Posting from Jon

Hi,
Just got back from my future site visit and it looks awesome! I can't wait! I am giddy with excitement. I’ll be living in my supervisor's guesthouse. It’s pretty posh pad for the Peace Corps. I’ll have a toilet, running water and electricity! The organization looks awesome. They do work in the Rakai region, which is in the southern part of the country, close to the Tanzanian border. I’ll be in the town of Kalisizo, which is a small town on the main road. It’s a poor region in which only about 50% of the people have access to a protected spring or protected well, in the adjacent sub-county the number is a mere 3%. It was hit hard by the AIDS epidemic in its early days and is still recovering. My organization is protecting a number of springs in the area, and is looking to expand that work. They are also very involved in environmental awareness work in the area, planting trees, cleaning up trash, promoting pit latrines and educating people about more sustainable living and farming practices. They also do work on malaria prevention and AIDS education. I’ll probably be working in all of those areas, but it looks like I’ll definitely be doing allot of engineering work on springs and maybe wells. I’d also like to get involved in the environmental work. My boss is very nice, in fact he has a master's degree from a Belgium University and is definitely not your average Ugandan! The region is very pretty. Lots of rolling green hills and bananas! It gets rural really fast once you are outside the cities. My town is only about 20-km from Lake Victoria, and I'm definitely looking forward to some weekend bike trips. There are two Internet cafes in town, so I’ll definitely be better connected than I have been. There is also a medical research facility run by John's Hopkins. So it looks like I’ll have some American neighbors.

I have just one week remaining in Luwero, and then a few days in Kampala before heading back to my site for good. I can’t wait to get started!

Check out my website that my mom has been updating for me: http://rtwjon.blogspot.com/

I guess that's about it for now, hope you all are doing well! As always, feel free to give me a call or shoot me a text: 256 751 700 560.

Cheers
Jon

Letter from Anna

Subject: Akosombo


Greetings from Akosombo. I'm at a larger district hospital now at the site of the hydroelectric dam that provides 60% of the power for Ghana. The water level is very low right now, which is creating shortages throughout the country. It's a very strategic location for Ghana, and very well planned. There are alot of good jobs here, and it's evident when you look at the community I'm living in. We have paved roads, trash collection, and street lights. Most houses have cars parked out front, and it would easily pass for southern CA. It's amazing the difference in living conditions that exist within the country. Every morning I see the gardeners out "mowing" with sickles.

I'm staying in a student hostel with close to a dozen other Ghanaian students. Medical school here is like hitting the jackpot as far as education is concerned. There are only 3 schools in the country, and they graduate less than 200 MDs a year. Those few though are guaranteed stable futures either here or abroad. In the US, if you have the academics, you can be fairly certain of getting into medical school and you've got access to sufficient loans to get you through. That's not the case here. If your family can't support you through school, you can't go.

This is a referral center for the area, and has really great attendings who are limited more by technology that by training. We currently have a patient recovering from tetanus, a young man with renal failure of unknown origin, another with the largest spleen I've ever seen, a couple patients with complications from sickle cell, 2 with probable TB, and an older gentleman with AIDS. They are really sick, and there aren't many investigations we can get. We just sent one patients family to the capital in search of stronger diuretics. Dr Mills isn't sure if there are any in the country, but it's his best option given that dialysis isn't available. The nearest EKG is in the capital. In the US there's one in every family practice office.

Most of the docs have spent at least a few months working or training abroad, and they tend to know the physiology better than we do. In the US, physical exam is not really emphasized because we're going to order the entire panel of labs regardless of whether your suspicions changes from 20%-80% for or against a particular disease. Then depth and breadth of their knowledge is really impressive, but access to technology is very limited. Most docs seem acutely aware of that. The head surgeon spent a good 5 minutes on rounds talking about the failure in the public health system that lead to a case of active tetanus in this day. He's really interesting to talk to. He has a larger role outside the hospital that is not entirely clear to me. He talks about things like pest control measures near the dam and the snake that managed to get into the electrical systems and threatened to short out the main power plant for the country. He's also involved in bringing health care to the people living on the lake that was created by the dam. There's a perception that the dam brought Schistosomiasis which is partially true. (carried by freshwater snails, the exposure to which has increased as there became more people relying on fishing for their livelihood.) They built a hospital ship to go up the lake visiting multiple isolated communities with no land based access. It was supposed to go out this week, but it's delayed for unclear reasons. First they said there was a problem with the kitchen equipment, then the holidays, then the water level, then the engines, then storms. He wasn't been able get anything consistent from anyone, but unfortunately can't do anything about it. I have met some incredibly hard working people here, but they frequently come up against strong resistance when trying to implement ideas that will really make a difference. This hospital has been great in that there are a lot of motivated people here. It's really eye-opening though to see the reality of working within a developing setting.

