So if you’re in Kampala, specifically if you live in the
upscale neighborhood of Kamwokya (ky pronounced ch) and you find yourself
unable to sleep at 3:18 in the morning, you’ll find that this is the quietest
time of the day. It’s still not perfectly quiet. There’s still the incessant
dog conversations going back and forth among the houses but Otis, our
neighbor’s dog, at least seems to be asleep so it’s a distant barking. There’s
also the sound of traffic, like an interstate nearby, only I know logically
that there is no interstate. There’s only cars driving at excessive speeds
taking advantage of the paved roads of the city and the lack of traffic at
three am, and yet it is still a ceaseless flow of traffic. There’s an
occasional boda (motorcycle) engine but otherwise they’re quiet at this hour.
The birds are quiet too and the international rooster has not yet woken. Being
in a decently sized metropolitan area, you have to try to listen for the
rooster. He’s not immediately outside my window like he often is. As many
others have found, the rooster is a universal barometer of just how urban your
setting is. Perhaps universal urbanometer would be the more appropriate
nomenclature. If someone were to study roosters around the world I’m sure she
could find a significant correlation between the proximity of the nearest
rooster and the reliability of internet, electricity, running water, paved
roads, or ability to purchase any number of international foods (be it Thai,
Greek, Mexican, American, Italian) by phone and have it delivered (thank you
hellofood.ug) to your door. All of which is to say that living in Kampala has
been quite easy. I have a great many things to be grateful for and many people
who were invaluable in helping me settle in (namely, Darlisha, Darlisha,
Darlisha, and not to forget Wendy, Mahsa, Nathan, Josh, and so many others).
Writing in public is to me an exquisitely personal
endeavor, and I’ve always been impressed by how many others do it so easily.
I’ve never been much of a Facebook-er. I often forget to check it (possibly because
people seem to post with a frequency that is inversely proportional to how well
I know them). And from the other end, I don’t have much interest in sharing
what’s on my mind only to have it remain viewable in perpetuity. What in the
world would I have to say that could be so remarkable? But I find myself being
chided by a certain former global health chief, and so here I am, examining my
reflections in writing. If I knew how to say, “not so remarkable” in Luganda I
would instill that as the title of my entry.
So what am I doing in Kampala? Much as I am a one
face in the throng of 2-ish million people in Kampala, my role here is a small
cog in a much larger apparatus. My background in epidemiology and working on
large cohort studies is just enough to keep me afloat (barely). The Infectious
Disease Institute where I’m working is a powerhouse of clinical research and a
“Center for Excellence” for cryptococcal meningitis. It has a feel that is
equal parts Ugandan and International. My clinical skills, on the other hand, feel
woefully inadequate as I have come to rely on the crutches of advanced
chemistry and microbiology and sophisticated imaging (none of which I can
perform on my own, I might add). Left alone we have the history and physical
exam which, as we know from morning report, leaves an awfully wide differential
by 8:30am. By 8:45am the advanced laboratory and imaging results have swept in
to save the day. Here at Mulago Hospital we’re left guessing after the 8:45
mark. So we guess at treatment and watch day to day as the patient either gets
better or worse. Of course this happens in the US as well, Mulago just seems to
take it to a new level.
