Night

So there are no street lights in Kisoro so at sundown around 7-7:30 it becomes pitch black. That doesn’t stop people on bikes and motorcycles speeding down the road. We usually use flashlights when walking at night. We work until 7 so we are walking around in the dark every night. The stars are so bright and numerous and beautiful. I had forgotten that they exist living in NYC. Then there are the noises of the night. There are 3 different frog sounds. One low corkscrew type bull frog. One high pitch chirping tree frog. And one frog that makes a noise like water dripping into a full sink. I call it the “water dripping into a full sink frog”.

Jerry continues to work us hard and astound us at the same time. We have had many interesting cases including 3 cases of impressive mitral regurgitation. Rheumatic fever is common here. Also 3 cases of endomyocardial fibrosis causing massive ascites. We also had a case of constrictive pericarditis. Remember all these are diagnoses soley by physical exam. No blood tests, no echos, no imaging. Some other fascinating things we have seen are a buruli ulcer and superficial spreading malignant melanoma. The only other death we have had is the guy with TB passed away last night. We have saved several people who have presented either in septic shock or hypovolemic shock and brought them back from the brink.

Rafi