The Latest:: Veg. Vs Non-Veg

MUMJ
The latest:
From the HIV Research Frontiers
Breakfast with the Chancellor
Vol: 16 January, 2010
MBARARA UNIVERSITY MEDICAL JOURNAL
WANT TO BE A SURGEON?
Veg. vs non-veg.
Is being vegetarian a healthier option?
Cusomise t your Frag rance
Essential Surgical Skills at MUST
JOINT CLINICAL RESEARCH CENTRE
CLINICAL OPERATIONAL AND HEALTH SERVICES RESEARCH (COHRE)
COHRE Background The International Clinical Operational and Health Services Research (COHRE) Training Award for AIDS and TB (NIH/FIC, U2RTW0006879-06) is based at Joint Clinical Research Centre (JCRC) with Prof. Peter Mugyenyi the Principal Investigator. The program has just won the National Institutes of Health (NIH) award renewal for another five years effective April 2009 to April 2014 after submitting an international competitive application for the Phase II to continue a very successful Phase I. The program consolidates achievements of the first phase and continues to strengthen the national capacity to address the growing challenges HIV/TB prevention, care and treatment in Uganda through short and long-term training among other contributions. The goal of COHRE training program is to conduct training, research and mentorship as well as the implementation of research findings in order to strengthen the national capacity to address the public health and scientific challenges of the evolving HIV and TB epidemic in Uganda. COHRE collaborating Institutions The core set of collaborating institutions include Joint Clinical Research Center
(JCRC), Makerere University, Mbarara University of Science and Technology (MUST), Kampala City Council (KCC), and Uganda National TB and Leprosy Program (NTLP), in Uganda, and Case Western Reserve University, USA. Two new institutions (Gulu University, Uganda and University of Georgia, USA) have joined the consortium. Short and long-term training Through consultative meetings among COHRE Faculty, and other key personnel from partner institutions, training needs are identified, prioritized and implemented. The policy documents provide guiding principles and these are a basis for determining implementation procedures and insuring sustainability. The program will continue to support longterm training, intermediateand short-term non-degree training. Subsequent shortterm trainings tailored to meet specific needs of personnel are identified and deliberated on with relevant stakeholders. COHRE support to MUST COHRE program supports students for postgraduate training, provides internet services, stationary, support to students and faculty for local and international conferences, and any other support that is in line with COHRE goals and objectives.
contents
Editorial & MUMJ Executive Committee Word from the MBUMSA Presidents Updates from major HIV conferences 2009 Starvation at Mbarara regional hospital A success story of the ISS clinic alongside JCRC Abstracts: Dont you ever think of giving up! Pictorial So you want to be a Surgeon Swine Flu - Bacons Revenge? The difficult patient Ethical Medicine Veg. vs non-Veg. Book Review: Take the risk Personalities demystified Customise your fragrance Village: Dungeon of a Palace
4 5 6 12 14 17 17 20 22 25 26 27 32 33 34 36 38
pg. 36-37
Breakfast with the Chancellor
M.U.S.T. Zain Brains
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A degree alone is not enough
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al Essenti pg.11 ills gical sk Sur .T at M.U.S
The walk
Mbarara University Medical Journal 3
to 2009
From the Chief from t he

