And here we are, ol' blog o' mine, back in action after an almost four year hiatus. I've been preparing for a few years (since starting residency at UCSF, really) for this clinical rotation at Mulago Hospital in Kampala, Uganda. But it wasn't until last week that it occurred to me to reboot this little blog. (Actually, it didn't occur to me at all - credit for that goes to Dad, who noted proudly that it was the only blog he'd actually ever read.) It's a little disorienting to read my last blog posts from my medical student self below, writing as she finishes up in Malawi. She sounds so perky and enthusiastic, cheerfully unaware of the Indiana-Jones-type boulder of residency training that is coming at her. We'll see if these new posts can live up to Dad's exacting standards.
The trip to Uganda was surprisingly smooth, capping off a crazy week of eight flights in seven days, starting in Honolulu, adventuring through Burma, then sailing into Entebbe airport around noon today. Easy peasy. It's an unexpectedly odd experience to come to Uganda from a relatively poorer country (which Burma/Myanmar definitely is). Turns out it's all about expectation-setting. Compared to their Yangon counterparts, Kampalans look pretty well to-do, really. Most of the street signs here are legible, some of the children are chubby, and there's not a single lizard in my bathroom! Though, of course, that may all be a glossy coat on a shaky foundation - it's hard to tell how much is true, up-and-coming African metropolis prosperity and how much is just shooing the sidewalk fruit and used shoe vendors off the main streets.
Luckily, there's no better way to learn about the true socioeconomic heart of a city than to visit its public hospital. True in United States cities, and undoubtedly true here. We'll see in the morning. I have a hard time putting my feelings about working at Mulago into words. It feels cowardly, somehow, to admit that I have a little bit of pit-of-the-stomach anxiety about walking in tomorrow. Some of it is the usual discomfort I have whenever I start a new rotation in residency; I hate the feeling of not being efficient because I don't know the system yet, and that'll be compounded in a place where I won't really even be able to guess at that system.
But I think part of that anxiety also comes from the expectation that I'll be asked to work further outside my comfort zone than I ever have before, and my ambivalence about how to respond to that. And it's a much more active choice, too; before, I was a student, but now, I'll be the surgeon. Mulago is huge, with endless need and drastically limited resources compared to US hospitals. I know from my predecessors here that UCSF residents may be asked to operate alone and unsupervised, to suture without proper instruments, to take patients to the OR without the safety net of a possible blood transfusion (when the blood bank runs out). Some residents oblige, others decline. The official residency line of advice is not to do anything "that you're not comfortable with".
This is not particularly helpful. Of course I'm not comfortable with any of that. I want these patients to have the care that I know has the best chance of keeping them safe. But what I AM comfortable giving to the patient, I won't be able to give her. Off the table. So then what? What am I comfortable with? What is fair, or ethical, or merciful? Am I just supposed to expect to know it when I see it? Hard for my little Type A personality to be walking in without a game plan.
So that, and possibly the weird Indian food I had for dinner, are making me sleep a little uneasy tonight. Wish me luck tomorrow.
The trip to Uganda was surprisingly smooth, capping off a crazy week of eight flights in seven days, starting in Honolulu, adventuring through Burma, then sailing into Entebbe airport around noon today. Easy peasy. It's an unexpectedly odd experience to come to Uganda from a relatively poorer country (which Burma/Myanmar definitely is). Turns out it's all about expectation-setting. Compared to their Yangon counterparts, Kampalans look pretty well to-do, really. Most of the street signs here are legible, some of the children are chubby, and there's not a single lizard in my bathroom! Though, of course, that may all be a glossy coat on a shaky foundation - it's hard to tell how much is true, up-and-coming African metropolis prosperity and how much is just shooing the sidewalk fruit and used shoe vendors off the main streets.
Luckily, there's no better way to learn about the true socioeconomic heart of a city than to visit its public hospital. True in United States cities, and undoubtedly true here. We'll see in the morning. I have a hard time putting my feelings about working at Mulago into words. It feels cowardly, somehow, to admit that I have a little bit of pit-of-the-stomach anxiety about walking in tomorrow. Some of it is the usual discomfort I have whenever I start a new rotation in residency; I hate the feeling of not being efficient because I don't know the system yet, and that'll be compounded in a place where I won't really even be able to guess at that system.
But I think part of that anxiety also comes from the expectation that I'll be asked to work further outside my comfort zone than I ever have before, and my ambivalence about how to respond to that. And it's a much more active choice, too; before, I was a student, but now, I'll be the surgeon. Mulago is huge, with endless need and drastically limited resources compared to US hospitals. I know from my predecessors here that UCSF residents may be asked to operate alone and unsupervised, to suture without proper instruments, to take patients to the OR without the safety net of a possible blood transfusion (when the blood bank runs out). Some residents oblige, others decline. The official residency line of advice is not to do anything "that you're not comfortable with".
This is not particularly helpful. Of course I'm not comfortable with any of that. I want these patients to have the care that I know has the best chance of keeping them safe. But what I AM comfortable giving to the patient, I won't be able to give her. Off the table. So then what? What am I comfortable with? What is fair, or ethical, or merciful? Am I just supposed to expect to know it when I see it? Hard for my little Type A personality to be walking in without a game plan.
So that, and possibly the weird Indian food I had for dinner, are making me sleep a little uneasy tonight. Wish me luck tomorrow.
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