March 18, 2005

Dear Friends,
There is a knock at our door, there are four gorilla permits available this morning. There is a scramble of activity as four of our visiting students; Anna, Rachel, Elizabeth and Conor search for backpacks, passports, water and food for the trek.
We pack them off and head down with the remaining students for rounds. Three interesting cases had been admitted yesterday; a 40 year old female with Kwashiorkor, a 35 year old female with an unusual combined upper and lower motor neuron paralysis probably due to syphilis and an 18 year old young man in heart failure likely due to endomyocardial fibrosis.
Later in the day four university based physicians from the US arrive with their spouses after having trekked the gorillas, interested in seeing the diseases of sub-Saharan Africa. I showed them the usual litany of patients on our ward with malaria, dysentery, mal-nutrition and TB. I then sought their insights on our recent admissions. They had a bit of trouble diagnosing Kwashiorkor and the neurological disorder but when I presented the young man with heart failure an infectious diseases expert named Richard mentioned that it was probably endomyocardial fibrosis. He then went into detail describing how this disease is second only to rheumatic heart disease in causing heart failure in some areas of sub-Saharan Africa and is probably due to either the filarial parasite, malaria or the high cerium contained in cassava. His friends and I listened with rapt attention, spellbound by his familiarity with this unusual disease.
I walk back to our home but is hard to find peace today as a carpenter and his assistant have begun hammering on our kitchen cabinets adding a rat-proof screen to keep out our furry friends. I am finally able to relax with a cup of java but I hear a disturbance outside the door. The Uganda military has just arrived and has brought three pygmies to our house who have stolen a cellphone. Twenty or so other pygmies also have gathered outside and are either hurling insults at the trio or are laughing. Somehow this life seems normal to us! When we return to the US we are amazed when visiting to find a large house with only two occupants enjoying each other's company relaxing in an environment of peace and calm, a situation virtually unknown here in Africa.
Later, 11 of us crowd around the dinner table and talk about the events of the day. I mentioned about how much the visiting specialist Richard had known about the disease afflicting the boy with heart failure. Conor piped up that he had been trekking the gorillas with Richard earlier in the day and that Richard had asked him about what sort of unusual diseases we seen here. Conor mentioned the case of endomyocardial fibrosis. “Never heard of it” was Richards’ response. Conor then proceeded to tell him all that he knew about this disease.  When visiting our hospital Richard had never let on that this was a novel disease to him, he just oozed confidence regaling us with his newly acquired knowledge.

Jogging

Jogging in sub-Saharan Africa is never dull. There is an endless web of trails connecting villages. These trails weave through lush fields, brilliant foliage and offer spectacular views across the mountainous terrain. Locals make their way along these trails also and are always want to make comments about the mzungu (white man) perspiring profusely and gasping for breath. As I have increased my language acquisition I have learned that all their comments are not complementary. This day at least they are not calling me a “muse” old man. Some kids run over to join me but as the trail's grade increases they break off the chase. Exhausted I reach more level ground and again come across some students returning from a soccer match. They too are tired but are interested in expending more energy. We jog along for awhile together we laugh as we each push the pace up, the trail divides and they take a different fork. I reach a level plateau and appreciate God’s majesty- the light green fields of matoke (bananas) and millet finally giving way to the deep green of the Bwindi Impenetrable Forest and finally the peak of the volcano Mahavura a lonely sentinel at the boundary of Uganda and Rwanda. I feel alive as I cruise along “maybe this “muse” is not so old” I think, satisfied by my efforts competing with the kids on the way up the slope. My revelry is broken by a slapping sound behind me. I turn and gaze at three women chasing after me their thong sandals slapping against their feet. Each is carrying a heavy load on their heads one even is supporting a huge load of matoke and what’s worse is that they are gaining on me!
So goes life here,
Scott