Dear reader,
I am delighted to present to you the sixteenth edition of the Mbarara University Medical Journal. Special credit goes to the editors who have worked tirelessly, with limited resources to ensure the production of this edition comes out better than ever before. I also wish to say, THANK YOU VERY VERY MUCH to the University administration, Joint Clinical Research Centre/Clinical Operational and Health Services Research Training Program as well as the companies and individuals who have given us support, for it is you who have made this publication possible. This edition contains a broad array of information; from abstracts, to the latest in medical and HIV research, not to mention perspectives on health as well as life at M.U.S.T, places, people to meet, and a pictorial not to miss. There is something for everyone. So come with me on this reading voyage of the journal, and believe you me this journal will be worth every penny; for as Benjamin Franklin once said, An investment in knowledge always pays the best interest. Editor-in-Chief, MUMJ. 2009/10
Chief
Keith Baleeta
Executive Committee
Patron/Head of Senior Review Committee Dr.Francis Bajunirwe Editor in Chief Keith Baleeta Deputy Editor in Chief Joanitah Atuhaire Senior Editor-Design and Publishing. Denise Kavuma Senior Editor Mercy Munduru Advertising manager Singh Parminder Circulations and Distribution Manager Ariaka Herbert
4 Mbarara University Medical Journal
Research Editor Abubaker Sempereza Editor Bibangambah Prossy Assistant Editors Martin Balaba Elisha Comfort Angela Nassazi Morris Maina Post graduate Coordinator Dr.Joseph Ngonzi Creative Consultant Abbey Ssemwanga Photographer Alex Noel
...influencing your imagination
+256 782 410036
Greetings
Dear reader
This 16th edition of the MUMJ, is unique in the sense that it is the first full colour publication the journal team has produced. It is my hope that the implementation of this plan gets all the desired support from all of you the readers. Writing, Editing, and publication works, especially for non-journalists is not an easy feat. I am particularly thankful to the whole journal team who are Self trained, self motivated and self inspired for carrying on the work of putting together this journal. Over the last one year, we pride ourselves in the support of our generous friends and partners. Without them, students work wouldnt be any easy. I thank all persons, companies and organizations that wholeheartedly donated in different ways to the medical students association and the journal in particularly. I am also grateful to the university administration for all the support accorded to us in these endeavors. The outgoing leadership was able to put together a few things notably the Mbarara University Medical Students Association Special Committees i.e. Special Committees for Public/ Community Health, Research, Human Rights and Peace, and Reproductive Health including HIV/AIDS. These are in line with international medical students engagements in different parts of the world. These committees are intended to broaden our medical students understanding and participation in extra-medical school activities. We welcome partners who share similar broad goals to these Special Committees. In conjunction with other medical students leaders in Uganda, a national body of medical students association-The Federation of Uganda Medical Students Association (FUMSA) was formed. This associations main goal is to protect, preserve and advocate for the rights and welfare of all medical students in Uganda. I encourage all our medical students to get involved in the activities of FUMSA and MBUMSA as well. Lastly, enjoy your reading, feel free to contact the journal team with your comments and articles, partnerships in all forms are highly welcome. REK John MBUMSA President 2008/2009 Vice President FUMSA
L-R: Joanitah Atuhaire, Babigumira Peter (Current MBUMSA President 2009/2010), Rek John, Singh Parminder, Ariaka Herbert, Maina Morris, Nassazi Angela, Munduru Mercy, Denise Kavuma, Balaba Martin, Keith Baleeta
MUMJ - Editorial Team
Mbarara University Medical Journal
est of the lat ew m An overvi search fro Re ces in HIV 09 Advan nces in 20 fere or HIV con Maj
Dr Muzoora K. Conrad, Lecturer, Department of Internal Medicine, Research Fellow MUST/ Harvard Collaboration Mbarara University
ho
We hav e
pe
here have been two major international conferences this year. On each occasion, a lot of ground breaking research was presented. The first was The Conference on Retroviruses and Opportunistic Infections (CROI 2009). The mission of CROI is to provide a forum for basic scientists and clinicians to present, discuss, and critique
2009 was held in Cape Town, South Africa on the 19th of July. Although attendance to these conferences is international, Africa is usually poorly represented for obvious reasons. We were however fortunate that the IAS 2009 was hosted by South Africa and the Ugandan attendance was so high that the author was turned away at the airport because South African Airways had overbooked its flights by more than 15%. Before we begin, I think we should say that CROI and IAS are very rich conferences, with so many simultaneous tracks, that our take will only highlight a few important points. We will also try to keep the discussions to the basics so as to make interesting reading to the majority. We will not entirely limit the discussions to the presentations at the conference, but also add a few more ideas from other well researched sources. For more details however, the reader is encouraged to visit the respective websites for abstracts and video presentations that are freely available (http://www.retroconference. org, http://www.ias2009.org). HIV Prevention It makes great sense to start with the latest findings on HIV prevention strategies since it is a well known fact that, even for curable diseases (of which HIV sadly doesnt belong to), prevention is always better than cure. The most worrying report at CROI, which was further re-affirmed at the IAS, was
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...it is a well known fact that, even for curable diseases... prevention is always better than cure.
their investigations into the biology and epidemiology of human retroviruses and the diseases they produce. The second most important is the international Aids society conference (IAS 2009) that usually takes place later in the year to bridge the gap by providing an opportunity for presentation of new findings that may have been accomplished in the middle of the year. CROI 2009 was held in Montreal Canada on the 14th of February while the IAS
the persistent failure by almost all ongoing vaccine trials in identifying a promising protective immune response to the HIV Virus. Millions of dollars in funding have been allocated to this front, but the HIV is still relentless.
...Obviously, the thought of taking a pill to prevent HIV is a very exciting prospect in one way.
A major focus of ongoing work is now on PrEP (pre-exposure prophylaxis, or in plain English, HIV treatment to prevent HIV) and treatment as prevention, or treatment for prevention. As of July 2009, there were nine clinical trials ongoing or planned right around the world to see if PrEP is going to be effective. But there remains a huge amount of concern and information that we do not have yet about how it's going to be rolled out and how it's going to be paid for. I'm on the fence regarding whether it's going to ever be effectively rolled out. Obviously, the thought of taking a pill to prevent HIV is a very exciting prospect in one way. But there may be negative aspects that haven't yet been discovered. It's just a matter of time, I think, before there'll be some type of PrEP program available, at least in places that can afford to pay for it. The most common PrEP drugs under study are Truvada [tenofovir/ FTC] or Viread [tenofovir]. The studies span everything from taking it on a daily basis, to taking it intermittently, to taking it at the time of exposure, to prior to exposure because the half-life of the medication is long enough that it's assumed it would protect against an exposure. There are several different ways that they're looking at it. Obviously, the intermittent method would end up being cheaper. We still don't know, but it's being used in different ways. ART and its complications When to Start HIV Treatment The data simply keeps piling up on the side of
treat earlier as opposed to later, though we're going to keep coming back to this issue of cost and what resources are available to provide antiviral treatment. If the resources are there, there's more and more evidence that treating earlier is better. However, you can't forget that we still don't know what the long-term implications of taking medications for life are. We have limited data. If people start taking drugs earlier in the disease course, what's that going to mean in terms of long-term side effects and adverse events? There's a lot that we still don't know. There's one trial that has started called the START [Strategic Timing of AntiRetroviral Treatment] study. It's a huge study that will be looking to see if starting treatment at a CD4 count of 500 has a benefit. But it's still five years away and recruitment's going to be a challenge. There's a lot of disagreement in the research community as to whether the resources being spent on this study are something that should have happened or maybe they could have gone to other places. A New Concern: Immune Activation It is becoming increasingly clear that the early years after someone has been infected may not be as latent or uneventful as we previously thought, that there are processes going on that are really damaging to one's body. We still do not understand that very well. We're used to charting the progress of HIV infection in terms of viral load, in terms of CD4 count and in terms of the development of classic opportunistic infections. What we're learning, as time goes on, is that there are other things happening in the body, specifically hyper-immune activation. This is when the immune system is on high alert, and it's revving all the time. What we're finding out is that it is not good for that to continue for years. There are inflammatory processes that are part of the way the body fights an infection. Over the years, the negative effects of inflammation add up. As a result, we see higher rates of heart disease, higher rates of bone loss, and higher rates of cancers that are Frontiers
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not typically associated or definitive of HIV or AIDS. As time goes on, we're accumulating more and more of this side-effect data. But we still don't really know what's going on during the so-called latency period, except that it's not latent. The unfortunate bit is that this is going on in people on antiviral treatment as well as those who have not yet started. This is because our treatments, again, are aimed at viral load and CD4 counts. We haven't thoroughly studied, and we certainly do not thoroughly understand, these inflammatory processes. One thing that was really exciting at IAS Cape Town was the new and ongoing research trying to unlock the mechanisms for activating the latent T cells so that the virus hiding in
Clearly we're in a much better place than we've been in a long time, and most patients are doing great on treatment with the drugs we have. But we all worry a little bit that the honeymoon will end...
those cells can be purged. That is what's considered a functional cure, which is a stretch, but we're not there yet. Obviously, there's a lot of research to do. It's in its early stages. But this whole idea about the latency period and activation of those latent cells is exciting. Trials on New ARVs What was surprising in CROI 2009 was the lack of clinical trial data in this category, which is something we usually talk so much about at CROI, signaling a period where we're not going to be seeing a lot of new drug development and new studies. But there's some good news to that. It means we're sort of satisfied at this moment with where we are. Clearly we're in a much better place than we've been in a long time, and most patients are doing great on treatment with the drugs we have. But we all worry a little
bit that the honeymoon will end and that, in a few years, we could have people with a lot of resistance to some of the newer drugs. The concerning thing is, if there's not a lot of drug development and we need new agents for those people, what will we do? Resistance to ARVs is really a worrisome issue. One study at this conference, done by Merck looked at Isentress [raltegravir, MK-0518], the new integrase inhibitor. They took patients who were on a Kaletra [lopinavir/ritonavir, LPV/r]-based regimen and doing well, and randomized them to either continue Kaletra or switch to Isentress. From their findings, the newer drug (Isentress) performed worse than expected. The problem was with the study, and this was what led to Isentress not performing well in the study, was that they allowed pretty much anybody into the study, regardless of how much resistance they had or how many prior regimens they had failed. There were some people who got into the study, who had been treated for 22 years with antiretrovirals, so that dates back to the AZT [zidovudine, Retrovir] monotherapy era, and who had been on as many as 16 different antiretroviral agents. So, the fact that they were doing well on just Kaletra and some nukes [nucleoside reverse transcriptase inhibitors or NRTIs] was surprising, but to expect them to do equally well by switching them to Isentress is naive. We know that boosted protease inhibitors [PIs] have a much stronger barrier against resistance than integrase inhibitors, so for all intents and purposes these patients were essentially taking Kaletra monotherapy. By switching to Isentress monotherapy in the SWITCHMRK study, they failed because it's easier to become resistant to an integrase inhibitor. I'm sure that that same thing is happening in clinical practice as well, and it's based on this belief that these new drugs are so great that you can do anything with them. I don't mean to paint a bleak picture. Obviously, most people are doing great, but it's so important when using these new drugs to use them wisely and carefully, and not just assume that any use of them will be fine.
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There was quite a feeling of surprise among the audience when Gilead announced that they had already co-formulated a combination drug containing all four Gilead drugs. This coformulation has the equivalent of Truvada (which is tenofovir and FTC), elvitegravir (which is their new investigational integrase inhibitor) and GS-9350 (which is a drug that they are developing to replace Norvir [ritonavir, RTV] as a booster). We use Norvir pretty much only for its ability to boost levels of other drugs. Elvitegravir needs a booster. Obviously, drug companies don't want to roll out a new drug that's dependent on ritonavir. They want to be able to co-formulate, so they are developing this booster in tandem with elvitegravir. What this does, in addition to allowing co-formulation, is that it allows them to study elvitegravir in treatment-naive patients. If they have to use ritonavir, they're not going to be allowed by the FDA [U.S. Food and Drug Administration] to study elvitegravir in treatmentnaive patients. The FDA is concerned about giving low-dose ritonavir to a patient who's not taking a protease inhibitor since it might create resistance. So that was leaving them stuck with a treatment-experienced patient population and a head-to-head comparison of elvitegravir with raltegravir, which just seemed like it was not likely to go quickly or go well. Now they can study this four-drug pill head-to-head in comparison with the three-drug combination Atripla [efavirenz/tenofovir/emtricitabine, EFV/ TDF/FTC] in treatment-naive patients, and it could lead to a much more rapid development of both elvitegravir and GS-9350. There'll be two purposes for GS-9350. One will be as a booster for elvitegravir. Gilead says it will also be a standalone product that can be used to boost other protease inhibitors. They'll be doing some studies looking at their booster boosting other PIs. Another small company called Sequoia Pharmaceuticals has a booster that they're studying with protease inhibitors. So far it looks like it's doing the job to boost those levels as well. My concern with that drug is that although they call it well tolerated, which is what all new drugs are always said to be, it seemed like there was quite a bit of nausea, headache and vomiting in the study, and even ritonavir doesn't do all that.
So we'll see what the tolerability profile looks like in further studies. There was a study presented about PRO 140, a new drug, which is a monoclonal antibody that's used by infusion, although I didn't get anything out of the presentation that was newer than what we've heard before. Most of the new drug presentations were in the very early stages of development and I sort of glossed over those. Long Term Complications of ART As people begin to live longer, more and more side effects of chronic HIV infection and the subtle side effects of anti-retroviral therapy are becoming more amplified and brought to the attention. Although it is difficult to tease out whether this is side effects to ART or the chronic HIV infection, or just the normal aging process in patients on ART. That said, there has been increasing trends of an association between HIV and coronary artery disease. There is lots of hypothesis ranging from dyslipidemia induced by ART to possibly the HIV itself. It may take some time before concrete evidence is mounted to make all these claims clearer. There was a lot of attention given to trying to further understand the possible connection between Abacavir [ABC, Ziagen] and heart attack, or cardiovascular, risk. Up until this conference, we had the SMART/INSIGHT study that showed a risk and GSK [GlaxoSmithKline] analysis of their data that did not show a risk. At this meeting there was some more information. Findings from the new study from the French National Hospital database are consistent with the SMART/INSIGHT in that, it is early and active use of abacavir that is associated with a risk. It is not a cumulative risk as you would see with a protease inhibitor. In this study, they also looked at the risk of heart disease with protease inhibitor use. Of course, we've always known. especially with the SMART/INSIGHT presentations in the past, that protease inhibitors have been associated with an increased risk in heart disease. They've helped further define that and showed that
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indinavir [IDV, Crixivan], which we rarely use anymore, is associated with a higher risk, as is Kaletra. What was interesting was that the risk in the case of indinavir was not associated with the use of ritonavir. In other words, you couldn't explain the increased risk of heart disease based on whether or not people were boosting indinavir with ritonavir. Also it was interesting to learn that the risk with indinavir and Kaletra was not dependent on their effect on lipids. It was an independent risk. There was also another presentation from the SMART/INSIGHT for they now have enough data on tenofovir [TDF, Viread] to look at the risk with tenofovir and they did not show a risk with tenofovir. The argument is that, had that been true, they should have seen the same thing with tenofovir and they did not. That argument has some problems, but I think they've demonstrated in many other ways that selection bias does not appear to be a big issue here. In this study, they also looked at the risk of heart disease with protease inhibitor use. Of course, we've always known. especially with the SMART/ INSIGHT presentations in the past, that protease inhibitors have been associated with an increased risk in heart disease. They've helped further define that and showed that indinavir [IDV, Crixivan], which we rarely use anymore, is associated with a higher risk, as is Kaletra. What was interesting was that the risk in the case of indinavir was not associated with the use of ritonavir. In other words, you couldn't explain the increased risk of heart disease based on whether or not people were boosting indinavir with ritonavir. Also it was interesting to learn that the risk with indinavir and Kaletra was not dependent on their effect on lipids. It was an independent risk. A lot of people have just assumed that the protease inhibitors increase heart disease risks because they increase cholesterol and if you control the cholesterol, you'll eliminate the risk with protease inhibitors. The SMART/INSIGHT study suggested that while cholesterol is part of the problem, it may not be the only problem, and that there may be
an independent association that's not just explained by cholesterol effects. I'm not trying to say that this is an established fact. This is an observational study, but that is what they found. A Holistic Approach to HIV and Aging There's still a lot to understand about how the effects of HIV are strongly related to the effects of aging. Also, there may not be much that we can do about it. I'm thinking that concentrating on holistic health and things
We've gotten magic bullets to control viral load and to increase CD4 counts.
like stopping smoking and eating better will have an impact on overall health as they do in people who are not positive. We've grown up in an era where we look for the magic bullet. We've gotten magic bullets to control viral load and to increase CD4 counts. There is no magic bullet for stopping smoking. Yet, it shows up again and again and again as a major health risk factor. So to be able to address that issue, to be able to address physical exercise, to be able to address diet and lifestyle issues, would probably have more impact than waiting for five or 10 years until some of this research bears fruit, and then maybe adding another pharmaceutical product to your regimen. In conclusion, my personal take it that there is as much setback in HIV research as the progress that has been made over the years. Every new progress highlights an otherwise unforeseen dilemma. The most disappointing thing about HIV care in the modern era is that the, despite all the progress on ART, more than 50% of patients in need of it still can not access it. See you at CROI 2010 San Francisco California.
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Essential Surgical Skills at

Mbarara University: The walk to 2009, Beginnings
Dr. Grace Ruhinda - Lecturer in Dept. of Surgery ecember 19th ,2001 marks the day the Canadian Network for International Surgery (CNIS) and Department of Surgery-MUST signed the first Memorandum of Understanding ( MoU) establishing the Department of Surgery at MUST as the second Essential Surgical Skills centre in Uganda, supported by CNIS. A new Memorandum of Understanding was signed on June 25, 2007. It replaced the old MoU signed in 2001, and runs up to the end of 2009. After 2009 we hope to convince CNIS to extend more help but the Faculty of Medicine is supposed to take over the ESS project. ESS Team and Resources We have15 certified instructors who were certified in August 2009 following successful completion an instructors course. They are drawn from the areas of Surgery, Obstetrics & Gynaecology, Anaesthesia and Orthopaedics. Previously we were using some non-certified instructors due to shortage. The last instructors course of August 2009 was conducted by Dr. Ronald Lett, president of CNIS. He also came along with training materials like ESS instructors manuals, ESS providers manuals and some Text books (Surgical Care at the District Hospital) on CD-ROMs We have a fully functional ESS laboratory is in place which also doubles as a lecture room year III MBChB students clerking Surgery and OBGY. Financing of the ESS course is from CNIS together with most essential equipment and literature. Animal materials and other consumables are locally purchased. Schedule We run two ESS workshops every academic year for final year MB.Ch.B clerking surgery and Obstetrics/Gynaecology. We also run one hernia workshop every calendar year for intern doctors, and an ESS instructors course every 5 years. Plans are underway to introduce a Structured Obstetric Course (SOO) for intern doctors. Current Status To date 23 ESS courses have been held, 4 TOT courses (instructors courses). We have graduated 584 students and doctors (381 male, 203 female) so far. Currently ESS course is part of the curriculum to be taught in the final year although still funded by CNIS Challenges The department of Surgery is grossly understaffed. We have over the last two years lost 14 (fourteen) certified instructors to; end of contract, other institutions, further studies and death. Nine of these instructors were from the department of surgery and five from Obstetrics and gynaecology. Way forward The University is to take up funding of the course from 2009 financial year. A proposal is on the desk of the Dean of Faculty of Medicine.
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Education
at Mbarara Regional Referral Hospital

