Only the innocent sleep

You would think sleep comes easy to someone who has been up for two days straight. But after managing only about an hour of rest I woke early the next morning around 5 to the turbine-sized fans above me fighting to keep the room a livable temperature. The daylight was creeping in but the quality of the light was remarkable. Everything had a soft glow as if artificially created for a movie set. It must something about being so close to the equator. Or perhaps it is the haze of pollution in the air. In either case it was a beautiful morning.

Set up a hill minutes from the hospital, our living arrangements are more than comfortable

A quick walk around our heavily walled compound showed I wasn't the only one awake. The house staff were already getting things under way. Our 24 hour gate security, dressed only in a pair of loose long under wear stumbled to the gate to let in our driver, Dave, who had fuelled the vehicle up for the day's activities. Dave does all the driving because if we did we would die before we pulled out of the drive way. Uganda is probably not unlike many countries in Africa in its road warrior-esce driving environment. It certainly makes Mexico look like Amish country. The concept of traffic lines are theoretical only. Most busy roads have a boulevard in a desperate attempt to keep drivers out of incoming traffic but it only partly works. After only a day I no longer react to the sight of a man, woman and two children packed onto a small motorcycle, no helmets with 4 huge sacks tethered to the sides. There are no stop signs, guess the metal can be better used elsewhere. Pedestrians frantically scramble across the street at their own peril, hugging loved ones goodbye before they make the dash. Crosswalk is a four letter word. It is no surprise vehicle trauma occupies a large portion of Uganda's  medical resources. Combine this with limited surgical resources and you have a large population with horrific injuries that are essentially palliative over a period of months to years. It is a reminder that heath care does not exist in a vacuum.

These extra tents for the two occupational therapists in our team seem nice from the outside but with no fans, these death traps heat up to the temperature of the sun over the day.

We also have a cook, Jobe, who will make our meals should we want to eat in the house. As other members of our team stumbled out of their rooms. Jobe pulled together a tasty breakfast of omelets, toast, yogurt, bacon and fresh fruits. I had always heard about topical fruit eaten at the source and this meal lived up to those expectations. One or two other staff help with cleaning and laundry, hovering around ensuring we were well taken care of. I'm not totally comfortable with this set up but all I can do is be polite and appreciative.

The conference was being held at Mulago hospital, the main government care facility in the region. In addition there are several private facilities, much newer, including one built recently by the Chinese. With over 70 attendees we spent the day talking about lower extremity reconstruction. The majority of attendees were the equivalent of residents like myself, young and eager but not much different from our trainees back at home, though a much lower percentage of women. Except of course that many of them are not paid during their residency. This necessitates working other jobs during their training which in turn limits their time in the hospital and learning in general. I can only assume what effect this has on the quality of their skills and attrition rates in their programs.

Everyone looks so young in Uganda it is hard to tell staff from trainees.

The attendees were very appreciative of our presentation. Once again an air of reverence created a barrier to getting to know these people better. People were horrified when I bent down to clean up a broken cup, shooing me away. Even at lunch it was insisted that we not line up with everyone else to get our meal. Despite my protests, I walked back to my seat with a predished out plate, and not the same food as the others were serve splats of curry and other items from an assortment of large messy pots. Maybe they are simply being good hosts but I know it is more than that. I also know my petty guilt is more a reflection of my ignorance about these people than insightful observation.

The conference ended with a cadaver dissection session. The majority of the bodies had been killed in trauma, virtually unheard of in a cadaver lab back home. Deep burns, motor vehicle crashes and gunshot wounds predominated adding a unique challenge to the dissections as well as the grim reminder of how short life can be in this country.

I discovered this preying mantis during lunch and sent it on its way out a window, but not before it chomped my finger, the little bastard.

With the session completed, we adjourned to our residence by late afternoon. We decided to walk to see a bit of the local area. We got lost. Every other street corner had a dishevelled looking soldier or two packing a dingy looking AK47, slung haphazardly to their shoulder or used a standing post. Sidewalks disappeared and reappeared forcing you out into the death path of traffic. Random massive holes scattered the journey like a Super Mario Bothers level. In one case a large tree branch had been shoved into a hole covering half the sidewalk's width. Problem solved! Now the larger children won't fall in as easily.

I'm not sure if it is more dangerous on the sidewalk or the roads...

During our wandering, Preparations could be seen all over the city for the 50th anniversary of Uganda's independence from the Brits this Tuesday. This is a bittersweet celebration as Ugandans are divided as to exactly how independent they really are. Regardless it will be a massive event of both celebration and protest and with 24 Presidents from surrounding countries attending, security is bound to be high and stretched thin. I suspect the hospital will be equally overloaded.

When we finally make it home I find one of the house staff cleaning my shoes. Happy independence day.

I'll be in touch.