TZ

Sadly, my four weeks in Uganda has ended and I am now writing from one of the most serene places in the world that I have ever been, the mountainous Gonja, Tanzania. (If I’m actually able to post this on day that I write this it will be a Gonja miracle as internet is not even up to dial-up speed yet.) My flight left at 5:35 am from Entebbe, meaning I had to leave my apartment at 1:00 am, which, if you know me, means that I obviously did not sleep that night and instead was with my friends and packing up until the last minute. With a full, but heavy heart, and in denial that this amazing part of my journey was over, I slipped out in the middle of the night, just as I had come.

After two short and uneventful flights, I touched down at Kilimanjaro International Airport to a bright, sunny morning. Immediately, I was struck by the beauty of this country. As I stepped off the plane I was met with a beautiful backdrop of mountains, bright pink flowers, clean cut green shrubbery and crisp, fresh air. Traveling in Kampala was a lot of like traveling with a hyperactive 7 year old; it was adventuresome, covered in dirt, really fun, full of laughter, but always a little bit crazy. Arriving in Tanzania, I felt like that 7 year old was replaced by Ghandi. The calmness and serenity was undeniable. As a stepped out of the airport I couldn’t find my driver, but within seconds there were helpful, friendly guides that gave me a Plan B if my driver didn’t show up. After standing outside of what I thought was a locked bathroom for 5 minutes (turns out I just pushed the door the wrong way :D-hey-I hadn’t slept okay?), my driver finally did arrive and we were on our way. My driver, Eligama, was not the strongest in English but made up for it with enthusiastic smiles and saying “ya, ya” a lot whenever I asked questions. Within the first few minutes he pointed out the snow covered peak of Kilimanjaro. Stupidly, my first thought was, “Wow, that is like, a real mountain” followed by, “OMG, I am going to supposedly climb that mountain in a couple of weeks.” The sight, even though it was mostly cloud covered, was amazing and aided in my anticipation of the trip.

As we left, Eligama told me we would be driving for a few hours and then would start on a very rough road that would take us basically straight up the mountain to Gonja. After a couple of hours of driving through sprawling green fields with women in colorful traditional clothing carrying baskets on their heads, we finally ascended the mountain towards Gonja. I cannot overemphasize how beautiful this drive was, the views of the layered blue mountain silhouettes, the green hills, the beautifully clothed Tanzanians dotting the miles and miles of farmland, and then finally, the breathtaking drive up the mountain to Gonja. Every two minutes Eligama would patiently stop so I could take yet another photo that couldn’t quite capture the beauty I was seeing. (Also, I would love to upload these for you, but by the time that happens I will be back in the States).

Finally, we arrived to Gonja Lutheran Hospital, which is a mission hospital campus nestled in the side of a mountain. It serves all the people that live on the mountain and without it, many of these people would be completely without health care. The hospital has under gone several renovations and is now a white and blue two-story hospital with open balconies that face the valley of the mountain below. Roaming the halls of the hospital are women in beautiful dresses and wraps, doting on their family members or patiently waiting to go into labor. (Women come up here and stay for weeks just so they can be sure they deliver with a provider to help them.) The hospital is grounded in very strong Christian faith and every morning the hospital staff starts their day with prayers in Swahili. Patients have their own area where they can cook, clean and do laundry. The hospital director on staff stays in the house next to mine and his wife is a nurse who works at the hospital as well. Overall the hospital has about 47 employees, but really there are about 20 main ones. It is definitely a close knit community and since my arrival I have been continually astonished at how friendly everyone is. So far, I’ve learned that Tanzanian’s favorite word is “Karibu” which means “Welcome.” They say it to me every time I enter a room and I have been told no less than 30 times since arrival that I should “feel at home.” We ended our tour in the hospital “cafeteria” where I met my mom away from home, Mama Joyce. I want you to picture the friendliest, most beautiful, and impeccably traditionally dressed, older African woman in your head-that is Mama Joyce. She exudes warmth and comfort and within minutes was serving me amazing African tea, rice and beans. She makes each and every meal for me here and I’m seriously contemplating trying to take her home with me so she can take care of me in residency.

