Sipi Slow, Live Fast

This weekend I went on an excursion to the beautiful Sipi Falls, a series of three waterfalls in Eastern Uganda, right on the Kenyan border and near Mount Elgon National Park (thank you Wikipedia). We started our adventure by being picked up by the Makerere University driver, James. Our group consisted of 6 girls from Holland, 2 girls from Sweden and myself, the lone American (more on the cultural lessons later). The daring drive took about 7 hours and was complete with potholes, speed bumps through every small town, swerving to avoid passing cars in the opposite lane and pit stops where Ugandans carrying soda, bananas, chips and chicken on skewers came up to the car pounding on the windows. However, after 7 hours of James' um...skilled...driving we arrived to a serene scene in the mountains of Uganda. We arrived, settled down in our “dorm rooms” (log cabins with bunk beds complete with thin mattresses, a cover sheet that had a suspicious amount of sand and random plant debris, and a wool blanket) and headed down to dinner. We had a lovely meal of tomato curry with chapatti, a local beer and then went to bed with the birds at 8:45 pm.

View from our "dorm rooms"

The next morning we woke up to a misty yet beautiful view. Sipi Falls had grown in size from the rain fall and all of us were jittery with nervousness due to the "abseiling" adventure ahead. For those of you that don’t know, abseiling is also known as "rappelling" and basically means you lower yourself down a cliff with nothing but a harness and a rope (aren't you glad I didn't tell you this before I went mom). Sipi's first falls is over a 100 m cliff and somehow Robert, the abseiling salesman/guide (who was wearing a Tyga and Lil Wayne sweatshirt) convinced us that rappelling over this cliff was totally safe and a "must do" at Sipi Falls. (But seriously mom, he and the old man running the resort, Albert, said no one had died in the 14 years they had been doing this and their equipment was up to European standards, so it was absolutely fine :D).

 The first step over the cliff was undoubtedly the most terrifying. All of sudden you put your foot down onto the mountain, look below and see nothing but 100 m of thin air with water crashing onto rocks below. I gave the safety equipment a good test with my first step off by slipping and slamming my entire body against the rock. Robert was not phased at all, and just looked at me and said, "You're doing great Mali, now just lean back and straighten your legs." Yeah, okay, Robert, I'll get right on that. Once I got past the first slip the rest was cake. I just fed myself rope and lowered myself down 100 m. I will not lie, I was holding on so tight my arms started cramping on the way down, and I never quite relaxed because I couldn't help thinking my skull was the next thing to crash onto those rock below. Nevertheless, the view was absolutely breathtaking as you descend 10 m from the waterfall and have the entire valley to look at. It was a once in a lifetime opportunity and as glad as I was to get to the bottom, I don't regret it one bit. (Special thanks to Steve Schneiter for making me go on all those roller coasters when I was little!)

Sipi Falls #1. Just a short 100 m drop....

Contemplating from afar if we can really do this or not and if we trust a man with a Tyga sweatshirt on...

I guess we trust him...so we gear up!!

My friend Sanna prepares to take the first step over...

My friend Anuk at about 20 m down (that little yellow dot that looks like a bug is her)

 After being welcomed safely to the ground by two local Ugandans, we waited for the rest to come down and took in a beautiful view of the falls. We then were accompanied/dragged back up the mountain by a very shrewd group of teenage Ugandan boys who kept asking for “money for books for school.” The hike was not a joke and us muzungos had to take several breaks. The boys were having a gay old time, telling us that they did this 5 times a day, and usually they had to bring various supplies up and down with them (show offs...).  At the top we were greeted by more local children who only knew two English phrases, “Hello” and “Give me something.” It was really sad to hear them say it, especially when our tour guide, Alex, told us that some of the boys would use the money for books, but some would use it as an excuse not to go to school and instead beg tourists for money because it was more lucrative.

