UgandAshis 38 Mad Professor

UgandAshis 38

July 23, 2009

Fort Portal, Uganda

Mad professor.

Yesterday I met Professor Ecke. A German pediatrician and public health specialist with 100’s of years of experience in Africa. He has worked in at least 30 countries and is currently attached to the Mountains of the Moon University. As we were swopping stories I was informed that hunger makes the devil eat flies and if you are in Congo rats and cockroaches become delicacies. The fat of the cockroaches is highly nutritious and is called embryonic fat. He hops around Africa and Germany. Nowadays he spends 4 months in Africa a year.

His latest affiliation is with the Mountains of the Moon University. And yesterday we started off by chatting in the Tooro golfclub. It is the oldest golf course in Eastern Africa and a beautiful one. We talked about African art that he collects, the methodologies of teaching and the acceptance of the difference in reasoning in the Western and African mind. Proper cross culture reasoning and his way of making it all work: no more questioning, blanking the mind and accepting what is.

When you work in Africa as a European it is very likely goal will want to change everything, make things more efficient, smooth and polish things up. You can wonder however if what you achieve is sustainable as mentalities differ; saying yay and acting nay is a piece of cake. As you leave the scenario what you perceived to be a permanent change is often temporary. Then you start questioning everything and seeking for the answers. A new stage of confrontation following this can be a letting go. To paraphrase the professor: “It will give your wings wind and make you fly.”

Back to the school he is infectiously positive and has asked me to prepare for 5 lectures with him. He prefers paper and pen, hands and feet instead of power points and it can work. What should be fun is the dual presentation one coming from the clinical angel and one from the public health angel. His biggest strength is grant fishing. He is labeled the grant shark in Germany. He was a professor by 32 has a multitude of degrees and in the end is a very humble, wise and funny gentleman. It should be great to learn from him.

Today we put him in front of a camera and we talked about art, medicine following our common passion the river Nile. He is like an encyclopedia of Africa. We talked and talked about malnutrition, schistosomiasis, tuberculosis. Onchocerciasis, rural Africa and how to remain positive in a setting often seen as so dark and violent. To end with another quote: “When you come to Africa you love it or leave it!” He came at age 16 with a car through the Sahara and has never left it.

Namaskar,

Ashis

UgandAshis 37 Yogi's BBQ

UgandAshis 37 Yogi’s BBQ

July 20, 2009

Kampala, Uganda

Friends, food and music make a magnificent evening. Saturday night Nard and I decided to throw a party. The house and garden make it a great place to have one. And the main reason was to reveal the name of my furry ball of hair. An occasion as such merits a hosts of guests so we settled for a barbeque for about 25 people. It ended being a mix of Persians, Dutch, Indian, Ugandan and French people living in Uganda. The plan was simple emulate ‘la grande bouffe’.

Local fruit and vegetable vendors, the bakery and butcher were all emptied of stock. There was beef, lamb minced meat, boerewors, chicken, tilapia, a pasta salad, potato salad, fruit salad, sheesha and more. To assure large quantities of meat could be prepared at the last moment I had to rush out to acquire a Ugandan style mega barbeque.

From 18.00 Joy, Nard and I were in the kitchen marinating the meat and fish, preparing the salads, organizing the tables. Guests started arriving around 20.30 with DJ Nard manning the turntable, chef cook Ashis on the BBQ and Joy assuring all food preparation churning meat by the kilo. To be on the sure side tons of food was prepared and we will be eating a while from the remains.

Around 23.00 I picked up the guest of honor to introduce Yogi to the crowd. It must have been an impressive event for the 26 day old puppy. The charmer was passed around like a hot dog and received an overdose of hugs and kisses. At around 00.00 I took a shower and put on my black suit. On the way out I kidnapped the dance hungry people for a night of wild dancing. Dom bolo, afro beat and Michael ran smoothly. I had never really barbequed but food is food. Given the help of my friends I enjoyed Jackson tributes were on the menu. I hear that the party in the house lasted till about 05.00.

It was great to see how doctors, film makers, accountants, travel agents and restaurant owners mingled. As the party was impromptu we did forget to invite some friends and there will always be a next time. Specially now there is a barbeque in the house the house feels more and more like a home.