 Mama Joyce and I 

My house!

View of the patient's kitchen from my house

Also within a few hours of arriving here I met a Tanzanian friend, whom a previous DMU’er who rotated here told me to contact. Chediel Daniel, is again, one of the warmest and most welcoming people I have met. (I know I’m being redundant but it is so true-these people are so nice!). After only meeting me for an hour, he invited me to his church the next morning. Bright and early Sunday morning he picked me up so we could walk to his church. After about 40 minutes of walking we arrived to a quaint white church with stained glass windows, planted just on top of a hill within the mountain. After the service, which consisted of three different offerings (one of which consists of farmers literally bringing their first harvest of beans, corn, etc. to the altar), some beautiful songs from the choir of 6 and a live auction of fresh fruit, we headed back towards our homes. On our way back we stopped at Chediel’s family store where his mom had prepared us fried bananas, beef, avocados, rice and African tea. His dad sat down with us and after a few hours and some traditional African drinks (apparently Africans love Sunday Funday just as much as I do), his dad invited me to his sister’s wedding sendoff next Saturday and insisted I stay at their house. He said, “My house is your house” at least 15 times. We eventually started heading back toward our homes but not before we stopped at met more of Chediel’s friends and stopped at his grocery store. I made it back just in time for Mama Joyce’s wonderful dinner and crawled into bed exhausted but in shock at how this experience never stops surprising me. Although I arrived in Tanzania feeling very homesick for my friends, life, hospital and dorm style living in Kampala, I have met so many wonderful people here and know that this experience is going to be amazing as well, just in a very different way. I feel so thankful that they have opened up their homes, kitchens and churches to me and am excited for the weeks to come!

Church with Chediel

Our Sunday Funday meal of fried bananas, meat and avocados

Serengetti's and Chediel's dad-a wonderful Sunday Funday mix

Repping my man Obama...apparently they call him "the chocolate boy" in Tanzania...

Learn, Grow and Give Back

I have to admit that I have been putting off blogging about my hospital experience here.  This is mostly because I’m personally still trying to process everything as it has been quite the emotional and educational roller coaster. That being said, I would like to add a disclaimer that some of my thoughts I’m going to blog about here are very raw, honest and I am very aware that I am by no means an expert on medical training or health care systems.   

Anyway, back to my roller coaster, on my overnight shift last night I delivered twins!!! I was by myself, with minimal supervision and the second twin was actually breech (feet first). It was an incredible experience and truly one of the coolest things I have done in my life. However, this amazing experience for me also highlights the health disparities at play between our two countries and systems. In the US, a twin pregnancy would be highly supervised, would most likely result in cesarean section, and no matter what happened, would definitely NOT be handled by a lone 4^th year med student. Additionally, as I was delivering twins, the woman in labor next to me was at risk of rupturing her uterus (and thus most likely losing her own life and her baby’s life) because no operating room was available for her to have a cesarean section due to the water being out and linens not being clean. While I have some guilt over the fact that I was basically alone while delivering these twins, I also think it is sad how much we are shielding our young doctors from experiences like this. We have come so far from trying to do things as naturally as possible, and instead have added a large amount of technology to the process and slowly chipped away at a hands on learning experience when dealing with rare complications. Don’t get me wrong, I am so happy our maternal mortality is much improved due to this technology, but a lot of times I feel the use is driven by litigation and defensive medicine than it is by true patient safety. We have very under served populations in the United States and I feel that adequate, comprehensive training to deal with their complications and events is harder to come by in the US than sometimes it should be.

This one hour of my experience pulls in so many things that I have been struggling with and growing from, but also have been really enjoying throughout my rotation here. Yes, resources are low. Yes, patients come to the hospital quite sicker and later than they should. Yes, sometimes things don’t go as efficiently as they should. However, the doctors, nurses and staff I have met are wicked smart, they are amazing diagnosticians and have skills that most physicians in developed countries have never even thought of having. For example, my first day on OB I was astonished to find that the fetal heart monitoring system was not electronic cords and dopplers surrounding and ensnaring the patient, but was a wooden “fetoscope” which looks more like it belongs in the kitchen than in the OB ward. The first few days I couldn't hear anything, but after a few dozen tries I finally am able to find most heart beats with the fetoscope. Just getting used to using this rudimentary tool developed my diagnostic sense and awareness within a few days.

