Swearing In and Bulamu Health Camp

August 11th to August 20th, 2016

"Ambassador of the United States of America Deborah R. Malac requests the pleasure of the company of 

Ms. Sarah Lynn Lovell Frey and Mr. Dennis Frey 

at the Peace Corps Volunteers Swearing-in ceremony

Thursday, August 11, 2016."

Team Mbale

After one full month of orientation, we are officially Peace Corps Volunteers!  The swearing in ceremony was held at the Ambassador's residence in Kampala, with the ambassador herself.  The groups being sworn in included the Global Health Service Partnership team, as well as the traditional 27 month Peace Corps Volunteers in the health and agriculture sectors.  It was a beautiful venue and a fun celebration, with many of those being sworn-in wearing outfits made of traditional African cloth called kitenge, and our bosses and language trainers wearing their best.  We were even joined by many of our supervisors and counterparts for the ceremony, including my supervisor, Professor Julius Wandabwa, Dennis's counterpart Paul Oboth, as well as the dean of Busitema University Faculty of Health Science, Professor Paul Waako.  

The night out of celebrating occurred at a delicious and relatively authentic Mexican food restaurant called Que Pasa, run by an Australian ex-patriot, in the heart of Kampala.  If you ever find yourself in the area and desiring a taste of home, Que Pasa is hands down recommended for Mexican food, while Mediterraneo has some delicious Italian with TONS of different and delicious cheeses. Never to compete with any Toti-Moles creation, though!

Friday was a surprise day off, which we used to hang out at the hotel complex, relax, read, edit photos, and enjoy not being lectured to for more orientation.  

The next day we were off again! After packing up our gear once more on Saturday morning, we hopped in a matatu (popular form of transportation in Uganda and all of East Africa) and headed east toward Jinja, the area best known for being the source of the Nile River (and Nile Beer), for a week-long medical camp run by Bulamu Healthcare International.  The camp was held at the Mpumudde Health Center IV, which traditionally functions as a resource center for HIV testing, counseling, and treatment with anti-retroviral therapy.  For the week, we were turning it into a free primary care site.  Our team, consisting of eight GHSP volunteers, two Peace Corps volunteers, and the Bulamu crew, working alongside six local Ugandan physicians, saw 2,989 patients in five days.  Whew!  Dennis was working administration and kept everything running smoothly, while Sarah focused on cervical cancer screening through VIA method and treatment with cryotherapy when indicated.

What is it like to...

Miles, Dennis, and Faroq
in "Dennis's office"

Gerald and Dr. Joseph
at morning report

...run administration for an NGO camp?

Dennis: I worked closely with Gerald Atwine, Bulamu's founder and CEO, to implement systems for collecting patient information, tracking the volunteers' hours, and accounting for the equipment and medicines that were brought in by Bulamu for the camp. I created several Excel spreadsheets for these tasks and then I essentially lived in them for the duration of the camp. We distributed raffle tickets to patients each morning to track the number of patients seen each day.  The tickets doubled as the patient medical record number as well as a way for them to get some food and water at the end of their day.  At the beginning of the camp we estimated that we could see roughly 500 people per day; each morning I would tear-off 500 tickets to get us started.  By 10am, we were usually out and had to decide if we had enough supplies and manpower to register more people.  Saying "No" was not a viable option since so many patients came from far-off places and coming back another time was not feasible.  Fortunately the staff was hardworking and the system flexible allowing us to screen almost everyone who arrived to the camp.

A note from Sarah: Dennis is underplaying his role.  He was the star coordinator for the week, and the camp would not have run as smoothly without him!

...perform cervical cancer screening in Uganda?


Sarah: The World Health Organization guidelines on cervical cancer screening, cryotherapy, and technical specifications are your best friends.  When women travel for miles on foot for screening, there is no pathology department or pathologist, and you are present in an area for a limited time, the best method is visual inspection with acetic acid (VIA) and immediate treatment with cryotherapy when the patient meets inclusion criterion.  The flashcards and atlas from Jhpiego were an incredible asset as well as teaching tool for the Ugandan midwives and physicians, so keep this in mind if preparing for VIA screening in the future.