As contacts were exchanged people like doctor Dickson met Debra and Joy who will be filming his work in Mubende soon hooked up. I missed my friend Joseph dearly he was in Hoima for work. This is another reason to give a barbeque soon. Today we spend recuperating, some had a hang-over and the party was great. For Monday and Tuesday planned a visit to the Red Cross Uganda Youth Section is planned and then off to Fort Portal to continue with the clinical work and the teaching. Staying in Kampala is also required to download teaching materials from the Internet. Well keep the fingers crossed even now it is very slow.

Namaskar,

Ashis

UgandAshis 36 Half Moon Monkey Mountain University

UgandAshis 36 Half Moon Monkey Mountain University

July 17, 2009

Fort Portal, Uganda

Yesterday was a good day. After missing out on all meetings of the public health team organizing the bachelors of Public Health course for the last month and a half I finally got hold of the team. The bachelor’s course is aimed at high school leavers and medical staff (nurses, midwives and community health workers). Because of that the course is taught in the evening and in the weekends. Also we are setting up a long distance component.

The university is a brand new one about 4 years now and it currently has 600 students enrolled. The public health course had about 25 students last year and there should be an increase this year to about 40 students this year. Students come from the Fort Portal region mainly and there are also Rwandese, Tanzanians, Sudanese and Ugandans enrolled from all over the country.

The course stands out for several reasons. One of which is that instead of the normal Masters course this is a three Bachelors course and the approach is a non doctor dominated one. The philosophy of the school is that Public Health can be practiced by all trained people and not just doctors. In the work and in our study we are trained from a curative perspective, hospital and technology heavy.

At the meeting we were distributing the courses. For the first semester I will be teaching Culture and Health to the second year students and Communicable Disease Control II to the third year students. The second semester I will be teaching Communicable Disease Control I to the first year students and Disaster Management to the third year students. For these courses I have 4 weeks to prepare. I shall be online a lot and sniffling through the library.

Next week I shall check out the library. From what I hear from my fellow teachers there are two main problems: First a lack of human resources and secondly a lack of resources. There is a lot to do and the team that is on the ground has done a lot of good. The first batch came out last year and in September the second batch will qualify. Plans are in progress to have a Masters course and a long distance course.

For this yea r the faculty will be in Fort Portal and next year the plan is to move to the new university complex. It is near a lake with a view of the Mountains of the Moon. It is stunningly beautiful. It has been a good day. A little dance was done. For my colleagues I have nothing but deep respect. Setting up a faculty with a core group of 6 in a city with 46.000 people is pretty awesome. I shall be writing more about it soon. We kick of August 15th. I cannot wait to get started. For those of you with power point presentations feel free to share.

Namaskar,

Ashis

UgandAshis 35 Pediatrics III

UgandAshis 35 Pediatrics III

July 14, 2009

Fort Portal, Uganda

What happens to a child with HIV/AIDS?

Well in theory all children have access to government service called the Joint Clinical Research Centers. What needs to happen are in a simplified and summarized explanation:

1. Diagnosis needs to be confirmed by a blood test after voluntary counseling and testing for the parents as well as the child. Given mother to child transmission is the most common route to develop HIV/AIDS mother and father need to be counseled. Often the diagnosis of mother and father is made when a child falls ill.

2. Once the diagnosis is made a work up is done using certain blood values (CD 4, total blood count) and/or clinical impression WHO HIV/AIDS criteria by a doctor. The grades range from I-IV depending on which group your symptoms can be classified the child will fall into the inclusion criteria for receiving Highly Active Anti Retroviral Therapy (HAART)

3. Before treatment is started underlying opportunistic infections (e.g. tuberculosis) need to be treated. Due to drug interactions between HAART and anti tubercular drugs (ATB) TB is treated first.

4. Prophylaxis (oral antibiotics, cotrimoxazole) is given to avoid diarrheal disease (Isospora belli, Cryptosporidium) and pneumonia (Pneumocystis carinii)

5. Emphasis is given to proper feeding. A nutritionist explains what are the high energy good quality food sorts to combat the illness.

6. Treatment with HAART is started and monthly the blood values are checked and follow up and treatment of opportunistic infections is done.

7. Common malignancies as Kaposi sarcoma and lymphoma are actively searched for.

8. Common infections as oral thrush (Candidiasis) are treated.

9. Psychosocial support is organized for the patient and its relatives. Destigmatization of HIV/AIDS is still needed. Joining groups of People Living with HIV/AIDS (PLWHA) is advised.

10. If and when a good family support system exists a child can live for years on treatment. Reaching child bearing age which then leads to a whole new set of steps to be taken.