Akosombo is beautiful. Lush spectacular mountainsides along the lake. We went canoeing this weekend, and out to a waterfall and amazing rock formations. I've also found some trails near the hostel that lookout over the mountains. Mangoes are in season, and they're great.

That's probably enough for now. I'll be back at the end of the month. Looking forward to Charlottesville in the spring.

Yours,
Anna

Jon got his assignment!

Jon got his assignment! He will be working in Kalisizo for the Community-based Options for Social Welfare and Responses . Below is an article from The New Vision, a Ugandan News paper.

Kyotera gets sh100m water project
Sunday, 8th April, 2007

By Ali Mambule

THE United Nations Development Programme is funding a sh100m sanitation project in Kalisizo and Kyotera town councils in Rakai district.

The eco-project is implemented by the Rakai Women to Save the Environment in Kyotera and the Community-based Options for Social Welfare and Responses in Kalisizo.

“We have already started sensitising residents on how to keep their homes and the surrounding areas clean and to construct latrines,” the Kalisizo manager, Joseph Mubiru, said on Wednesday.

He explained that part of the funds would be used to construct six spring wells in rural areas.

The project manager in Kyotera, Hadijah Ssozi, said the project would benefit women.

“We have a number of widows who have no jobs and I believe that this project will help them save some money.”
Kalisizo mayor Sande Ntambaazi commended UNDP for funding the project, saying the council had faced difficulties in convincing residents to clean their homes and the town.

The Well..

Here is a link to an interesting story. Jonathan told me that he had given a talk about his well project in Guatemala just before their group came across the well detailed in this story. Click here to read about one of his fellow PCV adventure going down the well. Sounded VERY scary to me!

NEWS FROM ANNA

Anna, Jon's girlfriend, is currently volunteering in Ghana before she starts her residency in general surgery at The University of Virginia. She has some very interesting stories to tell about her adventures.

March 9th 2007

It's Friday. I just finished my first 2 days in the hospital. They started me in the lab, which was pretty clean and easy. It's actually kind of interesting to see how the tests are run. They have very basic facilities, but that includes a scope, centrifuge, sink, and refrigerator. They do a lot of blood counts, which literally entails counting the various cell types under the microscope. You can also check for malaria and sickle cell with that. We did blood typing and cross matching by putting a drop of blood on a piece of white tile along with a drop of antibody solution. If the blood starts to clot, then it's positive. Three drops, A, B, and rh+ or -. They can do pregnancy tests and syphilis with strips and a typhoid test that's like the blood typing. We don't have any chemistry's, but those are way over ordered in the US anyway. Given that we couldn't put a patient on dialysis anyway, know precisely what there kidney function is isn't all that helpful. Everything is washed and reused at the end of the day and the numbering system starts fresh again with #1. Results are recorded in what looks like a big accounting ledger, and when you're done you write the results on a form and hand them to the patient waiting in the hall. They go back to the clinic side when they have their results.

I've seen that there is a radiology department, but I'm not sure what we can actually get, or whether patients would be able to afford it anyway. After spending a day in the chest Xray reading room at UVA though, I feel like that's more akin to reading clouds that to objective info. It'll be important for setting bones. It's strange not to have microbiology or any cultures. There's an awful that that will get treated
empirically (when you treat based on suspicion rather than confirmed diagnosis.) Yesterday they were really busy because they had prenatal
clinic in addition to the normal patient load. That meant they didn't have much time to teach, and I sat around along time. I spent the
afternoon chipping things out of their freezer. Everything was literally encased. That was probably really good. It gave me something to do, and they were really impressed that I'd stay and work on it as long as I did. (a good 2-3 hour job) I got major brownie points for that, which I'm guessing may come in handy if I'm trying to get something quickly later.