Prof. T. Wilson - Head of Dept. Internal Medicine
Star vation
Perspectives
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MUST programme to feed all starving patients admitted to Mbarara Regional Referral Hospital has nearly completed its third year, made possible by a grant from the Whittakers of The Parthenon Trust. We feed anyone referred to us and fulfilling criteria for serious malnutrition, with feeding an urgent medical need. In adults this is based on measures of body mass index, or maximum upper arm circumference when the patient is too ill to stand or be weighed. For children, their measurements are related to the new international WHO Growth Standard charts. More than half of children dying worldwide do so directly or indirectly because of malnutrition with marasmus or kwashiorkor. About 30 patients are fed each day, mostly children under 5 and adult tuberculosis patients, but also including burns patients, prisoners and those generally ill without attendants. Their lives are precarious. Most are listless, hypothermic, hypotensive and severely wasted. Without feeding they are unlikely to benefit from medical
treatment for any specific underlying disease. Multiple factors contribute to the malnutrition of our patients. Many are admitted with associated diseases, particularly tuberculosis, HIV infection, recurrent diarrhoea and chest infections. While such diseases may lead to malnutrition, malnutrition itself predisposes to disease. Many of the children come from households with severe food insecurity, their mothers frequently abandoned by the childrens fathers who take no responsibility for them. Illness and death of other family members may have destroyed family income and support. Poor knowledge of healthy foods and good food preparation is common, as is weaning practice which is not ideal. Large families in the context of minimal resources add to the risk of malnutrition. Other factors include poor crops due to climate change and nutritional depletion of the soil by poor practice, and the worldwide increase in food prices. Our feeding team is based on Natasha ward and consists of cook Florence, liaison nurse Filda,
, ...Vitamin A r he zinc and ot nt micronutrie s t supplemen are given.
...there is a pressing need for practical involvement from indigenous Ugandan services in addressing the amount of malnutrition in the community.
nursing assistant Annet, and medical research fellow Sunday. A nutritionist advised and oversaw the programme earlier but has not been replaced since her departure from the hospital. Patients are fed with high energy milk or porridge in the mornings and the evenings. There is a rotating menu of local products for midday meals to create a balanced diet. Vitamin A, zinc and other micronutrient supplements are given. Distressingly, invaluable supplies of PlumpyNut nutritional supplement coming to the Hospital, previously available to us, are no longer released for our patients. Most require feeding in hospital for 4 to 6 weeks, but up to 30% are taken away early because of various social and financial family constraints, even though we quite often resort to feeding attendants as well to try and help. Children are discharged when appetite has returned, weight gain is satisfactory, any oedema has resolved, and they are interacting and playful again. In adults, there needs to be return of appetite and a steady improvement in monitoring results.
A majority of children admitted to Hospital have malnutrition. We are only feeding those very severely affected, yet those less severely affected are likely to have long term consequences including growth restriction. Many do not make it to hospital. Mothers of children in the programme take an active part in food preparation and other educational efforts. The plan is to expand the existing kitchen to a better teaching facility and to establish satellite community feeding centres for nutritional support and community educational activity. Other agencies, including Healthy Child Uganda and the MUST/Harvard collaboration, are not providing food but are providing advice and other support to some groups and we hope to collaborate to enhance the service in Mbarara and Isingiro Districts from where most of our patients come. However there is a pressing need for practical involvement from indigenous Ugandan services in addressing the amount of malnutrition in the community.
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Perspectives
A success story of the ISS Clinic alongside JCRC;

he ISS clinic at Mbarara Regional Referral hospital was founded in the late January 1998 by one of the missionary Doctors under the Baptist mission of Uganda. Working as a physician under the Department of internal medicine he realized the HIV/AIDS disease burden was weighing heavily on the department and that there was a need of a specialized HIV/AIDS care unit to specifically cater for the people living with the infection/disease. Initially, the HIV/AIDS patients were attended to in the hospital generally like any other patient. Many of there special needs were not being addressed. Hence the ISS clinic was started as an auxiliary of the medical department. In its early days, the ISS (Immune Suppression Syndrome) clinic used to
Mbarara Regional Center of Excellence

As told by Dr. Ssebutinde
run a few hours once a week. It was initially located in the current records room in the year 1998 2002. When the clientele outgrew the size of the records room, the clinic was transferred to a metallic container placed under a certain tree within the hospital. The number of patients continued to grow till that time when the container could not accommodate them anymore. With the help of the missionary physician funds were solicited for from USAID and a .7 (seven) room structure was constructed which provided 2 clinicians` rooms, 2 counseling rooms, a triage room, a dispensing room and a drugs store that was between 2003 2004.
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Joint Clinical Research Centre (JCRC) Opening of Mbarara Regional Centre of Excellence Monday, June 26, 2006
THE REPUBLIC OF UGANDA
MINISTRY OF HEALTH
In the beginning, it could not provide free ARVS to the patients and so those who needed them had to somehow buy them. Other drugs for the opportunistic infections were largely provided by the Baptist Mission of Uganda. As the clinic grew, so were the demands and the challenges involved in taking care of the patients. At that time it was either through soliciting for funds and help from potential donors or through
groups of interested in taking care of people infected and affected by HIV and AIDS and also had realized the untapped potential of the ISS clinic by the Projects. Below is the chronology of the funders that are currently operating in the ISS clinic in Mbarara Regional Referral hospital as they came. Ministry of Health (MOH) under the government of Uganda;
The M.O.H started providing free ARVs to the patients in the ISS clinic in 2001. The number of patients started to increase tremendously as people started to realize that there were free treatment/ARVs. However due to the overwhelming disease burden coupled with multiple limitations within the mother institution (MOH), other projects came in to rescue people in sever need of ART and specialized HIV care. TREAT under JCRC; This collaboration came on board in 1999, initially taking care of orphans, vulnerable children, widows, pregnant mothers and the poor women. This JCRC/TREAT collaboration provided clients with ARVS and other specialized care services. Initially, TREAT provided the necessary logistics and drugs but as the numbers of people in need increased, TREAT was requested to support by proving personnel as well. Currently there are 2 doctors, 1 nursing officer, 1 data manager, 2 adherence officers, 1 counselor, and 5 lab technologists. TREAT also helped in the expansion of the clinic space by putting up the storied building in 2006 which is currently housing most of the ISS clinic personnel now. TREAT has also provided lab services, internet connection, some furniture in the clinic and other important equipment. In addition, TREAT provides drugs for Opportunistic infections but at lower scale. Mulago, Mbarara teaching hospital Joint AIDS Program (MJAP) Nov 2004;
This collaboration between the two teaching hospitals has also played a big roll in the ISS clinic. It provides ARVS to about 700 patients in the clinic. It caters for the CD4s (an expensive test done to determine how much someones immune system is badly damaged by the HIV virus) of all its patients as well as all the patients on MOH program. MJAP provides most of the drugs for opportunistic infections to all the patients in the clinic regardless of who provides there ARVs. It employs 4 nurses, 4doctors 2 lab technologists and 2counselors. It also has a number of data personnel and a dispenser in the pharmacy. It caters for a lot of stationery in the clinic. The MUST- Harvard Research collaboration); This is more into the medical electronic data and research (prospective, cohort study). UCSF has equipped much of the ICT department. To a very limited extent, it provides some ARVs under what is known as Family Treatment Fund (FTF). FTF was mostly acting as a buffer/ transitional zone for MOH patients who were in urgent need of ARVS but whose slots were not yet available, so they could not yet receive the ARVS from MOH. FTF would cater for them until their drugs finally arrived from the MOH. Now that MOH has not supplied ARVS in the last several months, a number of patients remained on FTF. Its not yet certain how long this is going to be. Words of hope; This is faith based. Its headed by the same doctor who started the ISS clinic. The church
Perspectives
The newest structure of the ISS Clinic
members back in his home country, USA, decided to make some donations to help out with the poorest of the poor in supplementing their food, home visitations, social and spiritual counseling. It also provides drugs for opportunistic infections to both adults and children in the clinic. Currently the clinic is operating as an annexed semi- autonomous department of internal medicine providing specialized HIV and AIDS care whose services include; General HIV and AIDS care Antiretral viral Therapy (ART) Research Training in (Lab. Techs, Medical students, student counselors, Nursing students) Social and support Counseling State of the art Lab. The laboratory services have grown from providing; Routine test (VDRL, Urinalysis, widle test,
blood slides for malaria) Haematology HIV rapid testing Organotesting (RFTS, LFTs, Hormonal assays) to providing sophisticated tests including; CD4 profiles Viral load testing DNA/PCR for Early Infant Diagnosis.
The very fast CD4 count was done in June 2006 and the service has grown since then to date. A year later the clinic was able to do its viral load testing (June 2007). As the year 2007 drew to the end the clinic was able to do DNA/PCR for early infant diagnosis. The picture below shows the Laboratory equipment which does majority of the tests above. All this was archived by and through the mighty hand of JCRC, Mbarara Regional Center of Excellence.
No. of Patients
Perspectives
16
The graph below shows the progressive clinic growth as of 31st Sept. 2009
3000
ISS CLINIC PROGRESSIVE YEARLY PATIENT ENROLLMENT
2596
2500
Female Male
2000
1610 1625 1475
1558
1500
1036
1000
764 638 496 379 276 163 17 12 23 14 32 21
951
1027 932 879
500
489
543
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
Year
Are Ugandans Contributing to Knowledge Generation in the
Biomedical Sciences?
Background; Uganda was the leading centre of research and education in the 1960s in East Africa. In this study we ask ourselves whether Ugandan scientists are doing research. And if they are doing research how are they disseminating their knowledge to the end users. Is there an impact in the academia or the community? We wish also to know whether their findings are available in the worlds being library. Methods; A search in the electronic version of the US National Library of Medicine and the National Institutes of Health was made. All publications with the word Uganda were retrieved and manually inspected. This was repeated with word Kenya for comparison.
Tusubira Deusdedit - Department of Biochemistry Mbarara University of Science and Technology Email; deusdedit2002@yahoo.com
Results; There were more than 6000 hits for all publications before 2009. Most publications were from 2007(429). There are a lot more publications about HIV/AIDS compared to any other single disease in 2007 but publications before 1960 were mostly in the major tropical diseases of the time. Conclusion; Kenya has overtaken Uganda as a major source of biomedical knowledge in East Africa over the years but Uganda has room to improve on the quality and quantity of publications. Uganda needs to design innovative ways of broadening scope of research, increasing the number of first-time publishers and passing on scientific knowledge to the end users.
Dont even think about giving up!!!

Jamilla Nabukenya
The story is told of Mr. Hyena walking in the jungle and spotting a bunch of juicy grapes hanging from a tree. With his mouth watering, he ran, leapt and snapped to try and get to them but the grapes were always beyond his reach. Hours later, exhausted after endless tries at the grapes, he finally gave up. Walking haggardly away in frustration, he consoled himself saying I dont care, after all those grapes are sour. I am thinking about this story right now as I am trying to figure out what would be my good excuse for giving up my desire to become the president of my club. Its not my style, would that make a good reason. I am not sure but this has made me wonder, what goes wrong when suddenly we decide to give up our dreams or when we sit back and decide to watch them as they crumble to the ground. Have you ever tried to think about how much time and energy that was put in the buildings that Bin Laden, destroyed in only in a few seconds? Or Lets be a little Ugandan, I mean lets talk about our lives, how many times do we give up just when we are about to reach the finish line and all we do, is to do it the Mr. Hyena way. It wasnt worth it after all, attitude. I know of a friend, lets call her Honey. Honey got pregnant at the university, and then she decided to give up with her education because she could not keep up with the shame and people judgments. Peter decided to give up his dream of being a musician just because the first person to hear him sing said that he was worse than a frog. The list is endless and I believe that the list may include you and I at some point in our lives. Doesnt it? Life is like pedaling a bicycle; you can only fall when you decide to stop pedaling. Honestly the person who said that life is what you make it, couldnt have said it any better. It doesnt matter how many humps are there on the road or the number of people who have decided to stop pedaling and wonder, you have to realize that its your dream and desires that you have to achieve. This makes humans very complex, if I were an animal, may be a chipmunk, I would only care about my day to day. But as human, we have something in our dictionary called future and it all depends on how we decide to prepare for it. Believe me or not, if you decide to give up today, you will be miserable for the rest of your life. You will be a failure in your eyes and thats the worst punishment you can give a creature known as a Human. So it does not matter how many times you leap so high to get to the juicy grapes, please dont give up and walk away with a silly excuse. You may never know the wind may blow them down just for you.
17
Abstracts
A comparative study of the main causative agents of

