Mmmbop, Mbarara

I'm writing from Mbarara, Uganda. I've found probably the only wireless internet point in the whole town--even here the internet still only creeps along. Or shall I say, at the risk of some response from my African friends, it runs on African time!

I'm on a journey to look at electronic medical records across Africa--specifically, OpenMRS, an open-source system developed by Partners in Health and AMPATH--a huge HIV program in Kenya that involves Indiana University and Moi Teaching Hospital. Health Information Technology is all the rage right now--but we've found so far that there's little data to support or refute the claims around how it improves care and efficiency in the developing world. So, that's the mission: bring some light to those issues. And hopefully, from my standpoint, bring a richer perspective to some of the key players in this field (including the large donors) around the potential for high impact investments and how to improve current funding and implementation models. And finally and most importantly, have an amazing time in the process.

We landed in Kampala on Sunday night and were shuttled to a guest house at Makerere University--essentially a house filled with beds occupied by American medical students. The next day, I visited to Mulago Hospital, which is the national referral hospital. The number of people waiting for care in this type of facility never fails to move me. Here, there are very few nurses, one person ballparked 1 nurse per 40 patients, so family members often have to perform many of the duties normally done by nurses. So they sleep outside the wards on the floors when they get kicked out of the patients' rooms at night. I had a chance to talk to a few physicians--all of whom do an amazing amount of work in extremely challenging conditions--and hope that they are able to find the support to pursue some of their very innovative ideas for how to improve Uganda's health system. I got a wish list from one doc for what he'd do with $100 million--if you all know anyone trying to figure out what to do with that kind of cash :) Top of the list was hire residents--here most medical officers (who have just done medical school) have to pay for residency.

We took to bus to Mbarara on Wednesday. The bus park was its own adventure--you tell one of the guys on the perimeter where you want to go, and then they grab you and help you run through the crowd so that you can catch the bus that's about to leave. Then you sit there on the immobile bus for a good 90 minutes while people try to sell you everything from "fresh" yogurt, watches, bibles, etch and sketch. you name it--I did most of my Xmas shopping. The bus ride itself was interesting--it's crammed full of sweaty people--and passes along a semi-paved road past miles (km, more precisely) of banana plantations, billboards, and small villages. We even saw a few impala.

Mbarara is small--maybe 40,000. It's very safe as long as you keep an eye on traffic (it comes from the left, and there are no sidewalks). People are very friendly--if you can think of ways to get out of having someone buy you a beer, please let me know (I usually have half a glass when they ask, so can't involve an excuse that includes full absention). AMAZING pineapple (50 cents for a whole one!) and bananas (75 cents for a full bunch) for breakfast, and avocado at lunch every day. I could REALLY get used to this. The shower on the other hand--sort of a "no pressure" situation. Even tepid water would be improvement. I can see why women have their hair in braids--I may have to more that way! I love the folks working at our hotel--it's a nice place--and I'm growing fond of the goats that seem to use the hotel grounds as a grazing area--I saw them chasing a cat away this morning and that just sealed it!

Took a break from the clinic this morning to go see a local elementary school play that a friend of a friend directed (I've literally met a dozen people from Boston here--so weird how small the world is). It was peter pan, with a michael jackson theme. Amazing acting, but one of the weirder things I've ever seen. Thriller Ugandan style?

Off to Lake MBuro for the weekend--minor game park near the town. This is just the beginning--the voyage continues through the end of August!