Countdown

We now have less than a week before we leave this tropical country where we have built a life, made great friends, learned so much, and had tremendous adventures for the past 8 months. And although we are both sad to leave, we are incredibly excited to see friends and family (and dogs). We have so much to look forward to back in Minnesota – I have a new niece Afton that was born in March in addition to Jaren and Pyper, whom I hadn’t realized would be so hard to be away from. Summer, weddings, baseball, good (cold) beer, the lakes – all to be enjoyed with family and good friends – awaiting us!

Afton Arlene Vogt - March 26, 2010

It is always easier to leave somewhere when you know you will be back, and I recently made the decision that I will come back to Uganda for 3 months in the fall. Grant says he will come back at some point, although when he returns to blazing fast internet and HDTV, he may never leave the US again :)

It has been awhile since we last blogged, and a lot has happened since our trip to Rwanda over Easter.

A couple other Minnesota medical students, Renee Donahue and Andrew Day, came and worked at Mulago Hospital as they finished up their last few months of medical school and are now MDs. I was fortunate enough to watch all my friends graduate live on the web, and was sad to be staying behind and missing all the graduation festivities.

Our landlord, Fred Kitutu, invited us over to his house one Sunday afternoon and we had a chance to see his home and meet his wife and daughter.

Our friend Karin had her housewarming, another epic house party in Kampala. The girls and I spent much of the night gossiping and taking pictures with ridiculous poses - it felt just like home!

The following day was ANZAC Day, an Australian holiday, that we celebrated in style. Above, Team America is taking down The Rest of the World in flip cup.

My birthday fell on a Sunday this year, which happened to be the last weekend in town for one of our close friends, Guy Brennan, and we did a good amount of celebrating among our friends. On Friday night we sang (screamed) out tunes in the private karaoke rooms of a Korean restaurant. Saturday included lounging in the garden of a boutique hotel before heading out to a mask party thrown by my basketball teammates. Sunday started with champagne brunch at another posh hotel, followed by pool-side wine-sipping in the afternoon, and dinner at a great Italian restaurant with good friends.

Unfortunately, we have said goodbye to some good friends already this year, as with spring comes a natural migration of the expatriates moving on to new jobs, other countries, or back to wherever they hail from. Fortunately, we seize each of these opportunities as a chance to throw a party and reminisce over the fun and frustration of Kampala and fantasize about things we miss from home.

Other fun events in the past month – sundowners on Acacia, Gareth’s birthday with an ‘interesting’ yet delicious cake, Sarah’s surprise birthday party at Mel’s, wedding planning meetings (I will be a bridesmaid in Sept!), Wii and beer pong at Adam and Gen’s, and Mar-Louise’s baby shower.

Grant has expanded his repertoire, and in addition to being a poker star has become a Kingpin! Who knew that he was such a bowling phenom?! Our friend Adam Williams started a weekly bowling league in Kampala, and Grant had the highest score two weeks in a row, including a 206. His team ‘Living on a Spare’ will be sad to see him leave.

Basketball has picked up and we are now playing 4-5 nights a week. We are undefeated in the national league and recently avenged our 2^nd place finish last year by beating the defending champions. It is such a great opportunity to be involved in the community here, and is a big reason why I am coming back in September. My teammates are all young, intelligent, successful women, who have taken me in and I will miss each and every one of the ‘glamour girls.’

Although we finished working over a week ago, I have still been at the IDI and Mulago a few days getting things finished up before we leave. As a study team, we have a couple big projects starting in the next few months, and it has been a challenge making sure everything will flow together. I have loved my work this past year and will continue to work on it when I come back in the fall, but I need a bit of a break from it all right now. It will be good to spend time working US hospitals for a few months and apply for the next step in our training – residency.

In the time we have had off from work we have been able to enjoy some of the great parts of Uganda. We went to a beautiful lodge in the Mabira Forest for a couple days, complements of a voucher we won at the Irish Ball. It was a relaxing vacation in which we relaxed, watched monkeys, butterflies, and lizards, and were gluttons in the presence of the delicious food.