The rest of the afternoon we spent hiking to the other two falls. The hikes took us through plains, forests, and villages where locals farm coffee, corn and beans. I tried my hand at some manual labor by helping some farmers hoe a few meters of land. (Okay, it was only like half a meter of land). I couldn't decide whether I was more shocked by the beauty that surrounded us or by the way the Ugandans in Sipi Falls live. Their homes are dirt huts with straw roofs without any running water or electricity. They spend their days living off of and farming the land, just to survive. They have to retrieve their drinking water and we saw women and children as young as 4 years old carrying 10 lb (at least) jugs of water on their heads.  The women wear worn, but beautiful, sashes and dresses while the children run around in random articles of clothing from Disney or Gap that are stained with red dirt and worn to the point they have gaping holes in them. However, their land is meticulously kept and is unbelievably well groomed, with the exception of the random chickens, cows and goats that regularly crossed our paths as they roamed freely.  Watching them farm and live made me realize how I have no real survival skills of my own and that I never have to manually work for any of my meals or water. Their carbon footprint is next to nothing and they are the most resourceful people I have ever met. They use huge leaves for umbrellas and old, dried up branches for brooms. They leave nothing unused and yet everything is clean and beautiful. It was truly humbling and incredible to see.

At the third and final fall it began to downpour. Our guide Alex escorted us to a rock where we sought shelter and waited out the heaviest part of the storm with a few locals. Eventually it let up and we embarked on a long, muddy hike home. Every member of the group fell on the way back and all of our hands were stained red from the mud. By the time we reached our camp we were tired, wet and hungry, but so happy, proud and blown away at the day we just had. After another wonderful dinner we chatted but mostly just waited until it was socially acceptable for us to go to bed. 

Sipi Falls #2

Laundry Day

Sipi Falls #3 

Uganda be kidding me (credit to Chelsea Handler)

This post is dedicated to reviewing my first few days at Mulago Hospital. The hospital itself is set up as a storied courtyard with outdoor hallways and staircases. The views are beautiful from every side and it really is surreal to walk out of a dark, damp room and see this beautiful scene. The hospital itself is run down with no air conditioning, minimal resources and an abundance of patients who need serious help. Patients line the halls in colorful clothing and wait for hours to be seen. Some patients even bring mats to lie on as they wait to be triaged.

They gynecology department, where I have spent my first week, consists of a hallway with several rooms and a parallel hallway branching off of it. Patients line the halls and are crowded into rooms, with 5-7 women in each one and sometimes women even have to lie on the floor with a mattress. Women bring their own bed sheets, have to retrieve their own water, food and prescriptions and have minimal family present as there really isn't that much room to accommodate visitors. The floor is "divided" (I use this term loosely as there are no real divisions) between annex (triage), benign gynecology, post-operative patients and most astonishing to me, a separate room for molar pregnancies.

Mulago Hospital Gyn Ward

My first day I rounded in the "molar room" with one of the OB/GYN residents. As I have very rarely seen a molar pregnancy in the US (honestly, I'm not sure I ever have, and certainly none that were this invasive), I appreciated the review of something I had only learned through a textbook. Over the next hour we examined these four patients and I was struck by a few things. First, these women were sick. I could see their pulses bounding in the carotid arteries, they had shockingly large and tender tumors in their abdomens and by any US standard would be rushed to the operating room ASAP. Instead, they had been waiting for at least a day and would likely be waiting for another day or two to be operated on. Second of all, I could not get over the sheer look of hopelessness, fatigue and resignation that they all shared. It was if they expected nothing more or nothing less than to lie on their bed for days until the physician had time for them. Third, I was shocked by how the physician patient relationship was much more abrasive, but more equal than it is in the US. Physicians talk in frank medical terms, tell patients to shut their phones off and show little emotion toward the seriousness of the patient's condition. Part of this is the stoic, lackadaisical temperament of  Ugandans, but part of it is because the physicians have such a large number of serious conditions on their hands that they cannot stop to coddle each and every patient. At the same time, patients are active and knowledgeable about the medical frenzy happening around them. They know exactly what labs they had drawn, they know exactly what x-ray is the newest one and they hold their charts until they show the physician which new results came in. It is a very different dynamic than the "gotta have it all", paternalistic, hurried, customer-service based relationship that physicians have with their patients in the US. At the same time, I do miss some of the humanistic,emotional interactions that often happen in the US.

These past two days I have participated and observed two surgeries I have never seen in the US. Now, a note about the ORs. In the gynecology theater (their word for operating room), the minute you step into the area you have to take your shoes off and walk in your socks to the back where someone will hand you *hopefully* clean scrubs and "gum" boots, which are white rain boots you wear in the theater. The first day, my scrubs had no tie and were 14 sizes to big for me so I had to wear two sets of scrubs. The theater is not air conditioned and sterile technique is merely a suggestion. Surgeons operate in minimal lighting, retrieve their own instruments, gown and glove themselves, and never yell or fuss about anything. Students crowd the room, nurses are in and out, people come in and out without masks or proper attire and the surgeons serves as his or her own scrub tech. Needless to say, this part has been the most shocking part of my journey thus far.