Post-Operative wound infection at surgical wards of Mbarara Referral Hospital (MRRH) AUTHORS: Deborah Nanjebe Kasumba1, Dr. Mugyenyi Godfrey2 KEY WORDS: Post-operative, Wound, Infection/Sepsis
Background It is estimated that post-operative wound infections develop in about 3 out of every 100 operations performed, accounting for 24% of the total number of infections acquired during hospitalization. (Nichols et al, 1991) Post-operative wound infection delays recovery and often increases length of stay and may produce lasting sequelae that require extra resources for investigations, management, and nursing care. Therefore its prevention or reduction is relevant to quality patient care. Studies support the concept that a reduction in post-operative wound infection is directly related to increased education and awareness of its causes. The clinical laboratory is thus crucial in the isolation and examination of the various organisms responsible for post-operative wound infections. Objective The main objective of this study was to compare the causative agents of post-operative wound infections at surgical wards at MRRH. Others were to identify the causative agents of wound sepsis in MRRH; determine the causative agents of wound sepsis in obstetrics/gynecology and those at the surgical ward; determine the prevalence of post-operative wound infection of MRRH. Methods A cross-sectional laboratory-based study was conducted on all septic post-operative surgical wounds of patients at surgical and obstetric/ gynecology wards of MRRH. A sample size of 40 septic wounds was analyzed. The specimen were collected using sterile swabs, then inoculated on blood and McConkey agar plates and incubated overnight at 37oC. Cultures that showed growth were Gram tested and treated to biochemical and sugar tests to identify the organisms. The obtained data was analyzed manually and presented in frequency tables, pie charts and bar
graphs. Results/Findings A total of 40 samples was analyzed, 33(82%) samples showed growth while 7(18%) showed no growth. At obstetric/gynecology ward, Staphylococcus aureus was the most isolated (30.8%), followed by Klebsiella pneumonia (27%), E.coli (19.2%), non-coagulase positive Staphylococcus (3.8%), and other coliforms (1.9%). At the surgical wards, Klebsiella pneumoniae was the most isolated (7.7%), followed by Staphylococcus aureus and Proteus species (3.8%), and other coliforms (1.9%). Generally, Klebsiella pneumonia and Staphylococcus aureus had the highest prevalence (34.6%), followed by Escherichia coli (19.2%) and Proteus species, and other coliforms and non-coagulase positive Staphylococcus had the same prevalence of 3.8%. Overall prevalence of post-operative wound infection at MRRH was found to be 82% in the sampled population. The study concluded that the prevalence of postoperative wound infection (82%) at MRRH is high and therefore, prevention and control measures should be re-evaluated. Recommendations This study should be continued in future to establish whether microorganisms responsible for post-operative surgical wound infection are the same as those found in operation theatre site culture (i.e. surgical wound swab taken from surgical site immediately after in the theatre). It should be continued with performance of antibiograms with a primary objective of establishing a sensitivity map for microorganisms isolated at MRRH, which should also be evaluated routinely. This research should also be continued in order to determine the prevalence of anaerobic microorganisms.
Abstracts
Anaemia in HIV-infected children attending Mbarara Regional Referral Hospital (MRRH) HIV clinic:
Severity, types and response to antiretroviral therapy. Dr Eunice Nyesigire
Introduction A high prevalence of anaemia and its associted increased morbidity and mortality in HIV-infected children has been well described. However, the prevalence, severity and types of anaemia as well as its effect on response to HAART in HIV-infected children attending the HIV clinic at MRRH has not been studied. Methods HIV-infected ART-nave children (n = 257) were enrolled into a cross-sectional analytical study. Clinical and haematological parameters were assessed to determine the prevalence, type and severity of anaemia as well as identify eligible patients to start on HAART. Eligible patients who were started on HAART according to WHO criteria, were enrolled (n = 88) into an observational cohort and followed up for 6 months to determine the effect of anaemia on short term response to HAART. Results Anaemia (Hb < 11g/dl) was present in 148/257 (57.6%) of children; of these, mild anaemia (9-10.9g/dl) was (93/148) 62.2%, moderate anaemia (6-8.9g/dl) was 47/148 (32.0%), and severe anaemia (<6g/dl) was 7/148 (4.8%). The mean Hb concentration decreased as HIV disease progressed (p < 0.0001). Microcytic-hypochromic anaemia (44.9%) was the commonest type of anaemia. Anaemia was independently associated with young age (p <0.0001), advanced HIV WHO disease stage (p = 0.034) and low CD4 percentage
(p = 0.048). There was statistically significant clinical and immunological improvement as well as significant viral load suppression among patients who started HAART. Clinically, mean WAZ improved from -2.55 at baseline to -1.81 at 3 months; (p = 0.001), to 1.36 at 6 months (p <0.0001). Immunologically, mean CD4+ percentage increased from 18.3 at baseline to 26.7 at 3 months (p < 0.0001) and to 32.84 at 6 months (p < 0.0001). Virologically, 64.8% of patients had a viral load < 400 c/ml at 3 months and this percentage was maintained at 6 months. However, there was no significant difference in clinical and immunological response between the anaemic and non anaemic patients, although virologically, the proportion of children who had attained a viral load suppression of, 400 c/ml at 3 months was significantly lower among the anaemic children, 31/58 (53.4%) compared to the non-anaemic children 26/30 (86.7%) (p =0.002). Conclusion Anaemia is highly prevalent among HIV-infected children. The presence of anaemia as well as its severity is associated with disease progression. HAART reduces morbidity and improves clinical, immunological as well as Virological status among HIV-infected patients including young children and those in advanced disease stage. There was no significant difference in clinical and immunological response to ART between anaemic and non anaemic patients in this study.
The pictures used herein depict children, not their HIV serostatus
Abstracts
Pictorial
20
So you want to be a Surgeon?

Keith Baleeta, Ariaka Herbert, Abubaker Sempereza
General Surgery is ou know many of a discipline of surgery us came to medical having a central core of school with the knowledge embracing dream to be able anatomy, physiology, to operate patients; right or metabolism, immunology, wrong? Come with me on this nutrition, pathology, ride and find out if you have wound healing, shock and what it takes to be a surgeon resuscitation, intensive and what surgery is all about. care, and neoplasia, which I know many of you look at are common to all surgical what surgeons do and think ...not all students will be happy with a specialties. to yourselves, Can I possibly surgical career... A general surgeon has do that? Brother/Sister, specialized knowledge and experience related then this article is for you and I first want to tell to the diagnosis, preoperative, operative, and you that there is no way to prove you are a born postoperative management, including the surgeon! Surgeons are trained, not born. Most management of complications, in nine primary importantly, becoming a good surgeon is a lifecomponents of surgery, all of which are essential long process. to the education of a broadly based surgeon: So, does that mean that any medical student can become a surgeon? Well, no. Use of both Alimentary tract hands, and reasonably good mental and physical Abdomen and its contents health are necessary. Most diligent students may Breast, skin, and soft tissue be able to gain a spot in some sort of surgery Head and neck, including trauma, vascular, training program, but not all students will be endocrine, congenital and oncologic disorders happy with a surgical career. First and foremost, particularly, tumors of the skin, salivary you must thrive on being part of the surgical glands, thyroid, parathyroid, and the oral enterprise, and you must absolutely look forward cavity. to opportunities to go to the operating room. Vascular system, excluding the intracranial Additionally, you must be flexible: a surgeons day vessels and heart. is seldom predictable, and surgeons must view Endocrine system, including thyroid, this unpredictability as an enjoyable challenge. parathyroid, adrenal and endocrine pancreas. You must be thinking that yea, maybe surgery Surgical oncology, including coordinated is the one for you, right? Then below are the multimodality management of the cancer specialties in surgery for it is such a wide field. Let patient by screening, surveillance, surgical us look at them one by one. adjunctive therapy, rehabilitation, and followup. General surgery Comprehensive management of trauma,
Careers
22
including musculoskeletal, hand, and head injuries. The responsibility for all phases of care of the injured patient is an essential component of general surgery. Complete care of critically ill patients with underlying surgical conditions, in the emergency room, intensive care unit and trauma/burn units. Neurological surgery Neurological surgery encompasses treatment of adult and pediatric patients with disorders of the nervous system: disorders of the brain, meninges, and skull, and their blood supply, including the extracranial carotid and vertebral arteries; disorders of the pituitary gland, disorders of the spinal cord, and vertebral column, including those which may require treatment by spinal fusion or instrumentation; and disorders of the cranial and spinal nerves throughout their distribution Orthopedic Surgery The scope of orthopedics includes the prevention, investigation, diagnosis, and treatment of disorders and injuries of the musculoskeletal system by non-surgical and surgical methods. Otolaryngology--Head and Neck Surgery An otolaryngologist-head and neck surgeon is a physician who provides comprehensive medical and surgical care of patients with diseases and disorders that affect the ears, the respiratory and upper alimentary systems, and related structures of the head and neck. Aspects of an otolaryngolists job include diagnosis and the medical and/or surgical therapy or prevention for diseases, neoplasms, deformities, disorders and/or injuries of the ears, the respiratory and upper alimentary systems, the face, jaws, and the other head and neck systems. Plastic Surgery Plastic surgery deals with the repair, reconstruction, or replacement of physical defects of form or function involving the skin, musculoskeletal system, cranio and maxillofacial structures, hand, extremities, breast and trunk, and external genitalia. It uses aesthetic surgical principles not only to improve undesirable
qualities of normal structures but in all reconstructive procedures as well. Special knowledge and skill in the design and surgery of grafts, flaps, free tissue transfer and replantation is necessary. Competence in the management of complex wounds, the use of implantable materials, and in tumor surgery is required. Urology Urology is the medical and surgical specialty involving disorders of the genitourinary tract, and the adrenal glands. Urologists are the prime caretakers of the male genito-urinary tract and the female urinary tract and operate on the kidneys, ureters, bladder, prostate, urethra, testes, etc. Furthermore, for many patients with prostate disease, kidney stones (nephrolithiasis), and incontinence, urologists are the primary physicians. Ophthalmology Ophthalmologists are physicians specializing in the comprehensive medical and surgical care of the eyes and vision. Ophthalmologists are the only practitioners medically trained to diagnose and treat all eye and visual problems including vision services (glasses and contacts) and provide treatment and prevention of medical disorders of the eye including surgery. So now, having armed you with all this information, you may feel like raring to join this noble profession. If you feel that you seem to like what you have read, but are not so sure yet, then this last message is for you; I want to assure you that it is extremely rewarding to act and see the impact of your actions on behalf of your patients, and only in surgery can you get that. If that resonates for you, and you find yourself having the time of your life on surgical rotations, a surgical career probably is right for you. Believe you me it is immensely satisfying to completely excise a cancer, convert a cold, bluish ischemic limb to one that is warm and pink, relieve the pain of an intra-abdominal catastrophe, or help a scarred patient gain better appearance and function. Dont miss the bus hitch on the wagon to becoming a surgeon, but first you have to finish your undergraduate studies!
Careers
DISTRIBUTORS: STAR PHARMACEUTICALS LIMITED

