This is definitely not Kansas.

I got into Mbarara yesterday, a 5-6 hour ride from Entebbe. It took a bit longer than I expected because (1) the university employed driver, Kato, needed to have breakfast (obviously, had to be my treat) and (2) he needed to buy some charcoal for cooking. Apparently one does better outside town than inside town, so whenever he’s coming back from Kampala or Entebbe, he stops, negotiates, purchases and schmoozes with the widowed lady that sellls charcoal. Kato knows everybody, including some of the police that stopped us at the half a dozen or so roadblocks. These are good roadblocks, not political/suppressive. They are to find unlicensed, uninsured drivers, drivers hauling large loads on a truck on a motorcycle permit, etc.

My apartment was supposed to be shared. The other guy never showed up. Serafina, the housekeeper tells me she will keep me informed. There is no knowledge as to why he hasn't shown up.  In the meantime I have a large, comfortable dining room and living room, two bedrooms, and a bathroom split into three: one cell with a toilet and bathtub, one cell with a toilet, and an outer room with a sink. My room has a double bed and a single bed. There are bars on all the windows, and I can lock both the front door and my bedroom. There are rifle toting guards both in our compound and basically near any entity of any value. After 24 hours, it’s just part of the scenery.

There are birds all over the place. There is a huge, insanely ugly bird called a maribou stork. I will definitely get pictures. They nest all over the place. There are also small cute birds. I will try and get some of those too, but they are fast. There is happily a supermarket within walking distance—(Bhutan blog fans: think of the 8-11.) It is a little light on veggies but there are a couple of stands where I can buy stuff.

There’s a large expatriate community at the hospital: volunteers, Peace Corps folks, professional do-gooders, some academic types doing research on global health, and probably a couple of folks wasting away in medical Margaritaland.  Not sure about the latter, but it does feel like a place where you could slowly slide under the surface and simply forget to come up for air. The great majority of expats here are genuinely good human beings concerned about the welfare of the community and are struggling against crazy odds.

Sooo… first day on the wards. Residents are smart, very smart. The residents PAY for the privilege of being residents. Yes, you read that right. And because of that, they self-select to be smart and work hard. The medical students and the interns are either completing school or finishing training and licensing requirements, so that self-selection hasn’t taken place yet. The hospital is typical developing world—extremely limited formulary, families take care of patients, overcrowding to the point that the patients are on mattresses on the floor. If the medication is not on formulary, patient’s families have to buy it in a pharmacy and bring it in for administration. If the lab test is not in the basic, covered suite of tests, the patient has to pay for it. This gets tough when non-covered labs include blood glucoses and electrolytes. Thus the problem is not that the docs are not good, but patients can’t pay for the care so they reject testing and management. Fortunately, anti-malarials are on formulary, and the government distributes anti-retroviral therapy and TB meds that are provided by international grants.

We saw about 25 patients in 4 hours. Malaria, glomerulonephritis from acute hepatitis C infection, every manifestation of HIV under the sun, and three cases of TB of the spine with paraplegia, and a woman with an ejection fraction of 17% and creatinine of 8.9. I was literally just stunned. I will need to work hard to find how I can be of help when I have so much to learn.