I eat lunch in the canteen which is all traditional Ghanaian, and mostly unidentifiable. Today there was a ball of some sort of starch made of corn (different than what you made Jon). It was about the size of a baseball, and I assumed stuffed with something. (nope) When I asked for it the lady offered my rice instead, but I was thinking tamale, and it looked good. I got that along with some really spicy sauces and a small piece of fish (for $0.70) Some of the others in the room were apparently entertained by my attempt to eat it with a knife and fork. Another women came over to sit by me and show me how to eat it. You just pick up a bunch of mush (tastes like tangy grits- weird), dip it in some really spicy pepper sauce, and eat it. Not much on texture, but the sauce did make it better. In the cooler, alongside the Coke and Fanta, they serve Amstel light. Not what I'd have expected from a Christian Mission Church.

It's a very evangelical place. They gave me a bunch of information about their founding, and it's more like a church with a hospital that the other way around. I had to fill out an employment application which included the questions:

What church do you attend? (none)
Have you accepted Jesus Christ to be your Lord and Saviour?
Do you believe that God heals the human body?

Except for the first one, I left them all blank. I'm kind of wondering if people are going to actively try to convert me now. The women I sat next to on the plane spent a good 2 hours talking about how the Lord had changed her life, and then actively trying to convince me that no amount of good living matter until you accept the Lord. In the US it would have been pretty easy to shut that conversation down, but it's definitely different here. People are more open and friendly. There's less that's considered personal, and that includes spiritual views. One of the other students was in the well baby clinic and said they all prayed together 5 times in 30 minutes to bless one of the new babies. I don't mind that, but I doubt I'm going to be able to dodge direct questions but for so long. Morning devotional is every day.

Outside of that though, everyone has been really friendly. They'll help you do and go anywhere, and without expecting anything. Everyone says hi on the street, and are really helpful if you look like you need anything. At the gate and on the plane, it was about 90% nationals, and was pretty easy to pick out the foreigner. Multiple people came up to ask me if it was my first time, and what I would be doing. It was the 50th anniversary of Ghanaian independance the day I arrived, and everyone was very proud of their country and wanted me to have a good time.

I think this has been the easy part though. The lab is pretty sterile emotionally. They get alot of patients with cerebral malaria and meningitis that don't survive. The boat is even more restricted. They get lots of abscesses and infections that they just can't treat in the few hours the boat is there. They're are really sick kids. One 6 month old who died later that evening after really heartbreaking arguments with the local nurses about what level of care they could try. It may have been too late when they first got to him, but you don't know, and too late in Ghana is different than too late in the US.

I'm nervous about starting in clinic, but a little less so after being around the lab. It's definitely a good way to ease you in. I'm expecting this will get hard soon. For now things are good. I'll be in touch.

Yours,
Anna

March 29th 2007

I hope everyone is enjoying the Spring weather at home. In Ghana it's warm and sunny, but with strong seasonal winds most days. Today was the second big rain in 10 days and may be the beginning of the rainy season. It's hard to believe a month ago I was cross country skiing and winter camping in feet of snow out in West Virginia.

Little kids here are great. I went up to a small city north of the capital my first just to look around. The little kids will see you and call out "abruni abruni" (white lady) just wanting you to wave to them. There was a group of 6-7, 2-3 years old who all ran out to hug my legs. They were really adorable. Another group was kicking a ball around, and it came straight to me. They got a huge kick out of it when I kicked it back.

Transportation is really convenient, but different from home. There's a shared taxi stand about 5 minutes from the house. When they get 4 people they're full, and we go. (Usually 2-3 minutes.) Then you pick up a van headed the direction you want, and get off at the main station. Vans to a specific destination leave as soon as they're full, so if you know the city you want, it's really easy. (crowded, but easy)

Last I wrote, I'd just finished a couple days in the lab. I moved into the pharmacy last week, which was much better stocked than I'd expected. We've got about 250 drugs in stock, but there are no computers. Imagine trying to track the inventory on paper with every sale recorded as a line item, frequently as just the patient name and the total collected. They hired a new pharmacist a few months ago to help get things organized. He trained for 6 years in the Ukraine, actually USSR when he started, and had his own pharmacy until deciding to go into hospital pharmacy. We worked on a developing a computer based inventory on Excel which is actually pretty slick given I have no programming skills, and everything needed lot numbers before we could even get started. I presented it to the head of the hospital at the end of the week, and he's in the process of getting a computer to run it from.