The mother of our roommate Emma was recently here from Sweden for 10 days. It was great to have her stay with us, although it made me miss my own mom even more. She treated us to a night at the Ndere Cultural Center, home of the Ndere Dance Troupe. It was a night of traditional dancing, comedy, and audience involvement in an open-air ampitheatre.

We still have a lot of social activities left to pack into our final week here in Kampala, not the least of which will be Grant’s 30^th birthday celebration this Saturday. Then, in between our usual basketball practices and games, poker tournaments, and bowling leagues we have final lunches, dinners, and drinks at our favorite restaurants (and patios). And then before you know it, we will be back on the other side of the ocean repeating the events in Minnesota! We both leave Tuesday, June 1 and I arrive in MN June 2, while Grant is staying in Amsterdam for 5 days and returning on June 7. Grant promises to write his final reflections of our time here while he is in Amsterdam next week.

Rwanda

This past weekend we spent our four day Easter holiday in Rwanda. We flew into Kigali on Thursday night and stayed at the Hotel des Mille Collines, the hotel made famous by the film Hotel Rwanda. This was where more than a thousand Rwandans were kept hidden from the genocidaires during the 1994 genocide. The next day we went to a bus company and reserved some seats for our trip to Ruhengeri, the staging point for gorilla trekking in the Parc National des Volcans (Volcanoes National Park). We got a little wet standing in the rain that graciously decided not to wait for us to get on our bus. I guess it is the rainy season. We also got a lot of conflicting information on which bus we were supposed to board making the situation somewhat more tense, however we eventually found out way. I think some of the employees were as clueless as we were.

Rwanda is nicknamed the land of 1000 hills due to it's mountainous terrain. It is densely populated and the people are largely subsistence farmers leaving very little land which is not being used to grow crops. The country has come a long way from the horrors of 1994. The country is very clean (no plastic bags allowed), the motorcyle taxis are registered and seem to have some sort of regulations they have to follow, and the country is developing very quickly (lots of construction, restaurants and businesses not mentioned in our guide books from a couple years ago).

Ruhengeri isn't much besides the place to stay before gorilla trekking. When we arrived in town we accidentally stumbled upon our hotel while looking for the tourism office, so that worked out well. Addresses don't really exist here, so you do what you can. We had dinner and sampled a few of the Rwandan beers, which not surprisingly taste exactly like all the beers from Uganda. They love their lagers in East Africa...why they need numerous different brands of the same thing is beyond me. It sure would be nice to enjoy an India Pale Ale...


What? Goats need exercise too...

The next morning we got up pretty early and took a ride to the park headquarters for the gorillas. We spent some time enjoying the scenery, got briefed on the whole process and were split up into groups based on which gorillas we would be visiting. After traversing quite possibly the worst "road" I've ever experienced, we arrived close to the tree line which coincided with the park border. It was really interesting to hike through some of the farm land before getting to the stone fence (meant to keep the animals in) marking the start of the park. We walked about 10-15 minutes into the park and were met by the trackers who stay near the gorillas during all daylight hours as poaching is still a very real concern (even though these beautiful creatures are nearly extinct). I felt like a kid in a candy store and had a few brief chills as we walked upon our first gorilla, the vice president. Our group contained 19 gorillas total including 3 silverbacks...this was the #2. We followed him to the rest of the group and spent the next hour literally standing amongst the group who were having a grand old time just laying around, eating and playing (the youngsters). We were entertained by a mother with her breastfeeding baby, a little guy picking fights with the others while basically performing for our group, and various gorillas just doing their thing. It was quite entertaining and definitely worth the (fairly expensive) cost. The hour didn't last nearly long enough, but it'll be something I never forget.


I couldn't convince them I was the only weapon we needed...


Could it be the mythical kingdom of Care-A-Lot? (Bonus point if you get the reference.)


Ruhengeri in the morning fog




Someone needs a bib!


Got sawdust?