 Additionally, I have also noticed how well adapted clinicians are to giving the best care they possibly can to patients day in and day out. The acuity and the amount of patients these physicians deal with is incredible. Often times when I am on the ward for merely 2 hours I feel is I have worked a 12 hour shift in the States. For example, I was working in OB triage checking a woman’s cervix when I turned around and saw two feet sticking out of a woman’s vagina. My intern (who is amazingly talented) luckily came in seconds later and delivered the very blue baby in the middle of triage without breaking a sweat (literally, he was completely calm and I was sweating my gazankers off). Afterwards, with nothing more than a drying blanket and a half functioning bag mask, the intern and I worked to resuscitate the baby. I, in no way, possessed the qualifications to be one of two people resuscitating that baby. I am not a pediatrician, I am not even a pediatric resident and I haven’t even taken by pediatric life support course yet. Thankfully, my intern is much more experienced than I and together we did succeed in resuscitating the babe and overall turned a terrifying situation into a really happy one.  Even though this situation turned out well, I have to stress how incredible it is that it was managed by the intern as well as it was. To give you perspective, a third year OBGYN resident from the United States told me she had never seen a breech vaginal delivery (she by the way is amazing to be on a rotation with and I feel so lucky to have her there too!). In the United States we scan and scan and scan and if the baby ever turns breech we try to turn it or we move immediately to Cesarean section. Very, VERY few physicians or midwives will attempt a breech vaginal delivery, and in my two weeks of being here I have been a part of 2.

Another refreshing thing is that patients take a lot of ownership over their health. This might mean that they frustratingly refuse treatment because they feel that it is just evil spirits that will take their disease away, but this also might mean bringing something up in their chart that I completely would have missed had they not pointed it out to me. Patients are incredibly strong, resilient and patient (no pun intended) as well. Women sit for hours in labor on the cold, dirty concrete floor as they wait for a cot to open up. Once they get a bed, they lay a plastic sheet or garbage bag down, labor and deliver with absolutely no anesthesia and minimal supervision. I’ve also seen episiotomies and vaginal laceration repairs done without ANY (not even local) anesthesia, and sometimes the woman doesn't even flinch. At the end of the day, no matter how much they scream, they always end up saying “Thank you so much musawo” (Musawo means doctor). I felt terrible that I was the only one at my patient’s twin delivery, however, judging by the gratitude coming from the patient and her husband, you would have thought I bought them a new house.

I can’t pretend all my thoughts and ideas are processed through rose colored glasses though. A lot of times I sit around with other international students at lunch and just debrief about how inefficient and sometimes just how plain wrong things go. There are many patients dying from preventable mistakes that could have been caught by a number of people (which also happens in our health care system). There is sometimes an incredibly frustrating lack of urgency. Often times, I just want to clean the C section OR myself because there are so many women on the list who needed a C section 1 week ago, but probably won’t be able to get in until the next day. Most frustrating though, is that even though this is exactly the type of patients and the severity of conditions I have a passion for treating, I have little to no say in what happens here. I feel like there are all these things that could be improved but again, I can do little to nothing about it. Furthermore, on the flip side, I feel like it is going to be really hard for me to bring the same empathy to developed patients as I once did. Suddenly a housewife from the suburbs whining about not vaccinating her children against very preventable diseases makes me even more angry as I’m watching children die every day but just not having basic resources available to them. Again, I apologize if this is too harsh, these are merely my knee jerk reactions and might especially be more blunt as I’m writing this after being up for 36 hours J.

While the above paragraph is probably my most negative and harshest critiques of both situations, what it comes down to is that we just come from such different worlds, backgrounds, resources and cultures. However, I do not think this is an excuse to allow one world to suffer so incredibly, while another has ample resources that could easily be shared. I’ve struggled a lot with exactly how to deal with these emotions and frustrations and I have to say the only answer I’ve really been able to come up with is that learning from each other and working with each other can hopefully bring our two worlds closer together. As my very wise global health professor e-mailed me “learn, grown and give back” and right now that is all I think we all can do to start solving these problems. 

