Caring for dad

Some of my afternoon lectures were rescheduled so I have time to write now. Yesterday we started with observing the screening procedures for tuberculosis in the wards of the hospital. Many people are co-infected with HIV which can result in an atypical presentation of the disease, i.e., chest x-rays may not have the characteristic “cavity” finding or hilar lymphadenopathy (enlarged lymph nodes in a particular region of the lung seen on x-ray) and other constitutional symptoms may be lacking (such as drenching night sweats, fevers, cough productive of phlegm often with blood). We happened to see mostly patients that were HIV negative as we screened. I wore my N95 mask for those worried about my exposure J


Patients undergo Tb and HIV health counseling before the medical officers (=physicians) see them. Eligibility for studies and informed consent occur before or after they meet with us depending on if they’ve been seen in the TBRU clinic (Tb Research Unit) first. All the patients we saw already had x-rays taken, which we held up to the ceiling light to read. I saw a number of disseminated Tb cases. Disseminated Tb occurs when Tb affects other organs. One woman had likely Tb of the kidney; another man had Tb of the abdominal region with mesenteric (an abdominal region) lymph node enlargement.


The most saddening and touching story for me of the day (and many of them are) was a 10-year old boy who came to the clinic. But not for himself. His dad is dying of AIDS-related illnesses, including widely disseminated Tb and Kaposi’s sarcoma (a type of cancer seen on the skin), and sent his son to get instructions from the medical officer. The boy will likely be an orphan soon. He had the innocence of childhood in his mannerisms that it appeared he didn’t realize yet how sick dad was and the outcome. So the doctor reviewed the most recent x-rays and the chart and wrote a note for the father that he gave to the son. The boy then walked out of the room with his father’s chart and x-ray, which was more than half the size of him and went to the chart room to drop it off. I talked with the boy and worked on making him laugh despite his shyness. Ali lost his father to an AIDS-related death and told me how HIV has affected his childhood. He quietly explained that he knew this boy’s future, one far too common still in Africa despite improvements and increasing access to HIV medical care.


I had lunch next at the medical school canteen. One of Ali’s colleagues, a physician named Fred, spoke with Ali about the “brain drain.” Both have spent time training in the Yale Medical system and discussed how frustrated they feel when docs leave Uganda to practice in the US or Europe. The three of us had a very good discussion and I asked a number of questions. Since this issue of brain drain has been important to some of my AMSA and PHR colleagues and classmates, it was a good opportunity for me to talk with people on the other side of the issue. More on policy measures being considered for addressing health care worker shortages in a later post.


The last event of the day was a general meeting of all the community health research workers gathering for the weekly status updates on a number of projects. They run quite a program here to say the least. I learned of a Alcohol-HIV study that I investigate further.


Last night Matt and I walked up to Kisimente so I could look at ads for roommates and flats in which to live. No such luck, but I bought some fantastic coffee that I tried this morning in my French press mug. Feeding the addiction once again! He and I walked through a flashy part of town called Kololo, and I found a few restaurants to try out and a Green Tea House. Excited about that one. He and I then ate dinner at a Korean restaurant here that had very cool Asian contemporary architecture and great food. We discussed religion, social issues, and literature which made for an enriching dinner time.


Today we had a meeting with one of the mentors on site for Ali and me, Dr. Kamya. He researches the HIV and malaria relationship with a University of California – San Francisco collaboration. I also met one of the Yale collaboration physicians who tracks many infectious diseases here. I hope to visit the a sleeping sickness treatment center in the eastern part of the country at some point with the Yale team.


I toured some of the hospital wards today. I thinks there’s a vigorous debate between Westerners here with staff here on the status/practices/conditions in the hospital. Unlike one of the hospitals I visited in Kenya, there was only one person per bed in the wards I visited today though. I met some other friends and colleagues of Ali and they were very gracious. The hospital is quite large, and I’ll post pictures at some point.


New foods (or old Kenyan favorites) of the past two days: posho (maize flour), chapatti (bread-like pancake of goodness), and a curry pea concoction. This weekend I’m going to explore the city and continue flat hunting!


3 Responses to “Caring for dad”

  1. chris Says:


    How crazy to hear you writing about Kaposi’s sarcoma. We so rarely see it here in the US, and yet it is one of the most common cancers you will encounter. Disparities abound.

    Thanks for writing about KS though – clearly my passion!


  2. Nate Bahr Says:

    If you somehow come home without a positive PPD I will buy you 10 kilos of green tea.

  3. Tricia Says:

    Hi Justin! We love keeping up with your blog. Let us know what “baby marrow” pizza is. Love those monkeys! Keep safe! You’re in our prayers.

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