11. Many of the children I see are the exception. Too many children die undiagnosed and untreated as the hospital is out of reach of their parents. Remember this referral hospital services 2.5 million people and has a mere 400 beds.

12. Conservative estimates point to 1 million HIV/AIDS infected in Uganda. At least 25% are children. Also there are many HIV/AIDS orphans. HIV/AIDS has been around in Uganda for decades.

Namaskar,

Ashis

UgandAshis 34 Paediatrics II

UgandAshis 34 Pediatrics II

July 14, 2009

Fort Portal, Uganda

So what do you do after a terrible start of the day as described in the last blog?
You go do the ward round – after all another 80-90 are awaiting you in 40-50 beds and several children of them on the floor and so are their parents eager for advice and treatment for their children. While we discharge about 10 children another 5 are lining up to be admitted. Those that can be sent home on oral drugs are sent so we can admit the sickest patients waiting on benches for a shared bed. One of those children was convulsing, another was one month old and about 1 kilogram. His mother had expired one week after giving birth of HIV/AIDS. His father had bottle fed the child for 3 weeks but it was not doing well.

As stated most of the patients have malaria, diarrhea, HIV/AIDS, pneumonia or a mixture of the previous. White ravens do exist as well and are a good starting point for discussions between the medical students, medical officers, nursing staff and myself. A learning experience for all and often it leads to a better treatment plan for the patients. As the young doctors and Nard ask many poignant questions I learn a lot myself.

One of the white ravens of the day was a child with a bad chest, shortness of breath, reduced air entry on one side. She had been examined by 5 people and all of them had missed one vital point. The heart beat was felt and seen on the right hand side. The medical officer and I noted it at the same time and asked the medical students to check the chest, heart and lungs. As it a very rare condition they also missed the diagnosis. It is called dextrocardia and may be seen in a syndrome called situs inversus which then leads to a multitude of organs in chest and abdomen to be located on the opposite side. She was also an orphan and the parents of the children in the bed next to here were helping her with feeding.

As our X-ray machine has run out of film we cannot take required X-rays to access her lung and heart function. Also an ECG machine is lacking let alone an echocardiogram. Given her social and financial status we will treat her symptoms and do a work up as good as we can. I am sure we can hoodwink her to the OTA clinic to do a chest X-ray.

As we rounded up our ward round I asked the nursing officer what had happened to the 1 month old malnourished baby. The last I saw of it a naso-gastric tube was inserted and an intravenous drip. ‘Oh’ he said the child had passed away. Those deaths are sadly just the tip of the iceberg as most patients do not reach the hospital.

Namaskar,

Ashis

UgandAshis 33 Paediatrics

UgandAshis 33 Pediatrics

July 14, 2009

Fort Portal, Uganda

Nard and I strolled from our hotel to the hospital in the morning at around eight. To make sure we would be on time we woke up at seven and I had kitogo (banana with beef in a gravy) while Nard suckled his milky tea. When we arrived at the hospital I called on of my doctors colleagues to find out he was in Kampala. Then I called the nursing assistant he was about an hour drive away in Kasese. The medical officer was not in either nor was the nurse. (Later I found out the nurse was around trying to find the key to access the medical cupboard)

A young girl, daughter of the dental assistant was sitting awaiting medical attention. She had a high grade fever, convulsions, erratic breathing and was slipping into a coma. The most common cause for these symptoms is severe malaria. On investigations of the child it became clear she needed urgent treatment as her heartbeat was slipping to a rate of about 20 a minute and her breathing became more and more labored. Also looking at her conjunctivae an estimation of her hemoglobin (red blood cell count) would be about 1-2 representing a deep anemia.

By now the medical officer, nursing officer and the nurse had showed up. And still no key to the medical cupboard, or emergency medical kit. One hour gone and the child was rapidly getting worse. We sent for diazepam to control the convulsions and tried to get an intravenous line in. Left and right arm, leg to no avail the veins where collapsed. By now there were 4 people working on the child and almost all required drugs and equipments were available.

Alas too late for the young child. It always feels bad to lose a patient and to lose a 6 year old is even worse. Later in the day as we were reflecting on the situation I noted that she was from a relatively privileged position. She was living in Fort Portal with a mother working in the hospital. Less hurdles to clear and yet it was not enough. Cerebral malaria kills rapidly. Of our about 100 children admissions more than half have malaria.