Nile Special

I promise I will blog more about my hospital experience in this next week, but I have to recount the amazing last few days I have had. Thursday evening, a few other American students and I were invited over to one of the international directors’ house for a home cooked Ugandan meal. Susan made us one of the best meals I have had in Uganda which consisted of hand squeezed passion fruit/mango juice, the best matoke (a bunch of smashed bananas with seasoning) I have had in Uganda, tilapia, Irish potatoes (normal white potatoes) and salad. The meal was delicious and the company even better. One thing I have learned is that Ugandans are extremely hospitable and Susan was the epitome of that. This week we are having her over for a “traditional” American meal which so far consists of my region famous beer dip, some sort of candy bar salad and either pizza or lasagna for the main dish.

Emily, Becky, Rachel, Susan and Reagan

After our wonderful meal and an eventful Friday at the hospital which I will blog about later, a group of 19 international students, including myself, crowded into a bus early Saturday morning and headed to Jinja, a city 2 hours from Kampala. Here we embarked on an exciting, somewhat crazy and definitely water logged adventure of white water rafting on the River Nile with a company called Adrift. Upon arriving to the Adrift site, we split into groups of  6 or  7 and piled into our respective rafts. Our raft guide was named Tutu, so naturally our team name was Team Tutu. Within 5 minutes, Tutu had us doing safety drills and jumping into the Nile, simulating that we had fallen overboard or flipped our raft (these later would definitely come in handy). 

TEAM TUTU!!!

 After our safety briefing, we headed out to our first rapid. The first rapid was fun, but thankfully uneventful; all paddles, arms, persons and body parts were intact so we headed toward the second rapids. This one was not quite as uneventful. After the first wave, we smashed into a second wave and seconds later I was underwater feeling 6 other bodies kicking and twirling around me with a huge raft on top of the whole mess. I finally was able to surface for air, but as soon as I gasped another wave pummeled me back down. After a few more seconds I popped back up and Emina, the baller extreme kayaking Olympian, came to my rescue and pulled me, along with a few of my friends, back to our raft. After our flip we all were a bit shaken so we took the rest of the rapids a little more easily. The views of the banks of the Nile throughout the entire trip were amazing, and after a few more rapids, 5 hours in the sun, some impromptu back flipping off the raft and a lot of cheering “TEAM TUTU!!!” our day was completed.

Rapid #1

Now begins the sequence of us on our 2nd rapid...here we are heading for our wave of terror.

Just demolished.

And there she went...we all were completely submerged, paddles flying everywhere, feet frantically kicking, and Tutu screaming (and laughing at us) while we tried to grab the boat. 

The rest of the rapids did not result in near drownings but were just as fun. At one point Tutu had us in the "washing machine" where the wave kept pulling us back and forth. : D

Our last rapid...notice me in the front right...not really sure of whether I should laugh, cry or admit that I just peed myself. 

After the trip ended the Adrift staff BBQ’ed meat and served us Nile Specials as we watched our videos and looked at our pictures. We also bought some merchandise from Emina, who will be competing in the summer Olympics for extreme kayaking. All proceeds from her business were helping her buy her plane ticket, so we all bought necklaces that she made out of magazine paper and some headbands.

After our lovely BBQ, we then boarded the bus and headed towards our campsite on the muddiest road I have ever driven on. After less than 2 minutes of driving, we were completely stuck. Knowing that there was little we could do, we all deboarded the bus and began talking to the local villagers and children. I and a couple of friends, along with the Adrift team and some local Ugandans, finally pushed the bus out of the mud, but not before I completely ate it in the mud and had 100 Ugandan children laughing at me. That night our Adrift crew met us at our campsite and we all bonded by climbing into a kayak that hands upside down in the rafters of the local watering hole. Almost our entire group complete the ritual and by the end of the night we all were exhausted and so happy we made it through the day. 

Mid fall as I am trying (obviously unsuccessfully) to get the bus out of the mud

Emily and I...completely covered in mud. 

Our baller savior/olympian, Emina.

