We recently returned from six weeks in Kampala, Uganda, shadowing, doing research, and studying tropical diseases at Mulago Hospital and the Uganda Cancer Institute. We lived with a host family outside of the city and commuted to the hospital during the week. On weekends we relaxed in Kampala, explored the country, and traveled to Rwanda for a day. This international health elective, which we completed in between our first and second year of medical school, is offered through the University of Vermont College of Medicine in partnership with the Western Connecticut Health Network and Dr. Majid Sadigh.
During our first week in Kampala we worked with Dr. Fred Okuku at the Uganda Cancer Institute. One day in the outpatient clinic we saw a young woman with nasopharyngeal carcinoma. Nasopharyngeal carcinoma is a common cancer here in Uganda and is associated with the Epstein-Barr Virus (EBV). This virus is well known at home because it causes mononucleosis. The patient came in with her older sister and right away we could tell that she was very ill. She looked visibly uncomfortable. Aside from her large neck mass, her left arm was extremely swollen. Her face was puffy; she was struggling to breath even with a tracheostomy tube, and she couldn’t stop coughing. Since we weren’t able to provide medical help, we offered what we could: companionship. We talked, and learned about their lives in Kampala. Our patient even smiled as we listened and danced to ’90s music in the small patient consult room. When the doctor came back, he was able to prescribe antibiotics so she could get healthy enough to continue her chemotherapy regimen.
When we saw her a few days later she seemed bubbly and bright. Clearly the antibiotics had worked, but so had our conversation. She entered the room, smiled, and began talking to us immediately. Since then, she came back to the clinic several times. Each time we were reminded that even though we cannot yet provide medical attention, taking time to show patients we care is just as valuable.
The next few weeks we were busy between the hospital, the cancer institute and other inpatient wards. We met many Ugandans and other international students. We had clothes made from vibrant African prints and enjoyed meals of matoke (a boiled banana mash), beans, eggplant, and chapati (a fried flat bread). As we settled into a routine between home and the hospital, the once exciting hour-long mutatu (a small bus) trip became ordinary. We were used to passing camels and goats, setting new records of how many people could fit in the mutatus, and bartering for cheaper fares. We learned to tolerate competing strong body odors, getting dust in our eyes, and running out of gas on the side of the road. Boda-bodas, or motorcycle taxis, started to seem more appealing. Most people use them getting to and from work because they can zip in and out of traffic, between cars, and over sidewalks and dirt paths. They are by far the quickest yet most dangerous mode of transportation in Kampala. That said, our program coordinator and host family adamantly discourage taking boda-bodas. They cited statistics of one death per day in Kampala from boda-boda accidents and told tragic stories of muzungus (foreigners) who took boda-bodas and died. Our host father admitted that he once took a boda-boda but paid the driver double to drive half as fast.
After hearing those stories, we were sad to discover that the two autopsies we would be observing one day were boda-boda fatalities. The first victim was a young man and had been a boda-boda driver. Despite his recent trauma, his body showed no obvious signs of death. He wasn’t banged up; he didn’t have big scrapes or obvious broken bones, and there wasn’t much blood. We soon learned that his injuries were internal. The medical examiner found a fractured skull and a brain covered in blood. The medical examiner rinsed the brain causing the blood to wash away. From this he concluded it was a subdural hematoma. A subdural hematoma results when veins surrounding the brain rupture and can be caused by blunt trauma. The medical examiner began to analyze the victim’s other organs. He cautioned us from jumping to a conclusion too soon. Sometimes, he said, a boda-boda accident can cause an internal injury, but sometimes an internal injury can cause an accident. In this case, he said, it seemed that the accident caused the injury but that one could never be certain. The medical examiner carefully replaced all the organs, closed up the incisions, and cleaned and dressed the driver.
These patients, along with many others, have taught us many valuable things about medicine, culture, and humanity. We were surprised by how quickly the time flew by, and are excited to share our experiences with our family and peers back home.