first day

The first thing I noticed about Uganda is the air. It unlike any other air I have ever experienced. It’s humid, yet thin and cool, which is extremely disconcerting. In my mind humidity will be forever associated with smothering heat and impossible lethargy. This is an entirely different kind of humidity. There is no sweat involved, and the temperature just broke 70 at the hottest point of the day today, so heat really isn’t a factor either. But the whole place is so wet that you can’t really get away from it. The entire country is more or less a rainforest, though especially up here in the mountains. It’s not quite jungle, that essential ground layer of shrub and brush is not really present. Forest is definitely the more appropriate term, but it is the wettest and most omnipresent forest I have ever experienced. Especially up here in Bududa district, away from all the roads and shipping and what not, it feels very much like the human element is fighting a constant battle to hack out some little plot of land, just big enough for a hut, an outhouse, and few crops. With the exception of birds (which are EVERYWHERE) there is not a lot of wildlife around here. Despite the fact that it is without question a wild area, the prevalence of humans discourages most of the wild animals from coming to this area. Herds of antelope occasional come through, but the mountains make it challenging for them, and the villagers quickly hunt them, so that happens very rarely. I spent my first day at the clinic shadowing around the various stations. The clinic operates on a 6 station rotational system. Basically it works like this: Station 1 is for patient intake and education. This is basic info, age, weight, complaint, that kind of thing. While people are waiting they also do public health education talks and info sessions. After they go through Station 1 they move to Station 2, which is basic vitals (BP, heart rate, respiratory rate, temperature, etc.). After they go through Station 2, they move to Station 3, where they see one of the CO (clinical officers. This is a degree most similar to an RN, though more like an RN+. Not quite a Nurse Practitioner). This is where the diagnosis and examination really happens. After this consultation they are either sent to the lab for testing (station 6), or to station 4. Station 4 is where most of the actual treatment happens. This is anything from dispensing medication to giving injections and IVs to relocating dislocated limbs and suturing wounds. Also, maggot removal. That is real gross. After their treatment the patients move to Station 5. This is where they receive consultation on their treatment and more specified health education. They also are surveyed about their experience at the clinic. I spent most of day 1 working at Station 3 and Station 4. Most of the cases that come in are sick children, though we also had a 12 year-old whose arm had been broken after he was beaten by a cop, a 50 year old woman in cardiac failure, a young girl with a dislocated shoulder and a young man who we think was suffering from a splenic abcess. It’s interesting, in some ways I think my EMT training has me better suited to be doing the diagnostic part part than the treatment part. So much of what happens at the treatment station is primary care stuff that I’ve never learned how to do or am very out of practice with. I felt a lot more helpful at Station 3 where I was working with Viola and learning about all the tropical diseases and what not she says, while helping her with some of the more hands on stuff (the shoulder dislocation, the wound care, examining a few stomachs, etc.). I think I must have listened to 40 different kids lungs yesterday. Hadn’t done that in years and by the end of the day was talking about bilateral breath sounds and air pockets in the pleural cavities and what not. I got to be rusty for about 2 hours but by lunch time we were in the thick of it. We saw 53 patients yesterday, which is actually a fairly light day, and the patient load cleared up by about 3:30. It rains unbelievable amount here. It’s like the frequency of rain that happens in Portland in the fall, but with the power of Chicago summer thunderstorms (and often the thunder as well). It rained at least 6 times yesterday, and each of those downpours was strong enough to have me soaked through in about 30 seconds. Dryness is a comparatively relative terms it seems, which I guess comes with the territory of being in mountain rain forest in Africa during the wet season. Lots more to tell, but I don’t want to get overly wordy in my first go round, so that’s all more now.

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3 Responses to first day

  1. Aunty Gail says:

    How very exciting for you, Nate. And you’ve never been one to back off from a challenge,
    so I think this will be an unusual but hopefully rewarding experience!

  2. I’m trying to feel the kind of air you described but humid and cool don’t go together. That’s great that they already have you working in the clinic. All your skills are going to come back fast.

  3. Matt Cohen says:

    Nate- Beautifully and vividly written….sounds like an amazing FIRST DAY. An incredible experience and you are just at the beginning. Stay dry. LOL! Dad

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