The amazing lab staff!

Patients waiting 
to be seen

Sunday was spent turning the procedure room and its adjacent storage room into a functional screening room and treatment room, respectively.  While cleaning the storage room we found boxes full of mixed medical supplies including intubation materials, old tracheostomy kits, foley catheters, masks, ostomy bags, lidocaine, epinephrine, and safe male circumcision kits (studies showing a reduction in transmission of HIV amongst circumcised men have had a large policy push in Uganda and all of sub-Saharan Africa). These supplies were located amongst rodent droppings, insects alive or otherwise, dust, and blood stained surgical gowns and drapes.  After a few hours of cleaning and organizing, we had two beautiful rooms ready for screening and treating!

At your cervix! Dr. Shambe,
Teddy, Anna, and Dr. Sarah

The cervical cancer screening team consisted of Anna P and Julia R, two amazing American midwives, Dr. Shambe who is in the middle of her residency training at the University of Toronto, the incredible Mpumudde Health Center midwives Joy, Vanisar, Margaret, Mary, and Ruth, alongside translators Teddy and Claire.  Esther became our scrub tech extraordinaire, ensuring that all instruments were cleaned and high level decontaminated to WHO specifications. 
During the week, we screened over 260 women (focusing on ages 30 - 49 or any age if HIV positive, per WHO guidelines), with 16 identified for cryotherapy and a further 16 referred for either LEEP or to Mulago Hospital, the national referral hospital in Kampala, for chemo/radiation due to outright advanced cervical cancer.  The downside?  The one (you read correctly - ONE) radiation machine in the country is currently down, uncertain when it will be back in operation.  This leaves women with cervical cancer to wait, without any other available option.  

Triage

The team also discovered during the week long camp that patients were rarely receiving a physical examination by a physician.  Ever.  Most patients who present with a complaint such as lower abdominal pain in a female are automatically treated for PID (Pelvic Inflammatory Disease) with Ceftriaxone 1g IV followed by Cefixime 400mg PO x 3 days, alongside Doxycycline 100mg PO BID x 14 days AND Metronidazole 400mg PO BID x 14 days.  It is true that PID is a large problem in Uganda, leading to tubal factor infertility; however the cervical cancer screening team were the only providers performing a pelvic examination.  There were times when PID was previously suspected and the above regimen prescribed, however many more instances when the complaints were consistent with UTI, constipation, musculoskeletal pain, or even pregnancy (which we did diagnose in someone previously prescribed the above regimen - with doxycycline being a teratogen in pregnancy) with no pelvic organ tenderness.  Combine this with automatic treatment without a speculum exam for candidiasis, trichomonas, or BV for any complaint of vaginal discharge :/ Always examine your patients!

After the long week, a recognition ceremony was held on Friday night with cake and certificates for all of the participants.  Both of these are HUGE in Ugandan culture!  We drank sodas and danced under the star-lit sky, while the kids did everything they could to get their hands on as much cake as possible.  

Saturday morning the group took a break from work to take a cruise tour around Lake Victoria to the source of the Nile River.  The lake is Africa's largest when measured by surface area. While cruising along the shallow shores, we encountered several sites. There are numerous fishing villages, where the lake front is not inhabited by the rich but rather by the poorest of the poor.  Due to weather changes, the lake has risen several meters in the past few years, leaving many houses underwater and uninhabitable.  Also due to over fishing, several fishermen have created fish farms in the lake, where they are fed a concoction of grains, including corn, to help them grow to harvesting and selling size quickly.  Cruising further along, we see a variety of birds stationed in the trees, flying over the lake, and looking longingly at the fish growing in the farms beneath the water.  As the boat approached the source of the Nile River, you could see the current picking up underneath the boat from the running water and the up swelling groundwater that contributes to the mighty river.  As we cruised along the river, the best sites were the monkeys stationed high in the trees and jumping from branch to branch.  Alongside sightings of yellow weaver birds, monitor lizards, and even an otter, it was the perfect outing after a week of camp.

Back on land we helped to pack up and record the supplies, before heading out in another matatu for Mbale.  Finally, heading to the city we will call home for the year!