As if extreme kayaking wasn't enough...tonight we decided to join an extreme running group. Hash House Harriers is an international "running group with a drinking problem." It is present in most major cities and usually consists of locals, some "in" tourists and expatriates. My running buddy/personal trainer/slave driver and I decided it sounded awesome so we got the "in" information from our friend Adam and convinced our friends Emily and Becky to join. The group meets every Monday in a different location, so you have to know someone in the group who can text you the location of run that night. Luckily Adam is a creepily good stalker and hounded the group enough to let us know the location :). The address took us to the rooftop of a mall where we met 120 other runners, mostly Ugandans, who were drinking beer, stretching, dancing and chatting. At 6 o'clock sharp the run started. Now, the way HHH is set up is that you have "hares" who mark the running route before and "hounds" who follow the route. The hares when they set the route up purposefully put dead ends, loops and "hooks" so that faster runners have to slow down or run farther, thus keeping the group together. After running about a quarter of a mile, our entire caravan stopped suddenly, and realized we were on the wrong route, so we had to completely turn around and join the rest.

Emily, Becky, Katie (my personal trainer) and I at the first checkpoint!

After a couple of miles and a killer hill, we reached our first checkpoint. Again, this is designed to keep the group together. Feeling more confident we pushed up towards the front of the pack and then started again. After getting to the top of another huge hill, and then descending down an even bigger one, a group of about 10 runners stopped in front of us and said, "Ok, you're the first 10 so you make the hook, go back up the hill and come back." I was so astonished I just started laughing and trucked my butt up the HUGE half mile hill we had just descended. After turning around again, descending the hill again and thus meeting up with the rest of the group we hit another check point. This time, it was complete with solo cups of beer. The leader of the group also lead us in a drinking/calisthetic song where we did jumping jacks and some other weird limb motions. Finally, after about 4.5 miles we ended up back in our original location and celebrated with a meal and more Nile Specials (newcomers had to partake even more and embarrass themselves in front of the entire group of course). We met some amazing people along the route, and one named Joseph even gave me the shirt off of his (sweaty) back because I said I liked it so much. At the end of the night the 5 of us were all (sweaty) smiles and became lifelong HHH'ers.

Asanta Sana Squash Banana

In light of all the drama surrounding recent events in Uganda which I will blog about later (don't worry, I'm feeling very safe), I thought I would blog about my Lion King inspired weekend in Murchison Falls. Murchison Falls is a waterfall of the Nile created by the narrowest bank in the Nile, measuring only 7 meters wide. It also is part of Murchison Falls National Park where many tourists and wealthy Ugandans go on safaris. It came highly recommended from several other students rotating with me, so with that a gaggle of 5 Americans, 6 Swedish and 3 Dutch girls all planned a getaway weekend. We left early in the morning and met our drivers, Rogers and Moses. They picked us up in extended jeep-ish cars that had a “pop-up” roofs and handles equipped to keep you in the car on bumpy roads. We set off, and 7 hours later (again-Uganda roads are nothing to mess with) we arrived to a beautiful scene of the Nile River.

We started our weekend off with a boat cruise of the Nile where we saw a family of elephants, a few lazy crocodiles, flocks of beautiful birds and tons of hippos (literally tons). We also fittingly had Nile special beer  and had a great happy hour in front of the beautiful Murchison Falls. After a minor incident where we ran out of gas in the middle of the Nile and had to be rescued by a dingy, we packed back into our jeeps and had  a sunset game drive through Murchison Falls National Park.
 

After our beautiful sunset drive, we arrived at our hotel/glampground, Fort Murchison, which overlooks the Nile. This place was unbelievably beautiful and for the first time since I arrived in Uganda I had a shower with actual water pressure. We had a wonderful four course meal and retired early to our glamping (glamorous camping) sites. The next morning we got up early to game drive. Within minutes of being on the savannah we saw huge troops of buffaloes with their white feathered buddies flocking towards them. They grazed lazily and we eventually moved on to finding a memory of elephants crossing our path. The enormity of these animals was astonishing and watching them feed and play was nothing short of awesome. Throughout the day we also saw towers of giraffes, flocks of beautiful birds, herds upon herds of antelopes, sounders of warthogs and barrels of monkeys (I had to google the group names of all of these animals-great 4^th grade review). After a while we all just put our cameras away because we saw so many beautiful sites and amazing animals that the pictures just weren’t cutting it anymore. Towards the end of the day some of us became adventurous enough to sit on top of the vehicle as we took one more tour of the savannah. Unfortunately we didn’t get to see lions, but the safari we had a beautiful day in the neighborhood with Mr. Rogers anyway.