Plot: 20/3, Madhvani Building, Opp: Spear House, Jinja Road, Kampala, Uganda Tel (Office) : 0414 232863/ 346851/ 0312 260786;
24 Mbarara University Medical Fax; 0414 231066 Journal
Swine flu;
Bacons revenge?
Morris Maina, MLS II I wish to start by saying enjoying pork will only get you more of Taenia species and nothing like Influenza. So what is this disease with a name that scares the non- Moslem community of Uganda? Why that community? We all know why, save for those whose world does not have places like Wandegeya! So what is this pigs cough? Simple, its a viral disease caused by H1N1 Influenza virus. The name swine comes from the fact that during the 1918 flu pandemic, pigs and humans fell ill concurrently, with pigs having their knownswine flu and for humans-clueless! Its quite rare that this disease has been passed from swine to humans rather, it may appear that the reverse is true. This new strain was initially described as an apparent re-assortment of at least four strains of influenza A virus subtype H1N1. Subsequent analysis suggested it was a re-assortment of just two strains, both found in swine. The symptoms of the 2009 "swine flu" H1N1 virus are similar to those of influenza and of influenzalike illness in general.i.e fever, cough, sore throat, body aches, dyspnea, chest or abdominal pain, sudden dizziness, or confusion In both children and adults, persistent vomiting headache, chills and fatigue. The 2009 outbreak has reported diarrhea and vomiting among the new symptoms. Because these symptoms are not specific to swine flu, a diagnosis of confirmed swine flu requires laboratory testing of a respiratory sample. The two major tests that are being used are the nasopharyngeal (or back of the throat) swab for viral culture, the gold standard, and the indirect evidence test by detection of antibodies to novel H1N1 with PCR studies as per international standards. Diagnosis can be made by sending a specimen, collected during the first five days for analysis. The most common cause of death is respiratory failure. Other causes of death are pneumonia (leading to sepsis), high fever (leading to neurological problems), dehydration (from excessive vomiting and diarrhoea) and electrolyte imbalance. Fatalities are more likely in young children and the elderly. The swine flu is most contagious during the first five days of the illness although some people, most commonly children, can remain contagious for up to ten days. It spreads through open coughing or sneezing, people touching something with the virus on it and then touching their own nose or mouth. Swine flu cannot be spread by pork products, since the virus is not transmitted through food. Recommendations to prevent the spread include frequent washing of hands with soap and water or with alcohol-based hand sanitizers, especially after being out in public, disinfecting household surfaces, which is done effectively with a diluted chlorine bleach solution. Social distancing is another tactic. Treatment includes antiviral drugs if started soon after getting sick make the illness milder and make the patient feel better faster and also prevent serious flu complications. Tamiflu (oseltamivir) or Relenza (zanamivir) are used for the treatment and/or prevention of infection with swine influenza viruses. Education
25
The difficult
patient
Keith Baleeta nless both the doctor and the patient become a problem to each other, no solution is found! said Carl Jung, a renowned physician of the 19th century. I would like to alter this quotation slightly and say that unless the patient becomes a problem to the doctor, no optimum solution is found. If it were not for complaining patients or patients who dont respond to prescribed treatment protocols, we would spend half of our professional lives as if asleep, automatically following protocols to the dot and forget that the patient we deal with is very human! Yes, we need the difficult patient to shake us back to the reality that we are dealing with people, to help us give the patients the utmost care and attention they deserve. Much of the time, we look at these difficult patients as an anathema to be avoided at all costs because it leads away from our comfort zone to the unpredictable and to unknown destinations, but remember that we have control over how we choose to react and can defuse the tight situation and leave both the patient satisfied and happy. Once while assisting in a caesarian section, when we were done with the operation, we rolled the patient onto the trolley her comment phrased in English would read like, You people are rolling me like a cow at a butchery. Probably that was the hospital protocol, but it served to remind me that patients have the right to be told what is coming, for it accords them the respect that they deserve. Here are some other examples of difficult situations that we may encounter; for instance, while on physical exam palpating for the apex beat and auscultating for the heart sounds and
murmurs in a woman, you may come to realize that the lady doesnt feel comfortable and it may do you a lot of good to ask the lady to lift up her breast. Examining a patient in severe pain is another Catch 22 situation; here, it is helpful to remind the patient that you are aware that they are in a lot of pain and that you will try to be as fast as possible.. When dealing with an anxious patient, encourage them to talk about their feelings and give them reassurances. For the angry patient, stay calm and dont get scared; let him express his anger, ask about the reason for his anger and address it in a reasonable way. For the patient who doesnt know the medications s/he is taking, ask the patient for a prescription, while for the crying patient, allow her to express her feelings and wait for her to finish. Then offer her tissue. Showing empathy in your facial expression does the patient a lot of good. A lot can be said about different case scenarios where you interact with different patients but nothing can ever prepare you for all the scenarios you will meet in your clinical practice. Just remember the age old aphorism which says, Firstly, do the patient no harm, then do good for the patient by positive actions. So, when you do meet the difficult patient, be pleased with the patient who asks you tough questions; the patient who doesnt respond to treatment or those who complain too much; or the patient who misunderstands or misquotes
Perspectives
you. Dont give up. Stick with your patient, listen to what he is saying and not saying and when you have understood your patient a bit more, negotiate, cajole, or even argue with your patient
but dont bully or blackmail her. Remember, seek first to understand your patient then to be understood. By this process, you may end up with a truly satisfied patient.
Ethical Medicine
Martin Balaba
students need to develop new ways of interacting with patients... its a challenge
Requiring students to immerse themselves completely in medical coursework risks disconnecting them from the personal and ethical aspects of doctoring and such strictly scientific thinking is insufficient for grappling with modern ethical dilemmas. For these reasons, aspiring physicians need to develop new ways of thinking about and interacting with patients. Training in ethics that takes narrative literature as its primary subject is one method of accomplishing this. Although training in ethics is currently provided by medical schools, this training relies heavily on an abstract, philosophical view of ethics. Although the conceptual clarity provided by a traditional ethics course can be valuable, theorizing about ethics contributes little to the understanding of everyday human experience or to preparing medical students for the multifarious ethical dilemmas they will face as physicians. A true foundation in ethics must be predicated on an understanding of human behavior that reflects a wide array of relationships and readily adapts to various perspectives, for this is what is required to develop empathy. Ethics courses drawing on narrative literature can better help students prepare for ethical dilemmas precisely because such literature attaches its readers so forcefully to the concrete and varied would of human events.
It does not follow that readers, including medical professionals, must relinquish all moral principles, as is the case with situational ethics, in which decisions about ethical choices are made on the basis of intuition ad are entirely relative to the circumstances in which they arise. Such an extremely relativistic stance would have as little benefit for the patient or physician as would a dogmatically absolutist one. Fortunately, the incorporation of narrative literature into the study of ethics, while serving as a corrective to the later stance, need not lead to the former. But it can give us something that is lacking in the traditional philosophical study of ethics-namely, a deeper understanding of human nature that can serve as a foundation for ethical reasoning and allow greater flexibility in the application of moral principles.
27
Perspectives
ne of the greatest challenges facing medical students today, apart from absorbing volumes of technical information and learning habits of scientific thought, is that of remaining empathetic to the needs of patients in the face of all this rigorous training.
The act of reading narrative literature is uniquely suited to the development of what might be called flexible ethical thinking. To grasp the development of character, to tangle with heightening moral crises, and to engage oneself with the story not as one's own but nevertheless as something recognizable and worthy of attention, readers must use their moral imagination. Giving oneself over to the ethical conflicts in a story requires the abandonment of strictly absolute, inviolate sets of moral principles. Reading literature also demands that the reader adopt another person's point of view -that of the narrator or a character in a storyand thus requires the ability to depart from one's personal ethical stance and examine moral issues from new perspectives.
28
MEFTAL- P suspension
INFECTIOUS AGENTS
(exogenous pyrogens)
UNIQUE DUAL BLOCKADE ANTI PROSTAGLANDIN ACTION ACTS BOTH AT PERIPHERAL AND CENTRAL LEVEL
Stimulate chemotaxis
Inflammatory cells
(endogenous pyrogens)
Liberate
Liberate
MEFTAL - P
PGE2
Pyogenic cytokines
Stimulate
PGE synthesized in brain
Stimulate MEFTAL - P
ANTERIOR HYPOTHALAMUS
FEVER
ASSURED, SUSTAINED AND BETTER RELEIF FROM PAIN AND FEVER
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M.U.S.TS
Angela Nasazi & Joanitah Atuhaire
ZAIN BRAINS!
L-R: Allan, Joseph, Dube, Alex
is a televised academic competition for students of African universities, sponsored by Zain. Season 3 brought together 32 universities from Ghana, Kenya, Malawi, Nigeria, Sierra Leone, Tanzania, Uganda and Zambia. Mbarara University was among the universities that participated and received $15,000 as a university grant and $1,500 per player. The MUMJ brings you the season 3 contestants: Alex Tuhairwe Med II, Allan Kasibante Pharm II, Dube Alice Sithabiso Med V, and Joseph Oweta Pharm II. MUMJ: Tell us about yourselves. Alex: I am a self-styled all-round student, a staunch Chelsea fan and also a writer. I have written a number of fictional works dealing with social life. I havent published my works, though. Allan: I love the arts, reading books, T.V, movies and playing video games. I am basically an indoors person. Dube: (Tells us her ten plus names) I feel that one paragraph is not sufficient to describe me. Anyway, I am a Zimbabwean student whos been integrated into the Ugandan
The Zain Africa Challenge
education system. I am very hard working, determined, creative, love doing things no one has done, love my friends and my family and travelling. Ive been to Kenya, Tanzania, Uganda, Zimbabwe, Botswana, South Africa, Namibia, Rwanda, Ive landed in Malawi for five minutes and will soon be travelling to Nigeria. Joseph: I am simple, quiet and disciplined. I like playing rugby, sleeping and eating. MUMJ: What was the ZAC experience like? Allan: Lots of fun! The West Africans were the most interesting especially UNILAG students, they still keep in touch! A few people were aggressive, though. The sleeping arrangements were cozy. We had a games room and played video games in our spare time. Some times the food was off the hook but other times it was too exotic for me. Dube: I loved meeting Navio! Ok, seriously, it was nice to meet the fresh young brains of people from other countries. Here in Uganda were underexposed and tend to think that the world ends at our borders. The experience was mind-broadening. I
People
had a Jacuzzi in my room; the pre and post challenge dinners were glamorous. We met great motivational speakers like Peter Sematimba. We made good friends, dressed up fancy, coined new slang (zone- to utterly defeat an opponent) and even came up with a motivational dance, the Mindanao dance. Joseph: Well, there was a lot of game tension but that didnt stop me from appreciating the pretty Zambian girls. The gym was great! I found West Africans self imposing. That food ah-ahaddictive! I was worried about missing school, though. Alex: It was cool! I Interacted with different kinds of people, increased my friends on facebook, and participated in recreational activities. The imperial royale has a nice swimming pool. I also enjoyed playing pool. MUMJ: In your opinion, what gave you the edge over other participants, both individually and as a team, right from M.U.S.T up to the international festival? Dube:Individually, Id have to say it was luck. But as a team, we were very strong because each of us had a specialty and we mastered our categories. We came first in the incountry qualifying tournament either because we were really strong or the other teams were really weak. Joseph: Being mysterious imposed fear in our opponents. My fro gave me an edgy aura. The adrenaline rush gives you good instinct. At M.U.S.T level, there were few people who tried so the competition wasnt stiff. Alex: I knew stuff no one else knew so thats how I got onto the team. (Dube interjects: This guy knows rocket science! The real rocket science.) We referred to ourselves as the Spartans (from the film The 300 Spartans). Thats how strong we were. Allan: Personally, I dont know how I made it, but as a team, it has to be because of the coach, Patience Muwanguzi. She was encouraging. Pesh was a friend and that
went a long way in favoring our success. MUMJ: How far did you go in the game? All: At the in-country qualifiers, we were the best out of 13 universities. In the international festival, we went up to quarter-finals, and we were among the top eight overall out of 32 universities. MUMJ: Wow, that was a brilliant performance! What challenges did you face? Joseph: The tension and nerves from the competition made me develop ulcers, thankfully, those are dealt with now. During school, dividing time between training and classes was a bit hard. Alex: I didnt appreciate the criterion used in pitting universities against each other. It was not fair. Allan: The training sessions are very difficult; sometimes you just have to rely on instinct. Dube:Ugandan universities dont stick together. The Nigerians were always looking out or each other and every win was celebrated as a country win. Our team strategy which was to limit interaction with other teams so they wouldnt know our categories worked against me because Im a naturally interactive person. MUMJ: You were an all-medical team, how did this impact on your performance? All: Negatively, what is considered basic knowledge in arts was Greek to us, economics in particular. But on a positive note, our opponents thought the team was not all round and underestimated us so we pulled out a few surprises for them. MUMJ: Youre now stars of international fame; how are you using this new-found status? All: Are we? Theres really no fame, and if there is, we are not actively using it. MUMJ: What books are you currently reading? Dube:An autobiography, The Story of My
People
Life by Joshua Nkomo, the former Vice President of Zimbabwe. It is actually a controversial book that has now been banned. Joseph: Body Language by Sir Alan Ayckbourn. Alex: Journey to the Centre of the Earth by Jules Verne. Allan: Half of a Yellow Sun by Chimamanda Ngozi Adichie MUMJ: What would you say to a student that wanted to give this a try? Joseph: Its not about how much you know, its about how much you want to win it. Alex: Opportunity comes once in a lifetime. Never be afraid to take it. Allan: Dont be intimidated by age, size, sex or even anything! And the money is a good motivational factor. Dube:Go for it!! Its the best decision you could ever make. It changes your life! Not only do you get to increase your confidence but you also increase your friends. Go Africa! Go Zain! MUMJ: Now, honestly, how did you amass all that knowledge? Alex: I am a naturally curious person. In the quest for knowledge, I ended up reading and knowing more. Allan: The knowledge is acquired over a lifetime; you dont amass it in one day. Ive always read
classics and watched lots of movies. The knowledge is acquired passively in everyday life. Dube: Ive been blessed to attend good schools; Whitestone primary school in Bulawayo and Dominican Convent High School. These are the kinds of schools where you learn horse riding, ballet and classical music. Joseph: T.V! But then there was also the prior preparation we made while training. MUMJ: And, of course, the one million dollar question: What did you do with the dollars? Allan: I used some for personal needs and pocket money then banked the rest. Dube:I bought a laptop, an expensive gift for my best friend, and lots of pizza. I sent some to my little brothers back in Zimbabwe, you know theres an economic crisis. Oh, and I banked the rest. Joseph: I bought a laptop, changed my wardrobe and cut my afro. Alex: I put almost all of it in the bank. MUMJ: What are your final words to the MUMJ readership? Dube:Always do what you like, and the money will flow. Joseph: Always try to be wiser than the people around you, but dont let them know it! Alex: Ask not what your university has done for you but what you can do for it. Allan: You should always maintain these three principles: Be yourself, Never give up, Always do your best. People
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Veg. vs Non-Veg.
Is being vegan the healthiest option?
Singh Parminder each day to maintain normal red cell maturation is only 1-3 micrograms.It can be obtained from yeast products though meat is the best source. There are different types of vegetarians: Vegans-avoid all foods of animal origin. Ovo-Vegetarian - Excludes all animal flesh and milk but consumes eggs Lacto-Vegetarian - Excludes all animal flesh and eggs but consumes milk Lacto-Ovo Vegetarian - Avoids all animal flesh but consumes eggs and milk Pesco-Vegetarian - Avoids red meat and fowl but consumes fish and seafood Semi or Partial-Vegetarian - Uses some milk products, eggs, poultry, and fish, but consumes primarily plant based foods. Where do you belong? Today, most medical professionals are emphasizing healthier living focused on diet as away to overcome sickness. So let us look at various risks that come along with vegan or non-vegetarian life styles. Risks of vegetarian diet Vitamin B12 deficiency. Vitamin B12 is found in only foods of animal origin,there being no plant sources of this vitamin T his means that vegans are at a risk of develop in Vitamin B12 deficiency which can be very serious, leading to anemia, irreversible damage to the nervous system including depression.T he minimum amount of vitamin B12 required
Health
Iron deficiency Vegetarian diets have got a lower amount and bioavailability of iron. Iron in foods is present in two forms: heme iron in meat ,poultry and fish and non heme iron present in a variety of animal and plant foods. The absorption of heme iron is much greater than that of non heme iron in plant based foods. Zinc deficiency Animal foods such as meat, poultry and fish are major sources of bioavailable zinc. The bioavailability of zinc from vegetarian diets may also be low owing to the prescence of phytates and other substances in plant foods that inhibit zinc absorption. The consequences of zinc deficiency include growth retardation, male hypogonadism, changes in taste acuity, delayed wound healing, decreased immunity and impaired cognitive functions. Infertility Researchers at kings college London showed that a compound in soya called genistein sabotages sperm as it swims towards the egg. Studies suggest vegetarians eat large amounts of soya because it contains a high protein content. Vegan women who take large amounts of soya risk infertility. Risks of non-vegetarian diet Rheumatoid arthritis Rheumatoid arthritis (RA) is a chronic autoimmune disease that causes inflammation
and deformity of the joints. Other problems throughout the body (systemic problems) may also develop. Results of a study carried out by British researchers, published in the December 2004 issue of Arthritis & Rheumatism indicates a high level of red meat consumption as an independent risk factor for inflammatory arthritis. It may be that the high collagen content of meat leads to collagen sensitization and consequent production of anticollagen antibodies, most likely in a subgroup of susceptible individuals," the authors noted. Alzheimers disease Alzheimers is basically a neuron degenerative disease,most common cause of dementia. Research shows that diets high in animal fats have the highest correlation with Alzheimers disease prevalence People who consume large amounts of saturated fats (like those in meat and diary products) have twice the risk of developing Alzheimers disease. Saturated fats are known to increase blood cholesterol levels. In a study, investigators found a correlation between increased cholesterol levels and increase in the number of plaques and tangles
in the brain and these are the two main characteristics of Alzheimers disease. Cancer According to an article published at www. cancerproject.com, Havard studies showed that daily meat eaters have approximately three times the colon cancer risk compared to those who rarely eat meat. Meat contains animal protein and saturated fat which increases hormone production thus increasing risks of hormone related cancers. In some cases carcinogenic compounds such as polycyclic aromatic hydrocarbons and heterocyclic amines are formed during processing or cooking of food. This has been associated with increased risk of breast, colon and stomach cancer. Gall stones Gallstones are caused by an alteration in the chemical composition of bile. A high fat and low fibre (meat) diet is among the factors influencing gall stone formation. This may cause severe biliary pain and also lead to other complications like pancreatitis, gastric ileus, proclein gall bladder, cancer of the gall bladder.
Book Review; Take the Risk

