Taking a social history....

I feel like I've learned a lot about medicine in the last few days. It's also been overwhelming to learn about many of the patients’ stories. There is so much unrest in the history of the continent and we have seen a lot of it since Kampala is home to many refugees. It is very difficult to comprehend the suffering, but so amazing to be involved with a part, even a small part, of their lives.

Somali
I have been able to get to experience real "family medicine". Families come into the clinic and members are taken care of one by one. Today a Somali refugee woman came in with seven children and an interpreter. The woman's husband had died when he went on a business trip to Ethiopia and was accused of being a spy and tortured to death. She had her own children and her brother’s children to take care of. The whole group was coughing. It seemed like that they were suffering from an URI that could be taken care of with Amoxicillin. However, we were not sure about the mother having TB. She wasn't able to afford a $4 TB test.

Congo
A Congolese man came for fever and malaise. His story was fuzzy about whether he had actually gotten a blood smear to prove malaria. Ellen decided to give him Doxycyclin: it's a treatment for malaria (an older one), and also a treatment for typhoid and some STDs, so it can cover a lot of the differential.

Ellen pointed out a bump on the back of his head. In 2004 he had been beaten. He had a scar across the head and on the back of his head was a bump where some meninges had come through his skull fracture and was stuck there after it healed. The Congo is a very dangerous, violent place. This man had most likely done nothing: beaten by an angry cop or in a small battle.


Northern Ugandan Orphans
Last night for dinner a girl I went to school with was over. She is working as a counselor with teenage orphans that had been captured by the Lord's Resistance Army in Northern Uganda. The LRA is notorious for capturing children and making them part of the Army. As part of the army they were forced to carry heavy bags of artillery on their heads and trained to kill or be killed. Resting or complaining was not tolerated and resulted in them getting shot. Some escaped during skirmishes, not knowing how to get back home or if they would be caught and killed by the LRA.

Jennifer has spent time talking with them about great fears and hopes. The culture here is does not encourage sharing thoughts and emotions, even with such seriously painful histories. Recently she got them to draw pictures of their greatest fear. One guy wanted his picture to be shared: it was a picture of a man and woman lying dead on the ground with blood flowing from their heads. The hut was on fire with a chicken squawking in the air, and in the background were tall grasses were separated by children marching in line carrying loads twice as big as them on their heads.

For more information on the LRA check out www.invisiblechildren.com