 The next day we left towards home but stopped at the Rhinoceros Sanctuary on our way back. Sadly, in 1983, rhinos became extinct in Uganda because of poaching. The horns of rhinos are apparently very valuable, so they were hunted ferociously until they became extinct. Years later, the Kenyan government and the US government donated white rhinos to the Ugandan government in order to set up a sanctuary. Land was donated by a wealthy Ugandan and the breeding of a new generation of rhinos began. An especially fun fact for me was that the first baby born in the rhino sanctuary was named Obama (papa rhino was from Kenya and mama rhino was from the US ;)). At the sanctuary we were  guided on foot to a location where a mama rhino and her baby were snoozing. There are no fences or any barriers between you and the rhinos during the tour and so we had to tip toe and be very quiet to keep them from charging. Luckily, mama rhino was pregnant and really tired and we were as quiet as church mice, so no charging incidents occurred.

The Crested Crane-national bird of Uganda

After the rhino sanctuary we headed back and eventually arrived back to the craziness and chaos of Kampala. Overall the weekend was amazing and I feel so lucky to have had that experience. Conservation of land, resources and animals within Uganda is hugely important to their economy, development and growth and so it meant even more to be able to witness how proud Ugandans are of this park. Our tour guides, Moses and Rogers, have been guiding for years and were incredibly knowledgeable not only about the animals and foliage, but also had a lot of knowledge about how these parks and conservation efforts affect their country and economy. Although economically Africa has its struggles, it is rich in natural resources, beautiful landscapes and majestic animals, which are all things Ugandans actively fight to maintain. As an American I had never seen many of these animals outside of a zoo, and it made me proud that we also contributed to the preservation of some of these species.

You Get What you Give

"Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it's the only thing that ever has." - Margaret Mead

Happy Easter to all! Whether or not you spent the day in church or with family or both, I felt this was a day that the generosity of a few donors should be highlighted. While planning for this trip, my friend Erika, who rotated at Mulago before me, described the state of need at the hospital and how any and every donation would help. Thanks to her advice (thank you Erika!), I began e-mailing a few people in Wisconsin. With just a few simple e-mails and some incredibly salient advice from my mom, I received an enormous response. By the time I returned from my internship in Washington D.C. I had several boxes of gloves, masks, inhalers, suture material, suture removal kits and irrigation supplies to donate. (A special thank you to Riverside Medical Center and specifically Mr. Craig Kantos and my mother for pulling all these together!) Furthermore, one of my preceptors, Dr. Ben Duffy (sorry if you wanted to remain anonymous, but you needed to be recognized!) even met me at the airport on the day I was leaving to donate an army bag full of trauma supplies and two beautiful otoscopes and ophthalmoscopes. Erika also played a huge role and somehow got a box of glucometers to Des Moines so I could also take these with me. When all was said and done, somehow the donations fit perfectly into my two suitcases with all my clothes (okay, it took a lot of sweat and tears for this to happen, but Jim and I got it done). 

Upon arriving to Mulago, I discussed with my coordinator that I had donations. After counting them, organizing them and hauling them to the hospital, we made a plan of action. I would donate most of the gloves, suture material and catheters to the gynecology department (they always get the shaft on supplies so I felt the need to spread some girl power), and the rest would go between the emergency department, internal medicine and pediatrics. After donating a huge box to a very appreciate gynecology department, my coordinator and I headed down to the emergency room/casualty ward. There we found the head sister (aka charge nurse). When I showed her the masks, glucometers and bandages she literally jumped for joy. She started dancing, I started laughing and immediately the supplies I brought out seconds before started being used by the residents. She could not believe she had not 1 but 2 new glucometers for her department, and she had suture supplies and TB protective masks for her residents. 