You can find our cultures obsession with avoiding risk everywhere, but is ducking risk the most productive way for us to live? Surgeon and author Dr. Ben Carson, who faces risk on a daily basis, offers an inspiring message on how accepting risk can lead us to a higher purpose. Simply put; No risk, pay the cost. Know risk, reap the rewards. In our risk-avoidance culture, we place a high premium on safety. We insure our vacations. We check crash tests on cars. We extend the warranties on our appliances. But by insulating ourselves from the unknownthe risks of lifewe miss the great adventure of living our lives to their full potential. Ben Carson spent his childhood as an at-risk child on the streets of Detroit, and today he takes daily risks in performing complex surgeries
on the brain and the spinal cord. Now, offering inspiring personal examples, Dr. Carson invites us to embrace risk in our own lives. From a man whose life dramatically portrays the connection between great risks and greater successes, here are insights that will help you dispel your fear of risk so you can dream big, aim high, move with confidence, and reap rewards youve never imagined. By avoiding risk, are you also avoiding the full potential of your life? In this book Dr. Ben Carson shares among others the story of the Bijani sistersconjoined twinsshared part of a skull, brain tissue, and crucial blood flow. One or both of them could die during the operation. But the women wanted separate lives. And they were willing to accept the risk to reach the goal, even against the advice of their doctors In his compelling new book, he examines our safety-at-all-costs culture and the meaning of risk and security in our lives. In our 21st-century world, we insulate ourselves with safety. We insure everything from vacations to cell phones. We go on low-cholesterol diets and avoid investing in any thing because its risky. But in the end, everyone faces risk, like the Bijani twins did with their brave decision. Even if our choices are not so dramatic or the outcome so heartbreaking, what does it mean if we back away instead of move forward? Have we so muffled our hearts and minds that we fail to reach for all that life can offer usand all that we can offer life? Take the Risk guides the reader through an examination of risk, including: A short review of risk-taking in history. An assessment of the real costs and rewards of risk. Learning how to assess and accept risks. Understanding how risk reveals the purpose of your lives.
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Health
Personalities Demystified
Denise Kavuma
The personalities we posses today can be affected by the experiences we have