We went back into town, checked out of our hotel and purchased bus tickets to Gisenyi on the shores of Lake Kivu which forms part of the border with the Democratic Republic of Congo (DRC). The drive took around 1.5-2 hours and was just as amazing as the previous trip. When we arrived in Gisenyi we obtained a taxi this time choosing not to rely on fate to point us in the right direction of our hotel. We walked along the lake to check out the other hotels, which was somewhat confusing considering they all had different names (or had disappeared) than was represented in our guide books. It was getting pretty dark, so we decided to eat at our hotel and get to sleep early as we had been up since quite early.


Lake Kivu (the mountains in the background are the DRC)


Side street in Gisenyi

The next morning we were slowed down by rain but eventually were able to go out and explore Gisenyi. Of course the sun rode into town and handed out some swift justice, but my head is now nearly finished peeling. Some highlights of Gisenyi include the amazing views of Lake Kivu, the proximity to the DRC, a dump truck tipped over in the oversized rain gutter along the side of the road (he probably was trying to avoid potholes only to end up in the ditch...smooth). We purchased another bus ticket back to Kigali for our final night to be spent in Rwanda.

We stayed another night at the hotel Rwanda and went to New Cactus for dinner. They had pretty good pizza and are a popular expat hangout. We also were able to experience our first slightly "good" beer in E Africa. Turbo King, which is basically a lager with some food coloring masquarading as a dark ale, was not too bad but my standards are basically in the cellar considering what is normally available to us. At least there is South African wine!


Kigali

Our final day was spent walking around Kigali and experiencing the Rwandan genocide memorial. It was intense to say the least. Really made me disgusted with the international communities ignorance towards the plight of the African people even in the most dramatic of circumstances. The sad thing is that it still continues to this day.

Time Marches On

We have really gotten busy over the last few months and our blog has suffered the consequences. Work has really picked up, especially for Ann. Her Lumbar Puncture study is up and running and she's handling most of the work on her own. I help out with some database updating and helped a little with the patient interviews at Mulago Hospital. The Neuro-Cognitive Deficit Study for Patients with Cryptococcal Meningitis is nearing its beginning, so I have been working on preparing forms and making sure the study will begin smoothly. Ann also continues to prepare for the Antiretroviral timing trial. I have also been lending a hand in the creation of various forms (of which there are many) for this study. We will learn in April when the funding will arrive which will determine the start date.

We took a trip to Tanzania so that Ann could run in the Kilimanjaro (as in Mount) Marathon (she ran the half) which was in Moshi. It also offered the opportunity to visit some friends from the U of Mn who live in Arusha. The race was set against the backdrop of Mt. Kilimanjaro, which made for an amazing sight, unfortunately the clouds obscured the mountain most of the morning. Elvis, a ninja, and an albino in a lion suit took part in the various distance races offered. We went on a two day safari to Tiringiri National Park and the Ngorongoro Crater. Tiringiri was ok, but not any better than Murchison Falls NP in Uganda. The tsetse flies actually made it much worse. I seem to have an exaggerated reaction to their bites and was covered with terribly itchy welts for the next week or so. One bit me on my knuckle and my entire hand literally swelled up. It was very uncomfortable. The crater was by far the best safari experience I've had in Africa. It's largely grasslands populated with all kinds of exciting creatures. We saw lions (12 or so), black rhinos (9ish, all from a distance), elephants, zebras, african buffalo, various types of antelope-like animals, hyenas, flamingos, ostrich, and crested cranes (the national bird of Uganda in which I've seen zero).


Arriving in Tanzania


The runners and their fancy visors.


Safari truck


Crested crane in the Ngorongoro Crater


Mr. Monkey enjoying the view in Tiringire NP


Mr. Baboon


Somewhere in Tiringire NP


The safari crew above Lake Manyara


Papa lion


Funny looking cows in the Ngorongoro Crater


Young lion hanging out on the ridge of the crater


The horde

We attended the Irish Ball last weekend. It's in celebration of St. Patrick's Day and the (real) Guinness, Bailey's, and Jameson were free and in full effect. Not being a big fan of whiskey made it easy to avoid the Jameson but it's safe to say I could have used less guinness (and wine). Ann had a basketball tournament that weekend, so we called it a night around 12am so she could get some sleep for her games Sunday. Her team got 3rd in their first tournament/games of the year. She's definitely excited to be playing organized basketball again.


