Vistas from the corner office

Not too much time to spare here, but wanted to share life as its been seen through our eyes over the past few weeks. We've been doing a lot of work in the community with our village health workers and in the classroom training the latest cohort alongside our clinical Kisoroan colleagues.

Sister Immaculate, Kisoro District Hospital's extraordinary mental health nursing officer, teaching the Doctors for Global Health VHWs about joint pain.

Mr. (?Dr.) Sam Musemenali, KDH's head clinical officer, teaching our VHWs about leg swelling. We learned about how patients with chronic leg swelling without any "danger signs" could be instructed to elevate their legs to reduce swelling and discomfort. George, a VHW in the front row, is demonstrating.

Here's Dickson, a nursing officer who is working full time for Doctors for Global Health. Behind him is Muhavura, a volcano taller than Mt Fuji. He and I were just leaving our "Chronic Disease in the Community" clinic on a hill in the midst of corn and bean fields in Mugwata Sooko. I like to think of this as "our office"...

Dickson again -- walking our motorcycle around this truck that had slipped through a muddy patch off the road.

More soon! 

Our Lake Bunyonyi Trip

There's been a lot of action around these parts: Thanksgiving, one big batch of med students headed back to the States, trying fried grasshoppers! But because there's also been a lot of action at work, it's been hard to find time to deliver this news in a timely fashion. We'll get to all of that good stuff, but until then, enjoy a photo gallery of our recent group trip to Lake Bunyoni.

We chartered an awesome guide named Robert who drove nine of us over the mountains and down towards the second deepest lake on the entire continent. It looks like a small sea got poured into a steep, verdant maze of valleys. The mountains drop straight into the lake and the peaks that aren't submerged make up the constellation of islands that fill the lake. Some are inhabited, all are gorgeous.

We hung by the dock at the compound of hillside cottages where we all stayed, took a boat tour with Robert, had lunch on a neighboring island and spent many hours on the patio of Birdnest Hotel -- the Ritz of Bunyonyi. The views were spectacular and we all got a well-deserved break from the hustle-bustle of the hospital. It felt great to visit another world for a weekend.

holy moley, it's the Crested Crane, national bird of Uganda!

we came across a family of baboons on the side of the road

mom and little babe

and dad who, i swear, could have pushed our van over if he'd wanted to

first glimpse of one of the long arms of Bunyonyi

r&r by the "pool"

so lovely... the lake is nice too

thinking about going in...and I did!

...but after these kids paddled past

after-lunch walk on one of the many islands

the sacred ibis! (yes, we're still pretty bird crazy)

daniel relaxing at the bow

L to R: Andrea, Kevin, Hannah, Robert, Priya, Cristina

ahhhh, nothing like a fancy dinner overlooking the lake

Grasshopper Apocalypse! (Part 1 of many...)

Kisoro natives would probably find the title "Grasshopper Heaven" more appropriate since these bugs are serious cash cows. We've been hearing about the impending descent of "the grasshoppers" for weeks now and it seems like today is finally the day. They fill the sky like the snow flurries that are probably starting to stir up in New England.

We both leap away in a barely concealed panic when one lands on us but locals are diving after these things, filling up enormous plastic bags, and then selling them by the side of the road, sometimes de-winged and de-legged for the consumer's convenience. On the way into the hospital today I saw a group of girls poised over a bush; while one of them shook it the others made mad-grabs for the 'hoppers that erupted forth.

We've also been hearing that they make a delicious fried snack. Hence the frenzy about capturing and selling these little guys. One of us is ready to chow down but unwilling to approach a live one, and the other of us is just unwilling, on both fronts. (Two guesses...)

Future posts will probably deal with our sordid attempts to seek out and eat this seasonal snack, but for now we have to just focus on surviving this very Old Testament massive swarm of insects.

Tutorials in the Field

 A few times a month, a clinical officer (usually accompanied by a medical student -- or a lowly elementary school teacher on hiatus) will mobilize a small number of Village Health Workers at a spot near their home villages, usually a church or a school with the purpose of extending their education in a less formal setting.