Ever wondered what kind of personality you have? Maybe you have a friend who cannot seem to control the mood swings, anger and nightmares they have. Or perhaps youre just interested in the way nurture can affect our nature. Well, if you have ever been interested in anyone of these topics in your life, then this will benefit you. The first step of this journey is the understanding of personalities. We all have one or two within us. Psychology basically points out four personalities or temperaments, a theory that has its roots in the ancient four humors. It was believed that certain human moods, emotions and behaviors were caused by body fluids (called humors): blood, yellow bile, black bile and phlegm. After many debates between psychiatrists (as always), four different words were used to describe the four temperaments. Sanguine was used for the light-hearted, fun loving, social person who is spontaneous and has leadership skills coupled with great confidence. But they could also be cocky and indulgent. The person many times tends to be idealistic, impulsive, with a short attention span. Choleric described a doer. Someone with a lot of ambition, energy and passion which they try to instil in others. Theyre bad tempered and like to dominate others. Melancholic are those who are thoughtful and are often very kind and considerate. They are
Perspectives
usually creative in poetry and art- but are usually cynical. Often, theyre perfectionists and are their own strongest critic with a tendency to prefer solitude. Phlegmatic was used for the self-confident, lazy, curious and highly observant individual. Phlegmatics have many friends and is a good diplomat with reliability and compassion as major attributes. People are usually a blend of two or more temperaments; one can be Mel-Chlor or SanPhleg or San-chlor and so on. The personalities that we posses today can also be affected by the experiences we had as young children. Many of us have seen examples of this as some people who were sexually abused as children end up being reserved, insecure and have perfectionist traits as adults. This is not surprising since the human nature always tries to overcome whatever has injured it. It is very interesting to know that children who have undergone any kind of abuse, whether its emotional, physical or even sexual, can develop into any of the four personalities mentioned above. The side effects tend to be similar in
These children tend to dissociate themselves experiencereflects from others, under the belief that they are filthy, on how they view unworthy and unfit to humanity be with other children, but later exhibit signs of extreme anger to either themselves, adults or to the opposite sex. As adults, the personalities these people take on reflect how they feel about themselves. It should not be assumed, however, that anyone with these personalities was abused as a child.
the joy children
It should be remembered that children can also end up being any one of the temperements mentioned above. The cholerics can turn out to be so due to the inspiring control of situations they saw their parents exhibit. The sanguines could have become so because for the encouragement they received to be themselves. The phlegmatics also could have grown up in a calm environment. The joy children experience in their childhoods, the freedom they feel and the love they receive reflects greatly on how they view humanity. This is not to say that if any negative experience were to occur, they would be traumatized for life; On the contrary, these experiences can teach them how to handle the negative sides of life. Touch is also an area the children should get used to as early as possible. It is used to show love, compassion, empathy and many other emotions, so children should be touched as early as possible in life. However, the touch should not be sexual or abusive in any way, for if it is, the child grows up loathing the human touch and feeling revulsion at its very thought. Well, now you have a better understanding of the temperaments and causes of personality failures in adults. You can also judge for yourself what kind of personality you have; Im melancholicphlegmatic, what are you?
Some could take on the choleric character if they felt helpless as children, so they have a need to take control of their lives so that none may take advantage of them. The sanguine character has been adopted by some as a means of deceiving others so as not to show the vulnerability the victim feels within. They tend to smile and have perfected the art of bottling things up. The melancholy personality is taken on by many of these victims as well, for it gives them the much needed privacy after their violation. More serious effects can result from these experiences as well like Post Traumatic Stress Disorder (PTSD).
Perspectives
all the cases though. The harm could be short term or long term depending on the intensity of the trauma and the strength of the child as well. The effects include depression which can lead to suicidal thoughts, anxiety, eating disorders, inferiority complexes, sexualized behavior, and substance abuse like alcoholism or even criminal mindsets.
Treatment of these effects can take months or even years and still the person may never fully recover. As depressing as these thoughts may be, they are realistic as well. However, happy children make for happy adults, and hence healthier men and women, both mentally and physically. It is essential when dealing with people that you accept who they have presented themselves as, before you try to pry any secrets from them. The veils they have used to cover themselves with can only be removed with patience and trust; this is the secret of counselors. If any of your friends exhibits the signs mentioned above, dont be rash, it may not be what you think. Take time, however, for we all need understanding friends who wont judge us by just the physical.
Cusomize your t
Joanitah Atuhaire
frag rance
Walk into any cosmetics store and youll agree with me that perfume prices are not exactly the most pocket friendly on the planet. You could part with no less than Ushs 200,000 for a genuine bottle of a designer perfume like Dolce and Gabbana or Chanel. Considering you will be sharing the scent with the few other people who can afford it, its really not worth it.
Novelty
36
ith a few tips from the pharmacognosy laboratory, you can make your personalized fragrance today at a lower cost and with just a few ingredients. Heres how: Ingredients The basic ingredients that go into a perfume, in their recommended proportions, are: essential oil (15% to 30%), ethanol (70% to 80%), and distilled water (5%). Essential oils correspond to a mixture of hemiterpenoids, monoterpenoids and some sesquiterpenoids that, in combination,
resemble oil. The mixture is highly volatile when is exposed to air at room temperature so they are also called ethereal oils. The odor and taste of an essential oil is determined by the main chemical constituent of the mixture. Sources Essential oils are secreted in special structures such as ducts, cell, schizogenous or lysigenous glands, trichomes and others. They are present in any part of a plant material and can be found in the bark of cinnamon and cascarilla, the flowers rose, mimosa, scented geranium, and jasmine
as well as the blossoms of citrus trees. Fruits such as vanilla, oranges, lemons, and limes. Leaves and twigs from lemon grass (omuteete-local Runyankole name), lavender, violets, rosemary, and citrus. Leaves can bring a "green" smell to perfumes; examples of this include tomato leaf. Resins(sap) from frankincense/olibanum, myrrh, Peru balsam, and gum benzoin are also valuable sources of perfume. Pine and fir resins are a particularly valued source of terpenes used in the organic synthesis of many other synthetic or naturally occurring aromatic compounds. Roots, rhizomes and bulbs of the iris flower and ginger. Seeds such as cocoa bean, carrot seed, coriander, and nutmeg. Woods such as pine, cedar, birch, and sandalwood. Many of these can be obtained from botanical gardens or in home backyard flower gardens. Ethanol can be obtained from a chemist
into the flask/kettle/drum and provide heat. Add few glass beads into the flask to prevent bumping. Heat gently, making sure that the water in the flask is maintained at gentle boil. Continue heating for two hours or until no more volatile oil is collected. What the fragrance experts dont tell you There are three different notes(scents) in a perfume. The first is base notes, which stay longest on your skin. Base notes include oils from vanilla, cinnamon, and sandalwood. The second of the notes are middle notes, which add to the scent but do not last as long as the base notes. These oils include lemon grass and geranium. The last of the notes are the top notes which give the perfume the distinct fragrance you smell when youre shopping for perfume. The top notes include oils such as rose, lavender, jasmine, bergamot and orchard. When making a perfume of more than one scent, add the base note oil first. Follow the base note with the middle note oil, and finish with the top note oil. To start, I suggest mixing cup of ethanol with 5 drops of the essential fragrance or oil of your choice as distilled above. Depending on how strong you want the perfume, you can let the mixture stand for as little as 48 hours all the way to a month. The longer it stands, the stronger it will be. After your perfume has sat for your preferred time, add 2 tablespoons of the diluted water. If the perfume is too strong, you can add more water to get your desired scent strength. To make your scent last longer, add a tablespoon of glycerine to your perfume mixture. Glycerine is a neutral, colorless, thick liquid that can be easily obtained from the nearest supermarket or cosmetic shop. When added to water and alcohol, glycerin remains liquid and helps the other ingredients dissolve faster and better. Store your perfume in a small glass or plastic container. You can buy a container with a sprayer or use an empty bottle of old perfume. Now you can wear your own perfume, named after you!
You can buy a container with a sprayer or use an empty bottle of old perfume. Now you can wear your own perfume, named after you!
shop. Alternatively, you could use pure grain alcohol like vodka. Preparation Once you have identified what your essential oil source is going to be, youre ready to start. Essential oils can be extracted in a variety of ways, including cold expression, extraction and steam distillation. I highly recommend the steam distillation because it is simple to set up and will give high yields in a relatively short time. You will need a source of heat, a flat bottomed flask, a lie-big condenser, a funnel for separation of layers, and a container for collection. Alternatively, you could improvise with a small drum/kettle connected to a tube/pipe placed in a basin of cold water to condense the oil vapours, leading into a collection container. Assemble the volatile oil apparatus and weigh about 10g to 100g of fresh plant material together with about 450 ml of water. Introduce them
Novelty
Village
Places
38
Dungeon of a lace Pa
Balaba Martin It definitely goes down as one of the 7 wonders of M.U.S.T. just a stone-throw away from the main university lies the famous hub; full of all inglorious acts but still a darling to almost all campusers. The gulley road welcoming you to this bizarre place is a monument treasured by village guys. Being so gulley and bumpy, the road has thrown many potential Uncle Sams into parking their injury prone wheels a distance away from their poaching grounds, making the competition quite free and fair, though the ultimate losers are just a sheer issue of common sense-the broke campus jamas. Filled with all moral corruption and filth, walking down village, ones eyes are met by the best structure in the area; whose purpose does not co-relate to its beauty. This is the place where those who carelessly colour (call it having sex) more often get medical and psychiatric uplifting after being swallowed by the infamous deadly worm. The presence of this TASO building hasnt derailed people from their Night Festivals, depleting MPP offices of all rubber supplies, signaling the great spirit of generosity amongst villagers. While in a hurry to catch a lecture on a Monday morning, the entire road is decorated by rubber flowers of all shapes, sizes and colours.
Festivity starts on Friday night as most people head to V.E Community Church to refresh their souls. I sincerely pity my fellow men because the ladies put on provocative garb on such nights, causing compromised cardiovascular blood flow, depleting them of all self-control fibers, evoking unholy thoughts of completing the jigsaw puzzle they have partially sighted. The hub provides a comfort zone for those in financially perilous times with the available wooden Hilton hotels offering very low priced food for as low as 800/- for beef and 1000/- for chicken! Chefs like Mama Gadaffi are heroes to many people. Rolexes, cassava and chips are such a great relief from Nalongos neonatal food portions and Managers monotony. Many call it the Crowned City of Tinea Soleum. A delicacy sold in 3 different places at very competitive prices has attracted the unquenchable appetites of both guys and chicks. The greatest amount of alcohol consumed in Mbarara Municipality is in this Village Its endowed with talented students with incredible levels of alcohol dehydrogenase, making people like Jukira survive the credit crunch. From beer, kasese, malwa and bwakata; drinking goes on all week long, from morning to morning. You ought not be in the U.S. to know what the
Grand Canyon looks like, coz hey; Village has got a Grand Canyon too. Well, it aint up to that of U.S., but your aerial view of the gracefully flowing Rwizi, embedded in greenery and tranquility, spiced by chirrping birds is so beautiful a scene, dubbing it the Lovers Palace. Its not all bliss and glamour getting to Rwizi. Huddles to this Lovers Palace are injurious to the intentions of many. Right from the gulley, steep, sloppy, narrow road to the amazing Olympic size swimming pool; sewerage pools that look beautiful from afar yet are far from any kind of beauty. Many people contemplate retreat at this point while the macho ones go on. I just cannot imagine going for an intimate picnic to Rwizi and I have to go past these sewerage pools. Well, love is the only form of stupidity coated in sweetness and pleasure that we dont realize how stupid we are acting till we get out of it. (not my words).
Its not all bliss and glamour getting to Rwizi. Huddles to this Lovers Palace are injurious to the intentions of many.
Its in village where people get so involved in peoples lives. Gossip
is an aphrodisiac to people; they try as hard as they can to find out who is Colouring with whom, what you have in your closet, financial statuses and the guys are always on the look out for the best babes about the place. People get baptized in alcohol in the infamous drinkups and let me say this; guys are so horny. one wonders if they take Vitamin-x (call it Viagra). They barely want no skirt to by-pass them and their game is very pathetic. What makes it a real village are the uncountable hostels with the likes of Triple-B and the never to be completed Mark residence. Every single day one gets to know of a new hostel; some very much like makeshift houses, similar to poultry houses, rentals like B. Brother amongst others. You need a duration of the entire MBCh.B course to take a complete census of these hostels because even Jukiros hut might soon become a hostel in the next academic intake. Every cloud has a silver lining though. Village has got it all but it all depends on what you take from this Dungeon of a Palace.
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Places
Breakfast with the Chancellor!

Interviewed by Joanitah Atuhaire MUMJ: What is your educational background? Chancellor: I started school in Kinyasano primary school in Rukungiri (before you were born, Im sure-1959!) then I went to Kigezi High School and then to Kings College Budo for my A-levels. I left Budo for makerere to pursue MBChB. I am a graduate of Royal College of physicians and surgeons of Glasgow, Im a fellow of the royal college of physicians of Ireland, I am a fellow of the royal college of physicians of Edinborough, UK, I hold two doctor of Science degrees (honorary) form Mbarara (HC) and Trinity college Dublin in Ireland , Im a fellow of the academy of Science of the developing countries , Im a fellow of the Uganda academy of Science and recently, I was elected a fellow of the academy of Science of Africa. I havent got the official letter yet, though. (Starts looking through papers.) MUMJ: Wow! Its humbling to be in the presence of such an accomplished scholar, but please do tell, what do you mean by fellow? Chancellor: Being elected a fellow means you have excelled in your field. It is equivalent to top professional excellence. Some of them are exclusive clubs. MUMJ: So tell us, apart from conferring degrees, what is being chancellor all about? Chancellor: youre a titular head of an institution.
People
You dont run the day to day activities of the institution; neither do you have executive powers but you appoint on recommendation of the university council. You represent the university to the government and certain international bodies and you confer degrees and diplomas of the university. The position is held for a period of four years. MUMJ: What projects are you currently undertaking? Chancellor: we are currently trying to extend the university to Kihumuro. This is project thats been a top priority for a long time to me. However, it cant be done by the chancellor alone. It requires full cooperation and participation of the council, administration, current students. MUMJ: Really? What power do students have? Chancellor: Yes! Students have power. Say WE WANT KIHUMURO!! (Laughs.) You see, students will become alumni, and later, parents of students at M.U.S.T. So they have power and
interest. From the V.C to the first year, all of us can join hands to make Kihumuro a reality. MUMJ: Why is Kihumuro so vital? Chancellor: M.U.S.T has got the biggest potential of all universities in the region. Easy access to information means we can now be at par with other universities in the world. To do this, you need infrastructure which requires space (land). Kihumuro provides opportunity to harness the potential of the university. You actually came to interview me on a historical day. Today, 20th November, the presidents of the five EAC countries are signing a charter that will make Tanzania, Kenya, Uganda, Rwanda and Burundi one economic block where labour and expertise can move freely from country to country. M.U.S.T has got the capacity to train the kind of young people needed in this EAC and it should help Ugandans not to lose out. MUMJ: What is your typical day like? Chancellor: Very busy!! (Laughs). Look at my desk, see how neat it is? It will be a mess by the end of the day. I arrive here at 8:00 am and do mostly administrative work; I am briefed on the progress in research by the project leaders; go for research developments, then head to the clinic to see some complicated referred patient cases. I have my lunch here in office as I work (attending to international communication). Some of the day, I go to give talks or lectures, and by late afternoon, Im receiving staff with various issues ranging from mentoring them in their career development to addressing work issues. Almost everyday I have to be writing a scientific paper or editing one of the many books that Im writing. I may also attend meetings abroad. I go to supervise the building of the new JCRC complex
in Lubowa thrice a week. Usually, by 9:00 pm Im home trying to relax. MUMJ: Aha! So you do have free time! How do you spend it? Chancellor: I like taking walks and listening to music. My favourite performer of all time is Nat King Cole. (Swivels around in his chair) Lee Armstrong too, hes got really incredible jazz, then Ray Charles and Stevie Wonder. I also like reading widely. MUMJ: So what books are you currently reading? Chancellor: Im reading Clinton, an autobiography by Bill Clinton. MUMJ: Tell us a little about your family. Chancellor: Im a widower; I lost my wife in 2000. I have five children who include a doctor, an accountant, an economist, a lawyer and a science student. MUMJ: What are your future plans? Chancellor: (Laughs heartily). Well, there are many things Ive wanted to do in life but I never get around to actually doing them. I intend to continue writing to put my humble experience on record, Id also like to do a little farming, although Im not sure I know how to do it. My ancient hobby is fine art. I could go back to it. Painting and sculpting were some of my very best subjects at A-level. MUMJ: Whats your final word to the MUMJ readership? Chancellor: In M.U.S.T, we have got a great institution. I am a full believer in its potential. What is lacking now is that it has not realized its full potential. Lets all come together to support an institution that I believe will be truly great in the near future. MUMJ: Thank you for your time. Chancellor: Oh, not at all. People
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A degree alone is not enough!