At our friend Sam's graduation dinner.

We paid for our gorilla tracking permits in Rwanda, where we'll be going over our 4 day Easter weekend (hopefully with a blog post soon to follow). We'll be spending some time in the capital Kigali, Lake Kivu, and Ruhengeri, the staging point for the gorillas. This is probably the one thing I absolutely have to do while in Africa even though it's not cheap. Rwanda is apparently beautiful in stark contrast to the devastation that took place in the 90's.

A long time coming...

I started interviewing patients yesterday. This may not seem like much, but it indicates that my very small project addressing perceptions of lumbar puncture (aka spinal tap aka LP) in Kampala, has begun! This is the project I originally came to work on in January 2009. Doing the right thing by applying to the Institutional Review Boards (research ethics committees, aka IRB) kept this project in limbo for a year and a half, but I now have approval from the University of Minnesota, the Infectious Diseases Institute, Makerere University, Mulago Hospital, and the Uganda National Council for Science and Technology. With a few letters and a nice research ID card, myself, two other medical students who are helping for a couple weeks , and a hired interpreter, went over to Ward 4A to start collecting data and interviewing patients and their family members about meningitis, LPs, assessing their medical knowledge (or lack of) and decision-making processes. We are also going to measure how long patients are in the hospital before (or if) they get a) an LP b) treatment c) a definitive diagnosis, and how they fare, whether or not they live and how long they were in the hospital. Ultimately, we want to use the information from the interviews to develop educational materials for patients and their families explaining meningitis and the spinal tap procedure and also to educate physicians as to why patients refuse and what they can do to prevent it from happening. Yay!

This project, aptly named “Perceptions of Lumbar Puncture for the Diagnosis and Treatment of Meningitis in Kampala, Uganda,” came to fruition just as so many other projects are also speeding up. I am currently collecting data from Mulago Hospital Records and the Microbiology department to see trends of a certain kind of fungal meningitis seen mostly in AIDS patients, Cryptococcal Meningitis (CM), over the past ten years. The deal is, drug therapy for AIDS became widely available in Uganda in 2004 and so we want to see whether the rates of CM have decreased since then because theoretically, more patients would have been on treatment and less would be sick. But on the Infectious Disease Ward at Mulago, we see a ton of CM and so we are checking out this theory. Another future project based on this would be that once we get the rates (by month and year), we could compare it to weather data and check the seasonal variation of the disease.

The Infectious Diseases Institute now has a low-tech kind of EMR (Electronic Medical Record), and a few databases tracking patient data. They want to cross-check these databases – specifically the pharmacy, clinic, and laboratory data – and find the real rates of certain infections that are common. A friend of mine has done this for Tuberculosis, and I will do this for CM. The public health courses I am taking right now through the University of Minnesota – Introduction to Epidemiology and Biostatistics – have definitely given me a better sense of what I am looking for and how to go about designing these new projects.

The big clinical trial that I am preparing for (the COAT trial) is chugging along. Last week we submitted many documents to be transformed into database-friendly forms to be barcoded and uploadable. There is this new program through the National Institutes of Health called DataFax, that scans all of our completed patient documents and automatically enters the info into a database. It may sound boring, but is going to save us a lot of time and prevent a lot of missing documentation. We also find out in April whether the trial will be funded and will have a better idea of when it could start.

Grant recently finished developing a bunch of documents for the neurocognitive assessment project that will be starting in March or April. Although we work together in the same office, we don’ t usually “work” on the same things. But his project will share patients with the COAT trial so we have been working together a bit to make sure it all flows together. Sometimes this can cause tense moments, as neither of us like being told what to do, and both of us are always right.

Our evenings have been pretty busy lately, but not like they normally are. We are making a concerted effort not to go out during the week. This isn’t too tough considering I have basketball practice two nights a week and my online public health courses take up the rest of the nights. And Grant makes it easy for me to get work done because he is busy playing poker, either at the casino or online. But we still manage to keep up with the Kampala crowd and accommodate visitors from all over. There is always a birthday celebration or going away party, rugby to watch and pork joints to patronize, and now that we have been here awhile we have house-warmings and baby showers to attend!

