out (i.e. the pygmies, or even the local Bantu farmers) so that they can be turned into ridiculously expensive sanctuaries that cater to hi-end tourism. So is it appropriate that we now have exclusive access to these parks? I'm not convinced. It bothers me. That and I hate hiking on a straightforward trail with a guide. Not my style.
So after that we feasted on goat, Joeseph (the Nun's brother in Kisoro, not the one on the border) had secured a goat for the Easter feasting and we ate that goat (who I have pictures of the family with). We feasted and feasted. I ended up in the living room of theirmothers place (they all live in a compound) with Joeseph and Jackson,our driver, having beer and, mostly, just staring at the wall.Relaxing and getting our manly drink on while the women made their local variant of scones (kinda like a bland, baked plain donut would be my best explanation, and not round), and prepared dinner/did dishes etc. Wierd feeling for me to have that going on and I couldn't even help clear the table.
I was exhausted and tried to nap but they came and got me so that we could watch some traditional dancers they had brought over. Interesting...ish. To me more interesting was the music, just women singing to a tribal beat on a drum. Everyone in the household seemed very into it. Then I passed out on the couch waiting for dinner (supper at 1600) which wasn't until 2300. After that they continued part two of a soap-opera-esque movie series, all filmed on a camcorder and just a couple light years away from the"style" of our TV. (style in quotes as it doesn't really describe the complex of commercialism, subtlety and artistry that we really do takefor granted in our TV).
Then we drove back in the morning, stopping at every different climate zone to buy the local produce, oranges, pineapples, sweet potatoes etc, to restock the convent stores. I watched sunset over the Queen Elizabeth Nationap Park, with the Rwenzori in the background, its was quite stunning, I think I pissed everyone off with my photography, and 11h later we made it back, only slightly the worse for wear.
I think I should stop now.
We left fri, drove down along the edge of the ridge of the Rwenzori mountains (I don't know I'm not impressed, it just looks like a jungle ridge to me, but I keep being told there are mountains with glaciers beyond). We descended into the dry plains area which was rathersavana-esque. Funky umbrella trees and all, water buffalo, gazelles and various birds. Oh and hot and sunny.
From there you climb up a ridge which borders the rift valley and descend into the valley proper, much greener and lusher than before,drive through constant forests, past a crater lake or two and then,from Kabale on, down a dusty dirt track to Kisoro. Turns out we overloaded the car on the way down, the nuns filled it with food, and so the muffler fell off about 10k from our destination, which means that we pulled into town with the muffler nestled comfortably between my legs... They got it fixed the next day though.
The next day, Sat, we feasted and wandered the town shoe shopping (yes nuns, being women, shoe shop) and then eventually went to meet my travelling Nun's brother who lives on the Rwandan border and is a business man of some sort (I didn't ask what sort). He wasn't there so we wandered across the border for a peek, went into a restaurant and Sister ordered every beer on the menu so I could try them all... Then her brother came and ordered spicy chicken wings! So good, roast chicken served with spicy peppers and fresh lime, you just rub the peppers and lime on to taste and go nuts, first spicy food in ages! So drunk(her brother and I, not the nuns) we wandered back across the border after it seemed to be closed, but it was ok, he knew the guards (hence not asking his business). The stopped us at first but he said hi, and they recognised him and just wondered if he had anything for them to drink, they were thirsty and wanted some water!
Oh and we did the whole Rwanda thing with no passports for the locals, and Jesse, the nun with whom I travelled's 8 year old nephew in tow and no parents.... a bit different from US border controls.
So yeah, the next day I climbed Sabinyo, an extinct volcanic cone (i.e. mountain) in Magahinga National Park. I was thinking of gorilla tracking but, alack, the gorilla's had gone back to Rwanda so I was SOL. Anyways, climbed the mountain which was cool, not hard, just a 1400 vertical metre slog, through new forest, then into virgin bamboo forest, into the acacia forest with great gobs of hanging old man's beard, then up into the montane (I guess that's what they call it)with the giant lobelias that are so talked about and yet I'm not entirely sure why.
It was misty on the ridge, a constant stream of misty cloud blowing onto us from the Rwandan side of the mountain. Fitting, you'd feel cheated if you didn't get the mist eh? Then I stood on the summit which straddles the Dr. Congo, Rwanda and Uganda, so I've now been to Dr. Congo as well, if only about 5 m. into Dr. Congo but that's really not the point is it?
Yeah, but the parks piss me off. I don't know what there point is really. If its to preserve natural wonders than who for, cause the way it is now I have serious ethical concerns. Ya see, its damned expensive, you have to go with a guide and an armed guard (we are assured he is for the animals more than anything, I suspect its for the guerrillas more than the gorillas). No wandering on your own. Its USD40 for a day, USD375 for a day of gorilla tracking.The locals have a reduced price, but by reduced price you are still talking a huge chunk of someones income, to the point that all these great parks are pretty much exclusively for the use of rich tourists. Which bothers me. We applied pressure through the WWF etc for them to define these parks, to kick the people who had been living in them out (i.e. the pygmies, or even the local Bantu farmers) so that they can be turned into ridiculously expensive sanctuaries that cater to hi-end tourism. So is it appropriate that we now have exclusive access to these parks? I'm not convinced. It bothers me. That and I hate hiking on a straightforward trail with a guide. Not my style.
So after that we feasted on goat, Joeseph (the Nun's brother in Kisoro, not the one on the border) had secured a goat for the Easter feasting and we ate that goat (who I have pictures of the family with). We feasted and feasted. I ended up in the living room of theirmothers place (they all live in a compound) with Joeseph and Jackson,our driver, having beer and, mostly, just staring at the wall.Relaxing and getting our manly drink on while the women made their local variant of scones (kinda like a bland, baked plain donut would be my best explanation, and not round), and prepared dinner/did dishes etc. Wierd feeling for me to have that going on and I couldn't even help clear the table.
I was exhausted and tried to nap but they came and got me so that we could watch some traditional dancers they had brought over. Interesting...ish. To me more interesting was the music, just women singing to a tribal beat on a drum. Everyone in the household seemed very into it. Then I passed out on the couch waiting for dinner (supper at 1600) which wasn't until 2300. After that they continued part two of a soap-opera-esque movie series, all filmed on a camcorder and just a couple light years away from the"style" of our TV. (style in quotes as it doesn't really describe the complex of commercialism, subtlety and artistry that we really do takefor granted in our TV).
Then we drove back in the morning, stopping at every different climate zone to buy the local produce, oranges, pineapples, sweet potatoes etc, to restock the convent stores. I watched sunset over the Queen Elizabeth Nationap Park, with the Rwenzori in the background, its was quite stunning, I think I pissed everyone off with my photography, and 11h later we made it back, only slightly the worse for wear.
I think I should stop now.
Posted by
Mark Masterson
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