If you happen to stay in the hospital with your mother and sibling one of the most common hospital acquired infection is malaria. Despite most Ugandans having gone through multiple bouts of the disease in life there is still under diagnosis and under treatment. Anti malarial drugs are generally available over the counter and it makes many people use the drugs in non optimal ways. Remember the story I wrote about Grace a couple of blogs ago.

With wide spread use of bed nets, public information, available treatment malaria remains one of the major killers in Africa. And those that die are generally the young like today.

Namaskar,

Ashis

UgandAshis 32 Return to Fort Portal

UgandAshis 32 Return to Fort Portal

July 13, 2009

Kampala, Uganda

It has been a pleasant weekend in Kampala. We have been scouting the city, visited Lake Victoria, spotted birds, with the good old Maribou as a favorite. As I danced the weekend away, Nard had a small bout of fever. We stayed back an extra day to make sure he is ok. There were two impromptu dinner parties. What is needed in this house is a sound system!

The DVD player is working and it seems I can be playing some computer games on my little laptop soon. Today at around 1500 we will be boarding a bus back to Fort Portal. Nard will be extracting teeth and I will be working at the pediatric and medicine ward. Also there is the ongoing teaching of the medical officers at the ward rounds and the theoretical sessions. Then I hope to be allotted one of the modules in the public health course.

Akiki aka Eveline will be having some guests so we hope to be lodging for 1 or 2 nights at Professor Edward and Phoebe’s house. The view from their house is spectacular and so is the banana cake. Internet connectivity will be mediocre and this time I will cook an Indian meal for some near and dear. There is a well stocked shop called Andrew & brothers and all Indian spices required are available there. Cooking is fun and relaxing.

The maternal and child health clinic should be about to open and if it takes off like the clinical ward OTA (www.outreachtoafrica.org) is bound to take off even more. As to PGHF, under the cover of the NGO we will be shooting short documentaries, pod-casts and vod-casts. And await the outcome of the project proposal rounds. The web site will be up and running soon now Joy has joined us.
Climate wise this place rocks also the people are laid back. Life just strolls by.

Namaskar,

Ashis

UgandAshis 31 The furry ball of hair

UgandAshis 31 The furry ball of hair

Kampala, Uganda

July 13, 2009

Snuggled in between my chest the keyboard and my bed sheets is a furry ball of hair. Black with brown and a tinge of white, 3 weeks old yawning and cute as cute can be. With a father called Fokker (after the Dutch airplane) of German shepherd descent and a mom of mixed German shepherd and Mechelse shepherd it is a long haired dog.
Mahdad has installed some photo shop like programs on my laptop so I hope, Internet allowing I may be able to send you a photo of my new friend and future house guard. Still without full vision he is currently trying to type some messages on the board. His eyes are still blue. This lovely dog was a gift from my friend Masoud and is one of the sweetest things I have ever received.

There is a saying in the Netherlands ‘Huisje, boompje, beestje’ translated it is ‘House, tree and animal’ . The proverb is about settling. I am sure to travel more in my life and at the same time it is the closest I have come to settling in a long time.

After a brief interlude in which the dog had peed in my bed and drank a whole bottle of milk he is now chewing on the defunct UTL modem. I am sure he wants a proper bed, blanket and some things to chew on tonight. To become a guard dog is the goal and mostly to be a friend.

I am still looking into names; it will likely be something Indian, mythological and pronounceable by Ismael and Emmanuel. Both guys are very happy to take on the care of the dog. Especially when I am in Fort Portal they will take excellent care. Surely the dog will grow. Out of the batch of his brothers and sisters I was told he had something special. Masoud even said he looks like me; hairy and chunky. The dog is always active and on the move, drinking and exploring the world.

For now I am off to get him a basket, in the near future he will be moving into the guard’s house in the day and roam the garden at night. First he can be a puppy. It will be fun training him. Fortunately all the other guys in the house have had many dogs before.

The charmer he is I am sure he will be flooded with affection and endless streams of milk. Once a name sticks in my mind I will post it. My little friend is crying for his bottle.

Namaskar,

Ashis

UgandAshis 30 The seven curses

UgandAshis 30 The seven curses

Kampala, Uganda

July 10, 2009

My house mate Mahdad and my friend Masoud have opened up their fancy fast food joint. This being Uganda however nothing comes easily.