Decklin - the owner of Bubbles, watching 6 Nations Rugby

Grant and Friends at Guy and Allison's housewarming party

Grant, myself, and Rosie out at Emin Pasha for her birthday

Some of my basketball teammates and I out for pork

And then Grant did some surprise planning (with some help from our wonderful friends), and VOILA…a beautiful Valentines weekend. He sprang for a room at the Serena Hotel in Kampala on Saturday night, and we stayed through Sunday to use their workout facilities and huge pool. It was so nice that we thought about getting a membership at their gym…until we realized their corporate rate listed was per person. Ouch! We got home in time to clean up and head to a very romantic dinner at the Chapter One Restaurant at the Protea. Champagne, a bouquet of roses, live music, and amazing food provided a wonderful end to the weekend.

Dinner at Chapter One (Protea Hotel) - February 14, 2010

Cape Town, South Africa

We ended up buying some last minute plane tickets to Cape Town, South Africa following our trip to Zanzibar. We flew in on the 19th of January with a layover in Johannesburg. Maiken met us at the Cape Town airport and we decided to rent a car for the week…a tiny little Hyundai. Ann did all the driving and conquered the whole driving on the wrong side of the road using your left hand to shift thing. We all stayed at the Ashanti Lodge Gardens hostel, which was a nice hostel...although our room was right next to where everyone hung out at night making it difficult to fall asleep. We got settled in and went out to Long Street for dinner and drinks with Justin, who had been in Cape Town working a number of months at a few hospitals. Long St. is very much like Haight St. in San Francisco with lots of bars and interesting places to eat. Not as many head shops, but that’s California for you. Had probably the best burgers since we came to Africa at the Royale Eatery. Afterwards we went to the Dubliner and listened to a brother/sister combo perform covers of American music. I was amazed at this Westernized version of Africa. Cape Town is unlike anything I have seen in Africa (admittedly I haven't seen that much)and it felt like we had gone back to the states or maybe Europe.


It's got a hemi.

We went to the Victoria & Alfred Waterfront our first full day in the city. It’s a functioning port and there were plenty of ships around, however the area with the tourists is full of tour boats including a sweet replica of a pirate ship. We had some very good sushi at Wang Thai…another first in Africa. Unfortunately we were unable to take the ferry to Robben Island, the location of Nelson Mandela’s prison, as it was booked. Had some nice steaks at Nelson’s Eye, an old steakhouse which was conveniently a half a block from our hostel. Ann finally got some of her beloved crème brulee for dessert. It wasn't as good as we've had before, although it's something that we haven’t seen in a while.

The next day consisted of a wine tour to four wineries around Stellenbosch and Paarl in the heart of wine country, just east of Cape Town. The first was Fairview which had wine and cheese tasting. Good cheese is nearly impossible to find in sub-saharan Africa and that was possibly more delicious than the wine! For lunch we stopped at a winery with a restaurant and had some bibooti(sp?), a traditional Afrikaans dish. Also went to Solms, Tokara, and Villiera. At Villiera we were treated to some sparkling wine opened with a sword. Ann and I bought 7 bottles total, 5 of which we took back to Kampala. Also bought some cheese (garlic-parsley camembert and sun dried tomato chevin). Went to Tank in the Cape Quarter for dinner. We both had sushi again…mine was good, however I don’t think Ann was too impressed.


Wine country...


Sleep it off...

The 22nd of January marks the day Ann cut her hair, removing over a foot of length! It was quite a drastic change, but I love it. I almost forget that it used to be much longer. Made our way south to the Cape of Good Hope and Cape Point. Along the way we stopped to eat in Hout Bay at Mariner’s Wharf, which had some great seafood and shockingly good bread. I was introduced to the Grapetiser, a sparkling grape juice. I proceeded to drink these the rest of my time in South Africa. The drive south from Cape Town is quite beautiful. You’re basically driving on the side of the mountains following the coast to the southern most point of the peninsula. We stopped in Simonstown to see the penguins at Boulder Beach. Penguins are strange creatures and quite hilarious. Most of the time they stood there with their eyes closed and beaks open pointing upwards. When they would walk around I could hardly keep from laughing. A few were playing in the water and many were keeping their babies warm. For dinner we went to the the place Justin was staying (Ivor and Shifra, some of Justin’s family) for Shabat dinner. I even got to wear a yamukah. Since we had meat, there were no dairly products, however we had a non-dairy ice cream. It was surprisingly good.


