Old?

It is possible that I am not as young as I used to be.  I'm not ready to make any absolute conclusions, but anything is possible.

It's been a rough few weeks for my body since I arrived.

On my first weekend in Kampala -- wandering around the city as is my wont -- I tripped.  Not a big deal really, but as I was in a rather busy pedestrian area of downtown kampala, and eyes are always on you, I tried to play it off as best I could -- just a stumble and kept walking.  It became tough to play off, though, when my flip flop started to fill with blood.  You see, as in many parts of sub-saharan africa, the sidewalk maintenance in Kampala leaves something to be desired. It is not wholly unusual to find almost anything jutting out of the ground - most commonly little twisted pieces of metal from old street signs or some such that were long ago driven over. While I didn't see exactly what caused me to trip, I have to assume it was one of these little guys that took a decent sized little chunk out of the tip of my left big toe.  

When I started to feel a warm, somewhat sticky sensation with each step, I knew what to expect when I looked down. I was impressed, however, with the flow rate.  Luckily, like any good traveler, I had toilet paper with me.  I wrapped my toe as best I could (though it quickly soaked through) and walked to the nearest pharmacy (only a block away). The folks there were very friendly, and after selling me bandages, tape, and an exorbitantly priced tube of providone-iodine ointment, they allowed me to use their scissors and sit on a bench inside the pharmacy to dress my wound while everyone watched intently. They also offered helpful advice like: 'be sure to wash that when you get home' and 'cut off that little hanging piece with a razor.'

By now the toe is healed.  And don't worry - my tetanus shots are up to date.  But it was an inauspicious start.

As soon as I was fairly certain that my toe wound wouldn't open up, I started running again.  Jogging in foreign places is one of my favorite things - no better way to explore new territory or confuse people who rarely see mzungu (white people), let alone running sweaty mzungu. I'd like to tell myself it's just that I was too exuberant in my exercise regimen, but whatever the reason, I started to develop a sharp pain in my left heel and the bilateral 2-3rd metatarsal areas.  Some of you may know that I run in those funny finger shoes, called Vibram Five Fingers.  They kind of make you feel like you're running barefoot, and I've always felt more aware of my running experience in them.  It's not always comfortable if you're running on a rocky surface, but overall I like it.

Barefoot running is a bit of a craze right now.  Proponents say that, rather than being hard on your feet, barefoot running actually forces you to change your stride in way which, ultimately, decreased injury.  The idea is that, because we are now accustomed to exercise in shoes with impressive amounts of heel cushioning, we learn to run with a heel-toe foot strike.  Biomechanically this transmits all the impact force directly up the leg into the knee, hip and back.  The ideal barefoot running technique, on the other hand, requires your foot strike be rather flat, or even completely on the forefoot, thus allowing the fascia, joints, and muscles of the foot to absorb the impact.  Decreasing the shoe padding also makes you more aware of the force of your impact, so you naturally land with lighter footfalls. Decreasing the support of the shoe allows more free movement of foot itself in response to terrain, requiring the use of your (now atrophied, though supposedly salvageable) intrinsic foot musculature, which, when healthy, is part of what decreases the incidence of running-related injuries, such as stress fractures, and plantar fasciitis.  You can read all about it in a very interesting book called Born To Run - a book about ultra-marathoners and a lost tribe of Mexican-Indian running savants - which I was in the process of reading when I, ironically, developed plantar fasciitis from running around Kampala in my barefoot shoes.

Sadly (for a runner anyway) the only real way to improve plantar fasciitis is to stop doing the thing that is causing it - running.  So I begrudgingly decided to take some time off, and when I restarted, to use the somewhat more padded sneakers that I have here.  It didn't seem like a big deal, regardless, as I was about to hop in a car for a 5 day trip to Rwanda and probably wouldn't have time to run much anyway.  I was traveling with a bunch of Yale medical students and a few other residents (from Stanford and UCSF) who are also working at Mulago hospital.  I had already been to Rwanda during previous galavanting in 2009, and remember it as a lovely place. So although I wasn't planning to go Gorilla Trekking again, I was happy to go along for the ride.

It was a lovely weekend!  Our first night was at Lake Bunyonyi in southwestern Uganda, just near the border with Rwanda.

Our second night was in northwest Rwanda, to let my travel-mates gorilla trek.  

After that it was off to Kigali for a few days and then back to Uganda.  Sadly, in Kigali, I met a buffet that I couldn't handle.  At least I'm pretty sure it was the buffet.  In fact, I think it was specifically the creamed spinach - the creamed spinach in which I mysteriously found an entire vertebrae (probably goat, by the size of it).  Surprisingly my GI symptoms were initially minimal, though the next day I developed fatigue, myalgias, fevers, and was sweating bullets -- all this while spending a day visiting genocide memorials.  Sounds cheery, right?  Perhaps my only bit of luck was that my symptoms were significantly improved the next day (for our 12 hour drive back to kampala) and my frank traveler's diarrhea didn't start until another day later.  Sometimes you gotta look on the bright side!

It wasn't actually that bad a bout, as things go, except that it was complicated by the terrible URI that I caught from one of my fellow travelers.  Sadly, some viral respiratory infection had found its way to a few of my fellow students/residents.  It started with a mild sore throat, then develops into a nasty head cold with flu-like systemic symptoms, and leaves you with a nasty sounding wet cough as your symptoms improve.  I was the third to develop this series of symptoms, and they hit me on the day we got back to Kampala - just about when my loose stool really kicked into gear.

So yeah.  My body has seen better days.  But I'm happy to say that as of today (about 5 days since we got back to Kampala from our trip), my toe is healed, my heel doesn't hurt (as clearly I haven't been running), my stomach has settled, and my cold is resolving.  And after it all, I can say that I'm resistant to another 2 (or more) African diseases.  Just checking them off the list.

Next post I'll tell you a bit more about the hospital and the rest...