My friend and clinical officer Dickson and I jumped on a motorcycle last week to lead one of these tutorial sessions. The roads were particularly bad (potholes that resembled the grand canyon -- nearly to scale), and the views were spectacular. We made it to both meeting sites and reviewed the homework the VHWs had been assigned at their last training at the hospital.

There is also time for the VHWs to ask questions they might not have had the guts to during our full-group classes. Even though I was filtered through the very accommodating translating of my fellow teacher Dickson, it felt great to be inspiring questions from interested students and doing my best to answer them. I've picked up enough basic medical knowledge organizing these last few months of VHW trainings to at least nod in assent when I hear a correct answer.

These VHWs are the newest cohort, only officially "on the job" for a the last few months, so they have a lot of questions and doubts but we are doing our best to encourage and empower them to be the primary linkage between their community and the wider healthcare network. Ideally, once they've been trained enough, these men and women (but mostly women!) will be able to treat most common illnesses right in the homes of their neighbors and will have the experience to know when a hospital referral is appropriate.

It feels great to be out riding through the countryside with the wind rushing past us and the sky wide open above, but it's perhaps even more satisfying to arrive to find adult students waiting to learn more about how to best care for the health of their communities.

A new fruit and a new bird!

Katrina is a very adventurous and bold market shopper and that quality led her to discover "tree-tomatoes", also known as tamarillos. The person who gave them this first name must have never actually seen or tasted an actual tomato because the resemblance between the two fruits begins and ends at their roundish shapes.

They are best eaten scooped right out of their skins with a small spoon. The taste is a little like a nectarine, a little like a guava, a little like a kiwi, and a little like something magically new.

I also caught this picture of a what I think is some variety of sunbird eating from the fruity end of the banana tree that grows right outside of our kitchen.

Our kitchen

We haven't provided too many interior shots of our living accommodations so here is a series that shows our rather spartan kitchen.
There's a medium-sized fridge (a puddle of water snaking out across the floor from it is usually the first sign the power went out over night...doesn't happen that often.) We also have two propane-powered burners that can be set to "High" and "Inferno". Ugandans, we hear, do most of their cooking over charcoal so this must not bother them.
The buckets you'll notice are for compost and trash (the two small ones) and for storing water in the very likely scenario of the kitchen sink not working.
I'll also throw in a picture of me relaxing right outside the kitchen door on our porch. It's a lovely place to sit.

Nights Here...

...are the darkest I've ever experienced.

One of our first evenings in town, we got taken out to a local bar/restaurant for dinner after dark (fun fact: in Kisoro, a "restaurant" is a place you can eat AND sleep [rooms in a back courtyard usually], while a "hotel" is just a place to eat.) and we were genuinely terrified to even cross the street. Hovering motorcycle lights whizzed by through the blackness; silhouettes of people cast eerie shadows by the smokey headlights of the few cars of the road. The two of us were practically paralyzed. The hotel we were going to eat at was literally 50 yards away but crossing the black expanse of road -- teeming with ill-(or not-)lit motorcycles, bicycles laden with 12 foot sugar cane, and any number of herded goats and cows -- was daunting, not least of all because we couldn't clearly see a single one of them.

 I couldn't shake the feeling of being 8 years old and deep into one of those "Haunted Hayride" experiences where bloody scarecrow leap out from corn stalks. The differences here are of course that the latter is farcical amusement and the former -- our night crossing the street in Kisoro -- is normal daily life.

I never realized how I've taken streetlights for granted until that first black night. Walking at night in the U.S. (while cautioned against by mothers) was never a particularly harrowing experience: follow the straight lines of the sidewalk from streetlight to streetlight, look both ways before crossing the well-lit streets and, after a series of right-angle turns you'd have reached your destination.

If the initial feelings of peril have lent a mildly sinister air to the night-time hours here, a cloudless night sky makes up for it. It's still the rainy season so clouds usually hang overhead but on days when  most of the rain was rung out during the day, the nights are left clear and sparkling. The edge of our galaxy is visible as a milky band stretching nearly from horizon to horizon and the stars teem in numbers unlike almost anywhere else I've been. Add the silhouettes of the impossibly huge volcanoes on the horizon and the magic of the Kisoro night more than makes up for its initial jitters.