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
Saturday, 25 July 2009
Wednesday, 15 July 2009
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
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
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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
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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
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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
Tuesday, 14 July 2009
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
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
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
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