Hout Bay


Absolutely no shaking hands with the penguins.


They used to be called jackass penguins...


...but that hurt their feelings. Please refer to them as African penguins.


You can see the road we were driving...


Random view heading south towards Cape Point.

The following day involved an early morning hike up Table mountain. It was a steep hike up large stone steps, like the ultimate stairmaster workout. Maiken and Ann handled it much better than I did…probably because I’m in much better shape than those two. Or maybe it’s the other way around. We took the cable car down, which was a quick 2 minutes compared to our 1.5 hour hike. Ann and I moved to a nice room in a different building, so the following nights allowed for much easier sleep than right next to the pool in our previous room. We drove to Camps Bay to enjoy Clifton 4th beach. It was very warm out and the water looked so nice. A few people were enjoying diving into the large waves breaking at the beach. Unfortunately, the best we could do was to put our feet in the water...once we did they instantly went numb. The ocean current in Cape Town comes directly from Antarctica, so it’s a tad bit like an ice bath. Saw a lawn bowling club near the beach with a bunch of old, white men in funny uniforms (goofy hats, polos and white trousers) rolling a ball towards other balls. That night we met a friend of a friend for dinner and jazz at the Rainbow Room. Before the show the host gave our group of medical professionals from America a shout out, which was cool and embarrassing. A group of teens from a local school performed first followed by Abigail Peterson, who was a wonderful singer/pianist. We had a good time, but were kind of falling asleep by the end. Apparently we're reaching that age...


On top of Table Mountain.


Cape Town from the top of Table Mountain.


Look at those athletes giving it their all.

The next day Ann and Maiken went for a 10 mile run along the coast and they say it was quite beautiful. We spent the day with Maiken and Justin at Canal Walk, a large shopping mall in a suburb. It was one of the nicer malls I’ve been in. The food court was very interesting with a large selection of things I’ve never seen before and of course McDonald’s and KFC, where everyone seemed to be eating. Had some tasty beef shwarma at a falafel place. When you ordered your meal they hit a button indicating what kind of meat the cooks should prepare…justin ordered the lamb and I had the beef. We both enjoyed the silly baaaa and mooooo recordings for our respective meats. Not sure if others see the humor in that, but we do. After searching all over Africa Ann finally was able to find a pair of basketball shoes. She has been practicing with her team, and their season starts in March. I’m excited to see her out there…I think she’ll be the only white person in the entire league, so she’ll probably have her own fan club! Of course I’ll be president. That night we ate at Arnold's, where I had the game platter containing an ostrich fillet, oryx fillet, crocodile ribs and warthog ribs. The oryx and warthog were especially good. Crocodile is a novelty, but not anything special. We then went to see Goldfish, a musical duo from Cape Town, who play a club night every Sunday at the same place right near the beach we had been to. It was packed and the indoor area was roasting. Luckily we were able to secure a nice spot at a table which allowed us to drink our illegally brought in box of wine. Nothing says classy like sneaking in a box of wine and drinking it with styrofoam cups.


Staying classy.


Dinner at Arnolds's.

The following day we flew back to Entebbe. It was a difficult transition as we both seemed to be a little homesick after being in a city so much like what we are used to back home. Although we're halfway through our time here...I imagine the rest of the time will fly by.

The past few weeks our two bosses from the U of Mn have been here along with the deans of our medical school and the school of public health and other high ranking officials from the U of Mn, so we’ve been involved in a few meetings and meals talking to the officials about our experience here. They’re exploring their connection with Makerere University and the IDI to see how it can be more significant. It was kind of fun to be ambassadors of a sort. Ann has started work on her public health certificate from the U of Mn. Between that, basketball, work and socializing she is quite busy. I don’t know how she does it, but she’s probably the most motivated person I know so I’m not surprised that she does!