1. Curse of the name
The brilliant name Chicken King has been taken and is registered, now the name will be Flamin’ Fast Food

2. Curse of construction
That what was supposed to take 3 weeks ended up taking up double the time. Builders disappeared, materials delivered in the wrong size and color. Roofs repainted in a different color. Holes poked in the roof. No wonder the bill more than doubled

3. Curse of rainfall
One night as the clouds over Kampala unleashed their heavy waters the roof partially collapsed

4. Curse of the window
Head butting a glass door can once but here it happened twice. When replacing the measured glass door on return the window fitter came back with a glass window 5 inch shorter than needed

5. Curse of the electricity bill
Opening up the shop with a slight delay on day 2 the power was cut for 24 hours as the other people in the building had not paid their bill

6. Curse of the cooks
Rotation is currently a well tried system in soccer teams, having 2 cooks rotate through in 3 days however is quite a turnover

7. Curse of ailment
Mahdad decided to try out if he could fry his hand in the cooking oil: second degree burn wounds. Masoud on the other hand is trying if he can burn a hole in his stomach.
Despite all the tragic comedy, the hardships, bullshit this place is bound to be a happening place. In my book the best sheesha’s and chicken in town. A deadly killer combination it is. All the best guys and with the third eye firmly installed at the doorpost things can only get better.

Namaskar,

Ashis

UgandAshis 29 Medicine in Fort Portal

UgandAshis 29 Medicine in Fort Portal

July 7, 2009

Kampala, Uganda

Today I have taken time to write. It was not a lack of inspiration or ideas to write about. I shall try and be more consistent over the next weeks and months. There are so many stories to tell fresh they may come alive even more.

To start off we helped out organize a house that will function as a maternal and child health clinic in Fort Portal for OTA. An operation theater and birthing stools are to be placed, staff has been recruited and the walls of the patient rooms are being painted. Basically all requirements to run a clinic like this are being put into place. For now I am just advising and there may be a moment in the near future I get more officially involved.

As in the first OTA clinic where I am getting involved in patient care and procedures as pleural taps. Imagine one of your pleural cavities holding 2 liters of fluid. Shortness of breath and painful breathing will follow. A differential (simple) to think about is an infection (Tuberculosis or pneumonia), or a malignancy (small cell carcinoma or mesothelioma). We are hoping for an infectious cause because it is treatable. The pleural tap ended up being 1.5 liter and we are awaiting the culture and other lab results.

The hospital work is getting more challenging mostly in a positive sometimes in way to teach patience. As I went to do ward rounds on Saturday I found no nurses in the hospital in the pediatric, female and male medical wards. I waited around for an hour, searched for medical officers in training to have 3 show up instead of 10 (usual number). Then my class was canceled as there was nobody. The reason for the absence of the clinical officer students was evident – they have their final examination coming up in one week.

A good talk with the principal followed and I shall focus and the students that will become third year’s from next week. Focusing on history, physical examination, differential diagnostic thinking, investigations and treatment plans. The best thing it sharpens my clinical acumen, as for all questions I ask I get questions back and I review my books a lot in Fort Portal. I shall do ward rounds with about 12 students at a time for about 2 hours and give a 2 hour theory session in the afternoon 2 -3 times a week.

As far as the medical work in the hospital itself – my friend doctor Pariyo has asked me to do his pediatric rounds 1-2 times a week, the other days I will do the rounds at the male/female medical ward.

One of the bonuses this week was when I found two 5th year medical students from Gulu University. They are eager to learn and have a deeper level of understanding then my clinical officers. Either way it is good to learn and teach at all levels. Gulu is on my itinerary and I have an opportunity to go next week meeting up with an NGO that wants me to teach a course for village health workers as well as meet up with the medical faculty there.

Finally for this blog: the public health course at Half Moon Monkey Mountain will be starting with at least 30 students in August, there is a flood of applications. Once I get my designated topic I can start preparing my course work for them as well.

Namaskar,

Ashis

UgandAshis 28 Art meets medicine

UgandAshis 28 Art meets medicine

July 7, 2009

Kampala, Uganda

For a few years I have been experimenting with all kinds of media to communicate health, human and spiritual messages to different audiences. This blog is one of the examples. Then there is a website: www.ashis.org , a host of online presentations on Darfur, news paper interviews, television shows, the CBS 60 minutes ‘ Searching for Jacob’ documentary , radio interviews on PBS/BBC The World. Most of it relating to my experiences on the border of Chad and Darfur in the refugee camp Oure Cassoni. The main goal is by telling of stories, sharing of experiences to give people around the world a view of people on ‘the other side’.