Mercy Munduru Doing Human medicine in Uganda takes five years. Its a double degree consisting of medicine and surgery so that means that it is two courses in one. That alone already spells lots of work!. In the five years a lot is taught in class, the wards, the community and a student is expected to know most of it. First and Second year usually brings with it biochemistry, anatomy and many other subjects. Biochemistry is usually a very tough bone and many teeth are broken while trying to crash it. When you think you have escaped the biochemistry and all the anatomy there is to know and cram, in jets third year with another level of stress altogether. Here, a student is worked mentally, physically, socially and even financially. Its a trying time for many medical students. While in third year, you console yourself with the prospect of a fourth year that will be full of free periods, trips to Kampala and parties but alas! when you get there, there is research to contend with and that just spoils the fun. Onwards you say, you figure that when you get to fiftth year, you will be in the final year and you can just smell being called Doctor so and
of Medicine
2010 Faculty Graduands
so but then there is a lot expected from you. You are a senior clerk and you are expected to know it all. Forget 3rd year when you could be excused for not knowing. In fifth year, you have to know, after all, you are going to be a doctor in a few months. These are some of the challenges of medical school. The work load is big and you have to pass. While your friends doing other courses have three course units a semester, you have eight very bulky ones. This causes many medical students to focus on the academic bit of medical school which is good but then they leave university as people who have a lot of medical data, a degree and nothing else much to show for five years of medical school. They dont join any groups, clubs, associations or play sports. They dont do any co curricular activities and rarely go out. They dont know much apart from what is found in their textbooksGrays Anatomy or Bailey and Loves Surgery Well, as we study to be future doctors, lets not only enrich our lives with medical data but also develop other parts of our life like the social, spiritual and physical.
Graduation
Medicine / MB Ch.B Reg No. 2004/MBR/011 2004/MBR/043/PS 2004/MBR/044/PS 2004/MBR/046/PS 2004/MBR/026 2004/MBR/047/PS 2004/MBR/048/PS 2004/MBR/007 2004/MBR/037 2004/MBR/022 2004/MBR/019 2004/MBR/027 2004/MBR/028 2004/MBR/002 2004/MBR/017 2004/MBR/003 2004/MBR/068/PS 2004/MBR/023 2004MBR/006 2004/MBR/004 2004/MBR/051/PS 2004/MBR/050/PS 2004/MBR/036 2004/MBR/033 2004/MBR/029 2004/MBR/025 2004/MBR/030 2004/MBR/066/PS 2004/MBR/015 2004/MBR/016 2004/MBR/005 2004/MBR/055/PS 2004/MBR/013 Name Abdallah Amir Adenya Brian Ajok Juliet (ms) Aloyo Gladys Onguti (ms) Amandu Godfrey Atuhe David Martin Beyagira Racheal (ms) Businge Stephen Bwanika John Mark Chakura Andrew Gingo Stephen Haguma Priscilla(ms) Iceanyi Patrick A Ictho Jerry Kaduyu Paul Kagwa K Sadic Kangethe Patrick Kiruki Kangwagye Peter Kasendwa Patrick Katungye Richard V Kiconco Sheilla (ms) Kilyewala Cathy (ms) Kirunda Samuel Kisinde Stanley Kiyimba Daniel Kyohere Mary (ms) Lema Felix Adriko Lubega Abubaker Lubega Paul Magera Steven Makhoba Anthony Maleni Stella (ms) Mazzi Michael
2004/MBR/056/PS 2004/MBR/067/PS 2004/MBR/008 2004/MBR/014 2004/MBR/041 2004/MBR/057/PS 2004/MBR/035 2004/MBR/020 2004/MBR/032 2004/MBR/031 2004/MBR/059/PS 2004/MBR/001 2004/MBR/024 2004/MBR/062/PS 2004/MBR/064/PS 2004/MBR/021 2004/MBR/009 2005/MBR/072/PS 2003/MBR/042 Pharmacy Reg No 2005/PHA/002/PS 2005/PHA/021/PS 2005/PHA/015/PS 2005/PHA/019/PS 2005/PHA/007/PS 2005/PHA/011/PS 2005/PHA/013/PS 2005/PHA/017/PS 2005/PHA/018/PS 2005/PHA/009/PS 2005/PHA/008/PS 2004/PHA/009/PS Nursing Reg No 2004/BNS/009/PS 2005/BNS/010/PS 2005/BNS/001 2005/BNS/025/PS 2005/BNS/002 2005/BNS/015/PS 2005/BNS/003 2005/BNS/016/PS 2005/BNS/026/PS 2005/BNS/005 2005/BNS/006 2005/BNS/008 2007/BNC/001/PS 2007/BNC/003/PS 2007/BNC/004/PS 2007/BNC/005/PS
Mugisha Dale Mutabiirwa Mugisha Jacob Ross Mukasa Wilson Mutumba Robert Mwenda Stephen Mwesigwa Mutakooha Marvin Nabukeera Damalie (ms) Najjemba Aminah (ms) Namala Angella C (ms) Nanjula Lydia (ms) Nyantaro Mary (ms) Odongo Leo Ojuka Andrew Rukundo B Gerald Taban Moses Kenyi Tambula May Nagayi (ms) Tino Susan (ms) Tusiime Susan (ms) Mapunda Bosco
2007/BNC/006/PS 2007/BNC/007/PS 2007/BNC/008/PS 2007/BNC/009/PS 2007/BNC/013/PS 2007/BNC/014/PS 2007/BNC/015/PS 2007/BNC/016/PS 2007/BNC/017/PS 2007/BNC/018/PS 2007/BNC/019/PS 2007/BNC/021/PS 2007/BNC/023/PS 2006/BNC/007/PS 2006/BNC/029/PS 2006/BNC/031/PS 2006/BNC/026/PS 2006/BNC/006/PS 2006/BNC/017/PS 2006/BNC/021/PS
BIIRA Antoinette (ms) BIRAKWATE T Margaret (ms) BUSHARIZI Antonia Kamate (ms) CHANDIA Tiza Joyce (ms) NABULO Harriet (ms) NAAMANYA Evans Bahendeka NAMBIRO Josephine Joyce (ms) NAMPIIMA Teddie Valentine (ms) NAMUBIRU Teopista (ms) NAWUSINDO Kekulina (ms) NDIKUYERA Denis OKELLO Isaac Wonyima UWIMANA Tarsis
KAMARA Basemera Agnes MUGUME Elly AKORA Susan AKELLO Teresa KISEMBO Angelica MUTESI Judith AMAKIA Esther DRARU Jessica PIDO Florence CHANGULO Mary Hilda C
Name AGIRO Filda (ms) LUBOWA Godfrey Gekibira WAJEGA Nathan SENKUNGU Ismail NIWAGABA Peter OWOR Steven TWIKIRIZE Osbert YUNUS Rahma Hussein UWIDUHAYE Eric OKELLO Okori Dennis OIK David Konrad Musinguzi M Gerald
2006/BNC/023/PS 2006/BNC/024/PS 2006/BNC/027/PS 2006/BNC/030/PS
Medical Lab. Science (MLS) Reg No 2005/MLS/001/PS 2005/MLS/063/PS 2005/MLS/009/PS 2005/MLS/010/PS 2005/MLS/012/PS 2005/MLS/014/PS 2005/MLS/016/PS 2005/MLS/017/PS Name ACHOL Emmanuel ASIIMWE K Alex BULEGYEYA Aniziyo BWALHUMA Abraham Muhindo DENG Agany Jacob IDRIS Hakim KAHESI Yakobo KALIMU Dennis MOI Alex Lasu MUGISHA Evelyne (ms) MUGUME Ronald MULAMBA Charles MULINDWA James MURUNGI MOSES Nuwatuha K MWAMBI Bashir NABAASA Bruce NAKAWUNGU Mary (ms) NAKAYE Marthe (ms) NAMUGGA Josephine (ms) NAJEMBE K Deborah (ms) NTAMBI Charles OTIM Isaac SENFUMA Oscar TUMUBEERE Lydia (ms) ZALWANGO Florence Kayemba
Name APUULISON Friday David ARINITWE Elizabeth (ms) ASIIMWE John Baptist BABIRYE Damalie Kintu (ms) Birungi Lillian (ms) KANYANGE Regina (ms) KATUSIIME Jovia (ms) KOBUTUNGI Fiona Priscilla (ms) NABWIRE Juliet (ms) NANTONGO Hanifah (ms) TORACH Denish Martine WANYANA Grace (ms) AGWANG Joyce (ms) APIO Anna (ms) ASASIRA Lydia (ms) ATARO Pamela Ridemta (ms)
2005/MLS/026/PS 2005/MLS/065/PS 2005/MLS/029/PS 2005/MLS/031/PS 2005/MLS/032/PS 2005/MLS/067/PS 2005/MLS/036/PS 2005/MLS/037/PS 2005/MLS/040/PS 2005/MLS/042/PS 2005/MLS/045/PS 2005/MLS/047/PS 2005/MLS/049/PS 2005/MLS/038/PS 2005/MLS/053/PS 2005/MLS/057/PS 2005/MLS/060/PS
43
Graduation
ONDORU Christine
Lake View Resort Hotel, Mbarara
Thinking of a conference or a holiday?

100 tastefully designed guest rooms complete with bath showers, DSTV, GTV and other local channels plus piped music, telephones, e.t.c. Conference equipment available includes overhead projectors, public address systems, tape recorders, video cameras, TV/Video monitors, flip charts and a fully equipped secretarial business centre with computers, photocopiers, fax, internet/ email to mention a few. Fully bituminized tennis courts, gardens for a variety of functions, sauna, steam bath, gymnasium, massage, half Olympic size swimming pool, salon, laundry services, video coverage, a fully stocked bar overlooking the lake, and pool table. Location: Strategically located on plot 129, Fortportal Kasese road, about 2 km from Mbarara Municipal centre, sharing a shoreline with Lake Kiyanja. For reservation, please contact, Lake View Resort Hotel P.O Box 1200 Mbarara Uganda. Tel: 0485 4 22112, 0772 516403, 0772 848920 Fax: 0485 4 421509

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MUMJ

Vol: 16 January, 2010

MBARARA UNIVERSITY MEDICAL JOURNAL

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Thinking of a conference or a holiday?

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