Mid dance party to celebrate her new supplies!

 After seeing the rest of the supplies we had, she immediately directed us to the sister in charge of the casualty ward. Here we donated more glucometers,  masks, gloves and trauma supplies. Upon opening the trauma supplies and intubation kit from Dr. Duffy she gave me a huge hug with tears in her eyes. She said to me, "You don't even know how much this will help, most of the time we work on patients blindly and don't have the supplies to properly assess and resuscitate them, these will help so much. God bless you." Following this wonderful reception, we went up to the endocrine ward and donated the rest of the supplies to another sister who again kept repeating "God bless you" with tears in her eyes. I really had no response to their reactions and only could smile, shake their hands and say "Kaale, kaale" (You're welcome/it's fine in Lugandan). Somehow, even after donating all these supplies, I still felt that I was gaining more from the experience than they were.

Thank you Dr. Duffy and Erika for the trauma supplies and glucometers!!

Checking out her new intubation kit for the casualty ward

Thank you again for all your support and donations. Many of you have reached out and expressed your interest in donating, but truly I was not able to carry anymore with me so please don’t feel slighted. Shipping to Africa is very unreliable, so I could really only ask for what I could personally take with me. However, I am trying to work on a way for others to donate money if they would like and will keep you updated on this. Even if you haven't physically donated something yet, I need you to know how much I appreciate your incredible support of my journey here. I can’t tell you how much this has helped me adjust to life here. Furthermore, your interest and donations have helped me feel that this journey is not completely selfish on my part. While we all benefit from learning together and learning about each other, I feel overall that I am benefiting exponentially more from this experience than the my generous Ugandan hosts are. That being said, I do feel that by the donations I brought and by sharing these incredible people’s stories, I can somehow return some of the favor. So thank you for helping me give back by reading about my experience here and by generously donating supplies for this hospital that desperately needs them! 

The Best I've Ever Had

As a former barista and med student, coffee and I are in a very steady relationship. I can’t live without it, I wake up every morning thinking about it and I go through withdrawal when it isn’t there. Hi my name is Mali, and I am a true coffee addict. So, when an option for a coffee tour came up during our trip to Sipi Falls there was no stopping me. It turns out our tour guide, Alex, comes from a family where they have been manually farming, harvesting, roasting and selling coffee for generations. Alex is a true coffee connoisseur and gave us a wonderful trip through the life of a coffee bean. Through the next several pictures and captions I am going to take you through what it takes to make a real cup of coffee. I promise you will never look at your Starbucks coffee the same, even when the barista purposefully spells your name wrong.

This is where the magic begins...a coffee tree field. 

Alex showing us that the coffee beans are ripe and ready to be picked. Keep in mind there are hundreds of these per tree, and thousands of trees around that will all be picked and harvested manually. 

The white, wet beans that are shucked out of their red shells. At this point the beans will be set out to dry, which can take up to 10 days during the rainy season.

After drying, the beans need to be shelled, which is done by this giant mortar and pestle. 

After we shelled the dry beans, the shells need to be separated from the actual bean. If they are roasted with the beans, Alex says they will be become very bitter. The technique to separate them is called "winnowing" and clearly is a talent that only comes after generations have mastered it before you. After trying as a group to winnow for 30 minutes,  Alex put all the shells back in the pan, winnowed for 2 minutes, and the shells were perfectly cleared.

Alex putting the beans over the fire to begin roasting...

The coal wasn't working well so he decided to roast over his grandmother's wood fire instead. This is inside her home, and she generously let us use her kitchen for the morning.

After roasting for approximately 25 minutes, the beans are finally ready!!

At this point, they can be sold as dark, dry roasted beans. However, Africans normally drink their coffee by adding scoops of ground coffee to hot water (like our instant coffee). So after the beans were roasted we did another round of mortar and pestling.

Alex then boiled us a huge pot of boiling water and poured it all into canteens for us. 

After two hours, standing in a hot kitchen and roasting beans over a fire, hiking up a mountain and manually grinding my own beans, this was the best cup of coffee I have ever had.