Pharmacy in the Forest

We have just arrived in Nairobi, and are staying with Matt and Jess (their blog is linked to this one). Before getting into our experiences here, I must recount our adventures from the Bwindi 'Impenetrable' Forest. After leaving Lake Bunyonyi, we headed for the forest. This was easier said than done, as transport to and from Kabale is spotty at best. We were lucky enough to secure a ride in the front of a pickup leaving shortly after we got into Kabale- had we missed this, we would have been stuck for the day. We mzungos were given the front, less out of courtesy and more because we could then be charged significantly more than the locals (~20) who were crammed into the box (see picture). Needless to say, not everyone had a seatbelt! For six hours we plied the high mountain windy dirt roads, stopping frequently for buying things, bladder relief, and breakdowns (twice, break failure and flat tire respectively). When we finally arrived at the Bwindi Community Health Centre (www.bchc.ug) we were greeted warmly and invited into our rooms at the well furnished guest house. The Californian doctor, Dr. Kellerman, who runs this Church of Uganda health centre is well known throughout the area and even broadly in Uganda. The clinic has accepted over 100 students on internships from the US, Canada, and the UK. After treating us to a feast (including the best cinnamon bread in all of Uganda), we were taken on evening rounds in this 30 bed facility. There were various ailments represented, the most severe being a young girl with cerebral malaria. The course of treatment for this dangerous form differs only in its urgency and aggressiveness: the patient can die quickly without intervention. The next morning, we were invited to come out on an 'outreach clinic' in the forest Batwa peoples community. The Batwa are pygmies that until recently lived a hunter-gatherer lifestyle in the forest. The were ejected from their traditional homes when the forest became a national park, and unfortunately suffer stigmatization and struggle with integration into general Ugandan society. Shortly after their removal from the forest, the infant mortality rate was approaching 50%. Anyways, we took a landrover, stoked with drugs, and penetrated the impenetrable. After an hour's drive, we arrived at their settlement, where people had congregated in anticipation. Chelsea and I were assigned to assist a nurse-in-training in dispensing drugs of various kinds. The setup was as follows: The assembled people were given a number, saw the doctors in that order, came to our 'drug hut' with their prescription. Given all the constraints and considerations, diagnoses were expedited and made on best available evidence. We handed out mainly de-worming pills, quinine (for malaria) Vitamin A (for malnutrition) and antibiotics. Most patients were young children, suffering from malnutrition, intestinal worms, or both. The aim of the outreach was not only treatment, but also triage. We took the sickest of the sick back to the clinic for admission. We took five very young children suffering from malnutrition and related complications (infections etc.) accompanied by their mothers. As we all had to fit back into the finite environment of the landrover, Chelsea, two doctors and I had to ride on the roof racks! Again, not everone had a seatbelt :)
Those who came with us received prompt treatment, without which they would have died within the next 3-5 days (according to the attending doctor).

The pictures are of our pickup ride, examination by Dr. Paul (UK), and a young girl peering into our forest pharmacy.