Despite the World Wide Web being a massive source of information I feel that the 800 million or so Africans have a very small voice on the Internet. Also the information coming from Africa tends to be much skewed. Negative stories of wars, violence, dictators, corruption, rape and spectacle seem to be the rule. For every negative story I am sure 100 positive stories can be told. And there is a time and place for these stories as well.

Alone however it is my perspective of in this case story telling on Uganda. So I am happy to tell you that with three Ugandans for now: Debra, Joy and Ronnie we have decided to meet, brainstorm and come up with different ways to use the different forms of media to communicate stories to the world. All have experience with media: Debra is a social activist, working with an orphanage through art exhibitions, film making and events to bring social messages of gender, orphans and HIV to the world. Joy is helping me out getting organized and has done text and video editing besides having a prior career as a world class butterfly stroke swimmer. Ronnie is a creative millipede; music editing, video editing, filming amongst other things are his interests. He has worked for Eveline’s OTA (Outreach to Africa) as well. Check out their videos online; www.outreachtoafrica.org .

You can feel blessed in life to meet an inspirational person and they are willing to work with you. How about you meet 3 and they will form the nucleus of what hopefully will be and uplifting loose media confederation of movers and shakers that wish to communicate honestly about the beauty that is Africa.

Tonight we have our second meeting and I am sure we shall be churning out internet videos on you tube, seismic as well as documentaries on Ugandan television, interviews for Ugandan and Internet radio soon.

I cannot wait to be involved and have articulate, authentic, inspirational Ugandans speak about their projects be it art or medicine. Let us bridge this so called Internet divide.

Namaskar,

Ashis

UgandAshis 27 Time flies

UgandAshis 27 Time flies

July 7, 2009

Kampala, Uganda

Wow two weeks and no writing.

Too long

Let us start saying that since about a week a friend, fellow fraternity brother and future surgeon Dr Nard from the Netherlands has joined me. He is in his first year of his specialization in facial surgery and this is his first visit (and time to work) in Africa. Some of the good and bad of Uganda has happened to him over the last few days.

First I would like to congratulate him and his girlfriend for buying a house in Utrecht as per yesterday. Lonneke will come and tour here in about four and a half week. I am looking forward to meet her after 10 years.

As I see Nard immerse in Uganda culture I feel protective, as if you want to give a younger brother the best there is to be seen knowing that not all is beautiful or easy to understand. Besides crossing roads he is doing great. Being of surgical inclination I have nicknamed him Dr Vlimmen (A Dutch cult hero in a novel written about 80 years ago) and we share the same passion for birds. As I write this a hawk is circling around my house. Yellow beaked and looking for a rodent or large rodent I guess. Our favorite bird is the marabou, with its carnavalesque beak on top of a white boa and black feathers.

As Nard is both a dentist as well as a medical doctor in Fort Portal he is working in the dentistry and surgical department s. It is not easy to explain to a patient who has travelled 200 kilometer that the material required to fill his tooth has run out and that he will have to return another day. Yet here we do it and travelling 200 kilometer may take the whole day and several days’ salary.

The first night he was here I took him to 3 of my favorite pubs, clubs and restaurants. An Eritrean restaurant across the street, a huge pool bar (9 tables) annex bar/dancing and the classic of classics; Al’s Bar. In Al’s Bar you can feel time warped as the action starts at 0300 AM earliest and the music seldom goes beyond the end of the seventies. And what a collection of music the owner has. In the restaurant we met Nick one of my dear friends here and several other guys. A straight plunge into a sheesha and discussions of Ugandan culture versus Dutch culture. Nice to hear from the side.

Then almost straight to Fort Portal where we stay at Eveline’s house. As I wrote before she has started a church, a boarding primary school, a health clinic, a maternal health clinic, mobile health clinic and a project for pygmies.

I will ask Nard to write a blog entry for this blog as a guest writer. It is not possible for me to crawl into his shoes all I can see that experiencing the health care system in Uganda and mostly the Ugandans are having a major impact on Nard.
What I will say is that the gift he has taken to our fellow doctors and clinical officer training school, a medical library of about 500 medical textbooks on DVD is the best remedy for a knowledge craving brother and sisterhood of medicine.

Namaskar,

Ashis