Super pumped about her new BP cuff. ; ) Her and the sisters were actually all ecstatic when I brought it as they had been sharing one between the entire floor. Thank you Dr. Duffy!

As far as the surgeries happening, first, I saw an "emergent" (emergent is really in the Ugandan vocabulary) ruptured ectopic pregnancy (a very emergent, life threatening condition)  my first day. This particular case was operated on a full 12 hours after being admitted because of all the other ruptured ectopic pregnancies that had come in that day. I then learned that this ward sees almost 10-12 ruptured ectopic pregnancies per week.

Today, another rare surgery occurred, this time it was even more crazy because it was only me and one resident at the operating table. Earlier in the morning, I had heard about a patient who had a uterine rupture (again, super rare) 4 weeks prior and had been readmitted 3 days ago to the ward due to a foul smelling discharge coming from her wound. The team had determined that she was septic, but because of the amount of ruptured ectopic pregnancies coming in, and the fact that only 1 operating room was available, she had waited three days to be operated on. As I waited for her to go back, the resident in charge of the surgery looked at me and said, "you assisting me?" "uh...yeah..." I stammered. For the next hour I tied knots in my scrubs to make sure I didn't look like an idiot (which of course happened anyway). I kept expecting another attending or resident to show up and take my spot across the table, however, that person never came. Instead, I was the first assist for a septic patient with a necrotic uterus that eventually had to be removed. At one point the resident realized the ureter had been damaged and torn from surgery, so eventually a specialist was called in for a few minutes. At the end of the day, the patient ended up with her bladder draining through a stent in her incision and an abdominal drain with another pending surgery in 4 weeks. However, she was alive and in stable condition. The entire ordeal was surreal and I learned more in one afternoon than I did on an entire month on some rotations. It is amazing what you can do when you are truly pushed to the brink of your capabilities, even when you are really, really, sweaty.

Giving in

Let's start at the very beginning..

I really resisted starting a blog, mostly because I was sure that by the end of my month here I would get too lazy to post. However, so much has happened that I just feel like I should write it down for myself and for those that want to know how things are going. Worse case scenario, I've just provided you with some really great bathroom material.

Anyway, my arrival in Kampala was so smooth. My flights were very easy. I slept, watched two movies (everyone needs to watch This Is Where I Leave You) and KLM British Airways stuffed more pasta, bread and free alcohol into me than I thought possible. We stopped in Rwanda (fun fact, Rwanda does not allow plastic bags into the country...*insert blank face emoji*) on our way to Entebbe. In Entebbe I flew through the Visa line and was greeted by the University Driver Erea (the first of many names whose spelling I will botch) who held a sign that said "Makram Cathreen". Close enough to Mali Kathleen I guess, so we drove. I finally arrived to Ham Suites at approximately 1 am sweaty and exhausted. I was escorted to my beautiful room with an almost functioning shower and a toilet that flushes. Score.

Ham Suites Ham

Monday morning I met my Ugandan medical student ambassador Derrik. We toured Makerere University campus which is the the Harvard, St. Olaf, Carleton and community college of Uganda all rolled into one. Derrik was an O.G. for me on day one. He helped me buy a SIM card for my 1997 burner phone, told me the history and political atmosphere of Uganda, and also introduced me to posho, a tasteless starch that is the staple of the Ugandan diet and I vow to never eat again. :p He also took me to dinner at another local restaurant called Club-5 which has a 4 page menu, but really only has the ingredients for 4 dishes (I've since learned this is typical in Uganda). Lastly, Derrik taught me the important art of crossing the street. Not to scare you mom, but this literally is a life or death event every time you cross. There are no cross walks, sidewalks, stop signs or street lights. It is you, the bodas (crazy motorcycle drivers that also function as taxi drivers), the millions of cars and God. Thankfully, I'm still here to blog about it. 


I woke up at about 1 AM that night to a RAGING storm. As in shaking the floors, rattling the windows raining cats and dogs kind of storm. The next day after talking to people I realized I had arrived in Uganda during the rainy season...classic Mali...I had no idea. Either way this actually works out well because this "mazungo" (Ugandan for white person) does not like raging heat and the rain brings cooler weather.

Uganda love this view