This week has had some long days for sure. I have made a few trips to Kampala for one of our patients; she is a 32 year-old female, mother of 4, who was diagnosed with Hodgkin’s lymphoma back in May. We began sponsoring her chemotherapy treatment in Kampala. However, after showing little improvement at Mulago Hospital, another biopsy was performed at the International Hospital and the diagnosis changed to non-Hodgkin’s lymphoma. It was sad news, since there is a much higher hope of surviving Hodgkin’s lymphoma, especially since she began treatment at such a late stage. Now it has reached stage 4.
Between treatments, I visited her at her home after her brother called saying she was not well. She was too weak to stand alone, with no appetite and vomiting for the last few days. She was complaining of pain on her right side and a tender right abdomen due to the cystic tumor masses that have spread to her liver. Although scheduled for another round of chemotherapy in a few days, I was worried she would not survive the drive to Kampala. We started her on oral morphine to help with the pain, and fortunately, she was looking much better by Monday. We decided to get her to the International Hospital in Kampala to continue her pain management.
I kept thinking to myself of the unofficial oath of medicine: do no harm. At this point, she is too fragile to undergo further chemotherapy. I discussed the options with her doctor. We decided it was time to discontinue treatment; the plan was to undergo blood transfusions to increase her Hb and counsel her to make plans for her children after she is gone. The doctor then spoke to her in Luganda, and I assumed told her what we had just discussed. I had offered to donate blood on Monday but all the nurses said there was enough (she is B+ and I am O+, the universal donor). Although I was hesitant to believe them, I left anyway.
I returned to Kampala yesterday after getting a hold of the doctor and learning that there actually was not enough blood for her. After donating in the lab, I walked upstairs to the Hope Ward to tell her that blood was coming her way very soon. Although I have donated many times, never before have I actually watched my own blood go to someone else, especially a friend and someone so dear to me. I began explaining that she will get this transfusion to boost her Hb and then she will come home to Bujagali in the next few days. She was very grateful, but then asked when she was going to get her chemo.
I took a deep breath, realizing that everything I had discussed with her doctor 2 days prior had not been explained to her. She had received no counseling and had not been able to mentally prepare herself for the steps ahead. I reached that point where I felt completely helpless; all I had left to give was a language barrier of emotional support and a pint of blood.
We had a meeting with the woman who is organizing this project at the Salini construction site. Although she agrees in our subsidized net sale program, the big boss up top at the World Bank does not. Either way, Jessie and I were at the dam site for our quick meeting. Afterwards, we asked if we could get a tour, and sure enough, we were given our neon construction vests and a hard hat and off we went. 
We drove around the construction site to see the remains of our long lost rapid. The guy told us how cool it was that a particular part of the site used to be an island. I sat there, holding back my actual opinion, and looked down to see what used to be this amazing play spot called the Ugly Sisters wave. We then saw the turbines under construction, the rock-crushing site, and the hundreds of buses and Salini cars. The place felt like a city of its own. It was depressing, but interesting to see it from their perspective. We definitely did not tell them that we were kayakers. 
Silverback is still up and running. I have heard rumors that it will be around for a while, maybe even until April 2010. I am skeptical to believe what I hear, but we will see. I am enjoying it while I can.