Update- Just got the computer today. I spent today getting is set up, and showing the pharmacist how to log in everything. He's very bright, but I think this was the first time he'd used a mouse. I feel pretty confident though that he'll be able to run it entirely independently before I leave.

In the house: When I got here, there were 2 other UVA students who'd been here since January. They went home, and another student arrived about a week ago. There's also a recent graduate from the Ghanaian medical system here who moved in last week. Really interesting guy. They only graduate about 180 med students a year, but the ones they have are really well trained. They do 3 clinical years (to our 1), and are truly ready to practice everything straight out of med school (despite the 5-7 more years they'll put in as house officers/residents). Here there's alot stronger focus on generalist practice, and they train you to be good at everything. (23 deliveries required to graduate med school- we don't teach people to deliver babies unless they're in OB/GYN or Family medicine residency). It's been really great working with him. I haven't done general medicine since before my research years, and it's a great review.

I've been in clinic for a week now, and it's not that different from home. (back pain, diabetes, hypertension...) We see people with malaria and typhoid several times a day, but they usually come in with symptoms something like a bad flu. It's very common here, and generally treated as an outpatient.

The difference is on the wards. We don't have much in the way of diagnostic tests, particularly for patients that are really sick. We had a patient this weekend who went into acute respiratory distress. We were able to treat her that night, but she was delirious, with a fever to 104 despite a whole gament of antibiotics, and we had no way of identifying what we were dealing with. The same thing happened the next day, and she didn't recover. We still don't know what we were dealing, or what we could have done differently, but she really needed full ICU care.

On a happier note, I saw one of my patients from last week today. She'd been losing weight for a month, with several gastrointestinal problems, and I was really worried about her. We treated her for parasites and reflux and sent her for an ultrasound to look for something more serious. She came back today and looked wonderful. She's been able to eat, and has started gaining weight and energy that had been gone for weeks. That was really great. It just made my day.

That's it for now. Have a great week.

Yours,
Anna

The source of the Nile - LETTER FROM JON

Subject: the source of the Nile

Hi folks, I'm in Jinja now and got a few minutes to write a quick email.

I'm in Jinja, the traditional source of the Nile, it's very beautiful and a nice town. peace corps took us on a little field trip here today, and it's good to get a day off from training. we also went to Mabira forest, which the government is trying to sell to a sugar company, which is a real shame, it is a real ecological hot spot and the last remaining forest in central Uganda, a country with the world's highest deforestation rate...

Training is going onward, I'm very glad it'll be over soon. The language is impossible, but I am making a little progress. I can greet someone, order food and tell them I like Uganda very much. It's frustrating talking to volunteers who have been here a year, they still can't even hold a basic conversation...

Anyway, still eating lots of banana mush at every meal, although they gave us pizza today. my host family is very nice, and I have a nice room to myself. they are training me for the business program although I wont be using much of what I've learned in the field. I find out where I'll be placed next Friday and I'll visit my site in two weeks. I get sworn in the 10th of may, which is when I'll officially be a peace corps volunteer. That is also the same day that we are sent to our villages. I'll be in a medium sized town in the central region.

All the other trainees are very nice, some are even more well traveled that me. I am almost the oldest one though. none has dropped out yet which is impressive since we are 50 strong.

I went to a introduction ceremony last week which was very interesting. It is basically an engagement ceremony where the man comes with his dowry to the home of his new bride. It started 3 hours late and the groom was another 2 hours late after that. When he got there the brides side made fun of them for the first 20 minutes. the bride and grooms side sat opposite to each-other and only one spokesman from each side could speak. In all, it was 7 hours long, during which time all the Ugandans sat patiently in the hot sun. I wore the traditional garb with a sports coat over it. I was dying. The dowry was one cow plus lots of other loot. I have lots of pictures which I'll post once I get a decent Internet connection.

Anyway, I guess that's it for now, hope all is well back in the states

cheers, Jon

Highland Park or bust...

We went to Highland Park this weekend to visit David and Cami. They seemed to be doing well, but are overworked. David had tons of lab reports to grade and Cami had both work and homework. Maybe we can do something fun together in the summer, when they are not so overwhelmed.

Cindy said something thought provoking. She said she thought of her children as friends, now that they growing up. I laughed and said I did too, however, I'm not so sure they think of us that way! I hope someday they will!